Like most healthcare facilities, Washington Hospital Center (WHC) in the nation’s capital used to struggle with asset management: finding the right pieces of equipment when employees needed them. But two and a half years ago, WHC, one of the 25 largest hospitals in the country, sought to address that knowledge management problem by attaching radio frequency identification (RFID) system tags to equipment in order to track them online.
"By optimizing our management and redeployment of equipment, we can cut down on rental expense," explains David Roseman, the hospital’s director of informatics solutions.
For instance, the hospital used to have trouble tracking telemetry monitors, small devices used to monitor patients’ vital signs. "Those are expensive, about $4,500 each, and we were losing quite a lot of them," Roseman says. As people cleaned rooms, the monitors were accidentally making their way into the laundry system, which is an outsourced service. Now with RFID tags on the 370 telemetry monitors, if any of them end up in the laundry, a supervisor gets an automatic page and a strobe light goes off in the laundry area.
As in other industries in which expensive equipment, staff and customers are mobile and need to come together with precision, RFID has drawn increasing interest in healthcare. The early healthcare adopters of wireless networks and active RFID technology have looked to do two things: manage assets and optimize operations. The first group wants to locate equipment such as infusion pumps, wheelchairs and small operating room equipment, and the systems they deploy are referred to as real-time location systems (RTLS). The second group is interested in increasing throughput in a surgical suite or increasing room utilization and patient flow. For example, RFID tags are starting to be used to keep track of hospitalized dementia patients. Massachusetts General Hospital uses patient RFID tags to study how patients flow through the hospital, their wait-times and all of their resource utilization from registration to surgery to recovery.
A 2006 report by research firm IDTechEx forecast RFID tags and services in the healthcare sector would grow from the $90 million market it was then to $2.1 billion by 2016.
Gregg Malkary, managing director of Spyglass Consulting, believes RTLS is just starting to take off. He recently surveyed 90 healthcare institutions, and found 42 percent had deployed some project to track mobile assets. Three years ago, that figure was only 10 percent, he says. "These are mostly larger organizations, with at least 250 beds," Malkary explains, adding that the solutions are getting more sophisticated, and hospitals are looking at expanding the scope of their networks to track patients and staff as well.
Yet applying that type of technology solution to a KM problem can be a challenge in a hospital setting. "Hospitals are notoriously conservative," says Tim Gee, principal at Medical Connectivity Consulting. "They want a complete product solution and they want to buy it with a high level of confidence that it’s going to work without extra effort or hidden costs. And one problem is that these systems cost hundreds of thousands, and an RFID vendor may not be all you need."
Gee says RTLS players such as Agility Healthcare Solutions don’t go straight to the CIO’s office, but to the chief medical officer or chief nursing officer to look at the type of problems they are trying to solve. "They design software to solve the problem, and then go looking for an RFID vendor that best matches the application," Gee says, "because it is not one size fits all."
Slicing rental costs
The Thornton Hospital at the University of California San Diego (UCSD) Medical Center used to spend $8,000 per month on infusion pump rentals, because its central supply department couldn’t always locate them when nurses needed them.
"Nurses tended to horde stuff in closets, because if when they called down to central supply there wasn’t one available, we would have to rent one, and it would take a few hours for the rental agency to ship it," explains Scott Sullivan, business manager of perioperative services. Now using RTLS technology from Awarepoint, a technician can go online to see if a patient with a pump has been discharged and locate the pump assigned to him or her.
"We have been able to cut two-thirds of that rental cost, which alone is paying 60 to 70 percent of the monthly cost of the Awarepoint system," Sullivan says.
UCSD also utilizes the new system to locate specialty items used in the emergency room. Operating room nurses now look online for small items instead of running around the entire suite looking for them. "We also can tell how long an item has sat unused," Sullivan adds. "Then when we are making up capital equipment lists, we can question whether we really need to buy more of something or not."
A safety issue
At Southern Ohio Medical Center (SOMC), the push for RTLS tracking came from the VP of health and safety. "We want to know the immediate location of equipment in case of a recall classification," explains Greg Malone, the hospital’s supervisor of biomedical engineering.
Using a system from Radianse, SOMC, a 222-bed, acute-care hospital in Portsmouth, Ohio, deployed 363 receivers and 2,000 RFID tags in November 2007.
The technology is already helping the hospital streamline workflows and meet regulatory requirements, Malone says. For instance, the Joint Commission on the Accreditation of Healthcare Organizations requires that 95 percent of the 700 pieces of equipment in use at SOMC receives preventive maintenance each month.
"We used to send staff to locate the equipment, and they would find 60 percent of it in the first two weeks. But the other 40 percent would take four people weeks searching room to room, disrupting patients," Malone says. "Now they can punch that item’s control number into the computer and see its exact location. It saves 20 to 30 percent of that manpower."
Malone says SOMC was also pleasantly surprised to see the prices for RTLS systems dropping. "About 10 years ago, we looked at this type of system and it was near $1 million," he says. "This came in at under $300,000, so the prices for these systems are getting much more reasonable."
Beyond just tagging equipment, the software solutions that provide a window onto equipment location are growing more sophisticated. At Washington Hospital Center, the data from a Parco Wireless ultra wideband network is fed into the hospital’s clinical information system, which becomes a knowledge management tool for asset tracking. David Roseman says he can create views of equipment location information based on geography or specialty.
"Someone in respiratory therapy can have a view that shows all the tagged respiratory equipment throughout the hospital," he explains. Or a view could be geographic—a nurse or clerk could see all types of tagged assets on their particular wing of the hospital. They know they have six IV pumps and in which rooms they are located.
Roseman also is studying the potential value of tracking tag-to-tag interaction. "If we knew that a tagged doctor was two feet from a tagged patient for a certain number of minutes, we could run a comparison with our financials to see if we were properly charging for a consultation," he says. "It could be valuable in the future to tag patients to manage throughput and have a better understanding of where patients are at any given time."
Although fewer than 10 percent of North American hospitals have deployed RTLS employing RFID, the technology has matured enough that CIOs are starting to share success stories with peers, says Mike Liard, research director for RFID at ABI Research. Facing so many other budget challenges, CIOs may have a hard time making the case for RTLS. Liard says, "You have to define the business challenge, the economic impact, and then start building return-on-investment models. The key is that you’re working toward business process efficiency gains, of which the asset tracking may just be the first."
Passive RFID bolsters medication safety system
Most of the healthcare industry’s interest in radio frequency identification (RFID) involves active RFID tags, which continuously send radio signals to networked receivers placed throughout a hospital. But passive RFID, which requires a user to swipe a reader near a tag, also has its uses.
St. Clair Hospital in Pittsburgh has created a hybrid system that includes a wireless network, barcode scanning and passive RFID tags. The system has had a dramatic impact on lowering medication errors, according to hospital VP and CIO Richard Schaeffer.
To improve patient safety, many years ago St. Clair became the first hospital in the country to use a robotic medication-dispensing unit, and that involved barcoding all medications. Schaeffer described how the system works: After the robot delivers a medication ordered by a physician, a nurse picks up a personal digital assistant made by Socket Mobile, swipes her own RFID tag and enters a PIN security code. That populates fields on the PDA screen with her patient list. She chooses the patient and gets a list of all medications to administer. She then goes to the patient’s room and scans his patient RFID, which also brings up a photo of the patient. The nurse then scans the
barcode on the medication.
"If there is an error, such as the wrong drug or the wrong dose, the nurse will get an error message alerting her," Schaeffer explains, adding that the patient photo is a key improvement. "All the other steps could be correct but they could be at the wrong patient’s bed," he says. Once the drug is administered, the nurse hits a send button on the PDA and the information about the dosage is transmitted to the patient’s electronic medical record.
Schaeffer says St. Clair has done three studies to measure the impact of the technology. The first, in 2004, found that the hospital had prevented 6,000 errors in a year. In the two following years, it estimated it prevented 5,000 errors each year. "You can imagine the impact barcoding could have," Schaeffer says, noting that across the country, only 15 percent of hospitals barcode their medications. "Those kinds of mistakes," he says, "are still going on."