I attended the Healthcare Information Management Systems Society (HIMSS) meeting this year in Atlanta. I had not attended the meeting for several years, and I was really amazed at the interest in real-time location system (RTLS) radio frequency identification (RFID) technology. There were nine different vendors with systems and several sessions discussing RTLS using RFID. It was nice to see the interest in and the promise of this technology. HIMSS inspired me to tell the story of our journey and how we are looking forward to the promise of this technology.
In 2006, we at Oregon Health & Science University (OHSU), Portland, Ore, were an early adopter of RFID. At that time, capital funding was approved for a comprehensive new Cisco medical-grade 802.11 wireless infrastructure, a Vocera voice over Internet protocol (VOIP) communication system, and AeroScout RFID RTLS. This was a rare opportunity to design all these critical systems together to ensure optimal performance of each—as opposed to trying to make them each work individually with the existing infrastructure or hardware.
From OHSU’s initial use model of tracking mobile equipment with a RTLS, it has now successfully developed and deployed a new architecture to meet its needs and demands.
At the same time, we were constructing a new 14-story patient tower introducing all these new systems with the opening of the new building. Being an early adopter of any new technology does present its challenges. As an example, our new building had a dog leg-like shape with massive amounts of insulated and shielded glass. This caused some design challenges, but we were very fortunate that all of these companies worked together with one another and as true partners with us. As this was one of the first large-scale deployments at an early stage of the Wi-Fi RFID technology, this deployment at OHSU assisted in building best practices that are serving many other customers today.
The Initial Plan
Our initial use model was to track mobile equipment with the RTLS. Through a series of pilot units using the system, we refined the use model and naming conventions for the devices we wanted to track, and we were pleased with the results we were seeing coming from the system. The system was very straightforward with a single set of servers running the application. Since there was really nothing critical that we were tracking, if the system went down, nothing was really lost. We simply used our backup system of having staff walk the halls looking for a device they needed.
While we went through the process of getting our equipment tracking system up and running, new technological advances were made with the RFID tags’ system software and additional use models specific to health care applications evolved.
In one of our regular meetings with our information technology group staff—Chris Coffman, one of OHSU’s senior application engineers—we were discussing some new possible use models for the system. We had been getting requests to use the system to track refrigerator, freezer, and ambient room temperatures to meet regulatory requirements as well as an application to monitor disoriented patients who were at risk of wandering off their nursing unit. The system as originally designed was certainly capable of performing those functions.
Track and log medical refrigerator/freezer and ambient room temperatures. Preliminary testing of this capability has gone very well. We were able to identify some refrigerators/freezers that would periodically exceed the test temperature ranges. The temperature control specifications on these units were just not able to consistently maintain the temperature within the required ranges. This has resulted in changing our standard refrigerator/freezer units that we purchase as well as replacing some units that are just not able to be adjusted to maintain temperatures.
We had just completed a system update that required us to take the system down for a period of time and then test the system after the upgrade to ensure everything was working properly. This was only a minor inconvenience for our system users. Chris pointed out that if we were to use the system with its current architecture for critical use models, we would have issues with missing temperature data and, of course, any alert from a wandering patient. Chris sketched out his thoughts for a system architecture that would allow redundancy so no data or alerts would be lost or missed, as well as a parallel test system to allow system changes to be tested and validated before they were put into a production environment.
We engaged our partner, AeroScout, in looking for possible solutions or configurations that would allow for a failover solution (if the primary server or database went down, the system would switch over to the secondary database and server with no loss of data), as well as a test environment. An architecture was successfully developed and deployed that would meet the needs and demands of a high-availability system. With this new architecture in place, we were free to dream of new, critical applications for our system.
These initial dreams (shown in the boxes) are but a few of the myriad possible uses for a system like this. I have truly believed since we started the installation of this system in 2006 that the only limitation of how you can use a system like this is your ability to dream. As time has gone by and software capabilities have evolved and new RFID tag functionality has been released, I can see that my original belief was correct. Dare to dream—your only limitation may be yourself!
Monitor patients who are disoriented and at risk of wandering off their nursing unit. Being able to quickly respond as a disoriented patient wanders toward the exit to their nursing unit allows staff to return the patient safely to their room. With multiple ways to quickly notify staff, we feel very confident that this will be a tremendous patient safety benefit.
Monitor and improve patient throughput in the hospital in busy procedural and clinical areas such as the cath lab, operating room (OR), and emergency department. This will enable us to monitor patient wait time and staff/patient interaction times, for example, and it will give us critical data for analysis. Being able to track this will allow us to identify bottlenecks and long waiting times, and improve productivity and patient satisfaction.
Track surgical instrument sets through the cleaning and sterilization process to be able to meet the needs of the OR. We have 50 ORs in six buildings, which makes this capability from a production and distribution perspective very critical. Our goal is to interface this data with our instrument management system software to manage a very complex distribution system.
Automatically update mobile equipment status managed by our equipment pool. RFID data will be interfaced with our St Croix logistics manager system to track the status of equipment from soiled to cleaned and ready for dispatch. This capability will assist us in meeting the needs of our customers, especially during times of high census.
Dennis Minsent, MSBE, CCE, CBET, is director, clinical technology services, Oregon Health & Science University, Portland, Ore. For more information, contact .