April 2015

Special Focus

Asset, patient tracking systems vie for dimensional expansion

Big Brother strives to fortify Big Data to generate Big Outcomes

by Rick Dana Barlow

During those years between the Clinton and Obama healthcare reform initiatives, supply chain professionals expressed interest in real-time location systems technology as a "next-generation" alternative to bar coding to track assets.

Since then, bar-code capabilities have expanded to at least keep pace with selected applications of real-time location system (RTLS).

But under a reforming healthcare system, the definition of "asset" may be changing.

Historically, supply chain relied on bar coding and RTLS modalities, such as radiofrequency identification (RFID), to keep tabs on equipment — when something was used on a patient, processed for future patient use, maintained and repaired for ongoing usage and in which remote closet or hallway it was stashed. They also relied on these automated techniques to record and track inventory throughout the supply chain — ideally from the raw materials supplier forward to receipt at the dock, stocking in the storeroom, usage on the patient and reimbursement from the payer.

Supply chain emphasized financial and operational efficiency, which justified investment in the technology.

Clinical applications ran a parallel course as facilities could track when and how often doctors and nurses met with patients, what they did and whether they followed proper protocols, such as handwashing and workflow parameters, all of which ideally could be entered into the electronic health/medical record.

Products and processes — including the clinicians and administrators involved — may have been tagged as assets before but they now enjoy company.

The current wave of thinking engulfs the patients themselves — the customers — and the data in their records as key assets to be tracked.

Amid infectious disease outbreaks (e.g., Ebola and measles) and database hacking and privacy intrusions, the application of asset tracking strategies and tactics gains a fresh perspective among healthcare providers.

It all ties together as a patient safety issue and a related data/information security issue.

Yet how far and how fast will this new emphasis (albeit not necessarily new issues) drive more adoption and implementation of RTLS technology?

Healthcare Purchasing News sought to explore the outlook of asset tracking systems as they permeate virtually every aspect of provider operations and serve as a linchpin to patient safety and information security.

First moves

Barry Brown, Director, Strategic Business Development, ARC Healthcare Technologies, espies something of a retail connection in healthcare, even if few are willing to make that leap.

"Data requirements and related performance requirements have changed considerably, and in supply chain terms, the demands in healthcare are now much more in line with those in the retail sector," Brown indicated. "This movement toward proactive management of supplies of all types is accelerating rapidly, and hospitals are seeing the major financial and patient care benefits available from the utilization of RTLS."

Still, Brown scoffed at those who sniff that healthcare is "unique" and "different" from retail and should not settle for retail or manufacturing software shoe-horned to fit the needs of healthcare providers.

"Yes, there are some differences but not enough to warrant a broad rejection," he insisted. "Let’s face it, management of inventory is common to many industries and sectors with mainly minor differences. We have to adjust our software much more to accommodate individual hospitals requirements for their unique purposes than we do because it’s ‘healthcare’ per se. The differences between automotive or retail and healthcare are much more related to attitude and approach than to specific industry requirements. The former have been practicing ‘lean’ inventory management for some time now. Healthcare is only just getting around to it."

When it comes to RTLS assignments healthcare facilities seem split between marking or tagging people (such as patients, staff, vendors and visitors), processes that people do or the products (such as consumables, reusables and equipment) that people use.

Costs determine how and where RTLS technology may be deployed, according to Brown.

"Hospitals that have prior experience of RTLS — usually in very specific applications such as tracking equipment — do not easily relate to the possibilities of tracking consumables as they tend to think of RTLS in terms of expensive battery-operated tags and more expensive installations for their tracking, and it requires a very different mindset to relate to a very inexpensive passive UHF tag system and to a totally comprehensive software engine that can track and manage supplies, equipment, personnel and more while interfacing and exchanging data with all other software systems already on site," Brown said. "So existing RTLS users are not necessarily the early adopters of passive-tag supply chain systems, and indeed may resist expanding RTLS due to less-than-totally successful previous experiences."

Brown links the prior challenges with RTLS to "issues with active tracking systems that suffer from battery expiration or failure and [other] limitations, such as knowing where the item is does not tell you whether it is, in fact, in use or not. [For example,] how do you find the item when the battery is dead? Looking at these issues and relating them to the costs associated with these systems has left many hospitals disappointed."

Still, Brown sees RTLS starting with Supply Chain from the distribution center to the operating room to the patient. "This will generally generate enough confidence and more than enough [return-on-investment] to proceed on to Assets (equipment), Pharmacy, Patient Room consumables, and finally to specifics such as Protocols," he added. These include high-dollar item-level tracking with passive radiofrequency identification tags for such products as orthopedic implants, heart valves and catheters; low-dollar consumable supplies, such as bandages, syringes and exam gloves managed with an RFID-enabled multi-bin Kanban system; and tracking of such medical devices as infusion pumps, wheelchairs and portable patient monitoring equipment with passive UHF technology.

Joel Cook

Joel Cook, Healthcare Solutions Director, Stanley Healthcare, emphasized the scalability issue, too. In fact, his company finds that hospitals tend to launch RTLS programs for environmental monitoring or asset management.

"Equipment-focused applications like these can be deployed and adopted by hospitals quickly, and offer a fast return on investment," Cook said. "This is especially true of environmental monitoring, which is a highly scalable solution and meets a pressing need. Manually checking conditions in refrigerated storage units, which could be required several times a day, is labor-intensive with low added value. By automating this task with RTLS, staff members are freed for more productive work, and the hospital is better protected against catastrophic events like [the] complete failure of a cooling unit."

Hospitals also should find "compelling ROI" for managing assets, such as infusion pumps and transport equipment, he continued. "Customers report immediate improvement in utilization rates, which translates into thousands saved annually in capital costs," he added.

"What’s really interesting about the adoption of RTLS today is that hospitals rarely stop there," Cook noted. "Once they see the results from asset or environmental monitoring, they become interested in more complex or sophisticated applications such as patient flow and staff workflow. Administrators using the technology realize the power of monitoring their equipment or inventories in real-time, and then want to apply these benefits to locating the people within their facilities as well."

Christine Rosier

Christine Rosier, Vice President, Client Services, CenTrak Inc., said her company already sees people-tagged RTLS.

"Today, in growing numbers, hospitals are finding that location awareness of staff and patients is a pivotal component of clinical efficiency and the patient experience," she said. "In the clinical setting, location awareness is dependent upon accuracy — the ability to segment spaces into clinically meaningful zones. For clinical applications, these zones are typically patient rooms, beds, bays, chairs, nursing stations, hallway segments and other relevant workflow areas. With this level of location granularity, all manner of clinical workflows — from monitoring simple staff tasks like hand washing, to monitoring the time and resources applied to each patient encounter, to staff efficiency in costly departments like the [Emergency Department], present opportunities to favorably impact clinical efficiency and quality, staff safety, patient satisfaction and cost compression."

David Reed

David Reed, Vice President, Healthcare Business Solutions and Operations, Corporate Compliance Officer, Cook Medical, told HPN that he’s been hearing from a limited number of hospitals expressing interest in incorporating RTLS into the identification badges worn by hospital staff. However, Reed said he thinks hospitals remain more motivated to incorporate RTLS into their product processes.

"For several years now, we’ve seen radio-frequency identification being used in many hospital systems for high-value items, but the trend lately has been to apply similar technology to more standard items," he noted. "For example, four or five years ago a hospital may have had one RFID-equipped cabinet where they stored aortic stent grafts. Today, they might have an entire warehouse of more every day usage products that are tracked by RFID. The driving force behind this kind of adoption is data. If hospitals have access to real-time consumption data, then we can start to create a more efficient model with the right level of inventory being manufactured and purchased based off of real consumption."

Jon Poshywak

Hospitals pursue tracking assets most likely because the ROI is immediate and easily apparent, according to Jon Poshywak, Vice President and General Manager, TeleTracking Technologies Inc.

"Historically, there has been some reluctance to tag people because of perceived intrusiveness," Poshywak noted. "However, the obvious benefits of RTLS in terms of operational efficiency are overcoming that reluctance. Many prospective RTLS clients now look at patient tagging and tracking for capacity management benefits. Using RTLS to tag patients and enable an ‘Auto Discharge’ event can deliver a far more significant ROI than any other RTLS-enabled workflow and can produce better financial outcomes for facilities that face either over-capacity or under-capacity challenges."

"Hand Hygiene Monitoring" is growing as a "must-have" for hospitals, Poshywak observed, but the same issue of intrusion exists. "The realization that improvements in hand-washing compliance can make a huge impact in lives and revenue saved is overcoming that issue," he said.

Still, hospitals are starting to understand more clearly that RTLS-enabled operational management software has the potential to save billions of dollars and dramatically improve the timely delivery of quality care, Poshywak acknowledged. TeleTracking calls this concept The Real Time Hospital because "it gives managers the ability to operate their departments and the entire enterprise, right from their mobile phones, anywhere in the facility," he added.

When the Ebola cases emerged in the U.S., TeleTracking was able to reinforce that "RTLS combined with operational software can trace the movement of all people and equipment that might have been exposed to an infected patient and provide names and locations instantly," Poshywak noted. "We see that as being just as important as hand-washing monitoring for the safety of patients and staff."

Quick wins

Which areas make the most sense to apply RTLS for some quick wins to justify a larger rollout depends on an organization’s particular needs and goals, sources agree.

Brown picks the product areas initially. "Typical supply chain installations in major hospitals will generate on average returns of double the initial investment within the first year, with major savings coming from inventory reduction, waste reduction, charge capture and workflow improvements," he said. "The fastest paybacks come on high-dollar items, such as implants, and tracking for these can be implemented on a small scale and expanded easily. Clinical staff will have more time to focus on patient-related issues as they do not have to worry about supplies.  Profits are improved, staff are happier, management has access to vastly increased amounts of useful real-time data, which enables more efficiency improvements."

If the goal is to acquire accurate, real-time data from the use of RTLS, then the quick wins could be identifying those points in the system where data isn’t being captured well and starting there, Reed advised. But this also reinforces efficiency, he added.

"If a lab manager doesn’t have to physically pick up every product that enters her department, scan it, and put it back on the shelf, then a win is that time she can spend on other things," Reed said. "The opportunity that’s probably most valuable for hospitals though, is to use RFID systems to collect that real-time usage data and lower their ‘just-in-case’ inventory, which is very expensive and inefficient."

Cook contended that environmental monitoring typically is the best place to start for hospitals looking for a fast return on investment. "These systems are very quick to deploy, and because the refrigeration and equipment storage units that these solutions monitor are stationary, few changes are required to the Wi-Fi network," he said. "The solution solves an everyday problem that all hospitals face, and provides a simple and quick remote monitoring solution.

"Generally, we encourage organizations to implement simple RTLS programs that can get staff comfortable with the system and help them to discover the system’s potential," he continued. "Once they see how useful these systems can be and the quick return on investment, then they can expand to the more sophisticated and wider-scale applications."

Poshywak promoted RTLS’ use on people to prevent "dead bed" problems.

"Patient tagging for the purposes of Auto Discharge is a relatively simple solution to be installed," he insisted. "It meets the low-cost and low-implementation complexity requirements that most facilities are challenged with and can deliver significant ROI. Auto Discharge occurs when departing patients place their wristband monitors into a Dropbox reader, initiating the entire process of bed preparation. It helps eliminate many hours of ‘dead bed’ time."

What if RTLS vendors pursued vendor credentialing?