Red: Things I have use and cited Blue: Things I have use but not cited Green: I want

to use, but thinks it need cited Purple: I want to use but thinks it need no cited TRACKI G !"# $P" G%$ An esti&ated ',()) ob*ects are le+t in patients during operations in the ,nited $tates each -ear. Two/thirds o+ these &aterials are sponges Two o+ this stud-0s authors work +or ClearCount 1edical $olutions, which is developing the $&art$ponge $-ste&. $ource: Initial clinical evaluation o+ a handheld device +or detecting retained surgical gau2e sponges using radio+re3uenc- identi+ication technolog-, Archives of Surgery, A 1acario, et al., 4ul- 5))6. 7or &ore in+or&ation, visit http://www.clearcount.com. B- replacing these two error/prone s-ste&s, ClearCount0s patented technolog- pro&ises to dra&aticall- reduces costs, i&prove patient sa+et-, and increase worker productivit-. In over 8) &illion operations each -ear in the ,.$., perioperative nurses spend '(/9) &inutes &anuall- counting surgical sponges and instru&ents be+ore, during, and a+ter each operation. The counts are intended to prevent a co&&on surgical risk: retained +oreign bodies. 7actoring in ti&e spent tracking surgical sponges and instru&ents with the costs o+ legal settle&ents and the repeat operation to re&ove the retained +oreign bodies, it is not surprising that this proble& costs ,.$. healthcare institutions in e:cess o+ ;' billion annuall-.
BAR C"!I G<$ R%P=AC%1% T> The passive tag has a range o+ about 9 +eet and is priced an-where +ro& 5? cents to ;' each In addition, these &ovable pieces o+ e3uip&ent are considered scarce resources to the hospital personnel that need the&. This leads to packing o+ e3uip&ent and increased costs, as e3uip&ent &anage&ent personnel +re3uentl- need to rent e3uip&ent to &eet usage de&ands. #ith R7I! technolog-, each piece o+ &ovable e3uip&ent is &arked with an R7I!tag. @"$PITA=$ T, % I T" R7I! Industr- representatives esti&ate that onl- about 5)) hospitals are using this radio wave/based technolog-, chie+l- +or tracking e3uip&ent or patients. 1ost o+ the earl- users have li&ited their R7I! Aradio +re3uenc- identi+icationB applications to e&ergenc- depart&ents, operating roo&s or s&all pilot progra&s on one +loor. Cuotes +ro& various vendors indicate that it costs ;5)),))) to ;6)),))) or &ore to install a +acilit- wide R7I! tracking s-ste& in a &ediu&/si2ed hospital. But vendors are 3uick to sa- that the new e++iciencies R7I! s-ste&s produce can pa- +or the invest&ent in one to two -ears, and &an- hospital clients agree. This is because R7I!/based tracking eli&inates sta++ ti&e spent searching +or e3uip&ent, and inventories can be pulled out because e3uip&ent does not get lost. $i&ilarl-, R7I!/biised patient tracking can speed up patient +low in high/volu&e areas such as the %! and "R, increasing inco&e and eli&inating the need +or costl- capital e:pansions. 1an- o+ the earl- users are sprawling institutions where keeping track o+ e3uip&ent and patients is a real challenge. But plent- o+ s&aller hospitals in the 5()/ to 8))Droo& range also are ac3uiring R7I! a big chunk o+ R7I!<s cost is installing a network o+ receivers 7or e:a&ple, R7 $urgical $-ste&s, Bellevue, #ash., puts passive tags in surgical sponges that e&it a signal to help prevent the& +ro& being le+t in patients. !1=$$ tests showed a 6E percent reading accurac- o+ the tags, but a new generation o+ passive tags is e:pected to have an al&ost per+ect accurac- rate, 1agee sa-s.

RA!I" 7R%C,% CF I!% TI7ICATI" $F$T%1$ T%C@ "="GF I T@% $,RGICA= $%TTI G

A passive R7I! tag has no internal power suppl- and uses the energ- provided b- the reader to respond. Passive tags are relativel- s&all and ine:pensiveG each tag costs between ;).() and ;'. An active R7I! tag, which can cost ;9) to ;?), "ptical bar coding iss so&eti&es viewed as co&peting technolog- that is a less e:pensive than R7I!. Both have their roles. R7I! has advantages that &ight *usti+- the increased cost: it is auto&atic and does not re3uire an- &anual intervention to work, which reduces the potential +or a &istake. In a chaotic operating roo& environ&ent, inventor- control cannot get in the wa- o+ taking care o+ the patient. This &ini&i2es so&e o+ the potential +or error. Three t9T9es o+ proble&s in the operating roo& in which i&ple&entations o+ R7I! can &ake a pro+ound i&pact are patient sa+et-, inventor- &anage&ent, and asset tracking. ,se o+ R7I! in these areas can, a&ong other bene+icial outco&es, lead to +ewer &edical errors, reduction o+ cost, and increased e++icienc-. #e believe that separate R7I! in+rastructuresH or active and passive R7I! used individuall- or togetherH &ight be necessarto custo&i2e R7I! to the di++erent t-pes o+ proble&s encountered. 7or e:a&ple, tracking patients &ight re3uire the +aster polling techni3ues o++ered b- active R7I!, whereas knowledge about whether a &edication or suppl- has le+t a cabinet &ight be better ac3uired with a less e:pensive, passive R7I! approach. The +irst role +or R7I! is in i&proving e++icienc- o+ operations. $urgical procedures are +re3uentl- dela-ed due to &issing pieces o+ e3uip&ent and sta++ spending inordinate a&ounts o+ ti&e tracking downshared resources. Active tracking o+ critical assets that are shared resources will likel- be the +irst &ainstrea& area o+ R7I! in &edicine and the operating roo&. R7I! asset tracking s-ste&s are reported to return their invest&ent in less than 9 -ears.< A stud- o+ tracking in the operating roo& showed an i&prove&ent in the utili2ation o+ the surgical depart&ent +ro& (EI to E)I, 'J which in turn paid +or the R7I! s-ste& through a reduction in the need +or overti&e pa-. we show the +ollowing e:a&ples o+ resources, which i+ tagged, would bene+it the operating roo&. Although &ost assets tagged are e:pensive ite&s, so&e relativel- ine:pensive ite&s that could create an e:pensive dela- or a critical patient sa+etevent i+ not available are also worth tracking. Inventor- &anage&ent is di++erentiated +ro& asset tracking in that it +ocuses on consu&able supplies and ensures these are reordered auto&aticalland billed +or correctl-. The use o+ R7I! +or inventor- &anage&ent has &ade substantial inroads in other industries. R7I! technologies were given a high pro+ile when the ,nited $tates !epart&ent o+ !e+ense announced to its suppliers that b- 5))( it would +ull- adopt an R7I! inventor- labeling s-ste&. An R7I!/enabled cabinet with an R7I! reader can deter&ine i+ a suppl- that has been tagged has le+t the cabinet and auto&aticall- ad*ust inventor- levels, so that supplies are auto&aticall- ordered. The +irst reports are beginning to co&e +ro& hospitals that have deplo-ed these s-ste&s in the operating roo&. A large &edical center running 59 operating roo&s deplo-ed R7I! inventor- tracking and clai&ed a -earl- savings o+ ;' &illion through the prevention o+ lost billing and +aster inventor- &anage&ent.KL Inventor- &anage&ent would likel- use passive tags, because these are s&aller and less e:pensive than active. In the ,nited $tates during 5))) to 5))5, 5,(M' cases o+ +oreign bodies le+t in patients during procedures were reported. The +iscal i&pact o+ such incidents is placed at ;'E.5( &illion in e:cess costs. 5L Inventor- needs to be tagged b- suppliers to prevent the use o+ R7I! resulting in a large up +ront &anual labor cost because having hospital sta++ has to laboriousl- assign each tag to an individual suppl-. Personal health in+or&ation is not at risk i+ R7I! tags carr- onl- a uni3ue I! that re3uires an e:ternal s-ste&s database to &atch patient de&ographics. $igni+icant privac- issues could result with R7I! i+ it is not care+ull- controlled. R7I! provides a re&arkable opportunit- to help patients receive a 3ualit- care e:perience in a sa+e and healing *ourne- through the health care s-ste&.

A I TR"!,CTI" T" R7I!

IT in+rastructure to handle large a&ounts o+ data. $ince R7I! tags contain &uch &ore in+or&ation than bar codes, &an- IT in+rastructures &a- have to be upgraded. There are three &ain parts o+ the R7T! s-ste&. The tag Aaka transponderB is a++i:ed to the ite& being tracked. I he reader Aaka interrogatorB is the device that reads the tag. $o&e readers can also write in+or&ation to the tag. The third part o+ the s-ste& is the antennasHan i&portant part o+ co&&unication between the tag and reader. The basic s-ste& co&ponents are shown in 7igure '. The tag here is &agni+ied and is shown without being attached to the ite& that it<s identi+-ing. The tag has an integrated circuit that contains all ot the electronics. The rest o+ the tag is the antenna. The- are t-picall- a loop antenna as shown in the +igure Tag prices and differences. #hile so&e tags are in the () cent region, bar codes cost about ).5 cents each. Tag operation di++ers greatl- depending on the protocols used. $o&e vendors use a proprietar- protocol. RFID standards. Protocols are still being written. "+ the 55 standards I could +indH'5 are not +inished.

" A R"==. R7I! 1"N%$ T"#AR! PATI% T $A7%TF.

"nce the in+or&ation is written to the tag, it<s electronicall- locked,so the in+or&ation cannot be changed or altered,O $tewart sa-s. OThe in+or&ation is encr-pted, so we &eet @IPAA co&plianc- because all the in+or&ation that<s stored on the tag is protected.O

#%ANI G T@R",G@ T@% @"P%$ A ! @FP% $,RR", !I G R7I!

Those readers are t-picall- large and e:pensiveHupwards o+ ;9,))). A lot o+ the attention around R7I! is related to privac-, with concerns being raised that rights are being co&pro&ised. It<s i&portant to understand, and to e++ectivel- co&&unicate with stakeholdersHincluding patientsHthat tags cannot be tracked an-where e:cept inside the hospital. Also, chnicians &ight e:pect the abilitB< to te&poraril- disable their tags when the- choose not to be disturbed. In evaluating a technolog-, veri+- that neither personal nor con+idential in+or&ation is trans&ittedG that data is stored on a secure serverG and that the solution provides the tools to allow the hospital to be co&pliant with the @ealth Insurance Portabilit- and Accountabilit- Act A@IPAAB. 7irst, consider all the costs to get startedH+ro& purchase price to i&ple&entation costs, as well as an- ongoing &aintenance and support costs such as replacing batteries. A&ong the potential wa-s to de&onstrate hard returns: P Reducing lost e3uip&ent that would re3uire repurchasing P Reducing e3uip&ent rentals P I&proving e3uip&ent utili2ation P I&proving consu&ables &anage&ent P Reducing dela-s in patient care P 7nabling auto&atic charge capture P Increasing patient throughput P I&proving depart&ent e++iciencR7I!<s potential to reduce e3uip&ent loss, enhance patient care, and i&prove work+low &easure&ent is here

Radio frequency identification applications in hospital environments

$ecours @ealth $-ste&, Rich&ond, Nirginia, with R7I! tags +or &edical devicesG the hospital is Qtagging appro:i&atel- '5,))) pieces o+ &ovable e3uip&ent at its three hospitals, including IN AintravenousB poles, pu&ps, wheelchairs, stretchers and hospital bedsR ABecker 5))8, 9?B. $ecours0 e&plo-ees were spending 5(S99I o+ their ti&e searching +or e3uip&ent and losing about ')I o+ their inventor- annuall-G R7I! tags saved nurses ti&e in locating e3uip&ent AGlab&an 5))8B. Rising healthcare costs are a &a*or concern, and hospitals are activel- seeking wa-s to reduce e:penses. Agilit- @ealthcare $olutions C%" 7ran !irks&eier, Qesti&ates a 5))/ bed hospital can save ;6)),))) annuall- +ro& less shrinkage, +ewer rentals, de+erral o+ new purchases and i&proved sta++ productivit-. A ()) bed hospital could save ;' &illion annuall-R AGlab&an 5))8B. Advocate Good $hepherd @ospital, Barrington, Illinois, i&ple&ented R7I! in 5))9 to help &anage inventor-G annual inventor- losses were cut b- about ')I AGlab&anB. 1anhospitals incur high costs related to lost, &isplaced, or stolen e3uip&ent. 7or e:a&ple, ;8 &illion

worth o+ e3uip&ent was unaccounted +or at 4ackson 1e&orial @ospital, 1ia&i, 7lorida, in 5))9G the hospital plans to i&ple&ent R7I! e3uip&ent/tracking technolog- within two -ears AGlab&anB. @ol- a&e @ospital, a 96'/bed +acilit- in Teaneck, ew 4erse-, +ound that R7I!/ tagged e3uip&ent saved ti&e in locating e3uip&ent and reduced rental costs because e3uip&ent was &ore +ull- used AGlab&anB. As hospitals seek to reduce costs, it is i&portant that patient satis+action is not adversel- a++ected. R7I! can i&prove patient treat&ent and sa+et- b- reducing &edical errors, i&proving the securit- o+ &edicine and the +acilit-, and i&proving patient co&pliance. Currentl-, the costs associated with i&ple&enting and &anaging the tagging s-ste&s are the &a*or proble&s associated with R7I!. These costs include obtaining tags, appl-ing tags to e3uip&ent or patients, purchasing tag readers, developing so+tware progra&s and database s-ste&s, and integrating and &aintaining the s-ste&s. Tags would have to be attached to ever-thing. 7or a ')))/bed hospital, that could &ean tagging 5),))) ite&s per da- A@osaka 5))8B. decisions would have to be &ade regarding who would appl- the tags. @osaka suggests that the tags originate at hospital registration where the patient0s in+or&ation and tag nu&bers would be stored in a database these costs do not include the costs o+ hardware, data/processing so+tware, or operating e:penses. The tags are also relativel- e:pensiveG passive R7I! tags cost appro:i&atel- ') cents per tag, whereas bar codes cost appro:i&atel- 9 cents per sticker ABecker 5))8, 9?B. These issues relate to data sharing and consu&erSpatient privac- concerns and present greater costs and challenges in the hospital industr- than the- do in other industries adopting R7I! technolog- ACollins 4. 5))8B. To prevent snooping, the tags would need either a rando& nu&ber stored in a secure database to identi+- the &edicine or a securit- code to access the data stored on the chip. %ither securit- option would increase the cost o+ chips and readers AKontnik and !ahod 5))8B. @ealthcare providers need to co&pl- with the ,.$. !epart&ent o+ @ealth and @u&an $ervices @ealth Insurance Portabilit- and Accountabilit- Act A@IPAAB, which re3uires an organi2ation to take QreasonableR &easures to sa+eguard electronic health data A7enner 5))8B. Although cost is a &a*or i&pedi&ent to R7I! i&ple&entation, increased de&and +or R7I! tags and supporting s-ste&s will drive technolog- to i&prove the s-ste& and lower associated costs.
BAR C"!%$ N$. R7I!: A BATT=% 4,$T B%GI I G.

1ost hospitals re3uire clinicians to conduct &anual sponge counts both be+ore and a+ter each surgical procedure to ensure sponges that were used are re&oved be+ore the patient is sewn up. But these procedures aren<t alwa-s +ollowed, and as a result Its all too co&&on +or sponges to be le+t inside patients, sa-s Ale: 1acario, 1.!., who last -ear led a stud- at $tan+ord ,niversit1edicai Center to deter&ine i+ R7I! technolog- could be used to help reduce such errors. The stud-, which was +unded b- grants +ro& the $&all Business innovation Research Progra& and the ational Institutes o+ @ealth, involved using surgical sponges that had been e&bedded with passive RPI! tags. The technolog-, +ro& ClearCount 1edical $olutions, Pittsburgh, has not -et been approved b- the 7ood and !rug Ad&inistration and is not -et co&&erciall- available. !uring the stud-, 5? o+ the vendor<s R7I! sponges were intentionall- le+t in eight patients who underwent abdo&inal or pelvic surgeries. ear the end o+ the procedure, surgeons pulled together the patients incisions and used the vendor<s scanning device to scan +or the sponges. Alt the sponges were detected. #hite barcode technolog- can be used to auto&ate sponge/counting processes, R7I! technolog- is &ore e++ective +or the process, 1acario contends.
I$ R7I! RIG@T 7"R F",R "RGA ITATI" > B- !ebbie 1urph-

Tracking e3uip&ent is a di++icult task that takes both nurses< ti&e and &aterials &anage&ent<s budget, especiall- when ite&s are never +ound, R7I! is an up/and/co&ing, technological solution +or this issue Also, deter&ining i&ple&entation costs, the t-pe o+ tags to be used and how the s-ste& will run on the network are onl- a sa&pling o+ the necessar- decisions to be &ade. @ospitals in Illinois, ew 4erse-, 1assachusetts and Nirginia, to na&e *ust a +ew, have i&ple&ented R7I! solutions in &aterials &anage&ent and +ound great savings and even greater e++iciencies. There is a clear advantage to using R7I! tags in depart&etits where tracking

supplies, beds, tra-s, plas&a bags and tbousands o+ other ite&s re&ains a &a*or challenge +or health care institutions. Govern&ent studies suggest strong IT invest&ent could cut health care costs b- 5) percent each -ear, and R7I! can de+initel- contribute to these health care cost reductions. Tbe tags are wireless and hands/+ree. The- can be reprogra&&ed, which allows users to add data to support speci+ic processes and to decrease ti&e +or stocking, reordering and &anaging supplies. $t. Nincent<s @ospital, Bir&ingha&, Ala., uses R7I! to &onitor surgical instru&ents and access in+or&ation on their location, last sterili2ation, &aintenance record and use statistics. The tags also displa- the purchase date, description, cost and utili2ation data o+ surgical suppl- ite&s. "ne co&pan-, Radianse, =awrence, 1ass., suggests R7i! costs between ;()) and ;5,))) per hospital bed. The 'Eth Annual @I1$$ =eadership cited patient sa+et- as the o. ' reason +or interest in the technolog-. &anaged inventories will lead to i&proved asset use, lower rental costs. &anage&ent depart&ents can reduce the ti&e re3uired to &anage e3uip&ent inventor-. &anage/&ent can lead to &ore precise suppl- orders and &ore accurate deliver- o+ appropriate &aterials to ph-sicians and patients. R7I! has been i&ple&ented in several &a*or hospitals around the countr-. Their e:perience shows how R7I! can decrease inventor- loss, increase ti&e devoted to patients and i&prove the accurac- o+ instru&ents re3uired +or surgeries and other treat&ents. Bon $ecours @ealth $-ste&, Rich&ond,Na., installed R7I! at three hospitals to track '5,))) pieces o+ e3uip&ent.The health s-ste& no longer has to spend &one- on replacing lost e3uip&entHa once co&&on proble&Hand the nurs&g sta++ saves 9) &inutes per shi+t because the- don<t have ro search +or e3uip&ent. In total, the s-ste& reports saving ;5)),))) a -ear over the cost o+ installation and &aintenance o+ R7I!, not &clud&g productivit- gains. The- 7or these earladopters, the savings and i&proved patient care +ar outweighed the cost o+ R7I! installation and &aintenance. B- targeting how it can work in the &aterials &anage&ent depart&ent, based on an anal-sis o+ business processes, it will beco&e apparent how it could i&prove e3uip&ent and asset tracking, &aterials &anage&ent, sta++ identi+ication =ook +or co&panies with a backgroundin R7I! deplo-&ents in an environ&ent like -ours. $urve- showed that patient sa+et- and &edical error reduction are top priorities +or hospitals. @ospitals using bar coding will continue to reap the bene+its o+ the technolog-, +avoring R7I! +or applications such as asset and inventor&anage&ent, where the potential +or return on invest&ent is the greatest
PITT$B,RG@ @"$PITA= C"1BI %$ R7I!, BAR C"!%$ T" I1PR"N% $A7%TF.

Although scanners can success+ull- read bar codes in &ost situations, he said, Qthere are drawbacks.R Bar codes re3uire a line o+ sight, precise ai&ing o+ the scanner, and the use o+ two hands in the scanning process, $chae++er said. QB- utili2ing R7I! scanning instead, the drawbacks o+ bar/code scanning can be di&inished,R he &aintained. 7or instance, $chae++er said, because i.v. bags are curved and wrinkled and the li3uid inside is re+lective, scanners o+ten have di++icult- reading the label0s bar code. Plus, he said, the height o+ i.v. poles creates a di++icult angle +or bar/code canningQ urses appreciate an- ti&e savings and convenience that can be applied to their work+low,R he said. B- adding R7I! to patient wristbands, $chae++er said, the need +or the caregiver to rotate the patient0s wristband into the scanner0s view is eli&inated because scanners can read R7I! tags through &ost &aterials. QI+ the patient is wearing a gown or has their ar& underneath the covers or so&ething, R7I! can pass right through the &aterials and still pick up the in+or&ation,R he said. $t. Clair0s co&bined R7I!Sbar code s-ste&, Ague said, has saved the +acilit- about ;69),))) annuall- based on the nu&ber o+ prevented adverse drug events. QThat0s &ore than enough to pa- +or a s-ste&,R he said. Technolog- +or sa+er surgerThe engineering %cono&ics o+ R7I! in speciali2ed &anu+acturing