A Tech-Savvy Medical Organization Gives the Thumbs-Up to RFID

By Bob Violino

Intermountain Healthcare implemented an RFID system to improve the speed and accuracy of laboratory testing.

Intermountain Healthcare, a nonprofit integrated health-care system consisting of 21 hospitals and more than 100 clinics in Utah and southeastern Idaho, is known for its innovative use of technology to improve services. In 2008, the Salt Lake City, Utah-based provider was cited in the annual Hospitals & Health Networks' Most Wired study as being one of the nation's most technology-savvy health-care organizations. It marked the ninth time in 10 years that the survey— a joint project of Hospital & Health Networks, Accenture, McKesson, the American Hospital Association and the College of Healthcare Information Management Executives—ranked Intermountain Healthcare among the nation's most wired organizations.

Intermountain has been developing computerized health records since the 1970s, and is now working on a project with GE Healthcare, a unit of General Electric, to develop the next generation of electronic medical records. The company is relying on homegrown clinical systems until the jointly developed system is ready. The health-care provider serves as a strategic development partner of GE Healthcare in building advanced decision-support and knowledge-management tools, as well as other functionality for GE Healthcare's Centricity system, an integrated clinical, financial and administrative system.

Lab analyzer with specimen delivery track in front

In one of its latest forays into technology, Intermountain Healthcare has implemented an RFID system to improve the speed and accuracy of laboratory testing. The company's lab directors and managers took note of research data from a hospital in Montreal indicating that each handoff of a lab sample—from a physician to the courier to the lab, for instance—added approximately 10 minutes from the point of specimen collection to the time it takes for the physician to receive test results. So if the process involved four handoffs—not uncommon in a typical testing scenario—that could mean up to 40 minutes of additional time.

Intermountain officials decided to implement an RFID system to automate the tracking of laboratory samples. "The business drivers for the automation system were our need to increase efficiency, decrease variation in process times and decrease staffing requirements to deal with staff shortages," says Sterling Bennett, medical director of the Intermountain Central Laboratory and chair of the Urban Central Region department of pathology.

Company officials had considered a partial automation solution known as front-end automation, Bennett says, where some of the steps in the testing process are automated and others remain manual. But they opted instead to automate the entire process, he notes, to eliminate all the handoffs.

Intermountain selected the Accelerator Automatic Processing System, manufactured by Inpeco in Milan, Italy, and marketed in the United States by Abbott Laboratories. The system automatically delivers specimens to centrifuges, lab analyzers and storage facilities. It comes with configurable middleware, called Instrument Manager, that manages and tracks the lab's data and is designed to improve operational efficiency, reduce processing errors and help make turnaround times on samples more consistent.

The Accelerator Automatic Processing System was deployed in March 2007 at Intermountain's Central Lab in Salt Lake City, a standalone facility located on the campus of Intermountain Medical Center, Utah's largest hospital. The Central Lab was also designed to handle many of the non-emergency functions of Intermountain's seven laboratories, which are spread along a 100-mile corridor encompassing 80 percent of Utah's population. Bennett says this was done, in part, to create sufficient sample volume to be able to utilize more efficient technology, including the automation system.

According to Bennett, creating the Central Lab and automating the testing processes has enabled Intermountain to increase capacity without adding additional staff. "We were running out of space in our hospital labs, and knew that we would need to introduce new tests to keep up with the requirements of medical care," he says. "We also have a labor shortage, and were looking for ways to do more testing with fewer people."

How It Works

A technician registers an incoming tube containing a specimen, places a bar-code label on that tube, then places the tube on a rack and puts the rack on an input bay. At that point, the Accelerator Automatic Processing System takes over: It picks up a tube and places it into a carrier sitting on a conveyor belt. Each carrier has a passive RFID tag.

When a tube is placed in a carrier, the system "marries" the bar-code identification of the tube with the RFID tag on the carrier, then tracks the tube's position by the position of the carrier as it passes in front of RFID interrogators. That information is sent via a wide-area network to the Instrument Manager software, which coordinates with Intermountain's laboratory information system software to determine what testing needs to be performed on the particular sample. The software programs run on central servers.

Input-output station

The conveyer system delivers the tube to a centrifuge, then routes the tube to whichever analyzers—instruments that actually run the lab tests, such as measuring various constituents of a blood sample—are required for that particular sample. Once all tests are completed, the system routes the tube to a storage module and, after a designated hold time, to a disposal unit. The system employs roughly 20 RFID interrogators.

The laboratory automation system significantly improves workflow, Bennett says, and results in faster, more meaningful laboratory outcomes. The system, he indicates, "has changed processes in that many routine, repetitive steps are now automated rather than being done manually."

Prior to automation, for example, a sample tube would arrive in the lab and an individual would register that tube into the computer system, place a bar-code label on the tube, then place the tube in a centrifuge and run the centrifuge for approximately seven minutes. The worker would then take the tube out, walk it over to one of the analyzers and place it on a rack on a table, from which another person running the analyzer would pick up the tube and place it on the analyzer, then begin the testing.

If the sample needed to be tested on a second analyzer, the worker would take the tube to the second analyzer and place it on a rack, from which another person would load the tube onto the second analyzer. When testing was completed, the tube would be placed in a rack and taken to a storage refrigerator, where it would be held for several days in case further tests were required. After the hold period, someone would pick up and discard the tube.

Among the key benefits of the automation system are greater productivity, decreased cost per test and more predictable process times. In addition, specimens can be located more quickly, and unacceptable samples can be identified with greater speed. Intermountain could not provide specific figures on these benefits.

When Intermountain first tested the automation system at the Central Lab, the goal was to have a 30-minute lab turnaround time for basic blood-chemistry tests. Multiple tests were conducted simulating this requirement, to determine how the system would perform. After several adjustments—such as tweaking the interfaces between the analyzers and the automation system—the lab now meets the 30-minute turnaround 80 percent of the time. The goal now is to increase this to 90 percent. In addition, as volumes of lab samples continue to increase, the facility expects to be able to increase sample throughput volume up to 30 percent before needing to add more employees.

A robot loading a centrifuge

Intermountain selected the Abbott system over competing automation systems for several reasons, Bennett says. For one thing, the system can handle multiple specimen tube sizes simultaneously, whereas some other systems can handle only one size. For another, Abbott has an "open" approach, meaning the system can interface with non-Abbott components. "This was important for us to maintain our enterprise-wide, multi-hospital laboratory analyzer standards," Bennett states.

In addition, the Abbott system provides flexibility in the placement of analyzers relative to the conveyer track. Finally, Intermountain uses other equipment from Abbott as part of its immunochemistry operations, so it was familiar with the technology.

According to Bennett, one main implementation challenge of the system involved learning how to restructure workflow to realize the new technology's benefits. Some employees had to learn new roles, and thus had to be trained in how to use the automation system. Some types of samples can not go onto the automation line, Bennett says, so Intermountain had to figure out how to keep some non-automated processes working.

Another challenge was the interface problems that arose between the automation system and the laboratory information system at Intermountain, as well as between the automation system and the various analyzers used by the lab. Having the various systems work together seamlessly required vendor cooperation and support, Bennett says, and Intermountain benefited from having long-term relationships with the analyzer, automation system and laboratory information system vendors.

Experience With RFID

This isn't the tech-savvy medical organization's first foray into RFID technology. For the past seven years, Intermountain's McKay-Dee Hospital Center in Ogden, Utah, has been employing the Versus Information System (VIS) real-time location system (RTLS) from Versus Technology to track assets, according to a hospital spokesperson. The system provides up-to-date location information, so the facility can utilize resources more efficiently.

The system uses a combination infrared (IR) and RF tag. "RF and IR are used in combination for a seamless tracking system," the spokesperson says. "RF signals communicate, but because RF signals penetrate doors and walls, they provide only general location data." The IR portion of the badge "provides definitive location information, even down to the bed level."

McKay-Dee is currently in the process of upgrading to a more powerful version of VIS, so it can continue to expand its use of the technology. "We have over 10,000 pieces of equipment in our database," the spokesperson says," and the 1,250 currently tracked is only a small portion of the portable devices in the facility."

The system includes a configurable "locator screen" for viewing the assets' location. "One shows all equipment in a department, regardless of ownership, and the second screen option shows a department's equipment regardless of where it is in the building," the spokesperson says. "We then have an all-assets screen. If we are tracking defibrillators for preventive maintenance inspections, we quickly know where they all are, in real time."

Originally, the hospital used the system to track the location of staff members as well. But it has since implemented a communications tool from Vocera Communications that also has locating abilities, so employee-tracking badges are no longer used. "We have yet to attempt or consider patient tracking," the spokesperson says, "but that is not outside the scope of the system."

For now, McKay-Dee Hospital Center is the only facility in the Intermountain Healthcare system that employs an RTLS. Utah Valley Regional Medical Center had planned to launch the technology, but that was put on hold due to the economy. The largest facility, Intermountain Medical Center, would like to deploy an RTLS, but nothing is planned as yet.