RFID (Radio Frequency Identification)

The RFID-enabled
intelligent hospital
Emily Sopensky

H
ospitals are dense with
electronics. From multi-
million-dollar machines
that scan the smallest
particles of the human
body to detect diseases to
ID badges that double as hand-wash-
ing monitors, hospitals are crammed
with wired and wireless systems.
Hospitals also produce inordinate
masses of data, much of it digital
only. A patients record is amended
many times as the results of each
diagnostic and periodic measure-
ments are recorded. The traditional
charts and paper trail in thick file
folders are gradually being replaced
by electronic health records (EHRs).
Quickly locating expensive life-
givingequipmentandsupplies
makes hospitals particularly in
need of accurate inventory and asset
tracking systems. In this highly reg-
ulated industry, generating reports is
an industry itself.
Radio frequency identification
(RFID) plays a huge role in enabling
manyofthewirelesssolutions
being used in hospitals in operating
rooms, intensive care units, pediat-
ric wards, emergency departments,
hospitalpharmacies,andeven
ambulances. When coupled with a
real-time location system (RTLS),
RFID enables real-time asset track- foreground image licensed by graphic stock

ing and enterprise data aggregation

and reporting.
The increased use of RFID to cap-
ture and automate the transference
Digital Object Identifier 10.1109/MPOT.2015.2410393
Date of publication: 8 September 2015
of data in real time is critical, espe-
cially for life-threatening events. As
important is the need to manage
assets. RFIDs major roles in the
intelligent hospital are real-time au-
tomatic identification and the man-
agement of assets.
Complex systems begat
complex solutions
Regardless of the problem, an RFID
technology is system based. Hospi-
tals are complex institutions and
physically challenging to any phys-
ics-based solution, such as RFID.

0278-6648/152015IEEE IEEE Potentials September/October 2015 n 27
Careful planning across multiple Where are the wheelchairs? VA pilot program
disciplines is paramount for such a The inventory says we have ten In March 2012, the U.S. Depart-
system to work. wheelchairs at the door for dis- ment of Veterans Affairs (VA) Veter-
Compound these inherent complex- charged patients. I count only five. ans Integrated Service Network
ities with the decrease in standalone Where are the remaining five? Rou- (VISN) 11a three-state treatment
hospitals and the increasing trend to tine questions like these sap an region in the Midwestinitiated a
consolidate. Some health consultants organizations momentum. Tracking sterilization process workflow proj-
report that the number of hospitals down the wheelchairs stashed ect. The team in Ann Arbor, Michi-
gan, began an automated instru-
ment-tracking system using auto-ID
In 1996, the VA began the creation of and RTLS. The goals were complex,
21 Veterans Integrated Service Networks (VISNs) honed by the Veterans Health
to transform VA health care from a hospital Administrations (VHAs) director of
the RTLS project, Kimberly Brayley
system to a health system. (Fig. 1). Most of the goals focused on
smoothing workflow and maximizing
in merger and acquisition deals hit a behind the nurses station or in the equipment utilization.
five-year high in 2013. Many hospi- breakout room can waste inordinate The VA operates the largest in-
tals are increasingly forced to become amounts of precious staff time, tegrated health-care system in the
part of vast interconnected organiza- skilled and unskilled alike. United States, with more than 1,700
tions that share financial and medical Something as mundane as hospitals, clinics, and other health-
interests. But what makes sense on managing assets better can have care facilities (Fig. 2). In 1996, the
paper often causes initial confusion cascading effects. Often the more VA began the creation of 21 VISNs to
and disarray. Merging assets and or- portable the asset, the harder it is transform VA health care from a hos-
ganizational cultures is guaranteed to to find. Infusion pumps, patient pital system to a health system.
be disruptive. Consequently, system- monitors, ventilators, even hospital Nurses prepare medical trays in
wide solutions are rare. Instead, pilots beds and wheelchairs have a way advance of any procedure. Check-
in one hospital are tested and evolved of walking to another nurses sta- ing and rechecking the contents of
before being introduced to the rest of tion or being stashed in an operat- the tray is mind numbing but as-
the hospital system. ing suite. sures the operating room procedure
is completed without interruption.
VISN 11 began attaching its sur-
gical instruments with RFID tags
that can endure sterile processing.
Now a reader is waved over each
tray, eliminating the need to man-
ually touch the tools, and quickly
identifies any that are missing.
Special RFID tags are used to
monitor temperature and humid-
ity conditions to ensure that perish-
ables, like pharmaceuticals, tissues,
organs, blood, and food, remain re-
frigerated at the correct temperature.
Another example of improved effi-
ciency involves the ubiquitous equip-
ment that pumps analgisics, such as
the pain killers that patients are given
partial control to administer. Locating
these popular pumps often led to false
fig1 The RHCC Intelligent Hospital Improving Regulatory Compliance Award was pre- scarcity, forcing staff to employ rent-
sented to U.S. Department of Veterans Affairs (VA VISN 11) and Ann Arbor, Michigan, Vet- als. VA pumps are now tagged; staff
erans Affairs Medical Center Sterile Processing Services (VAMC SPS) by RHCC Advisor are able to find, clean, and provide a
Keley John Booth, M.D. The recipients were Veterans Affairs Chief (Ann Arbor, Michigan) pump to a patient within 30 min.
Robin McLeod and VISN 11 Biomedical Engineering point of contact Michael McDonald
With this Sterile Processing Work-
(Indianapolis, Indiana). The recipients are flanked by Paul Frisch, Memorial Sloan-Kettering
Cancer Center, Department of Medical Physics, and RHCC president and chief technology flow pilot program in the VA VISN11,
officer; and Kimberly Brayley, director, RTLS Project Management Office, U.S. Department the staff can easily locate equip-
of Veterans Affairs. (Photo courtesy of the Intelligent Health Association.) ment for recalls. Need a particular

28 n S e p t e m b e r / O c t ober 2015 IEEE Potentials

scope? Want to know who touched it
last? The data is captured and staff
can now track the life of everything 20 AK WA ME
they process. MT ND
20 MN 1
In numbers, the pilot included OR 12 NY VT
19 MI NH
ID SD 23 2 MA
25,000 active RTLS tags; 94,000 WI 11 RI
CT
passive RFID tags; 2,000 wireless 21 WY IA OH PA 4 NJ 3
NE
temperature and humidity sensors; NV UT IL IN 10 MD 5 DE
CA CO WV
255,000 surgical instruments etched KS 15 KY VA
22 MO 6 Wash.
HI 9
with bar codes; and 63,000 passive 21 TN NC DC
AZ 18 OK AR
RFID tags for cardiac catheterization SC
Philippines Is. NM AL 7 Virgin Is.
annual consumables. 16 MS GA
17
With the success of this initial pi- American LA 8
Guam TX
lot (see Table 1), the VHA is extend- Samoa FL
ing the project throughout the VISNs PR
8
nationally. The VHA is already look-
Click on the VISN Number or Region for Information About VAMC Pricing There.
ing at applications for hand hygiene,
patient elopement and wandering,
fig2 A map of the United States and regions of the VHA. (Image courtesy of the U.S.
emergency management, and other Department of Veteran Affairs.)
clinical workflow automation.

Disney Worlds best To help OHSU manage in its fast-paced, complex

neighborFlorida Hospital
Celebration Health
Beneath the Magic Kingdom and
Main Street U.S.A., Walt Disney
World in Lake Buena Vista, Florida,
is renowned for its highly advanced
logistics and is a state-of-the-art
technology bonanza. Yet, with 52.5
million visitors annually, accidents
and illnesses do happen. Local resi-
dents and patients from around the
world are served by this 174-bed,
patient-centric hospital (Fig. 3).
Just down the road from Epcot
Center is Florida Hospital Celebra-
tion Health (Orlando, Florida), a
busy hospital with over 60,000
emergency room visits per year.
A laboratory for innovation, this
facility incorporates RFID/RTLS so-
lutions for staff visibility, asset man-
agement, hand-hygiene compliance,
temperature/humidity mon-
itoring, and data reporting.
Todd Frantz and Ashley Sim-
mons of Florida Hospital Cel-
ebration Health talk about
how RTLS is helping trans-
form delivery of care through
patient flow, hand hygiene,
environmental monitoring,
and more. Several YouTube
shorts in the Read More
About It section explain in
detail how the hospital is us-
ing RFID and RTLS.
environment and to take a stab at unnecessary
expenses in labor-intensive activities, OHSU
installed a technology-enhanced asset-location-
tracking and management system.
Top of the hill, Oregon Health In 2006, OHSU embarked on a
and Science University hospital prudent course to stem the finan-
The largest employer in Portland, cial losses incurred from looking for
Oregon, is located at the top of a hill equipment. The waste and lost pro-
that many access via an aerial tram ductivity totaled US$1.3 million an-
(Fig. 4). Oregon Health and Science nually. OHSU estimated that prior to
University (OHSU) is a nationally implementing RTLS solutions, it was
prominent research university and spending US$1.26 million per year
Oregons only public academic on time spent trying to locate equip-
health center. With nearly 14,000 ment for each of its 26 nursing units
employees, OHSU teaches more during each of their two shifts.
than 4,300 students and trainees. To help OHSU manage in its fast-
This 530-bed hospital is a Level 1 paced, complex environment and to
trauma center with 95% average take a stab at unnecessary expenses
occupancy of acute care beds. in labor-intensive activities, OHSU
Table 1. Benefits realization.
Functional Area Asset SPD Temp Cath Lab Inventory
Benefit Name Management Workflow Monitoring Management
Improve patient care
Improve managerial
decision support
Reduce inventory and
equipment costs
Improve staff efficiency
Improve consistency
of services

IEEE Potentials September/October 2015 n 29
 regulatory compliance and patient
safety. Reporting the temperature of
a unit twice a day is a requirement
that is labor intensive. By relying on
an automated system to collect and
report the data, OHSU took another
big ding out of the US$1.3 million an-
nualized loss.
OHSU is also working on solu-
tions to guard against patient elope-
ment (patient safety) and unit work-
flow to improve clinic throughput in
two of their outpatient clinics.

Waiting for the doctor,

and waiting
Its hard to deny that all of us have
had to wait for the doctor at some
point in our life. There are varying
strategiesall patient-devisedto
ward off the tediousness of having
to wait. Some of us take our techni-
cal journals to pass the time. Others
fig3 Located near Walt Disney World in Orlando, Florida Hospital Celebration Health take the earliest slot to avoid spill-
creates its own magic in its state-of-the-art facility.
overs from previous time-hogs.
Group Health Cooperative in Puy-
There is no such thing as a turn-key solution that allup, Washington, approached the

reduces inventory costs, synchronizes assets with problem as only a provider can. It
serves over 625,000 members and
critical need, eases paperwork burdens on nursing operates 25 medical facilities in
staffs, or flags an error before it is made. Washington State, and when plan-
ning to build a new medical center to
serve 30,000 patients, Group Health
installedatechnology-enhanced The second round of implemen- Cooperative used an integrated care
asset-location-tracking and manage- tation involved installing 500 tags and facility design (ICFD).
ment system. OHSU integrated 6,000 in 24 areas to wirelessly monitor To eliminate patient wait and
Wi-Fi RFID tags, 3,000 infusion equipment temperatures. Keeping to maximize the use of treatment
pumps, and over 130 types of equip- pharmaceuticals and blood packs at rooms, Group Health Cooperative
ment in 30 buildings. the correct temperature is critical to and its partners devised a system

fig4 The main OHSU campus is located at the top of Marquam Hill. (Photo courtesy of Wikimedia Commons/Cacophony.)

30 n S e p t e m b e r / O c t ober 2015 IEEE Potentials


Surgical sponges
Each procedure in an operating room
uses surgical sponges. It goes without
saying that what goes into the patients
body, must come out. The OR team
counts what goes in and inventories
what comes out. This is a manual
process subject to error. When RFID
tagged, each sponge has its own ID
number, which is read as it comes out
of its packaging in the OR, as it is used
in the patient, and as it is removed and
dropped into the container pictured for
disposal. Among the benefits: reduced
handling minimizes biohazard, unique
IDs prevent double-counts, and usage
is quickly read and recorded.
that uses infrared (IR) and active
RFID technology integrated with
t hest a nda rd-bea rerelect ron-
ic medical record system, Epic.
Group Health Cooperative now
has a state-of-the-art system that
eliminates patient wait. Both pa-
tients and all 150 employees wear
badges with unique IDs. Tagged
assets are quickly located physi-
cally or by viewing on a map using
RTLS software.
Heres how it works:
A software-enabled entry system
directs arriving patients to pro-
ceed directly to a care room
instead of waiting in a public
area. Battery-operated monitors
transmit infrared light. A patient
wearing a badge enters the room,
the badge detects the monitors
IR signal and transmits that sig-
nals unique identifier, along with
its own unique ID number, via a
900-MHz RFID transmission.
An RFID interrogator within the
vicinity then receives that trans-
mission and forwards it via a
wired connection.
An alert is e-mailed or texted to
staff members; alternatively, a no-
tification can be displayed on a PC.
The system notifies others after
staff has left the room; the soft-
ware also knows where designat-
ed employees are located.
IEEE Potentials September/October 2015 n 31
the steps to engage in technology-
based solutions.
Read more about it
(2015, May 30). Veterans Affairs
VISNs. [Online]. Available: http://
Photo courtesy of the Intelligent Health Association.
www.va.gov/directory/guide/divi-
sion.asp?dnum=1
R. Daly. (2014, June 14). Hospi-
tal consolidation trend to continue.
Health Business News. [Online]. Avail-
able: http://www.hfma.org/Content.
aspx?id=23307
Walt Disney World. (2014, Dec. 1).
[Online]. Available: http://en.wikipedia.
org/wiki/Walt_Disney_World
(2015, May 30). More about the
RFID/R TLS project at http://www.
youtube.com/watch?v=jG5-vscZm8o
and https://www.youtube.com/
watch?v=hSsVhJ_XRmk
To eliminate patient wait and to maximize
the use of treatment rooms, Group Health
Cooperative and its partners devised a system that
uses infrared (IR) and active RFID technology
integrated with the standard-bearer electronic
medical record system, Epic.
The healthcare provider can press (2015, May 30). The vendor-neu-
a button on his or her badge, tral, educational not-for-profit RFID in
thereby triggering a notification Healthcare consortium sponsors awards
for the lab staff. annually to recognize the pioneers in
A mobile lab serves the patient intelligent hospitals. [Online]. Available:
rooms. http://intelligenthospital.org/
E. Sopensky. (2014, Apr.) Health-
Managed technology care Symposium finds three recurring
addresses systemic issues themes. IEEE Life Sci. Newsletter.
Technologies offer ways of easing the [Online]. Available: http://lifesciences.
strife of healthcare administration and ieee.org/publications/newsletter/april-
patient well-being (see Surgical 2014/529-healthcare-symposium-
Sponges). But each hospital, commu- finds-three-recurring-themes
nity, and facility is different. There is
no such thing as a turn-key solution About the author
that reduces inventory costs, synchro- Emily Sopensky (e.sopensky@ieee.
nizes assets with critical need, eases org) is 2015 chair of the IEEE Tech-
paperwork burdens on nursing staffs, nical Committee on RFID. She is
or flags an error before it is made. also cofounder of the RFID in
Instituting a new technology solu- Healthcare Consortium, a vendor-
tionregardless of the proffered effi- neutral, not-for-profit dedicated to
ciency metricstakes courage. supporting the use of wireless solu-
Our applause goes to those pio- tions in hospital and at-home care
neering spirits at health-care insti- (http://intelligenthospital.org/).
tutions and their partners that take