The Health Care RFID Blog

In an article written by Stephen J. Dubner titled, “Is this the answer to Hospital-Acquired Infections?” , he mentions that it has been 10 years since first talks about the HAI (Hospital Acquired Infections) problem that the healthcare industry is now faced with and that in that ten years the problem has not gotten any better. But whose fault is it?

Many people like to place the blame on doctors, but in reality all healthcare workers should be held accountable. Trying to hold a single person and/or group accountable for something that is not tracked is impossible. Healthcare organizations need to start taking advantage of technologies that can aid in improving hand-hygiene compliance. Singling out one group, which will constantly be changing, will only be a temporary fix. Why not use technology as a tool to improve procedures?

Hospitals and other healthcare organizations should start implementing these new technologies in an effort to help change old habits and adopt new ones. Using technology to help mold a new culture within the healthcare industry would be a great start to improving the number of HAI incidents reported.

Now that the HAI problem has become visible to the public, hospitals, clinics and other healthcare organizations will need to start taking actions in an effort to improve compliance. RFID (radio frequency identification) and RTLS (real-time location systems) solutions have the ability to track compliance in real-time holding each healthcare worker accountable for themselves. Although there may be other variables involved in contracting nosocomial infections, improving hand-hygiene practices would show a significant increase in the annual improvement rate.

As EMR systems gain population in the industry, there will be many different applications available for use in an effort to manipulate all of the data collected. The systems are platforms for many different applications that can drive the industry to interoperability. Each “healthcare worker” has something different that they are focused on tracking, whether it is a mobile asset, compliance by healthcare workers or patient vitals.

According to an article published this week in Healthcare IT News, healthcare technologies have the potential to transform the industry. Lisa Suennen, a managing member at Psilos Group stated, “EMRs are becoming a commodity, but putting applications on top of EMRs to deliver usable data creates value.” Suennen also mentioned that another area with growth opportunity is patient safety.

RFID and RTLS technologies have the ability to seamlessly integrate with EMRs. What are the benefits that come from implementing RFID and RTLS solutions into EMRs?

·         Eliminate the need to manually enter data – by eliminating manual entry an organization will improve work flow, minimizing human error therefore minimizing costs.

·         Improving Patient Safety – Tracking compliance of hand-hygiene as well as OR/ED patient tracking and medication tracking.

The more activities that can be tagged and tracked on a sensory network provide an opportunity to manipulate additional data and additional input without additional manual entry. With real-time updates each staff member will have the ability to gain visibility geared toward their own interests within the organization, from wheel chairs to IV pumps. With this we can work to improve care, reduce costs and minimize risks.

According to the study, My five moments for hand hygiene by Dr. Didier Pittet and his colleagues, healthcare workers do not perform proper hand hygiene practices throughout their workday. This inferior quality of care has been a challenge to infection control management for many years. How can we change the culture of hand hygiene and improve patient safety and quality of care?

With any good study comes a great method of observation. Through the use of technology, not only can we record activity, we can attempt to prevent unsafe practices, educate real time and modify behavior. With the implementation of a hand hygiene compliance (HHC) solution, hospitals and other healthcare organizations can have the ability to capture all events and anticipate all situations in regards to patient contact.

Because infection never sleeps, our ability to practice safe hand hygiene must never sleep. Adoption of real time notification systems can help shine a light on the problems that healthcare organizations are faced with on a daily basis and help to fix them.

Hand hygiene is an incremental component that protects patients and healthcare workers from healthcare associated infections (HAIs). Dr Didier Pittet, professor of medicine, director of the Infection Control Department at the University of Geneva Hospitals in Geneva and the director of the WHO First Global Patient Safety Challenge: “Clean Care is Safer Care” , along with some of his colleagues, recognized hand hygiene as a growing problem in the healthcare industry worldwide in reference to high mortality rates and an increase in costs due to HAIs. According to Dr. D. Pittet, “healthcare workers practice hand hygiene less than half as often as they should.”

Together, the team came up with a list of critical moments of vulnerability during an interaction between a patient and a healthcare worker. Dr. Pittet and his team named these moments, “My five moments for hand hygiene.” The study focused on 2 zones, the patient zone and the healthcare zone, and the critical sites found within these zones. The team chose to separate these points into zones in an effort to geographically represent the critical points of contact in which hand hygiene is required.

The patient zone is noted as the area in which the patient has contact with his/her surrounding surfaces. There are two critical sites within the patient zone, clean sites and body fluid sites. Clean sites are the sites that must be protected from micro-organisms at all times. Body fluid sites are the areas were patient fluids are exposed. As noted in the study, clean sites and body fluid sites can co-exist, example: drawing a blood sample.

The healthcare zone is the area outside the patient zone. Theoretically, this zone is constantly contaminated with micro-organisms that can potentially be dangerous to the patient and/or healthcare worker.

Below is a list of the five critical moments resulting from the study:

1)      Before touching a patient… (example : shaking hands)

2)      Before clean/aseptic procedures… (example: wound dressing)

3)     After body fluid exposure/risk… (example: drawing  and manipulating and fluid sample)

4)      After touching a patient… (example: shaking hands)

5)      After touching patient surroundings… (example: holding a bed rail)

How can we use the results of this study to aid in changing the culture of hand hygiene?

A recent in-depth study conducted by Cummings, Anderson and Kaye indicates a 1% rise in hand hygiene compliance (HHC) equals a $39K savings for the hospital. Models were set up to simulate several occurrences of hand-hygiene noncompliance by a single healthcare worker. According to the article, “Hand Hygiene Noncompliance and the Cost of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Infection”, Hand hygiene noncompliance events are associated with significant attributable hospital costs. Minimal improvements in compliance lead to substantial savings. The study used two different models:

1.       Events of noncompliance with patients of an unknown MRSA status (results: associated with 42 MRSA infections (Cost resulting in nearly $1,000,000 in cost to the hospital)

2.       Events with a known MRSA patient followed by events of an unknown MRSA patient (results: associated with 980 MRSA infections)(Cost resulting in nearly $22,000,000 in cost to the hospital)

The cost savings involved with an HHC solution are immense. With the data collected by Cummings, Anderson and Kaye and an analysis of their findings by a partner of DCC below are the conclusions that have been discovered:

·         1% increase in HHC = $200 savings per bed / year; 100% HHC = nearly $10k savings per bed / year

·         A conservative 25% increase in HHC should equate to $5k per bed / year or $1M total for a 200 bed hospital

·         Assume 500k CCM beds in the US times $10k per bed / year = $5B / year CMS problem.

o     The Hi-Tech act “hopes” that EMRs will save $1.7B per year over 10 years

o     A 25% HHC increase would result in $2.5B savings per year (forever)

o    $2.5B is a 50% GREATER savings than Hi-Tech and saves 50,000 lives per year forever

RFID and RTLS technology has the ability to track each and every occurrence within a facility whether compliant or noncompliant. The HHC solution uses sensors in soap dispensing units that have the ability to read staff badges in real time in an effort to monitor each and every interaction with the patient. If a staff member is noncompliant one or more of the below actions can be taken:

·         Automatic email to a supervisor

·         Audible message in the room

·         VoIP “please wash hands”

·         Send message to handheld devices

·         Specific actions possible as requested

This solution is highly customizable and can be configured to work with each individual organizations needs. The HHC solution offered by DCC is highly reliable, affordable and beneficial to healthcare organizations seeking to improve care, reduce costs and minimize risks. “This is an example of how innovative technologies are transforming the way we deliver care. Everyone is a stakeholder,” Farida Ali, DCC CEO.

As HIMSS10 came to a close today there was a lot of buzz involving new technologies that can achieve measurable value and help improve care, reduce costs and minimize risks in the industry. Hospitals and other healthcare organizations are in major need of achieving “real” ROI from the software and hardware tools that they will be implementing in an effort to reach their 2015 goal for compliance. It is important for organizations to look at implementing the right technologies that can help them sustain ROI over time.

Patient tracking seemed to be a major buzz at HIMSS10. Patient tracking is a more unique solution than asset tracking in that it involves moving assets. (Patients) A patient tracking solution consists of granularity and a much faster refresh rate than an asset tracking solution. If a quick refresh rate and a high level of granularity are absent then the patients will be out of sight before the appropriate staff is notified. Dynamic Computer Corporation offers a variety of solutions using RFID (Radio frequency identification) and RTLS (real-time location systems) technologies that can automatically update location and status information of patients in as little as 3-second intervals. Healthcare organizations have options when implementing RTLS and RFID systems into their infrastructure. There are both wired and Wi-Fi technologies available to implement a successful patient tracking solution. Wi-Fi solutions use Wi-Fi-enabled tags that interact and communicate with access points within a building to define their location over an existing 802.11 wireless infrastructure. Wired solutions use IR (infrared) and RFID technologies that communicate to determine the ultimate location of a patient in real-time. Much like a wireless access point, wired solutions can either use IR and/or RF antennas to communicate with a tag in real time as a patient moves about the facility.

Another topic buzzing around HIMSS10 was how to get smaller hospitals and healthcare organizations on board with implementing EHRs. Data standardization is extremely important and will need to be clearly defined and seamless in order for the industry as a whole to achieve meaningful use objectives. The American Recovery and Reinvestment Act, as we all know, includes $19 billion in grants and loans available to healthcare organizations in an effort to aid in implementing an infrastructure and processes to improve care, reduce costs and minimize risks. Along with funding comes choosing the right solution for each individual organizations needs. Smaller clinics with less staff will have a problem keeping up with manual data entry processes. RFID and RTLS solutions can eliminate the need for manual entry and let the staff focus on providing quality patient care and sustaining financial stability and compliance with standardization.

With emerging technologies come advantages and disadvantages. It is important to determine what individual requirements fit your organizations needs when evaluating each solution. Dynamic has the ability to customize a solution that will not only take into consideration your current pains but will also help you plan for your future needs.

In the last few days there has been a lot of talk in the health care industry surrounding President Obama’s most recent health care proposal.  The year-long effort, and the fourth proposal, is focused on making health care more affordable, making health insurers more accountable, expanding healthcare coverage to all Americans and making the health system sustainable. A large portion of the proposal focuses on reforming health care insurance—designed to reduce the cost of healthcare for patients.  Moreover, Title III of the proposal, “Improving the Quality and Efficiency of Health Care,” includes incentivizing doctors, nurses and hospitals to improve care and reduce unnecessary errors that harm patients.

While the government focuses on roping in costs and incentives to improve patient care, what are healthcare providers doing to help meet these objectives?

Some of the most costly healthcare issues are healthcare acquired infections (HAIs). Annually, HAIs are estimated to affect more than 1.7 million patients, kill 99,000 patients, and cost between $35 billion and $45 billion. Under the new federal reimbursement policy, payment for care required as a result of HAIs will no longer be approved, making prevention urgently important to the bottom line. According to the Center for Disease Control and Prevention (CDC), HAIs are a top 10 cause of death in America.

One of the simplest ways HAIs can be prevented is by medical personnel properly washing their hands. 

While Washington works on the insurance issues, health care providers are looking to health information technology (HIT), including RFID solutions, to help reduce cost, minimize risks and improve patient care now.  One of the best ways to prevent HAIs is hand-washing, and one of the easiest ways to ensure compliance is to back it with technology.

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 the individual audibly. The information is stored in a database for reporting and is easily integrated with other systems.

The system effectively addresses hand-hygiene compliance by automatically capturing hand-washing 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 who washed their hands and when. 

Other RFID and RTLS solutions, such as patient tracking, medication tracking and lab tracking can help bring down the costs of healthcare by ensuring costly errors are not made. Let Washington worry about insurance reform and healthcare providers can focus on how to reduce costs, minimize risks and most important, improve patient care with HIT.

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!

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 problem with a recent Washington Post headline declaring “Electronic medical records not seen as a cure-all,” is its flawed premise. While EMRs (electronic medical records) will improve safety and prevent errors among other benefits, they are not a defining solution for creating a leaner, faster health care industry…in fact, nothing is.

Hospitals must manage multiple business processes, just like any other business. This includes management of patient records, medical equipment, medication administration, tracking of lab samples and of patients from admission to discharge. Of all these processes, EMRs have been under the microscope due to the federal stimulus package mandates;  related dialogue about technology that meets the package’s still uncertain ‘meaningful use’ objectives; and reports that some physicians are frustrated with EMRs because the technology is disrupting their daily workflow.

What has not been discussed as publicly is RFID, a radio frequency-driven infrastructure that tracks workflow and elevates EMRs beyond data entry to precise data capture.  Health care organizations with foresight have installed these location and sensing technologies to track patient flow, clinical staff, and critical equipment in real time, and with great success and minimal disruption.  Far from the productivity-drain physicians have reported from EMRs, RFID in the health care setting:

• gives you back the time you previously used to determine room, bed, or equipment availability.
• enables health care providers to see more patients in less time.
• eliminates patient waiting and increases the availability of staff and resources.
• improving patient safety by identifying and eliminating sources of infection.

Absolutely, the time is now for digitized healthcare. And, yes, your health care institution should implement EMRs. But you are missing out on significant cost and risk reductions and improved patient care if you have focused solely on the EMR imperative and failed to consider how RFID can integrate with EMR and achieve meaningful-use outcomes, too.