The Health Care RFID Blog

With the deadline quickly approaching for the implementation of electronic medical records (EMRs), one of the biggest concerns for physicians continues to be the amount of data EMRs require them to enter. Physicians, especially those who may not be particularly “tech savvy,” fear that the extensive data that will need to be entered will slow down the medical charting process.

In a recent guest blog post on KevinMD.com, Dr. Edwin Leap, an emergency physician in South Carolina, highlights frustration that both he and many other physicians are expressing about EMRs, primarily in regard to charting and improving patient care. Because EMRs offer the capability of holding so much information, beyond that of traditional charts, more data entry is required and can be time consuming if entered manually. While the industry as a whole can see the benefits of EMRs at the end of the day, if the process becomes too cumbersome, will it fail?

EMR data entry can be simplified by implementing RFID and RTLS systems alongside EMRs and creating interoperability. With RFID and RTLS working hand-in-hand with EMRs, a change or pause in work flow is not required in order to enter and share patient information, nor will it add extra duties to staff and clinicians. At Dynamic, we agree with physicians in that manual data entry is time consuming. Beyond taking valuable time away from the patients, manual data entry is expensive and prone to many of the same types of human errors found in paper records.

Another benefit to pairing the two technologies is accuracy, which is critical to EMR success. Automatic identification and data capture (AIDC) obtained through RFID solutions is accurate without requiring human intervention and seamlessly integrates with EMR systems. This addresses another concern Dr. Leap expressed in his posting, that he spends even more time confirming documentation from nurses and other staff are consistent and entered correctly.

A third benefit to using RFID and RTLS with EMRs is real-time updates. Most EMRs are accessible through Web browsers. Delivering information into the record immediately means that individual patient and facility summary data are available both through EMR systems and through the AIDC system dashboards. These executive dashboards allow clinicians to make informed decisions based upon the most current patient and facility data.

While EMRs require more information than traditional charts do, the result is better patient care if done correctly. While it still may be challenging for physicians who are not open to using the new technology, solutions are available to help make the process less tedious, allowing for doctors to be doctors and nurses to be nurses. Consider RFID and RTLS a form of a personal data capture assistant!

Can using a checklist help prevent infections and even deaths? According to Dr. Atul Gawande, author of, “The Checklist Manifesto: How to get things right,” implementing a checklist in healthcare for undertakings as large as surgery can help prevent healthcare acquired infections (HAIs) and therefore reduce the number of patients admitted to the Intensive Care Unit (ICU) because of infections and even prevent deaths. According to the Center for Disease Control and Prevention (CDC), HAIs account for about 1.7 million infections and 99,000 deaths each year and annual costs to U.S. hospitals (adjusted for inflation) range from $28.4 -$33.8 billion to $35.7-$45 billion.

A recent New York Times article appropriately titled, “A hospital how-to guide that mother would love,” gives great background on how Dr. Gawande’s book came to be.  Dr. Peter Pronovost, a critical care specialist at Johns Hopkins medical center in Baltimore borrowed the concept of using a checklist from the aviation industry. He began by first having physicians use it for inserting central lines to prevent subsequent infections and after discovering its great success, applied the same concept to other situations in the ICU, achieving similar results.

Following Dr. Pronovost’s lead, Dr. Gawande launched his own study along with a team of public health experts and surgeons and applied a very similar 19-point checklist to test whether  it would improve surgical care. The eight hospitals involved in the study saw the rate of major postsurgical complications drop by 36 percent in the six months after the checklist was introduced; deaths fell by 47 percent.   

While the results obtained in Dr. Gawande’s study are impressive and prove a very critical point, is the traditional checklist too fundamental? With cutting edge technology at our fingertips, that can go above and beyond reminding healthcare providers of steps to take when administering care, why stop at the checklist? 

Healthcare providers work in incredibly fast paced environments and missing vital steps, such as washing their hands, can lead to HAIs and even deaths. RFID can be viewed as the evolution of a checklist and embraced by the healthcare community as a ‘next generation’ best practice.  For example, the Dynamic hand-hygiene solution serves as an advanced form of a checklist, reminding care givers to wash their hands by not only tracking that they in fact did, but administering an audible signal if they fail to do so before approaching a patient. In addition, RFID applications for patient identification, error reduction at point of care, medications management, and asset and employee tracking ‘check the box’ with every move a provider, patient or asset makes. And, in addition to utilizing RFID as a means to more precise healthcare ‘to do’ management, the RFID is driven by a chain of data conversion events – each one a checkbox in and of itself – resulting in more intelligent and actionable information than a static checklist allows. If Dr. Gawande’s implementation of a checklist helped prevent so many HAIs and save so many lives, imagine what an RFID-enhanced checklist could do!

Meeting the JCAHO National Patient Safety Goals is no small task for any healthcare provider. Knowing JCAHO can call any day to inform you that it will audit your facility seems to be a constant fear in the industry. The JCAHO certification is an absolute MUST to be considered a reputable healthcare provider that provides a safe environment for both patients and staff. The National Patient Safety Goals serve as a scorecard for JCAHO. Healthcare providers must prove they are benchmarking toward these goals and demonstrate the steps they are taking to ensure they meet them in a timely manner.

So where do you start? Looking at a list of eight major initiatives can be intimidating. It is important to take a holistic approach to meeting these goals, not just simply checking them off a list as individual tasks.  At the end of the day, it is essentially one goal: creating an environment that is safe.

Here are a few steps you can take when tackling the 2010 NPSG:

1.       Get in front of it.

•  Don’t wait to receive the call from JCAHO that they may be there any day. Start taking the steps now to achieve these goals.

2.       Identify a strategic third-party partner to help you evaluate the situation.

• Technology is playing a bigger and bigger role in meeting the requirements. Working with a systems integrator like Dynamic can help you identify solutions that meet your needs, within your budget, and can work together to achieve interoperability.

3.       Identify where your strengths and weaknesses are.

• Do a complete site survey. Not everything can be fixed at once and this will help identify what areas need to have the most focus and what areas are working well already.

4.       Evaluate what changes will work for your hospital’s culture.

•  No matter what solutions you implement, if it does not align with your organization’s culture, it will not be adopted. For example, as part of Dynamic’s site survey process, we observe how the staff interacts, where they go to do certain tasks, among other indicators, to help us identify what RFID and RTLS solutions would be appropriate.

5.       Implement changes in phases.

• Dynamic never recommends rolling out a technology solution enterprise-wide. Integrate the solution in the area that needs it most and evaluate the pros and cons so that the solution can be perfected before it is deployed throughout the organization.

As healthcare reform continues to be debated, the role of health information technology continues to evolve alongside it. Hospitals are expected, now more than ever, to meet a growing list of requirements and hot button issues including compliance with various regulatory organizations and federal legislation such as HIPAA, Medicare and Medicaid; and the creation of comprehensive electronic medical records (EMR) and legal health records (LHR). Above all else, the objective on which every member of the health care community must place the most emphasis is increasing patient safety. Today’s healthcare providers are held more accountable and required to provide an environment that improves, and in no circumstance compromises, patients’ health. This, of all mandates, is the one that should not be viewed as ‘policy’…for the dedicated healthcare institution; it is the inspiration for doing what it does.

To help the healthcare industry maintain focus, on January 1 the 2010 National Patient Goals went into effect. Issued by The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO or the Joint Commission), an independent, not-for-profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States, the NPSGs were established to help accredited organizations address specific areas of concern in regards to patient safety. Half of the 2010 National Patient Safety Goals are directly applicable to healthcare organizations like yours, and those goals are as follows:

Goal 1 – Improve the accuracy of patient identification.

Goal 2 – Improve the effectiveness of communication among caregivers.

Goal 3 – Improve the safety of using medications.

Goal 7 – Reduce the risk of health care–associated infections.

Goal 8 – Accurately and completely reconcile medications across the continuum

Goal 9 – Reduce the risk of patient harm resulting from falls.

Goal 14 – Prevent health care–associated pressure ulcers

Goal 15 – The organization identifies safety risks inherent in its patient population.

Are these your organization’s goals? If so, how do you plan on achieving them? Dynamic works with healthcare providers every day to integrate RFID solutions that address several and sometimes all of JCAHO’s stated goals. We work hard to stay in front of industry issues and enlist technology partners that can help our customers address them head on – which is why we don’t feel like we need to ‘catch up’ to these goals each year. In fact, it feels a bit as though they’re catching up to us.

The industry is undergoing significant changes in a short period of time. However, there’s a difference between ‘knowing’ the trends, and ‘understanding’ them, the latter, which requires context and an action plan for applying them to one’s business. The paired adoption of EMR and RFID/RTLS systems holds the highest potential for reducing costs, minimizing risks and improving patient care, and it is this understanding that can drive the industry toward a truly interoperable model.

No surprise, then, that pairing the adoption of an EMR system with RTLS/RFID solutions helps to address many of the top trends identified in the Healthcare Technology Online above.

·         One way RFID can work efficiently with EMRs is to eliminate the need to manually enter data into the system. A change or pause in work flow is not required in order to enter and share patient information, nor will it add extra duties to staff and clinicians. Manual data entry is time consuming, expensive and prone to many of the same types of human error as found in paper records.

·         A second benefit to pairing the two technologies is accuracy, which is critical to EMR success. Automatic identification and data capture (AIDC) obtained through use of RFID solutions is accurate without requiring human intervention and seamlessly integrates with EMR systems. The best systems are accurate 100 percent of the time, with no missed events and no false positives, and they accept information in real time.

·         A third benefit is real-time updates. Most EMRs are accessible through Web browsers. Delivering information into the record immediately means that individual patient and facility summary data are available both through EMR systems and through the AIDC system dashboards. These executive dashboards allow clinicians to make informed decisions based upon the most-current patient and facility data.

As staff and budgets continue to be slashed throughout the sector, HIT is not just important – it is paramount in order to do more – and better — with less. By staying ahead of industry trends and working with the best-in-class vendors, Dynamic is able to provide cutting-edge technology and precise solutions to help healthcare providers meet both predicted – and unpredictable — challenges on the horizon  in the year ahead.

While no one knows exactly what the future holds, this time of year experts in all industries do their best to predict the trends for the year ahead. Identifying and predicting trends is something we at Dynamic do day-in and day-out for our clients. Being on the forefront of emerging technologies and the rapidly evolving marketplace allows us to identify industry issues early on, and select proven RFID partners to address them before they become full-scale problems for our customers.

Still, we are not alone in predicting that 2010 is going to be a paramount year for HIT implementations. Why? Primarily because of healthcare reform and nearly $20 billion in government stimulus funds allotted to go towards healthcare IT initiatives as part of The American Reinvestment and Recovery Act (ARRA).  What technology healthcare providers allocate their budgets to and how they take advantage of government incentives will be the key to reducing costs, minimizing risks and improving patient care.  So what are the trends in healthcare IT for 2010? According to an article published by Healthcare Technology Online, the top 10 healthcare IT trends to watch in 2010 are:

1. Electronic Medical Records (EMRs) will gain momentum
2. Personal Health Records (PHRs) earn legitimacy
3. Cost containment is a paramount
4. Alternative care delivery models emerge
5. War waged on Medicare fraud
6. Increased focus on outbreak preparedness
7. Patient safety initiatives intensify
8. Healthcare professionals in short supply
9. Storage and business continuity concerns abound
10. Physician groups join healthcare systems

Nearly all of these trends directly align with the benefits RFID and RTLS solutions can bring to the healthcare industry and map back to the need for interoperability. 2010 will be a critical year for healthcare providers and the HIT implemented will directly affect how healthcare reform will ultimately look in the end.

In a video posted on the Healthcare IT News Web site a registered nurse working at the Eastern Maine Medical Center describes her experience working in the Intensive Care Unit (ICU) and how EMRs have affected the productivity of the Medical Center. In the video she discusses how EMRs have improved the efficiency of providing care, especially in the ICU, serving as a fast way to obtain a patient’s medical history and that they have facilitated speedier data entry. Soon, this will become a reality for hospitals and healthcare providers of all sizes.

The video demonstrates a firsthand, practical account regarding how technology (i.e. EMRs) is empowering healthcare professionals with the support to do their jobs better. She describes how EMRs allow the medical staff to prepare for patients before they arrive via information from other hospitals, allows them to quickly view their medical history and to easily update and share the information. Beyond creating efficiencies, EMRs also help eliminate errors in delivery of medication. The RN specifically addresses the usefulness of having the information about medications right on the EMR so they can easily identify what the medication is, what it is used for and what it looks like.

While EMRs are helping to aim the industry in the right direction, they alone do not create a truly connected healthcare model. The healthcare industry, especially the ICU, is a very fast paced environment with multiple steps/checkpoints that are conductive to human error. When implementing RFID into the model, these processes are dramatically mitigated and many types of errors and risks can be eliminated altogether. The combination of these factors optimizes the health care environment for patient safety and staff efficiency.

RFID, specifically, addresses these factors and has virtually limitless applications once the infrastructure is in place. Automating many of these steps greatly reduces the opportunity for medical error through the correct identification of patients and staff, real-time transparency across the continuum of care, real-time location and maintenance management of assets and inventory. Here are some of the ways implementing RFID can create interoperability and its role in creating a truly connected healthcare model.

·         Improve the accuracy of patient identification: RFID wrist bands, handheld readers accurately identify patients every time (patient & staff tracking).

·         Improve the effectiveness of communication among caregivers: RFID makes real-time changes in EMRs accessible to all caregivers, facilitating the accurate and effective communication of key details (patient & staff tracking, lab & sample tracking, medication tracking).

·         Improve the safety of using medications: RFID ensures the right dosage of the right medication is given to the right person at the right time. It can prevent dangerous interactions and associate the caregiver who prescribes/ administers the drugs with the patient in the EHR (patient & staff tracking, medication tracking, inventory management).

·         Accurately and completely reconcile medications across the continuum of care: EHR via RFID provides real-time, accurate and complete information across the continuum of care (patient & staff tracking, medication tracking, lab & sample tracking).

·         Reduce the risk of patient harm resulting from falls: RFID Patient tracking can notify appropriate personnel when patients who are at high risk for falls get out of their beds/ rooms, allowing them to respond immediately and restore the patient to safe conditions. (patient tracking)

·         Improve recognition and response to changes in a patient’s condition: RFID can enable teams to quickly recognize, locate and reach a patient with the appropriate tools and medications to respond to their condition changes (patient & staff tracking, inventory management, asset tracking & maintenance, medication tracking).

It is when EMRs and other HIT are implemented to work together that the truly connected healthcare model will be achieved. Although the definition of meaningful use is continuing to change, we know that by reducing costs, minimizing risks and improving patient care, meaningful use is being achieved through this model.

While EMRs have assumed a starring role in the ‘meaningful use’ conversation (and rightfully so – they could profoundly overhaul and streamline the industry), integrating additional health information technology (HIT) will be necessary to create a truly connected healthcare model. The most ‘meaningful use’ of HIT is in integrated systems, and the power of the individual solutions are most evident when used in combination with others, thus creating interoperability.  With HIT solutions that speak and respond to each other, the result can be greater accuracy, reach and effectiveness than that which any single technology could possibly achieve on its own –a classic case of the whole being greater than the sum of its parts.

Interoperability is critical to making this next generation of the healthcare industry stronger, more efficient and safer for patients. At Dynamic, we all know how vital interoperability is and are excited to see the interactive demonstrations and exhibits at this year’s Interoperability Showcase that will be featured at the HIMSS10 Conference. If you are attending HIMSS this year, the Interoperability Showcase may help you envision how seemingly disparate HIT solutions can work together in harmony. The Showcase will, literally, bring to life standards-based connectivity in simulated healthcare environments. Dynamic will be exhibiting at HIMSS10 and will be showcasing a wide range of turn-key solutions incorporating RFID, RTLS, GPS and related technologies that enable real-time management of mobile personnel, assets and resources to government and commercial clients.

Our business does not operate in a vacuum; just like the connectivity being encouraged throughout an entire system, Dynamic believes in understanding the entire HIT universe in order to provide our customers informed, contextual information and guidance. Leveraging opportunities like the Showcase will help our own team better understand other solutions along the HIT continuum…after all, in a truly connected system, we may work together one day.

It’s that time when sages come out of the woodwork to take all the surprise out of the year ahead, and tell us what is going to occur. Whether in technology, health care, economics or fashion trends, you’re sure to read an article or two about what’s on the horizon for your industry or an area of interest. How often, though, are those predictions something you already know?  For the astute business leader or consumer, regardless of sector, many of these forecasts reiterate (albeit in one tidy list)  the growing body of evidence proving a ‘trend’ that they’ve already read, heard and talked about over the last 12 months.

Despite this, it is admittedly invigorating when the passionate, third-party endorsement of ‘something-to-watch’ actually validates what you already do.  Separate surveys conducted by Healthcare IT News and ABI point, respectively, to continued focus in 2010 on a truly integrated medical records system and RFID as a streamlining technology in the health care setting.  While these ideas are obviously not news, that doesn’t mean we don’t sit up and take notice when our – or our customers’ — businesses become the focal point of industry buzz.

According to Healthcare IT News survey results published in an article this month, the push under the federal stimulus package to encourage the adoption of EHRs received the most votes as the top 2009 HIT trend likely to continue to have the most impact in 2010. The push received 30 percent of the vote among a list of eight choices, with growing concern over privacy and security placing second (with 15% of the vote).

It stands to reason that if EHRs are going to be on even more tips-of-tongues in 2010 than in 2009, that the discussion around data integrity increases in volume, too. An EHR system is only as good as the quality of information that goes into it. Typical EHR protocols assume a world where end-users log on to web-based applications and type data or, in some cases, scan barcodes, then confirm and enter…all which bring ‘human’ and ‘error’ together more often than necessary, in light of RFID data collection solutions.   

So, how do we get the ‘buzz’ in 2010 focused on solutions to these challenges, rather than the challenges, themselves?

Let’s start with the Advance for Health Information Executives Dec. 14^th article that cites recent ABI research calling out three RFID ‘hot spots’ for 2010. Of these three hot spots, Dynamic has consistently been at the forefront of integrating two of them into our health care customers systems –  and they just so happen to address key driving factors in the EHR debate, improved patient care and cost savings:

·         Hot Spot 1 - Asset tracking and management: The ABI research mirrors what Dynamic knows; that RFID shows particular applicability to medical assets tracking. Using RFID technology eliminates time wasted searching for supplies and equipment, allowing nurses and doctors to focus on patients. In context of EHRs, this application of RFID can complement efforts to improve quality, safety, efficiency and care coordination within an enterprise.

·         Hot Spot 2 - Active RFID-based solutions: Active RFID, including real-time location systems (RTLS), is expected to have solid growth in a number of vertical markets, including health care, according to the research. With efficiencies and resulting cost savings central to the argument for EHRs, health care organizations should exercise due diligence and explore complementary technologies that can drive further efficiencies.  Leading edge hospitals across the nation have already saved millions of dollars in equipment and labor costs by instituting a real-time view into where and with who their precious assets are.

We don’t need 2010 trends research to tell us that EHRs will be a conversation piece in the year ahead, but it is interesting that these two independent pieces of research – when viewed side-by-side – corroborate the Dynamic RFID solutions value proposition. We take pride in helping our health care customers get in front of emerging industry issues by closely monitoring their organizations and how our RFID solutions can support their patient care and business objectives…all year long.  

With the fast-approaching December 31 deadline for HITECH’s issuance of “meaningful use” standards for incentive-eligible health care technologies (including electronic health records [EHRs]),  an advisory board to the Department of Health and Human Services (HHS) is making the case for measurement. This definition of meaningful use will influence, among other things, the technologies that will be implemented in the provider setting and the types of standards used for healthcare exchange to qualify for ARRA stimulus dollars.

Earlier this month, the advisory group, The National Committee on Vital and Health Statistics (NCVHS), submitted recommendations to  HHS Secretary Kathleen Sebelius urging that in addition to those standards being defined, it is critical that they be comparatively measureable.   These recommendations are based largely upon observations made during an October NCVHS hearing where public and private sector experts  shared thoughts on how to incorporate meaningful metrics into the complex quality measurement environment.

Among the Committee’s observations was that numerous testifying experts stated that existing EHR systems do not easily produce quality reports as required by various reporting initiatives, nor sufficient to meet incentive criteria.  Disparate data definitions and capture methods complicate data aggregation and reporting for providers, and, therefore, muddy the certification requirements for EHR vendors, according to the panel. Because EHRs would provide healthcare professionals with electronic access to an individual’s medical history, even when that history has been recorded by multiple providers, it is critical that a national EHR system supports inter-operable communication of standardized data between hospitals and physicians.

While the Committee did not outline specific technology solutions to meet this challenge, we at Dynamic have given the topic much consideration. In fact, as champions of RFID health care solutions, we feel like practicality and practice are, at last, shaking hands. Initially, RFID could represent a faster and less complex implementation of EHRs, and longer-term could provide the mechanism that ensures proper database alignment with each patient, striking at the heart of data integrity and comparability concerns.  

There are numerous ways RFID technology  can contribute to the development of EHRs and ensure their compliance with meaningful use compliance:

·         Improving quality, safety, efficiency and reducing health disparities, which for example, might require lab results to be incorporated into an EHR as structured data.

·         Engaging patients and families by providing these parties with access to data and tools to make informed decisions.

·         Improving care coordination by allowing information to be shared among varying physician groups

We know that RFID could play an important role in the development of EHRs, particularly given the initially tight – and increasingly narrow — timeframe established. There are many hurdles to clear before EHRs are a national and industry standard, including serious decision making about data, security and reporting protocol.  A careful exploration of RFID’s uses and benefits in an EHR scenario could move the decision about data capture along with relative ease.