Here’s what to look for and how to approach them
during the buying process

Certainly the higher initial costs of purchasing the technology should pay for itself over time in process improvement, productivity gains and quality service as noted by the leading vendors promoting a hospital’s return-on-investment. Beyond the black and white of the acquisition costs, however, looms the vast gray expanse of implementation costs, which can be affected by business operations, cultural resistance and unrealistic expectations.

As a result, Healthcare Purchasing News tapped a small group of RFID, RTLS and wireless automation vendors for insights to help healthcare supply chain managers be more informed and better prepared tech buyers.

In December, HPN reported on what these sources advised about the underlying issues that supply chain managers must be aware of when evaluating these systems. They 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.

This month, the group outlined some of the hidden costs to recognize that can sour any enthusiasm about RFID, RTLS and wireless automation systems from the moment the purchasing contract is signed to months after deployment. Some examples include battery charge retention and life in tags, disposable vs. reusable tags and in what areas to use them, expansion to multiple areas of concentration (e.g., moving from products to people) and adding access points when needed.

But Rutanen cautioned that manual tracking of inventory and workflow can be more costly, something that RFID can solve. "Largely uncounted for in productivity measures, staff spends hours looking for equipment. This is real dollars in staff salaries, and time lost that could be better spent with patients or doing productive work. Another penalty is that lost or stolen equipment jeopardizes a hospital’s regulatory status for [The] Joint Commission, [Sarbanes-Oxley], HIPAA and OSHA certifications," he noted. "Benchmarks should be developed to help justify the cost and changes related to migrating to an automated location system."

Still, hospitals should ask their RFID or RTLS vendor about its product offering and how it will integrate with the hospital’s own internal system. "If users are considering an RTLS solution, it is important to understand whether the vendor requires installation of a proprietary infrastructure above and beyond the existing WLAN in use at the site," Rutanen said. "Proprietary infrastructure can add significant cost and delays in getting an RTLS-based solution up and running."

Rutanen emphasized concentration on infrastructure basics. Key questions include, "Can the system scale across multiple facilities and geographically diverse locations? What are the costs of deploying and managing the active RFID/RTLS infrastructure? What spare equipment is required for ongoing infrastructure maintenance? If the system requires the installation of readers/antennas and running cabling, what is the cost of disrupting operations during the installation? Are the tag batteries inexpensive and readily available?"

"APs can cost several hundred dollars each," he continued. "Some RTLS vendors provide low-cost position input points, about $10 each, to augment the position data. These points are usually a fraction of a radio-based AP and do not require an Ethernet connection. The position input point, or P.I.P., can be located strategically to resolve difficult locations without having to expand the WiFi infrastructure."

Vendors charge for a site survey so it’s important for supply chain managers to ask what one will cost, he added. Most installations require some sort of pre-installation involvement from the system integrator.

Broder noted that a site’s specific location, particularly if it’s in a remote, hard-to-reach area, can contribute to higher costs if the vendor actually has to dispatch someone to do something onsite. Then you have to factor in the length of time spent at the facility, as well as the frequency of visits. "Remember that WiFi needs to be recalibrated manually to achieve a certain level of granularity," he said. "These aren’t really visible costs."

Kenney further advised to research application-specific tag life. "Each asset and each application has a different set of requirements on the tag and its battery," he said. "Most vendors will specify tag usage at a very low demand rate. Find out what your application will require of the tag and how that affects the tag’s life, and then ask if the tag has replaceable batteries."

But systems must be flexible enough to handle interfacing and integration with a hospital’s existing infrastructure and future expansion, according to Callahan.

"Changes in infrastructure from hardware to maintain the accuracy requirements have determined costs but installation and change also impacts labor," he indicated. "Readers and access point installation can be costly. Many dual-mode systems provide expansion and flexibility working with the initial installation with minor modifications."

Hospitals need to understand how these systems really work, according to Broder. "WiFi has to triangulate with antennas, which is why you get those blind or dark spots," he said. "Typical RFID systems use WiFi antennas to leverage a hospital’s existing WiFi network [to avoid the costs of upgrading or installing a new system]. But that’s where hospitals fall into a trap. They wind up bogging down the existing system with additional information, even if you try to make it more ‘robust.’ You may be able to do that but you won’t achieve the level of granularity you want. It’s great for IT managers. However, pushing all of that data through an existing system can hurt mission-critical tools, such as wireless PCs and PDAs, voiceover IP and EMRs." Interference and bandwidth overlap also can choke a system, he noted.

"Too much data bogs down the system and delays transmission rates," he added. "People get angry just waiting for their PC screens to change in 4 to 5 seconds."

Furthermore, Callahan said that each hospital’s "unique operational model" must be taken into account so "initial capabilities will vary, but the future demands of process management and multiple resource tracking will bring complexity. The software application should have the capability to grow with the expectations without required upgrades or additional software."

Interfacing to an existing system may vary greatly and prove expensive, Callahan admitted. "The nature of a system is to provide real time information. Other than a search and locate front-end, pushing this information into existing systems brings the greatest value," he noted. "Populating the biomedical application or support services management system minimizes training and acceptance as well as simplicity."

If it’s any consolation, Callahan mused that "most of the hidden costs are those that will be realized over time and expansion of the system."

As a result, Christianson urged supply chain managers to determine whether an interface truly is needed by the value that will be created. "For instance, if the staff is comfortable with running a daily report and keying data into other systems to support product replenishment needs, it may not be worth the time and cost to create a system interface to automate this process," he said.

Another cost consideration is a simple one: Adding power outlets and LAN/network drops in the areas supporting the technology. "As creating these additional sources of power and data connection in perioperative areas can cost thousands of dollars, it’s important to understand where technology will be located and how the physical space will accommodate the technology’s operating needs," he said.

It’s also important to understand the installation timetable and how it will affect operations. In fact, "process change management is often grossly underestimated," Caudill admitted.

"Many of the technologies that require single-purpose readers become limited to departmental installations because of the time and effort required to sufficiently cover the hospital," Daniely noted. "These installations tend to scale department by department. Contrast this with WiFi-based tracking installations, which can begin producing value hospital-wide from the start, and can instead scale with more and more tags over time."

A facility also must redesign its operational processes to take advantage of the new RTLS technology. "For example, setting RFID-enabled ‘par values’ for commonly-used medical equipment in each nursing unit can improve materials management processes, but only if the users know how to take advantage of this information," he said.

But start out realistically and slowly, Bryant advised. "Don’t try to track the 25-cent items with the $1 tag," he said. "Don’t say you want to track 10,000 or 20,000 items. I’ve had to talk some people down."

On a fundamental level, Daniely encouraged supply chain managers to perform the necessary due diligence before selecting a vendor to minimize risk. "Some of the companies providing RTLS technologies are small or start-up companies," he cautioned. "Is there a risk that the vendor will go out of business, leaving you with an unsupported technology?" Besides funding and industry references, it’s important to note if the vendor is supported by an integration partner who will help reduce any potential risk, he added.

Seiff advised healthcare facilities to look beyond tracking as the primary function of any RFID or RTLS technology. "Implementing an asset tracking system alone may not improve your asset management system, or reduce asset management costs or improve service levels," he indicated.

"If the goal of asset tracking systems is to increase asset utilization, the primary benefit promised by virtually all vendors, and the key question that must be asked is: What causes low asset utilization? The popular answer is that low asset utilization is caused by not knowing where assets are," Seiff continued. "Actually, we do know where they are — they just aren’t where they are supposed to be. Hiding in closets and cluttering hallways, the hospitals’ expensive equipment goes underutilized – and violating regulations on egress and preventive maintenance – costing the hospital more in capital purchases and emergency rentals than is necessary. Can an asset tracking system that does nothing more than locate assets solve this problem? No. In order to increase asset utilization, these assets must be physically moved to their needed locations. Therefore, using RFID to locate assets provides little, if any, value for increasing asset utilization.

IT tips

Sources

Active RFID asset tracking