Trends in RFID: Ready for Prime Time?


May / June 2006

Trends in RFID

Ready for Prime Time?

Radio frequency identification isn’t intended to replace barcodes. Instead, they can be very complementary technologies, as hospitals are finding out.

If big numbers impress you, consider that, according to Bradley Sokol, CEO of Fast Track Technologies (FTT), the application of radio frequency identification (RFID) and related technologies in the hospital marketplace will increase to $8.8 billion in just 4 years, in 2010. Of that, $4.0 billion will be in the now nascent technology of RFID alone, with the rest associated with connectivity and infrastructure.

Sokol muses, “What if a person could enter a hospital with the confidence that his or her treatment would be successful, efficient, safe, and environmentally clean, with accurate and seamless billing? It may be hard to fathom, but we have the technology to achieve this utopia. However, our medical system doesn’t have the infrastructure, funding, knowledge, or will to fully address these issues.”

He explains, “The solution is at hand, through the combined technologies of the new healthcare supply chain: wireless networks, radio frequency identification, and medical device/instrument connectivity. These technologies are laying the infrastructure for the 21st century medical delivery system.”

While at present, fewer than 10% of hospitals surveyed have actually deployed RFID, more than 27% have started with a pilot project or are testing the technology. Fully 55% are or recently have investigated using RFID in some part of their facility according to a BearingPoint/NAHIT (National Alliance for Health Information Technology) report. A key finding was that improvement to patient safety was cited as the top benefit from RFID.

However, Jay Srini, vice president for emerging technologies at the University of Pittsburgh Medical Center, cautions others not to think of RFID as replacing barcodes. Srini compares barcoding to RFID this way, “Barcodes require line-of-sight to read while RFID doesn’t; barcodes can be read one at a time while RFID can scan and read multiple tags at once; and barcodes are, obviously, read only while RFID tags can be read/write. Of course, RFID tags cost more, sometimes much more, than barcodes, but in return, they are more durable and improve accuracy of the read—and of course they are reusable.”

Srini adds, “RFID isn’t a replacement for barcode; the two technologies can coexist to create an effective solution. A robust wireless network with proper middleware to support the network architecture is critical to achieving the underlying benefits of RFID and barcode projects. What you must do is avoid the ‘Big Bang’ approach and remain focused on solving a business problem, that will make it can be easier to justify the investment.”

Saving on Equipment Rentals
At Bon Secours Health System’s four Richmond, Virginia, facilities, RFID was explored for patient, staff and equipment tracking. Jerrold Maki, chief of network operations at Bon Secours recalls, “We felt the tracking of high-value equipment was a good starting point. We implemented the AgileTrac equipment management system to get real-time automatic visibility of all our assets, have a centralized database of those assets, and improve equipment utilization.”

A tablet PC with scanner module can read the RFID chip in the wristband. This allows the user to have a multi-purpose handheld unit at the bedside.
Photo courtesy of Precision Dynamics Corporation

Maki says they have realized more than $1.5 million in savings on equipment rentals alone by being able to track their equipment location more accurately. The system has enabled Bon Secours to move its sterile processing center off-site and automate the case cart and tray tracking functions.

The AgileTrac system from Agility, also in Richmond, works to lower the overall equipment investment at Bon Secours by providing accurate inventory management. Bon Secours found that employees spent as much as one third of their time searching for equipment, patients were taking equipment, such as knee exercisers, from their rooms and therapy sessions, and even ambulances were driving off with the hospital’s infusion pumps.

Maki cautions, “The best approach is the business approach; determine clear business problems and find appropriate solutions. In this case, we were able to quantify benefits and savings, establish a well-defined future state, get all out stakeholders involved and develop an optimal solution. Technology is the enabler, and the right technology is what you want.”

Dr. James Fonger, cardiothoracic surgeon at Lenox Hill Hospital, New York City, agrees. “It’s not about technology for technology’s sake. It’s about solving the problem, which may or may not involve higher levels of technology. The reason technologies are successful is ease of use. We have to be cognizant of the fact that you can create lots of things, but if those things don’t have ease of use, you haven’t really created anything at all.”

Big Brother? Not Really
Adding comment is Ann Hendrich, RN, MSN, FAAN, vice president of clinical excellence, Ascension Healthcare, St. Louis, Missouri. “It’s important to be clear about what you are looking to measure and trying to fix,” says Hendrich. “Nurses need help. They definitely want to be more efficient, and they see tracking as a way to show administration how they waste time.”

Working with RFID tags from Radianse of Lawrence, Massachusetts, Ascension piloted a program to track nurse movements throughout the unit. When it comes to personnel staff tracking, many fear the shadow of ‘Big Brother’ and may question the motivation. Not at Ascension. Hendrich remembers, “Nurses stood in line to be a part of this study. ‘Strap that thing on us,’ they said. The reason for the response was because nurses know how hard they work, but they’re not sure hospital administration or physicians truly know it.”

“In healthcare,” Hendrich notes, “40% to 55% of costs are labor costs. Knowing where that labor is spending time and how the organization can help them be more efficient and satisfied with their work has immediate and ongoing value. Med-surg, where our study takes place, is the workhorse of the hospital and where so many bottlenecks occur. Thirty to 40% of preventable deaths here are due to lack of observation. In the 6.5 to 9 hours of a nurse’s shift, less than 20% of that time is spent touching the patient. A good deal is spent hunting and gathering. That’s where the real money is—avoiding this time away from the patient.”

Tracking staff is one use; tracking patients is another for RFID. An internal study at St. Vincent’s Hospital, Birmingham, Alabama, revealed that patient throughput suffered because staff members didn’t know what beds were available and didn’t know where patients were. After analyzing various options, St. Vincent’s settled on using an enterprise-wide patient visibility system from Awarix, also in Birmingham. The system provides a 360-degree view of the patient’s status in real time, using RFID tags from Radianse. The information is displayed visually on electronic patient care communication “whiteboards.” These electronic whiteboards contain a graphic representation of the hospital’s floor plan, making it easy for clinicians and other users to figure out what is going on with patients simply by glancing at the board. Information is taken from existing clinical systems and from location systems to create a synthesized single view, increasing awareness of patient care status in real time across the enterprise.

Costs Versus Benefits
A recurring discussion on the deployment of RFID and other technologies is often centered on the cost versus the current, non-tech way of doing the procedure. Srini points to the Surgichip as an example. Surgichip is an RFID label that is adhered to the patient prior to surgery to identify the patient, surgery, and location of surgery. “It can help prevent the Three Ws: wrong patient, wrong site, wrong procedure,” claims Srini. “But the total cost of implementing the system is about $25,000 to $75,000 the first year, and each tag costs about $2.50. Compare that to a box of markers at $0.79 each, and you have an uphill fight to get the technology approved.”

Fonger of Lenox Hill points to a similar problem. “We have been experimenting with CheckSite ID in pre-op. Upon admission to the hospital, surgical patients are issued a CheckSite ID bracelet equipped with an active microchip designed to ensure that pre-operative surgical site marking is not overlooked. Once site marking has been completed in the pre-op area, a green deactivation label is peeled from the CheckSite marker and is placed over the microchip on the patient’s wristband. The deactivation label not only serves as a visual confirmation of site marking, but it also renders the microchip in the bracelet inactive, allowing the patient to pass into the operating room unhindered.”

At Texas Children’s Hospital in Houston, Melita Howell, clinical information systems project manager, found that even the best of intentions can fail to produce the best results. In 2001 they installed both IR (infrared) and RF (radio frequency) networks in parts of the facility. As a pilot program, they worked with a nurse call system utilizing the new networks. Unfortunately, as Howell explains, “Inpatient staff tracking didn’t work very well because there was no transaction data available via the nurse call system. Neither the staff nor the leadership saw any benefits; there was, in fact, a large investment made with no return on that investment.”

But enough of the staff and leadership saw a future with the concept that they started again in 2003, this time with what is known as a “skunk works” approach. “Armed with the information we gained from the failed test, an innovative team, backed with solid leadership, was able to utilize the existing infrastructure, avoid the poor original configuration, and overcome the corporate reluctance to fund the project.”

The multidisciplinary team, consisting of members from biomedical engineering, nursing, central distribution (CD), facilities operation, and even security and financial services, began working with Versus Technology, Traverse City, Michigan, a supplier of real-time location systems (RTLS) based on both IR and RFID.

Multi-phased Approach
Phase one, the pilot, comprised 200 nursing and 40 CD staff members, 300 infusion pumps, 50 beds, and 10 respiratory therapy vests in the inpatient area. The results showed an improvement in quality, end user acceptance, capital savings from not losing equipment, reduced rental costs, and greater efficiency in central distribution, facilities, and biomedical areas. Perhaps the biggest benefit was the buy-in of facility executives who now saw the future potential of the system.

“We discovered some things that we hadn’t expected, as well,” claims Howell. “We found that the tags we used would sometimes go missing because the adhesive failed after repeated cleaning. The solution: common epoxy cement instead. And while the nursing staff acceptance was very high, the folks at CD were resistant.”

Jacobi Medical Center, Bronx, New York, did a pilot test with systems integrator Siemens Business Services of Norwalk, Connecticut, and Precision Dynamics Corporation (PDC), San Fernando, California, to implement an RFID wristband system for patient identification and medication administration. They report the RFID system improved patient safety and care, increased productivity, and helped cut costs.

The system consisted of an integrated RFID application, developed by Siemens that connects Jacobi’s electronic medical records, lab systems, and billing system. Jacobi’s existing computerized physician order entry system allowed for a seamless RFID implementation.

A tablet PC scans the patient’s RFID wristband prior to medication administration. The wristband inlays were encoded with a unique patient ID number. Once scanned, the patient’s medical file is instantly accessible at bedside. Daniel Morreale, the hospital group’s chief information officer at the time of the Jacobi implementation, states, “The RFID trial saved 1 hour per nurse per shift. If the application is rolled out network wide, it could potentially save $1 million a year, but more importantly this creates 2 to 3 hours during every nursing shift for additional patient contact and care.” The pilot was so successful that staff did not want to give back the equipment after the 2-month trial.

World-Wide Application
To improve diagnosis automation and the overall patient experience, Catholic Medical Center—KangNam St. Mary’s Hospital in Seoul, South Korea, is deploying the Visibility System from AeroScout, San Mateo, California. AeroScout T2 tags are used to track patient status as they progress through their visit. The Wi-Fi tags utilize standard Cisco Wireless access points to transmit location information used for automatic recognition of patients, wait and process times, patient history, exams that are needed, and other patient processes. In addition, AeroScout’s MobileView software provides easy access to patient location information along with time statistics, enabling improved business processes. All information is provided in real-time for maximum patient safety and throughput efficiency.

St. Clair Hospital of Pittsburgh, a 331-bed independent community hospital, is working to reduce medication errors with an innovative Five Rights Medication Verification System that equips nurses with an RFID reader so they can confirm they are correctly administering pills, IVs or other medications to patients in their care. The Five Rights system aims to ensure that the right patient receives the right medication and dose via the right form of administration at the right time.

The Socket adapter allows a handheld PDA, like this iPAQ, to read RFID tags.
Photo courtesy of Sculptor Developmental Technologies

At the heart of this system is an iPAQ Pocket PC equipped with the Socket CF RFID Reader-Scan Card, a dual-function plug-in card that provides both RFID and barcode scanning capabilities. Running on the Pocket PC is VeriScan software from Sculptor Developmental Technologies, a subsidiary of the hospital. When it’s time to administer medication, nurses first read the RFID tag in their badge to log in. They then scan the barcode on the medication package and the RFID tag in a patient’s wristband. The data is sent wirelessly to the main clinical database and compared with the doctor’s latest orders.

Voice commands on the Pocket PC announce “Patient identification confirmed” or, in the case of discrepancies, “Access denied.” Since the Pocket PC is connected to the hospital’s wireless network, nurses know immediately about any new medication orders, order changes or cancellations. “We see the handheld as the hub of all patient safety-related initiatives at bedside,” says Rich Schaeffer, CIO and VP of St. Clair.

Before St. Clair implemented VeriScan, only 1 in every 8 medication errors was identified, with only 600 errors reported annually. Now, 5,000 potential medication errors are identified and prevented each year. Nurses are also more aware of potential errors and how to avoid them.