Health-Care Facilities Embrace RFID

By Elizabeth Wasserman

Many hospitals that deployed RFID for a single application, such as tracking expensive medical equipment, quickly realized benefits and a return on their investment. Now, they're broadening their use of the technology to rein in costs and improve patient care.

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Greenville Hospital System University Medical Center, a five-hospital facility in Greenville, S.C., had a persistent and costly problem: losing or misplacing expensive medical equipment. It's a common problem at hospitals both large and small, and Greenville officials learned that other facilities were solving it with radio frequency identification. So in 2008, they began using RFID to track their high-end equipment.

The first application, deployed at Greenville Memorial Hospital, involved RFID-tagging 600 pieces of mobile equipment in a 32-room operating suite—including infusion devices, OR tables, stretchers and X-ray machines—with active Wi-Fi tags, leveraging the Wi-Fi network in the operating suite. "We were able to tag those devices and simply pull up their whereabouts on a computer screen at any given time and locate them in a matter of keystrokes," says John Mateka, executive director of Greenville Hospital's materials service group. "It saved us a lot of time and frustration and it improved productivity."

It also saved Greenville a substantial amount of money, by delaying purchases of "hundreds of thousands of dollars" of replacement equipment, Mateka says. The hospital saw a return on its RFID investment in less than a year. Greenville administrators were so impressed with the results that they decided to expand their use of RFID to track 5,000 devices hospital-wide, including small surgical devices with less expensive passive tags, so those items didn't "inadvertently get thrown in the trash," Mateka says.

Greenville plans to roll out RFID asset tracking to its four other hospitals over the next six months. In addition, the medical center is working with its IT consultant, Integrated Business Systems and Services, to develop an RFID application to assist in scheduling and tracking OR patients. The goal is to give surgical patients an RFID-enabled bracelet or badge upon admission, so the hospital can gather data on how long it takes them to go through pre-op procedures, surgery, post-op and discharge to patient rooms. "Now when a patient comes in, we will have a mechanism to manage the throughput of our patients and have a good idea how long a surgery will take," Mateka says. "It will also allow us to improve customer service. If a patient is in the waiting-room OR area more than 15 minutes, we can have an alert on the software that lets the staff know so they can take the appropriate action."

Greenville's story is not unique. Many health-care facilities that first deployed RFID to track wheelchairs and other assets, reducing the need to replace lost equipment, are using their ROI to expand coverage to other areas of the hospital or to fund new applications that cut costs, increase revenue or improve patient care. RFID is helping hospitals automate processes to improve inventory management, manage medical-equipment maintenance schedules, monitor temperature-sensitive medicines and alert housekeeping when patients are discharged, to facilitate room turnover. "It's adding visibility to invisible processes," Mateka says.

There's also increased interest in innovative applications. St. Mary Medical Center, in Hobart, Ind., and Saint Vincent Hospital, in Worcester, Mass., are among the health-care facilities RFID-tagging sponges, to ensure they're not left inside a patient's body accidentally during surgery. Both Princeton Baptist Medical Center, in Birmingham, Ala., and Mercy Hospital, in Coon Rapids, Minn., report significant reductions in health-care acquired infections (HCAIs) since they began employing an RFID-based hand-washing compliance system. According to the World Health Organization, 5 percent to 15 percent of people admitted to hospitals in developed nations catch HCAIs during their stays and require treatment. Other innovative RFID applications are empowering patients.

The willingness of hospitals to discuss the benefits they've achieved from RFID is one reason the technology is finding so much success in the health-care industry. Technology solutions designed specifically for the industry are also facilitating adoption. Passive tags, which are less expensive than active ones, are now sophisticated enough to let facilities track a wider variety of items, regardless of price or size. In addition, unlike industries such as construction or electronics that must develop RFID standards for use throughout the open supply chain, most health-care institutions are deploying closed-loop RFID systems, allowing them to pick and choose their own technology. "It's easier to prove the ROI and the total cost of ownership on a single campus," says Michael Liard, RFID practice director at ABI Research.

The University of California, San Diego Medical Center estimates that since it deployed an RFID-based real-time location system in 2006 to track assets at its Thornton, Calif., campus, it saves about $90,000 annually on IV pumps alone. (Photo: Lambert Photo)

RFID analysts and technology solution providers report continued growth in the adoption of RFID in the health-care industry. The $155 million that health-care providers spent worldwide on RFID in 2009 is forecast to more than double to $326 million by 2014, according to ABI Research. Technology provider AeroScout, for example, says its 2009 health-care business was 65 percent larger than in 2008, and its health-care business achieved record revenue levels in the first two quarters of 2010. Still, RFID Journal hears from numerous hospitals that while they understand the benefits RFID can deliver, they don't have the initial funding needed to deploy the technology. Some vendors have recognized this challenge and allow hospitals to procure the technology on a rental basis, minimizing the capital outlay.

In Europe, several issues—including a lack of comprehension about RFID, patient privacy concerns and questions about RFID interfering with medical devices—must be addressed before the technology will be more widely implemented in health care, according to a 2009 RAND Corp. report sponsored by the European Commission. "Currently, reasons for investing in RFID mostly concern quality of care and to address specific applications, and do not necessarily relate to cost reduction, as is more prevalent in the U.S.," says Rebecca Schindler, a RAND analyst and co-author of the report. "However, there is untapped potential of greater RFID use.… Demonstration of benefit to relevant stakeholders and a clear return on investment are required from RFID use in the sector for stakeholders to overcome the apparent technical, organizational and cultural impediments that limit such use now."

Most U.S. hospitals say they adequately protect patient privacy by using only an identification number on patient RFID badges that can be tied into a protected database. In addition, many already test RFID in conjunction with pacemakers and other implanted medical devices, and few complications have been reported. Still, AIM Global, the industry association on auto-ID and data-collection technologies, in collaboration with the Georgia Tech Research Institute and MET Laboratories, has started developing testing protocols for RFID in the health-care setting. They expect to have guidelines early next year.

Building on a Healthy ROI

Many health-care facilities initially deploy RFID to track expensive medical equipment to prevent loss and theft. Some devices are mistakenly thrown away, often rolled up in dirty bed linens; others are hidden by nurses, to avoid having to hunt them down when needed. Frost & Sullivan estimates that 5 percent to 15 percent of hospital inventory is written off each year because it can't be located. Equipment losses can cost hospitals hundreds of thousands of dollars each year.

"Any savings today are very important; many, many hospitals typically don't make money," says Ravi Pappu, cofounder of RFID reader and services provider ThingMagic, which worked on the Greenville deployment. "The cost of delivering care is extremely expensive and it keeps going up, mainly because of the cost of using more sophisticated technologies. But the revenues don't rise at the same rate. People are realizing that if we can figure out ways to prevent expensive equipment from leaving through the dirty laundry chute, it's a good way to save."

The University of California, San Diego (UCSD) Medical Center estimates that since it deployed an RFID-based real-time location system (RTLS) in 2006 to track assets at its Thornton, Calif., campus, it's saving about $90,000 annually on IV pumps alone. The RTLS from Awarepoint, which operates on a ZigBee network, can easily locate the pumps, eliminating the need to rent extra devices to meet demand.

The reduction in capital equipment expenditures convinced hospital management to track more devices at the Thornton facility and to expand the RTLS to its Hillcrest campus. UCSD was able to reallocate the money earmarked for replacement equipment. "Instead of spending $300,000 of capital to buy replacements, we could use that money someplace else and buy something we normally couldn't afford," says Brendan Kremer, associate administrator at the medical center.

In 2009, the medical center extended its RTLS coverage to the Moores UCSD Cancer Center. Now, the technology coordinates asset management over 1.5 million square feet and three hospitals across 14 miles. Among the devices being tracked are surgical instrumentation trays identified with Awarepoint's T2S tag, which can withstand a harsh sterilization process. Many of these trays are shared among the three campuses; the ability to locate them in real time lowers the need for additional inventory and reduces surgical delays. UCSD officials say they have been able to reduce their replacement inventory budget by more than $100,000 in the first year alone, and believe they can eliminate $275,000 per year from OR downtime.

UCSD has since turned to studying the use of RFID to track patients, and to reduce bottlenecks and wait times in its OR and, more recently, in its infusion center. "It's a time-in-motion study to see what happens if we're trying to get a patient through in a certain amount of time, to see if we need to re-engineer our patient flow so we're not wasting our patients' time," Kremer says. The study is examining how long it takes the staff to ready a hospital bed, how long patients are in surgery, how long they take to recover—all the steps in the patient-care process.

"You can detect where patients are in each stage in the workflow and who and what they're interacting with," says Matt Perkins, Awarepoint's CTO. "It ultimately reduces costs, increases revenue, improves quality of care and reduces risks. Those are the four essential elements in the health-care value equation."

Location awareness also can be used to manage infectious disease outbreaks, Perkins adds. "Knowing where an infected person was, who he or she interacted with, can be instrumental in reducing the spread of contagious diseases," he says.

Oregon Health & Science University (OHSU), in Portland, Ore., the state's only health and research university, became an early adopter of RFID in 2005, having received capital funding to invest in a new medical-grade 802.11 wireless infrastructure and an asset-tracking RFID RTLS from AeroScout. Asset tracking started in the nursing tower and paid for itself within nine months. Soon, the university extended it throughout the medical campus, which includes a children's hospital, the university hospital, outpatient clinics and support buildings. In 2010, OHSU started fitting sensor-equipped RFID tags to 350 refrigerators and freezers on the campus and in outpatient clinics, to monitor temperatures for blood, medicines and other regulated materials.

"It's worked very well as far as getting alerts out quickly if there is a problem with the temperature and allowing us to document in the application what we had to do in order to correct the problem—say, if a door was left open or a thermostat was misadjusted," says Dennis Minsent, OSHU's director of clinical technology services. "It's certainly saving time and, being a compliance issue, it's much easier for us to maintain records electronically rather than having a notebook filled with pages and pages with reports and check marks and such on them."

Focusing First on Patients

While cutting costs by tracking assets is often the initial business case for RFID adoption, some health-care facilities deploy RFID primarily to improve patient safety and customer service. Since 2007, Germany's Jena University Hospital has been using RFID to track medication from the hospital pharmacy through the drug's administration to intensive-care patients. The system is designed to ensure patients get the correct doses of the right drugs, because international studies show that one in 20 patients suffers from adverse drug events, such as medication-administration errors, a majority of which could be avoided.

In May, Apollo Hospital Chennai, India's largest health-care facility, implemented an RTLS to reduce the time patients spend waiting and allow the hospital to care for more patients each day.

The hospital serves a community of some 3.5 million people and typically sees 250 patients a day, who undergo a series of up to 26 diagnostic procedures as part of their annual health care. Often, patients used to go to the wrong departments, resulting in delays and bottlenecks.

Now, when patients register at the hospital for services, they receive lanyards with Ekahau tags, each containing a unique ID number, linked to back-end software. Hospital managers can view a map showing where each patient is located in the hospital at any given time, which procedures are yet to be performed, and the number of people waiting in each area. If a patient gets lost or there's a backup in a particular department, the patient can be redirected. Since the system became operational, Apollo Hospital Chennai has been able to move patients through procedures more quickly.

To minimize the risk that physicians will operate on a patient's incorrect body site (a rare but dangerous occurrence, according to the United Kingdom's National Patient Safety Association), in 2007, Birmingham Heartlands Hospital, in the United Kingdom, began using RFID-enabled wristbands to track surgical patients and procedures. The hospital's Safe Patient System is designed to ensure "correct site surgery"—that is, to confirm before the start of an operation that doctors perform the correct procedure.

Putting It All Together

Once health-care facilities begin using RFID technology to track equipment and people, they can use the information gleaned to automate business processes. Patient records can be updated automatically with new orders for medicines or procedures. Medical equipment delivered to a hospital room can be billed automatically to the patient's insurance company. While these applications could help hospitals control costs, they have not been widely implemented, due to the difficulty of changing business processes and complying with laws protecting patient information.

Health-care providers are interested in RFID solutions that can help them monitor patients once they are discharged from the hospital. "If you can monitor patients in their own homes, and encourage compliance with post-care regimens, overall cost of care can be reduced, re-admission rates can decrease and improvements in the quality of recovery can be realized," Awarepoint's Perkins says.

In May, Nyack Hospital, in Nyack, N.Y., announced it was testing an automated solution called eMedonline, from Leap of Faith Technologies, which enables the hospital to know when discharged patients fail to comply with their prescription regimens, or when side effects occur. The hospital's goal is to ensure that fewer discharged cardiac patients return for treatment because they didn't take their medications as prescribed.

RFID applications, such as asset tracking and patient monitoring, are "the pieces and parts" that improve productivity and processes and help us reach that "ultimate goal," says Greenville Hospital's Mateka. "What we're all about is providing quality care to the communities we serve. Hospitals are huge, complicated, and labor- and technology-intensive facilities. The more we know of how, when and where, the better position we are in to provide the best—and least expensive—patient care possible."

Hospital Rooms Get 'Smarter'

Two new hospital "smart-room" systems are putting medical information at health-care workers' fingertips and empowering patients. In April, 85 patient rooms at Fisher-Titus Medical Center, in Norwalk, Ohio, and 25 rooms at Magruder Hospital, in Port Clinton, Ohio, were equipped with Cerner's Smart Room technology, which interacts with an ultrasound-based real-time location system (RTLS) and workflow software from Sonitor Technologies.

Before a doctor, nurse or clinician enters a patient's room, the system reads his or her ultrasound ID tag, then displays the staff member's name, photo and brief bio on a wall-mounted monitor opposite the bed. "Patients really like knowing who that employee is who just entered their room," says John Britton, VP of information services at Fisher-Titus and consulting CIO at Magruder. "It doesn't eliminate the human factor of introducing yourself, but it provides an added level of comfort for the patient."

Cerner's Smart Room technology gives medical professionals access to a patient's electronic medical records.

The ID tag, in conjunction with a thumbprint biometric reader at a bedside computer terminal, also gives medical professionals access to the patient's electronic medical records, displayed in dashboards on the monitor. Another component of the system is a keyboard that lets patients access entertainment media, read education materials related to their diagnoses, verify their medical records and check their treatment schedules.

A similar system is up and running at ShadySide and Montefiore hospitals, both part of the University of Pittsburgh Medical Center (UPMC), according to a joint announcement in July from UPMC and IBM, which developed the SmartRoom technology together. The system, also used in conjunction with a Sonitor ultrasound-based RTLS, includes software that organizes and prioritizes tasks for nurses or patient-care technicians. Using a touchscreen in the patient room, nurses or aides can document the completion of those tasks in seconds, instead of writing records on paper and transferring them into electronic form later at the computer lab.

And smart rooms are likely to get even smarter. AeroScout, for example, is working with health-care clients and major health-care software vendors, including Cerner, to use Wi-Fi either alone or combined with ultrasound applications, according to Joel Cook, AeroScout's health-care solutions marketing director.

One potential application could push a patient's lab results or other clinical information to a doctor's smart phone as the doctor enters the patient's room, using the physician's RFID badge to trigger the event. And Wi-Fi RFID tags equipped with temperature and humidity sensors could interact with smart-room technology to customize the environment, providing better patient comfort, Cook says.