Healthcare Wireless and Device Connectivity

Integra Systems RTLS White Paper on AwarePoint

The "just add water" story WF-Fi marketers publicizes loses steam in real-world applications. Although many Wi-Fi RTLS vendors tout the plug and play attributes of using their existing infrastructure, the leading manufacture of WLANS has a deployment guidelines document that for Wi-Fi RTLS that is over 200 pages in length.  Go to FUD Busters on www.awarepoint.com  to download this white paper.

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RTLS White Paper by Integra Systems, Inc.

Integra Systems, Inc. has finalized it's "white paper" subject "Real-time Location Systems" (RTLS) in Healthcare.  This also available on www.awarepoint.com URL (web) site. This is a detailed analysis of the technical and financial impact of the various RTLS technologies that have been considered for healthcare. It also describes how the right selection of the RTLS technololgy can impact the total IDN supply chain model from a work flow perspective and financial outcome.

 

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Biomedical Device Integration and the Impact on Clinicians at the Point of Care

I have had the opportunity to most recently review a well written article by Brian McAlpine, Director of Strategic Products for Capsule Technologies.  The following comments are based upon my agreement with Mr. McAlpines article and also reference my experience with the very important issue of how technologies can impede or improve the clinical care process.

All of what was discussed in this article and the followng from the early stages when WIFI (or 802.11b), was ratified in 1999.  This set into motion great technological innovation surrounding the point of care, but also posed new challenges for the clinical care giver. The logical move with the adoption of wireless in the healthcare enterprise was to now enable early laptops with external WIFI client adapters and allow the point of care access to the EMR, not from the nurse's station.  This mobility greatly increased the patient to care-giver interaction.

Around this same time, the advent of BCMA (Bar Code Medication Administration), started to take hold because of the roll-out within the V.A. Healthcare System.  While the intent was there (the five rights), the healthcare industry had not and to this day has not standarized on a standard bar code symbology.  Unlike the consumer products industry with the UPC code that created standarization across the industry, healthcare is behind the times in supply chain management. One major reason is because it involves patient safety.

The author worked for the leading bar-code scanning company (Symbol Technologies)...now Motorola at thsi time and experienced first hand the frustrations of clinicians tryingto scan a 1-D linear wristband with a laser tethered scanner on a curved surface.

In order to de-code the actual laser scanner had to scan the entire bar code.  To relieve the need to use a tethered scanner, the BMCA application (for the V.A. application), was ported to a ruggedized hand-held scanner with a built in 1-D scan engine.  While the intent was there to allow for portability, it was an application specific PDA device, and clinicians did not welcome wearing a tool-belt of PDA(s).   With the aging nursing population, trying to read the EMR application on a PDA was pretty overwhelming.  Clinicians ofter overcame the problem (of scanning a curved bar code), by simply printing out an additional bar-coded wristband, taping it to the chart, and scanning it.  Thus, the entire application and completion of the 5-rights was defeated and/or "worked around"

Moving forward to the EMR, the majority of the EMR vendors now incorporated bar-code scanning to validate the patient's ID.  Then next came the use of bar-code scanning by the IV pump companies to valide the IV order (actual bag), with the patient. So in essence you had two different systems working in place at the point of care, neither of which are standarized on a "symbology" or even talk to one another.

In order to solve the issue of the linear bar-code, now CCD imagers started to emerge (they take a picture and decode), and the use of matrix, 2-D, composite symbologies allowed small bar codes to be imaged.

Again, there was no standarization in hospitals from the supply chain to the point of care.  Multiple systems, different symbologies, multiple scanners/imagers...no integration.

Additional questions came up such as after the patient is discharged, where does the actual IV pump go, when it is picked up for cleaning?  If the patient has a ventilator, how is it charged for and when the patient is discharged, how is the respiratory therapist notified?

If I go back to my original thought process of supply chain automation, this is one area surrounding the point of care where throwing more and more disconnected technology will impede workflow.  In some cases actually adding more and more layers of technology will demand more input from the clinician, and could/may create more safety related issues.

Application based patient association needs to have automation in the background working to help the clinician.  One simple example here on the East Coast is the E-Z pass toll system.  Using passive RFID you can drive anywhere on the highway system at the speed limit of course, it will know your car/license number, charge your credit card without slowing down a bit.  The same thought process surrrounding the point of care could be looked at from the glass of an aircraft cockpit.

The complexity of today's care delivery process and the potential for errors is highly present. It is not that we do not have highly intelligent care givers, but the ability to be able to handle more and more IT and imput demands can be difficult.  That it why on todays' modern aircraft not only do we have auto-pilot, but also automation of control surfaces such as fly by wire.  All this translates into allowing intelligent automation working in the background help with the job of flying a complex aircraft.

The technology is present to provide this kind of automation in today's healthcare environment, however it needs to be agnostic to the medical manufacture and or the EMR vendor.  The rationale for this is pretty simple. Just like what happened with bar code scanning solutions, they are all different and each company wants to have its unique competitive advantage.

A solution to these nagging work flow, association, disassociation problems seems to be the Capsule Neuron.

These are some of the potential future solutions and new power for intelligent automation.  Example One:  When 1 to xx IV pumps are brought into the room, what if the Neuron screen could automatically show those respective pumps.  Also, imagine that the care giver could be automatically identified by vicinity based RFID.  The same with the patient who is wearing an RFID band.

All the care giver would have to do is to "confirm" on the screen and a HL-7 message would be sent to any third party EMR.  Now this is some of the interesting stuff. When the patient is ready to be discharged, the pumps are taken out of the vicinity of the patient.  The Neuron screen could automatically show that they are dissassociated.  All the care-giver would have to do is confirm this again. An algorithm could be built to automatically notify the Sterile Processing Department to come pick up the pumps for cleaning. Since these specific pumps are assigned to this patient in this specific room, everybody would know where these pumps are on a real time basis.

Another interesting application is for ventilators.  Many times these are not charged for or it not known exactly when the ventilator is not needed anymore.  So, idel equipment sits in a room, waiting to be picked up.  Why not have the Capsule Neuron know when the ventilator comes into a patient's room.  It could automatically be associated to the patient and the Neuron screen would identify the ventilator.  The caregiver would simply confirm on the screen for this medical device and a HL-7 message could be sent to the EMR to charge for this ventilator at this time and data.  When the patient is disconnected from the ventilator (now the ventilator is disssociated), the care giver again confirms this on the screen.  This then sends a HL-7 message out to the EMR to "charge capture", and other message to the respiratory therapist that this ventilator is ready to be picked up.

The time has come to provide the right technolgoy and solutions that will "automate" the association and disassociation of medical devices, the patient, and the care-giver. This workflow should not demand more from the care-giver, but lessen the work load of the management of the complexity of interactions surrounding the point of care.  In doing so, new algorithms can be created that allow for automated charge capture, and provide real time knowledge awareness of medical equipment.  This will lessen stress of patient care, potentially lower risks of mistakes and save capital equipment dollars.

RTLS Discussions and the Value Proposition across the Healthcare IDN

Today, I had a great conversation and dialogue with Scott Sullivan of UCSD (University of Southern California-San Diego) on the recent Awarepoint deployment at the Moores UCSDC Cancer Center.  What is interesting is that UCSD is very forward thinking in its overall inventory IDN management strategy. They actually are looking at RTLS from a total integrated delivery model.  For the past five years or even longer, traditional RTLS strategies have been somewhat limited to departmental solutions. This often is due to cost considerations of the technology and many are not able to quantify the real business value across multiple departments throughout the continuum of care.  While clinically these limited deployments have some value to locate certain assets, the real supply value and ultimately derived financial ROI will be obtained by looking at RTLS from an enterprise perspective.

Since this Awarepoint solution it seems is non-disruptive for installation purposes,(Zigbee) is quick to deploy, actually works (meaning reliable), the clinicians have somewhat bought into this. (meaning they trust the data), this is a convergence factor of many sorts.  This converged and reliable data is very important to improve the business process with meaningful location data at the grass roots clinical level. Clinicians do not need another technology layered on to them that does not provide value and helping them with patient care.  Scott has also championed the different departmental areas across the Hillcrest, Thorton, and Moore Campuses, to look to novel ways to utilize this RTLS technology and the data obtained to improve their business practices.

One area of unique supply chain value in the operative area is the simple awareness of the medical instrumentation tray sets on a real time basis of which can translate into thousands of dollars of saved surgical time (even in minutes) and improved patient throughput.  While a lot of RTLS solutions have “hyperfocused” on “where is the I.V. pump”?, while this is important, the OR is a high cost supply chain model.  Knowing where your assets are, real time, for orthopedics, neurosurgical and cardiovascular, among other procedures just simply improves the overall operations.   We discussed a lot of unique business models, and I suggested tracking medical implants.  An actual example was having high value stock with sterility expiration dates on hand.  In this case UCSD had 2 VAD(Ventricular Assist Devices), at $40,000 a piece that had to be written off, because there was no location awareness on a real-time basis.  That is $80,000 that had to be written off to the bottom line.

The challenge for any RTLS system is that it has to provide value.  This value translates that it simply has to be deployed everywhere.  The caveats here are the cost to deploy, time to deploy, and actually does it really work.

While the issue of location accuracy (to a few meters), can be challenged;  the reality is the hospitals can derive huge cost savings and real operational improvements IF a reliable RTLS system can be deployed, not on a departmental basis…but enterprise.  It is a not of if but when.  Once the model is in, then it can be continually used to improve day to day operations, translating in real hard dollar  savings.

Some may not like this comparison, but the healthcare supply chain ecosystem is not unlike the DOD or other vertical markets.

Knowing where your assets are on a real time basis improves military readiness, and in the civilian sector provides better cost savings and improves real time supply distribution models.

It seems that the Awarepoint model is quick to deploy, provides a low cost solution, and is non disruptive from location awareness to the healthcare enterprise that translates into real value on a lot of levels.  It is the author’s opinion that this is a major first step to providing real time inventory awareness across the integrated delivery network on multiple levels.  It serves as the catalyst to drive forward improvements in operations because it is enterprise based.  This is critical.  Why this is critical is that for business processes to be improved they need to looked at from a holistic sense and quantified on the value (ROI), on both a CAPEX, OPEX, and TCO.  It seems that Awarepoint perhaps fits this model.

 

 

Integra Systems, Inc. helps to drive finally the right RTLS strategy

Integra Systems Inc., has worked with Centrak to drive and architect a luminary article with the leading  Canadian Healthcare Medical Device Magazine.  See also the post from GE on how an enterprise RTLS solution  can provide the final link in work flow and process improvement.

www.centrak.com

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Best of Breed RTLS Solution

January 8, 2009. Centrak, www.centrak.com a leader provider of Real Time Location (RTLS) systems for tracking equipment and people indoors has been recognized  in the Journal of Healthcare Information Management (JHIM) for its "best of breed inTouchCare tracking systemss. The article, entitled "The Optimal RTLS Solutions for Hospitals" evaluated RTLS technologies in three key tracking technology criteria for hospitals: accuracy and precision; installation and scalability; and flexibility. In all three measures, InTouchCare best met hospital's needs.

In TouchCare can provide hospitals 100% room-level, and sub-room level accuracy thanks to CenTrak's "Virtual Wall" technology, since infrared light cannot penetrate walls like other RF Technologies such as Ultra Wide Band (UWB), and ZigBee.  This is a significant advantage over competing solutions that according to the JHIM article, are accurate an estimated 70 percent of the time and therefore are not a practical long-term option for hospitals.  For hospitals, a 30 percent difference is significant, as knowing the accurate location of assets and people can result in measurable cost savings through increased productivity and decreased lost of medical equipment.

 

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Optimal RTLS Solution for Healthcare is Determined on Accuracy and Cost Effectiveness

To enable the correct RTLS solution for healthcare these such solutions  must provide room level accuracy, be cost effective, and reliable. Anything else than the aforementioned is simply a science project that cannot be deployed across the enterprise IDN.  Add to this from the technical, then clinicians will not have the confidence to utilize such systems to their fullest potential.  The reality is you have deploy a true enterprise RTLS solution to enable work flow and productivity improvements while helping to automate the healthcare supply chain management model. No small feat when you start comparing and dealing with physics of RF for RTLS versus marketing.

http://www.himss.org/content/files/5_Krohn.pdf

WIFI RTLS solutions and design requirements for healthcare?

This is a pretty good article that points out the ins and outs of WIFI RTLS systems for healthcare.  From www.wirelessdesignmag.com

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A Non-Technical Managers Guide to Indoor Tracking

Or, as Andrian Jennings say, "Dazzling your Technical Staff with you in-depth knowledge."  A good white paper that helps put a a lot of the technnology perspective out there.  Again, for any RTLS solution to work it has to be everywhere, be cost effective, have low infrastructure costs, be easily and quickly deployed, and have sub-room accuracy.

 

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RTLS Company Secures Funding

While I have seen a lot of venture capital go to technology, it is fair to say that today that the VC community wants and demands a significant track record of growth and marketplace dominance before investments are made.  Have followed many RTLS companies since 1999, some are still here, some are gone, but basically not one of them has been able to have the right business model with the right technological solution. In the healthcare market to drive improvements in workflow and productivity the RTLS technology must be cost affordable, be deployed across the "entire enterprise", provide minimal disruption to the enterprise, and then give you "realiable sub room" accuracy.

Awarepoint Corporation Closes $13.3 M Series D Financing Round. - Cardinal Partners Leads Investment and is joined by Venrock in Expansion Capital for Principal Provider of Real-Time Location Systems (RTLS).  - November 25, 2008