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Improving Patient Safety with RFID
I.4 RFID Applications for Hospitals
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RFID Applications for HospitalsImproving Patient Safety with RFID
In K. Mun, PhDDirector, Hospital Research, HRI, MIT
Director, Bio-Medical Research, AHMC
Cambridge, Massachusetts
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One million patients in hospitals daily 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 hospital
Staff shortage: nurse, physician, technologist
IOM Report in 2000
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• Optimize / Improve Workflow
• Computerize operation Hospital Information System (HIS)
Picture Archiving & Communication System (PACS)
Computerized Physician Order Entry (CPOE)
Electronic Medical Record (EMR)
Electronic Medication Administration Record (eMAR)
Standard Interface Protocols: HL7, DICOM, …
• Barcode-enabled Point-of-care (BPOC)
• Patient Safety Initiatives
Response To IOM Report
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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
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Technical Question
What Is The Main Source Of Problems?
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identification
We do not know how to identify patients and medications correctly.
We need to identify every item and relationship uniquely in a hospital.
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Unique Identification (UID) at item level
Barcode Not as good as expected
RFID (Radio Frequency IDentification) Promising new technology
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• Technology around since WWII
• Successfully re-introduced as technology for visible supply chain by AutoID Lab of MIT since 1999, with a possibility of saving $8 Billion per year for Wal-Mart.
• More expensive than barcode
• Direct sight is not needed to get information, since information is exchanged using radio-frequency
• More difficult to counterfeit than barcode
RFID (Radio Frequency IDentification)
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• Tag types Passive RFID (pRFID), tag powered by a reader
Active RFID (aRFID), tag powered by a battery
• Frequency types 135 Khz
13.56 Mhz
433 Mhz
869 / 915 Mhz
2.45 / 5.8 Ghz
RFID Types
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Reader
Information System
Tags
RFID System
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Tag-it Smart LabelsTag in mold
RFID Patient wrist band and Handheld readers
UHF tagInfusion Pump with active tag
RFID Tags and Readers
implantable tag
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RFID Tags and Readers
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Active RFID tag reader
Network Manager
Active RFID tag
CPOE / Portable passive RFID tag reader, wristband
w. passive RFID tag
HospitalNetwork
Nursing StationMonitoring Medication Orders, RFID system
WI-FIACCESS POINT
WI-FIACCESS POINT
passive RFID tag
Simple RFID System
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• Based On Standard Utilization Closed System
Open System
• Based On Clinical / Commercial Maturity Accepted Applications
Evolving Applications
Research Applications
RFID Applications
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• Closed system Novel applications
Early phase of market development
Changing technology
Fast development
Pressure on performance rather than cost
Difficult to control long term cost
Produced by smaller companies
May transition to an open system
Based On Standards
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• Open system Established markets
Stable technology
Standardized protocols reached by consensuses
Compromise on performance
Pressure on cost
Slow development cycle
Produced by large companies
Based On Standards
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• Accepted Applications Reasonably well known favorable ROI
Several pilot projects done
• Evolving Applications Trying to establish favorable ROI
Doing pilot projects
• Research Applications Estimated ROI based on optimistic projections
Novel ideas
Based On Maturity
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• Asset Management Managing equipment, device and consumables
Location, storage, inventory, service, repair
Theft prevention
Rental equipment
10 to 20 items per bed (5000 items for 300 bed hospital
Active tags (433Mhz, 915Mhz, 915Mhz, 2Ghz, 5.8Ghz
Managing infants and patients
Managing nurses, technologists and physicians
Accepted Applications
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Why Asset Management? Why Asset Management?
National average utilization of mobile equipment is 45% - Universal Hospital ServicesHospitals 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 Sentinal Alert
Baby mix-up
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3E MOTHER/INFANT
UNIT
3E SOILED
3N MOTHER/INFANT
UNIT
3S LABOR & DELIVERY
3N SOILED3N CLEAN
3S L&D SOILED3S L&D CLEAN
3W SOILED
3E NURSERY
3 EQUIPMENT STORAGE
3E NICU
3E NICU CLEAN
3S L&D OR
3W WOMEN’S MED/SURG
3 FRONT ELEVATOR
3 BACK ELEVATOR
3E MOTHER/INFANT
UNIT
3E SOILED
3N MOTHER/INFANT
UNIT
3S LABOR & DELIVERY
3N SOILED3N CLEAN
3S L&D SOILED3S L&D CLEAN
3W SOILED
3E NURSERY
3 EQUIPMENT STORAGE
3E NICU
3E NICU CLEAN
3S L&D OR
3W WOMEN’S MED/SURG
3 FRONT ELEVATOR
3 BACK ELEVATOR
Example
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Existing workflow
Tag type
Tag size
Battery life
Resolution
Dependencies
Installation
User interface
Clinical experiences
ROI (Return On Investment)
Issues To Consider
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433 Mhz active tag
Small tags to maximize number of items to track
Real-time tracking (broadcast few times per minute)
Variable resolution: bed, room, department,..
Manage high density of tags in a room
Minimum additional network traffic
Simple installation: invisible readers
Web applications: support PDA, laptop, …
Several large successful hospital installations
Less than three years for ROI
Willing to develop additional applications
Sample Case
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Interface to HIS / PACS / PDA
Total patient flow management
Blood product management
OR & ICU management
Medication management
Total care management
Next Steps To Be Taken
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• Patient wristband
• Blood product management
• Operating room management
• ICU management
Evolving Applications
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Unique Identification of each patient
Networked environmentHospitals with HIS & PACS
Read-only limited information, HIPPA
Non-networked environmentMilitary, natural disaster like hurricane, flood, earth quake
Read-write
Frequency, Read Range13.56Mhz / 433Mhz
Active / passive
Short, medium, long
Patient Wristband
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Accuracy
Reliability
Cost
Temperature monitoring
Two early sites: MGH & Georgetown
Frequency13.56Mhz, passive tag
433Mhz, active tag
Blood Product Management
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• Operating Room Management Optimizing OR processes
Active tags & 2D barcode
Surgical tool tracking
• Intensive Care Unit Management Improve ICU processes
Passive & active tags
Medication management
OR & ICU Management
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• Medication delivery
• Pharmaceutical pedigree
Research Applications
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Patient RFID wrist band
Interface with hospital information system (HIS), physician order entry system (POE) & inventory management system
Cost of item level tags and other related items
Change in workflow management
13.56Mhz / 433Mhz / 915Mhz
Read-only / read-write
Reliability, Accuracy
Open System?
Medication Delivery
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Legally acceptable pedigree information
Legally acceptable paper / electronic trail
Returned items
Recalled pharmaceuticals
Passive RFID tag frequency: 915Mhz / 13.56Mhz
Temperature monitoring
Interface to HIS, POE, inventory management system
Pharmaceuticals in a hospital, pharmacy, warehouse
Samples in physician’s office
Pharmaceutical Pedigree
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Manufacture WholesalerDistributor
Retail Pharmacy
Hospital
Out-patient
In-patient
Info-M
Info-M
Info-M
Info-H
Info-W
Info-W
DB-M DB-W DB-H
Global DBFDAFBI
DB-R
Global Pedigree With RFID
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Pharmaceutical stability under RF exposure
RFID Tag construct
Mass serialization for identification
Optimum frequency
Backup technology
RFID for medical devices
Workflow analysis
Interfacing to HIS, PACS,…
Home-bound patients
Pharmaceutical packaging
Electronic pedigree
Pharmaceutical stability under RF exposure
RFID Tag construct
Mass serialization for identification
Optimum frequency
Backup technology
RFID for medical devices
Workflow analysis
Interfacing to HIS, PACS,…
Home-bound patients
Pharmaceutical packaging
Electronic pedigree
Issues To ResolveIssues To Resolve
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RFID, not a silver bullet, but powerful.
RFID, a disruptive technology. Understand workflow and technology.
Modify workflow
Persistent engagement by everyone.
RFID, a method of managing persistant Unique Identification (UID) at item level.
Comments
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Thank You!
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