The Health Care RFID Blog

El Centro Regional Medical Center sits right along the fault line of last week’s earthquake that registered at 7.2, according to an article in Health Leaders Media. Fortunately the hospital only experienced minor damages and the safety of the patients and healthcare workers was not compromised.  It is important in situations, such as this, to have a system in place to aid in supporting the patient overflow. Safety is the principal concern when unforeseen disasters such as an earthquake occur. It is critical to immediately identify the location of staff, patients and equipment when in emergency situations. The time spent identifying the location of staff and equipment WILL compromise safety within the facility.

An RTLS asset tracking solution has the ability to rapidly gain location information on staff, patients and equipment in real-time. How does the solution work? With the ability to utilize an organizations current infrastructure, RTLS systems use enabled tags to send out a signal to an access point or sensor therefore identifying the location of the tagged “object” in real-time. This data is then passed on to the server where the data can be stored for current and future use.

In an extreme situation, such as a natural disaster, it is important to know the location of all assets on hand in order to execute a flawless recovery.  Other than the safety of patients and staff, a RTLS solution can also help identify loss of high valued inventory and equipment vital to the financial success of the organization.

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!

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.

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.

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.

One of the themes evolving from conversations at IHI was how behaviors can be changed in a hospital. The fast-paced, sometimes hectic environment opens countless opportunities for error. According to an IHI demonstration presented at the conference, up to 30 percent of the time, a critical step is missed, wrong or inconsistent when delivering patient care.

At this year’s conference, Versus Technology, Inc., a real-time locating system (RTLS) vendor working closely with Dynamic, demonstrated its Hand Hygiene Compliance solution.  Because small changes can add up to big results, multiple disciplines can be adopted by healthcare providers to meet the 10 percent reduction in costs they are aiming for. By 2015, it is Versus’s mission to save the healthcare industry a billion dollars. With 10 percent of the nation’s hospitals using Versus’s locating technology, they believe they can achieve this number with its Hand Hygiene Compliance solution alone.

“This year, compared to years past, we definitely noticed a higher level of interest from attendees in solutions like our Hand Hygiene Compliance solution,” said Henry Tenarvitz, Chief Intellectual Property  Officer of Versus Technology, Inc. “Healthcare providers know that reforming the healthcare industry is a huge undertaking, but integrating technology that will help them be more cost effective, safer and more efficient is how we can improve patient care right now.”

Experts estimate that compliance with recommended hand-washing protocols would prevent more than 50 percent of HAIs, but hospitals lack the necessary resources and technology to accurately monitor hand-washing compliance. In fact, current methods—short-term “Secret Shopper” surveys or costly observation audits—manage to skew compliance rates while only capturing 0.12 percent of all hand-washing opportunities. With the Versus Hand Hygiene Compliance solution, hospitals are now able to continuously collect data that was previously unavailable or unreliable. Monitoring hand washing in real-time helps hospitals prevent the spread of dangerous infections and the cost of non-reimbursable HAIs.

For after-the-fact discovery, the Hand Hygiene Report helps Infection Control and Patient Safety Managers direct additional education and training to areas where compliance rates are not in-line with patient care episodes. Advanced users will actually prevent non-compliant patient care events by alerting caregivers to their compliance state before attempting patient care. With this Hand Hygiene Compliance solution, hospitals have a reliable method to reduce their potential for costly Hospital-Acquired Infections (HAIs).

“Unlike banking or other industries that went through a necessary process of automation, one of the unique challenges the healthcare industry faces when exploring efficiencies is that healthcare simply cannot be replaced with technology,” added Tenarvitz. “We have to be able to integrate the technology with the people providing the care. RTLS can help automate the delivery of healthcare through the staff using the technology and increase efficiency.”

Last week more than 5,000 leaders from across the country joined the Institute for Healthcare Improvement (IHI) for its 21^st Annual National Forum on Quality Improvement in Health Care  in Orlando, FL.  According to an article published in HealthLeaders Media, IHI President and CEO Don Berwick began the conference observing how many healthcare organizations have made vast improvements in addressing some of healthcare’s largest challenges, including patient centered care, patient safety and chronic disease-care innovations. According to Berwick, with current reform efforts in Washington—carrying an estimated 10-year, $1 trillion price tag—a  debate about how to balance two fundamental options, investing scarce resources in improving quality-of-care or simply doing less for patients, has surfaced.Berwick’s stance is one we can all stand behind —  neither of these options to the extreme are sustainable solutions for  the current generation or future generations, he said.

While our elected leaders continue drawing battle lines around out what “reform” looks like, healthcare providers can take action now to lower their cost of providing care. Berwick suggested some ideas to get started:

• Understand your “healthcare commons”—its limits and boundaries, who uses its resources, and who is served.
• Adopt a goal—such as over the next three years, reduce total resource consumption of your healthcare system by 10 percent. This could be achieved without rationing or exclusion of needed services.
• Develop your strategic technology plan fast—”because there isn’t much time left,” he said. “Do not wait for external rules to be made or to change. Do it yourself.”

As healthcare providers look to technology to improve operations, at IHI there was an obvious shift toward adopting pragmatic, patient-centered solutions. Providers are looking to implement technology solutions that directly address key performance indicators (KPIs) and tie in with the implementation of Electronic Health-Records (EHRs). Behind every decision, healthcare providers are trying to figure out if the technology falls under the still undefined definition of “meaningful use.” At one time it was said the federal definition and criteria for the “meaningful use” of EHR systems would be released by mid-December, but that deadline passed today at noon with the next deadline being December 31, 2009. With more than 2 million patients developing HAIs each year, costing the healthcare industry more than $30 billion in preventable health costs, one of the best place to start implementing cost saving solutions is where HAIs can be prevented.

Preventing HAIs by improving hand hygiene compliance can save hospitals millions and the healthcare industry billions annually. Currently most hospitals depend on manual measures to monitor and improve hand hygiene compliance, sometimes hiring staff to observe hand washing behaviors. Signs are posted throughout facilities as reminders and patients are encouraged to remind their providers to wash their hands. Efforts also include educational campaigns, but have resulted in minimal improvements. The Association for Professionals in Infection Control and Epidemiology have referenced these manual methods as “inefficient, labor intensive and error prone.”

We all know that medical personnel have the best of intentions when it comes to handwashing. In fast paced work environments, such as hospitals, human error understandably increases.

Technology can be the solution.

The hand hygiene solution provided by Dynamic, built on Versus’ IR-RF technology, consists of badges, ceiling sensors and soap/sanitizer dispensers retrofitted with sensors. When a person dispenses soap or sanitizer, the sensor reads the ID badge and timestamps the occurrence.  If a badged person approaches a patient prior to handwashing, the system alerts them using an audible sound. The data are stored in a database for reporting, and are easily integrated with other systems.

The system effectively addresses hand-hygiene compliance by automatically capturing handwashing data in the background, 24-7. It alerts staff on compliance in real-time - allowing hospitals to prevent adverse events before they occur. The system tracks employees who washed their hands and when.  If a doctor or nurse visits a patient’s bed without first washing his or her hands, an audible alarm offers a gentle reminder.

The system automatically captures handwashing events of all badged employees, so it very simply provides a mechanism for measuring compliance improvement from the individual level, unit level and facility level. We measure success simply by increased hand hygiene compliance and decreased HAIs where the solution is in place.

So, should it be the patient’s responsibility to ensure medical personnel wash their hands or can the healthcare provider implement a progressive solution?  At Dynamic, we believe we can help redistribute responsibility by actively bringing handwashing to the forefront through RFID. This way, conversations between patients and care providers can stay focused on everyone’s goal…care.

Implementing RFID and RTLS technology is a proven way for health care organizations to reduce costs, minimize risks and improve patient care across many facets of the health care system. The most important aspect of getting started in implementing this type of technology is to find a trusted partner that is knowledgeable in this space to who can help create a strategy around implementation.   A strategic plan for deploying a new technology within your organization is by definition flexible – because it is only truly strategic if it maps back to your unique objectives, your organization’s deployment may look very different than deployment in another.  Your foray into RTLS can be as bold or as careful as you deem appropriate.

Realizing that you have options in the scale and timing of RTLS deployment can make even ‘baby steps’ into this arena sure and strong. Did you know that you can test, roll out and elicit staff support for RTLS by:

·         developing an enterprise level solution gradually while still realizing ROI?

·         ensuring smooth deployment by engaging with a solutions provider that both installs and supports specific RFID technologies (i.e. RTLS, Passive, BAP, IR-RF) for specific health care challenges?

·         participating in a pilot program first or just starting at a low level such as tagging equipment to make sure it is not leaving the doors of your building?

Taking the first “baby step” may seem intimidating, but ultimately, RFID and RTLS can and will do wonders for your organization.

Why RTLS and RFID ?

·         Immediate ROI in terms of reduced operating costs, cost savings, and mitigation of future risk and loss

·         Accurate and verifiable records of chain of contact and treatment times for each patient

·         Accurate monitoring of equipment maintenance and medication storage conditions

·         Tracking and monitoring of compliance with standards and certifications (Medicare, Joint Commission; CCHIT, etc.)

·         A means to immediately and automatically locate staff, patients and assets in real-time; to associate them with each other, and to integrate these data with virtually any other electronic system. This could include EHRs, HIEs, nurse call, billing, bed management, security, pharmacy, etc.

·         A distinct and proven advantage in the competitive health care marketplace

Working closing with a trusted partner can make implementing RTLS and RFID a painless process and help to get you the ROI you are looking for, finding the solutions you need that fit your budget.