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February 14, 2011

RFID Signals Innovation
By Alice Shepherd
For The Record
Vol. 23 No. 3 P. 20

A health system has incorporated the technology into its mobile EHR platform, while forward-thinking developers use RFID to help improve diabetes management.

Radio-frequency identification (RFID) technology has been around for decades but has not been widely utilized in healthcare. Concerns over cost and return on investment have led organizations to choose less expensive, albeit less versatile, bar-coding solutions. However, in recent years, consumer electronics companies have continued to lower prices for wireless devices and components, and both healthcare providers and medical device manufacturers are taking advantage of that cost curve to implement RFID technologies. Applications range from patient ID and chronic disease diagnosis and management to medication administration, medical records tracking, and EHR access.

RFID Streamlines EHR Access, Navigation
Heritage Valley Health System, which provides comprehensive healthcare in Pennsylvania, eastern Ohio, and the West Virginia panhandle, has developed a mobile clinical access portal (MCAP) and device application collaboration solution (DACS). MCAP is a handheld EHR device that allows physicians and clinicians to view patient records anywhere there is a Wi-Fi or broadband connection. In addition, these mobile devices are equipped with an RFID tag that gives users the ability to move seamlessly from the handheld EHR to any desktop or laptop computer equipped with an RFID reader. The technology has been successfully deployed for three years.

MCAP provides physicians with three years of online clinical data, including labs, radiology, pathology, and medication lists. Information is available any place, any time for ambulatory office patients, acute care patients, and long-term care environments. “For example, physicians who are rounding in the hospital can access their census, click on a particular patient, and then drill down to three years of clinical information or trend labs,” says Heritage Valley Chief Information Officer David Carleton. “On the ambulatory side, they can see the day’s schedule and drill down to details.”

Since the real estate on a handheld device is limited, physicians often want to view EHR information on a larger screen or collaborate with colleagues. This is where RFID comes in to establish a connection to a fixed device. Each handheld unit has a flat RFID tag attached on the back that identifies the device and the doctor who owns it. The physician simply walks up to one of the computers or other fixed devices provided on all floors and in every room that have mouse-sized flat readers for the RFID tag. The physician “tags” the reader (ie, moves the tag into close proximity to the reader), at which time the reader recognizes the tag number and logs the physician in to the fixed device, where information is shown on a larger screen.

“For example, when a physician needs to view a radiology image, he or she simply tags the RFID reader on the desktop computer [and] the reader reads the tag and initiates an automatic log-in,” says Carleton. “A full screen then opens with an expanded view of the electronic health record inclusive of the radiology image.”

The first time a doctor tags in each day, the application prompts for the password; it already knows the doctor’s user ID from the RFID tag. From that point on, a doctor who is rounding can go to any device and tag it without logging in again. “Repeated log-in to fixed devices is one of the biggest barriers for physicians,” says Carleton. “The handhelds automate log-in, so physicians can go from station to station or room to room, tagging in quickly rather than having to use their ID and password each time.”

The readers are not passive, meaning they don’t read a tag when a doctor enters the room or is anywhere within a few feet of it. “It would be too complicated if three or four devices were suddenly tagging in a doctor who is just walking by,” says Carleton. “Our hardware puts out a very short-distance signal, so the tag has to be right next to the reader to read it. The short-distance signal also avoids interference with other clinical engineering devices such as pacemakers.”

There is more to Heritage Valley’s technology than remote access and simplified log-in. “What makes it powerful is our software application which enables autonavigation to execute the EHR,” says Carleton. “As physicians access the electronic record using the handheld devices and tagging into fixed devices, the software tracks everything they do. It ‘knows’ who the doctor is and what he or she might want to do next. It also ‘knows’ where the device is located and defaults to certain settings accordingly. Based on all this information, the software automatically navigates the doctor to the screens that allow him or her to perform the desired tasks.”

For instance, if the device the doctor tags is located in a patient room, the system knows which room it is and that the doctor will therefore want to access records on one or both patients in the room. The software instantly offers a choice between the two patients, and when the doctor makes a choice, it brings up the patient’s vital signs, progress notes, labs, radiology, and other relevant information.

Physicians can also request specific defaults to collaborate with colleagues. By knowing a physician’s identity, the software can automatically log him or her in to the appropriate desktop without requiring an ID or a password. Physicians can also launch various vendors’ EMRs, but autonavigation is not available in that case.

Heritage Valley continues to develop its applications. For example, it is building a drop-down menu for MCAP that will allow physicians to quickly access tasks, such as order entry, that they cannot perform on the handheld device. “It will allow them to choose order entry from the drop-down menu and walk up to a desktop which will automatically log them in via the RFID tag and take them directly to order entry,” says Carleton. “The idea is to simplify the provider’s life.”

Physicians who don’t have their handheld device with them can log in to the EHR from anywhere using the RFID tag attached to their name badge. The only difference is the absence of MCAP’s intelligence to automatically take the doctor to a specific patient depending on the location. The system will default to the physician’s EHR standard first page or census page.

Similarly, nurses can log in to nursing documentation screens using the RFID tags on their name badges; they do not carry handheld devices.

Since Heritage Valley designed its own EHR software, it only has to purchase hardware. “The readers are about $125 to $150 apiece,” says Carleton. “The RFID tags are $1 to $1.25 apiece, depending on how many you buy.”

In 2009, Heritage Valley won the prestigious Microsoft Health Users Group annual MS-HUG Healthcare Innovation Award for Clinical Records – Inpatient for developing the MCAP and DACS. The awards showcase how organizations use technology to enhance and transform the quality of patient care, reduce costs, streamline clinical and business processes, drive interoperability, improve productivity and workflow, and enable informed decisions. In 2010, Heritage Valley was honored with the Hospital & Healthsystem Association of Pennsylvania achievement award for its work with MCAP.

RFID to Facilitate Diabetes Management
“Diabetes is on the increase in many developed countries and an expensive burden on the healthcare system, as it is associated with other debilitating comorbidity conditions,” says Robert McCray, president and CEO of the Wireless-Life Sciences Alliance, an international trade association and think tank that puts CEOs from the world’s most innovative wireless health companies together with global leaders in healthcare and technology to accelerate business opportunities. “In order to maintain appropriate levels of blood glucose, it’s recommended that insulin-dependent diabetic individuals test their blood glucose several times a day, which involves the invasive and painful task of pricking one’s finger. Many medical device companies have developed technologies that would allow the continuous measurement of blood glucose without the need to draw blood.”

PositiveID Corporation is developing the Wireless Body, a platform that enables a patient’s implanted and external medical devices to communicate wirelessly with each other, patients, physicians, and third parties. Allison Tomek, the company’s senior vice president for investor relations and corporate communications, explains the device’s evolution: “The foundation of the Wireless Body is an RFID implantable microchip that was cleared by the FDA in 2004 for patient identification. The microchip contains only a 16-digit number and is passive in that it has no power source or battery. The 16-digit number, when scanned with a handheld reader from a distance of a few inches, can be entered into an online database where the patient’s health record is stored. We are evolving that basic identification chip into a diagnostic product through a patent to include a biosensor on the chip, the first application of which is a glucose-sensing microchip called the GlucoChip. The microscopic biosensor will measure a diabetic’s blood glucose level, and the RFID chip will transmit the reading from inside the body to an external handheld scanner.”

Concurrently, the company has developed a prototype of a diabetes management device to facilitate the monitoring of blood glucose levels. Called iglucose, the device automatically and wirelessly transmits within seconds the glucose numbers for a person with diabetes from a data-capable glucometer to the iglucose database. In addition, iglucose automatically communicates blood glucose readings to healthcare providers and the patient’s loved ones.

The patient connects a glucometer to iglucose, which powers up the glucometer, pulls down the most recent data, and sends that data to the online database via a wireless network. “That information can be accessed, for example, by a parent who is monitoring the readings of a child drawing blood at school or by the caregiver of an elderly parent to ensure compliance,” says Tomek.

iglucose technology may eventually be combined with the company’s GlucoChip and Wireless Body to create a seamless way to obtain continuous blood glucose readings from inside the body and transmit them for monitoring and management.

 In the meantime, the GlucoChip is under development; no prototype has been created, and it has not been tested with patients. The sensor is being tested in the laboratory in blood and interstitial fluid. The company is also initiating a study with the Diabetes Research Institute at the University of Miami and Jackson Memorial Hospital to test diffusion and biocompatibility of the membrane to be used in the device’s sensor. The next step will be to incorporate the sensor with the electronic components of the microchip. Then the device will be tested in animals and humans.

“Assuming successful development, the GlucoChip product will be marketed for home use as a self-monitoring device to increase compliance and decrease the inconvenience and pain of drawing blood,” says Tomek. “Instead of pricking their finger, patients can do a quick scan over the area where the chip is embedded. If we incorporate the GlucoChip with the iglucose wireless communication technology, it will bring the extra benefits of eliminating the manual logging of glucose data and minimizing errors. The goal is to enable remote, continuous monitoring for patients, physicians, and caregivers.”

“An affordable, implantable glucose meter in combination with an RFID-powered microchip that transmits the information from the meter is a powerful concept,” says McCray. “At the end of the day, success will depend on the exact components and how they fit into a solution for the underlying problem. In order for patients to manage their diabetes, the information has to be actionable so it can be used to coach patients on lifestyle activities and calibrate the amount of insulin they receive.”

 Beyond diabetes management, the Wireless Body platform may be further developed for other vital sign-sensing applications and the identification of implanted medical devices such as vascular ports. “Our ultimate goal is to give patients freedom from the burdens of disease management, increase their compliance through painless applications, and therefore improve their health outcomes, decrease costs, and decrease the burdens on the healthcare system,” says Tomek.

“Wireless technology will increasingly be utilized in healthcare, as well as in health and wellness products and services, and will become as ubiquitous as the Internet is for communications,” says McCray. “RFID is one of many enabling technologies that can move data from inside or around the body onto a hub that connects to the Internet. Via the hub, which could be a specialized device, a cell phone, or a traditional computer, information can be moved to a database or EHR where it can be managed and analyzed to deliver actionable information to caregivers, clinicians, and patients. Giving medical devices the ability to ‘talk’ on a regular if not continuous basis brings immense benefits. It increases the transparency, affordability, and quality of healthcare.”

— Alice Shepherd is a southern California-based business-to-business journalist specializing in healthcare topics.