AutoID For EMR

“Improving Patient Safety with Active RFID and 2D Barcode”

In K. Mun, Ph.D.VP, Research & Technology, NFD/EG, HCA

Adjunct Associate Professor, Neurological Surgery, UMDNJE: IKM1@AOL.COM

↓↓ ReimbursementsReimbursements(BBA, APC(BBA, APC’’s)s)

Medical Cost Medical Cost Inflation (Inflation (PharmaPharma))

Management View

Technology cost Technology cost (MRI, CT, US..)(MRI, CT, US..)

ConsumerismConsumerism

HospitalHospitalFinancialsFinancials

TechnologyTechnologyRevolutionRevolution

(IT, PACS, Genomics)(IT, PACS, Genomics)New Procedures / New Procedures / ReimbursementsReimbursements

(PET(PET--CT)CT)

Growth InGrowth InOutpatientOutpatientEconomy / Economy /

Personal WealthPersonal Wealth

New Regulatory New Regulatory PressuresPressures

(HIPAA, Dose)(HIPAA, Dose)

StaffingStaffingShortagesShortages

DisasterDisasterPreparationPreparation

Quality ImperativeQuality Imperative(IOM, Leapfrog)(IOM, Leapfrog)

DemographicsDemographics

Technical View

Bedside Devices

POE

Surgery/ Nursing / Medication

Clinical Workflow Engine

Imaging / Laboratory / PACS / HIS

EnterpriseArchive

MissionCritical

Information

Order Entry

Scheduling

Data Repository

ED OR

Perin

atal

Phar

mac

yO

BR

adio

logy

Nur

sing

Surg

ery

Car

diol

ogy

ICU

\C

CU

Neu

rolo

gy MissionCritical

Information

Financial SnapshotMore than $2T (16% of GDP) spent on healthcare

Spend more for administrative processes (18%) than prescription medication (9%)

Substantial amount wasted due to errors, abuse, fraud, inefficiency (30%)

In 2007, GM claimed spending more for healthcare than steel for building an automobile

In 2000, more money than total GDP of France was spent on healthcare

Healthcare cost rising fastFast aging population of baby boomer

Most of healthcare spending for a person is during the last 10 years of life

Viability of Medicare fund

Many hospitals have financial difficulties

Building new hospitals without plan for staff

Snapshot from Florida

20 miles

IOM Report in 1999To Err is Human: Building A Safer Health System

Hospital data 770,000 injuries caused by medication errors per year

39% physician ordering

38% drug administration

11% drug dispensing

44,000 – 98,000 preventable deaths per year

5% of patients acquire an infection from a hospitalBarcoding “is an effective remedy” for medication errors, “a simple way to ensure that … all of the steps in the dispensing

and administration processes are checked for timeliness and accuracy.”

Other industry dataAirline Safety: > 99.999999%

Airline baggage handling: > 99.999%

Responses From Hospital • Optimize / Improve Workflow

• ComputerizeHospital Information System (HIS)

Picture Archiving & Communication System (PACS)

Electronic Medical Record (EMR)

Computerized Physician Order Entry (CPOE)

• AutoID (1D & 2D Barcode, passive & active RFID

• Patient Safety Initiatives

Auto-ID Activities at FDABarcode Medication AdministrationBarcode Specimen CollectionAnit-Counterfeiting Report Human RFID Chip implant approvedRFID GuidanceSurgical marking RFID

The pace of change “frustratingly slow”

The death rate has not decreased substantially.

Leap / Berwick, JAMA, May 18, 2005

5 Years After The IOM Report

Complex legal / liability issuesComplexity of healthcare systemsSystem not paying for improvementsReluctance to admit mistakesSystem paying for the mistakesComplex reward / payment issues (P4P)Insufficient leadership

Why So Slow In Changing?

1983 – The Health Industry Business Communication Council (HIBCC)1985 – First published account of medication bar-coding1985 – Medication dispensing

1985 – Hokanson JA, et al, Am J Hosp Pharm1985 – Nold EG & Williams TC, Am J Hosp Pharm1987 – Smith JE & Meyer GE, Am J Health Syst Pharm.

1989 – Medication administration1989 – Barry GA et al, Am J Hosp Pharm1991 – Lefkowitz S et al, Hosp Pharm1992 – Abdoo YM, Comput Nurs

1999 – IOM report: discussed barcode to improve patient safety1999 – 1.1% of hospitals (60) using barcode1999 – MIT AutoID Center to study RFID for supply chain issues2001 – FDA announces intent to propose a bar code rule2002 – 1.5% of hospitals (90) using barcode2003 – MIT AutoID Lab formed2004 – JCAHO make a proposal and drops mandate2005 – 9.4% of hospitals (560) using barcode

Reality of AutoID

Barcode ProjectShort term impact High volumeDisposable

RFID ProjectLong term impactLow volume / high valueReusable / durable

AutoID Projects

HCA Barcode Point Of Care

BPOC Experience by 2005

HCA 171 115,933,163 65,000

Mercy 010 7,359,897 10,698

UPMC 002 2,103,789 01,800

BSA 001 1,692,561 00,757

# sites # doses # users

Reviewing available technologies starting 2000Passive RFIDActive RFID

Defined problems to solve in 2002Focused on ROI: asset management for rental / leased items & theftProcess improvement tool

Selected active RFID technology in 2003Automation / ReliabilityReturn-on-investment (ROI)

Selected a vendor out of nine vendors in 2004Battery life / Size of tagOperational experience / future applications

Implemented a pilot system in 2005A 120 bed hospitalHospital-wide implementation

Additional sites for active RFID projectsAsset tracking Patient tracking, other applications

RFID Project

National average utilization of mobile equipment is 45% -Universal Hospital Services

Hospitals can lose nearly $1 million a year in medical equipment thefts alone - HCPro Healthcare Marketplace

Five to fifteen percent of hospital inventory is written off each year since it can no longer be located or more importantly serviced - Frost & Sullivan

“Equipment moving from patient to patient without going through decontamination in between has become a significant issue to JCAHO in regard to infection control in hospitals” - JCAHO Sentinel Alert

To build an infrastructure for future patient safety improvements. It is very difficult to get infrastructure money.

Why Asset Management?

Managing infants

Managing medical device, consumables Theft prevention, location, storage, readiness

Bio-Medical service, repair, PM

Rental equipment management

Managing Patients

Managing nurses, technologists and physicians

Asset Management

Existing workflow / definition of problem

Tag type: passive or active

Tag size

Battery life

Resolution

Dependencies: density of tags, network,

Installation

User interface

Project management experiences

ROI (Return On Investment)

Technology Selection Criteria

Medical device management: tracking, rental, service

433 Mhz active tag

Smallest tag to maximize number of items to track

Real-time tracking (few times per minute)

Variable resolution: bed, room, department,..

Manage high density of tags in a room

Minimum additional network traffic

Clean installation: invisible readers

Web applications: support PDA, laptop, …

Less than three years for ROI

To develop additional applications

Pilot Configuration

Tagged Items

Infusion Pump Utilization

0

50

100

150

200

250

4/1/200

6

4/8/200

6

4/15/2

006

4/22/2

006

4/29/2

006

5/6/200

6

5/13/2

006

5/20/2

006

5/27/2

006

Census Pumps on Floors Total Pumps

April1 through May 30, 2006Single and Multi-Channel Infusion PumpsExcludes rentals

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

$4,000,000

Year 1 Year 2 Year 3 Year 4(projected)

Realized Net Savings to Date: Over $1.5 MillionExcludes “cost avoidance” and “soft” savings

Savings By An Early Adopter

Common name used by nurses: Arjo LiftCommon name used by industry: Lift/PatientThe device name: Patient Lift

Manufacture Model # DescriptionArjo Hospital equipment Inc. KPA0310 Patient LiftArjo Hospital equipment Inc. KGA0310 LiftArjo Hospital equipment Inc. KKA5020 Arjo LiftArjo Hospital equipment Inc. KGA5020 Lift/PatientArjo Hospital equipment Inc. KPA0310 Lift/PatientArjo Hospital equipment Inc. KPA0310 Patient LiftArjo Hospital equipment Inc. KPA0310 Patient LiftArjo Hospital equipment Inc. KKA5020 Lift/PatientArjo Hospital equipment Inc. KPA0310 Lift/PatientArjo Hospital equipment Inc. KGA0310 Arjo Lift

Issues: Database Entries

Minimum change in workflow Reasonable cost for infrastructureLess physics & security issuesSolution for item level issuesData rich local environment

More info available to reduce additional errors Katrina factor

2D Barcode?

RFID & 2D Barcode

Cost effective unifying standard leading to EMR• Staff badges• Patient wristband / patient identification• Non-IV medication• IV-medication / smart infusion pumps• Medical device identification • Blood products

Documents of interests• Positive identification for patient medication safety• Working documents from ISBT-RFID Task Force.• Documents for HIBCC standards

Information on 2D Barcode

Clinical Touchscreen GUI

Engineer’s Handheld GUI

Select group

View Assets by Floor Sliding Zoom Bar

Zoom OutZoom In

MessageCenter

Messenger

Inbox (3)

In Use

Available

Soiled

Out of Service

Infusion Pump Utilization

OR Suite Utilization

In Use

Prep

Scheduled

Cleaning

Not Sched

Home Equipment Manager Surgical Services ED Manager Bed & Room Manager Other Applications

GUI for Upper Management

COMPLETED CASES

Time of Day0

5

10

15

20

25

30

35

40

7 8 9 10 11 12 13 14 15 16 17 18

Cumulative CasesCases/Hr

01 02 03 04 05 06 07 08 09 0

10 0

7 8 9 1 0 11 12 1 3 1 4 15 16 1 7 18

Time of Day

% AVERAGE BLOCK TIME UTILIZATION

01 02 03 04 05 06 07 08 09 0

10 0

7 8 9 1 0 11 12 1 3 1 4 15 16 1 7 18

Time of Day

% AVERAGE BLOCK TIME UTILIZATION

Surgical Services Metrics

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

Time to Triage

Time to Registration

Time in Waiting

Time to Exam

NurseResponse

DoctorResponse

Time inED

TotalTime

Actual TargetAVERAGE INTERVALS FOR TODAY (minutes)

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

Time to Triage

Time to Registration

Time in Waiting

Time to Exam

NurseResponse

DoctorResponse

Time inED

TotalTime

ActualActual TargetTargetAVERAGE INTERVALS FOR TODAY (minutes)

0

1

2

3

4

5

6

7

<15 20 25 30 35 40 45 50 55 60 60+

CURRENT PATIENTS IN WAITING ROOM

Minutes Waiting

# of

Pat

ient

s

0

1

2

3

4

5

6

7

<15 20 25 30 35 40 45 50 55 60 60+

CURRENT PATIENTS IN WAITING ROOM

Minutes Waiting

# of

Pat

ient

s

Emergency Department Metrics

Room Level for ED Patients

ED Dashboard

Questions Being AskedResolution require for positive patient identification.

ED / ICU / OR Imaging / Floor / OfficeAlzheimer’s Billing

Workflow changesED / ICU / OR / Floor / Office / Blood products

Security & backupDisaster managementIntegration / Interoperability / Connectivity StandardsEMR

Real-time Patient Location

Location IdentificationSecurityInventory ManagementUtilizationRequisition / DistributionRentalsSafety / Risk ManagementTransportEquipment CleaningRegulatory ComplianceClinical EngineeringPatient TrackingFinancing / Accounting

Operational Process

Management

RFID Positioning

System

RFID-EnabledAsset

Management Applications

AssetTracking

Operational Processes

Comments

Active RFID and 1D/2D Barcode without passive RFID may be sufficient to address most, if not all, issues facing hospitals, effectively.

Even though there are privacy and security concerns, there will be more and more applications based on real time motion and location information.

HospitalWhere we choose to do these things not because they are easy or hard, but because they are important

Thank You!

In K. Mun, Ph.D.ikm2@aol.com