A Short Overview of the RFID Technology in Healthcare

Antti LahtelaDepartment of Computer Science

University of KuopioP.O.Box 1627, FIN-70211 Kuopio, Finland

antti.lahtela@uku.fi

Abstract—The RFID technology is a growing phenomenonamong separate automated identification technologies. As atechnology, it is used from the early 1940’s, but just in the lastdecade, the IT (Information Technology) community and thehealthcare sector have been taking more action on studying anddeveloping the technology to correspond their requirementsand needs. In this paper, we represent a short overview of theRFID technology in healthcare. We will focus on the technologyitself, how it is used in different parts of healthcare and whatkind of results have been found.

Keywords-RFID; Healthcare.

I. INTRODUCTION

Healthcare is under continuous development and changes.Improving patient safety, nursing efficiency and quality oftreatments brings productivity to separate healthcare pro-cesses. To achieve this, healthcare has turned towards ITand its applications, as these are noted to bring efficiencyfor healthcare professionals. [1]

To improve healthcare and always notable patient safety,new systems and methods from the IT are deployed. Such asbar code medication administration, electronic health recordssystems and computerized provider order entry systems hasbeen shown to enhance patient safety. Additionally, use of ITin different operations in a hospital environment is noticed toimprove nursing efficiency and therefore decrease healthcareexpenses. [2] [3] [4]

Identification is on one of the critical parts in healthcare. Ithas an important role: patients need to be identified, differentkind of devices, materials, equipment, objects and instru-ments need identification as well as medications. There aremany targets among healthcare that need identification forregistration, tracking and monitoring purposes. For example,misidentified patient or medications can cause serious, oreven fatal, errors in medication care. This is the reasonwhy it is important to study and research how the RFIDtechnology is used in healthcare and find out what kind ofresults have been found.

This paper is organized as follows: the next sectiondescribes research question and methods. Section III con-centrates on the RFID technology itself and Section IVshows how the technology is used in healthcare. SectionV is conclusion.

II. RESEARCH QUESTION AND METHODS

A constructive literature review method was used in thispaper where the main contribution is to give a generaloverview of the RFID technology in healthcare. The researchquestions are:

• How is RFID used in healthcare?• What kind of results have been found?This paper is a part of the research project MaISSI

(Managing IT Services and Service Implementation) in theUniversity of Kuopio, Department of Computer Science,Finland. The work in our research project has been dividedinto eight subprojects (pilot projects) and the implementationof the automated identification system for the medicationcare process (AIMC) is one of the pilot projects. The AIMCwill use the bar code technology for medication identifi-cation and the RFID technology for patient identificationand nurse authentication. This is the reason why we areinvestigating different kinds of RFID systems in healthcare.Other MaISSI pilots are focused on improving IT servicemanagement processes such as problem management andrelease management. [5]

III. RFIDRFID (Radio Frequency Identification) [6] is a technol-

ogy for automated identification with radio waves. It hasthree main parts: an RFID identifier (a tag, also called aresponder), an RFID reader and a data system for dataprocessing. RFID tags, including an antenna and a datachip for information storage, are commonly installed ontargets that need to be identified, but they can also supplyinformation, for example from the Internet. The content ofthe chip can be read/written with an RFID reader whichoften is mobile or fixed and connected to a data system. [6]

The technology is comparable to the bar code technologywhere a reader reads the information from a bar code. TheRFID technology has some benefits comparing to the barcode technology, for example the reader can read/write tagsdata without a line of sight, the information of a tag can berewritten where the bar code is unchangeable and the RFIDreader can read several RFID tags simultaneously. [6] Otherbenefits of the RFID technology are its reading range, easydata transmission between the tag and the reader, reusabilityand data security. [7]

2009 Fourth International Conference on Systems and Networks Communications

978-0-7695-3775-7/09 $26.00 © 2009 IEEE

DOI 10.1109/ICSNC.2009.77

158

2009 Fourth International Conference on Systems and Networks Communications

978-0-7695-3775-7/09 $26.00 © 2009 IEEE

DOI 10.1109/ICSNC.2009.77

152

2009 Fourth International Conference on Systems and Networks Communications

978-0-7695-3775-7/09 $26.00 © 2009 IEEE

DOI 10.1109/ICSNC.2009.77

165

2009 Fourth International Conference on Systems and Networks Communications

978-0-7695-3775-7/09 $26.00 © 2009 IEEE

DOI 10.1109/ICSNC.2009.77

165

2009 Fourth International Conference on Systems and Networks Communications

978-0-7695-3775-7/09 $26.00 © 2009 IEEE

DOI 10.1109/ICSNC.2009.77

165

Figure 1 describes a simple case of an RFID system inhealthcare. A nurse is using a laptop with an RFID readerand a data system for data processing. With the system, thenurse identifies a patient who is carrying an RFID tag. Thetag contains an individual identifier which is read by theRFID reader. The reader sends the data of the individualidentifier for the data system. The data system can be con-nected, for example to a database where the correspondinginformation to the individual identifier is stored. The datasystem can also be connected to a host/server, the Internetor another information system. Finally, the information isreturned to the data system and for the nurse.

Figure 1. A simple RFID system in healthcare.

IV. RFID IN HEALTHCARE

The RFID technology is not a new technology in health-care. There are different kinds of RFID applications forhealthcare professionals for avoiding errors or risks thatcould endanger the patient safety. Here are some interest-ing RFID projects in healthcare and some notable issuesconcerning to the subject:

In a study, made at the University College HospitalGalway in Ireland, RFID handheld devices and wirelessnetworks were used for scanning patients’ RFID wristbandsfor identification. Once the patient identification was en-sured, the handheld device and the system sent the patientinformation over the wireless network for data processing.This eased the patient identification process and hastedaccess to get the patient information. [8]

Additionally, researchers at the University of Aarhus inDenmark, working with close collaboration between patientsand clinicians, developed a context-aware RFID system. Thesystem used RFID tags on patients and clinicians, whileother applications of the system were adapted to the contextin which they were running. The objective of this study wasto develop hospital infrastructure and applications. [9]

Intel, Autentica, Cisco Systems and San Raffaele Hospitalin Milan Italy have piloted RFID for enhancing bloodtransfusion safety. In the system, patients and healthcareprofessionals were identified by using RFID-enabled wrist-bands while blood bags used re-writable RFID tags. Thepurpose of the system was to supervise blood donations andtransfusions. The data was exchanged between transfusioncenter and RFID readers over wireless access points invarious wards of the hospital. [10]

WISH (Wireless Information Systems for Healthcare) isan RFID and Wi-Fi -based system for healthcare. WISHis used for reducing medication errors during medicationadministration and automating the work routines of health-care professionals. The WISH is used by a nurse who logsinto the system and starts his/her routine rounds at thehospital wards. At the patients’ room, the nurse uses a PDA(integrated with an RFID reader) to read the patient’s tag.The PDA is connected to the electronic health record system,from where the nurse can have the patient information aboutprescriptions and treatment. [11]

In a project, organized in Taiwan, the RFID technologywas used together with the bar code technology to identifypatients and their medications during medication administra-tion. A dispenser, located at hospital medication storehouse,was used to pack medications ready into doses. Each dosecontained a bar code which referred to the informationabout medications. At ward, patients were using RFIDtags for identification. During medication administration, anurse used a hand-held PDA for patient and medicationidentification. The PDA made a data comparison whetherthe right patient was having right medications. The systemshowed to improve medical quality and to reduce medicalmistakes. [12]

At Harvard Medical School, Beth Israel Deaconess Medi-cal Center, the RFID technology and the bar code technologywere used as a hybrid system where RFID tags were usedfor tracking IV pumps, equipment, ventilators, patient beds,electrocardiogram (EKG) devices and employees. Passivetags were used to identify some of patients, NeonatalIntensive Care Unit babies and mothers milk containers.Bar codes were used for medications, most patients andhealthcare professionals identification. This study led projectresearchers to predict that RFID will eventually replace barcodes in the near future, when the technology becomes moreeconomical. [13]

In a Taiwan hospital, RFID was used for locating andtracking SARS (Severe Acute Respiratory Syndrome) in-

159153166166166

fected patients. The LBMS (Location-based Medicare Ser-vice) system also raised an alarm, when a new SARSinfection occurred. In this study, the RFID technology wasfound to have the potential to operate efficiently for helpinghealthcare professionals to increase patient safety. [14]

Woodwards Laboratories have developed a hygiene moni-toring device that uses RFID to identify users. The iHygienesystem is designed for both healthcare and the food industryand it is capable of monitoring that the organization handhygiene policies are followed. The system consists of RFIDtags placed on badges, gel dispensers equipped with RFIDreaders and computers with data systems. The iHygienesystem collects information about the user each time hewashes his hands. The system also generates reports of thehygiene and checks that proper hand hygiene is maintained.[15]

The RFID technology is increasingly being used in every-day scenarios ranging from tracking and inventory controlto patient management in healthcare. The RFID tag’s verylow price at high volumes and the benefits compared tothe bar technology are a big factor behind this widespreadphenomenon. Additionally, the RFID technology promises tohelp and automate many supply chain processes, and it hasbeen shown useful in other areas such as in baggage handlingand in aircraft maintenance. A common factor for all ofthese applications is that they benefit from dedicated RFIDmiddleware that provides reader management functionality,routing and data processing. Also, RFID holds the promiseto eliminate many existing business problems by bridgingthe costly gap between the real world of logistics andbusiness units and the virtual world of IT systems. [16][17]

RFID data security is one issue that needs observation incritical environments. Recognizing threats and responding tothem is important, for example in hospitals. Maybe the mosttypical problem for the RFID technology is that the signal ofthe system is reaching over the intended area or an intruderis eavesdropping the system. [18] Other well-known RFIDsecurity and privacy threats are: [19]

• Spoofing. Attacker or attackers can generate ”au-thentic” RFID tags writing properly formatted data onrewritable or blank RFID tags.

• Tracking. RFID readers in separate strategic locationscan record unwanted sightings of unique tags.

• Sniffing. Tag reading may happen without the knowl-edge of the tag bearer.

• Replay Attacks. Attacker or attackers can intercept andretransmit queries using RFID relay devices.

• Denial of Service. In DoS attack the RFID systems areprevented from functioning properly.

Different studies about RFID and healthcare show that theRFID technology brings benefits to the healthcare sector.Figure 2 summaries these benefits. It is noticed that ifhealthcare and non-healthcare professionals use RFID, it

will eliminate paper-based documenting, increase efficiencyand productivity, improve patient safety, bring cost savings,prevent medication errors and reduce patients waiting time.[20]

Figure 2. Benefits of RFID in healthcare. [20]

Healthcare has also own requirements and limitations forRFID. Patients, healthcare professionals, medical equipmentand healthcare applications set a list of issues that needto be notified by the technology. Based on the studies,represented earlier in this section, figure 3 summaries theserequirements.

V. CONCLUSION

In healthcare the future seems challenging as the pop-ulation, especially in western countries, is ageing and atthe same time people are provided with better and moreextensive health services. This is bound to increase the costof medical care and new methods are needed to both cutcost and make the work more cost efficient. In order to beable to deliver the service people are used to, healthcareprocesses have to become more efficient and less burdeningfor healthcare professionals.

In order to create more efficient healthcare processes,IT and its use in healthcare has been studied extensively.

160154167167167

Figure 3. Requirements and limitations for the RFID technology fromseparate healthcare sectors.

One promising technology that can be used to both stream-line processes and make them more secure is the RFIDtechnology. It can be used for many operations in health-care (figure 4): patient identification, material identification,equipment identification, device identification, medicationidentification, access control, location and information trans-mission. Ultimately, the technology increases patient safetyand brings efficiency for work of healthcare professionals.It can be noticed that most of the systems are focusing onpatient identification.

Additionally, there are other automated identification tech-nologies, such as the bar code technology and the NFC(Near Field Communication) technology, that healthcare candeploy. For example, NFC which is a newcomer in health-care could be used for patient and medication identificationduring medication administration. The NFC technology isalso available in mobile phones where the reader is placedin to the phone’s shell. This gives to NFC a big benefit,compared to the RFID technology, because now the ”reader”can be used also for communication. [21]

Finally, the RFID technology shows a way to automateidentification processes. In healthcare, many studies andprojects show that it can both improve patient safety aswell as streamline healthcare cost thus decreasing expensesand workload of healthcare professionals. In this paper wepresented a research that was aimed to finding how RFID isused in healthcare and what kind results have been found.

Figure 4. RFID in healthcare

ACKNOWLEDGMENT

This paper is a part of the research project MaISSI(Managing IT Services and Service Implementation) at theUniversity of Kuopio, Department of Computer Science,Finland. MaISSI is funded by the National TechnologyAgency TEKES, the European Regional Development Fund(ERDF) and ten partner companies.

REFERENCES

[1] R. Perrin and N. Simpson, “Rfid and bar codes - criticalimportance in enhancing safe patient care,” Journal of Health-care Information Management, vol. 18(4), pp. 33–39, 2004.

[2] R. Kaushal and D. Bates, “Information technology andmedication safety: What is benefit?” Quality and Safety inHealthcare, vol. 11, pp. 261–265, 2002.

161155168168168

[3] E. Oren, E. Shaffer, and G. JB., “Impact of emerging tech-nologies on medication errors and adverse drug events,”American Journal of Health-Systems Pharmacy, vol. 60,no. 15, pp. 1447–1458, 2003.

[4] L. Moody, E. Slocumb, B. Berg, and D. Jackson, “Electronichealth records documentation in nursing.” Computers, Infor-matics, Nursing, vol. 22, no. 6, pp. 337–344, 2004.

[5] University of Kuopio, Deparment of Computer Science,“The maissi project,” 2008-2010, in Finnish, availablehttp://www.uku.fi/maissi.

[6] RFID Journal, 2002-2008, referred 2.5.2009, availablehttp://www.rfidjournal.com.

[7] L. Cheng-Ju, L. Li, C. Shi-Zong, W. Chi Chen, H. Chun-Huang, and C. Xin-Mei, “Mobile healthcare service systemusing rfid,” in Proceedings of the 2004 IEEE InternationalConference on Networking, Sensing and Control, 2004.

[8] A. Aguilar, W. van der Putten, and F. Kirrane, “Positivepatient identification using rfid and wireless networks,” inHISI 11th Annual Conference and Scientific Symposium,November 2003.

[9] J. E. Bardram, “Applications of context-aware computingin hospital work: examples and design principles,” in SAC’04: Proceedings of the 2004 ACM symposium on Appliedcomputing. New York, NY, USA: ACM, 2004, pp. 1574–1579.

[10] J. Dalton and S. Rossini, “Using rfid technologies to reduceblood transfusion errors,” white Paper by Intel Corporation,Autentica, Cisco Systems and San Raffaele Hospital, 2005.

[11] W. Yu, P. Ray, and T. Motoc, “A rfid technology basedwireless mobile multimedia system in healthcare,” e-HealthNetworking, Applications and Services, 2006. HEALTHCOM2006. 8th International Conference on, pp. 1–8, Aug. 2006.

[12] F. Wu, F. Kuo, and L.-W. Liu, “The application of rfid ondrug safety of inpatient nursing healthcare,” in ICEC ’05:Proceedings of the 7th international conference on Electroniccommerce. New York, NY, USA: ACM, 2005, pp. 85–92.

[13] J. Halamka, “Early experiences with positive patient identifi-cation,” Journal of Healthcare Information Management, vol.20(1), pp. 25–27, 2006.

[14] S.-W. Wang, W.-H. Chen, C.-S. Ong, L. Liu, and Y.-W.Chuang, “Rfid application in hospitals: A case study on ademonstration rfid project in a taiwan hospital,” hicss, vol. 8,p. 184a, 2006.

[15] Woodward Laboratories, 2004, referred 2.6.2009, availablehttp://www.woodwardlabs.com/pdfs/iHygiene Press Release.pdf.

[16] M. Kodialam and T. Nandagopal, “Fast and reliable estima-tion schemes in rfid systems,” in MobiCom ’06: Proceedingsof the 12th annual international conference on Mobile com-puting and networking. New York, NY, USA: ACM, 2006,pp. 322–333.

[17] C. Floerkemeier and M. Lampe, “Rfid middleware design:addressing application requirements and rfid constraints,” insOc-EUSAI ’05: Proceedings of the 2005 joint conferenceon Smart objects and ambient intelligence. New York, NY,USA: ACM, 2005, pp. 219–224.

[18] A. Juels, “Rfid security and privacy: a research survey,”Selected Areas in Communications, IEEE Journal on, vol. 24,no. 2, pp. 381–394, Feb. 2006.

[19] M. Rieback, B. Crispo, and A. Tanenbaum, “Is your catinfected with a computer virus?” Fourth Annual IEEE Inter-national Conference on Pervasive Computing and Communi-cations, 2006. PerCom 2006., p. 10 pp., March 2006.

[20] B. Chowdhury and R. Khosla, “Rfid-based hospital real-time patient management system,” Computer and Informa-tion Science, 2007. ICIS 2007. 6th IEEE/ACIS InternationalConference on, pp. 363–368, July 2007.

[21] A. Lahtela, M. Hassinen, and V. Jylha, “Rfid and nfc inhealthcare: Safety of hospitals medication care,” PervasiveComputing Technologies for Healthcare, 2008. Pervasive-Health 2008. Second International Conference on, pp. 241–244, Feb. 2008.

162156169169169