Article

RFID in Healthcare – The Emerging Enabler : A.U. Jai Ganesh, S. Srikrishna

RFID in Healthcare

[This article was published in the July 2007 issue of the eHEALTH Magazine (https://www.ehealthonline.org)]

RFID has the potential to become a atalyst for new efficiencies and enhanced ervices for healthcare service providers.

RFID has the potential to become a catalyst for new efficiencies and enhanced services for healthcare service providers. Hospitals and medical facilities seeking competitive advantage can make use of RFID to optimize their workflows, improve productivity, reduce operating costs, and provide better patient care. RFID could help prevent patient identity mix-ups, medication errors, and also reduce thefts of expensive mobile medical equipments.

The rapid advances in medical electronics have brought about a revolution in the healthcare industry. In the recent times, radio frequency identification (RFID) has received considerable attention within both healthcare and pharmaceutical industries due to its potential to efficiently track hospital inventory, mobile medical equipments, medications, patients and personnel as well. Also RFID systems are being increasingly considered as an alternative to the existing barcode technology. The purpose of an RFID system is to enable data on the identity of an object and wirelessly transmit it using radio waves. As with any emerging technology, the deployment of RFID too seems to be fraught with potential uncertainties, including privacy and security concerns. Internationally accepted standards, guidelines for RFID technology and practices, coupled with lower deployment costs might hold the key for the widespread acceptance of RFID applications in healthcare.

An Overview of RFID

RFID is a form of automatic identification and data capture (AIDC) technology that uses radio frequencies to transmit information and can be used to identify many types of objects. Every RFID system includes a radio frequency (RF) subsystem, composed of tags and readers. Each object that needs to be identified has a small RFID tag affixed to it or embedded within it. A RFID tag is a tiny radio device made of a microchip and an antenna, usually surrounded by some material. The tags are of two types, active and passive. Active RFID tags are larger, battery-powered, generally rewritable and more expensive, whereas passive tags are relatively small, inexpensive and operate using power from the RFID transceiver. While active RFID tags offer a much better identification range, and allow updating, passive tags have lower range and typically store read-only data. The tags have a unique identifier and may optionally hold additional information about the object. Devices known as RFID readers wirelessly communicate with the tags to identify the item connected to each tag and possibly read or update additional information stored on the tag.

This communication can occur without optical line of sight and over greater distances than other AIDC technologies. Passive RFID tags require manual scanning to capture the identification data whereas an active RFID tag does automatic scanning and transmits the data to RFID-enabled devices. RFID technologies support a wide range of applications including asset management, tracking, access control and automated payment.

RFID vs Barcode

Though RFID and barcodes are perceived to be competitive technologies, both seem to complement each other. The distinct advantages of RFID system over barcodes could be summarized as follows:

It is sufficient for RFID tags to be within range of a reader to be ‘read’ or ‘scanned’ whereas barcodes have to be scanned at specific orientation to establish the line-of-sight.

RFID tags are more durable than barcodes and can withstand harsh environments that would normally destroy barcode labels, thereby rendering them unreadable.

Tags can be reprogrammed and reused whereas new data cannot be updated on barcodes, unless the user reprints the code.

RFID tags can be read in bulk, resulting in a nearly simultaneous reading of contents, whereas barcodes must be read individually.

A RFID reader can scan multiple items simultaneously and do not require any human intervention for data transmission unlike barcodes.

RFID tag memory can be programmed, permanently locked, or erased to protect privacy.

Applications in Healthcare

RFID has the potential to become a catalyst for new efficiencies and enhanced services for healthcare service providers. Hospitals and medical facilities seeking competitive advantage can make use of RFID to optimize their workflows, improve productivity, reduce operating costs, and provide better patient care. RFID could help prevent patient identity mix-ups, medication errors, and also reduce thefts of expensive mobile medical equipments. RFID systems, when used in combination with secure wireless networks such as WLANs, can enable a fully automated solution for information delivery at the point-of-care; thereby increasing efficiency in the care process and minimizing possibilities of human error.

While active RFID tags offer a much better identification range, and allow updating, passive tags have lower range and typically store read-only data. The tags have a unique identifier and may optionally hold additional information about the object. Devices known as RFID readers wirelessly communicate with the tags to identify the item connected to each tag and possibly read or update additional information stored on the tag.

Though the scope of RFID-enabled applications in healthcare is quite vast, they could be broadly categorized under the following:

(i) Patient Identification and Tracking

Incorrect identification of patients gives scope for medication errors, mis-diagnoses and even having an invasive procedure done on a wrong patient. In order to prevent these serious clinical errors, RFID-enabled patient identification and tracking systems are used, wherein the patients are given a wristband/bracelet with a RFID chip that stores the unique patient id and other relevant medical information. The caregiver uses a hand-held RFID reader or a PDA to access electronic patient records, cross-check the medication dosage prescribed, and update the record with observations and comments on diagnosis in real-time. Also patient identification and location assistance tools of RFID systems can be very useful for care providers, especially in cases of long-term care, mentally challenged patients, and newborns.

(ii) Asset Tracking and Inventory Management

RFID systems could help streamline the tracking and recording of the available inventory efficiently and accurately. This would facilitate hospitals to maintain optimal stock of medical inventory on a real-time basis and reduce the overall inventory cost by maximizing resource utilization and maintaining ‘just in time inventory’. RFID-enabled hospital equipments and wheel chairs could be easily identified and tracked. This could help trace misplaced equipment and also prevent thefts of mobile electronic devices throughout the facility.

(iii) Laboratory Automation

RFID-enabled identification of specimen, blood samples and management of transfusion could help achieve significant improvement in preventing errors, during transfusion and laboratory processing, besides saving valuable time.

(iv) RFID-enabled Remote Health Monitoring

Research initiatives are on to interface RFID tags with wireless microsensors that can monitor and store ECG, pulse rate, basal temperature, and other vital signs of patients noninvasively, and transmit them to the care providers’ database at predefined intervals. This could facilitate real-time health monitoring and provision of care for elderly, and people working in dangerous conditions like relief workers in disaster situations and soldiers on the battlefield. RFID-enabled wireless telemedicine applications could substantially reduce response time to medical emergencies and improve the accuracy of remote diagnosis. RFID-enabled sensors can collect and transmit information on environment such as temperature from time to time, and help monitor the shelf life of sensitive medical items and processes.

(v) Pharmaceutical Applications

Pharmaceutical companies loose substantial revenue every year due to drug counterfeiting. Counterfeit drugs might pose serious health risks to patients due to the possible use of substandard and dangerous ingredients. Using RFID into packaging of prescription drugs can counter drug counterfeiting; identify fake, tampered, recalled or expired drugs. This will enable verification of their authenticity throughout the supply chain, from the point of manufacture to the point of dispensing; thereby resulting in money savings for the industry and ensuring safe medication for the patients.

Challenges in RFID Adoption

Though the application space of RFID is growing and gaining popularity, its acceptance and adoption in healthcare is not without challenges. The key restraints include:

(i) Cost

Though the costs of readers and tags are decreasing, implementation of RFID systems might still require substantial capital investments. This needs to be reduced for wider acceptance of RFID systems in the healthcare industry as potential adopters like hospitals with thin IT budget would not be keen to consider RFID systems, unless the investment is more affordable and offers better price-performance advantage.

In order to prevent these serious clinical errors, RFID-enabled patient identification and tracking systems are used, wherein the patients are given a wristband/bracelet with a RFID chip that stores the unique patient id and other relevant medical information. The caregiver uses a hand-held RFID reader or a PDA to access electronic patient records, cross-check the medication dosage prescribed, update the record with observations and comments on diagnosis in real-time.

(ii) Environmental Limitations:

The reliability of RFID tags can be impacted by certain environment such as humidity, metal surfaces, etc. making it less ubiquitous than expected. For RFID systems to be widely used and accepted by the healthcare industry the products and solutions needs to be absolutely reliable.

(iii) Technology Incompatibilities and Standards:

Issues of compatibility between wireless devices and electromagnetic interference, needs to be addressed. Lack of established industry standards in RFID will force the adopters to incur high costs to ensure interoperability between readers and tags from multiple vendors.

(iv) Security & Privacy:

The process of unique identification and authentication- the core competence of RFID systems- involves collecting large amounts of sensitive information that needs to be treated confidentially. There are serious security and privacy concerns relating to the use of RFID systems, especially when it comes to the tracking of patients and their medications. It is one thing to deploy RFID to track mobile equipments or consumables and quite another to monitor medications and activities of patients. It is difficult to achieve access control and data security in a highly mobile environment without the support of encryption features. But incorporation of basic security functionality tends to significantly increase the cost of tags. Imagine the logistical challenges and operational costs involved in performing some basic IT security controls such as setting unique passwords and changing them regularly for thousands or millions of tags!

Case Examples of RFID Implementations

Notwithstanding the challenges involved, there are some noteworthy examples of RFID implementations which we have elaborated here:

(i)Wayne Memorial Hospital, Goldsboro, N.C., has saved more than $300,000 in expenses thanks to the active UHF RFID tags to track about 1,300 medical devices throughout the hospital. The hospital is using an RFID-based real-time location system (RTLS) from RadarFind to keep tabs on infusion pumps, diagnostics machines, blood warmers, computers on wheels, wheelchairs and other equipments. The system indicates whether an asset is in use, needs cleaning or is ready for use, and also provides caregivers and administrators with simple map views as well as sophisticated reporting functions to track maintenance, trend equipment utilization, make better planning and budgeting decisions.

(iiThe Bhagwan Mahaveer Jain (BMJ) Heart Center in Bangalore, India has been using passive UHF RFID tags from Aventyn, San Diego, California to help maintain patient records, monitor patient flow and care, and track assets throughout its outpatient department. With the web-based Clinical Information Processing Platform (CLIP) from Aventyn, the hospital tracks an average of 100 new patients a day, as well as returning patients, as they check into the facility’s outpatient department, the health records movement in the OPD, high-value items such as stents, pacemakers, wheelchairs and gurneys, as well as certain mobile equipments, such as those used in diagnostics labs. BMJ is also keen to expand the use of CLIP to track and manage processes very specific to patient care, in the inpatient and acute-care departments.

(iii)The Masaryk Oncological Institute, operated by Masaryk University’s School of Medicine in Brno, Czech Republic, uses passive, HF tags to reduce the likelihood of theft and human error while handling chemotherapy medication, which are expensive and can cause severe harm if administered incorrectly. The RFID solution, implemented with help from IBM Global Technology Services and funding from the Czech Ministry for Education, uses nano-sized RFID tags from Tagsys to tag individual vial/ampoule of cytostatic drugs to identify patients and personnel, simplify and speed up the inventorying of high-cost medical supplies, and deter theft. The patient’s name and other basic information are printed on the label applied to RFID-tagged IV bag, while the pharmacist performing the work wears a ring-shaped passive tag on one finger. At a later phase of implementation, the institute plans to deploy RFID to validate administration of medication to the intended recipient, by reading the RFID tag worn by each patient and the RFID tag embedded in the ID badge of the nurse administering it.

(iv)Hospital St. Louis, the largest hospital in Luxembourg, has opted for RFID system as an alternative to implanting electronic tracking tags among its dementia patients. The Wi-Fi based active RFID system from AeroScout Inc. which is installed at the hospital, facilitates monitoring the movements of its high-risk dementia patients around the hospital. The system alerts the staff with real-time detection information if such patients move through doors or other designated ‘choke points’ unaccompanied. The hospital has plans to use RFID to track equipments such as infusion pumps and wheel chairs.

The Road Ahead

RFID applications in healthcare seem to present a vast scope of opportunities towards achieving improvements, in both supply chain productivity as well as patient care applications. But this huge potential of RFID-based applications is being hindered by various issues like the economics in deployment, lack of established international standards, and concerns over security and privacy. Once these are adequately resolved, we can expect the adoption of RFID technology to accelerate. A concerted effort towards the development of an international standard that guides the application of RFID in the healthcare industry might hold the key.

References:

�Karygiannis, T.; Eydt, B.; Barber, G.; Bunn, L.; Phillips, T. Guidelines for Securing Radio Frequency Identification (RFID) Systems (Special Publication 800-98), National Institute of Standards and Technology (NIST), April 2007

�Dighero, C.; Kellso, J.; Merizon, D.; Murphy-Hoye, M.: Tyo, R. “RFID: The Real and Integrated Story.” Intel Technology Journal. Volume 09, Issue 03 Published August 3, 2005; DOI: 10.1535/itj.0903

�”RFID in Healthcare – A Panacea for the Regulation and Issues Affecting the Industry” A UPS Supply Chain Solutions White Paper, 2005

�Xiao, Y.; Shen, X.; Sun, B.; Cai, L. “Security and privacy in RFID and applications in telemedicine”, IEEE Communications Magazine, vol. 44, no. 4, pp. 64�72, 2006

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