The Health Care RFID Blog

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!

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.

“Studies suggest that only 50 percent of caregivers actually wash their hands when they’re supposed to before patient contact, although 90 percent think they do it when they should.”

According to an article posted on HealthLeaders Media by  Cheryl Clark, a CDC video is now being shown to hospitalized patients and visitors urging them to insist they witness providers washing their hands by the bedside, even if the doctor or nurse says he or she already washed just before entering the room. The five-minute video portrays a patient asking her doctor to wash his hands before being examined to reduce the risk of acquiring infection. According to the Center for Disease Control and Prevention (CDC) Healthcare-Acquired Infections are a top 10 leading cause of death in America — killing about 100,000 people a year and infecting about 2 million. One of the simplest ways HAIs (Healthcare Acquired Infections) can be prevented is by medical personnel properly washing their hands. 

A before-and-after survey conducted by Premier Inc. Healthcare Alliance showed that after patients watched the video, twice as many were willing to ask their doctors or nurses to perform hand hygiene than before the video was provided. Nearly 1,000 nurses and 611 physicians were also shown the video at points in time both before and after the video was widely shown throughout the hospital. Both doctors and nurses said they were much more likely to get reminded by patients about washing after the video was shown.

According to the article, HAIs are estimated to affect more than 1.7 million patients, kill 99,000 patients, and cost between $35 billion and $45 billion annually. And, under the new federal reimbursement policy, payment for care required as a result of hospital acquired infections will no longer be approved, making prevention quite influential on the bottom line.

I decided to start a new post to respond to comments and questions about the solution due to the length. www.theregister.co.uk has been a site of much discussion around this solution. I have provided some insight on topics that have arisen in the comments section under the story about our RFID tracking project at the University of Miami UM-JMH Center for Patient Safety. Please see the responses I posted below, or in their original place: Comments on: Miami health centre starts RFID soap snooping

Clarification about the Miami Hand Hygiene Project

By Mika at DCC-Online Posted on theregister.co.uk on Tuesday 18th August 2009 19:30 GMT

All of your comments and questions are great. I have answered a few of your questions and concerns below.

QUESTION

Jason Bloomberg: it does seem fair to use a tiered warning system, a discrete beep to warn the doctor first so they can rectify their mistake or over-sight before it becomes a danger, or when a system failure hasn’t logged use of the hygiene facilities.

ANSWER

This is all being tested currently. The system is cabable of issuing an audible and/or visible alert through virtually any electronic system. Miami is testing the audible alert, vibration to the pager and flashing light options.

QUESTION

Jason Bloomberg: Making false claims in a very public manner which brings a professional’s reputation into disrepute opens the door to a defamation action for slander. I wonder how they deal with that aspect of things ?

ANSWER

This has been considered. Rest assured that the Center required a 100 percent accuracy threshold. Stay tuned to my blog for the results. Also, this is being tested in one small area right now. It is not announced to an entire ward — just within the room to gently remind the clinician to wash his/her hand BEFORE an adverse event occurs. As stated before, we are also testing other methods of alerting staff if they forget to wash their hands before approaching a patient.

QUESTION

zerofool2005: But what I think would be better is that while the doctor is in range of the bed but not the dispenser the tag knows hes dealing with a patient. If he walks out of range the tag bleeps to tell him to wash his hands you dirty mofo.

ANSWER

You will be happy to know that the system does in fact do this. Again, you are welcome to visit our site and see the short flash demo showing how the system works. The flash demo can be viewed at http://www.dynamicrfidsolutions.com/solutions/preventing_HAIs.php.

I would be happy to provide more information to interested parties upon request. You may email me at mlofton@dcc-online.com with questions or if you are considering testing such a system in your health care facility.

We invite health care organizations who are interested to sign up for a Webinar about our RFID solutions to improve patient care, reduce costs and minimize risks. Learn about this case study and others.