Aeroscout Hca

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In K. Mun, Ph.D.VP, Research & Technology, EG, HCA

Adjunct Associate Professor, Neurological Surgery, UMDNJT: 305-582-722, E: [email protected]

AutoID at Hospital“Information Rich Environment For Hospital”

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March 22, 2007 AutoID at Hospital 2

IOM Report in 1999To Err is Human: Building A Safer Health System

One million patients in hospitals daily770,000 injuries caused by medication errors per year

39% physician ordering

38% drug administration

11% drug dispensing

44,000 – 98,000 preventable deaths per year

5% of patients acquire an infection from a hospital

Barcoding “is an effective remedy” for medication errors, “a simple way to ensure that … all of the steps in the dispensing and administration processes are

checked for timeliness and accuracy.”


Medication Errors:

events occurring in a hospital when there is not enough information to identify each item uniquely.

How can we create information rich local environment to prevent errors?

What does it mean?


Traditional ID Issue


Barcode Linear Barcode

• Well known technology in many industries • Lower cost, easy to copy / print• Manual process • few digits of identification number / characters

2D barcode• Reasonably known technology • Expensive reader,• Store more data than linear barcode

RFIDPassive RFID

• Smartcard in Europe using 13.56 Mhz tag• High cost, good security, limited range• Transaction based automation

Active RFID• Military products using 433Mhz• Expensive, good security, longer range• Proactive automation possible

Identification Technology in 1999


Barcode ProjectLow tag cost• Disposable items

Manageable for high volume Good ROI

RFID ProjectHigh tag cost• Reusable/durable items

Better for low volume projects Uncertain ROI

AutoID Projects


1983 – The Health Industry Business Communication Council (HIBCC)1985 – First published account of medication bar-coding1985 – Medication dispensing

1985 – Hokanson JA, et al, Am J Hosp Pharm1985 – Nold EG & Williams TC, Am J Hosp Pharm1987 – Smith JE & Meyer GE, Am J Health Syst Pharm.

1989 – Medication administration1989 – Barry GA et al, Am J Hosp Pharm1991 – Lefkowitz S et al, Hosp Pharm1992 – Abdoo YM, Comput Nurs

1999 – IOM report: discussed barcode to improve patient safety1999 – 1.1% of hospitals (60) using barcode2001 – FDA announces intent to propose a bar code rule2002 – 1.5% of hospitals (90) using barcode2004 – JCAHO make a proposal and drops mandate2005 – 9.4% of hospitals (560) using barcode

Barcode For Healthcare

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HCA Barcode Point Of Care


BPOC Experience by 2005

HCA 171 115,933,163 65,000

Mercy 010 7,359,897 10,698

UPMC 002 2,103,789 01,800

BSA 001 1,692,561 00,757

# sites # doses # users


• BPOC does reduce medication errors

• Better documentation possible

• An important building block of EMR/EHR

⇒ Issues noticedManual processes

Everybody must be engaged

Barcode labels can be duplicated easily

Work around is possible

Lessons From BPOC


Reviewing available technologies starting 2000Passive RFIDActive RFID

Defined problems to solve in 2002Asset management for rental / leased items & theftProcess improvement tool

Selected active RFID technology in 2003Automation / ReliabilityReturn-on-investment (ROI) based on existing cost figures

Selected a vendor out of nine vendors in 2004Battery life / Size of tagOperational experience / future applications

Implemented a pilot system in 2005A 120 bed hospitalHospital-wide implementation

RFID Project


Tag-it Smart LabelsTag in mold

RFID Patient Wrist Band and Handheld Readers

UHF tagInfusion Pump w. active tag

RFID Tags and Readers

implantable tag


RFID Tags and Readers

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• Patient Wristband

• Blood Product Management

• Cold Chain Management

• ER, OR, ICU Management

• Point of Care

• Pharmaceutical Pedigree

• Combating Counterfeit Drugs

• Asset Management

Hospital RFID Applications


1. Asset Management

2. ER, OR, ICU Management

3. Patient Wristband

4. Blood Product Management

5. Point of Care

6. Cold Chain Management

7. Pharmaceutical Pedigree

8. Combating Counterfeit Drugs

Hospital RFID Applications


Managing infants

Managing medical device, consumables Theft prevention, location, storage, readiness

Bio-Medical service, repair, PM

Rental equipment management

Managing Patients

Managing nurses, technologists and physicians

Asset Management


National average utilization of mobile equipment is 45% -Universal Hospital Services

Hospitals can lose nearly $1 million a year in medical equipment thefts alone - HCPro Healthcare Marketplace

Five to fifteen percent of hospital inventory is written off each year since it can no longer be located or more importantly serviced - Frost & Sullivan

“Equipment moving from patient to patient without going through decontamination in between has become a significant issue to JCAHO in regard to infection control in hospitals” - JCAHO Sentinel Alert

To build an infrastructure for future patient safety improvements

Why Asset Management?


• AeroScout 1610

• Agility Healthcare 3450

• AwarePoint 1714

• Communication Specialists 7938

• Cygnus Inc 4452

• Ekahau 1504

• Extreme Integration 5204

• General Data Company 5704

• Healthcare Pilot 7838

• Indidge System 7200

• Infosys technologies 7703

• MediTek Interactive 7926

• PanGo 4050

RFID Vendors at 2006 HIMSS• Parco 7229

• Patientree 7224

• Per-Se Technologies 3623

• Precision Dynamics 0142

• Radiense 5700

• RF Ideas 1851

• Sayers Healthcare 7015

• Scuptor Dev Tech 1252

• Sun Microsystem 3649

• USA Mobility 7850

• Visible Assets 7037

• GE Healthcare 4509

• Siemens Healthcare 1237


Existing workflow / definition of problem

Tag type

Tag size

Battery life

Resolution

Dependencies: density of tags, network,

Installation

User interface

Project management experiences

ROI (Return On Investment)

Selection Criteria

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I

I

I

Wireless 802.11 Coverage

802.11 Network DesignFor data

100 ft diameter

I

I

I

Pow

er

100+ ft~ 40-50 ft.30 ft.

Range

802.11 Network DesignFor resolution50 ft diameter

* There are several issues to be considered carefully before using wireless 802.11 for asset management.


Tag density at Bio-Med

* Easily more than 100 tagged items could be in a bio-med service room!


Other Busier Bio-Med Shop


Step A

Primary patient care areas covered

Storage locations identified

Low resolution, only discriminate between zones A & B

A

B


Step B

Add coverage for exits for theft control


Step C

Add additional readers to identify patient rooms and waiting areas

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Step D

Add additional readers for full coverage.


Device management: tracking, service, rental

433 Mhz active tag

Smallest tag to maximize number of items to track

Real-time tracking (few times per minute)

Variable resolution: bed, room, department,..

Manage high density of tags in a room

Minimum additional network traffic

Clean installation: invisible readers

Web applications: support PDA, laptop, …

Less than three years for ROI

To develop additional applications

Pilot Configuration


Installation & staff training done

Few hiccups & push backs

Interfaced to bio-medical service database

Interesting informationSome items not moving

Relationship among unexpected items (rental / discharge

Device service record

Designing new workflows to improve operationsTo increase ER throughput

Surgical tool tracking in OR

To improve workflow in ICU

New interface to physician PDA

Less than three years for ROI based on hard benefits

Current Status


Tagged Items


Clinical Touch-screen GUI


Engineer’s Handheld GUI

Select group

View Assets by Floor Sliding Zoom Bar

Zoom OutZoom In

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Infusion Pump Utilization

0

50

100

150

200

250

4/1/200

6

4/8/200

6

4/15/2

006

4/22/2

006

4/29/2

006

5/6/200

6

5/13/2

006

5/20/2

006

5/27/2

006

Census Pumps on Floors Total Pumps

April1 through May 30, 2006Single and Multi-Channel Infusion PumpsExcludes rentals


Common name used by nurses: Arjo LiftCommon name used by industry: Lift/PatientThe device name: Patient Lift

Manufacture Model # DescriptionArjo Hospital equipment Inc. KPA0310 Patient LiftArjo Hospital equipment Inc. KGA0310 LiftArjo Hospital equipment Inc. KKA5020 Arjo LiftArjo Hospital equipment Inc. KGA5020 Lift/PatientArjo Hospital equipment Inc. KPA0310 Lift/PatientArjo Hospital equipment Inc. KPA0310 Patient LiftArjo Hospital equipment Inc. KPA0310 Patient LiftArjo Hospital equipment Inc. KKA5020 Lift/PatientArjo Hospital equipment Inc. KPA0310 Lift/PatientArjo Hospital equipment Inc. KGA0310 Arjo Lift

Issues: Database Entries


Addressing DB IssuesHow much information do we need?

Information rich local environment is the key in reducing most medical errors.

Manually correct errors in DB

To prevent recurring errors

Local DB?


Minimum change in workflow Reasonable cost for infrastructureLess physics issuesSolution for item level issuesData rich local environment

More info available to reduce additional errors Katrina factor

2D Barcode for Local DB


RFID & 2D Barcode


2D Barcode

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Cost effective unifying standard leading to EMR• Staff badges• Patient wristband / patient identification• Non-IV medication• IV-medication / smart infusion pumps• Medical device identification • Blood products

Documents of interests• Positive identification for patient medication safety from

Partners Healthcare Systems• Working documents from ISBT-RFID Task Force.• Documents for HIBCC standards

Information Content


Cost Structure IssuesStart-up cost

Recurring cost

Liability cost

Monopoly cost


Cost: MonopolyPatents

Start of new idea / businessIntellectual property

Law, rules & regulationsProtecting citizens by governmentSource of liability

StandardsIndustry / government sponsored guide linesHelpful for a wider adoption leading to lower cost


Foot NotesMinimize monopoly

Break financial links / associationsStop cross subsidiesMore rational patent law

Maximize competition & innovationRemove 800 lbs snakesNot empowering rats or termites


Location IdentificationSecurityInventory ManagementUtilizationRequisition / DistributionRentalsSafety / Risk ManagementTransportEquipment CleaningRegulatory ComplianceClinical EngineeringFinancing / Accounting

Operational Process

Management

RFID Positioning

System

RFID-Enabled Device

Management Application

AssetTracking

Operational Processes


$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

$4,000,000

Year 1 Year 2 Year 3 Year 4(projected)

Realized Net Savings to Date: Over $1.5 MillionExcludes “cost avoidance” and “soft” savings

Savings By An Early Adopter

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Active RFID can be cost effective. Rental equipment managementInventory control of equipment: lower the asset levelBetter management of PM & service issues

Cost / workflow managementUtilization based on proactive data using active RFID Must be willing to change workflow

Additional developmentsED & patient trackingBlood products / BiologicalsGlobal view of hospital operationHow do you manage database?What do I do with surgical tools?Backup information?What happens without connectivity??

• Natural disaster like Katrina, earthquake • Remote areas • loss of power

Lessons from Active RFID


Work-In-Progress


Room Level For ED


Patient Level


Real-time Patient Location


MessageCenter

Messenger

Inbox (3)

In Use

Available

Soiled

Out of Service

Infusion Pump Utilization

OR Suite Utilization

In Use

Prep

Scheduled

Cleaning

Not Sched

Online: 21

Patient-Tag Association

Home Equipment Manager Surgical Services ED Manager Bed & Room Manager Other Applications

GUI for Upper Management

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COMPLETED CASES

Time of Day0

5

10

15

20

25

30

35

40

7 8 9 10 11 12 13 14 15 16 17 18

Cumulative CasesCases/Hr

0102030405060708090

100

7 8 9 10 1 1 12 13 1 4 15 1 6 1 7 1 8

Time of Day

% AVERAGE BLOCK TIME UTILIZATION

0102030405060708090

100

7 8 9 10 1 1 12 13 1 4 15 1 6 1 7 1 8

Time of Day

% AVERAGE BLOCK TIME UTILIZATION

Surgical Services Metrics

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

Time to Triage

Time to Registration

Time in Waiting

Time to Exam

NurseResponse

DoctorResponse

Time inED

TotalTime

Actual TargetAVERAGE INTERVALS FOR TODAY (minutes)

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

Time to Triage

Time to Registration

Time in Waiting

Time to Exam

NurseResponse

DoctorResponse

Time inED

TotalTime

ActualActual TargetTargetAVERAGE INTERVALS FOR TODAY (minutes)

0

1

2

3

4

5

6

7

<15 20 25 30 35 40 45 50 55 60 60+

CURRENT PATIENTS IN WAITING ROOM

Minutes Waiting

# of

Pat

ient

s

0

1

2

3

4

5

6

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<15 20 25 30 35 40 45 50 55 60 60+

CURRENT PATIENTS IN WAITING ROOM

Minutes Waiting

# of

Pat

ient

s

Emergency Department Metrics


CommentsAutoID (RFID & Barcode) is being applied in more and more areas to improve patient safety and reduce cost.

New business model for standard has emerged, which may create a world-wide monopoly outside of any government control even beyond US FDA

Cost of AutoID is dropping where competitive pressure exists. (RFID: 12 - 50 cents passive tags, $15 - $200 for active tags) (barcode: less than 0.2 cent / 0.5 cent for 1D / 2D )

Active RFID and 2D Barcode without passive RFID may complement each other well enough to create information rich local environment, which is critically important in improving patient care and reduce healthcare cost for hospitals.


Thank You!In K. Mun, Ph.D.

e: [email protected] / m: 305-582-7221

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