From X-ray to computed tomography to magnetic resonance imaging to positron emission tomography to nuclear medicine and a growing list of hybrid/hyphenated modalties, clinicians order the appropriate imaging method to serve a particular function inside the body, such as identifying masses in bone or soft tissue or monitoring blood circulation.

Supply chain managers face similar choices in applying visual mechanisms externally for tracking the movement and location of patients, staff members, products and equipment, along with temperature, pressure, humidity and a host of secondary parameters.

But do those external tracking "modalities," such as bar coding, radiofrequency identification (RFID) and other real-time location system (RTLS) software applications specialize in certain areas, just like selected imaging modalities can be used for selected applications? In a way.

If you break from the herd and focus on the process for which you’ll use the technology applications prior to selecting any tracking technology you’ll be ahead of the game, according to Al Cook, CMRP, FAHRMM, senior director, healthcare resources, Integrated Business Systems & Services, Columbia, SC, and Chief Resource Director, The Regional Medical Center, Orangeburg, SC.

"The real issue, I think, with the technology is that if you select the equipment before you identify the process issues, you try to force the equipment to do things that it may not be designed for," Cook told Healthcare Purchasing News. "This fits the concept that if the only tool that you have is a hammer, then every problem begins to appear as a nail."

Yet one of the challenges in tracking assets and processes is being able to differentiate the technology applications. Specific delineation between bar coding and RFID may be evident at first glance but for many the view blurs when they try to distinguish between RFID and RTLS – if that’s even correct. And it may not be.

Brian McAlpine, director, strategic products, Capsule Tech Inc., Andover, MA, purported one way to clear up the ambiguities.

"RFID refers to a pure technology – [it] could be active RFID or passive RFID technology for example – and RTLS is a tracking/asset solution that could leverage RFID as an underlying technology," he noted. "But some RTLS systems can also rely on non-RFID technologies, such as ultrasound, infrared or combinations of any of these technologies. To put it more simply – RTLS is the solution that locates an asset or person, and RFID is one of the technologies that is used by the RTLS system."

RTLS is a market segment and not a technology, according to Valerie Fritz, vice president, marketing, TeleTracking Technologies Inc., Pittsburgh, and different RTLS vendors use different underlying technologies.

"Within RTLS there are a variety of underlying technologies used to obtain the location data needed to drive these solutions," she clarified. "Infrared and ultrasound are two of the options used by RTLS solution providers to obtain this location data. RTLS solutions are really only as good as the underlying location technology used, combined with the software and process improvement applications and services it is paired with."

Even so, Fritz noted that bar coding, RFID and RTLS "describe very different technologies that are independently and collectively useful for different applications." If anything, bar coding and RFID share the most similarities in function.

"Bar-code systems require a person to scan items and do not necessarily report asset location," Fritz continued. "RFID systems read an asset’s location as it passes through a fixed reader." However, bar coding and RFID serve a different need than RTLS in that they are characteristically used to manage information and eliminate manual data entry, she added.

"Both RFID and bar coding are typically used in the supply chain process for product shipping and receiving purposes, can be used to manage inventory levels for replenishment ordering of medical/surgical supplies, [such as] stents, catheters, bandages, etc., and for medication administration or treatment verification at the bedside. RFID can overcome some of the problems associated with bar codes in that it eliminates human compliance issues, but RFID is unlikely to replace bar codes any time soon as it remains more costly than bar coding.

"RTLS is the right choice for mobile medical equipment management, patient tracking, staff locating and temperature/environmental monitoring," she said. "RTLS provides a network throughout the hospital enterprise and continuously reports when and where a tagged asset or person is located in real-time, and without manual intervention. Because RTLS is active locating technology, meaning the tag includes a battery to continuingly signal its location, the tag form factor is typically too large to apply for disposables, medications, specimens and surgical instrumentation."

Marcus Ruark

Marcus Ruark, vice president, marketing, Intelligent InSites Inc., Fargo, ND, traced RFID’s popularity in healthcare to the emergence and use of passive tags within the Department of Defense and Walmart roughly a decade ago. Since then, RFID’s definition morphed to include active RFID technologies – essentially battery-powered or battery-enhanced passive RFID tags – but is also sometimes used to refer to RTLS solutions that use RF for location purposes, he added. "Within the healthcare industry, I think it is simplest – perhaps as shorthand – to think of RFID as passive RFID, whereas anything related to active-tracking would fall under RTLS," he noted.

RTLS as a term is gaining more relevance in healthcare, particularly given the increased focus on cost savings and the connection that customers are making between enterprise RTLS solutions and hard-dollar cost savings, according to Ruark. RTLS includes any tracking technology capable of providing real-time information — usually location information, but sometimes also environmental information, such as temperature or humidity, or event information like a button press.

"Unlike passive RFID technologies, which require the RFID tag to cross a threshold, enter a chokepoint, or be within range of a handheld reader, RTLS allows tags to be tracked or monitored continuously and ubiquitously throughout the healthcare environment," he said. In short, RTLS technologies include Wi-Fi, infrared, ultrasound, ZigBee, Bluetooth and proprietary RF.