RFID Moves Beyond Assets

Beckie Kelly Schuerenberg, Senior Editor
Health Data Management Magazine, January 1, 2008

Columbus (Ind.) Regional Hospital executives wanted to get the most bang for the buck from their new nurse call system.

So when they discovered that the technology, from Rauland-Borg Corp., Skokie, Ill., can use radio frequency identification technology to track clinicians to enable them to better communicate with each other, they came up with some other ideas for how RFID could help improve workflow and patient care.

Before implementing the integrated system they went to the RFID technology vendor, Versus Technology Inc., Traverse City, Mich., with a laundry list of proposed features.

For example, they wanted to track emergency department patients and issue a timestamp when they reached certain destinations, says Roni Kagley, systems analyst. Additionally, they wanted to create alerts for ED nurses based on analysis of the timestamps, such as if a patient has been waiting more than 15 minutes without being seen, she adds.

During 2005, Columbus Regional's I.T. staff worked with Versus and South Western Communications Inc., Newburgh, Ind., to integrate the new features with the nurse call system and install an enterprisewide RFID network. Now the hospital gives every ED patient an RFID badge at registration. Clinicians also wear badges. Each patient badge is embedded with select information via an interface with its admission-discharge-transfer system, from McKesson Corp., San Francisco.

The badges emit infrared signals containing location data every three to five seconds. The signals are picked up by the RFID network and transmitted to a management application. Nurses use the system to view a hospital floor plan that displays where all ED patients and clinicians are-and how long they've been there.

Though the additional features have provided many efficiency and patient care benefits, Columbus Regional is still on a learning curve with the technology, Kagley says. "We've had to wait to get enough data in the system to use some custom reporting tools we created," she says. "But we already know RFID has enabled our ED nurses to be more efficient."

RFID has carved out a niche in health care as a technology that can be used to electronically track equipment or people. Some early adopters reported major savings by using it to determine the real-time location of assets and keep track of equipment that's often misplaced and needlessly repurchased.

As more hospitals continue to tinker with RFID, the technology is proving its worth in a growing number of applications, including tracking patients and staff, and for more specialized tasks such as tracking paper medical files.

The bottom line: RFID is moving beyond the perception of being solely an asset tracker and increasingly being viewed as a technology that can improve care.

"Some hospitals put RFID in to help track objects, but are now discovering secondary uses for it," says Patrick Rossignol, principal at New York-based Deloitte Consulting. "The technology has the capability to provide time and motion analysis that can be used to produce recommendations to improve processes. If you look at RFID in terms of patient safety, the ability to act as a patient locator is compelling."

Columbus Regional Hospital's RFID-based nurse call system uses multiple technologies to locate patients, staff and assets.

Its patient and staff badges emit both infrared and RFID signals. IR doesn't penetrate through walls as RFID signals do, so the badges send IR signals to indicate their location with room-level accuracy. The badges also have a button that when pressed emits an RFID signal.

Columbus Regional nurses press the RFID buttons on patient badges for other communication, such as to indicate to the system the time they saw a patient. The function is a form of "passive" RFID technology, which requires human intervention to transmit identifiable information.

Press Of A Button

For example, physicians press a nurse call button in exam rooms to indicate they have seen a patient. Nurses also press a button on their badges while in a room to communicate they will take over care of the patient from another clinician.

Other hospitals also are using passive RFID tracking, (see sidebar, page 38.) But Columbus Regional didn't want its system to rely too much on clinician intervention, says Kagley, the systems analyst.

The hospital's RFID system, however, can automatically detect when a patient has been discharged or if a room needs cleaning. After nurses discharge patients, they remove the badge from the patient and place it into a drop box. The RFID system detects the badge in the drop box and changes the color of the room in the application's floor plan display to indicate it's vacated and needs to be cleaned, Kagley says.

Patient tracking is on the horizon at Southern Ohio Medical Center, but the Portsmouth-based hospital already has improved workflow and care quality just by using RFID to track assets. About six months ago, the hospital purchased the technology, from Lawrence, Mass.-based Radianse Inc., to enable biomedical engineering staff to more quickly locate recalled medical supplies and equipment, says Greg Malone, supervisor of the department.

It often took several days for his three-person staff to locate items across the 222-bed hospital for preventive maintenance. But with recent recalls of I.T. and medical equipment with potentially exploding batteries and other dangerous malfunctions, the hospital wanted to increase the speed of locating assets, Malone says.

Southern Ohio installed an RFID network and began tagging assets last July. But before biomedical engineering staff had the chance to test the system to locate recalled assets, other clinical departments jumped at the chance to use RFID. For example, inpatient rehabilitation and patient direction staff began using it to locate wheelchairs for patients entering the hospital.

"We were excited people were using it already," Malone says, especially because biomedical engineering had planned to offer enterprisewide access to the tracking system by September.

As of late November, Southern Ohio has tagged 1,700 pieces of equipment. The hospital writes identifiable information about each asset to each tag, such as its serial number, biomedical engineering number and manufacturer information, so staff can search the management application using those parameters.

The hospital has yet to use the RFID system for its original patient safety goal of tracking recalled equipment-none of its equipment has recently been the subject of a recall. But biomedical engineering and other clinical staff have saved at least 40 hours that would have been spent searching for assets, Malone says.

Southern Ohio also is planning to use the system to locate quarantined equipment. The hospital requires equipment involved in a incident during patient care to be immediately isolated and tested to ensure it's working properly.

But clinicians sometimes forget the serial number of the device in question when reporting incidents, so biomedical engineering staff must test all such devices before they can be used again.

The hospital also is developing an RFID-based alarm system to alert staff when Alzheimer's or dementia patients leave areas of the hospital, Malone says.

RFID is a leap forward in automation, but Baltimore-based University of Maryland Medical Center has found a "retro" use for the technology-tracking clunky, voluminous paper records.

The medical center uses an enterprise electronic health records system from Kansas City, Mo.-based Cerner Corp. But it has yet to customize the EHR to handle the nuances of radiation oncology treatment, says John Kornack, project manger for the hospital's I.T. group.

As a result, the radiation oncology department has a separate medical records department that manages paper records for its patients' consultation, simulation, chemotherapy treatment, radiation treatment and post-treatment information.

The records are so big that they are contained in three-ring binders. But they aren't so big that they don't get misplaced, Kornack says. While the records aren't supposed to leave the department, physicians from other departments often need to review them, and as a result they sometimes ended up missing when a patient needed to be treated.

The department's medical records staff kept a paper sign-out sheet for the binders but still had to find the physician who signed them out and seek permission to unlock their office to access them. Occasionally, physicians would deny entrance to their offices, or if they granted permission, the files wouldn't be there.

"The process was delaying patient treatments," Kornack says. "Without the chart, clinicians don't know how to follow a patient's treatment plan. We needed an automated system to manage them."

The department decided to try a system that could run on the hospital's existing enterprisewide Wi-Fi network. In June 2006, it purchased 30 RFID over Wi-Fi tracking tags from InnerWireless, Richardson, Texas, and used a double-sided Velcro adhesive to attach them to the inside front cover of patient binders.

They then began using the vendor's software to track the binders across the department as well as the entire hospital. Now it uses the technology to track nearly 600 files, Kornack says.

Sidebar

Passive RFID yields workflow benefits

Active radio frequency identification often the RFID flavor of choice for tracking assets and people. But some facilities are finding that passive RFID, used strategically, can provide many of the same benefits.

Active RFID uses battery-powered tags that continuously send information to readers in antennas installed in ceilings or walls. Passive systems use tags that must be read by a scanning device to transmit data.

Active RFID is superior if the intent is to determine the exact location of people or supplies at any given minute. But passive RFID is proving effective when the tracking requirements aren't as exact or the workflow is more hands-on. For example, Mayo Clinic has been able to improve workflow in its endoscopy department using passive RFID to track patient specimens.

Before implementing the Track and Trace technology from 3M, St. Paul, Minn., the Rochester, Minn.-based organization used printed or handwritten labels and paper requisitions to manually track 20,000 biopsies a year, says Schuyler Sanderson, M.D., surgical pathologist.

In 2006, Mayo installed the system's scanning pads, about the size of a sheet of paper, at various locations along the path that specimens take from collection to the lab. It also placed passive RFID chips on the bottom of each new specimen container.

When a patient sample is taken, clinicians scan a new container on a pad in the endoscopy suite to embed it with various data, such as the patient's name; time and date the specimen was taken; and the name of the physician who did the procedure. The data is transferred to the chip via an integration with Mayo Clinic's homegrown gastroenterology database.

The clinician then takes the specimen container to a "tube station" where it awaits transportation to the lab. A clinician scans the specimen on a pad at the tube station to indicate it is ready to be transported. A nurse on the other side of the tube station then scans it on a pad on their end and transports it to the lab. A clinician in the lab scans the container on another pad to indicate it has been received. Finally, the container is transported to the specific area where it will be processed and scanned again.

Department management uses software to view how many specimens were collected and how many are at each station along the transportation route.

While the passive RFID system has added a step to the process, it's enabled nurses to save one to three minutes per case because they don't have to fill out paperwork to identify the specimen, Sanderson says.

"It's been a challenge to manage specimens, especially when we have several that belong to a single case," he says. "But tracking them with RFID has enabled us to give time back to nurses to do what they were trained to do, take care of patients, rather than fill out paperwork."

Sidebar

Keeping up with supplies
New York Presbyterian Hospital/Weill Cornell is using passive RFID to improve patient care in its cardiac surgery department.

The hospital initially implemented the tracking system, from Pittsburgh-based Mobile Aspects Inc., to manage supplies, such as heart valves, implants and other human tissue products. It used to store the items on open shelves, but clinicians sometimes couldn't find them as needed, says Martin Dagata, director of finance and business operations.

"A lot of times we were unable to determine what was happening to our inventory," he says. "So it was a matter of money. But there's also a patient safety aspect to what we are doing."

The RFID system comprises a storage cabinet, RFID tags and a management database. When cardiac surgical supplies arrive in the hospital's receiving department, staff uses the database to create passive RFID tags embedded with each item's serial number and expiration date. They attach the tags to each item and transport them to the storage cabinet.

An RFID reader in the storage cabinet detects the items and links them with their description in the database. When clinicians need an item, they swipe their bar-coded ID badge on a reader on the cabinet. Then they use a touch screen on the cabinet that's been integrated with the hospital's admission-discharge-transfer system to choose the patient with whom a supply will be used. The cabinet then unlocks and scans the RFID tag on the supply the nurse removed.

New York Presbyterian/Weill Cornell's technology creates an extra workflow step, but nurses don't mind because it's reduced the time they spend looking for supplies, Dagata says.

"The RFID system secures our inventory. If anything goes missing, I know exactly who took it out of the cabinet," he says. "Also, we open patients first then determine what size valve we need. So if we don't have it, we have a serious legal risk management and patient safety risk."

New York Presbyterian/Weill Cornell also has been able to cut its inventory because the system offers a digital view into what supplies it currently has. As a result, it's been able to save $230,000 by taking back unneeded heart valves to vendors, Dagata says. Since implementing the system in 2006, the hospital also has installed it in its general surgery for implants and ambulatory surgery departments.

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