Jun 10, 2015The Newcastle upon Tyne Hospitals NHS Trust, in northeastern England, is employing a combination of radio frequency identification and bar-coding technologies to manage hundreds of thousands of patient files. The Intelligent File and Inventory Tracking (iFIT) solution, provided by 6PM Group, includes passive ultrahigh-frequency (UHF) EPC Gen 2 RFID tags affixed to files, fixed and handheld readers, and bar-coded labels attached to shelves in the hospital libraries. The iFIT solution, 6PM reports, improves overall staff efficiency and reduces the risk of losing a file entirely, while helping to improve safety by ensuring that the necessary paperwork can be located quickly in the event of a patient emergency.
Newcastle is one of the largest teaching hospital trusts in the United Kingdom, with 1.1 million outpatient appointments annually. (Each NHS trust serves a specific geographic region in the United Kingdom, and can include multiple hospitals.) The Newcastle Trust's three campuses provide in-patient and emergency care to a combined total of 500,000 people per year, and also manage 1.1 million outpatient appointments annually. The three sites operate a total of 18 libraries in which the patient files are stored, and about 4,000 of the trust's 14,500 employees use the files on a daily basis.
The trust transports thousands of case notes daily from one location to another, according to Gordon Elder, Newcastle's outpatients and records manager. This helps the facility to ensure that clinicians have the information they need when treating or following up with patients.
Without an automated system, tracking the files that contain patient records can be extremely time-consuming, Elder says, and require considerable walking around the facilities to search for files that may or may not be where they're expected to be.
"We wanted a system that would assist our staff in locating case notes, especially in an emergency," Elder explains. Newcastle stores 2.1 million files of case notes, and is currently in the process of digitally scanning its files. To date, about 500,000 of the files have been digitally scanned. In the meantime, since the majority are still on paper only, the trust's staff must track those files' locations, whether they are actively in use or are stored within one of the libraries.
"Managing the libraries on a daily basis was very demanding and resource-intensive," Elder says, describing the file-tracking process prior to Newcastle's adoption of the iFIT system. "All case notes were filed numerically. This involved a lengthy process of general sorting, a second step of more specific file sorting, and ultimately placing the paperwork on shelves according to the numerical system. With iFIT, this process is now almost gone, as staff can now track directly on shelves."
The iFIT system was taken live at Newcastle in February of this year. After four weeks of operation, library staff members had attached Tageos RFID labels to 158,000 of the 1.6 million paper-only files. Each label was encoded with a unique ID number that was also printed on the label in bar-code form. That ID number is linked to the patient's ID in the iFIT software residing on the hospital's server, says Steve Wightman, 6PM's deputy chief executive officer. When a file arrives at a library to be put away, a staff member uses a handheld device to scan the file's bar code, and to then scan the unique ID number printed on the bar-code label on a shelf near where that worker is standing. The shelf ID number is then linked to that file in the software. If a library worker later needs to locate that file, Wightman says, he or she then simply looks up the shelf ID for that file in the software and proceeds to that shelf, "very much in the same way a modern logistics organization works."
This enables the trust to forego the numerical filing system, so that employees do not have to walk through the aisles when putting a file away. Rather, they can simply put it wherever they find space.
"This has truly revolutionized our processes within the libraries," Elder says.
If a worker has any trouble finding a file where it was expected to be, a handheld RFID reader can be used to locate it on the shelf.
The system also tracks where files go when they leave the libraries. 6PM has installed 26 fixed RFID readers—the firm declines to name the make and model of the handheld or fixed reader being used—at the three locations, with two to four antennas installed with each of those readers. The interrogators are strategically deployed in and around the medical records libraries, as well as in mailrooms, the clinical coding area and the main outpatient departments. These areas, Elder explains, are the busiest departments within the trust, "and, therefore, we can track case notes as they move around these key areas, ensuring that they get to their destination on time."
Each time a file passes one of the fixed readers, that device captures the file label's unique ID and forwards it to the iFIT software, thereby updating the location status of that file. With the two to four antennas, the readers are able to send back data that also indicates the direction in which the file is moving, thus providing a clue regarding what department the file is headed to next. If a file has not been returned to the library and is needed by another health-care professional, personnel can take the handheld reader—known as the Go-Find Gun—walk to the area where the RFID file was last read by a portal reader, put the handheld in Geiger counter mode and begin walking around until it has been identified.
Staff members in the libraries or elsewhere throughout the hospital can also perform inventory checks, by placing a handheld reader into audit mode and walking through a room, passing shelved files or trolleys loaded with files, and obtain an updated location record for each file.
Since the system was installed three months ago, it has enabled a reduction in the amount of time that personnel spend in the libraries searching for files. "Staff have reported that pulling case notes is easier and quicker," Elder says, "as they are able to locate the case notes within a range of 15 to 25 case notes."
To date, the trust has tagged 250,000 of its 1.6 million paper-only patient records, and has performed more than one million iFIT read transactions. All other files will be tagged as they leave the library for use by clinicians as needed, while the remaining files not being used will eventually be archived offsite.
Next, the trust hopes to expand the system to provide greater location coverage in areas through which pass a high volume of files. It is also investigating whether iFIT could be used for tracking specimens in the pathology area, as well as medical devices hospital-wide. The tagged specimens or devices could be read using the same RFID reader portals and handhelds already deployed, and their locations could be stored in the existing iFIT software.
U.K. hospitals are all in the process of digitizing medical records, Wightman reports. However, until that lengthy and costly process is completed, they have been seeking automated systems to manage the thousands of records that they must track physically. For that, he says, passive UHF RFID has been a popular choice.
