In 2006, 747-bed Brigham and Women's Hospital (BWH) Boston implemented Radianse's indoor positioning system (IPS). According to Radianse (Andover, Mass.), its solution uses active RFID (radio-frequency identification) tags, LAN-ready receivers and Web-based location analysis software to provide BWH's 17-floor facility with the real-time equipment location.
"It was a big undertaking for Brigham, we're now tracking around 6,000 pieces of equipment throughout our many departments," says Michael Fraai, director of biomedical engineering at BWH. However, the decision to implement an IPS throughout the entire hospital was contingent upon the results of an early pilot study.
"We have a lot of competition for capital dollars, and to make an investment that significant, I needed a level of certainty that we would see an ROI," says Sue Schade, CIO at BWH. The hospital initially only implemented RFID in selected nursing units, Schade says. Early results showed a 50 percent reduction in lost equipment, and of the $80,000 that was invested, $66,000 was recuperated in nine months.
Fraai says the technology has allowed nurses to concentrate on patient care rather than "hunting and gathering" for equipment. The technology has also expedited surgery turnaround time, as physicians no longer need to wait for medical devices, he says. In addition, Fraai contends there are a number of regulatory benefits associated with the technology. For example, when the FDA issues a recall, staff can pinpoint the exact location of missing assets.
Another benefit of the system, Fraai says, is that the technology is straightforward to use. "You have a tag attached to the device you want to track. The tag communicates through a receiver that's installed in various locations throughout the hospital," he says. "The information that's transmitted to the receiver travels over the hospital's wires to a Web-based computer application. The application then graphically displays the location of the device."
Fraai says there were considerations he and his team took into account before selecting an RFID vendor. It was important that the system worked harmoniously with the hospital's existing wireless infrastructure, he says. "We have a large number of clinical applications running on our wireless network, including life and mission critical telemetry devices, and we needed to make sure that the IPS would not interfere."
BWH decided to implement active RFID tags rather than passive devices, even though active systems are more expensive. Passive RFID tags operate using power from the RFID receivers but, Fraai says, generally have poor range. Active RFID tags are powered, usually by a battery, and offer better coverage.
"Passive RFID tags are used very little in hospitals at the moment because proximity is an issue," says Chris Lavanchy, engineering director of ECRI Institute, a Plymouth Meeting, Pa.-based nonprofit group that conducts technology evaluations.
Fraai says his team decided against installing a client-based system and opted to use a Web-based application to visualize the location of hospital assets. "We didn't want to have to download a bunch of software onto each desktop. With a Web-based application, you can use Internet Explorer to access the application." Fraai says the major benefit of this is that staff doesn't have to spend time upgrading computers.
In conjunction with addressing the functional requirements of a system, it's important to take into account the financial stability of an RFID provider, Lavanchy says. "There are a lot of vendors out there, and it's kind of the Wild West right now," he says. Some are start-ups and may not be around tomorrow. "If a company you choose goes belly-up, you'll have no support."
Once the vendor was selected, Fraai says there were a number of challenges. Initially, the size of the tags was a problem. However, "We worked with the vendor and the size of the tag has now come down 25 percent," he says.
Because the business cases for RFID are undefined, manufacturers are not ready to spend money on RFID readers that are purpose-built, suggests Jeff Woods, a senior analyst at Gartner, an information research and technology company based in Stamford, Conn. As institutions implement a more standardized plan of exactly where and how to use this technology, manufacturers will build more mature equipment, which means users won't have to do as much onsite engineering, he says.
Schade says she felt the biggest challenge was putting the actual RFID infrastructure in place, which involved putting cables and wires into the ceiling. "We're a busy academic center that runs at 100 percent capacity, so closing off sections to do the hard wiring was a significant disruption," she says. However, Schade contends that the hospital utilized holidays, weekends and nights to implement the network.
In order to surmount the infrastructure challenge, Woods suggests that some facilities opt to implement Wi-Fi for asset tracking, as leveraging a hospital's existing hard wiring is difficult. However, Chris Lavanchy warns, "You have to have a number of things in your favor to make that work." A hospital has to have a high enough density of access points — signal receivers — throughout the facility. This might be possible if an organization has already installed VoIP (voice over internet protocol), because it also requires a lot of access points, he says.
Often, the challenge of RFID is not with its functionality or implementation, but with defining the best way of utilizing the technology, says Woods. "We advise people not to invest in a general purpose RFID infrastructure. Don't think that it's a one size fits all application." For wheelchair and infusion pump tracking, referred to as asset tracking, the application is getting more mature, though Woods says inventory tracking problems are far more difficult to solve.
Some hospitals are concerned about purchasing a technology with no defined standards in place. "I think this issue of standards versus proprietary confounds a lot of hospitals," Woods says. Many of the active RFID technologies are proprietary, he explains, and that gives a lot of people pause. "However, we don't advise clients to wait for standards to emerge because there's no evidence this is going to happen anytime soon."
According to Schade, a recent Ann Arbor, Mich.-based CHIME survey reported that a very high percentage of respondents had no plans to implement RFID technology for asset tracking. "I think the reason that BWH is able to go ahead and deploy this type of technology is that we're not faced with some of the tough choices about core clinical systems that other hospitals are making right now — we already have them in place," she says. It's a huge cost to implement an IPS system, and hospitals that have not yet implemented applications such as EMRs, PACS, or CPOE need to prioritize their IT dollars, Schade says. "Asset tracking probably isn't at the top of their list."
Lavanchy agrees that implementing an RFID system is "a very expensive proposition." He says, "The advice we generally give a facility if they called up and said they're having problems finding infusion pumps, would be to first think about non-high-tech solutions — they are far less expensive." He contends this isn't necessarily a glamorous alternative, and most times merely involves process changes of equipment returns, but it's a lot cheaper than spending hundreds of thousands of dollars, or millions of dollars, to wire an entire hospital.
However, when Schade was asked if BWH considered a low-tech alternative to RFID asset tracking she responded, "Oh sure, we tried all that. But if you came and visited our hospital you'd see that standard methods aren't necessarily going to work in terms of what our clinicians need. You just need to consider the size of our facility, the acuity of our patients, the number of patients, physicians and nurses we have, and you can see that we need to back them up with technology solutions as much as we can."
