Interesting arguments about the terminologies at Techliberation: http://www.techliberation.com/archives/040149.php http://www.techliberation.com/archives/040172.php More discussion about the terminologies: http://dsonline.computer.org/portal/site/dsonline/menuitem.6dd2a408dbe4a94be487e0606bcd45f3/index.jsp?&pName=dso_level1_article&TheCat=1001&path=dsonline/2006/02&file=o2002.xml&;jsessionid=H2TCCpncgvy1SQmZPXGCcX8mQdKRx1dXBNl958MzVtSMtZ3Pk5QX!545993162 http://en.wikipedia.org/wiki/Access_control
Using a giant table-like display, users are able to draw, interact with media, and use another new technology called domino tagging, in which a real-life object on the computer's surface is identified and becomes an on-screen object that can be interacted with.
Symbology: Support high reliability: minimize confusions in distinguishing 2 different characters, scanning from left to right, right to left, error checksum... Semacode : While cell phone cameras are not suitable for many traditional barcodes, there are 2D barcodes optimized for cell phones . Using Semacode SDK software, a URL can be converted into a type of barcode resembling a crossword puzzle, which is called a &quot;tag&quot;. Tags can be quickly captured with a mobile phone's camera and decoded to obtain a Web site address. This address can then be accessed via the phone's web browser. Movie, music, book catalogs Calling cards: 2D barcodes can store contact information for importing. - Characteristics: A standard range laser Barcode Scanner can read a barcode from about 6 to 24 inches away, and a long range Barcode Scanner can read one from perhaps 2 to 8 feet away. Certain extra long-range laser Barcode Scanner are capable of reading a barcode from up to 30 feet away. A basic handheld laser Barcode Scanner can cost as little as $180, with specialty laser Barcode Scanner costing as much as $2000. It will cost about US$0.005 to implement a barcode. Current uses: UPC: 7 bars to encode a number: 0 – 9, left-side encoding, right-side encoding - All pharmaceuticals dispensed in hospitals are required to have a bar code identifier at the unit-of-use packaging level by April, 2006, according to an FDA rule issued in February, 2004.
Characteristics: Highly standardized: the magnetic stripe contains three tracks, each 0.110 inches (2.79 mm) wide. Tracks one and three are typically recorded at 210 bits per inch (8.27 bits per mindustry.m), while track two typically has a recording density of 75 bits per inch (2.95 bits per mm). Each track can either contain 7-bit alphanumeric characters, or 5-bit numeric characters. Track 1 standards were created by the airlines industry (IATA). Track 2 standards were created by the banking industry (ABA). Track 3 standards were created by the Thrift-Savings
-A smart card is any pocket-sized card with embedded integrated circuits which can process information. -Contact, contactless: Contact cards do not contain batteries; energy is supplied by the card reader. Contactless: the chip communicates with the card reader through RFID induction technology (at data rates of 106 to 848 kbit/s ). Because smart cards are often used to store confidential information, the operating range should be limited to provide more security. ISO/IEC 14443 - t he standard for contactless smart card allows communications at distances up to 10 cm. An alternative standard for contactless smart cards is ISO 15693 , which allows communications at distances up to 50 cm. Current uses: Contactless credit/debit cards: Since mid-2005, introduction of contactless credit and debit cards has focused on markets that have lower value transactions (less than $25), where consumers use cash for payment, and where transaction speed and customer convenience are critical. Mastercard PayPass, Visa Wave, American Express - Express Pay, be built into cards or other devices such as key fobs. As of 2Q 2007, there are more than 16 million PayPass cards and devices in the market, and PayPass is currently accepted globally at 55,000 merchant locations.
Idea: intrinsic but must be unique. physiological are related to the shape of the body: fingerprint, face, DNA, iris, voice behavioral are related to the behavior of a person: signature Characteristics : designed to be more convenient and reliable, but a lot more to be done. Current uses : Digital IDs: when requiring higher security, one is required to scan his fingerprints and compare with digital fingerprints extracted from his ID. (avoid problem with twins). The proposed U.S. Electronic Passport is the same as a regular passport with the addition of a small contactless integrated circuit (computer chip) embedded in the back cover. The chip will securely store the same data visually displayed on the photo page of the passport, and will additionally include a digital photograph. The inclusion of the digital photograph will enable biometric comparison, through the use of facial recognition technology at international borders. Issues : once a fingerprint or other biometric source has been compromised it is compromised for life, because users can never change their fingerprints. A theoretical example is a debit card with a personal Identification Number (PIN) or a biometric. In 2005, Malaysian car thieves cut off the finger of a Mercedes-Benz S-Class owner when attempting to steal the car
Current uses: In October 2004, the FDA approved USA's first RFID chips that can be implanted in humans. Current uses: - WalMart requires all suppliers to put RFID tags carrying Electronic Product Codes on pallets and cases by the end of 2006. DoD – Jan 2005 - China's market dominance is due to the &quot;peaking&quot; of orders for the nation's contactless identification cards. China has allocated a whopping $6 billion to the national ID card project, $1.65 billion of which will be spent this year on 300 million cards and the necessary infrastructure, according to IDTechEx. By December 2006, the pharmaceutical business has to implement a “pedigree” system for all supscription drugs in the supply chain. (Pharmaceutical supply chain different with good supply chain in that the pricing for each end user is different. Diversion is the first concern: cheap price drugs are diverted to open market, “controlled drugs” are sold without supscription)
Patient misidentification: - Report by JCAHO: 13% of wrong-site surgeries involved surgery on the wrong patient. The Wrong Patient an article, studies a case in which a 67-year-old woman undergoes a wrong invasive surgical operation. 17 distinct errors were found. 3 main latent causes, which can be remedied, are: communication failure, teamwork failure, and lack of an effective patient identification technique and procedure . (similar name, doctors and nurses refer to patient as “ my patient”...) Adverse drug event: In pharmacology, any unexpected, or unwanted effect caused by the administration of a drug. - medterms.com average cost per ADE of $2,257 => $1,737,890,000 each year (more than 1.7 billion) National Patient Safety Goal: http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/08_hap_npsgs.htm 2 identifiers: (e.g. name and date of birth) to verify a patient’s identity upon admission or transfer to another hospital or other care setting and prior to the administration of care. Neither of these identifiers should be the patient’s room number. (WHO and JCAHO)
Medication administration - All pharmaceuticals dispensed in hospitals are required to have a bar code identifier at the unit-of-use packaging level by April, 2006, according to an FDA rule issued in February, 2004. U of Wisconsin Hospital deployed patient identification, using barcode in 22 of the hospital’s units and has been reported to reduce medication administration errors by 87 percent. The process for verifying that patients receive the right blood products is very similar to the process for medication administration.
Regulation: Every electrical device emits electromagnetic energy. This energy can interfere with other devices the way a hair dryer creates &quot;snow&quot; on a nearby television. Most of the time the problem is merely annoying. For example, EMI could cause static on the screen of a hospital computer. But whenever anything interferes with a lifesaving medical device like a pacemaker or an apnea monitor, the results can affect the patient. A pacemaker failed during an ambulance ride while the two-way radio was in use. A pulse oximeter machine displayed a pulse rate and oxygen level on a dead body when a telemetry receiver that was part of the system was placed too close to the body. A fetal heartbeat detector picked up local radio and CB broadcasts instead of the baby's heartbeat. Electrical wheelchair malfunctions because of EMI - the wheelchairs' brakes would release and the wheels would begin turning in relatively low-strength electromagnetic fields. A police radio held about a meter away (3 feet, 4 inches) could cause some wheelchairs to move. http://www.fda.gov/fdac/reprints/emi.html http://www.fda.gov/cdrh/emc/persp.html Reliability: Reliability is a very important requirement. The process might not be able to take place if the patient was not identified. Need a backup workflow for situations when technological errors occur. Privacy concerns: Patients do not want others to know their confidential data, or keep track of their location inside the hospital. Ex: many would not wear a wristband which writes his name, age, blood type... in clear text. Convenience: For the nurse, and the patient. Size and weight of devices, how seamless is the process... Cost for hospital: Depends on what the hospital already had, and what applications do they want to deploy. Ex: if a hospital has an existing wireless network, and want to implement patient identification, and patient tracking, using wifi rfid tags would reduce the cost. If no tracking involved, barcode would be the least expensive solution. Cost for patient: Not a big concern because patient pay thousands of dollars already.
Barcode Advantage -Conform to regulation -Proven reliability. -It only cost about US$0.005 to implement a barcode, even cheaper because tags do not require any power supply. Disadvantage Near operating range => limited applications Line of sight, shape – inconvenient Low capacity: want to store as information which is used frequently: name, birth date, blood type, allergies info Not writable: sometime want to update information – allergies info Magnetic stripe Advantage -Cheap: around 20 cent for a card, no power supply -Proven reliability. Disadvantage - Complicated operation – inconvenient – which also leads to lower reliability - Near range => limited applications
RFID: Advantage Disadvantage RFID tags have trouble with some environments like metal and liquid – But some research showed positive result Chang-Gung Memorial Hospital , Taiwan, 100% patient ID accuracy, patient privacy, while saving staff an average of 4.3 minutes per patient A wearable device for a fully automated in-hospital staff and patient identification – some Italian researchers, regulation conformation, power management, security issues (authentication protocol).
the clinician/nurse then scans the patient, the device, and herself in some order using the mediator. It also gets the reading from the device the mediator then sends a tuple containing the information from the last step to the server mediator. -the server mediator parses the tuple, sends back a webpage which provides the information about in a human readable format. -the nurse clicks on a save button to save the data if it seems like a reasonable reading to her. the data is then saved in the database -otherwise the nurse hits a cancel button and the whole process is repeated without saving the data in the database.
563.12.1 Automated Identification Anh Nguyen University of Illinois Fall 2007
1. Identification <ul><li>“ The function of identification is to map a known quantity to an unknown entity so as to make it known. The known quantity is called the identifier (or ID) and the unknown entity is what needs identification...” – Wiki </li></ul><ul><li>No guarantee of provenance or right mapping. </li></ul>
Need and concern <ul><li>Why Identification: </li></ul><ul><ul><li>In many cases it is a required part of the workflow. </li></ul></ul><ul><ul><li>Build up profile (better shopping experience). </li></ul></ul><ul><ul><li>In security: </li></ul></ul><ul><ul><ul><li>Authorization = Identification & Authentication + Assigning Privilege(s). ( Identity Crisis: How Identification Is Overused and Misunderstood - Jim Harper - debate at Techliberation) </li></ul></ul></ul><ul><li>Security concerns according to CIA model: </li></ul><ul><ul><ul><li>Confidentiality: Might not want outside parties to learn your ID (SSN) </li></ul></ul></ul><ul><ul><ul><li>Integrity: of ID transferred. </li></ul></ul></ul><ul><ul><ul><li>Availability: the ID is ready when needed. </li></ul></ul></ul>
2. Automated Identification (AID) <ul><li>The process is done automatically, less human interventions. </li></ul><ul><ul><li>To save times, increase productivity </li></ul></ul><ul><ul><li>To operate in harsh environment where it is harmful for human </li></ul></ul><ul><li>Either replace traditional identification procedure to provide more seamless workflow, or bring new applications: </li></ul><ul><ul><li>Commercial: Product identification, Supply chain & Logistics, E-Commerce. </li></ul></ul><ul><ul><li>Healthcare: Equipment tracking/ Patient Identification (later) </li></ul></ul><ul><ul><li>Transportation: E-Tickets </li></ul></ul><ul><ul><li>Others: Animal Tracking, Vehicle / People Identification </li></ul></ul>
AID Technologies - Barcode <ul><li>Printing ID in a way which is machine readable. Information can be expressed via different symbologies. </li></ul><ul><li>History: developed in 1948, commercial use 1966, </li></ul><ul><li>not commercially successful until the 1980s. </li></ul><ul><li>Recent developments: 2D Barcode / stacked barcode, Semacode. </li></ul><ul><li>Characteristics: cheap, short/long operating range, line of sight, low data rate. </li></ul><ul><li>Current uses: Groceries – UPC, Books – ISBN, drugs </li></ul>Barcode , Semacode , UPC , ISBN – Wikipedia
Magnetic Stripe Card <ul><li>Storing data by modifying the magnetism of tiny iron-based magnetic particles on a band of magnetic material, as in video tape. </li></ul><ul><li>Sticking a piece of magnetic tape to a plastic card base. </li></ul><ul><li>Characteristics: cheap, higher data rate, near operating range, inconvenient (operation + reliability), low coercivity card easily damaged. </li></ul><ul><li>Highly standardized. </li></ul><ul><li>Current uses: ID cards (UID), Credit & Debit Cards, Subway and Bus Card. </li></ul>
Smart Card <ul><li>Adding processing power: any pocket-sized card with embedded integrated circuits which can process information. </li></ul><ul><li>Contact, contactless. Contactless and RFID. </li></ul><ul><li>Characteristics: has processing power, often come with tamper resistant feature, short operating range (ISO 14443 – 10cm, ISO 15693 – 50cm), more expensive. </li></ul><ul><li>Current uses: Mobile phone SIM, ATM Cards, contactless CC/DC, smart driver licenses. </li></ul>RFID Vs Contactless Smart cards – An unending debate - Parul Oswal – 2006
Biometrics <ul><li>Uniquely recognizing humans based upon one or more intrinsic physical or behavioral traits. (but must be unique) </li></ul><ul><li>Characteristics: convenient / inconvenient, not very reliable (collision, effect of aging), usually more expensive. </li></ul><ul><li>Current uses: Personal laptops, digital IDs, ePassport (US, Brazil, Germany). </li></ul><ul><li>Concerns: once compromised it is compromised for life, danger to owner. </li></ul>Biometrics - Wikipedia Biometrics: Universality Uniqueness Face H L Fingerprint M H Hand geometry M M Keystrokes L L Hand veins M M Iris H H Retinal scan H H Signature L L Voice M L Facial thermograph H H Odor H H DNA H H Gait M L Ear recognition M M
RFID <ul><li>Using radio frequency to transfer identifier. </li></ul><ul><li>Characteristics: very flexible (HF/LF/UHF, active/passive, implantable..), convenient, does not require line of sight. </li></ul><ul><li>Concerns: privacy, cancer (implantable tags). </li></ul><ul><li>Emerging market: DoD and Wal-Mart’s mandate, Prescription Drug Marketing Act (PMDA) - pharmaceutical supply chain (pedigree system by Dec 2006 – FDA), China national ID card, Qatar National Identification Project... </li></ul>
3. Patient Identification <ul><li>Current practice </li></ul><ul><ul><li>Use text/color wristband </li></ul></ul><ul><ul><li>Use barcode wristband (ex: University of Wisconsin Hospital – 2004) </li></ul></ul><ul><ul><li>Use RFID wristband (ex: Bangkok Hospital – 2006, Birmingham Heartlands Hospital - 2007) </li></ul></ul>
Need to Improve <ul><li>Patient misidentification is identified as a root cause of many errors: adverse drugs event, wrong invasive surgical operations... </li></ul><ul><li>Study by FDA shows that adverse drug events (ADEs) range from 2.4 percent to 6.5 percent per facility, with a mean rate of 4.3 percent – about 770,000 adverse events in the U.S. each year, $1.7 billion cost – Zebra white paper. </li></ul><ul><li>Joint Commission – JCAHO - listed “ improving patient identification accuracy” as the first of its National Patient Safety Goals introduced in 2003, and this continues to be an accreditation requirement from 2004 to 2008. </li></ul><ul><li>WHO and JCAHO encourage the use of at least two identifiers. </li></ul><ul><ul><li>(*3) </li></ul></ul>The Wrong Patient - Mark R. Chassin – 2002, Patient Identification - WHO Press - 2007
Applications <ul><li>Combine it with automated medication administration systems. U of Wisconsin Hospital reduced medication administration error by 87%. </li></ul><ul><li>Blood Administration </li></ul><ul><li>Sample / Treatment Management (to prevent unnecessary procedures) </li></ul><ul><li>Automated Billing </li></ul><ul><li>Patient tracking (babies, sleepwalker) </li></ul>
Technology Trade-off <ul><li>Regulations (FDA, FCC compliance; EU Directive – CE mark) </li></ul><ul><li>Reliability </li></ul><ul><li>Privacy concerns </li></ul><ul><li>Convenience. </li></ul><ul><li>Cost for hospital. </li></ul><ul><li>Cost for patient. (not a big issue) </li></ul><ul><ul><li>(*4) </li></ul></ul>
Barcode, Magnetic Stripe, Smart Card <ul><li>Barcode: </li></ul><ul><ul><li>Advantage: conform to regulation, proven reliability, cheap </li></ul></ul><ul><ul><li>Disadvantage: inconvenient, limited applications, low capacity, not re-writable. </li></ul></ul><ul><li>Magnetic Stripe </li></ul><ul><ul><li>Advantage: conform to regulation, acceptable reliability, cheap, higher capacity. </li></ul></ul><ul><ul><li>Disadvantage: inconvenient, limited applications, not easily re-writable </li></ul></ul><ul><li>Smart card </li></ul><ul><ul><li>Advantage: conform to regulation, high reliability, high capacity, flexible (contact/contactless, rewritable/not), computation & security features. </li></ul></ul><ul><ul><li>Disadvantage: more expensive, limited applications (range). </li></ul></ul>
RFID, Biometrics <ul><li>RFID </li></ul><ul><ul><li>Advantage: higher capacity, more applications, convenient, flexible (long/short range, re-writable/not, passive/active) </li></ul></ul><ul><ul><li>Disadvantage: regulation conformation, reliability (metal & liquid), privacy concerns (more engineering researches), more expensive. </li></ul></ul><ul><li>Biometrics </li></ul><ul><ul><li>Advantage: conform to regulation, convenient, no extra cost for patient. </li></ul></ul><ul><ul><li>Disadvantage: limited applications, no extra information, most expensive (for hospital), reliability improvement. </li></ul></ul>http://www.pdcorp.com/healthcare/case-study-chang-gung-hospital.html
My research <ul><li>Working with Ayesha: </li></ul><ul><li>“ To design, implement and verify a system that will enable clinicians to gather, verify and store medical device reading in an automated fashion” </li></ul>Ser-ver Nurse Medical Device Patient Nurse ID Patient ID reading (Nurse ID, Patient ID, reading) Nurse info, patient info, human readable reading (*) Yes/ No (*) Yes/No https://agora.cs.uiuc.edu/display/cs598cag/Automated+Medical+Data+Acquisition
Conclusion <ul><li>Automated Identification is very useful. </li></ul><ul><li>RFID is an emerging technology. </li></ul><ul><li>Patient Identification need to be improved. And could be done using AID. </li></ul><ul><li>Each AID technology has its own advantage and disadvantage. </li></ul><ul><li>More researches to prove/improve reliability of RFID and Biometrics, design so that RFID will conform with EMC requirements. </li></ul>
References <ul><li>Identity Crisis: How Identification Is Overused and Misunderstood - Jim Harper - 2006 </li></ul><ul><li>www.rfidjournal.com </li></ul><ul><li>www.rfidupdate.com </li></ul><ul><li>Patient Identification - Patient Safety Solutions - volume 1, solution 2, May 2007 - WHO Press </li></ul><ul><li>Patient identification - a crucial aspect of patient safety - patient Safety First </li></ul><ul><li>The Wrong Patient - Mark R. Chassin, MD, MPP, MPH, and Elise C. Becher, MD, MA* - 4 June 2002 | Volume 136 Issue 11 | 826-833 </li></ul><ul><li>It's All in the Wrist: Improving Patient Safety with Bar Code Wristbands – Zebra – 2006 </li></ul><ul><li>A wearable device for a fully automated in-hospital staff and patient identification - M. Cavalleri, R. Morstabilini, G. Reni – 2004 </li></ul><ul><li>Interoperability Issues regarding Patient Identification in Europe - C. Quantin et al - IEEE EMBS - 2007 </li></ul>