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July 10, 2006
Whether it be active or passive, more hospitals are planning to install RFID systems. What are the technology’s potential benefits? And where can it all go haywire? Although the technology has been around for more than 50 years, radio frequency identification (RFID) has only recently begun making inroads into the healthcare arena, thanks in part to the development of standards and network models as well as a drop in prices. While most facilities that have implemented RFID have done so primarily to track physical assets such as equipment and supplies, a growing number of pilot projects are underway that are demonstrating the value the technology can also bring to patient care and safety. “Given the inherently mobile nature of healthcare, RFID offers potential benefits that can impact quality of care, outcomes, and healthcare delivery costs. Many activities that occur in healthcare require the coming together of a very specific group of workers and assets in order to run a diagnostic test or deliver therapy” such as cardiac catherization, interventional radiology, and gastroenterology studies, says Tim Gee, principal, Medical Connectivity Consulting. “Complex logistics are required to pull these events together, deliver safe and efficacious care, capture charges, and document everything. So tracking equipment, personnel, and patients throughout the care delivery process can greatly impact both clinical and financial outcomes.” A 2005 survey by Spyglass Consulting Group found that while only 10% of participating healthcare organizations were currently using RFID to track mobile equipment, 45% indicated they planned to implement RFID systems by the end of 2006. Further, while only 8% of responding organizations were using RFID for patient tracking, 21% anticipated they would be implementing them by early 2007. The Spyglass report also found that active RFID applications, which can be tracked on an RFID network, were far more popular than passive applications, which require a nearby reader. That is in spite of the higher price for active RFID tags—anywhere from $50 to $100 per tag, plus the network infrastructure, as compared with 50 cents or less for passive tags. “While it’s not a new technology, RFID is enjoying a renaissance,” says John Pantano, cofounder and vice president of marketing for Radianse. “Combined with specialty location software, RFID’s value goes up and, based on technology innovations, its price and size are going down. It’s truly a great problem solver. Attaching active RFID tags to equipment for tracking was an obvious application, but we’ve seen just as much, if not more, interest in benefits around patient location and flow applications. Radianse customers are applying RFID to make big improvements in their processes, including throughput and patient satisfaction. Three years ago, we were talking about the potential; today hospitals have proven ROI [return on investment]. The potential has become a promise.” How It Works RFID serves the same purpose as bar codes or magnetic strips on the back of a credit card; it provides a unique identifier for that object which must be scanned to retrieve the identifying information. However, it has a significant advantage because the reader does not need to be positioned precisely relative to the scanner. “Active RFID for location-based services for tracking mobile assets, patients, and staff is an incredible value proposition today,” says Gregg Malkary, managing director, Spyglass Consulting Group. “With passive RFID, many of these applications are anywhere from three to seven years out, depending upon the application.” Active RFID uses tags that are battery powered and can be read from greater distances, allowing readers to be placed in an environment where multiple readers can see the same tag and determine that tag’s physical location. Passive RFID tags, on the other hand, are not powered and rely on radio frequency energy radiated from the tag reader to transmit data. “This method of reading the tags limits the distance between tags and readers to several feet,” says Gee. “Passive tags typically rely on readers placed in specific ‘choke points’ where they read tags as they go by. Passive tag systems are rarely used for real-time location, but rather track the tag through a known process or workflow.” Both active and passive RFID have a place in healthcare, although the distinction is important, according to Pantano. “To locate people or equipment in real-time, active RFID tags are required. It’s a matter of matching the technology to the problem,” he says. “To reduce asset loss, enable smarter machines, and automate care processes to create a safer environment; that’s the value of active RFID.” Achieving Maximum Benefits For example, Hannibal (Mo.) Regional Hospital, a 100-bed facility that uses an RFID system from Radianse as part of a perioperative workflow application, saw a documented increase from 57% to 73% in operating room utilization within the first year of system implementation. Another Radianse customer, Brigham & Women’s Hospital in Boston, saw losses reduced by as much as 50% after implementing RFID for equipment tracking and is now in the process of expanding that system facilitywide. In fact, a main reason for its growing popularity is RFID’s ability to address the increased pressure facilities are under to improve quality, reduce costs, manage nursing shortages, and increase patient satisfaction. However, realizing maximum benefits from the technology requires more than just the financial commitment, according to Fran Dirksmeier, CEO, Agility Healthcare Solutions, which offers a turnkey solution, including installation, asset tagging, software installation, staff training, and ongoing account management, for a flat monthly fee. “RFID provides an opportunity to manage workflow and improve business processes by obtaining critical information automatically and acting upon it in real-time vs. manually entering it or not entering it at all. As an enabling technology, RFID alone, however, will not improve any business process,” he says. “It is the application software to address the use case and the willingness to change processes that delivers benefits. If providers are unwilling to change process, RFID-enabled solutions will not achieve benefits.” Additional technologies in use at a facility will also impact the benefits realized from deploying RFID. Gee points out that little of RFID’s true potential can be realized if it is treated as a stand-alone system. “To deliver maximum value, RFID is usually integrated into the information systems that maximize workflow,” he says. This includes common applications such as surgical management systems, hospitalwide patient flow management systems (including bed management), and emergency department systems, all of which tend to track patients, staff, and assets to better manage resources over time. Passive RFID systems are sometimes used in materials management and supply logistics, which track the flow and utilization of supplies in a clinic or hospital, ensuring maximum utilization at the lowest possible inventory levels. “Hospitals may purchase a passive RFID system to manage high-cost consumables like catheters, stents, and implantable devices,” Gee says. “These are expensive procedures dependent on these devices; they come in a variety of sizes and configurations and have a limited shelf life. Ensuring availability while keeping inventory levels low, and reducing the occurrences of devices that expire before use, thus becoming scrap, are key benefits” to RFID. Addressing the Challenges In the Spyglass survey, an overwhelming number of respondents cited network infrastructure as the primary barrier to deployment. In particular, says Malkary, the ability to utilize an existing wireless infrastructure without the need for significant upgrades is key. “The whole idea is that RFID leverages a common platform to deploy not only RFID but also mobile computing solutions for physicians and nurses, for voice-over IP, etc. That’s how it really becomes economical,” he says, adding that the infrastructure must be able to handle widespread use of tags or RFID could “bring the network to its knees.” Other challenges include implementing the network management tools necessary to provision the RFID network, as well as ensuring the right applications are in place to work with the data generated by RFID. “You need more than just a Pac-Manlike application for tracking that shows you moving dots of patients or assets; you need analytical tools that can turn the data into knowledge,” says Malkary. Cost is another barrier, particularly for smaller organizations that may not have the existing infrastructure in place to support RFID. According to Pantano, when thinking in terms of cost per bed, a facility should budget between $1,000 and $1,500 for basic identification/location applications, as well maintenance costs, including battery replacement costs which “in some systems over a 12- to 18-month period can be as much as the actual price of active RFID tags in another. Also keep an eye out for recurring license fees and excessive maintenance fees.” To determine the true cost of RFID, however, facilities must look beyond the hard costs of the systems themselves and consider the price of implementing the processes required to make RFID truly effective. “It goes beyond the cost of the devices, the tags, and readers,” says Malkary. “You have to look at workflow process redesign and training. Those are big unknowns and they add up quickly.” Finally, cutting through the confusion over RFID to identify which system—and which vendor—is the right one for a facility based on the organization’s unique needs and infrastructure is a significant challenge. “There are a lot of companies making claims about how different technologies are better than others. For example, some hospitals have bought off on the idea that location technologies that require special receivers are more costly than location systems that use standard WiFi access points. This has never been proven, but may sound logical,” says Pantano. “In reality, the system must provide accuracy of at least room-level precision, the ability to locate both people and things, and the ability to cope with dramatically changing RF environments in hospitals. Total cost of ownership has to be analyzed before making a decision.” Adds Dirksmeier: “Organizations must understand the use case, commit to improving the business process, and partner with a company that can deliver solutions to the business problem vs. companies that provide RFID hardware alone.” Making the Decision The best first step is to conduct a comprehensive needs assessment that identifies the requirements for a complete solution, of which RFID may only be a small part, advises Gee. “A healthcare delivery organization should do a thorough needs assessment that includes a full workflow analysis and survey of current and planned requirements for all of the operational areas involved. Given the silo organizational structure of most delivery organizations, an adequate needs assessment can be challenging,” he says. “The requirements that fall out of the needs assessment will indicate whether the vendor selection process will focus on a broader solution that includes RFID or simply an RFID system. The technology upon which the RFID system is based is the last consideration; making the technology decision too early can result in a system that does not fully meet requirements.” Also critical is clearly defining the expectations a facility has for the RFID system, according to Pantano. Do they want to eliminate overbuying, rental, or replacement of lost equipment? Regain staff time lost to equipment-hunting expeditions? Help nurses make priority-based decisions and be available when patients need them? Improve response times and/or workflow efficiencies? “They are all perfect applications for an active RFID solution,” he says. “My advice to hospitals is this: You will realize cost savings, improved safety, and productivity if you carefully match the solution to the problem,” says Pantano. “The potential for this technology is enormous. Yet RFID is a broad category and there is definitely confusion in the market. If a hospital is specific about what it wants to achieve—now and in the future—[and] researches the technologies and vendors, [it] could realize substantial benefits.” — Elizabeth S. Roop is a Tampa, Fla.-based
freelance writer specializing in healthcare and HIT.
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