March, 2006 2 March, 2006


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March, 2006 2 March, 2006

  1. 2. Improving Patient Safety with RFID I.4 RFID Applications for Hospitals
  2. 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>
  3. 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
  4. 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
  5. 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>
  6. 7. Technical Question <ul><li>What Is The Main Source Of Problems? </li></ul>
  7. 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.
  8. 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>
  9. 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>
  10. 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>
  11. 12. Reader Information System Tags RFID System
  12. 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
  13. 14. RFID Tags and Readers
  14. 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
  15. 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>
  16. 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>
  17. 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>
  18. 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>
  19. 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>
  20. 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>
  21. 22. Example
  22. 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>
  23. 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>
  24. 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>
  25. 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>
  26. 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>
  27. 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>
  28. 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>
  29. 30. Research Applications <ul><li>Medication delivery </li></ul><ul><li>Pharmaceutical pedigree </li></ul>
  30. 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>
  31. 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>
  32. 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
  33. 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
  34. 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>
  35. 36. Thank You!