Many hospitals and health care systems are considering the installation of tracking systems for equipment, personnel and patients. In fact, there are almost as many options as there are potential clients, whether the goal is to track staff, assets, patients, visitors, drugs, tools, carts, PCs or phones on campus, within a building, on a floor, in vitro or in vivo.

With so many technical possibilities, so many different topologies and so many potential applications, there is a certain amount of confusion on the health care end-user side that must be addressed.

Making an informed decision

Clearly, manufacturers are trying to sell hospitals the most advanced systems money can buy. But learning the differences between radio-frequency identification (RFID) and real-time location services (RTLS) systems is a good place to start making an informed decision.

RFID is simply defined as the identification of a tagged object or person through a wireless communications network. It can be used to identify a tagged patient, manage and locate assets, prevent theft, and locate or manage staff. Passive RFID technology is used for access control, checking in and out of health care facilities, and tracking goods within the supply chain as well as other environmental conditions.

RTLS provides the ability to track and locate an object or person carrying an RFID tag through a series of wireless choke points or Wi-Fi network access points in real time. Real-time systems can express the exact location of an object, depending on a few variables; the expected current and/or next location; prior locations; and, with the right technology, an object can be viewed moving down a corridor or across a city. An RTLS system is required to locate assets, know who entered which rooms, find out who's hoarding the pumps and where the broken ventilator went in real time.

So the question is whether a health care facility needs the real-time locating power of RTLS or if it can be satisfied with the spot-locating ability of a simpler RFID system.

Following the sequence

Using the following planning sequence should help hospitals arrive at the right decision for their facilities:

Form a committee. The committee should comprise all stakeholders that might be interested in the technology so that one type of system is selected and installed. Even if unique needs dictate more than one system, a committee will help air requirements of all departments and mitigate the number of RFID/RTLS networks that will end up being installed in the facility.

Frequency interference, operational and maintenance costs, incompatibility of tags and readers, servers to house the head-end software, and training voids all can be mitigated by agreeing to one type of compatible and interoperable location system.

What's good for one department may not work for another. For example, if the transport department wants to know where wheelchairs are located, they may elect to purchase a passive system that will tell them where the chairs were last seen. This may be a perfect system for patient transport, but not good enough if patient admitting wants to know exactly where a patient is positively located in real time or if infection control needs to know exactly what bedside components are in which rooms.

A passive system that only fits the needs of patient transport may necessitate an additional system for another department. Add the different needs of the pharmacy, facilities management, materials management, IT, police and security and several systems may end up fighting for space, annual maintenance monies and for communication frequencies.

CLOCKWISE FROM TOP LEFT: A dissembled small form factor (SFF) antenna; an SFF antenna suspended from a high ceiling; and an antenna/reader in a drop-down ceiling with the antenna and reader exposed.

Make a checklist. Include all items that must be covered by the location system. These include general staff, visitors, patients and specific staff such as charge nurses and security. They also include physical assets such as carts, medications, wheelchairs, beds, pumps, vents and specific types of medical devices.

Systems should be prioritized based on most value for the dollar. In other words, which system or system-type can offer the most departments the most options with the least outlay of money?

Also consider areas that have the best opportunity for return on investment like surgical admitting, where smart scheduling using location services enables blocked surgical procedures and frees staff time. When surgeons can keep busy with patients instead of being idle and waiting for the next case, they are much happier because they will ultimately have more free time to schedule their own patients later in the day. This could lead to better physician recruitment and retention.

Another area of focus is replacing manual practices or procedures that are required with automatic interventions. For instance, many RFID tags come with temperature sensors built in. These tags can be used to monitor refrigeration units for compliance, reducing the need to use staff on each shift to take readings.

Consider current practices. Determine where the items that need to be tracked are normally located and decide if there's a problem with items ending up far away from where they are expected to be. If wheelchairs are normally found within 100 feet of their point of use and transport is the decision driver, buying into a location system does not make sense. However, if they are normally scattered within the facility and incoming patients are queuing at the door waiting for transport, a return on investment predicated on reducing staff time used to locate the chairs could be a good driver.

Hoarding is another potential driver and hiding medical equipment is about as much of a problem in health care as the nurse shortage. Hoarding is wasteful, expensive and a major source of aggravation for some staff members. When staff locates a normally hard-to-get item, they will sometimes hide it in a closet, medication room, clean supply space or any number of other places where no one else can find it. Hoarding costs money—equipment that does not "exist" cannot be counted and therefore needs to be replaced.

Determine if the entire campus, the main hospital building or a few key areas within a building need to be covered. These location systems are scalable and an initial investment in a problem area could go a lot further than covering the enterprise with a network when the key requirements are within a few hundred thousand square feet. Go small, prove the concept, check the return on investment and then take the next step. The final factor entails deciding if items must be found in real time or if the last known location is good enough.

Decide on the level of detail. Establish what level is needed for the organization's location system (e.g., "the item is on 3 West" or "the item is on 3 West currently headed East, and associated with patient Smith, wheelchair number W2343 and staff member Richards").

Most active and some passive systems can provide extraordinary detail, indicating the exact current location of an item or person. If a health care organization needs to know the location within a 10,000-square-foot area, systems are available to accommodate that. If an organization needs to know which side of a patient room an item is located, systems are available to provide this level of detail.

Of course the more granular the search, the more the search costs. Most location systems can get granular because the manufacturer adds more access points. Associated with these additional access points are electrical costs, operational costs and maintenance costs.

Facilities professionals should think about these questions, too: Is it necessary to know the temperature of the tag? Is it necessary to continue tracking the tag if it is moving or if the battery is low? What if there are many similar assets in the location the tag has been? What if the tag is in an unexpected or unauthorized location? Most importantly, facilities professionals should decide the value in knowing these things and where money can be saved in terms of capital costs. Once these questions are answered, a good understanding of the type of system needed will ultimately emerge.

ABOVE: RTLS provides the ability to track an object or person carrying an RFID tag through a series of wireless choke points or Wi-Fi network access points in real time. BELOW: Passive RFID technology is used for access control, checking in and out of facilities and tracking goods via choke points.

Taking the time

Purchasing too much location system technology happens all the time. How is this dilemma best avoided? By taking the time to get all interested health facility departments involved in the process and listening carefully to their needs.

Though it may seem like a daunting proposition, selecting a proper location system is not an impossible task, especially if stakeholders are brought together to determine what needs to be tracked and where it's expected to be located.

Careful up-front planning will result in a system that works well and will meet an institution's needs and circumstances for years to come.

Sidebar - RFID keeps children's facility rolling

Some children's hospitals use lots of wagons for parents and staff to cart children around. One health care facility on the West Coast has implemented a passive radio-frequency identification (RFID) system using choke points at exit doors to the multilevel parking garage to better track the movement of these wagons as well as other equipment. The hospital was buying wagons every quarter, assuming they were being stolen because the hospital could never account for all of them—at least not all at once. In many cases, however, the wagons were being taken out into the garage by parents and left there as they drove away. For many health care facilities, a live update in real time is not necessary. In these applications, a location system using RFID technology in a more passive mode is the preferred alternative. These passive RFID-based systems can determine the last known location of a tag using choke points—RFID tag readers that are generally installed at doorways to read an asset as it passes that point. Hospital staff looked into a tracking system and decided early on that they did not need to know exactly where every wagon was located in real time; they simply wanted to lessen the search effort. Now, when wagons are scarce, the hospital staff simply engages the location system on any personal computer and clicks on the icon for the wagon. The RFID tags respond to the system with the last known location of all the wagons. Then it's just a matter of claiming the prize.

Sidebar - RFID tracks OR-bound patients

In one hospital in the Midwest, surgeons were frustrated by the amount of time it took to get patients prepped and into the operating room (OR). The hospital decided to invest in a passive tracking system for the patients to understand where roadblocks were within the process and to know where each patient was located within the program space. Patients now are tagged with a small, clip-on radio-frequency identification (RFID) unit that responds to choke points installed on certain doors. When the staff needs to find patients who have not entered the admitting department, it can be assumed they are still in waiting. Once the patients pass the doors into admitting, prep, the OR suite, the OR room and recovery, the tag updates the tracking system, which is viewed on large, flat-panel monitors located throughout the surgical area. The location of each patient is now known and accuracy is ensured because the choke point will only notify the system of the door the tag passed, and not another door. By using this system, the hospital can block surgeries very tightly in the morning, freeing surgical staff with the expectation of seeing other patients all afternoon. For the future, the hospital is considering expanding to an active real-time location services (RTLS) system, which would provide even greater accuracy.

Alan Dash is associate partner at the Houston office of Syska Hennessy Group, a consulting, engineering, technology and construction services firm. He can be reached via e-mail at adash@syska.com.

This article first appeared in the November 2009 issue of HFM.

---

To respond to this article, please click here.

Click here for a FREE subscription to Health Facilities Management.