Patient Care Using Radio Frequency Identification

Transcription

1 Daniel Morreale, Chief Information Officer Patient Care Using Radio Frequency Identification AN ADVANCEMENT IN PATIENT SAFETY Jerry Moy, Client Executive

2 One of seven regional networks established by The New York City Health and Hospital Corporation in 1994 & composed of Jacobi Medical Center and North Central Bronx Hospital Specialties include a Regional Level 1 Trauma Center, Venomous Bite Center and the Regional Perinatal Center. Burn Unit is a pioneer in early surgical intervention to preserve skin and minimize infection Pediatric Emergency Department was lauded as one of just four of the best facilities in New York and we have the only multi-person Hyperbaric Chamber in downstate. Offers a comprehensive Behavioral Healthcare program including inpatient, Partial Hospitalization Outpatient, Emergency, and Addictive Treatment Programs. Performed 47,000 inpatient discharges, 1,073,000 outpatient visits and 192,000 E.D.visits per year.

3 Awards 1998 Computerworld Smithsonian Award 2002, 2003,& 2004 HHN Most Wired Award 2003 TETHIC Award for Excellence 2004 Computerworld Smithsonian Honors Laureate Award 2004 HCRIC Award for Best advances in Patient Safety 2004 Storage and Networking World Best Practice in Storage

4 System Environment 103 integrated clinical and ancillary systems. Primary application suite includes Misys CPR (EHR including Lab. & Pharmacy) AGFA Impact (PACS) Siemens Unity/Invision Patient Management ADVIA CentraLink Laboratory Robot McKesson Pharmacy Robot- 100% CPOE

5 Technical Environment 96 servers of assorted flavors (Unix, AIX,Solaris,W2K,VMS). 8,000 node high density 10 gig network. 4,500 PC s, 1,300 printers, and 900 assorted clinical devices. Robust Nextel Environment. Fully digitized imaging department. (no film) Highly motivated clinical and technical teams. Robotic assisted Laboratory and Pharmacy. Fully integrated voice and data environment including unified messaging. Modest wireless infrastructure. 180 terabytes of integrated enterprise storage (SAN/NAS/& CAS).

6 The Challenge and Issues Clinical Staff was looking to do documentation at bedside. Nurses wanted to document meds and vital signs and the docs wanted to place orders and review lab results Respond to the National Patient Safety Goals Patient Identification and Medication Administration were high on our list of mandates we had most of the order entry process on-line with the exception of the MAR. Medications were bar coded, staff were bar coded, we needed something for the Patients. Originally we were going to put a bar code on the wrist band, but changed our mind. Stop the incessant complaining by physician that I can t type This statement must be a requirement for graduation. Get over it It s the 21 st century, You were smart enough to graduate from medical school learn to type. In the mean time we needed to reduce the input required to access a patient chart.

7 The Challenge and Issues Physician and Nurses were looking for better Point of Care Access Tools Laptops and Hand Held Devices just didn t meet the care givers needs Hand Helds were to small to read and laptops to heavy to carry. We realized about 2 years ago that we needed a tablet but have been waiting for the industry to catch up Complete the last step in Electronic Medication Administration The organization has 100% CPOE, medication alerts, allergy alerts, pharmacist review all on line but the final step of administering medication was done on paper. Simplify documentation & Provide more time for Patient Contact An overwhelming issue has been the need to simplify the documentation process yet provide greater detail in notes and to increase the opportunity for nurse-patient contact.

8 The solution then must: 1) Be a wireless tablet with direct access to the clinical record 2) Provide for the MAR and clinical documentation on-line 3) Perform an electronic patient identification 4) Reduce key entry as much as possible 5) Simplify the work flow to create more time for patient contact so we turned to a vendor/partner to help build the solution

9 Siemens Business Services: A Siemens company within the I&C segment I&C Automation and Control Power Transportation and L&A Automation and Drives Power Generation Transportation Systems Siemens Communications Industrial Solutions and Services Power Transmission and Distribution Siemens VDO Siemens Business Services Siemens Dematic Siemens Logistics and Assembly Systems Siemens Building Technologies Medical Lighting Financing and Real Estate Siemens Elektro Medical Solutions Siemens Financial Services Siemens Elektrogeräte Osram Siemens Real Estate

10 Our Business: IT Services Customers $6.1 billion sales and 33,600 employees in 44 countries* Solution Business Operation Related Services Product Related Services Consulting, project-based business solutions and system integration Outsourcing of computer centers, desktop services, local networks (LAN/WAN) and call centers Maintenance of hardware and software products, infrastructure services Consult, Design, Build Operate Maintain * 2003 fiscal year We offer the full range of IT services

11 Services Needed to Support Your RFID Environment Application Network End-User Design Business Justification Strategic Planning Migration Planning Service Desk Assessment Technology Impact Analysis Desktop Deployment OS Migrations Asset Tracking Deploy RFID readers, WI-FI infrastructure Business Justification Server & Network Strategic Planning, Migration Planning, Deployment of RFID RFID and WI-FI Network Design infrastructure and Wi-FI Assessment, Network Performance Exchange Migration Assessment SMS 2.0 Deployments Enterprise Management Assessment Enterprise Management Security Design Assessment QuickStarts Application Performance Assessment SAP Assessments/Project Planning Active Directory Planning RFID encoder and reader Applications Program Management Build SAP ERM/CRM/SCM Implementations, upgrades RFID Apps Integration with existing systems Operate/ Maintain Field Services Help Desk, Desk side, Depot Mobile Device (RFID Readers /Tablet PCs, etc.) Asset Tracking Remote Network Services Wintel & Unix Server Support Data Center WI-FI and LAN support SAP/Exchange RFID Application Management Hosting Services Continuous Improvement

12 Key Differences Between RFID & Bar Codes RFID does not require line of sight RFID can read multiple tags simultaneously provides Automated reading can store significantly more information Information can be dynamic added or deleted Increased functionality replace security tags, integrate with sensors, difficult to counterfeit

13 Barcode For this Project: Barcode or RFID? RFID - single reading - direct access only -orientation critical - write once - no hidden or secure data possible - no access control - usual use of several barcodes during a patient stay - no sensor capability - daily problems with dirt, wear, etc. -established and cheap - single or bulk reading - no direct access necessary (read/write through sheets, blankets - tracking possible - orientation not very critical - rewritable - can write hidden or secure data to tag - access control including encryption - a single chip serves throughout the patient stay -robustness, adaptable (size, memory, x-ray tolerance, etc.) -higher price

14 What is RFID (Radio Frequency Identification)? Simply put, RFID is a small, thin, low-cost, wireless communications device Stores, transmits & receives data Can be applied to or embedded into a package, ID card, wristband, etc. IC-Chip contacts antenna substrate

15 Jane Doe MRN: SSN: ADM: Bar Code Bands Today Jane Doe MRN: SSN: ADM: 04/25/03 Jane Doe Issues: Band 1 BC too long Curvature hard to scan Band 2 Not enough room for data Multiple scans Both Bands BC not readily accessible Need 2 hands for 1 st time read Problems: Band 1 Can t scan Key entry required Band 2 Hard angles to scan Key entry used Both Bands Work arounds created Not enough hands Results: Potential increase in medical errors due to incorrect patient ID Solution: RFID Wrist Band

16 RFID Key Features Passive vs active Frequency Read vs read/write Write once-read multiple Write multiple-read multiple Memory Size Multiple Over-the-Air Communication Protocols Form Factors

17 RFID Wristband 2000 bits of data storage = 256 characters

18 Frequencies Electromagnetic Spectrum Electric Waves Radio Waves Infra-red Visible Light Ultra- Violet X-Rays Gamma Rays Cosmic Rays Radio Spectrum 9kHz 30kHz 300kHz 3000kHz 30MHz 300MHz 3000MHz 30GHz 300GHz 3000GHz VLF LF MF HF VHF UHF SHF EHF Not designated Long Wave Medium Wave Short Wave The RFID Frequencies VLF Very Low Frequency VHF Very High Frequency LF Low Frequency UHF Ultra High Frequency MF Medium Frequency SHF Super High Frequency HF High Frequency EHF Extremely High Frequency khz Mhz MHz 2.45 and 5.8 GHz Criteria for Frequency Selection: Read Range - Data Transfer Rate - Power Requirements - Interference Issues

19 Some Frequencies May Be More Suitable For Certain Applications Feature 125 Khz Mhz 433 Mhz 868 Mhz 915 Mhz 2.45 Ghz Read Range Approx 3 ft Approx 10 ft Approx 10 ft Approx ft Approx ft Hundreds of feet Data Transfer Slow Depends on Distance Slow Fast Fast Fast Interference Poor Best Poor Good Good Best

20 Barcode AND RFID! Barcodes and RFID can and should complement each other. First use RFID to positively and non invasively identify a patient and gain access the electronic medical record and specific clinical screens. Then use barcode to read a single dosage medication and capture that administration into the electronic medical record AND

21 Radio Frequency Identification Project Radio Frequency Identification is a non-invasive means of accurate Patient identification by broadcasting the patient s medical record number which is picked up by a special receiver on a tablet PC. The Process uses a small program which reads the MRN and automatically signs into the patient s clinical record (Misys CPR) saving time, keystrokes and guaranteeing 100% accuracy in identification.

22 Radio Frequency Identification Project Siemens Medical UNITY Admission/Registration System Misys CPR Patient Information System RFID wristbands are placed on the patient by nursing Admitting Registers patient recording Medical Record Number, Patient Name, Patient Sex in unity which is sent to the RFID encoder/printer. RFID Encoder Printer Human Readable RFID Wristband With bar code

23 Radio Frequency Identification Project Wireless Wireless LAN LAN Patient Information / Clinical System Lab Systems RFID Patient Identification at the Bedside Access Point Medical Registration System Patient with RFID Wristband Wireless Tablet PC with RFID Reader and Client Software Wireless Tablet PC with RFID/Barcode Reader on Med Cart Medical Billing System

24 Radio Frequency Identification Project Our goals were to : 1- Demonstrate that healthcare professionals are able to access medical patient records, stored in the MISYS Patient Information system, from the bedside, using RFID enabled Tablet PCs 2- Streamline the collection of information at point of care by reducing keystrokes 3- Provide a platform for point of care documentation, order entry, and result review 4- Meet two of the 2005 Patient National Safety Initiatives by: a: improving the accuracy of patient identification b: improve accuracy of medications administration 5- Reduce nursing documentation time to provide more patient contact opportunities

25 Radio Frequency Identification Project Team Nursing Physician Propeller Head Clinical Analyst Risk Management Specifically kept small and simple

26 Radio Frequency Identification Project The 7 Rights Right Patient Right Medication Right Dose Right Route Right Time Right Reason, Right Documentation The Nursing Practice Guideline, Administration of Medication, August 2004

27 Radio Frequency Identification Project Findings (Value Proposition) Prior to the RFID MAR Nursing staff would spend approx 45 minutes per medication event and there are three to four medication administration events per 12 hour shift. The average was 2.5 hours per shift. Nurses would typically administer 12 medications per patient per twelve hour shift. Each Nurse typically takes care of 8-10 patients For nursing staff administering medication; the system has saved 25 minutes per administering nurse per shift. This creates approximately 1 hour per nurse/per shift for patient contact and other tasks. Financially that is a potential saving of $22,000 per unit or $594,000 for Jacobi and $220,000 for NCB, Total savings for the network would be approximately $814,000.

28 RFID Value Proposition RFID technology closing the gap between physical and digital world without human intervention and in realtime Gap between physical and digital world (media discontinuity) Manual data entry Speech recognition Barcodescanning Transpondertechnology Real world Human beings Supplies Fixed Assets Virtual world inter and cross-company information system (e.g. supplier, SCM-systems) communication networks (e.g. Internet) Human intervention required No human intervention required Time

29 RFID in the Hospital Network Mhz

30 Form Factors Transponder in Wristband Transponder in Key Ring Button Transponder Encased Tags Transponder on Metal Cylinder Transponder on Pape

31 Antenna/Readers Mobile Readers Customer Specific Static Antennae

32 Handheld Readers Type II PCMCIA RFID Reader/Writer External antenna available for laptop PCs etc. Compact Flash Readers Handhelds

33 PDC DR1000 RFID/Barcode Reader Read and Write to Patient RFID Bands Update Patient Information on Band Positive Patient ID Scan 1D and 2D Matrix Bar Codes Five Rights for Medication Administration Point of Care Sampling

34 RFID Application Initiatives Clinical / Patient Applications: Patient ID Tracking/flow through the ED Complexity of Integration Site of Surgery/ Allergies/ Current Medications Inpatient and Outpatient Kiosk patient education Operational / Administrative Applications: Faster Outpatient Registration with RFID cards Employee ID Locator: IT Integration (security, time, efficiency) Mobile Asset Tracking: Extend Scope, Improve Service Supply Chain Integration: medication, blood supplies, etc.

35 Outpatient RFID Application Jacobi Medical Center OUT PATIENT John Doe 1400 Pelham Parkway Bronx, NY Faster self registrations and secure access to web Based Medical record for care in other facilities

36 Patient tracking in the Emergency Department Orlando 1-John Rhodes 3-Manual Rico 5- Freda Winbush 7- Joe Donner 2- Ida Silverstein4- Joe Orlando 6- Tony Carr 12- Mary Clark

37 The smart OR table. knows when the patient has arrived; knows WHO the patient is; A Pos knows when the patient leaves. Tablet PC: 1. gets input from table (patient ID) 2. has built in 2 nd RFID reader to read blood bag tags 3. has software to check match between bag and patient.

38 Blood Transfusion Check Screen

39 Blood Transfusion Check Screen

40 RFID enables Benefits in Healthcare RFID is an enabling technology that when combined with other technologies such as wireless access, tablet PCs, and effectively integrated with clinical and administrative systems can deliver many benefits: Better collection and analysis of healthcare data enabling the tracking of operations more efficiently Increased work efficiency decreasing the amount of time physicians and nurses spend tracking down administrative and clinical information. Prevention of adverse events by immediately presenting critical information such as pharmacy data, allergies, and institutional guidelines. Increasing caregiver satisfaction by speeding access to legacy systems and simplifying the input and access to patient information Improved management of assets through the real time tracking of critical care equipment and supplies

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