Friday
May 14, 2004
Khaki Weber sits calmly in her cluttered, basement materials management office at Bon Secours St. Mary's Hospital in Richmond, Va. Last year at this time, if a nurse asked for a few extra I.V. poles, she would have gone on a useless hunting expedition to several unit utility rooms. There was no telling if she would find what she needed, if she would have to rent equipment or incur courier charges to borrow from a sister facility.
Today she does not even receive frantic phone calls. Nurses simply press an icon on their computers, pick from a list what they need, then a map of the floor appears on a computer screen pinpointing where the nearest EKG machine is located, even if it's stored in a remote alcove. The practice is similar to air traffic control tracking planes in the air.
"Our nursing staff was telling us they were spending a lot of time looking for equipment and were frustrated because they couldn't find things when they needed them," says Jerrold Maki, vice president, resource management, for three Bon Secours Richmond community hospitals, including St. Mary's. "Between the clinical and materials staff looking for things, there was a lot of unproductive time."
Earlier this year, 12,000 pieces of mobile medical equipment at Bon Secours Richmond hospitals--from $300 wheelchairs to $40,000 portable heart monitors--were tagged with tiny cube-size RFID badges in what is believed the largest U.S. hospital installation of budding RFID technology to date.
RFID, or radio frequency identification, is the next generation in bar coding. It has been used for years for tracking and verification by the military and in automotive and cattle industries. But only in the last year has it begun to gain acceptance as a solution to some of the problems in health care.
"Interest is tremendous. Possibilities are endless. Benefits are huge," says Bill Allen, manager of marketing communications for RFID, Texas Instruments, Plano, Texas.
The $15 battery-operated tag transmits a unique identification number every four seconds through antennas in hospital ceilings linked to a computer server. Hardware and software determine the location, which is displayed on a floor plan of the hospital on the hospital's computer. Tags identify products, but they can also identify people and track the movements of both.
Engineering studies ordered by Bon Secours demonstrated employees spent 25 percent to 33 percent of their time searching for equipment; that patients were taking home knee exercisers from physical therapy or other equipment left in their rooms; and that ambulances were driving off with hospital infusion pumps. "They were losing 10 percent of their inventory annually," says Fran Dirksmeier, CEO, Agility Healthcare Solutions, Richmond, whose company conducted the studies and installed an RFID system.
RFID eliminates some shrinkage because tags send e-mails or pages to hospital security when assets are taken outside a building; when wheelchairs are pushed beyond the campus perimeter and when telemetry devices are mistakenly bundled in the laundry.
In its first year, RFID is expected to save Bon Secours Richmond a conservative $203,000, Maki says, though he admits the figure could be much higher.
Dirksmeier estimates a 200-bed hospital can save $600,000 annually from less shrinkage, fewer rentals, deferral of new purchases and staff productivity. A 500-bed hospital could save $1 million annually.
At the 148-bed suburban Advocate Good Shepherd Hospital, Barrington, Ill., RFID has been in place for a year, which is long enough to determine if the hype bears up under scrutiny. "It has cut in half inventory losses that were about 10 percent annually," reports Paul Drake, director of materials management. "I fell in love with it. I can find things in seconds. The productivity of people is fantastic."
Drake used Deerfield, Ill.-based Baxter International's QuickFind Asset Management system to tag 700 pieces of mobile equipment in March 2003. He has been adding 100 pieces monthly.
"Previously after we received equipment, it went up into the units where it fell into a black hole," Drake says. "If you're constantly bringing in rental equipment and it never leaves, that's a huge expense."
Holy Name Hospital in Teaneck, N.J., a 361-bed hospital, purchased an asset tracking system with wireless technology. Benefits of the new system in which more than 2,000 pieces of equipment are being tagged, include less time for nursing and ancillary staff to track down equipment, the ability to locate equipment due for preventive maintenance more quickly and the reduction of rental costs due to improved availability of the equipment.
The system can be accessed through computers in each nursing unit and in other designated areas. When staff needs to locate a device, a person can search for specific items or search for a category of equipment.
An example of the system usefulness is in such areas as the post anesthesia care unit, which is responsible for pain management infusion pumps. By searching for this category of pumps, they can generate an inventory report listing the location of each of these pumps. This makes retrieval of the pumps convenient and increases their use.
Agility's research indicates hospitals lose 5 percent to 15 percent of their equipment inventory annually, much of that owing to theft. Multiple entrances and exits make it difficult to monitor who and what comes in or out. "It's not uncommon to lose assets. Doctors in private practice 'borrow' something," says Perry Stearns, Baxter's senior project manager, asset tracking. Also, thieves off the street steal and sell hospital items.
Last year, The Miami Herald reported that Jackson Memorial Hospital, Miami, could not account for $4 million worth of equipment--20,000 items--some as large as hospital beds, stretchers, defibrillators, sterilizers, lasers and oscillating saws. Within two years, the hospital plans to install a sophisticated RFID system, says Al Cook, Jackson's vice president, logistics and distribution.
In addition to equipment tracking, Cook is investing in some of RFID's other applications. "Once you make the commitment to the expense of infrastructure, it behooves you to run as many applications as you can over the network," he says. "Some of these applications might include a scrub dispensing machine that uses RFID instead of hand data entry."
Doctors who return scrubs would receive credits to their account so they can have more, up to three pair. Cook also is considering attaching tags to every ER stretcher to find out if a missing patient is in radiology or the lab. "A lot of times, ER doesn't know where a patient is," Cook says.
Tags will be affixed to such expensive products as stents, balloons and aortic grafts to record movement, track vacancies and monitor shortages due to theft. Surgical instruments could have tags too, so that after an operation, each set can be tracked to assure it has been sterilized. Patients will receive RFID armbands for bedside verification of medication.
But one of the most significant uses is in billing. "We will be able to push a button at midnight every night and know every chargeable piece of equipment that is in each room and tie it to admissions," Cook says.
The applications require tiny antennas every 50 feet over Jackson's 50-acre campus, an infrastructure that will cost $2.5 to $3 million dollars. Extra antennas are required in radiology to ensure signals reach through lead-lined walls. One of the primary justifications for the infrastructure is medication safety and malpractice avoidance, Cook says.
There are less expensive ways to install RFID to locate assets without creating a lot of infrastructure, says Robert Ufford, co-founder, RF Code, a Mesa, Ariz., RFID manufacturer. For $5,000 to $10,000, smaller hospitals can buy hand-held devices that can find equipment within 60 feet. But they won't interface with hospital computers.
RFID tags are just for expensive equipment. "We have people who tag a 50 cent key with a $15 tag," Ufford says. "Especially if the key is a master that opens 300 locks. The expense of re-keying outweighs the cost of the RFID tag." Though it seems impractical to tag relatively inexpensive I.V. poles, they are used a lot, so finding one when needed is critical.
RFID and bar coding are complementary technologies. "I'm terribly afraid that with all the excitement about RFID's potential, people may wait for RFID and not implement bar coding," says Cook. "Bar-code technology is fully developed and should not be delayed--the two can complement each other. You would only replace bar coding with RFID if it were economically feasible. For instance, it's not economically feasible to put a costly RFID tag on an aspirin, but it might be for feasible for some expensive chemotherapy drugs."
Hospitals have always been slow to adopt such new technologies as computerization and barcoding. It is no different with RFID. "About 3 percent of U.S. hospitals have some form of RFID in place," estimates Allen of Texas Instruments.
And, adds Stearns, "In 10 years, at least half of all hospitals will use at least some RFID. They have to, because they are in a competition for the best talent so they are driven by cost reductions. It's a matter of how quickly hospitals will justify return on investment."
Technology arises to solve problems. The first known use of RFID technology was during World War II, when American and British allies shot each others' aircraft down because they couldn't determine if they were friend or foe. The U.S. military equipped planes with RFID transponders to transmit signals, according to representatives of the RFID trade group the Association for Automatic Identification and Mobility (AIM), Warrendale, Pa.
About 50 years later, in the late 1980s and early 1990s, RFID use accelerated when retailers applied simple versions of RFID tags on merchandise that beeps if customers leave stores without paying. ExxonMobil distributed 6.5 million RFID Speedpasses that shorten the time it takes to pay for gas at a pump. Municipalities began pushing Ezpass or SunPasses that debit a credit card as people drive through toll stations. The automotive industry further sanctioned the technology when it bought oversized keys with RFID tags inside for certain cars to prevent car thefts.
Some of the newest applications are time savers. For example, Seattle Seahawks football club ticket holders who want a hotdog at halftime pay for their concession purchases by waving a key over a reader to have charges deducted from their debit or credit card accounts.
But so many potential uses for the technology have sprung up for hospitals that an entire conference devoted to RFID in health care took place last December in Washington, D.C., for the first time, bringing some of the most important manufacturers and industry leaders together. A quarterly, RFID Journal, one of the industry's trade magazines, issued a January cover story on RFID in health care, "A Healthy Dose of RFID."
Among the most recent RFID hospital developments are:
In a February report, Combating Counterfeit Drugs, the FDA recommended, but did not mandate, the use of RFID tags on medications by 2007 to thwart prescription drug counterfeiters.
It's a way to find fake, diluted or mislabeled medications. Each tag would identify a product's manufacturer, describe the product and include a unique serial number. Manufacturers, distributors or customs agencies could scan a tag and, check a database to verify the origin of the shipment. If the drug lacks a unique serial number or duplicates an existing number, it could indicate tampering or counterfeiting.
Introducing a new technology is not without challenges. Some RFID issues include interference, acceptance and privacy. Drake says it took six months to iron out the kinks.
Tagging a Doppler unit caused an audible pinging noise and interference occurred when tags were placed on portable sonogram machines. Changing the tag position eliminated the problem.
Also, selecting a wireless network that offers flexibility in its frequency of operation also will reduce potential interference. There is some concern about RFID interference with pacemakers and cell phones.
"Some technologies are not ready for prime time," says Allen. "Texas Instruments did an internal study and found RFID had no effect on pacemakers, but they can disrupt a cell phone and vice versa. These issues have to be worked out." Agility's studies found no interference with telemetry equipment.
Devices can falter for other reasons too. "Sometimes equipment fails because signals cannot be transmitted through some metal, liquids, magnets and other objects," says Thomas Bruno, president of Bruno Associates, a consulting firm in Arlington, Va. "Also, the amount of glue on an RFID label, electrical noise from generators, tag to tag interference and software issues are troublesome."
Bruno says that RFID equipment can have up to a 40 percent failure rate. "Batteries die before their expected lifetimes." And, although RFID has sophisticated encryption, it isn't hackproof.
Both Drake and Maki say an engineering study is imperative prior to RFID installations to curb some of the problems before they occur. "You must have enough antennas to ensure adequate coverage. Too many antennas are unnecessary and expensive; too few and the system won't work properly," Maki says.
Bruno suggests hospitals strapped for cash look to their local colleges to conduct studies. "Hospital materials managers can go to a local university with Ph.D. engineering, math and business departments to get research help for feasibility studies, and statistical and business analysis. Universities have grant funds for this purpose."
Besides equipment failures, some hospitals found fear and apprehension of the new technology among their nursing staffs, requiring extensive training and retraining. "A lot of nurses are not computer savvy. You should not buy a system that requires a nurse to go through 16 screens to locate a piece of equipment because they won't use it," Drake says.
Finally, there is the issue of privacy. Privacy advocates don't have a problem when tags are placed on equipment. They draw the line when they see the hand of Big Brother placing tags on people, even though it may be argued safety concerns outweigh privacy issues.
"A lot of medical applications being proposed violate the privacy of doctors, nurses and patients," says Katherine Albrecht, a Harvard doctoral student who founded CASPIAN, (Consumers Against Supermarket Privacy Invasion and Numbering), one of the most vocal anti-RFID groups, which claims the game of tag is being played unfairly. The group formed in 1999 to protest retail cards that track who is buying what products through RFID tagged products purchased by credit card. "On human beings, RFID is totally inappropriate. The whole idea of being treated as a numbered inventory unit is unacceptable. If a patient gives informed consent, that's fine. But it sets an extremely dangerous precedent for tracking human beings across the board," Albrecht says.
The American Civil Liberties Union also takes issue with RFID. "The real scandal is that there are no laws about how RFID technology can be used," says Barry Steinhardt, director, ACLU's technology and liberty program. "Will bracelets track patients once they leave the hospital?"
Most RFID hospital applications are under study. The costs--hardware, software, installation, upgrades and maintenance--have to merit the expense. "RFID sounds cutting edge, but there needs to be a payback," says Maki.
Maureen Glabman is a freelance writer based in Miami.