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
    • In K. Mun, PhD
    • Director, Hospital Research, HRI, MIT
    • Director, Bio-Medical Research, AHMC
    • Cambridge, Massachusetts
  • 4.
    • 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
  • 5.
    • 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
  • 6. 5 Years After The IOM Report
    • The pace of change “frustratingly slow”
    • The death rate has not decreased substantially
      • Leap / Berwick, JAMA, May 18, 2005
  • 7. Technical Question
    • What Is The Main Source Of Problems?
  • 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.
    • Unique Identification (UID) at item level
      • Barcode
        • Not as good as expected
      • RFID (Radio Frequency IDentification)
        • Promising new technology
  • 10. RFID (Radio Frequency IDentification)
    • 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
  • 11. RFID Types
    • 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
  • 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
    • Based On Standard Utilization
      • Closed System
      • Open System
    • Based On Clinical / Commercial Maturity
      • Accepted Applications
      • Evolving Applications
      • Research Applications
  • 17. Based On Standards
    • 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
  • 18. Based On Standards
    • Open system
      • Established markets
      • Stable technology
      • Standardized protocols reached by consensuses
      • Compromise on performance
      • Pressure on cost
      • Slow development cycle
      • Produced by large companies
  • 19. Based On Maturity
    • 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
  • 20. Accepted Applications
    • 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
  • 21. Why Asset Management?
    • National average utilization of mobile equipment is 45% - Universal Hospital Services
    • Hospitals 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
  • 22. Example
  • 23. Issues To Consider
      • Existing workflow
      • Tag type
      • Tag size
      • Battery life
      • Resolution
      • Dependencies
      • Installation
      • User interface
      • Clinical experiences
      • ROI (Return On Investment)
  • 24. Sample Case
    • 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
  • 25. Next Steps To Be Taken
    • Interface to HIS / PACS / PDA
      • Total patient flow management
    • Blood product management
    • OR & ICU management
    • Medication management
      • Total care management
  • 26. Evolving Applications
    • Patient wristband
    • Blood product management
    • Operating room management
    • ICU management
  • 27. Patient Wristband
      • Unique Identification of each patient
      • Networked environment
        • Hospitals with HIS & PACS
        • Read-only limited information, HIPPA
      • Non-networked environment
        • Military, natural disaster like hurricane, flood, earth quake
        • Read-write
      • Frequency, Read Range
        • 13.56Mhz / 433Mhz
        • Active / passive
        • Short, medium, long
  • 28. Blood Product Management
      • Accuracy
      • Reliability
      • Cost
      • Temperature monitoring
      • Two early sites: MGH & Georgetown
      • Frequency
        • 13.56Mhz, passive tag
        • 433Mhz, active tag
  • 29. OR & ICU Management
    • 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
  • 30. Research Applications
    • Medication delivery
    • Pharmaceutical pedigree
  • 31. Medication Delivery
      • 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?
  • 32. Pharmaceutical Pedigree
      • 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
  • 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.
    • 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 Resolve
  • 35. Comments
    • 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.
  • 36. Thank You!