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March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
March, 2006 2 March, 2006
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March, 2006 2 March, 2006

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  • 1.  
  • 2. Improving Patient Safety with RFID I.4 RFID Applications for Hospitals
  • 3. RFID Applications for Hospitals Improving Patient Safety with RFID <ul><li>In K. Mun, PhD </li></ul><ul><li>Director, Hospital Research, HRI, MIT </li></ul><ul><li>Director, Bio-Medical Research, AHMC </li></ul><ul><li>Cambridge, Massachusetts </li></ul>
  • 4. <ul><li>One million patients in hospitals daily </li></ul><ul><ul><li>770,000 injuries caused by medication errors per year </li></ul></ul><ul><ul><ul><li>39% physician ordering </li></ul></ul></ul><ul><ul><ul><li>38% drug administration </li></ul></ul></ul><ul><ul><ul><li>11% drug dispensing </li></ul></ul></ul><ul><ul><li>44,000 – 98,000 preventable deaths per year </li></ul></ul><ul><ul><li>5% of patients acquire an infection from a hospital </li></ul></ul><ul><li>Staff shortage: nurse, physician, technologist </li></ul>IOM Report in 2000
  • 5. <ul><li>Optimize / Improve Workflow </li></ul><ul><li>Computerize operation </li></ul><ul><ul><li>Hospital Information System (HIS) </li></ul></ul><ul><ul><li>Picture Archiving & Communication System (PACS) </li></ul></ul><ul><ul><li>Computerized Physician Order Entry (CPOE) </li></ul></ul><ul><ul><li>Electronic Medical Record (EMR) </li></ul></ul><ul><ul><li>Electronic Medication Administration Record (eMAR) </li></ul></ul><ul><ul><li>Standard Interface Protocols: HL7, DICOM, … </li></ul></ul><ul><li>Barcode-enabled Point-of-care (BPOC) </li></ul><ul><li>Patient Safety Initiatives </li></ul>Response To IOM Report
  • 6. 5 Years After The IOM Report <ul><li>The pace of change “frustratingly slow” </li></ul><ul><li>The death rate has not decreased substantially </li></ul><ul><ul><li>Leap / Berwick, JAMA, May 18, 2005 </li></ul></ul>
  • 7. Technical Question <ul><li>What Is The Main Source Of Problems? </li></ul>
  • 8. identification We do not know how to identify patients and medications correctly. We need to identify every item and relationship uniquely in a hospital.
  • 9. <ul><li>Unique Identification (UID) at item level </li></ul><ul><ul><li>Barcode </li></ul></ul><ul><ul><ul><li>Not as good as expected </li></ul></ul></ul><ul><ul><li>RFID (Radio Frequency IDentification) </li></ul></ul><ul><ul><ul><li>Promising new technology </li></ul></ul></ul>
  • 10. RFID (Radio Frequency IDentification) <ul><li>Technology around since WWII </li></ul><ul><li>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. </li></ul><ul><li>More expensive than barcode </li></ul><ul><li>Direct sight is not needed to get information, since information is exchanged using radio-frequency </li></ul><ul><li>More difficult to counterfeit than barcode </li></ul>
  • 11. RFID Types <ul><li>Tag types </li></ul><ul><ul><li>Passive RFID (pRFID), tag powered by a reader </li></ul></ul><ul><ul><li>Active RFID (aRFID), tag powered by a battery </li></ul></ul><ul><li>Frequency types </li></ul><ul><ul><li>135 Khz </li></ul></ul><ul><ul><li>13.56 Mhz </li></ul></ul><ul><ul><li>433 Mhz </li></ul></ul><ul><ul><li>869 / 915 Mhz </li></ul></ul><ul><ul><li>2.45 / 5.8 Ghz </li></ul></ul>
  • 12. Reader Information System Tags RFID System
  • 13. RFID Tags and Readers Tag in mold RFID Patient wrist band and Handheld readers UHF tag Infusion Pump with active tag implantable tag Tag-it Smart Labels
  • 14. RFID Tags and Readers
  • 15. Simple RFID System Active RFID tag reader Network Manager Active RFID tag CPOE / Portable passive RFID tag reader, wristband w. passive RFID tag Hospital Network Nursing Station Monitoring Medication Orders, RFID system WI-FI ACCESS POINT WI-FI ACCESS POINT passive RFID tag
  • 16. RFID Applications <ul><li>Based On Standard Utilization </li></ul><ul><ul><li>Closed System </li></ul></ul><ul><ul><li>Open System </li></ul></ul><ul><li>Based On Clinical / Commercial Maturity </li></ul><ul><ul><li>Accepted Applications </li></ul></ul><ul><ul><li>Evolving Applications </li></ul></ul><ul><ul><li>Research Applications </li></ul></ul>
  • 17. Based On Standards <ul><li>Closed system </li></ul><ul><ul><li>Novel applications </li></ul></ul><ul><ul><li>Early phase of market development </li></ul></ul><ul><ul><li>Changing technology </li></ul></ul><ul><ul><li>Fast development </li></ul></ul><ul><ul><li>Pressure on performance rather than cost </li></ul></ul><ul><ul><li>Difficult to control long term cost </li></ul></ul><ul><ul><li>Produced by smaller companies </li></ul></ul><ul><ul><li>May transition to an open system </li></ul></ul>
  • 18. Based On Standards <ul><li>Open system </li></ul><ul><ul><li>Established markets </li></ul></ul><ul><ul><li>Stable technology </li></ul></ul><ul><ul><li>Standardized protocols reached by consensuses </li></ul></ul><ul><ul><li>Compromise on performance </li></ul></ul><ul><ul><li>Pressure on cost </li></ul></ul><ul><ul><li>Slow development cycle </li></ul></ul><ul><ul><li>Produced by large companies </li></ul></ul>
  • 19. Based On Maturity <ul><li>Accepted Applications </li></ul><ul><ul><li>Reasonably well known favorable ROI </li></ul></ul><ul><ul><li>Several pilot projects done </li></ul></ul><ul><li>Evolving Applications </li></ul><ul><ul><li>Trying to establish favorable ROI </li></ul></ul><ul><ul><li>Doing pilot projects </li></ul></ul><ul><li>Research Applications </li></ul><ul><ul><li>Estimated ROI based on optimistic projections </li></ul></ul><ul><ul><li>Novel ideas </li></ul></ul>
  • 20. Accepted Applications <ul><li>Asset Management </li></ul><ul><ul><li>Managing equipment, device and consumables </li></ul></ul><ul><ul><ul><li>Location, storage, inventory, service, repair </li></ul></ul></ul><ul><ul><ul><li>Theft prevention </li></ul></ul></ul><ul><ul><ul><li>Rental equipment </li></ul></ul></ul><ul><ul><ul><li>10 to 20 items per bed (5000 items for 300 bed hospital </li></ul></ul></ul><ul><ul><ul><li>Active tags (433Mhz, 915Mhz, 915Mhz, 2Ghz, 5.8Ghz </li></ul></ul></ul><ul><ul><li>Managing infants and patients </li></ul></ul><ul><ul><li>Managing nurses, technologists and physicians </li></ul></ul>
  • 21. Why Asset Management? <ul><li>National average utilization of mobile equipment is 45% - Universal Hospital Services </li></ul><ul><li>Hospitals can lose nearly $1 million a year in medical equipment thefts alone - HCPro Healthcare Marketplace </li></ul><ul><li>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 </li></ul><ul><li>“ 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 </li></ul><ul><li>Baby mix-up </li></ul>
  • 22. Example
  • 23. Issues To Consider <ul><ul><li>Existing workflow </li></ul></ul><ul><ul><li>Tag type </li></ul></ul><ul><ul><li>Tag size </li></ul></ul><ul><ul><li>Battery life </li></ul></ul><ul><ul><li>Resolution </li></ul></ul><ul><ul><li>Dependencies </li></ul></ul><ul><ul><li>Installation </li></ul></ul><ul><ul><li>User interface </li></ul></ul><ul><ul><li>Clinical experiences </li></ul></ul><ul><ul><li>ROI (Return On Investment) </li></ul></ul>
  • 24. Sample Case <ul><li>433 Mhz active tag </li></ul><ul><li>Small tags to maximize number of items to track </li></ul><ul><li>Real-time tracking (broadcast few times per minute) </li></ul><ul><li>Variable resolution: bed, room, department,.. </li></ul><ul><li>Manage high density of tags in a room </li></ul><ul><li>Minimum additional network traffic </li></ul><ul><li>Simple installation: invisible readers </li></ul><ul><li>Web applications: support PDA, laptop, … </li></ul><ul><li>Several large successful hospital installations </li></ul><ul><li>Less than three years for ROI </li></ul><ul><li>Willing to develop additional applications </li></ul>
  • 25. Next Steps To Be Taken <ul><li>Interface to HIS / PACS / PDA </li></ul><ul><ul><li>Total patient flow management </li></ul></ul><ul><li>Blood product management </li></ul><ul><li>OR & ICU management </li></ul><ul><li>Medication management </li></ul><ul><ul><li>Total care management </li></ul></ul>
  • 26. Evolving Applications <ul><li>Patient wristband </li></ul><ul><li>Blood product management </li></ul><ul><li>Operating room management </li></ul><ul><li>ICU management </li></ul>
  • 27. Patient Wristband <ul><ul><li>Unique Identification of each patient </li></ul></ul><ul><ul><li>Networked environment </li></ul></ul><ul><ul><ul><li>Hospitals with HIS & PACS </li></ul></ul></ul><ul><ul><ul><li>Read-only limited information, HIPPA </li></ul></ul></ul><ul><ul><li>Non-networked environment </li></ul></ul><ul><ul><ul><li>Military, natural disaster like hurricane, flood, earth quake </li></ul></ul></ul><ul><ul><ul><li>Read-write </li></ul></ul></ul><ul><ul><li>Frequency, Read Range </li></ul></ul><ul><ul><ul><li>13.56Mhz / 433Mhz </li></ul></ul></ul><ul><ul><ul><li>Active / passive </li></ul></ul></ul><ul><ul><ul><li>Short, medium, long </li></ul></ul></ul>
  • 28. Blood Product Management <ul><ul><li>Accuracy </li></ul></ul><ul><ul><li>Reliability </li></ul></ul><ul><ul><li>Cost </li></ul></ul><ul><ul><li>Temperature monitoring </li></ul></ul><ul><ul><li>Two early sites: MGH & Georgetown </li></ul></ul><ul><ul><li>Frequency </li></ul></ul><ul><ul><ul><li>13.56Mhz, passive tag </li></ul></ul></ul><ul><ul><ul><li>433Mhz, active tag </li></ul></ul></ul>
  • 29. OR & ICU Management <ul><li>Operating Room Management </li></ul><ul><ul><li>Optimizing OR processes </li></ul></ul><ul><ul><li>Active tags & 2D barcode </li></ul></ul><ul><ul><li>Surgical tool tracking </li></ul></ul><ul><li>Intensive Care Unit Management </li></ul><ul><ul><li>Improve ICU processes </li></ul></ul><ul><ul><li>Passive & active tags </li></ul></ul><ul><ul><li>Medication management </li></ul></ul>
  • 30. Research Applications <ul><li>Medication delivery </li></ul><ul><li>Pharmaceutical pedigree </li></ul>
  • 31. Medication Delivery <ul><ul><li>Patient RFID wrist band </li></ul></ul><ul><ul><li>Interface with hospital information system (HIS), physician order entry system (POE) & inventory management system </li></ul></ul><ul><ul><li>Cost of item level tags and other related items </li></ul></ul><ul><ul><li>Change in workflow management </li></ul></ul><ul><ul><li>13.56Mhz / 433Mhz / 915Mhz </li></ul></ul><ul><ul><li>Read-only / read-write </li></ul></ul><ul><ul><li>Reliability, Accuracy </li></ul></ul><ul><ul><li>Open System? </li></ul></ul>
  • 32. Pharmaceutical Pedigree <ul><ul><li>Legally acceptable pedigree information </li></ul></ul><ul><ul><li>Legally acceptable paper / electronic trail </li></ul></ul><ul><ul><li>Returned items </li></ul></ul><ul><ul><li>Recalled pharmaceuticals </li></ul></ul><ul><ul><li>Passive RFID tag frequency: 915Mhz / 13.56Mhz </li></ul></ul><ul><ul><li>Temperature monitoring </li></ul></ul><ul><ul><li>Interface to HIS, POE, inventory management system </li></ul></ul><ul><ul><li>Pharmaceuticals in a hospital, pharmacy, warehouse </li></ul></ul><ul><ul><li>Samples in physician’s office </li></ul></ul>
  • 33. Global Pedigree With RFID Manufacture Wholesaler Distributor 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 DB FDA FBI DB-R
  • 34. <ul><li>Pharmaceutical stability under RF exposure </li></ul><ul><li>RFID Tag construct </li></ul><ul><li>Mass serialization for identification </li></ul><ul><li>Optimum frequency </li></ul><ul><li>Backup technology </li></ul><ul><li>RFID for medical devices </li></ul><ul><li>Workflow analysis </li></ul><ul><li>Interfacing to HIS, PACS,… </li></ul><ul><li>Home-bound patients </li></ul><ul><li>Pharmaceutical packaging </li></ul><ul><li>Electronic pedigree </li></ul>Issues To Resolve
  • 35. Comments <ul><li>RFID, not a silver bullet, but powerful. </li></ul><ul><li>RFID, a disruptive technology. </li></ul><ul><ul><li>Understand workflow and technology. </li></ul></ul><ul><ul><li>Modify workflow </li></ul></ul><ul><ul><li>Persistent engagement by everyone. </li></ul></ul><ul><li>RFID, a method of managing persistant Unique Identification (UID) at item level. </li></ul>
  • 36. Thank You!

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