April 2016

Special Focus

Asset, patient tracking technology jockeys for bottom-line position

by Rick Dana Barlow

Track and trace represents a simple concept, really.

You track where something is and where it’s going; you trace where it’s been. This is how you close the loop electronically between the past, present and future of a patient along a clinical pathway or a product in the supply chain.

While that may be simple in concept and theory, it can be a bit more complex in design and practice.

Due largely to the myriad technological options from which healthcare organizations can choose, tracking and tracing patients and products has morphed into as much an art form as it is a science.

While bar coding in healthcare has been around since the mid-1970s, radiofrequency identification (RFID) represents more of a 21st century phenomenon with real-time location systems (RTLS), including RFID as one of several different "modalities" in its quiver, such as infrared, ultraviolet, ZigBee, and others that have emerged as well.

At the turn of the millennium, when facing all three options first movers tended to gravitate toward the latest and greatest at the expense of their predecessor technologies. Pragmatics retained what they knew worked based on their experience and waited for more proof to advance. Progressives implemented upgrades as needed based on making the most of what they already used before using efficiency and economic justification to move to the next one up. Realists, however, figured out a way to apply and utilize all three to varying degrees, pursuing a more holistic approach that allowed for specialization.

Conrad Emmerich

"Anything beyond early adopters and one-off type science experiments really requires a strong plan to be successful, especially at an enterprise scale," said Conrad Emmerich, Vice President, Operations, Wake Forest Baptist Medical Center. "What we’ve experienced is that through focus and committing to an enterprise-wide program, we’ve been able to achieve the type of success with RTLS technologies that weren’t even considered five years ago. This is largely due to the fact that we subscribed to solid methodologies to increase the opportunity for success and invested in people who knew how to make it all work together.

"The technologies themselves have advanced to the point where the reliability and accuracy is sufficient to support advanced use cases — where the value is — and the prices work within the business model," he continued. "All three of the specified technologies play a role in the solutions we deploy, and we believe that they will continue to do so. Projects are moving far beyond the basics and we are seeing exponential value from a hospital perspective."

Whatever philosophy they embrace, healthcare organizations’ interest remains steady for bar coding and relatively hot for RFID and RTLS. As such, technological advancements and applications remaining just ahead of that curve, observers told Healthcare Purchasing News.

Full speed ahead

Makers of track-and-trace technologies report considerable growth in adoption and implementation since 2010, nearly coinciding with healthcare reform’s deployment that includes electronic health record provisions.

Gary Wittbrodt

In fact, Gary Wittbrodt, Director, Product Management, Versus Technology, cited various reports showing RTLS growth estimated at around 35 percent for the next five years.

"Adoption and implementation rates are definitely increasing," Wittbrodt indicated. "Early adopters have had tremendous success and return on investment with the technology, and this is causing others to take notice. Additionally, we’ve seen adoption move from just a location and tracking tool to using RTLS as a business intelligence tool. By applying sophisticated workflow rules to location data, RTLS can help improve workflows not only for assets, but also for patient flow in the ED, OR, outpatient clinics and hospital-wide."

And he’s not alone in witnessing the functional expansion of traditional track-and-trace tech.

Ari Naim

"With the technological improvements in speed and accuracy of location services, we have seen a tremendous shift in the healthcare industry from using RTLS for simple asset tracking to much more advanced use cases, such as patient locating and workflow automation," said Ari Naim, President and CEO, CenTrak Inc. "Five years ago, the market was not quite ready for higher performance technology. Estimated location, using a single RF technology (i.e., Wi-Fi only), was sufficient for basic asset tracking. However, with the advancements of a clinical-grade locating infrastructure, the industry has realized the true value in patient tracking and using their RTLS technology to integrate information into other enterprise systems and automate operational workflows. From tagging a few pieces of equipment, to true enterprise-wide implementations across entire hospital networks, gaining insights into the location, movement and interaction of hospital patients, staff, and equipment has been proven to increase workflow efficiencies, reduce costs, protect critical assets and increase clinical quality." (See graphic, below.)

Shane Waslaski

In a bit of irony, Shane Waslaski, President and CEO, Intelligent InSites, linked increasing facility interest to decreasing device and technology size.

"In the past five years we have seen sensory technology and devices get smaller, faster, smarter and far less expensive, which has triggered rapidly growing adoption in health systems," Waslaski noted. "The result is a vast amount of automatically generated location data that a growing number of healthcare leaders are leveraging to streamline processes, improve patient and staff experience, and reduce costs."

Waslaski highlighted two notable organizations that declared location-based operational tools something they "must have" vs. "nice to have." One is the Department of Veterans Affairs’ 2013 investment in RTLS across 152 medical centers and seven consolidated outpatient pharmacies. The second is Hospital Corporation of America’s recent enterprise license agreement with Intelligent InSites for several RTLS-based products across its more than 160 facilities nationwide.

Tom O’Boyle

Tom O’Boyle, Director of RFID, Barcoding Inc., acknowledged that education and experience has inspired more of a multidisciplinary approach to track-and-trace technologies, contributing to tremendous growth in bar coding, RFID and RTLS.

"Users’ understanding of the benefits and limitations of each technology has allowed for system designers to deploy multiple, and sometimes all three, technologies within the same system," O’Boyle said. "RFID and RTLS have a tremendous benefit of allowing a system to read many items — assets or patients — at one time. Bar coding is still the preferred method to [locate] an asset or a patient and verify a manual operation.  So deploying bar codes in certain instances, like medication dispensing, makes very good sense."

O’Boyle further noted that facilities tend to deploy and use active RFID tags to locate the position of an asset or patient with a facility using triangulation, but even that technology is changing. "Using Wi-Fi-based tags is expensive and the infrastructure burden is high," he said. "Newer active tags using Low Energy Bluetooth (BLE) technology will over time become the dominant technology in the space.  BLE tags and readers are lower cost, follow an accepted standard and have tremendously long battery life. On top of that, every smartphone or tablet being manufactured has a built-in reader allowing for more handheld-based applications."

O’Boyle foresees continued evolution with Passive RFID for automatically updating inventories of assets. "As a technology, its low-cost benefits will allow many suppliers to tag and build in readers into supply cabinets," he said. "We are seeing advancements on the surgical kits, drug supply for LOT tracking, and normal patient consumables.  The costs of the label tags have been consistently coming down over the past five years.  We see some costs below 10 cents now for some tags at high volumes.  That cost will continue to fall with the push to have the RFID antennas printed on the labels. This reduced the label manufacturing costs and allows for custom antennas to quickly be designed and deployed."

Looking forward

Ask track-and-trace tech experts on what asset and patient tracking systems really can achieve if properly applied and smoothly operational and you’ll likely notice them all hovering around higher quality care, improved patient outcomes and lower costs long-term. But what does all of that really mean and how do these nebulous terms apply?

"With an enterprise-wide installation of certainty-based RTLS, healthcare facilities are able to implement workflow automation, automated nurse call cancellation, staff duress/assistance, infant protection, wander management, infection control/contact tracing, among many others," CenTrak’s Naim listed. "By automating processes and making them more effective and efficient, the caregiver is able to spend more time at the bedside with their patient and less time being burdened by data entry, searching for equipment and other manual procedures."

Further, Naim attributes innovative technologies spearheading the creation of the "ultimate experience" for patients who will receive higher quality care as "the standard."

"With lower costs, minimal wait times, efficient care, and reduced risk of infection, the stress patients feel when going to the hospital will be greatly reduced," he added.

When it comes to safety and satisfaction, Intelligent InSites’ Waslaski concurs. "In healthcare, all efforts and investments are geared toward improving patient experiences and outcomes, and that certainly holds true for the use of asset and patient tracking technology," he noted.

Operational efficiency is one key area. For example, giving staff real-time visibility to the location and status of mobile medical equipment empowers them, according to Waslaski. Nurses spend less time searching for equipment, which gives them more time at the bedside. Biomedical technicians save steps and avoid waiting by seeing when equipment is available for pickup versus in use with patients. Supply Chain staff save countless hours by simply waving a wand in storage areas to complete inventory counts, or print a report to show the current location of recalled equipment.

Analyzing the actual utilization of tagged equipment allows Purchasing to avoid redundant purchases and paying rental fees for equipment that isn’t being used, he continued. Real-time PAR level dashboards automate equipment replenishment with notifications and tasks being triggered when equipment counts drop below pre-set minimums. "This means the equipment is just there — with no running around searching or making phone calls to Sterile Processing," he noted. "Bar codes can be attached to folders containing patient discharge instructions so that timestamps are collected when they pass through unit exit doors, enabling length-of-stay metrics that don’t require manual data entry."

Waslaski pinpointed the common element in all of these examples as the use of "pervasively available technology that removes steps, guesswork, redundant data entry, and reliance on busy caregivers to interrupt time with patients to write things down or make phone calls."

Patient safety represents another key area.

"Healthcare facilities are busy and sometimes chaotic environments where caregivers rush between patients while working to maintain compliance with dozens of procedural and diagnostic regulations," Waslaski noted. "Advances in research and predictive modeling help caregivers guard against misdiagnoses or harmful drug interactions."

But Waslaski contended that "far too much reliance is placed on individual human intervention to ensure that basic safety standards are consistently met." These include ensuring patients stay within designated care areas or are seen within an hour of receiving pain medication. Using RTLS, staff can receive notifications when patients pass through designated doorways or aren’t within proximity of a caregiver within an hour of ingesting pain medication, he indicated. Immediately after learning of a patient with an infectious disease being in a healthcare facility, a Safety Officer can print a proximity report showing all of the people and equipment that patient came in contact with so that further spread of infection can be contained and affected individuals can receive appropriate preventative care. Knowing which staff was in a patient room and for how long helps Unit Directors and Nurse Managers understand sequences of events leading to patient falls or abrupt changes in heart rate so they can adjust processes accordingly.

An RTLS-enhanced patient experience also may improve HCAHPS scores, which affect reimbursement, as more satisfied patients spend more time with physicians and less time waiting in overcrowded waiting areas or alone in exam rooms, according to Waslaski.

Minding economics

Albert Larose

Facilities need a low-cost RTLS technology that acts as a business tool, providing optics and analytics to help reduce operating costs by clearly pointing out waste and inefficiencies that may be suspected but not able to be "tangibly quantified" without the technology, insisted Albert Larose, Executive Vice President, Secure Care.

"The cost of RTLS is a major variable enabling this business tool to be justifiable, since the saving must be justified against the purchase price and cost of ownership to enable a [return-on-investment] against the RTLS system investment."

Larose noted that RTLS transmitters can help prevent supply shrinkage or unauthorized interdepartmental transporting or hoarding with mobile alerting and alarming. Add in door management and alarming to prevent assets from being inadvertently loaded onto ambulances from Emergency Departments, left in a stage of "Not in Use" or "Needs Maintenance or Calibration" for weeks on end due to not knowing the state of that equipment or not being able to find it and re-commission it for use quickly.

Further, RTLS tools can be deployed to monitor and regulate which staff members have access to certain areas as well as which vendor representatives, contractors and visitor business associates can access certain areas, he added.

Versus Technology’s Wittbrodt painted an alluring picture of the ideal patient experience where from the moment of arrival the entire visit runs smoothly with no waiting room and no wait time between seeing a nurse, a physician or receiving services such as lab work or imaging, he described. Meanwhile, the visit is fully and accurately documented from both a resource and clinical perspective.

"Envision all clinical staff being able to spend more time with their patients because they are only entering clinical data for the patient," he continued. "All other information — where the patient is, where they were and for how long, who was with them, all equipment present, etc. — is automatically documented in real time. Throughout the patient stay, all procedures are scheduled and on time so the patient is not left waiting and wondering what is going on.

"When the patient leaves, they receive a report of their visit and all information is properly billed and documented," Wittbrodt said. "The facility does not spend a lot of time and resources following up on billing and insurance issues because it is already part of the patient record."

At best, RTLS software applications can result in "consistent, measurable and impactful improvements in staff workflow and patient safey," he said. For example, RTLS can help prevent equipment that may require maintenance or that may have been recalled from ending up in a patient’s room through flagging and electronic notification. RTLS also can influence hand hygiene practices that can curb the spreading of hospital-acquired infections, according to Wittbrodt.

"When RTLS is integrated with hand sanitizer systems and/or soap dispensers in a facility, hand washing rates are efficiently and accurately recorded 24 hours per day," he noted. "This is in sharp contrast to the current system which is heavily reliant on direct observation — a method that only captures, at best, 4 percent of hand hygiene opportunities. Administrators use RTLS software to precisely monitor how often staff sanitizes their hands. Users of our system have seen hand hygiene rates more than double, with one even documenting a 12 percent decrease in HAIs."

Wake Forest’s Emmerich has classified more than 50 current projects with another 50 underway or in planning as part of five general categories: Quality and safety, access and throughput, labor optimization, supply chain effectiveness, patient engagement and experience and population health. RTLS can be applied to all of them.

"Currently our largest focus is on patient flow and experience, with emphasis on improving wait times, understanding the patient experience, and making sure that providers get more quality time with their patients," Emmerich said. "We are finding new and innovative ways to incorporate our real-time systems into solving these issues every day. As such, the value we realize from our investment continues to rise."

Emmerich foresees RTLS maturing to the point that it creates "a seamless integration of information technologies," to "support the orchestration of care throughout the clinical enterprise," he said. "A visibility platform that provides real-time and historical insights about the conditions, status and movement of equipment, patients and staff throughout the facility will empower healthcare professionals more than ever before — allowing them to more effectively focus on patient care and experience." HPN

Horizon scanning for asset, patient tracking tech