RFID Delivers Healthy Return for Hospital

By Jonathan Collins

Jacobi Medical Center's RFID-enabled patient ID system not only enhances patient care and staff working conditions, but will also save $1 million a year when fully deployed.

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When the Jacobi Medical Center in New York City considered using RFID to improve patient care and increase efficiency in its operations, RFID became another in a long line of technologies introduced to help streamline its operations. "The hospital has a very pro-technology bent and has had so for about 15 years," says Daniel Morreale, chief technology officer for the North Bronx Healthcare Network, which owns and operates the Jacobi Medical Center.

Jacobi, which serves more than 1 million New York City-area residents, already operates a completely computerized physician order-entry system so that any request from a doctor—ranging from patient admission to meals to surgery or medication—is created and managed entirely electronically. In addition, around 95 percent of the hospitals health records are managed electronically.

However, Morreale was looking for a way to extend the reach of its IT operations into areas where manual processes were still being used and could be made more efficient. RFID promised to provide a solution, by changing how doctors and nurses interacted with patients at their bedside.

Working with systems integrator Siemens Business Services, Jacobi deployed a pilot system that put RFID-enabled plastic wristbands on patients admitted into the two wards at the hospital's acute-care department. The pilot, which began in July last year, was set to run for just two months.

"I thought, 'If I can just wave the PC over the patient's wrist and bring up the problem list, medications, allergies and other critical information, it will simplify patient identification and save clinical-staff keystrokes,'" Morreale says.

During that initial trial, doctors and nursing staff used RFID readers installed in portable PCs to automatically identify each patient. The devices read the unique ID number encoded on an RFID tag embedded in the patient's wristband and opened the patient's medical file on the PC screen, enabling the patient's records to be reviewed and updated at bedside.

Two months later, when the trial was supposed to end, Morreale maintains that the reaction from the staff alone proved the value of deploying the technology further. "Staff refused to give back the equipment, and other departments had started to say they wanted it too," says Morreale. "The system has completely proven its worth."

According to Morreale the system has increased productivity, improved patient care and promises to create savings for the hospital as well. "The trial system saved one hour per nurse per shift. That's a $1 million saving per year if rolled out across the hospital, but more importantly that creates two to three hours in every nursing shift for additional patient contact. Patients get more time with doctors and nurses, get better faster and are more satisfied," Morreale says.

Not only was the trial system left up and running, it also has been expanded to include the hospital's medical surgery unit. In addition, when the hospital moves all its wards into its planned new campus building, Morreale intends to use RFID wristbands throughout.

Designed, deployed and managed by Siemens Business Services, the pilot RFID system replaces a heavily manual system that issues patients a wristband printed with the patient's name, date of admission and unique medical record number (MRN), written both in human-readable numbers and in bar code format. To check a patient's electronic records using the old system, a doctor, nurse or other hospital caregiver needed to enter the wristband's MRN into the hospital's computer system by means of PCs located at the nurses' station within each ward.

The old system also required staff to manually enter the MRN by reading the human-readable information or, when administering drugs from a medical trolley, use a handheld bar code reader to scan the MSN number printed in bar code format. However, using the bar code system proved an invasive way for staff to check a patient's identity, which must be verified before any medication or treatment can be administered. Reading a wristband's text or scan its bar code requires a line of sight between the wristband and the staff member. Because patients are likely to have their arms under bed sheets and blankets, identifying a patient could be a disruptive procedure under the old system (RFID chips, on the other hand, can be scanned through bedcovers).

"In a typical room, there are six patients, and on the midnight to 8 a.m. shift, no one wants to turn on the room lights to read a wristband or wake the patient to get access to the patients wristband bar code," says Jerry Moy, senior client executive at Siemens Business Services's U.S. arm, which is based in the Norwalk, Ct.

In the two acute-care wards where the trial took place, patients usually stay less than five days, but during their time in the wards, patients will see multiple doctors and nurses across multiple shifts, so patient identities have to be checked often, according to Moy.

"We observed the existing process and then set about developing a system that used RFID to enable more positive interaction between care staff and patients," Moy says.

In addition to improving the way patients are identified, the trial sought to replace highly manual procedures for updating a patient's medical records. In that older system, notes on patients are written on paper and kept in three-ring binders wheeled around the wards in a library cart. When the staff needs to update information—such as a patient's medication or progress—the staff handwrites the information in the binder and later enters it into the patient's electronic records using a computer at the ward's nursing station. Replacing that system with the RFID tags and tablet PCs did away with having to enter the information twice—improving efficiency as well as improve working conditions for Jacobi's staff. "When you go to work in a hospital ward, you don't want to spend your time as a data-entry clerk," says Moy.

For the trial, Siemens Business Services deployed two Zebra R402 RFID printer-encoders at the admissions office, so that as patients were checked into the hospital and assigned to the trial ward, they were issued an RFID-enabled patient wristband was encoded with patient's MRN and the patient's name, date of birth, and gender in human-readable text, with the patient's MRN in bar code format and human-readable information. The bar code was included so that hospital staff could read the MRN using already existing Jacobi Medical Center lab, billing, and pharmacy information systems.

Over the course of the trial, the hospital issued the RFID wristbands to approximately 200 patients. The wristbands, which contain a passive 13.56 MHz RFID tag, were made by San Fernando, Calif., Precision Dynamics Corp. (PDC). The hospital didn't deploy any fixed readers but instead equipped five tablet PCs with RF PC Handheld Readers from ACG Identification Technologies, an RFID equipment supplier based in Walluf, Germany. The readers were fitted into the PCMCIA slots of the tablet PCs.

Siemens Business Services also developed the software to encode the patient's medical record number on the RFID wristband's RFID tag and also developed the user interface on the tablet PCs for reading the tag.

The trial system allowed a doctor or nurse to take one of the five tablet PCs deployed for the trial from their docking stations mounted on a medical cart before staring his or her rounds. The PC's RFID reader delivered a read range of 4 to 5 inches, which enabled staff to be certain of which patient's tags was being read. Once the device read the RFID tag in a patient's wristband, an application—written by Siemens Business Services and integrated with the hospitals existing electronic patients records system—immediately displayed the patient's medical file on the PC's screen.

"What we developed was an automatic script so that whenever a patient was scanned the PC would access the clinical information system bringing up the patients records without a key stroke," says Morreale.

The PCs access the hospitals other electronic applications over a wireless network installed for the trial. Any new information to go into the patients file can be entered directly into the patient's electronic record, doing away with any need to make handwritten notes that required later entry into the hospital's electronic record system. In addition to eliminating the bulk of its paper forms, the RFID-based system also ensures that the information used by its medical staff is always up to date.

According to Morreale, the investment in the trial and the cost of expanding the system across the hospitals other wards is more than outweighed by the improved service enabled by the RFID-based system.

"The wristbands will cost an average of $65,000 a year to cover the 47,000 admissions we have a year, and we don't need additional printer-encoders, as the admitting department already has two machines to provide some redundancy," says Morreale.

Expanding the system across other hospital operations next year will also mean spending an additional $325,000 to acquire and deploy another 165 tablet PCs equipped with RFID readers and to train staff to use them. That expense, combined with tag costs, is still well below the predicted $1 million in annual savings that the hospital projects it can make from deploying the RFID system across its patient operations. However, the real benefits stem from providing improved services, says Morreale. "This system means significant savings in dollars and in patient time, but underpinning that, patients get more time with doctors and nurses, and they are more satisfied," he says.