Radiofrequency identification and wi-fi systems are helping BMETs track hard-to-locate equipment.

Everybody hoards something.

In the busy wards of hospitals, nurses and aides hoard all kinds of patient-monitoring and -treatment devices. The staff would rather have these devices on hand when the need arises, even though from a hospital’s efficiency point of view, they are supposed to be shared.

The hoarding drives biomedical equipment technicians (BMETs) and clinical engineers crazy. How can they perform preventive maintenance (PM) on devices that are hidden away in a closet?

David Wickersham, BMET, ISE, Aramark Clinical Technology Services, is manager for clinical engineering at Bon Secours Richmond, a four-hospital health system in Richmond, Va, that totals more than 700 beds. “We don’t need 500 infusion pumps,” Wickersham says, talking

about the main hospital. “We manage effectively with 250, but departments like to keep spare equipment on hand when it isn’t in use to ensure they can find it if they need it.”

He uses another example: pulse oximeters. “We might have 35 sitting around that are not in clinical use, and that’s $75,000 that doesn’t have to be spent.”

It isn’t just for the all-important PMs that devices need to be found. There may be Food and Drug Administration recalls on equipment that then has to be located, Wickersham says. And, of course, the equipment needs to be found whenever a patient needs to use it.

Another need to locate equipment is for infection control, Wickersham says. “ [The Joint Commission on the Accreditation of Healthcare Organiza-tions (JCAHO)] wants you to keep track of where a patient has been and what equipment was used on that patient. It is possible for infections to pass from the equipment to the patient if proper infection-control procedures are not followed.”

For all of these reasons, hospitals like Bon Secours have been deploying radiofrequency identification (RFID) tracking systems that use sensors and wave-emitting tags to keep track of devices such as ventilators, infusion pumps, noninvasive blood pressure modules, and even beds and wheelchairs as they move about in the hospital. These asset-tracking tags have also been shown to reduce device theft.

Tracking technology isn’t new. It’s been used in big distribution centers like grocery warehouses for years, Wickersham notes. What’s new is its adaptation to the health care setting, an adaptation that’s far from complete. It isn’t just equipment that can be tracked. Patients, nurses, and physicians can potentially wear the tracking tags, too. “I’m by no means an RF guy, but I can see we’re just scratching the surface.”

Wickersham says the radiofrequency (RF) tags, each about the size of a “one-bite candy bar,” will eventually go on 7,000 or more pieces of equipment at the Bon Secours hospitals.

The tags are tracked by hard-wired sensors mounted in locations throughout the hospital. The tags send out a signal every 5 minutes or so, Wickersham says. The equipment can be located using computer software that operates on a PC and shows where the equipment is, he says.

“We can also use a handheld device and walk through the hospital and locate the equipment using its security number,” he says. He likens the handheld device to a Palm Pilot and says arrows tell him to go forward or backward to find the device he’s looking for—like medical hide-and-seek.

“For now, we’re concentrating on getting the portable equipment into the database,” Wickersham says, but he adds that Bon Secours will probably tag even stationary equipment at some point so it can manage those assets too.

Will there be a new role for biomed technicians taking care of RFID and other tracking systems? Wickersham says that will happen “eventually,” but for now, he adds, the vendor is under contract to maintain the system.

Choosing Wi-Fi
Not all tracking systems use RFID. At Palmetto Health Richland, a vast 1.5 million-square-foot hospital complex in Columbia, SC, that is soon to add a heart hospital to its other structures, administrators have turned to a wireless fidelity (wi-fi) system to handle equipment tracking.

Thomas E. Heideman is clinical engineering manager for the hospital. He says cost was a major factor in choosing wi-fi. “We looked at RFID, but for the same price for 400 tags, we got [both main buildings] and 7,000 tags with wireless.”

He says three antenna systems placed around the complex use triangulating techniques to track the tagged equipment with the help of software. A technician has to do a walk-through of the hospital the first time and punch in location points so the software knows where each location is, he says.

Each tag is programmed using a wireless router, he says. Once programmed, the tag sends a signal to wireless sensors located throughout the hospital and linked to the antennas. The Palmetto information technology (IT) department put in the antennas, and the wi-fi vendor supplied the tags and software, Heideman says. One hospital technician has been assigned to program the tags, monitor the batteries in each tag, and oversee the system. Heideman says the first 350 tags, which the technician recently finished programming, were done one at a time, but the vendor now has a system to program as many as 100 tags at a time.

Since it is just beginning its project, Palmetto is focused on tagging its nearly 800 infusion pumps, hoping to end the need to rent additional machines if hoarding can be stopped, Heideman says. He estimates that in the next month or two, all of the wi-fi tags will be deployed on various equipment, perhaps including beds, ventilators, blood warmers, suction pumps—“anything that’s mobile that we need to do a PM on, that’s what we want to put the tags on.”

He says already for July, the tags raised the infusion pump PM-compliance rate to 97%, well ahead of the JCAHO standard of around 90%. He says PMs are done on roughly 80 pumps monthly.

“Normally, at the beginning of the month, they are easy to find. In the last 2 weeks, they are hard to find because they’re out there on a patient somewhere. It’s like looking for a needle in a haystack.”

But that’s not the case when the pumps have been tagged. “We were having the pumps report location once a week, but when we got down to the last few, we told them to report four times a day, and we found them,” Heideman says.

Unlike passive tags, the tags Palmetto uses are “smart” tags that can be told when and under what conditions to report their location, Heideman says. Commonly, they are programmed to report location when they go in motion and again when they stop.

But every time they report, the tags use up battery capacity. The tags are big, about the size of a pager, Heideman says, and in the beginning, the more information they had to relay, the more their rechargeable battery packs wore down. Those packs had to be swapped out while the old packs were recharging, and this took time. So, the tags were reprogrammed not to report as often.

Heideman says he’s now come up with a partial solution to the battery-charging problem: On equipment that has its own power, like an infusion pump, he’s been able to route a small cable from the pump to the tag’s battery pack so the power from the pump keeps the tag charged. “The competition doesn’t have this yet,” he says, “but they will.”

The Interoperability Payoff While asset-tracking technologies allow medical devices to send location and identification data to central locations, those devices still cannot communicate with one another, nor can they relay clinical information. But that soon may be changing, according to Julian M. Goldman, MD, a physician adviser to Partners HealthCare Biomedical Engineering (Boston). Standards are currently being developed that will allow medical devices to talk to one another and send data to hospital- and patient-information systems, Goldman says. If data from machines—information such as blood pressure over time, or drug dosage, or ventilator settings—could be sent to a centralized source, it would substantially improve the quality of information in a patient’s electronic medical record, Goldman says, adding, “The missing piece is that we currently can’t generate a complete medical record because of the challenge of acquiring data from medical devices.” If software-coding standards such as some already being used—digital information and communication (DICOM) in imaging or health language 7 (HL-7) for medical-report writing, for instance—were in place for medical devices, the devices could send data to hospital and patient files, Goldman says. Moreover, the devices might even be able to communicate with one another and control one another when sequential tasks were called for. This would be the true plug-and-play (PnP) world that Goldman and other medical-engineering experts dream about: A device would arrive from the manufacturer already programmed to do business with its fellow machines and to feed its data into information systems. As of yet, there are no such wide-ranging communication standards to get information from or to control medical devices. There are only specific interfaces, says Goldman, which require tangles of cable running from one machine to another. Goldman and others are trying to change this. They have formed the Medical Device PnP program and are working with the Food and Drug Administration, Center for Integration of Medicine and Innovative Technology manufacturers, clinicians at other institutions, medical societies, Kaiser Permanente, and other federal agencies to lead the implementation of medical device interoperability standards. “For the past year, we’ve been working on eliciting high-level clinical requirement and analyzing the results to extract more specific, actionable specifications that can be implemented by engineers,” Goldman says. “It’s a difficult, but essential, first step that will help to ensure the clinical relevance of interoperability standards.” More information about the Medical Device PnP Interoperability Program can be found at www.mdpnp.org.

Beyond Asset Tracking
At Massachusetts General Hospital (MGH) in Boston, a lot of time and money has been spent to construct what the hospital calls its Operating Room of the Future (ORF).

Julian M. Goldman, MD, is a physician adviser to Partners HealthCare Biomedical Engineering, which provides biomed services to the hospital and the ORF. He is also an MGH

anesthesiologist, who works in the ORF, and is the principal investigator for the hospital’s medical device interoperability program. At MGH, they call the ORF “a living laboratory to evaluate new technology and perioperative processes.”

One piece of that technology is a patient- and equipment-tracking system that is being put through several clinical

trials at Partners HealthCare, Goldman says. Both active, or “smart,” RFID tags and passive RFID tags are being tested, Goldman says.

The tracking system that the ORF uses is similar in functionality to satellite-based global positioning systems, most well-known for their usage in cars and trucks as dashboard map- and vehicle-location displays. The ORF’s system and others like it are called indoor positioning systems (IPSs). The system in use at MGH combines RF with optical (infra-red) to enhance location resolution.

“The term IPS describes the function, [and] the RFID is the technology,” Goldman says. In contrast to the active RFID-based IPS technology, passive RFID technology is the basis of a “smart” ORF anesthesia-medication and -equipment-cart project being led by Warren Sandberg, MD.

Outside as well as inside the ORF, Partners HealthCare is evaluating RFID IPS systems to track medical devices and other hospital assets. For example, a trial at Brigham and Women’s Hospital, Boston, is using IPS technology to reduce loss, improve the quality of staff work life, and speed access to devices, such as telemetry transmitters, 12-lead ECG cables, and portable external pacemakers.

In one of the clinical trials, led by Walter Dzik, MD, to enhance the safety of blood transfusions, MGH patients are being fitted with a wristband containing an RFID chip and matched to blood bags containing an RFID chip, Goldman says. The chip carries a limited amount of data, like the patient’s identification data. A handheld reader/writer can be used to read data from the chip and to send new data, like the latest medication notes, to the chip. One drawback, however, says Goldman, is that the reader and writer have to be close to the chip, about 6 to 9 inches away.

Goldman says this data-chip system is not yet “widely rolled out.” But it has promise in diverse health care settings, he says, because data can be written to the RFID chip in the absence of network connectivity to the hospital’s information system, and it could be synchronized with the hospital’s information system and a patient’s electronic medical record (EMR) when connectivity is reestablished.

In other tracking trials in the ORF, patients, physicians, and nurses were fitted with active tags that are tracked continuously through the process from patient arrival to recovery. Data from these trials are being used to compile time and motion studies. These studies are then being compared to similar studies in other ORs at MGH, Goldman says. These studies may show how the ORF’s streamlined and safety-conscious surgical protocols compare with those in traditional ORs.

“There are still many things that can best be learned through real-world trials,” Goldman says. He says one study used time-stamping from the moment the tracking system shows that both patient and anesthesiologist have come together in the induction room, to automatically assign a “start of anesthesia care” event in the EMR.

Goldman suggests that asset tagging is going to be “one of the next big things” to improve hospital efficiency, and calls it the “low-hanging fruit of the RFID world.” According to Goldman, “As more items, patients, and personnel are tagged, and interactive tracking applications become more sophisticated, these systems will become essential to run a modern hospital. We will depend on the technology to improve the safety of medication administration, identify the location of patients and equipment, and place that information into the EMR or trigger real-time alerts to improve both safety and efficiency. One example will be the capability of rapidly locating and alerting the nearest potential responder in the case of an emergency.”

Goldman applauds RFID tracking, calling it a “success story” already. But in terms of the interoperability that he foresees in the future (see sidebar, page 20), “RFID is just a little piece of the big picture,” he says.

Someday, BMETs may not have to track infusion pumps for PMs. Once these devices arrive in the dirty room, they will announce their location and tell the BMETs when it’s time for maintenance.

“This work is all synergistic,” Goldman says. 24x7

George Wiley is a contributing writer for 24x7.