Mar 14, 2013
Harvard Medical School teaching affiliate Brigham and Women's Hospital (BWH) is testing a Near Field Communication (NFC) RFID system it developed that enables health-care staff members to manage the administration of medication at a patient's bedside. The solution—designed last year by an interdisciplinary group headed by Adam Landman, a medical doctor who serves as the director of clinical informatics for BWH's emergency medicine department—consists of a Google Nexus 7 tablet and a software app that interprets RFID tag data regarding patients and the medications they receive. The system works with passive NFC RFID tags attached to medications, to patients' wristbands and to staff members' ID badges, thereby enabling a user to read the tags and link the patient, caretaker and medication in the app.
Since 2005, BWH has managed its medication administration data via bar codes. Increasingly, Landman explains, hospitals are using bar codes or other electronic data systems to manage which pharmaceuticals are being administered to which patients. The U.S. Centers for Medicare & Medicaid Services incentivizes hospitals and health-care providers to adopt electronic health records in a series of stages, one of which (Stage 2) requires that, starting in 2014, medicine must be tracked via an electronic medication administration record (eMAR). BWH has been providing its own eMAR system that involves scanning a bar code printed on a medication, along with the bar code on a patient's wristband, in order to link that individual with a particular medicine.
To use the system, nurses bring a workstation-on-wheels to patients, along with a bar-code scanner and the appropriate medications. At each bedside, they scan each bar-coded identifier of every medication, and those IDs are automatically entered into that patient's electronic health record on the workstation-on-wheels computer, via a Bluetooth connection. However, Landman notes, the time spent scanning bar codes, as well as the difficulty in ensuring a strong Bluetooth connection, can often make data collection during these visits time-consuming. The bar codes themselves could be difficult to scan as well—in many cases, a bar code is printed on a crinkled wrapper that can be difficult to scan. What's more, he says, pushing the workstation-on-wheels from one room to another is cumbersome.
"That led us to thinking about new ways to do this," Landman states. In 2012, BWH's Biomedical Research Institute awarded him a grant for translatable technologies and care, to design a better eMAR solution.
Landman put together an interdisciplinary project team that includes Anne Bane, BWH's nursing director of clinical systems innovation; Stephen Miles, a research affiliate at the MIT Auto-ID Labs; and Pamela Neri, the research project manager for clinical and quality analysis at Partners HealthCare. The group developed an app that stores a list of patients, as well as data about each patient, such as the medications he or she should receive, how often and when they should be administered, and in what doses. Landman's team built a prototype system, using a Nexus 7 tablet, which comes with a built-in NFC RFID reader. They loaded the tablet with the app, and then attached NFC RFID tags to some pharmaceuticals, staff badges and patient wristbands.
The team is presently performing initial testing of the system within a medical-simulation environment, using mock patients (mannequins) and comparing its efficiency against that of the traditional bar-code solution. For the NFC system, users first open the app, which lists patients, and then select the specific patient name they seek. The app lists the medications and dosages that the patient should be receiving. The nursing staff can then remove those medicines from the shelf. When administering the medication, they use the Nexus 7 tablet to read the RFID tag on the patient's wristband, and the tag on the medicine. The system indicates, on the tablet screen, whether the patient and pharmaceutical pairing is correct. If that medicine is incorrect for that patient, an error message will be displayed on the screen. The employee then also reads the tag on his or her own badge ID, in order to link the three tags in the software and thereby retain a record of which medication was administered to which patient, and by whom.
The system could provide more than just verification of which medications are administered—it could also enable personnel to enter information into the software while at a patient's bedside. For example, when administering pain medication, a nurse could enter the patient's pain level on a scale of one to 10, as well as the dosage that he or she decides to provide, based on that information. That data could then be stored, to be viewed by other health-care practitioners when the next dosage is scheduled. The tablet would transmit information back to the patient's electronic health record via a Wi-Fi connection.
Based on nurses' comments, Landman says, early testing is finding that the NFC solution "is well received." He notes that although it may only save a few seconds per visit for each nurse, the overall reduction in time spent fiddling with the technology over the course of a week or longer could be extensive.
The pilot involving mock patients has been underway since January 2013, and is expected to be completed next month. If the results from the pilot indicate that it was a success, Landman says he plans to conduct a second pilot on live patients at the hospital.
According to Landman, the tags currently being used are "off-the-shelf NFC tags," though he declines to name the vendors. So far, he says, he has observed that some tags are difficult to read on foil-wrapped medication, such as blister packs, and different tags may need to be acquired for this type of packaging.
"We think this will be a big advantage to have the scanner and data collection all possible on one device," Landman states. To enable the data to be integrated with the hospital's electronic health record, he says, the facility may look for other technology providers that could assist with that integration.
Landman says his group hopes to share the results of the pilot in a peer-reviewed journal. In the future, he adds, he could envision the technology being adopted by BWH, as well as by other hospitals and health-care providers.
