Keeping Track

“We believe that the point of verification and the point of documentation should be at the point of care, not down the hall on a computer,” he says. He advocates scanning the barcode on the medication and the patient, entering that information in real time into the eMAR at the point of care to eliminate gaps where errors can occur.

WE ARE AGGRESSIVELY LOOKING AT NEW AND EVOLVING TECHNOLOGIES; WE ARE MUCH MORE CONSERVATIVE ON THE DEPLOYMENT.-PAUL FRISCH, ph.d.

Neuschwander is hopeful that terms such as closed loop-closing the entire medication administration loop with technology-and even the term barcoding, will be included in the next round of meaningful use requirements.

TRACKING ASSETS

RFID has made inroads in asset tracking in hospitals, both in the active RFID, in which the tag uses a battery to power its circuitry and antenna; and passive RFID, in which the tag contains no battery, and is powered by a reader. One hospital that has deployed RFID and is in the process of researching potential applications is Memorial Sloan-Kettering Cancer Center in New York.

The deployments that Sloan-Kettering has made with RFID devices demonstrate the various tradeoffs that need to be considered when deciding which technology to implement. One concern of Paul Frisch, Ph.D., assistant attending, department of medical physics and chief, biomedical physics and engineering, is the risk of stratification if technologies are implemented without a unified strategy, which could be costly in terms of dollars and workload, he says.

So far, Sloan-Kettering's experience has primarily been with active RFID technology, used for asset inventory applications. It rolled out its first active RFID application in January 2007, which was associated with the hospital's financial auditing process. “As a research institution, we do a significant amount of funding. And there are various audits associated with these grants. We use RFID to audit all of the hardware purchases associated with these grants,” he explains.

The RFID tags are integrated with the hospital's extensive WiFi backbone, which extends throughout the hospital and research center. It has since expanded its asset tracking, using active RFID to locate wheelchairs and stretchers for escorting patients, as well as all of the hospital's infusion pumps. With the infusion pumps, the RFID tags are used for both asset tracking and workflow, by providing information about their location, as well as whether they are in use or not.

Active RFID tags are also being implemented for tracking staff, replacing an infrared (IR) tags that have been integrated with the hospital's nurse call system. Using the RFID tags will allow the hospital to precisely locate the clinician, as well as do various device integrations, Frisch says.

One of the advantages of active RFID technology is that it allows the collection of data, such as response times, that can be applied to various metrics.

One of the deciding factors in choosing the appropriate technology is the hospital's infrastructure itself. In Sloan-Kettering's case, active RFID made sense, because it could be integrated with the hospital's existing WiFi infrastructure. Passive RFID would require installing a separate infrastructure, Frisch says. Neither solution is inexpensive, he says. “It comes down to your ultimate number of tags and also has to do with the application and what you are trying to achieve,” he says.

In general, Frisch says, active RFID tags are attractive for asset tracking in institutions with a large footprint. Passive RFID tags enable tracking on a localized scale. Many institutions can benefit by a combination of both technologies, he says. The trick becomes how to merge the two so they are transparent to the user, and also so the two systems share information as much as possible, he says.

Most of the work Sloan-Kettering is doing with passive RFID is investigational. Its only actual implementation of embedded passive tags is to track and count surgical sponges.

It is also investigating the use of passive RFID tags to track certain surgical devices have gone through the washing process, as well as the use of passive tags to make sure surgical kits are complete before going into service. One potential problem is that surgical instruments are metal; and placing tags on instruments would come off during the cleaning process. To work, he believes tags would need to be embedded in the instrument by the manufacturer.

Another potential application is to use passive RFID sample collection, which is currently cataloged with barcodes and manually. In addition, the hospital is working on a project (with Capsule Tech Inc., Andover, Mass.) to develop an RFID-based bedside platform for patient-specific patient identification and association.

“We are aggressively looking at new and evolving technologies; we are much more conservative on the deployment,” Frisch says.