RFID Technology IntroductionRadio Frequency Identification (RFID) is a subset of a group of technologies, often referred to as automatic identification, that are used to help machines identify objects, and which include bar codes and smart cards. RFID refers to the subset of automatic identification that uses radio waves to automatically identify bulk or individual items. RFID has been around for a long time, one of its original uses being the identification of aircraft during the Second World War. Until recently it was viewed as being too expensive and too limited in functionality for many commercial applications. Advances in technology have both reduced the cost of individual system components and provided increased capabilities, to the point where numerous organizations are either using or considering using RFID technology. In fact, some organizations, notably Wal-Mart and the US Defense Department, have mandated the use of RFID by their business partners. While RFID technology offers numerous benefits for manufacturers, for instance, certain characteristics of the technology also raise a number of privacy concerns.What is Radio Frequency Identification Technology?An RFID system consists of three components: a tag (or multiple tags), a reader or interrogator and the necessary supporting infrastructure (both hardware and software). An RFID reader, or interrogator, is a device to communicate with the RFID tag. It broadcasts a radio signal, which is received by the tag. The tag then transmits its information back to the reader. Readers can either be portable handheld terminals or fixed devices that can be positioned in strategic places such as loading bays in shipping and receiving facilities, or the doors in transport trucks.RFID tags, also known as transponders, are usually small pieces of material, typically comprising three components: an antenna, a microchip unit containing memory storage and an encapsulating material. Tags can be either read-only or read-write tags. These terms refer to whether or not the information stored on the tag can be changed or erased. A Read-only Tag is a form of RFID tag that has an identification code (more specifically, an Electronic Product Code) recorded at the time of manufacture or when the tag is allocated to an object. Once programmed, the data on the tag cannot be modified or appended but it may be read multiple times. A Read-Write Tag is a tag that can have its memory changed, or written to, many times. Because their ID codes can be changed, they offer greater functionality albeit at higher price.While commonly seen as a replacement for the Universal Product Code (UPC), or bar code, RFID tags differ from bar codes in several ways. More than one tag can be read at a time. Tags do not require a direct line of sight for reading and may be read through hard material such as book covers or other packaging material. Each tag can uniquely identify the object to which it is attached, even if that object is one of a multitude of identical items. It is these latter characteristics that are the cause of any of the privacy concerns associated with the use of RFID technology. In addition to the tags and readers, an RFID system also includes other software and hardware. The most important component is the RFID-specific software that translates the raw data from the tag into information about the goods and orders that are represented by the tags. This information can then be fed into other databases and applications (e.g., inventory management) for further processing. In the case of read-write tags, software is also required to control whether data can be written to the tag, which tag should contain the data and to initiate the process of adding data to, or changing data in the tag.Potential Uses of RFID TechnologyMany public and private sector organizations are either using or planning to use RFID technology. Because the technology basically turns an inert object into one capable of communicating, the potential for use is enormous and limited only by our imagination and the capabilities of the technology involved. Potential uses include: Supply Chain Management (monitoring and controlling the flow of goods from raw materials through to finished product, from manufacturer to consumer); Product Integrity (ensuring that products (e.g., pharmaceuticals) are authentic and have not been altered in any way); Warranty Services (marking durable goods with a tag incorporating a product registration code to facilitate warranty services);ID, Travel, and Ticketing (providing a means to verify the identity of the traveler and to ensure that the documents are genuine); Baggage Tracking (monitoring and controlling the movement of baggage from check-in to loading on an airplane); and Patient Care and Management (providing a means to rapidly and accurately verify information concerning patient allergies, prescription history, etc. to prevent surgical errors). Privacy ConcernsNotwithstanding the current state of RFID technology or current practices, certain aspects of the technology – notably the small size of the tags and the ability to uniquely identify an object – pose potential threats to individual privacy. These include, but are not necessarily limited to the following

a) Surreptitious collection of information. RFID tags are small and can be embedded into/onto objects and documents without the knowledge of the individual who obtains those items. As radio waves travel easily and silently through fabric, plastic, and other materials and are not restricted to line of sight, it is possible to read RFID tags sewn into clothing or affixed to objects contained in purses, shopping bags, suitcases, and more. Tags can be read from a distance, by readers that can be incorporated invisibly into nearly any environment where human beings or items congregate. It may not, therefore, be readily apparent that RFID technology is in use, making it virtually impossible for a consumer to know when or if he or she is being "scanned”;

b) Tracking an individual’s movements. If RFID tags are embedded in clothing or vehicles, for example, and if there is a sufficiently dense network of readers in place, it becomes possible to track those tags in time and space. Applications to do just this, using a combination of RFID and Global Positioning System technology, are being proposed by RFID vendors. If the tags can then be associated with an individual, then by that association the individual’s movements can be tracked. For example, a tag embedded in an article of clothing could serve as a de facto identifier for the person wearing it. Even if information about the tagged item remains generic, identifying items people wear or carry could associate them with, for example, particular events like political rallies or protests;

c) Profiling of individuals. When using bar codes, one bottle of water has the same barcode as all other bottles of water of that particular brand. RFID technology potentially enables every object on earth to have its own unique ID (i.e., each bottle of water would have a unique identifier). The use of unique ID numbers could lead to the creation of a global item registration system in which every physical object is identified and linked to its purchaser or owner at the point of sale or transfer. If these unique identifiers are associated with an individual (by linking through a credit card number, for example), then a profile of that individual’s purchasing habits can easily be created; d) Secondary use (particularly in the sense of limiting or controlling such use). The creation of profiles and the tracking of movement can reveal a great deal of additional information. For example, the revelation of personal information such as medical prescription or personal health histories could have an impact on the availability of insurance or employment; ande) Massive data aggregation. RFID deployment requires the creation of massive databases containing unique tag data. These records could be linked with personal identifying data, especially as computer memory and processing capacities expand. This, in turn, could facilitate any of the practices listed above.Application of Fair Information Practices to RFID Technology The ten principles of the CSA Standard, attached as schedule I of the Personal Information Protection and Electronic Documents Act, provide the basis for a privacy management framework that can be applied to RFID technology. It is important to clarify to what the principles would apply. In the context of RFID technology, this means that: If the chip has had the personal information of the individual written to it, then it is a repository of personal information; If the tag is unique, and can be associated with an individual, it becomes a unique identifier or proxy for that individual; and Information about possessions or purchases which can be manipulated or processed to form a profile is personal information, whether gathered through multiple visits to a facility or organization, or through access to the data base of RFID purchase information.

During the past decade, patient safety and high-quality patient care have increasingly become the focus for healthcare organizations across the country. Opened in 1951 with 140 beds and one of the nation's first post-operative recovery rooms, Baptist Hospital is now the largest hospital in the Baptist Health Care Network with more than 490 beds. This award-winning hospital provides a full range of medical, surgical, and obstetrical services. Specialized critical care is provided by the hospital's emergency center and three intensive care units: coronary, surgical, and neurological intensive care.

Baptist Hospital has been frequently recognized for providing a quality work environment, as well as demonstrating a commitment to quality care by implementing processes, procedures, and technology to reduce medical errors, eliminates inefficiencies and errors, and improves quality patient care and safety.Active-RFID IPS has been shown to streamline patient flow, improve equipment management and staff efficiencies, and deliver a return on investment in less than a year. These tags transmit a consistent signal over a long range, which makes them effective for identifying and locating people or items that move frequently and over large distance indoors. Passive-RFID systems are effective for uniquely identifying things and people in controlled settings. For example, the technology might be used to identify and manage

the inventory of narcotics. For hospitals using active-RFID IPS to optimize surgical workflow and patient throughput, the ability to automatically know and use real-time patient location throughout the complex phases of surgery enables a smarter perioperative care environment. Clinicians achieve greater efficiencies, patients realize a better overall surgical experience, and waiting loved ones are engaged with relevant surgical status information. Her decision paid off with a return on investment within the first year based on increasing OR utilization, reducing overtime, and improving inventory management.Date published: 2006-02-23. Date modified: 2006-02-23Important Notices

Using RFID technology, WaveMark CIMS collects, reports, and manages usage and inventory data in real time. This information allows hospital staff to accurately manage supply levels, easily monitor expired products, and efficiently track product usage. With WaveMark CIMS, clinical environments can improve operating efficiency and reduce costs. Having the right products, for the right doctors, at the right time, is increasingly complicated and challenging, potentially trade-off patient safety, staff job satisfaction and overall productivity. surgery centers are recognizing the need to more efficiently manage and control the flow of their high-value physician preference items. RFID technologies offer benefits such as improved operational efficiencies and enhanced health care services, but where such systems involve personal health information, then obligations under the Personal Health Information Protection Act (PHIPA) may be engaged

Taking an Infrastructure Approach to RFIDMany hospitals are implementing one-off systems to achieve a specific goal, such as tracking assets and managing inventory. Find out how Hamilton Health Sciences and the Hospital for Sick Children are leveraging RFID today to improve product and asset controls, and hear their thoughts on how RFID can support healthcare facilities in the future.

Medication safety is an area of great concern for consumers and health care providers. Technology is a strategy to enhance patient safetyhospitals can also use it to take inventory of hospital resources. According to Hermann, many hospitals have a "broken process" for their equipment and often claim a shortage when there isn't one, which can lead to excessive orders for supplies they already have in stock.

Inventory control is concerned with minimizing the total cost of inventory. In the U.K. the term often used is stock control. The three main factors in inventory control decision making process are:

The cost of holding the stock (e.g., based on the interest rate).

The cost of placing an order (e.g., for row material stocks) or the set-up cost of production.

The cost of shortage, i.e., what is lost if the stock is insufficient to meet all demand

Inventory control is concerned with minimizing the total cost of inventory. In the U.K. the term often used is stock control. The three main factors in inventory control decision making process are:

The cost of holding the stock (e.g., based on the interest rate).

The cost of placing an order (e.g., for row material stocks) or the set-up cost of production.

The cost of shortage, i.e., what is lost if the stock is insufficient to meet all demand

By monitoring the status and whereabouts of critical medical equipment used in the operating rooms, doctors and nurses can ensure that equipment and rooms are ready for surgical proceduresIntegrated REID technology allows capture of theinformation coded on the unique REID tag on the sponges, padsand towels.RFID technology has great potential in healthcare to significantly reduce cost, and improve patient safety and medical services.

Paperwork is time consuming, patient transfers are often poorly coordinated, and busy providers juggling multiple responsibilities do not always communicate well with each other or with the patient and their family. These system inefficiencies create opportunities for medical errors and safety gaps, potentially harming a patient.Medical Technology in the Fast Lane

RFID Is Making Rapid Inroads in the Healthcare and Medical Device Markets

Christopher DelporteGroup Editor

Proposal for RFID in surgical unitsIn this pre-conference, you will learn about the way hospitals and health care providers are using RFID today as well as insights into how to move from one-off applications to an infrastructure approach to RFID.

The system reduces the time nurses spend entering data about the patient, leaving them more time to provide care. The system also reduces misidentification of patients and allows for more accurate, automatic billing for procedures.Many hospitals are using RFID to track high-value assets within their facility so that care givers spend less time looking for assets, utilization is improved and routine maintenance can be scheduled and managed automatically. Learn how one hospital achieved a return on investment in an asset tracking system in less than a year.Many hospitals are implementing one-off systems to achieve a specific aim, such as identifying patients or tracking one type of assets. While these system can achieve significant benefits, implementing RFID infrastructure that can be used to track patients, assets, surgical instruments that need to be decontaminated and other applications can profoundly improve a hospitals bottom line.

They can help prevent sponges and other materials from being left inside a patient during surgery.

According to a recent study at the Stanford University in California, involving eight patients who underwent abdominal and pelvic surgery, RFID-tagged or untagged sponges were placed by a surgeon. Another surgeon, who did not know which of the sponges contained the tags, ran a wand over the patients' abdomen to look for the sponges. The wand could identify all the tagged sponges and never reported the presence of a tagged sponge when there was none. It took just three second for the tagged sponge to be identified.

This manual process is time consuming and subject to human error. When there is a discrepancy in the counts, at most hospitals, an X-ray is required before leaving the operating room. Additionally, many hospitals call for X-rays for high risk cases such as emergencies, transplants and surgeries greater than five hours in order to assure no retained objects.application of RFID for counting surgical instruments which would improve safety, time and inventory control.

Why not put rfid tags into all the instruments and sponges. Then after surgery, run a scanner over the patients body - anything left inside should show up quickly. According to ClearCount, recent studies have estimated that cases of retained foreign bodies occur between 1 out of every 100 to 1 out of every 5,000 surgical procedures, and studies have shown that two-thirds of all retained foreign bodies are surgical sponges.

SmartSponge, surgical teams will be able to scan the patient with an RFID interrogator in the form of a wand during postoperative safety checks to find any sponges mistakenly left behind. The technology could supplant time-consuming manual counts done by at least two nurses several times during the course of a surgery, or costly and time-consuming X-rays that can detect threads sewn into the sponges.

Surgical Equipment to Contain RFIDThis seems like a really clever use of RFID. The idea is to embed chips in surgical equipment, and then wave a detector over surgical patients to make sure the doctors didn't accidentally leave something inside the body.Another advantage is that the technology may help minimize staff time in the operating room not dedicated to patient care through use of RFID for instrument counting before and after procedures.Many of them are not discovered until years later. Infections around the sponge cause them to be detected earlier. Thisrequired an additional operation, causing unnecessary worry to both doctors as well as patients.Anyone facing surgery gets the jitters. Among the fears are a mistake such as the doctor operating on the wrong leg or performing the wrong procedure. Although such mistakes are rare in the thousands of operations that take place in the United States each day, they do happen. Government estimates indicate that five to eight wrong-site surgeries occur each month. New RFID technology approved by the Food and Drug Administration last November is starting to help some patients relax and doctors and surgical staff to be more secure that the correct operation is about to be performed on the right person and on the correct place on the body. The new RFID verification system, called Surgichip, is being sold by AMTSystems as part of its suite of PatientSafe patient-safety systems, which also include medication-verification products. Surgichip is an RFID tag that gets encoded by medical staff with the patient's name and other identification such as date of birth and medical-record number, as well as information about the type and site of procedure and other surgical instructions. The tags also are HIPAA-compliant and meet national patient safety standards of the Joint Commission on Accreditation of Healthcare Organizations, says Todd Stewart, AMTSystems' VP of business development. The 2-inch-by-1-inch nonallergenic label gets stuck to a patient's skin near the surgical site, such as a left knee, before the operation. Before surgery begins, the tags are read by operating-room staff with handheld readers to confirm the patient and procedure. "This is one more way for us to be super-sure" that the correct patient is about to undergo the right surgery, says Dr. Frank Cook, an orthopedic surgeon at The Palm Beach Orthopedic Institution During the first year use of Surgichip, the cost of the system comes to about $6 to $9 per surgery, including the costs of software installation, says Stewart. However, by the second year, the cost drops to about $3 per procedure. Huntsville Hospital decided on an RFID-enabled system mainly because it wanted to improve efficiencies and communications that would directly improve surgical start times, Cathcart says. "The surgery department had identified several components to the patient throughput and staff workflow that often creates a bottleneck throughout the continuum of care," she says. The hospital specifically wanted to improve communication among staff via real-time updates of patients' status, provide caregivers with visual cues via an LCD monitor of scheduled procedures and their status, as well as provide a mechanism that would correctly identify patients being prepped for surgery. "JCAHO [the Joint Committee on Accreditation of Healthcare Organizations] is reporting five to six wrong site surgeries per month," said Debbie Murphy, a life sciences expert at Zebra Technologies, the company that provides the RFID printer/encoders and labels for the product. The product could provide a useful means for health care organizations to avoid surgical errors and assuage patient concerns, she said.

According to Stanchfield, end-to-end setup of the standalone SurgiChip system will cost health care organizations anywhere from $25,000 to about $75,000, including software, hardware, installation, labels and staff training. 2007—A Taiwanese hospital is using passive RFID to help correctly identify surgical patients and track their operations to ensure they get the correct procedures and the proper medications at the right time.

By automating the storage, tracking, utilization, and billing of clinical resources through RFID, healthcare providers realize enhanced care quality, increased productivity, accurate billing, and significant inventory cost savings.