Keeping Track

At healthcare facilities, logistical challenges can literally be a matter of life and death. And this is especially true for large organizations such as the Defense Department’s Tricare or its Defense Health Services Systems (DHSS).

Whether treating warfighters or veterans, federal healthcare facilities have to ensure that patients and the equipment they need are together at the right place at the right time; that medications are administered to the right patients in the right dosages; and that patients and clinicians can be located quickly. If organizations fall down in these areas, medical errors rise and quality of care drops, says Ernie Spain, project manager for the Patient Movement Items Tracking System in the DHSS Medical Logistics Division.

The most powerful technologies available for government healthcare organizations to meet those logistical problems are barcode and radio-frequency identification tools.

“The number of critical medical processes that can benefit from barcoding, and even more from RFID, is enormous,” says Michael J. Liard, practice director for RFID at ABI Research. “The technologies can improve safety and efficiency while making patients and families more satisfied with the care they receive and clinicians’ jobs much less burdensome.”

For about 10 years, some Veterans Affairs Department and DHSS healthcare facilities have been using barcodes for medication administration and inventory control. It’s a relatively inexpensive and, with widely available software, easy-to-implement technology. Now, pioneering organizations are trying to raise the bar by implementing RFID.

Although a bit more expensive to deploy than barcodes, RFID scanning is much faster — and can be automated — allowing for new and better applications, Liard says. Companies such as AeroScout, Symbol (now Motorola Enterprise Mobility) and Zebra Technologies make RFID tags, printers, encoders, scanners and readers.

How RFID Works

Functionally, RFID is somewhat similar to barcoding. In both cases, users or readers capture information from tags on equipment, badges or supplies. But with RFID, the user need not necessarily scan each item separately.

“Barcoding is useful, but the process can be time consuming,” says Garry D. Duvall, deployment manager and RFID project officer for DHSS’ Services Support and Logistics Department. “For a common warehouse activity such as receipt processing, an activity that could take hours using a barcode scanner can be captured using RFID in just minutes.”

For example, DHSS is piloting RFID technology to help track medical equipment used to support critically injured warfighters being evacuated by helicopter or plane. Items such as defibrillators, ventilators and pulse oximeters are housed at warehouses around the world. DHSS maintains and supplies this gear to the field as needed.

“Keeping track of the equipment manually was difficult because as items moved throughout the aero-evacuation system, they were recycled without any way to locate the items or determine whether or not they were operational,” Spain says. “We ended up with huge equipment surpluses at some evacuation and treatment sites and shortages at others.”

After the Gulf War shone a harsh spotlight on logistics problems, DHSS implemented a barcode system to track equipment location, service records and other data. The barcode system was a great improvement over the previous manual process, Spain says. But the time-consuming scans limited the currency of the data.

“If we’re scanning once a week, there’s the danger that some of this information will be out of date,” says Spain. Both he and Duvall expect that by moving from barcodes to RFID, the frequency of the scanning process can be increased to once a day — or even more often at critical locations.

Active Versus Passive

Duvall points out that even daily inventories are not as good as real-time counts, which would only be achievable using active RFID tags. Active (as opposed to passive) tags send constant signals to a local server that collects the data and transmits it to a central location.

So far at least, DHSS has not been able to justify the expense of an active system. “Active RFID tags cost around $30 to $60 compared to less than $1 for passive tags,” he says. “And active tags require more infrastructure, such as antennas, wireless connections and increased maintenance since the batteries must be replaced periodically. This is more useful on high-cost items. We may revisit an active RFID pilot however, if funding becomes available.”

But Duvall is quick to add that some RFID applications, such as patient tracking, could benefit from an active system and be worth the added expense. A cost-versus-benefit calculation must be done separately for each type of use, he says.

fact: 50 to 300 Feet

The distance from which a long-distance reader can capture active RFID tag information
Source: IJIS Institute

The department has been delving into active RFID. The eye clinic at the VA hospital in St. Louis now uses an active RFID system for its patient tracking. But the clinic’s system evolved from decidedly low-tech beginnings, says Dr. Nathan Ravi, an oph­thal­­­mologist and chief of staff at the St. Louis VA Medical Center.

In summer 2007, hoping to improve patient and clinician flow, the medical center hired college students to follow everyone around with clipboards and stopwatches in the eye clinic.

The center’s project team then transferred the data to an Excel worksheet that was used as the basis for a discrete event simulation (DES), which creates and then plays out several what-if scenarios.

The move to RFID came when the project team wanted to do a second test applying some of the initial DES results. But the medical center couldn’t find enough students willing to take on the mind-numbing tracking portion of the research. “We realized we needed a way to track staff and patients electronically,” Ravi says.

To handle the job, the clinic deployed a real-time location system using active RFID tags that contain ultrasound and infrared technology.

Using a blueprint of the clinic, the RTLS technology gathers information through receivers placed at strategic locations throughout the facility. Patients and staff wear RFID badges that transmit location information — even as they move from place to place. The data can be viewed on a map of the facility by all of the staff in the eye clinic.

With this real-time data in hand, Ravi and his team now make decisions, such as when to increase staff and at which locations, to reduce waiting time. “We no longer need a periodic review of patient and staff flow. We can do it continually” on the fly, he says.

Seeing Is Believing

In addition to monitoring patient flow, the system now plays an integral role in the workflow itself. Nurses know which patients have checked in, how long each has been waiting and where in the process they are. Staff also can see if a patient has left the waiting room — for example, to go outside or to use the restroom — and when the patient returns. This relieves nurses from trying to locate patients who are not in the building. And instead of announcing patient names (problematic for addressing hard-of-hearing patients), staff now check where patients are seated and go to them.

Ravi, who sits on a VA advisory council for RTLS technology, acknowledges that he will have to answer a number of questions regarding safety, accuracy, software capability and cost before other VA clinics broadly adopt RTLS applications. “We don’t have all the answers yet,” he says. “But from the initial results, this looks like it will be an important technology for us.”

RFID will not replace barcodes any time soon. Using barcodes to dispense medication, for instance, can improve patient safety at relatively low cost, points out Liard. But RFID applications have the potential to move the tracking process closer to real time, and that in turn opens up a whole host of new potential applications, Ravi says.