Patient Care Using Radio Frequency Identification · 2006-03-14 · Global network of innovaton Technical Environment ¾96 servers of assorted flavors (Unix, AIX,Solaris,W2K,VMS)

Global networkof innovaton

Daniel Morreale, Chief Information Officer

Patient Care Using

Radio Frequency Identification

AN ADVANCEMENT IN PATIENT SAFETY

Jerry Moy, Client Executive


One of seven regional networks established by The New York City Health and Hospital Corporation in 1994 & composed of Jacobi Medical Center and North Central Bronx Hospital –

Specialties include a Regional Level 1 Trauma Center, Venomous Bite Center and the Regional Perinatal Center.

Burn Unit is a pioneer in early surgical intervention to preserve skin and minimize infection

Pediatric Emergency Department was lauded as one of just four of the best facilities in New York and we have the only multi-person Hyperbaric Chamber in downstate.

Offers a comprehensive Behavioral Healthcare program including inpatient, Partial Hospitalization Outpatient, Emergency, and Addictive Treatment Programs.

Performed 47,000 inpatient discharges, 1,073,000 outpatient visits and 192,000 E.D.visits per year.


Awards

1998 Computerworld Smithsonian Award

2002, 2003,& 2004 HHN Most Wired Award

2003 TETHIC Award for Excellence

2004 Computerworld Smithsonian Honors Laureate Award

2004 HCRIC Award for Best advances in Patient Safety

2004 Storage and Networking World Best Practice in Storage


103 integrated clinical and ancillary systems.Primary application suite includes

Misys CPR (EHR including Lab. & Pharmacy)

AGFA Impact (PACS)

Siemens Unity/Invision – Patient Management

ADVIA CentraLink Laboratory Robot

McKesson Pharmacy Robot-

100% CPOE

System Environment


Technical Environment

96 servers of assorted flavors (Unix, AIX,Solaris,W2K,VMS).8,000 node high density 10 gig network.4,500 PC’s, 1,300 printers, and 900 assorted clinical devices.Robust Nextel Environment.Fully digitized imaging department. (no film)Highly motivated clinical and technical teams.Robotic assisted Laboratory and Pharmacy.Fully integrated voice and data environment including unified messaging.Modest wireless infrastructure.180 terabytes of integrated enterprise storage (SAN/NAS/& CAS).


The Challenge and Issues

Clinical Staff was looking to do documentation at bedside. Nurses wanted to document meds and vital signs and the docs wanted to placeorders and review lab results

Respond to the National Patient Safety Goals Patient Identification and Medication Administration were high on our list of mandateswe had most of the order entry process on-line with the exception of the MAR. Medications were bar coded, staff were bar coded, we needed something for the Patients. Originally we were going to put a bar code on the wrist band, but changed our mind.

Stop the incessant complaining by physician that “I can’t type”This statement must be a requirement for graduation. Get over itIt’s the 21st century, You were smart enough to graduate from medical schoollearn to type. In the mean time we needed to reduce the input required to access a patient chart.


The Challenge and Issues

Physician and Nurses were looking for better Point of Care Access Tools Laptops and Hand Held Devices just didn’t meet the care givers needsHand Helds were to small to read and laptops to heavy to carry. We realized about 2 years ago that we needed a tablet but have been waiting for the industry to catch up

Complete the last step in Electronic Medication Administration The organization has 100% CPOE, medication alerts, allergy alerts, pharmacist review all on line but the final step of administering medication was done on paper.

Simplify documentation & Provide more time for Patient Contact An overwhelming issue has been the need to simplify the documentation process yet provide greater detail in notes and to increase the opportunityfor nurse-patient contact.


The solution then must:

1) Be a wireless tablet with direct access to the clinical record

2) Provide for the MAR and clinical documentation on-line

3) Perform an electronic patient identification

4) Reduce key entry as much as possible

5) Simplify the work flow to create more time for patient contact

…so we turned to a vendor/partner to help build the solution…


Siemens Business Services: A Siemens company within the I&C segment

Siemens Business Services

I&C

Automation and Control

Power

Transportation and L&A

Medical Lighting

Financing and Real Estate

Automation and Drives

Industrial Solutions and Services

Power Generation

Power Transmission and Distribution

Transpor-tation Systems

Siemens VDO

OsramMedical Solutions

Siemens Financial Services

Siemens Real Estate

SiemensCommunications

Siemens Elektro Siemens Elektrogeräte

Siemens Building Technologies

Siemens Dematic

Siemens Logistics and Assembly Systems


Our Business: IT Services

Customers

$6.1 billion sales and 33,600 employees in 44 countries*

SolutionBusiness

Operation Related Services

Outsourcing of computer centers, desktop services, local networks (LAN/WAN) and call centers

Product Related Services

Maintenance of hardware and software products, infrastructure services

Consulting, project-based business solutions and system integration

Consult, Design, Build Operate Maintain

We offer the full range of IT services* 2003 fiscal year


Business JustificationStrategic PlanningMigration PlanningService Desk AssessmentTechnology Impact Analysis

Desktop DeploymentOS MigrationsAsset TrackingDeploy RFID readers, WI-FI infrastructure

Field ServicesHelp Desk, Desk side, DepotMobile Device (RFID Readers/Tablet PCs, etc.) Asset Tracking

Business JustificationStrategic Planning, Migration Planning,RFID and WI-FI Network Design Assessment, Network Performance AssessmentEnterprise Management AssessmentSecurity Design Assessment

Server & Network Deployment of RFID infrastructure and Wi-FIExchange MigrationSMS 2.0 DeploymentsEnterprise Management QuickStarts

Remote Network ServicesWintel & Unix Server SupportData CenterWI-FI and LAN support

Application Performance AssessmentSAP Assessments/Project PlanningActive Directory PlanningRFID encoder and reader Applications

SAP ERM/CRM/SCMImplementations, upgradesRFID Apps Integration with existing systems

SAP/ExchangeRFID Application ManagementHosting Services

Program Management Continuous Improvement

Build Operate/Maintain

App

licat

ion

Net

wor

kEn

d-U

ser

Design Services Needed to Support Your RFID Environment


Key Differences Between RFID & Bar Codes

RFID does not require line of sight

RFID can read multiple tags simultaneously

provides “Automated” reading

can store significantly more information

Information can be dynamic – added or deleted

Increased functionality – replace security tags, integrate with sensors, difficult to counterfeit


For this Project: Barcode or RFID?Barcode RFID

- single reading- direct access only-orientation critical- write once - no hidden or secure data possible- no access control- usual use of several barcodes during a patient stay- no sensor capability- daily problems with dirt, wear, etc.

-established and cheap

- single or bulk reading - no direct access necessary

(read/write through sheets, blankets - tracking possible- orientation not very critical- rewritable - can write hidden or secure data to tag- access control including encryption- a single chip serves throughout the patient stay -robustness, adaptable (size, memory, x-ray tolerance, etc.)-higher price


What is RFID (Radio Frequency Identification)?

Simply put, RFID is a small, thin, low-cost, wireless communications device

Stores, transmits & receives data

Can be applied to or embedded into a package, ID card, wristband, etc.

IC-Chip

antenna

substrate

contacts


Bar Code Bands Today

Issues:Band 1

BC too long

Curvature hard to scan

Band 2Not enough room for data

Multiple scans

Both BandsBC not readily accessible

Need 2 hands for 1st time read

Problems:Band 1• Can’t scan • Key entry required

Band 2• Hard angles to scan• Key entry usedBoth Bands• Work arounds created• Not enough hands

Results:Potential increase in medical errors due to

incorrect patient IDSolution:RFID Wrist Band

Jane Doe MRN: 123456789SSN: 123-45-6789 ADM: 04/25/03

123456789

Jane Doe MRN: 123456789

SSN: 120-38-9615 ADM: 04-25-03

1234

5678

9

Jane

Doe


RFID Key FeaturesPassive vs active

Frequency

Read vs read/write

Write once-read multiple

Write multiple-read multiple

Memory Size

Multiple Over-the-Air Communication Protocols

Form Factors


RFID Wristband – 2000 bits of data storage = 256 characters


FrequenciesElectromagnetic Spectrum

ElectricWaves

RadioWaves

Infra-red VisibleLight

Ultra-Violet

X-Rays GammaRays

CosmicRays

9kHz 30kHz 300kHz 3000kHz 30MHz 300MHz 3000MHz 30GHz 300GHz 3000GHz

VLF LF MF HF VHF UHF SHF EHF Notdesignated

LongWave

MediumWave

ShortWave

VLF Very Low Frequency VHF Very High FrequencyLF Low Frequency UHF Ultra High FrequencyMF Medium Frequency SHF Super High FrequencyHF High Frequency EHF Extremely High Frequency

Radio Spectrum

13.56 Mhz 860-930 MHz

2.45 and 5.8 GHz125-134 kHz

The “RFID” Frequencies

Criteria for Frequency Selection: Read Range - Data Transfer Rate - Power Requirements - Interference Issues


Some Frequencies May Be More Suitable For Certain Applications

Feature 125 Khz 13.56 Mhz 433 Mhz 868 Mhz 915 Mhz 2.45 Ghz

Read Range

Data Transfer

Approx 3 ft

Approx 10 ft Approx 10 ft

Approx 10-12 ft

Approx 20-25 ft

Interfer-ence

Slow Depends on Distance

Slow Fast Fast

Hundreds of feet

Fast

BestPoor Best Poor Good Good


Barcode AND RFID!

Barcodes and RFID can and should complement each other.

First use RFID to positively and non invasively identify a patient and gain access the electronic medical record and specific clinical screens.

Then use barcode to read a single dosage medication and capture that administration into the electronic medical record

AND


Radio Frequency Identification Project

Radio Frequency Identification is anon-invasive means of accuratePatient identification by “broadcasting”the patient’s medical record numberwhich is “picked up” by a special receiver on a tablet PC.

The Process uses a small program which reads the MRN and automatically signs into the patient’s clinical record (Misys CPR) saving time, keystrokes and guaranteeing 100% accuracy in identification.



Misys CPR Patient Information System

RFID Encoder Printer Human Readable RFID

Wristband

With bar code

Siemens Medical UNITY Admission/Registration

System

Admitting Registers patient recording Medical Record Number, Patient Name, Patient Sex in unity which is sent to the RFID encoder/printer.

RFID wristbands are placed on the patient by nursing


Wireless LANWireless LANLab SystemsPatient Information /

Clinical System

Medical Billing System

Wireless Tablet PC with RFID Reader and Client

Software

Patient with RFID Wristband

Access Point


RFID Patient Identification – at the Bedside

Medical Registration

System

Wireless Tablet PC with RFID/Barcode Reader on Med Cart


Our goals were to :

1- Demonstrate that healthcare professionals are able to access medical patient records, stored in the MISYS Patient Information system, from the bedside, using RFID enabled Tablet PCs

2- Streamline the collection of information at point of care by reducing keystrokes

3- Provide a platform for point of care documentation, order entry, and result review

4- Meet two of the 2005 Patient National Safety Initiatives by:a: improving the accuracy of patient identification b: improve accuracy of medications administration

5- Reduce nursing documentation time to provide more patient contact opportunities



Radio Frequency Identification Project Team

NursingPhysicianPropeller HeadClinical AnalystRisk Management

Specifically kept smalland simple



The 7 Rights

Right Patient

Right Medication

Right Dose

Right Route

Right Time

Right Reason,

Right Documentation

The Nursing Practice Guideline, Administration of Medication , August 2004



Findings (Value Proposition)

Prior to the RFID MAR Nursing staff would spend approx 45 minutes per medication event and there are three to four medication administration events per 12 hour shift. The average was 2.5 hours per shift.

Nurses would typically administer 12 medications per patient per twelve hour shift.

Each Nurse typically takes care of 8 - 10 patients

For nursing staff administering medication; the system has saved 25 minutes per administering nurse per shift. This creates approximately 1 hour per nurse/per shift for patient contact and other tasks.

Financially that is a potential saving of $22,000 per unit or $594,000 for Jacobi and $220,000 for NCB, Total savings for the network would be approximately $814,000.


RFID Value PropositionRFID technology closing the gap between physical and digital

world without human intervention and in realtime

Gap between physical and digital world(media discontinuity)

Real world• Human beings• Supplies• Fixed Assets

Time

Man

ual d

ata

entr

y

Spee

ch re

cogn

ition

Human intervention required

No human intervention required

Virtual world• inter and cross-company information system (e.g. supplier, SCM-systems)• communication networks (e.g. Internet)

Bar

code

scan

ning

Tran

spon

der-

tech

nolo

gy


RFID in the Hospital Network

13.56 Mhz


Form Factors

Transponder in Wristband Transponder in

Key Ring

Button Transponder

Transponder on PapeCylinder

Transponder on MetalEncased

Tags


Antenna/Readers

Mobile Readers

Customer Specific

Static Antennae


Handheld Readers

• Type II PCMCIA RFID Reader/Writer

• External antenna available for laptop PCs etc.

• Compact Flash Readers• Handhelds


RFID/Barcode Reader• Read and Write to Patient RFID Bands

• Update Patient Information on Band

• Positive Patient ID

• Scan 1D and 2D Matrix Bar Codes

• ”Five Rights” for Medication Administration

• Point of Care Sampling

PDC DR1000


RFID Application InitiativesClinical / Patient Applications:

Patient ID Tracking/flow through the ED

Com

plex

ity o

f Int

egra

tion

Mobile Asset Tracking: Extend Scope, Improve Service

Employee ID Locator: IT Integration (security, time, efficiency)

Faster Outpatient Registration with RFID cards

Inpatient and Outpatient Kiosk patient education

Site of Surgery/ Allergies/ Current Medications

Operational / Administrative Applications:

Supply Chain Integration: medication, blood supplies, etc.


Outpatient RFID Application

Jacobi Medical Center

OUT PATIENTJohn Doe1400 Pelham ParkwayBronx, NY 123459876543210

Faster self registrations and secure access to webBased Medical record for care in other facilities


Patient tracking in the Emergency Department

1-John Rhodes 3-Manual Rico 5- Freda Winbush 7- Joe Donner2- Ida Silverstein4- Joe Orlando 6- Tony Carr 12- Mary Clark

Orlando


The “smart” OR table….…knows when the patient has arrived;

…knows WHO the patient is;

…knows when the patient leaves.A Pos

Tablet PC:

1. gets input from table (patient ID)

2. has built in 2nd RFID reader to read blood bag tags

3. has software to check match between bag and patient.


Blood Transfusion Check Screen


Blood Transfusion Check Screen


RFID enables Benefits in HealthcareRFID is an enabling technology that when combined with other technologies such as wireless access, tablet PCs, and effectively integrated with clinical and administrative systems can deliver many benefits:

• Better collection and analysis of healthcare data enabling the tracking of operations more efficiently

• Increased work efficiency decreasing the amount of time physicians and nurses spend tracking down administrative and clinical information.

• Prevention of adverse events by immediately presenting critical information such as pharmacy data, allergies, and institutional guidelines.

• Increasing caregiver satisfaction by speeding access to legacy systems and simplifying the input and access to patient information

• Improved management of assets through the real time tracking of critical care equipment and supplies



Documents

Patient Care Using Radio Frequency Identification · 2006-03-14 · Global network of innovaton Technical Environment ¾96 servers of assorted flavors (Unix, AIX,Solaris,W2K,VMS)