Aeroscout Hca
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Transcript of Aeroscout Hca
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In K. Mun, Ph.D.VP, Research & Technology, EG, HCA
Adjunct Associate Professor, Neurological Surgery, UMDNJT: 305-582-722, E: [email protected]
AutoID at Hospital“Information Rich Environment For Hospital”
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March 22, 2007 AutoID at Hospital 2
IOM Report in 1999To Err is Human: Building A Safer Health System
One million patients in hospitals daily770,000 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 hospital
Barcoding “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.”
March 22, 2007 AutoID at Hospital 3
Medication Errors:
events occurring in a hospital when there is not enough information to identify each item uniquely.
How can we create information rich local environment to prevent errors?
What does it mean?
March 22, 2007 AutoID at Hospital 4
Traditional ID Issue
March 22, 2007 AutoID at Hospital 5
Barcode Linear Barcode
• Well known technology in many industries • Lower cost, easy to copy / print• Manual process • few digits of identification number / characters
2D barcode• Reasonably known technology • Expensive reader,• Store more data than linear barcode
RFIDPassive RFID
• Smartcard in Europe using 13.56 Mhz tag• High cost, good security, limited range• Transaction based automation
Active RFID• Military products using 433Mhz• Expensive, good security, longer range• Proactive automation possible
Identification Technology in 1999
March 22, 2007 AutoID at Hospital 6
Barcode ProjectLow tag cost• Disposable items
Manageable for high volume Good ROI
RFID ProjectHigh tag cost• Reusable/durable items
Better for low volume projects Uncertain ROI
AutoID Projects
March 22, 2007 AutoID at Hospital 7
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 barcode2001 – FDA announces intent to propose a bar code rule2002 – 1.5% of hospitals (90) using barcode2004 – JCAHO make a proposal and drops mandate2005 – 9.4% of hospitals (560) using barcode
Barcode For Healthcare
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March 22, 2007 AutoID at Hospital 8
HCA Barcode Point Of Care
March 22, 2007 AutoID at Hospital 9
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
March 22, 2007 AutoID at Hospital 10
• BPOC does reduce medication errors
• Better documentation possible
• An important building block of EMR/EHR
⇒ Issues noticedManual processes
Everybody must be engaged
Barcode labels can be duplicated easily
Work around is possible
Lessons From BPOC
March 22, 2007 AutoID at Hospital 11
Reviewing available technologies starting 2000Passive RFIDActive RFID
Defined problems to solve in 2002Asset management for rental / leased items & theftProcess improvement tool
Selected active RFID technology in 2003Automation / ReliabilityReturn-on-investment (ROI) based on existing cost figures
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
RFID Project
March 22, 2007 AutoID at Hospital 12
Tag-it Smart LabelsTag in mold
RFID Patient Wrist Band and Handheld Readers
UHF tagInfusion Pump w. active tag
RFID Tags and Readers
implantable tag
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RFID Tags and Readers
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• Patient Wristband
• Blood Product Management
• Cold Chain Management
• ER, OR, ICU Management
• Point of Care
• Pharmaceutical Pedigree
• Combating Counterfeit Drugs
• Asset Management
Hospital RFID Applications
March 22, 2007 AutoID at Hospital 15
1. Asset Management
2. ER, OR, ICU Management
3. Patient Wristband
4. Blood Product Management
5. Point of Care
6. Cold Chain Management
7. Pharmaceutical Pedigree
8. Combating Counterfeit Drugs
Hospital RFID Applications
March 22, 2007 AutoID at Hospital 16
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
March 22, 2007 AutoID at Hospital 17
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
Why Asset Management?
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• AeroScout 1610
• Agility Healthcare 3450
• AwarePoint 1714
• Communication Specialists 7938
• Cygnus Inc 4452
• Ekahau 1504
• Extreme Integration 5204
• General Data Company 5704
• Healthcare Pilot 7838
• Indidge System 7200
• Infosys technologies 7703
• MediTek Interactive 7926
• PanGo 4050
RFID Vendors at 2006 HIMSS• Parco 7229
• Patientree 7224
• Per-Se Technologies 3623
• Precision Dynamics 0142
• Radiense 5700
• RF Ideas 1851
• Sayers Healthcare 7015
• Scuptor Dev Tech 1252
• Sun Microsystem 3649
• USA Mobility 7850
• Visible Assets 7037
• GE Healthcare 4509
• Siemens Healthcare 1237
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Existing workflow / definition of problem
Tag type
Tag size
Battery life
Resolution
Dependencies: density of tags, network,
Installation
User interface
Project management experiences
ROI (Return On Investment)
Selection Criteria
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I
I
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Wireless 802.11 Coverage
802.11 Network DesignFor data
100 ft diameter
I
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Pow
er
100+ ft~ 40-50 ft.30 ft.
Range
802.11 Network DesignFor resolution50 ft diameter
* There are several issues to be considered carefully before using wireless 802.11 for asset management.
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Tag density at Bio-Med
* Easily more than 100 tagged items could be in a bio-med service room!
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Other Busier Bio-Med Shop
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Step A
Primary patient care areas covered
Storage locations identified
Low resolution, only discriminate between zones A & B
A
B
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Step B
Add coverage for exits for theft control
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Step C
Add additional readers to identify patient rooms and waiting areas
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Step D
Add additional readers for full coverage.
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Device management: tracking, service, rental
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
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Installation & staff training done
Few hiccups & push backs
Interfaced to bio-medical service database
Interesting informationSome items not moving
Relationship among unexpected items (rental / discharge
Device service record
Designing new workflows to improve operationsTo increase ER throughput
Surgical tool tracking in OR
To improve workflow in ICU
New interface to physician PDA
Less than three years for ROI based on hard benefits
Current Status
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Tagged Items
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Clinical Touch-screen GUI
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Engineer’s Handheld GUI
Select group
View Assets by Floor Sliding Zoom Bar
Zoom OutZoom In
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Infusion Pump Utilization
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50
100
150
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250
4/1/200
6
4/8/200
6
4/15/2
006
4/22/2
006
4/29/2
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5/6/200
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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
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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
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Addressing DB IssuesHow much information do we need?
Information rich local environment is the key in reducing most medical errors.
Manually correct errors in DB
To prevent recurring errors
Local DB?
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Minimum change in workflow Reasonable cost for infrastructureLess physics issuesSolution for item level issuesData rich local environment
More info available to reduce additional errors Katrina factor
2D Barcode for Local DB
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RFID & 2D Barcode
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2D Barcode
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March 22, 2007 AutoID at Hospital 38
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 from
Partners Healthcare Systems• Working documents from ISBT-RFID Task Force.• Documents for HIBCC standards
Information Content
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Cost Structure IssuesStart-up cost
Recurring cost
Liability cost
Monopoly cost
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Cost: MonopolyPatents
Start of new idea / businessIntellectual property
Law, rules & regulationsProtecting citizens by governmentSource of liability
StandardsIndustry / government sponsored guide linesHelpful for a wider adoption leading to lower cost
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Foot NotesMinimize monopoly
Break financial links / associationsStop cross subsidiesMore rational patent law
Maximize competition & innovationRemove 800 lbs snakesNot empowering rats or termites
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Location IdentificationSecurityInventory ManagementUtilizationRequisition / DistributionRentalsSafety / Risk ManagementTransportEquipment CleaningRegulatory ComplianceClinical EngineeringFinancing / Accounting
Operational Process
Management
RFID Positioning
System
RFID-Enabled Device
Management Application
AssetTracking
Operational Processes
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$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
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Active RFID can be cost effective. Rental equipment managementInventory control of equipment: lower the asset levelBetter management of PM & service issues
Cost / workflow managementUtilization based on proactive data using active RFID Must be willing to change workflow
Additional developmentsED & patient trackingBlood products / BiologicalsGlobal view of hospital operationHow do you manage database?What do I do with surgical tools?Backup information?What happens without connectivity??
• Natural disaster like Katrina, earthquake • Remote areas • loss of power
Lessons from Active RFID
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Work-In-Progress
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Room Level For ED
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Patient Level
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Real-time Patient Location
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MessageCenter
Messenger
Inbox (3)
In Use
Available
Soiled
Out of Service
Infusion Pump Utilization
OR Suite Utilization
In Use
Prep
Scheduled
Cleaning
Not Sched
Online: 21
Patient-Tag Association
Home Equipment Manager Surgical Services ED Manager Bed & Room Manager Other Applications
GUI for Upper Management
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March 22, 2007 AutoID at Hospital 50
COMPLETED CASES
Time of Day0
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7 8 9 10 11 12 13 14 15 16 17 18
Cumulative CasesCases/Hr
0102030405060708090
100
7 8 9 10 1 1 12 13 1 4 15 1 6 1 7 1 8
Time of Day
% AVERAGE BLOCK TIME UTILIZATION
0102030405060708090
100
7 8 9 10 1 1 12 13 1 4 15 1 6 1 7 1 8
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
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<15 20 25 30 35 40 45 50 55 60 60+
CURRENT PATIENTS IN WAITING ROOM
Minutes Waiting
# of
Pat
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s
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2
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<15 20 25 30 35 40 45 50 55 60 60+
CURRENT PATIENTS IN WAITING ROOM
Minutes Waiting
# of
Pat
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Emergency Department Metrics
March 22, 2007 AutoID at Hospital 51
CommentsAutoID (RFID & Barcode) is being applied in more and more areas to improve patient safety and reduce cost.
New business model for standard has emerged, which may create a world-wide monopoly outside of any government control even beyond US FDA
Cost of AutoID is dropping where competitive pressure exists. (RFID: 12 - 50 cents passive tags, $15 - $200 for active tags) (barcode: less than 0.2 cent / 0.5 cent for 1D / 2D )
Active RFID and 2D Barcode without passive RFID may complement each other well enough to create information rich local environment, which is critically important in improving patient care and reduce healthcare cost for hospitals.
March 22, 2007 AutoID at Hospital 52
Thank You!In K. Mun, Ph.D.
e: [email protected] / m: 305-582-7221