An epidemic of misplaced, stolen and stashed medical equipment is costing hospitals millions of dollars a year. Fortunately, technologies to help keep track of valuable assets are pervading the industry, leaving one main question on every CIOs lips: which IT solution is right for my health system?
According to Stan Schatt, vice president and practice director of networking at ABI, a New York-based technology market research firm, the two major wireless technologies vying for position to provide hospitals with real-time locating systems (RTLS) are WiFi (wireless fidelity) and active RFID (radio frequency identification) running off a proprietary network.
“Less than 5 percent of North American healthcare facilities are equipped with RTLS to manage their equipment and inventory, so the market is truly up for grabs,” says Schatt.
The greatest benefit of utilizing a WiFi-based asset tracking system is that hospitals can leverage their existing WiFi infrastructure, explains Schatt. The value proposition is that a facility doesn't need to install a proprietary network, which can be both costly and cumbersome, he says.
An easy choice for CHS
For Carolinas HealthCare System (CHS) — the third largest healthcare system in the United States with 4,900 beds across it 20 hospitals, nursing homes, ambulatory surgery centers and radiology centers in North and South Carolina — being able to leverage its existing wireless network was a major factor in its decision to deploy Ekahau's (Saratoga, Calif.) RTLS, says Clay Fisher, director at CHS.
The facility is currently using Ekahau's system to track medical assets such as infusion pumps and ventilators, and Fisher expects the installation to be complete by early 2008, he says.
CHS invited several vendors to give real-time demonstrations, in which they were each given an hour to map out a certain square footage, says Fisher. He claims, “Ekahau won hands down,” and its accuracy levels were significantly better than anyone else in the marketplace, “aside from a separate proprietary network.”
The decision not to install a proprietary RFID network was not only based on financial considerations, but also on the logistical challenges it presented. “We didn't want to have to punch into the ceilings and pull cables through the millions of square feet that we own. Anytime you don't have to go above the ceiling, the better off you are,” he says.
Although the accuracy levels achieved by an active RFID proprietary network are said to be superior, Fisher claims Ekahau's RTLS can provide what the hospital needs, which is predominantly an asset management solution. He claims 90 percent of items are found within an average of 10 feet, which is more than sufficient when looking for bigger equipment such as wheelchairs or ventilators. However, he is hesitant as to whether WiFi technology is capable of providing “true room-level accuracy.”
Fisher says that although he feels a WiFi-based RTLS will allow CHS to track patients, there are some limits. “I've heard some folks out there are claiming that if a patient is standing side-by-side to a physician, then at that point a billing action kicks off,” Fisher explains. “I don't think that WiFi technology is capable of something like that yet,” he adds.
The resolution of many types of WiFi tracking systems can be pretty poor says Chris Lavanchy, engineering director of the health services group at ECRI Institute, a Plymouth Meeting, Pa.-based non-profit organization that provides consulting services for healthcare IT evaluation. “By resolution, I am referring to the granularity or degree to which the system can identify the exact location of a tagged item,” Lavanchy explains. The best systems can locate an object to within six inches or so, where some of the poorer locating systems can only provide location accuracy to 10 to 30 or more feet, he says. “WiFi technology generally has a reputation of having poorer locating accuracy unless the system is installed with a very high density of access points,” Lavanchy says. “You can't simply take the network and throw the WiFi tags into the mix and expect good performance,” he says.
Organizations that require a very high level of accuracy must go through a lengthy process of mapping the signal strengths of tags in various rooms, explains Lavanchy. “You are likely going to have to add access points (APs), which can be costly and disruptive,” he says.
However, because CHS had originally designed its network for VoIP (voice over Internet protocol), which already requires a high level of APs, Fisher says the organization didn't need to add additional access points. But tweaking the APs presented a minor challenge.
“Some of the access points were directional, and we needed for them to be omni-directional to get adequate coverage,” Fisher says. In other words, instead of the access points pointing straight down the hallway in one direction, they needed to present in more of a circular configuration, he explains.
Ekahau's system uses software-based algorithms to compute the location of tracked objects, Fisher explains. He says that the RTLS is server-based and can be installed in a network operations center so that a multi-campus facility can easily scale to support thousands of tags on a single server. Such scalability was critical, says Fisher.
He notes that CHS needs to be able to track items that move from facility A to facility B. “A big advantage of Ekahau's system is that organizations don't have to add exiters at doorways to track items as they leave, because once you calibrate facility A and facility B, and you load up those calibrations onto your centralized server, the item you're tracking will show up in either facility,” he touts. “And the system works like this out of the box.”
CHS went through a beta transition with Ekahau to help the company define and design its software, explains Fisher. “One of the key elements they did not have prior to contract was that their solution was not Microsoft sequel-based,” he says. Fisher claims this was important because CHS needed to integrate the data provided by the RTLS with other applications. “We can now see the data from Ekahau in our master inventory system,” he says.
The question on everybody's mind with all burgeoning technology is “what's the ROI?” However, Fisher claims that CHS was more concerned with creating efficiencies than saving money. “It was not sold as a true ROI play. There are some soft benefits of course, but a dollar figure was not sold specifically because it was a necessary evil going forward to be able to find your equipment rapidly,” he explains.
UMC chooses differently
The University Medical Center (UMC) at Tucson, Ariz., a nonprofit 355-bed acute-care hospital, recently deployed AeroScout's (Redwood City, Calif.) WiFi-based active RFID asset tracking and location solution throughout its facility. AeroScout's RTLS uses WiFi-based active RFID tags that can be run off a standardized WiFi network, explains Bill Wood, clinical engineering manager at UMC.
“Over the past four to five years, I've been reviewing the various solutions on the market, but all of them were pretty much cost prohibitive because of the infrastructure required. Anything for a facility of our size was looking like it was going to be well in excess of $1 million,” Wood says.
However, when AeroScout approached UMC with an opportunity to deploy a pilot asset-tracking program, “It seemed like a good fit,” he says. Because the solution utilized the hospital's existing wireless network and AeroScout offered the system as part of a “pilot program,” Wood says it came at a “significantly reduced price.”
He claims that AeroScout's solution works well — UMC is currently tracking 3,000 items including infusion pumps, wheelchairs, stretchers, beds, and various portable devices. The accuracy achieved by the RTLS was “better than advertised,” he touts. Specifically, UMC was looking for an accuracy level of 3 to 10 meters, with AeroScout it can find items within 5, says Wood.
However, one of the biggest challenges has been UMC's constantly evolving wireless network, he says. The facility recently converted from the standard wireless protocol to LWAPP (light weight access point protocol), he says.
The decision to change UMC's wireless protocol was made to better facilitate its VoIP system. “For VoIP to work, we had too many access points, and so the solution was to either remove access points or upgrade to the LWAPP. Removing access points would have killed the asset tracking completely,” Wood explains.
UMC is still going through changes with the Cisco (San Jose, Calif.) wireless network, so some of its uses are not yet fully functional, he says. For example, “Our floor separation right now is not very good, we're still waiting on a patch from Cisco that will supposedly solve this issue,” he explains. In other words, if the RTLS reports that a device is on the fifth floor, sometimes it's actually on the fourth or sixth.
The floor separation issue not only slows down the amount of time it takes to find an object, but also causes problems with the hospital's location history reports, explains Wood. “If a device turns up broken, we use the location history report to determine the path it took in order to identify where it was broken,” he explains. Not knowing exactly what route the equipment has traveled makes producing such an audit trail impossible.
Wood claims that the actual implementation of AeroScout's solution went smoothly. “Nothing in healthcare is easy, but I would say that this deployment was pretty routine,” he says. Because the receivers are the wireless access points, there was no installation required, they were already in place. However, UMC did have to install exiters at the building's entry and exit points, so the system knows when something is walking out the door.
Although Wood claims AeroScout's solution is tracking equipment well, because the wireless network is still evolving, “It's not yet a 100 percent fully functional system.”
For this reason, he maintains that it's impossible to come up with an exact ROI.
He also notes that UMC had anticipated the RTLS would be fully operational within a year, but that timeline has fallen by the wayside. “I wouldn't find fault with any particular vendor, I would just say that as the program has evolved, targets have changed,” says Wood.
When asked what improvements he would like to see in the overall system, he says, “I don't know that I really need to see improvements, but what I need to see is more stability. I need for things to reach a level that encompasses all of what we're trying to do, and then have it stay stable for a period of time so we can actually utilize our system.”
Wood stresses that ensuring leadership buy-in, especially from the IT department, is extremely important in the early days of implementing a tracking system. “We didn't think there was going to be that much IT involvement since we were jumping on an existing wireless network, but we discovered later that they had to be heavily involved. In order for the project to be successful, you need cooperation between clinical staff, IT staff and the clinical engineering folks,” he says.
Weighing up a WiFi-based RTLS
Many facilities fear that running an asset tracking system off a hospital's wireless network could pose significant security issues, says Schatt. But how can tracking an infusion pump be a security threat?
“The problem is that a network defaults to its lowest level of security. So a hacker could conceivably get into a network by spoofing a pump. Once he's in the system, he could have access to a hospital's medical records,” says Schatt. “The probability of that happening is pretty low, but nonetheless it is something we hear about.”
IT directors are often concerned with how an RTLS is going to affect a network's bandwidth. “Interestingly, this is a concern generally raised by competing vendors, and for the most part, we have not heard about hospitals having a problem with this,” says Lavanchy.
Tuomo Rutanen, vice president of business development at Ekahau, says capacity problems are highly unlikely. “At any given time, 95-98 percent of the tags are in sleep mode, and in the unlikely event that all the tags did communicate at once over the network, it would essentially go unnoticed,” he says.
Echoing Rutanen, Wood claims that UMC did the calculations with AeroScout's system, and if every device burst at exactly the same time, it still would take up less than 2 percent of the hospital's bandwidth. “However, this is something to watch out for, it's important to make sure your bandwidth is adequate for whatever devices you add to it. But this is just basic common sense,” he opines.
Another commonly cited disadvantage of a WiFi-based RTLS is the battery life of the tags, says Lavanchy. “Because the electronics and components for WiFi were designed for devices such as laptops and PDAs, which generally have a significant power supply and a battery that's pretty decent, we find that the power requirements for the electronics tend to be fairly high,” he explains.
However, Rutanen maintains the next generation of WiFi-based tags feature new ultra-low-power-consumption devices that have a battery life of five to seven years — current tag batteries have a lifespan of three to five years. Rutanen says the new tags are due to be released at the end of 2008, and although price points are not set, he assures they will be less expensive than the current models.
A significant advantage to using a WiFi-based RTLS is that it's a standardized technology, whereas many RFID technologies are not, explains Lavanchy. Because there are standards in place, many of the electronic components are interchangeable and can be used on any system, he says. “It's unlikely that you could use an RFID tag that's run on a proprietary network with more than one vendor,” he says.
WiFi is something that hospitals should at least consider, adds Lavanchy. “I don't think it's for everybody; I certainly recognize some of its limitations,” he explains, “but I also see the tremendous benefits, both from a cost and convenience point of view.”