SOURCES

Roberti, Mark. (2002). Glossary of RFID Terms. Ed. RFID Journal. <http://www.rfidjournal.com/article/glossary/>Radio Frequency Identification: A method of identifying unique items using radio waves. Typically, a reader communicates with a tag, which holds digital information in a microchip. But there are chipless forms of RFID tags that use material to reflect back a portion of the radio waves beamed at them.RFID a definition: RFID is a wireless AIDC (Automatic identification and data capture technologies) use to track and manage items with minimal (human) intervention. RFID is a system that involves electronic tags containing data encoded (e.g. identification) onto a integrated circuit (IC). A device (reader) sends an electromagnetic signal to the tag. The tag transmit its code when a signal is received from a reader.

RFID tag: A microchip attached to an antenna that is packaged in a way that it can be applied to an object. The tag picks up signals from and sends signals to a reader. The tag contains a unique serial number, but may have other information, such as a customers' account number. Tags come in many forms, such smart labels that can have a barcode printed on it, or the tag can simply be mounted inside a carton or embedded in plastic. RFID Tag also called a transponder. The transponder components are a integrated circuit (chip), a antenna and the substrate (support). RFID tags can be active, passive or semi-passive.Active tag: An RFID tag that has a transmitter to send back information, rather than reflecting back a signal from the reader, as a passive tag does. Most active tags use a battery to transmit a signal to a reader. However, some tags can gather energy from other sources. Active tags can be read from 300 feet (100 meters) or more, but they're expensive (typically more than US$20 each). They're used for tracking expensive items over long ranges. For instance, the U.S. military uses active tags to track containers of supplies arriving in ports. Battery-assisted tag: These are RFID tags with batteries, but they communicate using the same backscatter technique as passive tags (tags with no battery). They use the battery to run the circuitry on the microchip and sometimes an onboard sensor. They have a longer read range than a regular passive tag because all of the energy gathered from the reader can be reflected back to the reader. They are sometimes called "semi-passive RFID tags."Passive tag: An RFID tag without its own power source and transmitter. When radio waves from the reader reach the chip’s antenna, the energy is converted by the antenna into electricity that can power up the microchip in the tag. The tag is able to send back information stored on the chip. Today, simple passive tags cost from U.S. 20 cents to several dollars, depending on the amount of memory on the tag, packaging and other features Passive-RFID systems are effective for uniquely identifying things and people in controlled settings. Semi-passive tag: Similar to active tags, but the battery is used to run the microchip's circuitry but not to broadcast a signal to the reader. Some semi-passive tags sleep until they are woken up by a signal from the reader, which conserves battery life. Semi-passive tags can cost a dollar or more. These tags are sometimes called battery-assisted tags.Antenna: The tag antenna is the conductive element that enables the tag to send and receive data. Passive, low- (135 kHz) and high-frequency (13.56 MHz) tags usually have a coiled antenna that couples with the coiled antenna of the reader to form a magnetic field.Fixed Reader: An RFID interrogator mounted to a wall, doorway, gate, table, shelf or other permanent or non-mobile structure, enabling employees to read the unique ID numbers of RFID tags attached to items in a warehouse or other setting along the supply chain.Mobile Reader: An RFID interrogator that can be carried or transported on a person, vehicle or apparatus, enabling employees to read the unique ID numbers of RFID tags attached to items in a warehouse or otherRead range: The distance from which a reader can communicate with a tag. Active tags have a longer read range than passive tags because they use their own power source (usually a battery) to transmit signals to the reader. With passive tags, the read range is influenced by frequency, reader output power, antenna design, and method of powering up the tag. Low-frequency tags use inductive coupling, which requires the tag to be within a few feet of the reader.Low-frequency: From 30 kHz to 300 kHz. Low-frequency tags typical operate at 125 kHz or 134 kHz. The main disadvantages of low-frequency tags are they have to be read from within three feet and the rate of data transfer is slow. But they are less subject to interference than UHF tags.High-frequency: This is generally considered to be from 3 MHz to 30 MHz. HF RFID tags typically operate at 13.56 MHz. They can be read from less than 3 feet away and transmit data faster than low-

frequency tags. But they consume more power than low-frequency tags.Middleware: In the RFID world, this term is generally used to refer to software that resides on a server between readers and enterprise applications. It's a critical component of any RFID system, because middleware is used to filter data and pass on only useful information to enterprise application or back-end systems. 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 for further processing. Some middleware can also be used to manage readers on a network.Bar code: A standard method of identifying the manufacturer and product category of a particular item. The bar code was adopted in the 1970s because the bars were easier for machines to read than optical characters. The main drawbacks of bar codes main are they don’t, in most cases, identify unique items and scanners have to have line of sight to read them.

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

Is RFID better than using bar codes? The two are different technologies and have different applications, which sometimes overlap. The big difference between the two is bar codes are line-of-sight technology. That is, a scanner has to "see" the bar code to read it, which means people usually have to orient the bar code toward a scanner for it to be read. Radio frequency identification, by contrast, doesn't require line of sight. RFID tags can be read as long as they are within range of a reader. Bar codes have other shortcomings as well. If a label is ripped or soiled or has fallen off, there is no way to scan the item, and standard bar codes identify only the manufacturer and product, not the unique item. The bar code on one milk carton is the same as every other, making it impossible to identify which one might pass its expiration date first But if tags can be made cheaply enough, they can solve many of the problems associated with bar codes. Radio waves travel through most non-metallic materials, so they can be embedded in packaging or encased in protective plastic for weatherproofing and greater durability. And tags have microchips that can store a unique serial number for every product manufactured around the world.

Juels, Ari. (2005). A Bit of privacy: Blocking. RFID journal, 1. <http://www.rfidjournal.com/article/articleview/1536/1/82/>May 2, 2005—RFID privacy inflames passions as few other technological issues can. If item-level RFID tagging comes to pass, there is no gainsaying the privacy concerns it will bring. Vendors and users have designed EPC tags of the Generation 2 variety so that they can be "killed." Killing means rendering tags permanently inoperative at the point of sale. To address the problem of consumer privacy, RFID vendors and users have designed EPC tags of the Generation 2 variety so that they can be "killed." Killing means rendering tags permanently inoperative at the point of sale. This solution to the privacy problem—preemptive capital punishment for RFID tags, as it were—is psychologically gratifying; it is simple and direct. But it too casts the question of consumer privacy in black-and-white terms. The practice of killing RFID tags presupposes that their dangers to consumers are otherwise uncontrollable. The collateral damage would be extensive. RFID read command, which we might call private-read. A tag with its privacy bit turned off will respond to an ordinary read command; a tag with its privacy bit turned on will respond only to a private-read command. The private-read command enables a few different approaches to privacy enforcement: Blocking. Reader auditing detects violations as they occur, or after the fact. A technological tool known as a blocker tag or blocker, on the other hand, can prevent privacy violations before they occur. A blocker effectively jams readers that emit private-read commands. In a nutshell, when it detects a private-read command, it simulates all possible RFID tags in the world, rendering the reader incapable of communicating with other tags.Clear Count Medical Solution. “Tracking down wayward sponges.” Nursing 36.10 Oct

2006: 35-35. Health source: Nursing/Academic Edition. 9 Nov. 2007. GALILEO.

An estimated 1,500 objects are left in patients during operations in the United States each year. Two-thirds of these materials are sponges Two of this study’s authors work for Clear Count Medical Solutions, which is developing the Smart Sponge System. Source: Initial clinical evaluation of a handheld device for detecting retained surgical gauze sponges using radio frequency identification technology, Archives of Surgery, A Macario, et al., July 2006. For more information, visit http://www.clearcount.com. By replacing these two error-prone systems, ClearCount’s patented technology promises to dramatically reduces costs, improve patient safety, and increase worker productivity. In over 40 million operations each year in the U.S., perioperative nurses spend 15-30 minutes manually counting surgical sponges and instruments before, during, and after each operation. The counts are intended to prevent a common surgical risk: retained foreign bodies. Factoring in time spent tracking surgical sponges and instruments with the costs of legal settlements and the repeat operation to remove the retained foreign bodies, it is not surprising that this problem costs U.S. healthcare institutions in excess of $1 billion annually.

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.

Most hospitals require clinicians to conduct manual sponge counts both before and after each surgical procedure to ensure sponges that were used are removed before the patient is sewn up. But these procedures aren't always followed, and as a result Its all too common for sponges to be left inside patients, says Alex Macario, M.D., who last year led a study at Stanford University Medicai Center to determine if RFID technology could be used to help reduce such errors. The study, which was funded by grants from the Small Business innovation Research Program and the National Institutes of Health, involved using surgical sponges that had been embedded with passive RPID tags. The technology, from ClearCount Medical Solutions, Pittsburgh, has not yet been approved by the Food and Drug Administration and is not yet commercially available. During the study, 28 of the vendor's RFID sponges were intentionally left in eight patients who underwent abdominal or pelvic surgeries. Near the end of the procedure, surgeons pulled together the patients incisions and used the vendor's scanning device to scan for the sponges. Alt the sponges were detected. White barcode technology can be used to automate sponge-counting processes, RFID technology is more effective for the process, Macario contends.

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

Implementing RFID-enabled wristbands to track surgical patients and procedures in two of its surgical departments. According to Jeremy Turbervill, head of sales and marketing for Safe Surgery Systems, the company wished to help improve patient safety by ensuring that each patient receives the proper care. NPSA) reports, there have been cases in which doctors have operated on incorrect sites on their patients' bodies. The term "correct site surgery," the agency explains, refers to operating on the correct side of the patient and/or the correct anatomical location or level (such as the correct finger on the correct hand). The RFID wristbands are being issued to surgical patients, printed and encoded using an RFID wristband printer when the patients are admitted to the hospital. The RFID inlay embedded in each wristband, Turbervill says, is encoded with a patient's ID number, name, date of birth and gender. The patient inlay data is then associated with patient records held within back-end hospital systems, including the patient administration and surgical booking systems. The Safe Surgery System software uses a series of so-called traffic lights, which change from red to green as pre-operative checks are performed. Once all pre-operative checks have been completed and the patient is ready for

surgery, the Safe Surgery System update's the traffic light to green, indicating the patient is ready for surgery. When the patient is sent to the surgical ward, an RFID interrogator in the ward reads that person's wristband to retrieve the appropriate patient record, including the planned procedure. In addition, the Safe Surgery System records post-operative procedures. As the patient moves to each stage of surgical process, nurses or other caregivers scan the tag, and the tag ID number is automatically entered into a patient kiosk-comprised of an embedded CPU, a touch-screen monitor, a Wi-Fi card and an RFID scanner, Cathcart explains. The staff at Huntsville Hospital values the system, particularly because they can easily check on the status of patients via the electronic boards. Moreover, the system is helping the hospital document its clinical operations and keep patient surgeries on schedule. Since using the system, Huntsville Hospital says OR room utilization has become more efficient, and staff members now know in real-time the location and status of a patient.

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

The FDA has cleared for marketing a high-tech tag intended to provide additional protection for people undergoing surgery. The SurgiChip Tag Surgical Marker system is the first to use radio frequency identification (RFID) technology to mark parts of the body for surgery. It aims to minimize the likelihood of wrong-site, wrong-procedure, and wrong-patient surgeries. The patient's name and the site of the surgery are printed on a SurgiChip tag. The inside of the tag is encoded with the date of surgery, type of procedure, and the name of the surgeon. The tag is scanned with a desktop RFID reader for confirmation by the patient and is then placed in the patient's hospital file. On the day of the surgery, the tag is removed from the file and scanned again, and the encoded information is verified by the patient. The tag, which has an adhesive backing, is then placed on the patient's body near the surgical site. In the operating room, the tag is scanned again and the encoded information is verified with the patient's chart. The tag is removed just before surgery and returned to the patient's hospital file. The device is manufactured by SurgiChip Inc. of Palm Beach Gardens, Fla. The FDA also has stepped up its efforts to use RFID to improve the safety and security of the nation's drug supply. In this case, RFID uses electronic tags on product packaging to allow manufacturers and distributors to more precisely track drug products as they move through the supply chain.

Page Leigh. “Hospitals tune in to RFID” Material management in Healthcare. 16.5 May 2007: 18-20. MEDLINE with Full Text. 22 Nov. 2007. GALILEO.

Industry representatives estimate that only about 200 hospitals are using this radio wave-based technology, chiefly for tracking equipment or patients. Most of the early users have limited their RFID (radio frequency identification) applications to emergency departments, operating rooms or small pilot programs on one floor. 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. This is because RFID-based tracking eliminates staff time spent searching for equipment, and inventories can be pulled out because equipment does not get lost. Similarly, RFID-biised patient tracking can speed up patient flow in high-volume areas such as the ED and OR, increasing income and eliminating the need for costly capital expansions. Many of the early users are sprawling institutions where keeping track of equipment and patients is a real challenge. But plenty of smaller hospitals in the 250- to 400~room range also are acquiring RFID a big chunk of RFID's cost is installing a network of receivers For example, RF Surgical Systems, Bellevue, Wash., puts passive tags in surgical sponges that emit a signal to help prevent them from being left in patients. DMLSS tests showed

a 67 percent reading accuracy of the tags, but a new generation of passive tags is expected to have an almost perfect accuracy rate, Magee says.

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.

Hospitals in Illinois, New Jersey, Massachusetts and Virginia, to name just a few, have implemented RFID solutions in materials management and found great savings and even greater efficiencies. Bon Secours Health System, Richmond,Va., installed RFID at three hospitals to track 12,000 pieces of equipment. The health system no longer has to spend money on replacing lost equipment—a once common problem—and the nursmg staff saves 30 minutes per shift because they don't have ro search for equipment. In total, the system reports saving $200,000 a year over the cost of installation and maintenance of RFID, not including productivity gains. For these early adopters, the savings and improved patient care far outweighed the cost of RFID installation and maintenance. Government studies suggest strong IT investment could cut health care costs by 20 percent each year, and RFID can definitely contribute to these health care cost reductions. The 17th Annual HIMSS Leadership cited patient safety as the No. 1 reason for interest in the technology. Managed inventories will lead to improved asset use, lower rental costs. Management departments can reduce the time required to manage equipment inventory. Manage-ment can lead to more precise supply orders and more accurate delivery of appropriate materials to physicians and patients. 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 and other treatments. Survey showed that patient safety and medical error reduction are top priorities for hospitals. Hospitals using bar coding will continue to reap the benefits of the technology, favoring RFID for applications such as asset and inventory management, where the potential for return on investment is the greatest.

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.

Optical bar coding is sometimes viewed as competing technology that is a less expensive than RFID. Both have their roles. RFID has advantages that might justify the increased cost: it is automatic and does not require any manual intervention to work, which reduces the potential for a mistake. In a chaotic operating room environment, inventory control cannot get in the way of taking care of the patient. This minimizes some of the potential for error. RFID asset tracking systems are reported to return their investment in less than 3 years.' A study of tracking in the operating room showed an improvement in the utilization of the surgical department from 57% to 70%, which in turn paid for the RFID system through a reduction in the need for overtime pay. Inventory management is differentiated from asset tracking in that it focuses on consumable supplies and ensures these are reordered automatically and billed for correctly. The use of RFID for inventory management has made substantial inroads in other industries. RFID technologies were given a high profile when the United States Department of Defense announced to its suppliers that by 2005 it would fully adopt an RFID inventory labeling system. An RFID-enabled cabinet with an RFID reader can determine if a supply that has been tagged has left the cabinet and automatically adjust inventory levels, so that supplies are automatically ordered. The first reports are beginning to come from hospitals that have deployed these systems in the operating room. A large medical center running 23 operating rooms deployed RFID inventory tracking and claimed a yearly savings of $1 million through the prevention of lost billing and faster inventory management! Inventory management would likely use passive tags, because these are smaller and

less expensive than active. In the United States during 2000 to 2002, 2,591 cases of foreign bodies left in-patients during procedures were reported. The fiscal impact of such incidents is placed at $17.25 million in excess costs. 2^ Inventory needs to be tagged by suppliers to prevent the use of RFID resulting in a large up front manual labor cost because having hospital staff has to laboriously assign each tag to an individual supply. Personal health information is not at risk if RFID tags carry only a unique ID that requires an external systems database to match patient demographics.

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.

RFID tags saved nurses time in locating equipment (Glabman 2004). Hospitals are actively seeking ways to reduce expenses. Agility Healthcare Solutions CEO Fran Dirksmeier, “estimates a 200-bed hospital can save $600,000 annually from less shrinkage, fewer rentals, deferral of new purchases and improved staff productivity. A 500 bed hospital could save $1 million annually” (Glabman 2004). Advocate Good Shepherd Hospital, Barrington, Illinois, implemented RFID in 2003 to help manage inventory; annual inventory losses were cut by about 10% (Glabman). For example, $4 million worth of equipment was unaccounted for at Jackson Memorial Hospital, Miami, Florida, in 2003; the hospital plans to implement RFID equipment-tracking technology within two years (Glabman). Holy Name Hospital, a 361-bed facility in Teaneck, New Jersey, found that RFID-tagged equipment saved time in locating equipment and reduced rental costs because equipment was more fully used (Glabman). RFID can improve patient treatment and safety by reducing medical errors, improving the security of medicine and the facility, and improving patient compliance. Currently, the costs associated with implementing and managing the tagging systems are the major problems associated with RFID. Tags would have to be attached to everything. For a 1000-bed hospital, that could mean tagging 20,000 items per day (Hosaka 2004). Decisions would have to be made regarding who would apply the tags. Hosaka suggests that the tags originate at hospital registration where the patient’s information and tag numbers would be stored in a database these costs do not include the costs of hardware, data-processing software, or operating expenses. The tags are also relatively expensive; passive RFID tags cost approximately 10 cents per tag, whereas bar codes cost approximately 3 cents per sticker (Becker 2004, 38). These issues relate to data sharing and consumer–patient privacy concerns and present greater costs and challenges in the hospital industry than they do in other industries adopting RFID technology (Collins J. 2004). To prevent snooping, the tags would need either a random number stored in a secure database to identify the medicine or a security code to access the data stored on the chip. Either security option would increase the cost of chips and readers (Kontnik and Dahod 2004). Healthcare providers need to comply with the U.S. Department of Health and Human Services Health Insurance Portability and Accountability Act (HIPAA), which requires an organization to take “reasonable” measures to safeguard electronic health data (Fenner 2004). Although cost is a major impediment to RFID implementation, increased demand for RFID tags and supporting systems will drive technology to improve the system and lower associated costs.

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

Many hospitals are implementing one-off systems to achieve a specific aim, such as identifying patients or tracking particular asset types. Many hospitals are implementing one-off systems to achieve a specific aim, such as identifying patients or tracking particular asset types. While these systems can achieve significant benefits, implementing an RFID infrastructure that can be used to track patients, assets, surgical

instruments requiring decontamination and other applications can profoundly improve a hospital's bottom line. RFID systems can help improve patient care while cutting costs.

Young, Donna. “Pittsburgh hospital combines RFID, bar codes to improve safety.” American journal of Health-system pharmacy. 63.24 Dec. 2006: 2431, 2435. CINAHL with Full Text. 19 Nov. 200. GALILEO.

When RFID tags are used on caregiver badges, Schaeffer said, nurses and other caregivers can more quickly and conveniently authenticate their identification with the medication administration system. “ Nurses appreciate any time savings and convenience that can be applied to their workflow,” he said. By adding RFID to patient wristbands, Schaeffer said, the need for the caregiver to rotate the patient’s wristband into the scanner’s view is eliminated because scanners can read RFID tags through most materials. “If the patient is wearing a gown or has their arm underneath the covers or something, RFID can pass right through the materials and still pick up the information,” he said. St. Clair’s combined RFID–bar code system, Ague said, has saved the facility about $630,000 annually based on the number of prevented adverse drug events. “That’s more than enough to pay for a system,” he said.