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August 2008

News

Unleashing the potential of RFID, RTLS

End users find creative ways to push the technology

by Rick Dana Barlow

Tracking people, processes and products in any location may be the fundamental and primary application of radio-frequency identification (RFID), real-time location systems (RTLS) and other wireless automation technologies, but a growing number of organizations are finding ways to expand the possibilities.

To learn how, Healthcare Purchasing News asked a small group of RFID, RTLS and wireless automation vendors for their insights to help healthcare supply chain managers make smarter purchasing decisions.

Back in December 2007, HPN reported on key issues about the technology for supply chain managers to understand, as well as important questions to explore. In February, HPN also recruited the group to reveal some of the hidden costs to recognize about the technology before the purchasing contract is signed. Finally, HPN asked the vendors to highlight some of the creative ways their customers are using RFID, RTLS or other wireless automation technology to improve operations, prior to a controversial study published in late June by the Journal of the American Medical Association that posited that RFID signals may interfere with key medical devices and equipment. See JAMA reaction story

"While most of our healthcare customers use active RFID to track assets such as infusion pumps, specialty beds and wheelchairs, for patient and staff safety, ER/OR workflow management or other inventory and preventative maintenance management applications, we do have several innovative approaches among our customer base," said Gabi Daniely, vice president of marketing and product strategy, AeroScout USA, Redwood City, CA. He flagged eight applications he deemed "interesting:"

• Integrating RFID with biomedical software applications to meet The Joint Commission requirements for preventive maintenance rates.

• Applying RFID to track laptop computers, hand-held devices and tablet PCs.

• Using tags as sensors to take automated temperature readings in refrigerators or freezers to comply with The Joint Commission standards.

• Tracking staff members in "uncooperative patient environments" to minimize staff duress. "Staff members can press a call button on the tag, triggering an immediate location-enabled alert," he noted.

• Integrating tags with patient monitoring devices to add location data to patient emergency alerts.

• Supplying patients’ families with real-time information about their family member’s status and location as they move through the facility.

• Applying the technology as a nurse-call system in aged-care facilities.

• Reporting on the prior locations of commonly broken items to determine the origin of any trends in misuse of medical equipment.

Candid camera

Bryant Broder, senior product manager at Skytron, Grand Rapids, MI, marveled at the creative suggestions of hospital clinicians and administrators on how they’d like to insert RFID into their operations. "It’s amazing when you listen to the voices of customers as you explain the technology to them and how it works and then what they come up with," he said. Broder oversees Skytron’s SAM asset management technology in partnership with Awarepoint Corp.

Some creative applications Broder related include programming alerts in the system that tells you when a device exits an area it’s not supposed to leave. The system can issue a command to automatically close a door or turn on a camera and start shooting video feed. "One customer had the system close the campus gate at the bottom of a hill," he noted.

One doctor wanted the system to identify the patient in the room and when he was in the room, turn on the light and link that visit to billing, he continued. Others use it to track room turnovers and even handwashing.

"Workers wear badges that talk to sensors on the soap dispensers, and the system can tell if the soap dispenser has been touched before or after an event," he said. How does that work? Each tag has a unique identification number or locator on it that enables the system to track whether a person stopped at point B, which may be the soap dispenser, when moving from point A to point C, he indicated. One challenge to this application is whether the facility is unionized, he added.

Another facility applied tags to the keys that orderlies use. "That facility found out how many times those keys showed up in the smoking areas and made some changes," he added. "No one was fired."

Saratoga, CA-based Ekahau Inc. reflected on how several hospitals, as well as two companies outside of healthcare, are using RTLS technology in ways other hospitals can emulate.

"A Japanese hospital is using Ekahau RTLS to track its staff, but isn’t using their location information until there is a contagious disease outbreak," said Tuomo Rutanen, vice president, business development. "With this historical location information maintained in their database, they then can trace the paths of staff members over a given period of time and determine who has been in touch with contaminated people, equipment and areas."

Another hospital is using its Wi-Fi network with Ekahau RTLS to manage assets at multiple locations in a multi-state region, Rutanen noted. The hospital has been able "to seamlessly deploy a tracking solution at their facilities and have enterprise-wide visibility across their entire system on the usage and need for mission critical assets," he added.

Outside of healthcare, a Canadian mining company is using Ekahau RTLS to signal when a hauler enters an underground area, according to Rutanen. "Once detected, the tag notifies the server to turn on fans that help cool and blow fresh air into the area. Once the hauler leaves, the fans turn off. The mine has achieved immediate ROI because it is saving thousands of dollars in electrical costs each quarter," he noted.

In the transportation industry, one company uses Ekahau RTLS to create an open loop national network to notify terminals a truck is arriving. The Wi-Fi tag, which is attached to each truck, automatically announces itself and is registered with the Wi-Fi network as it arrives, he said.

Bryan Christianson, vice president of marketing at Pittsburgh-based Mobile Aspects Inc., noted that as its customers become more comfortable using RFID technology to manage medical devices and supplies they’re identifying more opportunities to apply the technology in creative ways. For example, some are managing high-value pieces of equipment, such as patient monitoring systems and procedural scopes that are used frequently and have designated storage areas for accessing and returning the items. RFID helps to identify issues such as misplacement or theft and reassures clinicians of device availability when needed, according to Christianson.

Many of its customers also are using the data that are "by-products of the automation" for strategic planning, he noted. "In looking at data on clinical activities, the organizations are able to assess performance measures and patterns of clinical behavior that allow them to be much more familiar with data involving cost, efficiency and quality," he said. "A specific example is being able to assess the supply costs per case at the organizational level and then creating an ability to measure the clinical preference patterns among physician peer groups."

TUG, you’re IT

But one executive contended that traditional RFID and RTLS thinking needs to address the fundamentals and may be overlooking the real challenge hospitals face – low asset utilization. Peter Seiff, vice president of customer solutions at Aethon Inc., Pittsburgh, commonly refers to this underutilization problem as "assets ‘hiding’ in plain sight." And nurses are blamed for their surefire solution.

"Nurses are often accused of creating the problem by hoarding," Seiff said. "But don’t blame them — they are doing what’s in the best interest of their patients. Having grown impatient waiting for equipment to be delivered when they need it, and having lost confidence in the ability for it to be done efficiently, nurses have created their own system to ensure that they have assets when they need them. They maintain an ‘illegal’ local inventory of assets because they fear if they return the assets, they will never get them back.

"This is a classic case of localized optimization," he continued. "While this may work on a limited basis, it is bad for the whole hospital and it leads to excessive investments in equipment inventory or rentals. But can you blame them? If you look at all the assets hiding in plain sight in hospital hallways, it becomes obvious that their concern is valid — there is a serious lack of transportation resources for delivery and pick-up."

Aethon hospitals use its autonomous mobile robots, called TUGs, and RFID to locate, recover and deliver assets throughout the facility. The TUGs are configured with an active RFID antenna and use an internal navigation system to navigate around the hospital.

FirstHealth Moore Regional Hospital, Pinehurst, NC, has been using TUGs for the last three years, specifically for delivering drugs from pharmacy, according to Doug Keeney, director of materials management.

"Initially, we felt [the TUG] wasn’t real-time because you had to wait for the TUG to come back and plug in to download information," he said, "but it turned out not to be a problem at all because we have installed six portals in a number of areas for the TUGs to plug into that help us see data in real time." Those areas include the ER, PACU and the clean storage room in sterile processing, and three other clinical departments with a high volume of products.

Technicians are equipped with laptop computers to access TUG data, Keeney noted. The TUGs are outfitted with RFID tags that the portals can read in real time. The hospital has tagged between 600 to 700 individual devices that the TUGs track.

With the Aethon system, the hospital was able to reallocate three full-time equivalents to work in other areas of the facility, according to Keeney, and may be able to move two more once they expand the TUGs’ reach in delivering supplies to nursing units.

Where FirstHealth Moore Regional realized clear financial benefits was in the need to rent various devices. "We were spending about $10,000 a month to rent compression devices and PCA pumps because we didn’t know where the ones we owned were at all times," Keeney noted, "but with the RFID tags and TUGs we’ve been able to find these devices and eliminate the need to rent within two months of implementation. These were the first things we tagged. It was an easy hit."

Tagging IV pumps was a bit more difficult, Keeney admitted. "We had to tag them and change the way they were distributed throughout the hospital," he said. "Prior to the tags, every nursing unit had X number of pumps kept in patient rooms whether those rooms had a patient in them or not."

Nurses weren’t too happy with the change. "We had to convince nursing that we could find the pumps, clean them and get them back in services when they were needed," he said.

The system has been in place for about a year with few negative results, Keeney noted. They’re looking now to tag crash carts and wheelchairs, among other products. "I was asked by the radiology director to track lead aprons, which we did, because we have 700 in stock at $40 apiece," he said.

Keeney recalled some initial pushback by employees who feared the TUGs would replace them and they would lose their jobs. "They said ‘I can walk faster than a TUG so why do you need it?’" he noted. But the facility didn’t lay off anyone in pharmacy or materials management due to the TUGs. "So far, everyone has really embraced it," he said. "They realize they don’t have to leave the storeroom."

The real challenge, Keeney quipped, is how to deal with increased TUG traffic in the hallways as the facility adds more TUGs. "They’ve been exceptionally reliable," he added. "They operate without any of us getting too involved. When a storeroom door is inadvertently closed, the TUG will call the main office, which then calls the specific location to open the door."

For more information, visit the company Web sites at www.aeroscout.com, www.aethon.com, www.awarepoint.com, www.ekahau.com, www.mobileaspects.com and www.skytron.us.