Earlier this year, the cardiovascular (CV) laboratory at Saint Luke’s Hospital of Kansas City deployed passive EPC RFID tags and readers that have enabled the hospital to better manage its stock of pacemakers, coronary stents and defibrillators. Through improved tracking and control over these items, the facility has managed to reduce the size of its coronary device inventory by half a million dollars, while also more accurately associating each piece of equipment with the particular patient on whom it is used, thereby reducing costs associated with patient billing. The RFID system has also helped St. Luke’s to save hundreds of thousands of dollars annually, by enabling the CV to buy more items in bulk, thereby earning bigger discounts.
Previously, the lab depended on nurses, doctors and other medical staff members to help the material-management department accurately track the use of each device, by manually scanning the bar code attached to its packaging, and then scanning the bar code printed on the wristband of the patient for whom that item is used. This still occurs, but RFID readers now capture the ultrahigh-frequency (UHF) Gen 2 inlay embedded in the bar code label as the device moves from inventory stock to the operating room and, ultimately, when the packaging is disposed of. In this way, says David Strelow, the hospital’s director of CV lab services, St. Luke’s has deployed a product-tracking system not unlike that deployed by Wal-mart Stores.
In June 2006, the hospital issued a request for a proposal (RFP) for an RFID system that would enable Strelow and his staff to more accurately manage the inventory of roughly 1,500 different high-value devices located in the CV lab. The request was for passive RFID tags that would allow such items to be tracked with minimal changes to the lab’s existing workflow.
“We looked at HF [high-frequency] tags, but we preferred the usability of UHF,” Strelow states. “We didn’t want staff to have to hold tagged items directly up to reader antennas,” he explains; therefore, the hospital required a tag with a longer read range.
Cenbion Medical, which provided the inventory-management software that the lab was already utilizing to track its inventory solely through bar-code technology, responded to the RFP with a solution based on EPC Gen 2 RFID tags from Alien Technology—the Squiggle inlay, with a Higgs 3 chip embedded in a thermal transfer label—and FX7400 fixed readers with AN480 antennas, both manufactured by Motorola Solutions.
The lab selected Cenbion’s proposal in late 2006, and moved forward with a pilot of the system that the company designed, which commenced in early 2007. Cenbion spent years, however, seeking an RFID hardware partner that could help it design a reader and antenna architecture that could provide reliable performance. After partnering with Motorola, Strelow says, Cenbion and Saint Luke’s found a system that works, and so the hospital opted to deploy the current solution in early 2011.
When St. Luke’s receives an order containing high-value devices, a lab employee uses a bar-code scanner to collect the International Article Number (EAN) code printed on the packaging. The Cenbion software then instructs a Zebra Technologies R110Xi RFID printer to produce a label containing the Alien tag. The software, says Randal York, Cenbion’s president, generates a unique identification number that is both printed as a bar code on the label, and also encoded to the tag’s memory, thereby overwriting the factory-issued tag number. This unique number contains lot and expiry data, and is associated, in the Cenbion software, with the full EAN printed on the package.
Each labeled device is then placed into inventory. When a particular is needed for a patient, it is moved out of the stockroom to one of the six operating rooms in the CV department. All of these ORs, as well as all three stockrooms, are outfitted with RFID reader antennas, mounted around each room’s doorway. As a tagged device moves into or out of one of these rooms, the interrogator for that doorway collects the RFID tag data and transmits it to Microsoft BizTalk software, running on a central server. The BizTalk software manages the readers, and performs such basic data functions as filtering out duplicate reads. BizTalk forwards the tag data to the Cenbion software, which saves each tag read to its database. The tag-read event includes the tag number, along with the time of the event and the location of the interrogator that collected it.
When a device is used, a member of the medical team is supposed to scan the bar code printed on the label, as well as scan the bar-coded ID printed on the patient’s wristband, in order to associate the two and ensure that billing is accurate. But sometimes, this step is missed.
“There might be 20 different products used in a procedure,” Strelow explains. Nurses are extremely busy during an operation, he notes, and it’s thus understandable that they might miss a scan or two. If that happened before the RFID system was deployed, the device would end up missing from inventory, and would never show up again in a patient’s billing records. In such a scenario, Strelow says, he had no easy way of knowing what happened to that asset.
Now, using the RFID tag data, Strelow can see that the device moved from the CV lab to, for example, an operating room. The item’s tag is read one final time by a reader antenna mounted at the opening to the wastebasket into which the packaging is disposed once the device is used. Armed with this information—which indicates the time and location of each tag read—the lab can easily associate the devices with the patient and surgery scheduled for the specific OR in which the tag was read, even no bar-code scans were captured during the procedure.
Because of the RFID-tracked system’s accountability, Strelow is now able to post operating expenses based on each device’s actual usage, rather than posting the full expense of an order, as was previously done. “With the assurance that charges will be fully captured, we can get purchasing authorization for larger orders,” he explains. Thus, he is able to order these high-value devices in bulk, earning him discounts. “We recently checked in a $900,000 order of pacemakers and defibrillators. By buying in bulk, we saved 12 percent, or $127,000, on that order alone.”
What’s more, Strelow says, the ability to more accurately associate each device with a patient’s bill—known as charge capture—has major economic implications for the hospital. Improving charge capture by just 0.1 percent annually represents $54,000 in billing that would have otherwise been lost to St. Luke’s.
Eventually, the CV lab might begin employing the RFID tags to conduct inventory counts, which are currently performed annually using bar-code scanners. But until Strelow is able to prove to his accounting department that he can achieve a 99.5 percent read rate for the RFID tags when conducting inventories in the stockroom—a rate that he believes is likely when using a handheld reader—he plans to stick to the current manual inventory practice, using bar-code scanners.