AutoID at Hospital
“Information Rich Environment For Hospital”




                     In K. Mun, Ph.D.
               VP...
IOM Report in 1999                                                           What does it mean?
To Err is Human: Building ...
HCA Barcode Point Of Care                                                                                  BPOC Experience...
Hospital RFID Applications                                                     Hospital RFID Applications
      • Patient ...
Wireless 802.11 Coverage                                                                                            Tag de...
Step D
                                                                                          Pilot Configuration
Add a...
Infusion Pump Utilization                                                                                                 ...
Information Content                                                                     Cost Structure Issues
      Cost e...
Lessons from Active RFID
          Active RFID can be cost effective.
                 Rental equipment management
       ...
Comments
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Aeroscout Hca

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  1. 1. AutoID at Hospital “Information Rich Environment For Hospital” In K. Mun, Ph.D. VP, Research & Technology, EG, HCA Adjunct Associate Professor, Neurological Surgery, UMDNJ T: 305-582-722, E: ikm1@aol.com 1
  2. 2. IOM Report in 1999 What does it mean? To Err is Human: Building A Safer Health System Medication Errors: One million patients in hospitals daily 770,000 injuries caused by medication errors per year events occurring in a hospital 39% 38% physician ordering drug administration when there is not enough 11% drug dispensing information to identify each item 44,000 – 98,000 preventable deaths per year uniquely. 5% of patients acquire an infection from a hospital Barcoding “is an effective remedy” for medication errors, “a simple way to How can we create information ensure that … all of the steps in the dispensing and administration processes are checked for timeliness and accuracy.” rich local environment to prevent errors? March 22, 2007 AutoID at Hospital 2 March 22, 2007 AutoID at Hospital 3 Traditional ID Issue Identification Technology in 1999 Barcode Linear Barcode • Well known technology in many industries • Lower cost, easy to copy / print • Manual process • few digits of identification number / characters 2D barcode • Reasonably known technology • Expensive reader, • Store more data than linear barcode RFID Passive RFID • Smartcard in Europe using 13.56 Mhz tag • High cost, good security, limited range • Transaction based automation Active RFID • Military products using 433Mhz • Expensive, good security, longer range • Proactive automation possible March 22, 2007 AutoID at Hospital 4 March 22, 2007 AutoID at Hospital 5 AutoID Projects Barcode For Healthcare 1983 – The Health Industry Business Communication Council (HIBCC) Barcode Project 1985 – First published account of medication bar-coding Low tag cost 1985 – Medication dispensing • Disposable items 1985 – Hokanson JA, et al, Am J Hosp Pharm 1985 – Nold EG & Williams TC, Am J Hosp Pharm Manageable for high volume 1987 – Smith JE & Meyer GE, Am J Health Syst Pharm. Good ROI 1989 – Medication administration 1989 – Barry GA et al, Am J Hosp Pharm 1991 – Lefkowitz S et al, Hosp Pharm RFID Project 1992 – Abdoo YM, Comput Nurs High tag cost 1999 – IOM report: discussed barcode to improve patient safety • Reusable/durable items 1999 – 1.1% of hospitals (60) using barcode 2001 – FDA announces intent to propose a bar code rule Better for low volume projects 2002 – 1.5% of hospitals (90) using barcode Uncertain ROI 2004 – JCAHO make a proposal and drops mandate 2005 – 9.4% of hospitals (560) using barcode March 22, 2007 AutoID at Hospital 6 March 22, 2007 AutoID at Hospital 7 1
  3. 3. HCA Barcode Point Of Care BPOC Experience by 2005 # sites # doses # users HCA 171 115,933,163 65,000 Mercy 010 7,359,897 10,698 UPMC 002 2,103,789 01,800 BSA 001 1,692,561 00,757 March 22, 2007 AutoID at Hospital 8 March 22, 2007 AutoID at Hospital 9 Lessons From BPOC RFID Project Reviewing available technologies starting 2000 • BPOC does reduce medication errors Passive RFID Active RFID • Better documentation possible Defined problems to solve in 2002 Asset management for rental / leased items & theft Process improvement tool • An important building block of EMR/EHR Selected active RFID technology in 2003 Automation / Reliability ⇒ Issues noticed Return-on-investment (ROI) based on existing cost figures Manual processes Selected a vendor out of nine vendors in 2004 Battery life / Size of tag Operational experience / future applications Everybody must be engaged Barcode labels can be duplicated easily Implemented a pilot system in 2005 A 120 bed hospital Hospital-wide implementation Work around is possible March 22, 2007 AutoID at Hospital 10 March 22, 2007 AutoID at Hospital 11 RFID Tags and Readers RFID Tags and Readers Tag in mold Tag-it Smart Labels implantable tag Infusion Pump w. active tag UHF tag RFID Patient Wrist Band and Handheld Readers March 22, 2007 AutoID at Hospital 12 March 22, 2007 AutoID at Hospital 13 2
  4. 4. Hospital RFID Applications Hospital RFID Applications • Patient Wristband 1. Asset Management • Blood Product Management 2. ER, OR, ICU Management • Cold Chain Management 3. Patient Wristband • ER, OR, ICU Management 4. Blood Product Management • Point of Care 5. Point of Care • Pharmaceutical Pedigree 6. Cold Chain Management • Combating Counterfeit Drugs 7. Pharmaceutical Pedigree • Asset Management 8. Combating Counterfeit Drugs March 22, 2007 AutoID at Hospital 14 March 22, 2007 AutoID at Hospital 15 Asset Management Why Asset Management? National average utilization of mobile equipment is 45% - Managing infants Universal Hospital Services Managing medical device, consumables Hospitals can lose nearly $1 million a year in medical equipment thefts alone - HCPro Healthcare Marketplace Theft prevention, location, storage, readiness Five to fifteen percent of hospital inventory is written off each Bio-Medical service, repair, PM year since it can no longer be located or more importantly serviced - Frost & Sullivan Rental equipment management “Equipment moving from patient to patient without going Managing Patients through decontamination in between has become a significant issue to JCAHO in regard to infection control in Managing nurses, technologists and physicians hospitals” - JCAHO Sentinel Alert To build an infrastructure for future patient safety improvements March 22, 2007 AutoID at Hospital 16 March 22, 2007 AutoID at Hospital 17 RFID Vendors at 2006 HIMSS Selection Criteria • AeroScout 1610 • Parco 7229 Existing workflow / definition of problem • Agility Healthcare 3450 • Patientree 7224 Tag type • AwarePoint 1714 • Per-Se Technologies 3623 • Communication Specialists 7938 • Precision Dynamics 0142 Tag size • Cygnus Inc 4452 • Radiense 5700 Battery life • Ekahau 1504 • RF Ideas 1851 • Sayers Healthcare 7015 Resolution • Extreme Integration 5204 • General Data Company 5704 • Scuptor Dev Tech 1252 Dependencies: density of tags, network, • Healthcare Pilot 7838 • Sun Microsystem 3649 Installation • Indidge System 7200 • USA Mobility 7850 • Infosys technologies 7703 • Visible Assets 7037 User interface • MediTek Interactive 7926 • GE Healthcare 4509 Project management experiences • PanGo 4050 • Siemens Healthcare 1237 ROI (Return On Investment) March 22, 2007 AutoID at Hospital 18 March 22, 2007 AutoID at Hospital 19 3
  5. 5. Wireless 802.11 Coverage Tag density at Bio-Med I I I I I I Power 802.11 Network Design 802.11 Network Design For data For resolution 100 ft diameter 50 ft diameter 30 ft. ~ 40-50 ft. 100+ ft Range * Easily more than 100 tagged items could be in a bio-med service room! * There are several issues to be considered carefully before using wireless 802.11 for asset management. March 22, 2007 AutoID at Hospital 20 March 22, 2007 AutoID at Hospital 21 Step A Other Busier Bio-Med Shop Primary patient care areas covered A Storage locations identified Low resolution, only discriminate between zones A&B B March 22, 2007 AutoID at Hospital 22 March 22, 2007 AutoID at Hospital 23 Step B Step C Add Add additional coverage for readers to exits for theft identify patient control rooms and waiting areas March 22, 2007 AutoID at Hospital 24 March 22, 2007 AutoID at Hospital 25 4
  6. 6. Step D Pilot Configuration Add additional readers for full Device management: tracking, service, rental coverage. 433 Mhz active tag Smallest tag to maximize number of items to track Real-time tracking (few times per minute) Variable resolution: bed, room, department,.. Manage high density of tags in a room Minimum additional network traffic Clean installation: invisible readers Web applications: support PDA, laptop, … Less than three years for ROI To develop additional applications March 22, 2007 AutoID at Hospital 26 March 22, 2007 AutoID at Hospital 27 Current Status Tagged Items Installation & staff training done Few hiccups & push backs Interfaced to bio-medical service database Interesting information Some items not moving Relationship among unexpected items (rental / discharge Device service record Designing new workflows to improve operations To increase ER throughput Surgical tool tracking in OR To improve workflow in ICU New interface to physician PDA Less than three years for ROI based on hard benefits March 22, 2007 AutoID at Hospital 28 March 22, 2007 AutoID at Hospital 29 Clinical Touch-screen GUI Engineer’s Handheld GUI Zoom In Zoom Out Select group View Assets by Floor Sliding Zoom Bar March 22, 2007 AutoID at Hospital 30 March 22, 2007 AutoID at Hospital 31 5
  7. 7. Infusion Pump Utilization Issues: Database Entries Common name used by nurses: Arjo Lift 250 Common name used by industry: Lift/Patient The device name: Patient Lift 200 150 Manufacture Model # Description Arjo Hospital equipment Inc. KPA0310 Patient Lift 100 Arjo Hospital equipment Inc. KGA0310 Lift Arjo Hospital equipment Inc. KKA5020 Arjo Lift 50 Arjo Hospital equipment Inc. KGA5020 Lift/Patient Arjo Hospital equipment Inc. KPA0310 Lift/Patient 0 Arjo Hospital equipment Inc. KPA0310 Patient Lift 6 6 6 6 6 6 6 6 6 00 00 00 00 00 00 00 00 00 /2 /2 /2 5/2 2/2 9/2 3/2 2 2 0/ 7/ Arjo Hospital equipment Inc. KPA0310 Patient Lift 4/1 4/8 5/6 4/1 4/2 4/2 5/1 5/2 5/2 Census Pumps on Floors Total Pumps Arjo Hospital equipment Inc. KKA5020 Lift/Patient Arjo Hospital equipment Inc. KPA0310 Lift/Patient April1 through May 30, 2006 Arjo Hospital equipment Inc. KGA0310 Arjo Lift Single and Multi-Channel Infusion Pumps Excludes rentals March 22, 2007 AutoID at Hospital 32 March 22, 2007 AutoID at Hospital 33 Addressing DB Issues 2D Barcode for Local DB How much information do we need? Minimum change in workflow Information rich local environment is the key in Reasonable cost for infrastructure reducing most medical errors. Less physics issues Solution for item level issues Manually correct errors in DB Data rich local environment More info available to reduce additional errors Katrina factor To prevent recurring errors Local DB? March 22, 2007 AutoID at Hospital 34 March 22, 2007 AutoID at Hospital 35 RFID & 2D Barcode 2D Barcode March 22, 2007 AutoID at Hospital 36 March 22, 2007 AutoID at Hospital 37 6
  8. 8. Information Content Cost Structure Issues Cost effective unifying standard leading to EMR Start-up cost • Staff badges • Patient wristband / patient identification Recurring cost • Non-IV medication • IV-medication / smart infusion pumps • Medical device identification Liability cost • Blood products Monopoly cost Documents of interests • Positive identification for patient medication safety from Partners Healthcare Systems • Working documents from ISBT-RFID Task Force. • Documents for HIBCC standards March 22, 2007 AutoID at Hospital 38 March 22, 2007 AutoID at Hospital 39 Cost: Monopoly Foot Notes Patents Minimize monopoly Start of new idea / business Break financial links / associations Intellectual property Stop cross subsidies More rational patent law Law, rules & regulations Protecting citizens by government Maximize competition & innovation Source of liability Remove 800 lbs snakes Not empowering rats or termites Standards Industry / government sponsored guide lines Helpful for a wider adoption leading to lower cost March 22, 2007 AutoID at Hospital 40 March 22, 2007 AutoID at Hospital 41 Operational Processes Savings By An Early Adopter RFID $4,000,000 Location Identification Positioning Asset Tracking $3,500,000 Security System $3,000,000 Inventory Management $2,500,000 Utilization $2,000,000 Requisition / Distribution Operational $1,500,000 Rentals Process $1,000,000 Safety / Risk Management RFID-Enabled Management $500,000 Device Transport Management $0 Equipment Cleaning Application Year 1 Year 2 Year 3 Year 4 (projected) Regulatory Compliance Realized Net Savings to Date: Over $1.5 Million Clinical Engineering Excludes “cost avoidance” and “soft” savings Financing / Accounting March 22, 2007 AutoID at Hospital 42 March 22, 2007 AutoID at Hospital 43 7
  9. 9. Lessons from Active RFID Active RFID can be cost effective. Rental equipment management Inventory control of equipment: lower the asset level Better management of PM & service issues Cost / workflow management Utilization based on proactive data using active RFID Must be willing to change workflow Work-In-Progress Additional developments ED & patient tracking Blood products / Biologicals Global view of hospital operation How do you manage database? What do I do with surgical tools? Backup information? What happens without connectivity?? • Natural disaster like Katrina, earthquake • Remote areas • loss of power March 22, 2007 AutoID at Hospital 44 March 22, 2007 AutoID at Hospital 45 Room Level For ED Patient Level March 22, 2007 AutoID at Hospital 46 March 22, 2007 AutoID at Hospital 47 Real-time Patient Location GUI for Upper Management Home Equipment Manager Surgical Services ED Manager Bed & Room Manager Other Applications OR Suite Utilization In Use Message Prep Center Scheduled Cleaning Inbox (3) Not Sched Messenger Infusion Pump Utilization In Use Available Soiled Out of Service Online: 21 Patient-Tag Association March 22, 2007 AutoID at Hospital 48 March 22, 2007 AutoID at Hospital 49 8
  10. 10. Comments AutoID (RFID & Barcode) is being applied in more and more areas to improve patient safety and reduce cost. New business model for standard has emerged, which may create a world-wide monopoly outside of any government control even beyond US FDA Cost of AutoID is dropping where competitive pressure exists. (RFID: 12 - 50 cents passive tags, $15 - $200 for active tags) (barcode: less than 0.2 cent / 0.5 cent for 1D / 2D ) Emergency Department Metrics AVERAGE INTERVALS FOR TODAY (minutes) Actual Target CURRENT PATIENTS IN WAITINGROOM Surgical Services Metrics Active RFID and 2D Barcode without passive RFID may 160 7 6 % 100 90 AVERAGE BLOCK TIME UTILIZATION 40 COMPLETED CASES Cases/Hr Cumulative Cases complement each other well enough to create information rich local environment, which is critically important in improving 140 80 35 120 5 70 30 # of Patients 60 25 100 80 4 3 50 40 30 20 20 15 10 patient care and reduce healthcare cost for hospitals. 60 2 10 5 40 0 0 7 8 9 10 11 12 13 14 15 16 17 18 1 7 8 9 10 11 12 13 14 15 16 17 18 20 Time of Day Time of Day 0 0 Time to Time to Time in Time to Nurse Doctor Time in Total <15 20 25 30 35 40 45 50 55 60 60+ Triage Registration Waiting Exam Response Response ED Time Minutes Waiting March 22, 2007 AutoID at Hospital 50 March 22, 2007 AutoID at Hospital 51 Thank You! In K. Mun, Ph.D. e: ikm1@aol.com / m: 305-582-7221 March 22, 2007 AutoID at Hospital 52 9

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