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Page 1: March, 2006 2 March, 2006
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March, 2006 Improving Patient Safety With RFID 2

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!