In The News

Excerpt from Materials Management
March 2005.
Full article is available at Materials Management Online

On A Roll

by Robert Neil

RFID moves toward patient safety

The technology is already receiving positive reviews in the retail and defense industries, and it soon could be used to track the whereabouts of large herds of cattle and members of the U.S. Congress.

And the health care industry hasn't been forgotten. The high-tech tool known as radio frequency identification (RFID) is serving many purposes, including patient safety.

Several companies are offering different products incorporating RFID technology, which feature direct and indirect methods of addressing patient safety.

The use of RFID in health care is in the early stages of what will become a large trend. Planning wisely for the future is essential at this point, says John Pantano, an executive with Radianse, Lawrence, Mass., a company that deals in RFID systems that can be set up to track medical equipment or patients.

"I highly recommend that hospitals--even if today they only want to do asset tracking--look for a system that will allow them to do patient tracking later on so they don't have to double their investment," he says.

Lower costs as well as improvements in the technology are two reasons RFID systems are being considered more seriously by hospitals.

In the past, a number of different technologies were available, but they required an expensive infrastructure that included specialty cabling with highly precise receivers and I.D. tags.

"And it wasn't uncommon for a 200-bed hospital to be looking at a price tag of $1 million or even more," Pantano says. "A hospital looking at us is going to be looking at between $200,000 and $300,000 depending on exactly what they want to do."

Radianse is one of the suppliers that has generated early name recognition in the market with 10 hospital customers, including Massachusetts General Hospital, Boston.

However, it's too early to determine which companies ultimately will be the dominant players in the emerging field, which also includes such firms as PanGo Networks, Framingham, Mass.; Symbol Technologies, Holtsville, N.Y.; eXI Wireless, Vancouver, British Columbia; and AMTSystems, Cheshire, Conn., as well as others.

Safe start

For hospitals interested in jumping into the RFID movement, the task is to evaluate each technology company's proposal and determine if it suits their needs. It's important to note that even though all firms are using RFID technology, the use and services derived from the technology can differ with each company.

In the area of increasing patient safety in the OR, the FDA recently approved a first-of-its-kind RFID product designed to help prevent wrong-site surgeries.

The system, Surgichip, is an RFID surgical site identification system currently in pilot studies at three hospitals in Connecticut, Florida and Rhode Island.

The device was the idea of orthopedic surgeon Bruce Waxman, M.D., who partnered with AMTSystems to bring the technology to the marketplace. The product uses a passive tag to help prevent wrong-site surgeries, a pervasive problem in the industry.

The system works by encoding information about a patient and procedure into an RFID tag, which is printed on a special printer and stuck to the part of a patient's body where the surgery is to take place.

The tag is coded with necessary information when the surgery is scheduled using a hospital's existing scheduling software, so no dual data entry is required, says Todd Stewart, vice president of business development for AMTSystems.

Through an interface established using the company's software, the scheduling information can be manually or automatically sent to a printing system from Zebra Technologies, Vernon Hill, Ill., and a tag is printed on special media that contains an RFID signal

"Once the information is written to the tag, it's electronically locked, so the information cannot be changed or altered," Stewart says. "The information is encrypted, so we meet HIPAA compliancy because all the information that's stored on the tag is protected."

Using handheld readers, a nurse can access a tag's encoded information, which consists of such things as a patient's demographics--name, medical record number and date of birth.

Also, a tag has information on the planned surgical procedure--type of surgery, side for the body and body part where the surgery is to be performed, the surgeon's name and the date the surgery is to take place.

The company plans to release data on the product's effectiveness after pilot studies are concluded later this year.

Another pilot study taking place is in the emergency department at Beth Israel Deaconess Medical Center (BIDMC), Boston. It has been using an RFID system from PanGo since the fall of 2004 to locate medical equipment.

"Emergency departments are a little bit like mazes. There are lots of little rooms, closets and cubbyholes, so, to know where each piece of equipment is at all times is very hard," says John Halamka, chief information officer for CareGroup Healthcare Systems, Boston, an integrated delivery system comprising four hospitals--BIDMC; Mount Auburn Hospital, Cambridge, Mass.; New England Bap- tist Hospital, Boston; and Beth Israel Deaconess Hospital Needham (Mass.) Campus.

"We have 100 rooms of various sizes and types in our emergency department. So you can waste a lot of time trying to find equipment," says Halamka.

BIDMC is using PanGo's proprietary software, installed by PanGo staff during the setup period, which took a few days.

In that time, sensors were installed at various locations in the emergency department using the hospital's existing wireless LAN (WLAN) system. Although there's some debate among competing technology companies about the accuracy of RFID systems running off of wireless networks, Halamka says the tracking technology is doing what needs to be done.

Being able to locate medical equipment quickly is a patient safety issue because it allows clinicians to spend more time with their patients rather than searching for items that are difficult to find, says Alan Foster, president of eXI Wireless.

Tracking systems also could prevent another dangerous consequence that, according to Foster, occurs when clinicians worry they won't be able to have the equipment they need in an emergency. His company has data showing nurses spend up to 30 percent of their time looking for products or equipment, and working in that type of environment sometimes leads to hoarding or stashing products.

Such methods can lead to skipping the proper sterilization processes, which raises concerns about contributing to the problem of hospital-acquired patient infections, Foster says.

While enabling hospital staffs to find the right equipment at the right time is an indirect way of improving patient safety, RFID technology can be used to directly affect patients by tracking them.

Tags can be attached to patients, or patient beds and gurneys; and locating a patient can be accomplished with the same method used to track equipment.

"In a big emergency department, patients often get shuttled around from room to room," says Halamka. "They're shuttled off to radiology, shuttled off to various places in the hospital for diagnostic testing, and so just as part of delivering good care, it's really useful to know where your patient is at any given moment."

The PanGo system used at BIDMC features tags about the size of a pager, too large to attach to a patient wristband, which is why the hospital is affixing them to beds and gurneys. However, like all companies in the field, PanGo is working to improve RFID technology to meet hospital demands, and the company plans to have a smaller active tag later this year that can be attached to a patient.

Radianse recently introduced such a tag, and eXI Wireless has had one on the market for a while. The ability to track patients is a safety issue that not only addresses medical care, but also security concerns for "potential elopement," i.e., patients that might leave without being discharged, according to Greg Popham, director of security at St. Elizabeth Medical Center, Edgewood, Ky.

Working with eXI Wireless, the hospital has recently started using RFID tags on certain emergency department patients, such as those with head injuries, psychological problems or substance abuse issues. The concern is that patients might leave the hospital and harm themselves or someone else.

"The hospital is liable if that person escapes from the hospital," Popham says. "So, what we've done in the early stages of this, is put a system in our emergency department, and we are tagging elopement-potential patients."

A system designed to prevent patients from leaving the hospital uses the same RFID technology required to locate equipment, but the setup is different.

When tracking equipment, enough sensors are installed to be able to read the signal from the tags throughout a department, floor or other defined area.

Preventing unauthorized departures requires installing sensors at strategic locations near stairwells, elevators and exits, creating an invisible boundary.

The response is determined by a hospital when a tag crosses a boundary. Reactions can include an alarm, doors automatically locking and elevators shutting down.

Setting up the system will probably require contracting with a building security vendor, which can work with an RFID technology company, according to Popham.

It's too soon to evaluate the operation of the system in St. Elizabeth's emergency room, but a similar configuration has been used for years in the pediatric and maternity wards of the hospital. Infant and child abductions from hospitals have become a concern, and Popham says RFID tags on young patients are the best way to keep children and babies safe.

A nurse places a wristband with an RFID tag on all children when they're admitted to a hospital, and newborns receive a tag shortly after birth.

Any attempt to take a patient off the floor will trigger an alarm. Also, eXI has developed skin-sensitive tags, which means they must remain in constant contact with a patient's skin or an alarm will sound.

"It's not a loud bells-and-whistles kind of alarm. It's an alarm that the nursing staff has become accustomed to through drills," Popham says. "There's an alarm that goes off in security, obviously, so we can radio dispatch people to respond."

The RFID technology is only part of an overall plan to keep a hospital's youngest patients safe, he says, and other aspects involve training the staff to be observant, not having a nursery where anybody can view babies and placing signs to inform visitors that a security system is in place that prevents abductions.

"Our game plan is not to have any attempts--not to mention an abduction," Popham says.

The number of patient safety uses for RFID systems is starting to get the attention of hospitals, a point made clear by the size of crowds gathering around RFID vendors at the recent conference put on by the Healthcare Information and Management Systems Society, Chicago. Companies dealing in the technology say the learning curve for hospitals is beginning to move up, and that will be helpful as competition heats ups and more products incorporating RFID technology hit the market.