A vision of the future

Will Mobile Indoor Location Become a Commodity? Will RFID Technologies Start to Integrate with Mobile Location?

Will RTLS Tags Become Integrated into Devices?

Scott PhillipsPrincipal, RFID Portfolio ManagerKaiser Permanente

HIMSS 2014IEEE and RHCC/Intelligent Hospital

February 23, 2014

Scott Phillips has no real or apparent conflicts of interest to report

Conflict of Interest Disclosure

Learning Objectives

Assuming ubiquitous adoption in Healthcare for RTLS, Passive RFID and mobile indoor location, understand the

future financial requirements.

Increase understanding of the feasibility and benefits of an enterprise location infrastructure designed for many

use cases.

Increase understanding of the feasibility and benefits of embedded tags and the importance of infrastructure

standardization.

Kaiser Permanente

• 7 regions serving 8 states and the District of Columbia• 9.1 million members• 17,000 physicians; 175,000 employees (including 48,000+ nurses)• 38 hospitals (co-located with medical offices)• 600+ medical offices• $53 billion annual revenue• $1.8 billion invested in our community• 68 years of providing care

Decision: Work with suppliers to embed RTLS tags into medical equipment.

Types of RFID Examples Visual

Passive

Supplies Specimens Pharmacy

Active /Real-time Location Systems (RTLS)

Assets Patients

Mobile Indoor Location SmartPhones Tablets

GPS Specimen Temperature In-Transit Tracking

What is RFID?Radio Frequency IDentification is technology that uses communication through the use of radio waves to transfer data between a reader and an electronic tag attached to an object.

Active RFID Tag Adoption

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Production

Implementing

Total Asset Tags ~147,000

Temperature Sensors: ~6,000

Wireless Location Coverage: ~32,000,000 Sq Ft

Current RFID Use Cases at Kaiser Permanente

Active RFID Geographical Activity

37 of 38 Hospitals & 337 of 600+ MOBs

1. Active RFID (RTLS)

• Asset Tracking

• Equipment Maintenance

• Rentals

• Temperature Monitoring

• Infant Safety

• Patient Activity (Pre-Pilot)

2. Passive RFID

• Retained Foreign Objects

• Medication (Pilot)

• Lab Specimens (Pre-Pilot)

3. Mobile Location

• Wayfinding (Pre-Pilot)

Future Examples - More Infrastructure x3

Members can find the facility using GPS, and then once indoors navigate using indoor location

to their doctor’s appointment.

Mobile Indoor Wayfinding

Asset Tracking – Enhanced Location AccuracyNursing and Clinical Technology can quickly find needed equipment by knowing the exact room the equipment is in. Accuracy enables

advanced equipment/patient workflows as well (e.g. par levels).

Nurses can track the location of on demand medications in transit; plus know when and where they are delivered to.

Medication Tracking

Today Exploratory

Use Case Today’s Infrastructure Requirement

Tomorrow’s Infrastructure Requirement

Sensors Type(s)

Asset Tracking 2-3 meters Room, bay, alcove, more exact coordinates and interactions RTLS

Infant Safety Unit exit points Unit exits and beyond RTLS

Retained Foreign Objects (RFO) Proximity/Wand OR bed level, OR room level, supply room, supply chain Passive

Medication Tray counts Pharmacy, medication rooms, patient rooms, en route Passive

Mobile Indoor Wayfinding N/A Enterprise with points of interest and area triggers

Mobile(Consumer Wi-Fi, BLE?)

Patient Activity N/A Highly accurate distance for very short walks (e.g. <20’ ) All

Summary – More Infrastructure x3

Could the Future be Room Level or Better for 3 separate location networks? If not, what rooms would be excluded?

Room Level or Better RFID Infrastructure x3

Room with multiple sensors and RFID tags

Future hospital floor with room level coverage x3

Location Network Active RFID / RTLS Passive RFID Mobile Location

Coarse Location Yes No Yes

Room Level Location (All) Yes Yes Yes

Unit and Building Perimeter (All) Yes Yes Yes

Temperature Monitoring (All) Yes Yes No

Financial Approximations

Average Hospital Per Year

• Room Level or Better Hardware

• Installation and Support Costs

• Full Network Infrastructure

• Ubiquitous Tags (except Mobile)

• RFID Technology Refresh

~$500K ~$340K ~$150K

Average Medical Office Per Year

• (same as above)~$23K $23K ~$20K

Option 1: Large Provider Potential Annual Investment for 3 Location Networks (e.g. 38 hospitals, 600 MOBs)

~$75M+

Option 2: Same Large Provider Annual Investment with Network consolidation and embedded RTLS Tags.

~$37M

Note: These are not actuals. This is merely an illustration with rough approximations which includes several assumptions around widespread use case adoption, coverage requirements, location accuracy and future support costs for all three infrastructures.

Room Level Location Networks x3 - Estimated

Sensor Consolidation Feasibility and BenefitsTraditional Implementations

1. Consumables Passive RFID2. Assets RTLS proprietary networks3. Mobile Absent of Indoor Location

Future Opportunities1. Passive Remains + assist RTLS?2. RTLS – Standardized?3. Will Mobile Dominate? ->

Consumer Wi-Fi + BLE?

Bluetooth Low Energy (BLE) looks promising for mobile and retail applications. iPhones are sensors too. Could it be used for more?

Feasibility• Which technology(ies)?

Benefits• One Infrastructure = Cost

savings.• Industry growth through greater

use and adoption.• Increases attractiveness for

suppliers to “design in”.

Embedded Location Feasibility and Benefits

Progress - Examples• Kaiser Permanente is deploying select

gauze with passive RF tags built in by the suppliers.

• 6+ Years Ago, Kaiser Permanente Clinical Technology Identified this as a future requirement for RTLS tags.

• Today Kaiser Permanente is starting to address this issue with its strategic medical device manufacturers.

• Intel announced an initial step• Mobile indoor location applications are

emerging – using mobile embedded location already.

Feasibility• Lacking a comprehensive

RTLS standard for sensors and tags.

Note: It is expected active tags will always be required for medical equipment that doesn’t have a battery (e.g. standard wheelchairs)

Benefits• Reduces initial and ongoing

costs for “tags”.• Doesn’t fall off.• Small/Zero form factor.

Future Recommendations

Be Prepared and Contribute:

• Encourage the advancement of standards for embedded RTLS, making it possible for standards to emerge more quickly enabling industry-wide embedded RTLS.

• Where possible, encourage blending RTLS with passive and mobile, which can increase the value of the infrastructure/sensors through reuse.

• Learn from mobile; plan for mobile users and encourage greater use of additional onboard sensors for enhanced location accuracy (e.g. accelerometers, pedometers).

• Help encourage integrated GPS location with indoor mobile location for use cases such as seamless door to door wayfinding (e.g. home to parking lot to doctor’s appointment).

Driving Value in the Present

• In the meantime, we will continue to use the technology to create the most value:

– Make it easier for clinicians to do their jobs– Service more patients– Reduce the cost of equipment and supplies– Optimize asset utilization– Drive positive patient and family experiences

• Things to Consider– What is the return on investment, given the facility’s current state?– What technology best addresses the know use cases and the future use

cases?• Passive• Active• Mobile

Summary / Lessons Learned

If ubiquitous location infrastructures are adopted (x3), the financial benefits from consolidation are operationally significant.

A technology approach that results in a single RFID / Location infrastructure for all use cases which maximizes sensor reuse is likely to lead to the lowest long term cost.

Location is embedded in mobile devices already for GPS, and is an emerging reality for indoor location. RTLS could accomplish the same providing standards are available.

Single Network + Embedded Tags = Increased Value and Faster Industry Adoption.