AutoID For EMR - rfidjournal.net · AutoID For EMR “Improving Patient Safety with Active RFID and...
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Transcript of AutoID For EMR - rfidjournal.net · AutoID For EMR “Improving Patient Safety with Active RFID and...
AutoID For EMR
“Improving Patient Safety with Active RFID and 2D Barcode”
In K. Mun, Ph.D.VP, Research & Technology, NFD/EG, HCA
Adjunct Associate Professor, Neurological Surgery, UMDNJE: [email protected]
↓↓ ReimbursementsReimbursements(BBA, APC(BBA, APC’’s)s)
Medical Cost Medical Cost Inflation (Inflation (PharmaPharma))
Management View
Technology cost Technology cost (MRI, CT, US..)(MRI, CT, US..)
ConsumerismConsumerism
HospitalHospitalFinancialsFinancials
TechnologyTechnologyRevolutionRevolution
(IT, PACS, Genomics)(IT, PACS, Genomics)New Procedures / New Procedures / ReimbursementsReimbursements
(PET(PET--CT)CT)
Growth InGrowth InOutpatientOutpatientEconomy / Economy /
Personal WealthPersonal Wealth
New Regulatory New Regulatory PressuresPressures
(HIPAA, Dose)(HIPAA, Dose)
StaffingStaffingShortagesShortages
DisasterDisasterPreparationPreparation
Quality ImperativeQuality Imperative(IOM, Leapfrog)(IOM, Leapfrog)
DemographicsDemographics
Technical View
Bedside Devices
POE
Surgery/ Nursing / Medication
Clinical Workflow Engine
Imaging / Laboratory / PACS / HIS
EnterpriseArchive
MissionCritical
Information
Order Entry
Scheduling
Data Repository
ED OR
Perin
atal
Phar
mac
yO
BR
adio
logy
Nur
sing
Surg
ery
Car
diol
ogy
ICU
\C
CU
Neu
rolo
gy MissionCritical
Information
Financial SnapshotMore than $2T (16% of GDP) spent on healthcare
Spend more for administrative processes (18%) than prescription medication (9%)
Substantial amount wasted due to errors, abuse, fraud, inefficiency (30%)
In 2007, GM claimed spending more for healthcare than steel for building an automobile
In 2000, more money than total GDP of France was spent on healthcare
Healthcare cost rising fastFast aging population of baby boomer
Most of healthcare spending for a person is during the last 10 years of life
Viability of Medicare fund
Many hospitals have financial difficulties
Building new hospitals without plan for staff
Snapshot from Florida
20 miles
IOM Report in 1999To Err is Human: Building A Safer Health System
Hospital data 770,000 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 hospitalBarcoding “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.”
Other industry dataAirline Safety: > 99.999999%
Airline baggage handling: > 99.999%
Responses From Hospital • Optimize / Improve Workflow
• ComputerizeHospital Information System (HIS)
Picture Archiving & Communication System (PACS)
Electronic Medical Record (EMR)
Computerized Physician Order Entry (CPOE)
• AutoID (1D & 2D Barcode, passive & active RFID
• Patient Safety Initiatives
Auto-ID Activities at FDABarcode Medication AdministrationBarcode Specimen CollectionAnit-Counterfeiting Report Human RFID Chip implant approvedRFID GuidanceSurgical marking RFID
The pace of change “frustratingly slow”
The death rate has not decreased substantially.
Leap / Berwick, JAMA, May 18, 2005
5 Years After The IOM Report
Complex legal / liability issuesComplexity of healthcare systemsSystem not paying for improvementsReluctance to admit mistakesSystem paying for the mistakesComplex reward / payment issues (P4P)Insufficient leadership
Why So Slow In Changing?
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 barcode1999 – MIT AutoID Center to study RFID for supply chain issues2001 – FDA announces intent to propose a bar code rule2002 – 1.5% of hospitals (90) using barcode2003 – MIT AutoID Lab formed2004 – JCAHO make a proposal and drops mandate2005 – 9.4% of hospitals (560) using barcode
Reality of AutoID
Barcode ProjectShort term impact High volumeDisposable
RFID ProjectLong term impactLow volume / high valueReusable / durable
AutoID Projects
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
Reviewing available technologies starting 2000Passive RFIDActive RFID
Defined problems to solve in 2002Focused on ROI: asset management for rental / leased items & theftProcess improvement tool
Selected active RFID technology in 2003Automation / ReliabilityReturn-on-investment (ROI)
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
Additional sites for active RFID projectsAsset tracking Patient tracking, other applications
RFID Project
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. It is very difficult to get infrastructure money.
Why Asset Management?
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
Existing workflow / definition of problem
Tag type: passive or active
Tag size
Battery life
Resolution
Dependencies: density of tags, network,
Installation
User interface
Project management experiences
ROI (Return On Investment)
Technology Selection Criteria
Medical device management: tracking, rental, service
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
Tagged Items
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
$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
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
Minimum change in workflow Reasonable cost for infrastructureLess physics & security issuesSolution for item level issuesData rich local environment
More info available to reduce additional errors Katrina factor
2D Barcode?
RFID & 2D Barcode
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• Working documents from ISBT-RFID Task Force.• Documents for HIBCC standards
Information on 2D Barcode
Clinical Touchscreen GUI
Engineer’s Handheld GUI
Select group
View Assets by Floor Sliding Zoom Bar
Zoom OutZoom In
MessageCenter
Messenger
Inbox (3)
In Use
Available
Soiled
Out of Service
Infusion Pump Utilization
OR Suite Utilization
In Use
Prep
Scheduled
Cleaning
Not Sched
Home Equipment Manager Surgical Services ED Manager Bed & Room Manager Other Applications
GUI for Upper Management
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
01 02 03 04 05 06 07 08 09 0
10 0
7 8 9 1 0 11 12 1 3 1 4 15 16 1 7 18
Time of Day
% AVERAGE BLOCK TIME UTILIZATION
01 02 03 04 05 06 07 08 09 0
10 0
7 8 9 1 0 11 12 1 3 1 4 15 16 1 7 18
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
7
<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
Room Level for ED Patients
ED Dashboard
Questions Being AskedResolution require for positive patient identification.
ED / ICU / OR Imaging / Floor / OfficeAlzheimer’s Billing
Workflow changesED / ICU / OR / Floor / Office / Blood products
Security & backupDisaster managementIntegration / Interoperability / Connectivity StandardsEMR
Real-time Patient Location
Location IdentificationSecurityInventory ManagementUtilizationRequisition / DistributionRentalsSafety / Risk ManagementTransportEquipment CleaningRegulatory ComplianceClinical EngineeringPatient TrackingFinancing / Accounting
Operational Process
Management
RFID Positioning
System
RFID-EnabledAsset
Management Applications
AssetTracking
Operational Processes
Comments
Active RFID and 1D/2D Barcode without passive RFID may be sufficient to address most, if not all, issues facing hospitals, effectively.
Even though there are privacy and security concerns, there will be more and more applications based on real time motion and location information.
HospitalWhere we choose to do these things not because they are easy or hard, but because they are important
