Grace Ministries HospitalMemo

To: Robert Repetto, Executive Champion

From: Tonquita Davis, Product Champion

Date: November 19, 2007

Subject: Bar Code’s Replacement

Here is the proposal you requested for implementation of Radio Frequency Identification. The proposal includes secondary research that shows how RFID can enhance the quality of patient care in our surgical department. Although bar coding reap some improvements, RFID will do a more efficient job. Recommendation for the following RFID application includes: patient identification, surgical equipment and inventory tracking.

Bar code’s replacement: Radio Frequency Identification

Prepared by Tonquita DavisProduction champion

Report Distributed November 19, 2007

Prepared for Grace Ministries Hospital

Surgical department

ABSTRACT

The purpose of this proposal is to show how RFID can have a profound impact in our surgical department. Providing quality care to patient in our surgical units includes the following: Cost reduction, fewer errors, increased patient safety, and reduce patient wait time, which promotes patient satisfaction. RFID is also intended to respond to the potential problem that can occur in our surgical units such as, misidentification, foreign retainer, and lost or misplaced inventory. The results of this study show more effort is needed to increase patient safety and manage inventory. In this area RFID can do a more efficient job than Bar Code because of it many advantages. The primary goal of RFID is to enhance patient care in our surgical unit by reducing medical errors, potential law suits, and cost and time not spent on patient. Recommendation includes the following RFID application to achieve these results in our surgical department:

Patient safety identification Tracking surgical equipment Managing inventory

Table of contents

ABSTRACT ………………………………………………………………………

INTRODUCTION ………………………………………………………………. 1

Advantages of RFID over barcodes ……………………………………….. 1

COMPONETS OF RFID TECHNOLOGY SYSTEM ………………………… 1RFID Tag ………………………………………………………………….. 2RFID Reader ……………………………………………………………… 2RFID database …………………………………………………………….. 2

THE BENEFITS OF USING RFID ……………………………………………... 2

THE PROPOSE PLANS/SOLUTIONS ………………………………………... 3Patient safety identification ……………………………………………….. 3Tracking surgical equipment ………………………………………………. 4Managing inventory ……………………………………………………….. 4

COST OF IMPLEMENTATION………………………………………………… 5

PRIVACY CONCERN …………………………………………………………… 5

CONCLUSION/RECOMMENDATION ………………………………………... 6

WORKS CITED........................................................................................................ 7

1

Introduction

Rising health care cost and patient safety are a major concern for hospital. Controlling these issues will be essential to keep our competitive advantages and improve the quality of patient care. Government studies suggest strong Information Technology investment could cut health care costs by 20 percent each year, and Radio Frequency Identification technology can definitely contribute to health care cost reductions (Murphy 28). As our hospital seek ways to reduce expenses, it is important that patient safety is not the trade-off; Radio Frequency Identification (RFID) holds great potential to significantly reduce cost, while improving patient safety. RFID can help prevent potential mistakes that can occur in surgical procedures, which contribute to the rising health care cost and help close safety gaps within surgical units. Although Bar Code eliminates some potential problems and provides some safety measure, it has drawbacks. RFID is a more efficient process for the job. Quality care promotes patient satisfaction, and that is very important, especially since now more patients than ever are choosing their hospital. I propose that to promote the over all quality of patient care, we implement RFID technology to enhance our surgical department.

Advantages of RFID over barcodes

RFID (terminology: a wireless automatic identification and data capturing communication technology uses to track or identify people or objects.) is really an upgraded barcode. (General RFID information): Unlike traditional Bar Code, it doesn’t require a line of sight to visually read or scan tags. So therefore, RFID data can be read through patient clothing, non-metallic materials, and even the human body. RFID scanner can read at longer distances than bar code, and read multiple tags at once. It also yields larger memory capacities and faster processing. Bar code scanning has drawbacks like not being able to read barcode, if the paper is ripped off or becomes unreadable. RFID will continue to grow in its established roles where barcode or other optical technologies are not as effective because of the unique identification at the product level.

Components of RFID technology system

A RFID system consists of three key components a RFID tag, RFID reader, and RFID database. Inside of each tag are integrated circuits. The reader decrypt the data encode in the integrated circuit of the tag and the data is passed to the host computer processing.

2

RFID Tag

An RFID tag (terminology) A.K.A transponder is a device attached to or embedded in a physical object to be identified or tracked. It contains an embedded microchip, radio receiver and radio transmitter. The chip stores basic information about a tagged object, typically a product code and a unique serial number. The information is relayed using radio waves to an RFID reader, which then transmits the data to business software systems where it can be put to use. RFID tags are available in three different types: passive, semi passive, and active. Passive tags store a small amount of data, are powered by an electronic reader, have a range about 3 feet, and react when a signal is received. Semi-passive tags are similar to passive tags, but contain an internal power source. Due to this power source, the semi passive tag holds more data and has a greater range. Active tags offer the most features, data, greatest range, and uses battery power source.

RFID Reader

Readers (terminology) can either be portable handheld terminals or fixed device. Often antenna is packaged with the transceiver and decoder to become a reader/interrogator. 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. This enables a RFID reader and RFID tag to communicate to each other through a specified radio frequency. Low- frequency systems have short reading ranges. High frequency systems offer longer read ranges and higher reading speed.

RFID database

RFID middleware (terminology) consists of computer hardware and data processing software that connects readers to computer systems and data storehouse. It converts data from tags into tracking or identification information. It takes the raw data from the reader filters it and passes on the useful event data to back-end systems. Middleware plays a key role in getting the right information to the right application at the right time.

The Benefits of using RFID

RFID can have profound impact and benefits for our surgical units when the right resources are tracked and identified. RFID will help eliminate potential problem in our surgical department and provide the following significant benefits:

Improved inventory efficiency and management Fewer errors Cost reduction

3 Reduce administrative burdens on care givers Shorten patient wait times Increase patient safety

These benefits will help enhance the overall quality of patient care in our surgical centers. The benefits of using RFID in our surgical department are compelling. To achieve these benefits at Ministries Hospital, I propose that we implement RFID technology to identify patient, track surgical equipment, and manage inventory.

The propose plans/solutions

To achieve these benefits at Grace Ministries Hospital, I propose that we implement RFID technology to identify patient, track surgical equipment, and manage inventory.

Patient safety identification

As you know, the FDA now requires hospital to do a universal protocol procedure to eliminate the likelihood of wrong site, wrong procedure, and wrong patient surgeries (FDA 1). Government estimates indicate that five to eight wrong-site surgeries occur each month (FDA). Due to the fact that paperwork is time consuming and busy staffs juggling multiple responsibilities do not always communicate well with each other or with the patient and their family. These inefficiencies can create opportunities for medical errors and safety gaps, potentially harming the patient. Using RFID to identify patient can help enhance our standard operating procedure by making the process more accurate, efficient, and less time consuming. Marcy hospital implemented RFID to patient wristband and reported, “Nurses appreciate the time savings and convenience that can be applied to their workflow” (Young 2435). The RFID wristband also reduces misidentification of patients. Before surgery begins, surgical staff can read RFID tags embedded in wristband with handheld readers to confirm the right patient and right procedure. The memory of the tag can store information like doctor’s name, patient’s name, age, gender procedure, operative site, and medical-record number (Bacheldor 5). The unique ID number of the tag is then associated with the record of the patient in the hospital’s back end information system. It also lists critical information such as allergies, precaution, and special needs (Bacheldor 5). The device also displays a checklist of procedures that must be carried out before that specific patient can progress through to the next stage of the surgical process (Bacheldor 5). Our nurses will be aware of the status of their patients and can avoid delays in patient flow caused by a lack of information. The RFID system will reduce the time nurses spend entering data about their patient, leaving them more time to provide care. RFID could provide a useful means for our hospital to avoid surgical errors and alleviate patient concerns.

Tracking surgical equipment

4Our nurses spend 15 to 30 minutes counting surgical sponges before, during, and after each surgery to ensure that all sponges used are removed. This manual process is time consuming, and subject to human error, even with our most conscientious surgical staff count can be unreliable in a busy surgical unit. According to clear count, an estimated 1,500 object are left inside patients during surgery each year, and studies have shown two-thirds of them are sponges (Clear Count Medical Solution 35). Many of them are not discovered until years later, which required an additional operation. Embedding our surgical equipment, tools and assets such as, sponges with RFID tags can save us from potential lawsuits. RFID can prevent sponges and other materials from being left inside our patient during surgery because it does not require a line of sight to read tags. Therefore, sponges and other surgical instruments can be detected inside the human body (Schuerenberg 34). Alex macario, M.D. led a study at Stanford University medical center to determine if RFID technology could be used to help reduce such errors (schuerenberg 34). During the study, 28 RFID sponges were left in eight patients, surgeons pulled together the patient’s incisions and used scanning device to scan for sponges and all sponges were detected (schuerenberg 34). By implementing RFID to track surgical instrument, our surgical teams will be able to scan the patient with an RFID reader (interrogator) in the form of a wand after surgery to make sure no sponges are mistakenly left inside patients. RFID technology could supplant time-consuming manual counts done by nurses several times during the course of a surgery, or costly and time-consuming X-rays that can detect threads sewn into the sponges which reduces staff time not dedicated to patient care.

Managing inventory

Asset management is critical for patient safety. Our staff spends vast amounts of time looking for surgical equipment and shared resources, which frequently delay our surgical procedures. Having the right products, for the right doctor, at the right time, is complicated and challenging which, potentially trade-off patient safety, staff job satisfaction and overall productivity. By monitoring the status and whereabouts of critical medical equipment used in the surgical units, our staff can ensure that equipments are ready for surgical procedures. Using RFID to manage inventory can lead to more precise supply orders and more accurate delivery of appropriate materials to physicians and patients (Murphy 31). Our hospital often incur high costs related to lost and misplaced equipment, which leads to increase cost because of the need to rent equipment to meet usage demands. Managing inventories with RFID System will lead to improved asset use and lower rental costs because of the ability to pinpoint the misplaced items, which saves a lot of money spent for replacing items. Bon Secours Health System installed RFID at three hospitals to track equipment and reported they no longer had to spend money on replacing lost equipment and the nursing staff saved 30 minutes per shift because they don't have to search for equipment (Murphy 30). An RFID system can save labor cost, improve operating efficiency and reduce costs. A study of tracking in operating room

5showed an improvement in the utilization of surgical department from 57% to 70%, which in turn paid for the RFID system through a reduction in need for overtime pay (Nagy 63).

Cost of Implementation

The cost of implementing RFID depends on the application, the size of the installation, the type of system, maintenance and many other factors, so it is not possible to give an exact figure. Each key component will have up-front costs and some unexpected costs. RFID passive tags are priced anywhere from 28 cents to $1 each. Semi-passive tags range between $6 and $50 a tag, depending on the capabilities. Active tags are priced between $15 and $100 each, based on the options and memory. RFID readers price range from $500 to $3,000, depending on their functionality. RFID middleware can be purchased for as little as $5,000 to $20,000 based on the number of locations where it will be installed, the complexity of the application. Our Company will need to invest in training for employees and pay for the installation of the readers. We may also need to hire a systems integrator, upgrade enterprise applications and networks within our facilities. It's not possible to provide a list of every element that our company will need and the cost of those systems. These questions will be discussed and answer with RFID vendors. According to Page, quotes from various vendors indicate that it costs $200,000 to $600,000 or more to install a facility wide RFID tracking system in a medium-sized hospital, but vendors are quick to say that the new efficiencies RFID systems produce can pay for the investment in one to two years, and many hospital clients agree (Page 18). In total, the system reports saving $200,000 a year over the cost of installation and maintenance of RFID, not including productivity gains (Murphy 30). For these early adopters, the savings and improved patient care far outweighed the cost of RFID installation and maintenance (Murphy 30).

Privacy concern

A lot of the attention around RFID is related to privacy, with concerns being raised that rights are being compromised. Significant privacy issues could result with RFID if it is not carefully controlled. However, we can do a lot of things to make sure patients privacy are protected and that we meet HIPAA compliance/ requirements. We could invest in a technological tool known as a blocker tag that emit private-read commands that jams readers, rendering the reader incapable of communicating with other tags (Juels 15). By carrying a blocker, our patients can be ensured against scanning of their personal possessions (Juels 16). We can also purchase RFID tags that include a built-in 'kill'

6function and with the correct pass-code, the tag can be either reprogrammed or told to 'self destruct', rendering it useless (Juels 2). Personal health information is not at risk if we carry RFID tags that only have a unique ID that requires an external systems database to match patient demographics (Nagy 66). To consume patient fear of third party snooping, tags can have a random number store in a secure database to identify health information or a security code to access the data stored on the chip (Wicks 6).

Conclusion/Recommendation

Upon my research I found, RFID technology that can be applied across many health-care applications. Many hospitals are implementing one-off systems to achieve a specific aim, such as identifying patients or tracking one type of assets (Roberti 4). While these systems can achieve some potential benefits, implementing RFID infrastructure that can be used to track patients, assets, and surgical instruments can profoundly improve the quality of hospitals bottom line (Roberti 4). I recommend that to get the full potential benefits of RFID we implement it to identify patient, track surgical equipment and inventory in our surgical department. It is also where the potential return on investment will be the greatest. Implementing RFID can help enhance patient safety, inventory management and asset tracking in the surgical department of our hospital, which can help reduce cost and increase patient safety. RFID has been implemented in several major hospitals around the country; their experience shows how RFID can decrease inventory loss, increase time devoted to patients and improve the accuracy of instruments required for surgeries (Murphy 30). There is a clear advantage to using RFID tags in department where tracking supplies, equipment, and thousands of other items remains a major challenge for hospital. If this proposal is adopted, I am looking forward to finding leading RFID vendors to help us with process changes and training. I am confident that we can make the transition and that the staff will be happier with the workflow, it is design to make our work process easier not harder. Implementation phase take about 12 months. The advantages of RFID systems are more than cost and ROI investment are seen. RFID systems are reported to return their investment in less than 3 years (Nagy 63).

7 Works Cited

Bacheldor, Beth. (2007). Tags Track Surgical Patients at Birmingham Heartlands Hospital. RFID Journal, 1-2. <http://www.rfidjournal.com/article/articleview/3222/1/1/>

Clear Count Medical Solution. “Tracking down wayward sponges.” Nursing 36.10 Oct 2006: 35-35. Health source: Nursing/Academic Edition. 9 Nov. 2007. GALILEO.

FDA Consumer. “Technology for safer surgery.” FDA Consumer 39.1 Jan/Feb 2005: 2-2. Alt HealthWatch. 9 Nov. 2007. GALILEO.

Juels, Ari. (2005). A Bit of privacy: Blocking. RFID journal, 1. <http://www.rfidjournal.com/article/articleview/1536/1/82/>

Murphy, Debbie. “Is RFID right for your organization?” Materials Management in Health Care 15:6 (2006): 28-33. Medline With Full Text. 9 Nov. 2007. GALILEO.

Nagy P, George I, Bernstein W, Caban J, Klein R, Mezrich R, Park A. “Radio frequency Identification systems technology in the surgical setting.” Surgical Innovation 13.1 Mar 2006: 61-67.Medline with full text. 9 Nov. 2007. GALILEO.

Roberti, Mark. (2002). RFID's Role in Improving Hospital Operations. Ed. RFID Journal, 1-2. <http://www.rfidjouralevnents.com/healthcare/>

Roberti, Mark. (2002). Glossary of RFID Terms. Ed. RFID Journal. <http://www.rfidjournal.com/article/glossary/>

Roberti, Mark. (2002). General RFID information. Ed. RFID Journal.<http://www.rfidjournal.com/faq/16/50>

Schuerenberg, BK. “Bar codes vs. RFID: a battle just beginning.” Health Data Management 14.10 Oct.2006: 32-4, 36, 38. MEDLINE With Full Text. 9 Nov. 2007. GALILEO.

Wicks AM, Visich JK, Li S. “Radio frequency identification applications in hospital environments.” Hospital Topics 84.3 Summer2006: 3-8. MEDLINE with Full Text. 9 Nov. 2007. GALILEO.