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RFIDHealthcare Technology

Radio Frequency IdentificationIn Healthcare Industry

BY SHIRLEY A. BUGOSH

DEC 2012

RFID TechnologySocial Responsibility

Ethical ConcernsChallenges of RFID

Radio Frequency IDWhat Is It? P.10P.7 P.8

2 RFID in Healthcare Industry NOV 2012

Healthcare TechnologyNEWS

NEWSHealthcare Technology

Shirley A. Bugosh is a graduate student in Education Technology at Webster University. She obtained a Baccalaureate in Nursing Science at

the University of Texas Health Science Center in Houston, Texas.

RFID in Healthcare Industry NOV 2012 3

RFIDAs healthcare institutions struggle to balance the increasing need for their services with decreasing financial resources, they must look for efficient and cost effective means to manage delivery. Although not a new technology, radio-frequency identifica-

tion (RFID) is recently demonstrating its poten-tial in all sectors of industry, including health-

care. Implementation of RFID technology can improve effectiveness of health care

delivery and increase patient outcomes, in considerations of cost containment,

risk management, and utilization re-view. But ethical issues can impact its adoption, including concerns re-garding access to personal informa-tion and privacy rights violation, as well as systems and process integrity.

Radio Frequency IdentificationIn Healthcare Industry

By Shirley A. Bugosh, BSN, RN



Nursing staff can

“spend up to 30 minutes per shift tracking down equip-ment”

Cost Containment

Coordinating healthcare services often results in de-lays or inefficiencies of care delivery, straining the industry’s financial resources. For example, a facility can incur financial losses as a result of wasted time. Daily challenges, particularly in larger hospitals, in-clude locating patients or staff members in other ar-eas of the facility or mobile assets like intravenous pumps and wheelchairs. One report noted nursing staff can “spend up to 30 minutes per shift track-ing down equipment” (Turisco & Rhoads, 2008). Financial losses can be attributed to unintention-al incidents as well. For example, some surgical probes can cost thousands of dollars and acciden-tally be thrown out with medical waste or lost in soiled linens (Kumar, Livermont & McKewan, 2009). Radio frequency identification (RFID) technolo-gy incorporated into employee badges and patient wristbands or placed on equipment can automate monitoring and tracking of these mobile assets.

Asset location is not the only challenge. Equip-ment maintenance is a crucial factor in providing equipment that is ready when needed. Portable de-vices such as IV pumps need charging and “surgi-cal instruments and other devices must be proper-ly cleaned, sterilized and packaged between uses” (Reiner & Sullivan, 2005). Recent RFID tech-nology provides tags that can now withstand the steam sterilization processes (Kumar et al., 2009).RFID’s potential contribution in hospital supplies management can also be seen in the replenish-ment systems. The automated data capture trig-gered by tags in real-time reports as new supplies are stocked or removed for patient treatments can “almost completely eliminate backorder situations . . . and eliminate counting stock” (Bendavid, Boeck & Philippe, 2010). Just as tags capture data of med-ical supplies in and out of replenishments systems, they can also keep track of resources used for pa-tient billing purposes as well (Bendavid et al., 2010).

Turisco & Rhoads, (2008)



igree” of medications in concerns of pharmaceutical counterfeiting, where a medication’s life, from manufacture to administration can be traced. Estimates of coun-terfeit pharmaceuticals by the World Health Organization on average can range between 5 and 8 percent and can be as high as 25 to 40 percent in some coun-tries, representing losses to the pharmaceutical industry of nearly $2 billion each year (Reiner & Sullivan, 2005).

RFID readers that capture re-al-time information, including removed, diminishing or expired stock and staff identification data (Bendavid et al., 2010). In combination with RFID patient cards, this information can be cross-referenced with pertinent patient-specific data such as cor-rect dosage, drug interactions and allergies as well as billing data of items.

The “read” and “write” tags can also be used to monitor the “ped-

Risk Management

“Annually, an estimated 44,000 to 98,000 Americans die from med-ical errors” (Institute of Medicine, 2000). The complex process of inpatient medication manage-ment and administration involves multiple disciplines (e.g., phar-macists, nursing personnel, techs and physicians), providing many opportunities for errors to occur (Turisco & Rhoads, 2008).

A prime goal of healthcare indus-try is to decrease risk factors that can affect positive patient out-comes. The use of RFID technol-ogy in medication management can assist with this objective. For instance, RFID tags that have

“read” and “write” capabilities provide a means where historical data or patient-specific safety in-formation, like drug allergies and blood type, can be placed within the chip of medication labels and patient wristbands (Figarella, n.d.). Additionally, medication cabinets can be equipped with

“Annually, an estimated 44,000 to 98,000 Americans die from medical errors” Fisher & Monahan, (2008)



Utilization Review

Work flow management systems utilizing RFID can provide staff with real-time information, as-sisting in “prioritizing tasks, [as well as] recognizing and allevi-ating bottlenecks” (Turisco & Rhoads, 2008). Results are less time on phone calls to access the same information. In one study,

“Nurses recouped up to one hour per shift by eliminating seven to ten phone calls and three to four workstation log-ins” (Turisco & Rhoads, 2008). RFID systems can also assist facility management in providing “more-balanced staffing” as real-time data re-veals under and over staffed units (Turisco & Rhoads, 2008).

“Surgical errors are second only to medication errors as the most frequent cause of error-related deaths” (Institute of Medicine, 2000). In the surgical environ-ment, RFID technology can in-crease outcomes by making read-

ily accessible the data necessary to complete surgical procedures. For example, the synchronization of information (e.g., patient, staff and facility), supplies, and equip-ment can be integrated, allowing patient-specific analysis and eval-uation (Egan & Sandberg, 2007).

One community-based health sys-tem in southwestern Pennsylvania is implementing a “suite of clini-cal access management and per-formance management solutions” that will provide “a single integrat-ed technology backbone across its two hospital campuses and more than 70 community-based patient-care locations” (Heritage Valley Health System, 2011). Via “hand-held” devices, physicians can “quickly view . . . simply by touching their RFID equipped hand-held to any desktop com-puter” within the system (Heri-tage Valley Health System, 2011).

•

“Surgical errors are second only to medication errors as the

most frequent cause of error-related deaths”

Institute of Medicine,( 2000)



ETHICAL CONCERNSRFID CHALLENGES Several chal-lenges are related to recent inter-ests in RFID technology in the healthcare industry. The econom-ic crisis has forced institutions, including governmental agency such as Medicare and Medic-aid to review spending through the scrutiny of such factors as resource waste, for example equipment loss or theft, reim-bursements for unproductive or non-medical time, and additional service charges resulting from medical errors. Noted in a report by Vilamovska (2010), “medication errors alone are estimated to harm 1.5 million Americans and to incur $3.5 bil-lion in treatment costs each year”. Also reported by the Institute of Medicine (2000), preventable medical errors “placed the cost of inadequate patient safety at 44,000 to 98,000 U.S. lives and at

least $17 billion in direct health-care costs and productivity losses”. In addition, new regulations and initiatives such as the American Recovery and Reinvestment Act (ARRA) and President Obama’s healthcare initiatives are “adding urgency to an already serious need to contain care cost growth and better the efficiency of health-care delivery” (Vilamovska, 2010).

PRIVACY RIGHTS Although RFID promises to assist with these urgent issues, several concerns have been expressed with the major one being priva-cy rights. In the article Tracking the Social Dimensions of RFID Systems in Hospitals, the authors write, “these systems may have a valence toward surveillance” resulting in a “panoptic effect” of self-policing that could extend “to enforce unequal social sorting

of individuals through profiling based on race, class, gender, and/or sexual orientation” (Fisher & Monahan, 2008).Privacy issues also include pa-tient concerns in security of their personal medical information, for example, who will access it and how will it be used? In a keynote address of the 2011 Health Priva-cy Summit, Columbia University

professor of Public Law, Dr. Alan F. Westin presented survey data that indicated, “health

and financial infor-mation ranked most sensi-

tive” in privacy concerns.

SYSTEMS & PROCESS Tech-nology interoperability and integration within the healthcare institution is a complex issue. The industry’s lack of common

Ethical Concerns continued on page 9



“RFID is not merely a computer chip and antenna placed on a product, but rather it is an entire infrastructure that requires investment in many components and systems to make it work. This includes hardware, middleware and software components.”

tags rely on the reader’s power to activate the transmission of their data. The most frequently used RFID tags in hospitals include active and hybrid - semi-passive types. Active tags contain bat-tery sources that boost their sig-nals, which can be transmitted as far a far away as 100 meters. Active as well as hybrid tags can be equipped with sensors that can relay data regarding their environment like temperature or pressure.

Tags are the heart of the sys-tem, storing information asso-ciated with the asset they track, which in most cases is a unique identification number. Tags in-clude a memory chip and anten-nas and may be equipped with a power source. Their radio fre-quency of operation can include low, high, and ultra high frequen-cy radio waves or microwaves. Having a discoverable range from several millimeters to a far as 12 meters, passive tags have no built-in battery source. These

RFID What Is It ?

TAGS

Active tags can use wireless local area network systems and Wi-Fi to connect to middleware. Ad-ditionally, some tags have the capability of not only storing a unique identifier number but can store additional information, for example, drug allergy information and blood type stored on patient wristbands.

READERS

Readers can be portable, includ-ing hand-held readers and mo-bile data collection devices, or they can be fixed readers where tagged assets are read as they pass through or near the device. Read-ers use antennas to capture radio waves from tags and transmit this information back to middleware systems for processing.

The system that receives the data from readers is called the mid-dleware. This system is respon-sible for collecting the raw data from the tags and making sense of it. Examples include the event management of patient and staff work-flow and real-time alerts like medication cabinet access. This software also communicates with the host system or the facili-ty’s main information system.

MIDDLEWARE

Health Industry Business Communications Council



. . . Ethical Concerns continued from page 7

standards of tags and readers results in the inability of com-munications between proprietary systems. Intellectual property patents of RFID systems are held by technology companies that can be from anywhere in the world, resulting in differences of chip design, middleware programing code as well as radio frequen-cies (Kikirekov & Oehlmann, n. d.). Integration issues also arise between emerging technologies and existing host systems, often written in legacy code (Egan & Sandberg, 2007).The significance of these issues is institutions buying into pro-prietary systems may limit their potential for financial and man-agement gains offered by imple-menting RFID technology. As expressed in one report, “different Auto-ID technologies best serve different purposes, an organiza-tion seeking to deploy Auto-ID technology might well find itself using a number of vendors, each with a standalone system” (Egan & Sandberg, 2007).Noise interference in competing air space of essential medical equipment presents challenges as well (Egan & Sandberg, 2007). For example in a research study looking at electromagnetic inter-ference of RFID and its effect on critical care equipment such as infusion syringe pumps, exter-nal pacemakers and mechanical ventilation, demonstrated po-tential hazards and a need for further studies (van der Togt, van Lieshout, Hensbroek, Beinat, Binnekade & Bakker, 2008).

HOST SYSTEM

In healthcare, the host system is known as health information system (HIS). It is the complex system that manages the storage, retrieval, sharing, and use of information throughout a health-care institution.



Portability and Accountability Act of 1996)” (Fisher & Monahan, 2008). Additionally, meshing the radio frequency technology with the many technical devices within the hospital’s environment is a daunting task. As Berwick (2008), stated, “design in isolation is risky”. Creators and manufacturers of RFID technol-ogy must develop design teams that include stakeholders of the healthcare industry with end-us-ers included. Additionally, design must accommodate the complex needs of the healthcare environ-ment.

RESEARCH Policy makers and healthcare administrators need to make informed decisions regard-ing return on investment and relevance of use in choosing to adopt new technology like RFID. Noted by Vilamovska (2010), “High-quality empirical data on the quality and cost of healthcare RFID applications are scarce” as are studies that reflect its impact on the “people-ware” involved in its use (Fisher & Monahan, 2008). We must promote research that documents outcomes of RFID application and best practices in specific uses, to provide evidence that can back-up decisions made by those responsible for the deci-sion-making process.

PRIVACY A range of concerns regarding RFID technology have been expressed, from a “misun-derstanding” of what the technol-ogy is, to an extreme “portrayal of a tool for Orwellian Big Brother observation of private lives and activities” (Vilamovska, 2010). Additionally, in a study on social dimensions of RFID in hospitals, nurses expressed concerns of “being overly scrutinized by these tracking technologies” in which the “systems are based upon ratio-nal management models that do not accurately match the messy realities of hospitals” (Fisher & Monahan, 2008).Responsibility of hospital admin-istration is to ensure that patients and staff members have an un-derstanding of RFID technology. Educational opportunities should provide information about what data will be stored on RFID tags, how it will be used and who will have access to it. In addition, this information should be put into institutional policy and reviewed frequently as RFID technology advances and as its use changes.

STANDARDS The lack of RFID industry standards presents a challenge in the healthcare indus-try’s concerns of compliance with “privacy protection mandated under HIPAA (Health Insurance

Healthcare presents with unique and complex environments “full of tightly coupled, hard-to-see systems” that can make RFID implementation difficult (Berwick, 2008). To make RFID implementation successful., several major

issues must be addressed.

SOCIAL RESPONSIBILITY

“High-quality empirical data on

the quality and cost of healthcare RFID

applications are scarce”

Fisher & Monahan, (2008)


Radar is refined and used in major World War II development effort. The first RFID application was the “Identification Friend or Foe” system - IFF or transponders. Invented in 1948, these IFFs were placed into fighter planes and tanks. Successors of this technology are still used in armies around the world today.

1940’s

The 1970’s were characterized by developmental work in radar and microwave theory. Advancements lead to the totally passive tag with detectable ranges of up to several meters. Animal tracking, mostly in Europe, and vehicle tracking, and factory automation in the United States became the focus of intended uses.

1970’s

The 1980s became the decade for full implementation of RFID technology, with differing interest throughout various parts of the world. In the United States, studies of RFID uses primarily focused on transportation, with greatest interest in toll collection. Advance-ments in circuitry design contributes to reduction in size, as well as increases in functionality of tags.

1980’s

The 1990’s was a significant decade for RFID because of wide scale deployment of electronic toll collection in the United States. In the Northeastern United States, seven regional toll agencies formed the E-Z Pass Interagency Group (IAG) in 1990 to develop a regionally compatible electronic toll collection system. This system is the model for using a single tag and single billing account per vehicle to access highways of several toll authorities.

1990’s

Since 2006, RFID tags included in new US passports have stored the same information that is printed within the passport and also has included a digital picture of the owner. In October 2004, the FDA approved USA’s first RFID chips that can be implanted in humans. The emergence of standards, decreased cost of equipment and tags, and increased reliability of 99.9% provide incentive for widespread adoption.

2000’s

Source: Landt, J. (2005, October/November). The history of RFID. IEEE Potentials, 8-11.


RFID TIME LINE

References

Bendavid, Y., Boeck, H., & Philippe, R. (2010). Redesigning the replenishment process of medical supplies in hospitals with RFID. Business Process Management Journal, 16(6), 991-1013.

Berwick, D. M. (2008). Taming the technology beast. Journal of the American Medical Association, 299(24), 2898-2899.

Egan, M. T., & Sandberg, W. S. (2007, March). Auto identification technology and its impact on patient safety in the operating room of the future. Surgical Innovation 14(1) 41-50.

Figarella, L. (n.d.). Radio frequency identification (RFID) in healthcare: Benefits, limitations, recommenda-tions [Whitepaper]. USA: Health Industry Business Communications Council.

Fisher, J. A., & Monahan, T. (2008). Tracking the social dimensions of RFID systems in hospitals. Interna-tional Journal of Medical Informatics, 77(2008), 176-183. Retrieved on November 27, 2011 from: http://torinmonahan.com/papers/Fisher_Monahan_RFID_IJMI.pdf

Heritage Valley Health System. (2011, August 01). Heritage Valley Health System selects the Sunrise acute care electronic health record from Allscripts [Press release]. Retrieved on November 29, 2011 from: http://www.heritagevalley.org/Media/Releases/2011-29A.aspx

Institute of Medicine (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.

Kikirekov, K., Oehlmann, H. (n. d.). Radio frequency identification (RFID) in healthcare: Benefits, limita-tions, recommendations (Whitepaper]. Health Industry Business Communications Council. Retrieved on November 27, 2011 from: http://www.hibcc.org/PUBS/WhitePapers/RFID%20in%20Healthcare.pdf

Kumar, S., Livermont, G., & McKewan, G. (2009). Stage implementation of RFID in hospitals. Technology and Health Care 18(2010) 31-46.

Reiner, J. & Sullivan, M. (2005). RFID in healthcare: A panacea for the regulations and issues affecting the industry? [Whitepaper]. USA: United Parcel Services of America, Inc.

Turisco, F., & Rhoads, J. (2008, January). Equipped for efficiency: Improving nursing care through technol-ogy [PDF document]. Oakland, CA: California Healthcare Foundation.

van der Togt, R., van Lieshout, E. J., Hensbroek, R., Beinat, E, Binnekade, J. M., & Bakker, P. J. M. (2008, June 25). Electromagnetic interference from radio frequency identification: Inducing potentially hazard-ous incidents in critical care medical equipment. Journal of the American Medical Association, 299(24), 2884-2890.

Vilamovska, A. (2010). Improving the quality and cost of healthcare delivery: The potential of radio fre-quency identification (RFID) technology. (Doctoral dissertation). Retrieved on November 20, 2011 from Rand Corporation at: http://www.rand.org/content/dam/rand/pubs/rgs_dissertations/2010/RAND_RGSD239.pdf

Westin, A. F. (2011, June 13). What two decades of surveys tells us about privacy and HIT today [Video presentation]. Keynote address presented at 2011 Health Privacy Summit. Washington, DC: Health Privacy Summit. Retrieved on November 22, 2011 from: http://www.healthprivacysummit.org/videos/session-1-keynote-speaker-dr-alan-westin

Radio Frequency Identification: In Healthcare Industry

© 2012 Shirley A. Bugosh

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