Locating People and Items in Hospitals in Real-Time using RFID

The problem 

Finding people and equipment quickly directly saves lives in acute care hospitals.  This is why RFID, which has been around for 40 years, is extensively used in hospitals and medical supply chains overseas. It has however been hard to establish in New Zealand for 2 reasons: 

1. RFID options have historically been bespoke and very expensive, so was only pursued by the largest organisations in very narrow use-cases.  Organisations were limited to the functionality of existing RFID based applications (e.g. for asset management, sterilisation, laundry), resulting in an expensive proliferation of applications. Alternately they had to build and support their own RFID applications to accommodate their workflow. 

2. RFID is not like other IT technologies in that it requires electronics engineering skills with a specific focus on RFID and needs to be designed for 100% readability.  A default IT approach will fail to deliver results that meets the organisation’s needs.  The necessary skills were scarce in NZ. 

Changes in both technology and economics means RFID is now more accessible and relevant for all businesses. Zebra, the global leader in location technologies, has resolved these challenges through the availability of their rules engine that can automate general location-based workflow when integrated with existing systems. The software is called MotionWorks Enterprise (MWE) and is available through their certified business partner in NZ, Synergic Technologies. 

Use Case

The top 5 technology priorities identified in a recent survey, Zebra Global Healthcare Vision Study Report, of 500 hospital leaders within the clinical, IT and procurement disciplines are:  

1. Medication tracking  

2. Patient throughput  

3. Nursing workflows  

4. Inventory management  

5. Asset tracking 

RFID technologies provide the real-time location information necessary to achieve all these outcomes.  The business case typically offers a return on investment measured in months, rather than years.   

The broader hospital use cases revolve around: 

• People:  

  • Finding clinicians and patients quickly 

  • Optimising utilisation and reducing wait times 

  • Alerting on breaches of containment or quarantine conditions 

  • Managing fatigue in clinicians 

  • Identification of patients 

• Devices 

  • Locating Emergency Equipment 

  • Asset ManagementF

    • Locate, e.g. wheelchairs, IV pumps 

    • Loss prevention (theft, accidental disposal) 

    • Resource planning e.g. beds, linen 

    • Lifecycle management 

  • Extracorporeal Devices (process automation, time reduction - 1 min i.o. 1 hour while maintaining 100% accuracy) 

  • Sterilised equipment (status and planning) 

• Inventory 

  • Rapid Stock Takes 

  • Planning (Inventory reduction is possible due to reliable location and utilisation data) 

• Laboratory Samples  

  • Service Level / Exception Management 

  • Identification Accuracy 

  • Tracking for Workflow Improvement and Escalations 

• Medication 

  • Improved controls over restricted drugs 

  • Supply planning 

• Digital Record (accuracy and automation)  

  • Compliance  

  • Deep analytics required for Insights 

  • Prerequisite for future AI based solutions 

This list is not comprehensive. During the Covid pandemic, hospitals used RFID to monitor for proximity and the appropriate use of sanitisation stations.  Any workflow that is dependent on presence, location and identification can be automated using RFID. 

Understanding the Building Blocks of RFID Solutions used in Hospitals 

There are several building blocks that make up an RFID solution.   

1. Rules Engine: Large hospitals or groups need a single RFID rules engine (MWE) that handles all the RFID and even other location (e.g. GPS) or identification records (e.g. barcodes).  The reasons are: 

• Most location-based workflows can be coded within the rules engine when also using integration, obviating the need for lots of specific applications or expensive software development. This engine turns the trillions of presence notices into system records or exception alerts. A normal database cannot handle such RFID records and the common IoT engines such as Amazon or MS offer do not offer an integrated rules engine, alerting, integration, asset management, device management etc. 

• The collated data is essential for any advanced analytics or workflow improvement.  It is hard to know what data we will need till will need it.  The data will also become even more important as the use of AI increases. 

• The exact location and movement can be represented on a map of the facility or the area. 

• The benefits will only increase as the vendor (Zebra) continues to invest in new features and incorporates emerging technologies such as other sensory data (temperature, humidity, volume, pressure, torsion etc.)

• The lack of an enterprise rules engine often hampers the expansion of point RFID trials beyond that trial or use case. 

2. Passive RFID is a close proximity and generally interior technology.  It is used on bulk items such as inventory, anything requiring accurate identification, items that have to be rapidly located (to within a short rage), or anything that needs to be tracked in and out of locations or through a staged process. 

Passive RFID Tags

• The Tags are comprised of a chip that contains information, an antenna, and a housing.  Housings exist or can be created for most use cases e.g.  

  • Labels on which barcodes are printed.  These cost single cents and are usually used in place of such barcodes.  

  • Stainless autoclavable tags used for large devices such as trolleys that need to be sterilised (c. $20) 

  • Inert glass tags that can be swallowed or embedded subcutaneously 

  • Micro tags for surgical equipment 

  • Zip tags to seal and identify bags 

While some passive tags can be read more than 10m away, most passive RFID use cases are designed to operate within 5m. It is worth noting that most surgical equipment, medical supplies and assets already either come with RFID chips in them or are available with them as an option the vendor. 

• Fixed Readers constantly excite RFID tags within range, resulting in radio frequency emissions, which are picked up on antennae. These are placed at choke points and allow tracking through a portal (door), or to and from a zone such as a ward, theatre, sterilisation facility etc. The engineering to select the correct tags, select, orient and tune the antennae need to be exact to ensure 100% readability of the tags given environmental factors. This is another area where a general IT provider will usually fail to deliver. Understanding the detailed workflow implications is also critical. 

Zebra FX9600 Fixed Reader

Handheld readers cause nearby RFID tags to respond when triggered and help 

• Locate critical equipment in an emergency 

• Accurate identification 

• Rapid, bulk stock takes 

Zebra RFD40 Handheld Reader

• Array Readers are omnidirectional fixed readers that can triangulate the exact position of a tag to within a few centimetres.  Since they need wide open spaces to operate these are seldom used in hospitals. 

• Custom Fixed Readers act as portals for specific use cases e.g. those built into medication cabinets or for laundry. 

3. Active RFID Tags have a battery that constantly cause the RFID chips to signal.   

Zebra Active RFID and BLE Tags

• BLE Tags (Bluetooth Low Energy) are the most common of these and are usually used to capture the presence of people or assets near a reader (room level). Low cost temporary tags are ideal for patients, whereas longer lasting tags are ideal for permanent assets ($25-$80 per tag) or staff.  High value assets are often tagged with passive tags as well in order to track movement too. 

• Wi-Fi Access Points (AP) already in place can serve as readers. The main brands (Aruba, Cisco, Extreme etc.) now come with the ability to pick up and pass along such BLE signals, obviating the need for special readers.  The IoT and BLE over Wi-Fi protocols have not yet stabilised so will continue to undergo flux, which will require testing and development. 

• BLE Receivers are available at low cost (<$100) from the vendors to supplement the APs and provide points of presence. 

Zebra BLE Reciever

• Other Active Tags such as UWB, WhereNet etc. tags are usually used in wide open areas or outside and therefore less relevant to hospitals. The tags are even more expensive than BLE tags so the business case only stacks up for large volume, high value items. 

  Active tags are less dependent on accurate engineering and have lower infrastructure (reader) requirements, however while it is cheap to prove the technology works in a trial, the business case for a full deployment often fails purely on the cost of the tags and the battery maintenance.  For interior use cases where the volume of tags is high, a passive RFID solution is much more cost effective and usually provides more useful data due to its high fidelity.  

4. Clinical Mobility requiring a Phone or PDA is one of focus areas identified in the Vision Study above. MWE has a generic personal device application for common tasks such as proximity or map locate, cycle counting, receipting, item update etc. however consideration should be given to the wider clinical mobility requirement.  There are various vendors offering such apps and since it is an emerging market there are still many gaps in their offerings.  Determining the long-term path is a big task that many health organisations will struggle with till the clear leaders emerge.  In the meantime, there is some low hanging fruit (existing apps) that could affordably be incorporated into a shorter-term strategy. 

Zebra PDA ET45-HC Phone for Clinical Mobility

5. Functional Applications still have a place for very large organisations who require more detailed workflow and reporting than it would be time efficient to encode within MWE and the existing systems.  This is particularly relevant for use cases requiring custom readers (linen, medication) but could also apply to other vertical use cases.  Enterprise class solutions will nevertheless have the necessary application integration support in order to retain centralised records within MWE.  

Getting Started 

The challenges we face in NZ are not too dissimilar to those already resolved by the big health organisations overseas. Even though the scale and specifics are different, we can fortunately leverage Zebra’s experience, resources and relationships to shortcut the solutioning process and ensure an accurate budget and a successful outcome.   

Synergic Technology work closely with Zebra’s global RFID team, are certified by them as RFID implementations specialists and already have active RFID deployments in the NZ healthcare sector.  Talk to us to qualify the use case you have in mind. We can quickly provide a demonstration, conceptual design, business case and suggested steps. 

© Janke van der Vyver 

Chief Technical Officer 

Synergic Technologies Limited 

www.synergictechnologies.com