Hospital Defines Its Problem, Then Deploys RFID Technology

By Michael Belfiore

University Hospital in San Antonio improved its workflow processes and used a real-time location system to automate them.

Gene Winfrey knew he had a big problem on his hands in the summer of 2013, when he found an IV pump behind the ceiling tiles of a supply room. IV pumps were in such short supply at University Health System's University Hospital in San Antonio, Texas—where Winfrey serves as the director of information services in the biomedical engineering department—that nurses were stashing them wherever they could to ensure that they'd have one available when a patient needed it.

University Hospital was constructing a new 10-story building, and Winfrey and Jim Magers, the hospital's health-care technology manager, decided it was a good time to install technology that could track smart pumps, including IV pumps, and improve availability. "We wanted to eliminate hoarding of equipment," Winfrey says, "and get nurses out of the pump-management business."

University Hospital deployed a passive RFID-based real-time locating system to track and manage all of its smart medical pumps.

In March 2014, when the 420-bed Sky Tower opened, the facility included a passive RFID-based real-time locating system (RTLS) from Mainspring Healthcare Solutions, which it uses to track and manage all of the smart medical pumps used at the hospital. As a result, pump utilization rates jumped from less than 45 percent in the old facility to more than 70 percent. Just as important, Winfrey says, University Hospital "won back the trust of nurses."

Improving Workflow Processes
To implement the project, Winfrey and Magers created a cross-functional team that included the chief nurse, the VP of the supply-chain department, the director of materials management, the hospital's CIO, CFO and COO, and a representative from the biomedical engineering department. A key issue the team knew it had to address upfront was how to change its workflow.

In 2009, Winfrey says, UHS had deployed an active RTLS to track pumps, but it wasn't solving the problem because the hospital didn't put procedures in place to use it. "We threw technology at it," he says, "but we didn't support it with any appropriate workflow." The hospital learned the hard way, he adds, that keeping track of devices is as much a procedural problem as a technological one. In addition, he says, the wireless network at the old facility—which was optimized for data and voice communications—wasn't up to the task of pinpointing active RFID tags. (Winfrey says he and his team are working with the original solution provider to use the active RTLS to track some equipment in the new tower.)

UHS had been working with a company, now known as Mainspring Healthcare Solutions, to create a new database for its biomedical engineering department. The system was designed to document repairs and maintenance performed on medical equipment at the hospital, and to create work orders for maintenance technicians.

In a crucial first step toward creating a new asset-tracking system, Winfrey and his team approached Mainspring for advice. "We asked them to evaluate us and give us some pointers and direction," Winfrey states.

Confidex Steelwave Micro ultrahigh-frequency passive RFID on-metal tags identify the pumps.

Mainspring conducted an operational workflow analysis. The resulting report quantified what Winfrey's team had been observing—namely, that fewer than 10 percent of all pumps were available at any given time. Moreover, it wasn't uncommon for IV pumps to be hidden above ceiling tiles or behind curtains, stuffed into cabinets, or locked in out-of-the-way storage rooms.

The team worked with Mainspring to improve workflow processes. "We don't lead with technology," says Todd Stewart, Mainspring's VP of enterprise workflow solutions. "Technology is only going to tell you, in faster and more levels of visibility, that you have broken workflow you need to fix."

Next, Mainspring and the biomedical engineering department ran informal tests at the hospital to choose the right tags, readers and antennas for the system. The team selected Confidex Steelwave Micro ultrahigh-frequency passive RFID on-metal tags to identify the pumps. Zebra Technologies FX7500 fixed RFID readers were installed in the soiled utility rooms, where the pumps were to be returned after use. Five-foot-long Wave antennas from NeWave Sensor Solutions and Advantenna-p33 tile antennas from Keonn Technologies were also installed in the utility rooms.

"We needed to make sure the tag read rates were as close to 100 percent as possible," Winfrey explains, "in order to drive the automated workflow model Mainspring designed for closed-loop distribution and management."

The field test validated the hardware choices, and readers and antennas were installed in the soiled utility rooms located on each inpatient care unit, as well as in the clean equipment supply areas in the emergency department and postoperative care unit. Readers were also installed in the hospital's central equipment distribution center and the biomedical engineering department, to track the progress of equipment from decontamination and repair back to storage. Some 7,000 pumps were initially tagged. In addition to IV pumps, the hospital tracks feeding pumps, drains, large volume pumps and patient-controlled analgesia pumps.

If a utility room is low on equipment, nurses can request that it be restocked by logging into the Intranet at the hospital and, from there, accessing Mainspring's Web portal, known as ServiceLink.

It took approximately three months to complete the operational workflow analysis, and to test and fully implement the solution.

Automating Workflow Processes
University Hospital deployed Mainspring's Hospital Operations Management (HOM) software platform, to track and manage tagged pumps and automate workflow processes. To use the system, nurses simply pick up freshly cleaned and maintained equipment from the supply room on each floor. The solution automatically checks out a device, and used equipment is returned to a soiled utility room, where it is automatically logged back in.

Maintenance workers monitor the comings and goings of devices with the help of Mainspring's iGotIt application, which runs on Apple iPod Touch handheld devices. The app alerts them when a critical mass of devices have arrived in a soiled utility room and need to be picked up for cleaning and possible repairs, or when a supply area is running low on equipment.

Maintenance personnel also receive service requests from nurses via the app. "It's a mobile task-based assignment app," Mainspring's Stewart explains. "Any time an equipment request for a delivery or a pickup is generated, whether it's from a nurse ordering it through our Web app or if it's coming in from the passive RFID monitoring, it automatically, intelligently gets routed to the next available materials management tech."

If a utility room is low on equipment, nurses can request that it be restocked by logging into the Intranet at the hospital (which hosts its own servers) and, from there, accessing Mainspring's Web portal, known as ServiceLink. Much of the time, however, a nurse can simply visit a supply room and count on a needed piece of equipment being there.

Instilling Trust
Thanks to the new system, equipment hoarding is no longer an issue, Winfrey says. Nurses previously had to wait for up to two hours before receiving a pump. Now, the wait time is down to just 8 to 12 minutes. The nurses, Magers says, are very happy with that improvement.

In addition, Winfrey reports, equipment technicians no longer waste time going on "fishing expeditions" by visiting soiled utility rooms to look for used devices to pick up for cleaning. Similarly, they don't need to continually visit clean equipment storage areas just to keep track of what's there. As a result, they can spend more time actually servicing equipment.

Winfrey attributes the new system's success to the first step of clearly defining the problem to be solved before investing in technology. "People have a tendency to try to solve the problem before the problem is defined," he says. "Going this route really helped."

Mainspring's Stewart says no technology, no matter how good, would have worked without the trust of the people who were to use it. The solution was designed for ease of use and required minimal training. The status of equipment is updated automatically as nurses move it in and out of the supply rooms.

Head nurse Nancy Ray made it clear to Stewart that unless he could prove the new system would work as advertised, she wouldn't be able to get her staff behind it. As it turned out, she needn't have worried. "I remember her coming back," he recalls, "saying, 'I can't believe you guys actually pulled it off!'"

UHS is saving money as well as time. One solution that had been considered was to outsource materials management to a third party, at an estimated cost of $450,000 just to get started. The Mainspring solution cost less than $100,000. In addition, increased utilization of the pumps saves equipment costs—UHS estimates that it needs to purchase 100 fewer units.

Since the initial deployment, the hospital has begun RFID-tracking video monitors and heart monitors as well. Now, the RFID team is developing plans to expand the RTLS solution by adding RFID readers to hospital entrances and exits, so patients on IVs can go outside in favorable weather, while still enabling the maintenance department to keep an eye on their equipment.

Meanwhile, Winfrey says, the nurses are happier, patient care has improved and the hospital is operating more efficiently.