Today’s radio-frequency technology keeps tabs on all equipment enterprisewide, identifying location and condition of assets.

Over the last decade, radiology has changed significantly. New modalities, innovative tests, wireless communications, and digital record-keeping have revolutionized the entire field. But the revolution is not over. Indeed, it’s poised for an enterprise-wide change to the way that equipment from the largest capital piece to the smallest consumable is tracked and measured.

Radio-frequency identification (RFID) technology is quietly making inroads into the health care setting. This mainly unobtrusive, digital method of tracking equipment, staff, and patients had its origins in the early 20th century and its first practical applications during World War II, but it wasn’t until the beginning of the 21st century that many industries, including health care, began experimenting with and adopting the technology.

The technology relies on the emission of radio signals from a tag attached to an object. These can be either “active” signals that are broadcast from an object or “passive” signals that use transponders that are activated when radio waves come in contact with them (see sidebar: “Common RFID Terms” below right).

Typically, in the health care setting, RFID tags—whether active or passive—simply tell an administrator, nurse, or technician where a piece of equipment is. Essentially, it uses a kind of barrier system, placing RFID antennas in key entry points, such as doorways, stairwells, and entrances and exits. This is an effective way to keep track of equipment such as wheelchairs, but doesn’t allow personnel to know its condition. RFID has become synonymous for a whole class of radio-frequency ID technology, including real-time location systems.

Active-Passive Marriage

Redwood City, Calif-based AeroScout and Chelmsford, Mass-based Reva Systems offer an active-passive solution that delivers an enterprise-wide one-two punch. The two companies have been partners for the last 18 months or so with AeroScout supplying the active tag-based monitoring system and Reva the passive one.

Common RFID Terms

As with any new technology, radio-frequency identification (RFID) technology brings with it a plethora of new, technical terms.

  1. RFID: Radio-frequency identification is a method to determine the location, identity, or other parameters of medical equipment, personnel, and patients using radio waves. RFID was first perfected during World War II.
  2. RFID Tag: Is a microchip attached to an antenna that broadcasts information to a reader. This information can be a unique serial number or other identifier. An RFID tag is most typically either active or passive.
  3. Reader: Is a device that communicates with an RFID tag and sends the information to a computer system.
  4. Active Tag: Is an RFID tag that has a self-contained power source (usually a battery) and broadcasts a signal to a reader.
  5. Passive Tag: An RFID tag that is not battery powered. The tag is energized and transmits when it encounters a radio wave.
  6. RTLS: Real-time Location System is a combination of wireless hardware and real-time software used to continuously locate a tagged item. Though it isn’t synonymous, RTLS and RFID can be used as interchangeable terms.

Both pieces of technology are linked into a hospital’s wi-fi network, which allows it to act in much the same way as a global positioning system, according to Gabi Daniely, vice president of marketing and product strategy for AeroScout.

Because the partners offer a full range of tracking options, it allows hospitals to tag everything from the largest capital equipment to the smallest consumable item. The tracking is handled through a centralized computer system, and, because the tags are completely integrated, a user will not know if the tag is an active or passive one. “We believe that having a hybrid system like ours is a real advantage,” said Ashley Stephenson, chairman and cofounder of Reva.

Early versions of RFID technology simply told an observer where a tag (which of course was attached to a piece of equipment) was; AeroScout and Reva’s systems do the same, but also can tell what condition the equipment is in. According to Daniely, there are five key ways in which AeroScout tags can monitor equipment—maintenance alerts, asset management, condition monitoring, patient and staff safety, and workflow management.

Equipment monitoring, such as tracking temperature and humidity in refrigerators, can be checked remotely instead of by technicians directly, saving staff time for patient care or equipment repair. Patient and staff tracking are of particular necessity for those in high-risk situations, eg, dementia patients or psychiatric staff. Maintenance schedules—such as those for imaging equipment—can be kept more regularly by programming the active tags to transmit alerts at certain times. The active tags have a range of about 100 feet or more. These tags are about as big as a key fob, and the batteries in them are rated to last about 4 years, according to Daniely. This is because the tag broadcasts only when it needs to.

The passive tags can be used alone or in concert with the active tags. For instance, Stephenson notes that the passive tags can be attached to specimen trays or in cabinets, allowing for inventory use tracking. They also can be set to activate if something has or hasn’t happened. For instance, if medical personnel didn’t wash up before entering the operating room, an alert can be sent automatically to an administrator or supervisor. Passive tags have a range of about 15 feet.

The ability to send individualized, automatic alerts is another advantage of the system, according to Stephenson. Parameters for alerts and notices are dynamic and can change throughout the day several times depending on the needs of the staff or protocols of the hospital.

Depending on the requirements of the hospital, the system takes between 1 and 3 months to install. Hospitals have the option of installing the entire system or purchasing it separately.

While the AeroScout-Reva partnership gives hospital enterprises a dynamic range of options to remain efficient, it is not the only system of its kind that’s available.

It’s a Snap

According to Awarepoint chief technology officer Matt Perkins, his company’s real-time location system is a wireless sensor network. And unlike a traditional RFID system, the San Diego-based company’s does not involve an invasive installation process.

Instead, Awarepoint installs sensors that look surprisingly like Glade plug-in air fresheners. And, according to Perkins, in most cases staff won’t even be aware that the devices are being installed. These sensors are typically plugged into an unobtrusive or little-used outlet in every third room, creating an ad hoc network. “[Graphically] it looks like a spider web,” Perkins said.

One of the big advantages of the Awarepoint system is that a hospital’s information technology department does not even have to be involved with the installation. All the company needs is a connection to the hospital’s Internet and it can be made live. According to Perkins, the system can even be set off from the rest of the hospital Web site with firewalls and other security protocols and still be fully functional.

The system relies on active tags, and, because of the sensor network, it continuously updates the tracking database. When a tagged piece of equipment passes a sensor, it tells the tracking database where it is. This allows administrators to keep track of physical assets, personnel, and patients. The company can monitor the system, making corrections as needed. If a sensor is damaged, blocked, or removed from the wall, the system will recalibrate the “spider web.”

Like the AeroScout system, Awarepoint’s can help maintain radiology capital equipment—making sure that it is calibrated correctly, for instance, or if it’s even still in the hospital. The system also is ideal for managing workflow, identifying where patient bottlenecks are occurring. Perkins said that one client had an eye-opening revelation about throughput after installing his company’s system. “This client thought that the average wait time was 30 minutes or so. In fact, the average wait time was 97 minutes,” he said.

Five Requirements Critical
for RFID Success

Matt Perkins, chief technology officer of Awarepoint, identified five requirements that are critical to make RFID implementation a success.

  1. The RFID system has to be deployed enterprise wide.
  2. Make sure the system meets the hospital’s accuracy requirements.
  3. It has to be easy to deploy and maintain.
  4. It has to be interoperable with other systems.
  5. The system has to conform to a low-risk business model.

But it’s not just in the mundane, day-to-day business concerns of the enterprise where an RFID system finds its value, but in the life-and-death moments. Perkins said that one dramatic case shows how Awarepoint’s system can save lives as well as money.

Within 15 minutes of activating a system recently, a patient coded during an operation and needed life-saving equipment that wasn’t typically available in the operating room. Before the Awarepoint system was installed, the standard operating procedure was to send out 12 to 15 people to find the equipment. During this emergency, a staff member searched for the equipment on the database and found it in 15 seconds. Because of the almost instantaneous location and retrieval of the equipment, the patient was saved.

Saving money and lives is perhaps the biggest reason that the University of California San Diego (UCSD) Medical Center recently expanded the system to its main campus.

Case Study: UCSD Medical Center

UCSD first installed the Awarepoint Real-time Location System almost 2 years ago in its John M. and Sally B. Thornton Hospital. Scott Sullivan, business manager Perioperative Services at UCSD, said that installation was extremely easy, taking about 2 weeks to install the sensor network throughout the 119-bed, 250,000-square-foot hospital. “The pain was all on our side, trying to decide what we wanted to track,” he said.

The implementation of the system was launched in the second floor operating suite, and then throughout the rest of the hospital. And while there were no staff or patient disruptions during the installation, there were a few surprises after the system went online. The first was a minor glitch. Because the sensor zones overlapped, the radius of the building was extended, so some equipment was actually located by the “spider web” outside the building. Awarepoint contacted Thornton administrators almost immediately and corrected the problem.

Sullivan said that the biggest surprise for him was how much equipment was on the hospital’s books that was no longer present at the facility. About 30% of all the equipment listed on the inventory sheets had been either disposed of or lost. Among the pieces of equipment that the hospital tracks are infusion and feeding tube pumps. The improved tracking of these pieces of equipment alone saves the hospital almost $6,000 a month, about the cost of the tag rental fee from Awarepoint—the company gives the system to its clients for free, only charging for the tags.

Though radiology is currently not using the Awarepoint system, the operating room is tagging its x-ray aprons, which have cut down on what Sullivan terms “relocation.”

The system also has been tailored to the UCSD system, with numerous pregenerated reporting functions loaded into the database that conform to the hospital’s protocols. All of the computers have shortcuts set up to the database. In all, Sullivan calls the system very user friendly.

The Awarepoint system proved itself during the San Diego fires of 2007. During that emergency, the system was tasked to locate mobile equipment such as gurneys and wheelchairs needed for patient evacuation. Location of all this equipment took about 5 minutes. At UCSD’s main Hillcrest campus, it took several hours, and included gathering the equipment into a centralized holding area where security officers had to monitor it. After the fires were contained, Sullivan approached senior management about expanding the system to Hillcrest. It was installed in the 1-million-square-foot facility in October 2008.

From an asset management perspective, having Hillcrest taking part in the system has been extremely beneficial for both hospitals. This is because the tags can be tracked between hospitals, meaning that if a piece of equipment that belongs to Thornton shows up at Hillcrest (which is 14 miles away) and vice versa, it can be identified and returned. This also would be the case if a piece of equipment belonging to a hospital outside the UCSD system showed up at Hillcrest or Thornton.

No matter the vendor or particular technology, the benefits of RFID technology for asset and personnel tracking are becoming apparent. It may not be common in the radiology suite—yet—but there’s little doubt that once it enters its confines, RFID will be there to stay.

C.A. Wolski is a contributing writer for Axis Imaging News.