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While healthcare industry interest in anything RFID-, RTLS- and wireless-related continues to burn hot, actual facility adoptions and implementations have yet to catch up to the technology’s popularity, in part because hospitals may not be culturally, financially or operationally prepared to take the plunge and may question the return on investment.

Even so, a growing number of facilities are jumping into the high-tech tracking world of chips and tags, portals and scanners, to keep a computer-driven, productivity-oriented eye on products, equipment, patients, employees or locations.

Moving beyond the fundamental issues of what and who to track, which type of chips or tags to use (active vs. passive) and the initial costs to make it happen, Healthcare Purchasing News wanted to delve a little deeper into the key fundamental questions to ask and hidden costs to consider and understand before diving in. That’s not to say tag price, tag type and what to tag aren’t important issues to iron out but tackling those infrastructure and systems issues can be a time-consuming and weighty process if you’re unaware what you’re about to face.

That’s why HPN reached out to a handful of RFID, RTLS and wireless automation vendors for insights and intelligence to help healthcare supply chain managers be more informed and better prepared tech buyers.

HPN asked these experts about the underlying issues to explore when evaluating technologies and vendors to make more effective purchasing decisions. Those include how to choose between Wi-Fi or LAN connectivity, RFID, RTLS, infrared or ultrasound modalities; how to choose radio signal frequencies to minimize interference or couple multiple frequencies; how to ensure accuracy and overcome blind spots; how to choose the right vendor to set up the necessary Wi-Fi network if one doesn’t exist; how to triangulate price, value and overall effectiveness; and finally how to ultimately incorporate location-based content.

Tim Callahan - SYMX

"Every hospital has its initial pain points to address and provide initial contribution to the ROI," said Tim Callahan, president, SYMX Technologies, Miami. "A strategic plan for implementation and analysis will help change the way you deliver services."

Callahan recommended exploring the following five issues.

"The very first thing a hospital needs to understand is what their expectations [are] for the system," he said. "Many RFID initiatives are driven from the pain points in
support services and biomedical engineering. These are important factors, but the capabilities of RFID have the ability to encompass far more areas. It requires administrative, clinical and technological input to develop a comprehensive plan. Determine a road map that will begin with the fundamental tracking and management information. Then develop plans for expansion and areas of opportunity. If a dynamic vision is determined initially then capturing the requirements and matching the appropriate system will be better aligned.

"Accuracy of captured information is the ‘critical success factor’ before moving forward with any system," Callahan noted. "Unreliable data is worse than having no system at all. Therefore, a key point is how to achieve 99.9 percent reliability on the captured information. Determining the present future expectations is important to decide if a system will provide the necessary accuracy long term. Visibility and location of an asset can often be accomplished from a zonal perspective. To have the system contribute to management and process automation, far greater granularity will be required to insure accuracy to room level and at times sub-room level."

Callahan noted that because some systems are affected by wall density and certain materials that distort reading and tag location information, many systems have embraced controllers/enhancers to assist in overcoming these issues. "Dual-mode technologies couple other technologies such as [infrared] to provide dedicated location as well as the ability to control open space within a single location, such as a post anesthesia care unit. Some systems offer an application-based software program that can accept location data as well as functional status information and provide a real-time location engine coupled to the status of each device being monitored," he said.

"Leveraging an existing 802.11 (Wi-Fi) network always has initial appeal," he continued. "The primary expectation for this standard was communication. Particular consideration should be given to both present and future communication requirements. When expanding Wi-Fi data coverage and adding [Voice over Internet Protocol] both capacity and client density become important design factors. It is imperative that [access points] are placed close enough together for coverage, yet far enough apart as not to cause co-channel interference or impact mission critical applications. It may prove advantageous to keep the tracking system off of this network. Other RF frequencies such as 433.92 MHz and 2.45 GHz have been globally accepted enabling location specific protocols to be used that are designed for RTLS."

Although there are initial installation costs that are comparable for increased access points, readers and controller requirements, the hardware/firmware cost should be determined for cost and scalability over a multiyear period, according to Callahan. "Leveraging the existing Wi-Fi system, installing a different frequency reader network or adopting a dual-mode technology will have variables in cost to compare over time," he said. Other long-term factors to be considered include the cost of expanding the number of assets, locations and patients, redesigning departments and doing building projects, he added.

"Determining an ROI goes well beyond location and tracking," Callahan said. "Many companies provide tools to quantify financial impact. Determining asset location will provide initial improved utilization and staff time as well as improve future budgets. Patient tracking impacts the through-put and patient flow in certain departments. These are all contributions to the ROI but initial stages to supporting the investment. This initial contribution is relative to the extent of the roll-out of the system."

Bryan Christianson - Mobile Aspects

Bryan Christianson, vice president, marketing, Mobile Aspects Inc., Pittsburgh, PA, suggested that healthcare supply chain managers should focus on the external process as well as internal use of the technology.

Is RFID technology the only technology solution that will work?

"In addressing supply chain management within perioperative care, a hybrid strategy using RFID technology and an additional point-of-use solution can create a more comprehensive solution," Christianson said. "Often, high-cost physician preference items represent only 20 percent of inventory volume but typically represent 80 percent of inventory cost. An organization can focus an RFID technology on the higher-cost items while using a solution, such as barcode scanning for lower cost items. Although a barcode scanning solution can be more error-prone, the results of error on cheaper items is not nearly as significant when compared to the cost of errors for physician preference items worth thousands of dollars."

Besides hospitals, many manufacturers are actively using RFID technologies within their corporate supply chain and distribution initiatives, Christianson noted. As a result, many products arrive at the hospital already sporting different types of RFID tags. "These can be problematic to the successful operation of the hospital’s RFID system," he admitted, "but also may present an opportunity for the hospital, manufacturer, and RFID technology vendor to collaborate and create a more comprehensive, aligned strategy with RFID systems."

For medical devices and supplies, many times there is nothing written to the passive RFID tag itself prior to its placement on an inventory item, according to Christianson. Rather, each tag already has its own unique identification number so when it’s placed on a device or supply, the system will associate the RFID tag and the item together. Commonly, he noted, this is referred to as a "license plate" approach. From there, this information is recorded in a database. Once associated and stored in the database, more descriptive information on the item can be included, such as item description, lot number, serial number and other data elements, he added.

What makes this a key question to address is that fact that usually item tagging is completed by hospital staff, Christianson noted. "If this is the case, it’s critical that the hospital is able to identify the appropriate individual(s) for this role in supply chain or elsewhere and make certain that their skill set and role profile is appropriate to support," he said. "In turn, vendors should provide the necessary level of training and support to create a proficient tagging process at the hospital."

"Most vendors typically offer options of having a hospital host the system within their data center or having the vendor host the system at an offsite location, typically for an additional fee," he said. "Hosting options should be explored to find the right fit for the hospital and in doing so, supply chain managers should also understand how is data being secured and who will be accessing the hospital’s data. Some vendor models are based on giving access to data for multiple parties, not just the hospital, and it’s important to understand the technical details of those models."

Michael Kenney - PinPoint RTLS

Michael Kenney, general manager, PinPoint RTLS, an RF Technologies Inc. company, Brookfield, WI, stressed the infrastructure angle that drives integration and expansion concerns.

I already have a Wi-Fi infrastructure in place. What else do I need to purchase to make your RTLS system work?

"Although a facility may have Wi-Fi coverage, it may not be extensive enough to implement a RTLS system," Kenney noted. "A site survey conducted by the vendor will answer this question. The usual recommendation is to increase the coverage or density of access points. In some applications this can be quite expensive. Some RTLS vendors can do this with lower-cost modules that provide increased coverage."

As applications grow in RTLS, RFID and bar coding, the need to integrate them will become increasingly important, according to Kenney. "A central point of data induction could be the RTLS middleware," he said. "RTLS system solutions should have the scalability to handle additional auxiliary data inputs."

"Each application is a unique financial scenario," he noted. "However, a good vendor will have a [return-on-investment] tool that you can use to develop your own evaluation."

"A complete solution will have application suites capable of incorporating data from the RTLS and RFID systems, generate reports, initiate alarms, secure doors and integrate new applications," Kenney listed. "Make sure to express your expectations for the full system solution and see if one vendor can meet all your needs," he advised.

"A complete system solution will allow you to take the application-generated data and push it out to enterprise wide applications," he indicated. "When there are more users of the data, the ROI will continue to improve."

Gabi Daniely -  AeroScout USA

Gabi Daniely, vice president, marketing and product strategy, AeroScout USA, Redwood City, CA, urged healthcare supply chain managers to focus on five fundamental issues.

Infrastructure and total cost of ownership:

Can you track items with your existing wireless infrastructure, and if not, what will be the total cost of ownership of this new tracking infrastructure (including wiring, management, etc.)?

Can your solution scale to accommodate tens of thousands of tracked items without network interference, and has your potential partner done so successfully in the past?

Can tracked items be located accurately throughout the hospital, across multiple buildings and facilities, and both indoors and outdoors, or is the installation limited to a single unit?

How many successful healthcare installations does your potential partner have?

Does your potential partner offer a range of the healthcare RFID solutions (i.e., inventory management, preventive maintenance, temperature monitoring, clinical and resource workflow, and patient and staff safety)?

Jim Caudill - Xterprise

But don’t overlook the fundamentals, according to Jim Caudill, senior vice president, marketing and stra-tegy, Xterprise Inc., Carrollton, TX.

Caudill advised that the big picture should drive purchasing decisions.

• What is the business case you are addressing and why?

• What are the operational process changes that have to [be] put in place? What cannot change? Why does it need to change?

• What software is required? How will it interface to legacy systems?

• What RFID technology is best suited for my business case?

• How will I be able to measure if I have been successful, using which key performance indicators before and after?

Tuomo Rutanen -  Ekahau

Tuomo Rutanen, vice president, business development, Ekahau Inc., Saratoga, CA, also stressed the need to master the deeper fundamentals.

• How does an RTLS/RFID solution fit into your total asset management practices?

• Does your Wi-Fi infrastructure have the ability to support Wi-Fi- based tracking (e.g., do you have coverage in the areas where you need to locate mobile assets)?

• What technology is the best fit for your organization?

• How will you future-proof your investment if you decide to change your underlying infrastructure in the future?

• Do you need to track assets/people at a single site or multiple sites?