Finding a piece of medical equipment—an IV pump, wheelchair, or stretcher, for instance—can be like searching for the proverbial needle in the haystack, only the haystack is often a large, multistoried facility, and the needle is an expensive piece of medical equipment that impacts patient care. Asset location management systems can help eliminate time-consuming searches, as well as assist biomeds with other work-related tasks.
According to Kevin Swank, director of product marketing for InnerWireless Inc, Richardson, Tex, a wish list for biomeds in the market for an asset location management system looks something like this: “I want to find equipment. I want to improve the utilization of that equipment. I want to prove I am in compliance with the regulatory requirements for that equipment. I want to improve the productivity of the people using that equipment. I want to reduce patient stays through improved usage of the equipment. I want to increase patient revenue and move more patients through the facility. I want to improve safety in all these areas.” This is what they want, but how do they find it?
Asset location management systems have a few monikers: real-time positioning systems, indoor positioning systems, and indoor/outdoor positioning systems, to name a few. But whatever the system is called, there are primarily two technologies currently available to achieve these biomed goals: Wi-Fi, or systems that use the 802.11 bandwidth; and proprietary radio frequency identification (RFID) systems that operate on frequencies other than that utilized by 802.11.
Each methodology has advantages and disadvantages, which can help to guide a hospital in selecting the system that is right for it. Existing infrastructure, number of assets, area to cover, and budget are factors facilities take into account. Often, budget can be the major driver for a decision, but users are cautioned to accurately forecast an investment before basing a decision on numbers. Unexpected costs can drive up the price of a system.
The good news is that it is possible to see a return on the investment within 1 year; in fact, some facilities have realized a return in as little as 9 months, according to Joshua Slobin, director of marketing for AeroScout Inc, San Mateo, Calif.
Extra bells and whistles may be worth the additional investment if they help to increase the value and maximize the return. Innovations will not only serve to increase the functionality of the systems, but also to expand their scope, positively impacting workflow processes throughout health care.
At their most basic, asset location management systems locate and track equipment. Whether using Wi-Fi or RFID, the system basics are the same: small tags affixed to the object to be tracked collect information about the item’s—or a person’s—location. This information is then transmitted to the system via wireless communication, where users can access the data to complete tasks such as tracking or maintenance. The big differences between the technologies fall within their methods of determining position and the transmission of this information.
“There is always a tag communicating with some sort of receiver, but there is no single list of technologies. On the one hand, you have the software and algorithms used to determine positions, and on the other, you have the different technologies used for the communication or the air interface,” Slobin says.
Three methodologies can be used to determine a tag’s location, according to Slobin: received signal strength indication, which determines the location of a tag through the strength of its signal; triangulation, which uses the distance or direction from multiple receiver points, often three; and presence detection, which provides simple detection capabilities more than a precise location. “If a tag leaves, the receiver will no longer detect its presence and will determine it is no longer there, which is a form of location determination,” Slobin says. A system may use one or a combination of these methods to determine the position of the objects it is tracking.
|Asset location management systems help biomeds eliminate time-consuming searches. Aethon’s HOMER (above) travels the halls pinging tagged assets and tracking their locations. AeroScout’s T3 tag (below) includes features such as tamper proofing, two call buttons for alerting and status reporting, and multiple LED indicators.|
“The accuracy of these systems has been improving. In the past, they could misread by an entire floor, but today, accuracy within 15 feet is common,” says Troy Gillette, director, clinical engineering at Robert Wood Johnson University Hospital in New Brunswick, NJ.
Location information can be indicated in a number of ways, depending on the system. Maps, tables, room numbers, and other lists can provide an item’s location. “Users can search for IV pumps, for example, by unique identifiers, the entire category, or a particular type, and retrieve a list or map showing where those pumps are as well as where they’ve been. You can watch them move around on the map,” Slobin says.
Tags can be affixed to a broad range of items; factors in deciding whether certain equipment is “tag-worthy” include the item’s cost or value, size, use, and cleaning methods. Tags are small—Slobin notes one of the smallest is 3 inches by 2 inches by 0.4 inches. “There are practical limits in that you cannot tag an item smaller than the tag,” Slobin says. Use and maintenance will impact whether the tag is affixed using mounted plates, adhesive, or some other method. Both permanent and temporary tags, which some facilities affix to rental equipment, are available.
How often the tag sends information can differ according to the item. Large stationary items can be programmed to “ping” the receiver less frequently than more portable objects, or even personnel. This frequency impacts the tag’s battery life, meaning those tags that ping with greater frequency need replacement more often. “Tag life can be measured anywhere from a year to 7 years,” Swank says, though 3 to 5 is the most common life cycle. Battery replacement can be scheduled as part of the maintenance cycle.
Each tag collects position information and related data, which it then transmits to the system wirelessly. The messages, however, do not carry any patient information, minimizing Health Insurance Portability And Accountability Act security concerns. “There is no way to hack a tag or use a tag to hack the network,” says Lionel Carrasco, chief technology officer of Neoris, Miami. Next-generation tags, however, may be smarter, carry more data, and create a greater risk, but Carrasco believes encryption technologies will continue to minimize concerns. “The tags are just reporting location,” Carrasco says, adding, “To do that, they can transmit over almost anything.”
Many hospitals choose to use their existing Wi-Fi data communication infrastructure, or their 802.11 a, b, g bandwidth, for the asset location management system communication transmission, for the primary reason that they already have the infrastructure installed. Using an existing Wi-Fi system can also reduce the time needed for installation, the maintenance requirements, personnel requirements, wiring requirements, and cost.
“This is a predominant method in use, and its advantages include the lower cost of installation,” Gillette says. However, the cost may not be as low as expected because to maximize the system’s use, a facility often needs to install more access points than it currently has. Gillette suggests that one access point can handle about 15 items and compares this to the 70 to 80 IV pumps in one 10-bed unit at the Robert Wood Johnson University Hospital, a level one trauma center. “Therefore, you may have to increase the number of access points,” Gillette says.
Peter Seiff, vice president of customer solutions for Aethon Inc, Pittsburgh, concurs. “To deliver on the promise of accuracy, you need a lot of infrastructure—more than you would normally put in.” Seiff suggests a facility could need two, three, or even more times the number of access points than it uses for data communication.
The additional access points may be needed for triangulation. “Wi-Fi data communication occurs through contact with only one access point, but triangulation requires three,” Seiff says. Incorporating vertical location can also be a challenge.
Slobin suggests that many hospitals can begin to develop their asset location management system with the infrastructure they have in place, but he also acknowledges that some will need to bolster their capabilities. “It is really based on what they wish to do with the system,” Slobin says. If the facility wants room-level accuracy, it may need to add extra access points.
In addition to accuracy, Wi-Fi asset location management systems may also have issues with bandwidth, but many are not sending enough data to create any real problems. Other vendors have found a way around the bandwidth issue. “Our tags don’t act as a client device but work a bit differently. They send a very small message one way to the network so that it has a negligible impact. We can have up to tens of thousands of tags,” Slobin says. He notes that while some customers outside of health care do use this many tags, those within the medical field have used only up to several thousand tags.
Other companies avoid the bandwidth issue by operating on different frequencies. The systems still typically utilize receivers and tags but operate on proprietary platforms. InnerWireless stays within the 2.4 GHz range of 802.11, but operates using 802.15.4. Since it does not share the same bandwidth, it does not run the risk of interfering with a facility’s existing Wi-Fi system.
Many other proprietary systems use 433 MHz or 418 MHz, Gillette notes. “Because the frequency is completely off the hospital’s network, you can have a substantially increased number of tracking tags—thousands of tags, for example—and not have to worry about loading down the hospital’s Wi-Fi network,” Gillette says.
In addition, Gillette notes that RFID systems seem to exhibit longer battery life. “There is typically a 5-year life on RFID tag batteries, while on Wi-Fi we see about 3 years,” Gillette says.
The Evolution of Asset Location
Management: From Resource
Flow to Workflow
Joshua Slobin, director of marketing with AeroScout Inc, San Mateo, Calif, divides the functions of asset positioning systems into four categories: track, alert, manage, and integrate. “There are a number of things you can do with location information to create value beyond simply locating an asset,” Slobin says.
Of course, being able to locate an asset is the primary value. Eliminating the time it takes to locate equipment can save personnel much time and frustration, in addition to improving patient care and the bottom line. “Health care personnel, such as physicians and nurses, are in the business of saving lives, not managing equipment. When they are done with something, they often leave it where they used it,” says Lionel Carrasco, chief technology officer of Neoris, Miami. As a result, Carrasco notes there are people working 24/7 who collect, clean, and store a medical facility’s assets.
Once a piece of equipment can be easily found, it becomes easier to inventory and maintain. “When biomeds look for equipment for preventive maintenance on IV pumps, for example, they may not be able to find up to 20% of the inventory, meaning it can take weeks to complete an update or recall. Asset location management reduces this time significantly,” says Kevin Swank, director of product marketing for InnerWireless Inc, Richardson, Tex.
Alerts proactively notify users when something location-based has happened, such as removal from the building or a room, or extended time without sanitation. This can reduce the amount of inventory that disappears or is unavailable when needed.
Managing capabilities includes reports that can provide insight on inventory and utilization. Does the facility have too many of a certain piece of equipment? Do they not have enough? “Some of the reports can be done in real time; others provide a historical perspective,” Swank says.
Integration refers to the system’s ability to interface with existing biomed systems. With some systems, biomeds can initiate the location request directly from an existing program that tracks asset information, such as maintenance, capitalization, and depreciation.
Tracking, alerts, and reporting are fairly standard features; integration may not always be an option. Additional innovative features include tags that produce audio signals when an item is being sought, and tags with buttons that permit users to send a service alert to the biomed department.
Over time, tags have become more sophisticated, featuring smaller sizes, longer battery life, tamper-proof mechanisms, and less expensive costs. The software has also advanced: Accuracy has improved, and programs are often able to recognize patterns in addition to location.
As the technology improves, the focus may begin to change from that of resource flow to workflow. By tracking patients and personnel as well as assets, facilities can better examine efficiency.
“When the Internet first debuted, we didn’t understand the implications for e-commerce and new business models and how processes would be affected, but it changed a lot of processes. The same will happen with these systems. Once you understand the technology, it becomes a discussion about processes,” Carrasco says.
RFID systems, however, will often require a significant capital investment since the infrastructure—access points as well as receivers, cabling, and other resources—will need to be built from scratch. Similarly, the time for installation will increase as well.
But RFID companies have realized this limitation and are beginning to develop solutions. InnerWireless uses master radios, beacons, and tags that operate wirelessly, eliminating the need for additional room-level wiring and infection control, thereby reducing the initial investment and time required for the installation.
Another unique approach utilizes mobile autonomous robots not only to find equipment but also to capture and transport it. Aethon decided to build upon its TUG offering. TUG is a mobile, autonomous robot that can be attached to a variety of cart types, which it transports throughout the hospital according to its programming; materials are varied and include laboratory specimens, linens, dietary trays, medicines, and garbage.
The robot’s programming uses the building’s architecture to move so that it always knows where it is and has x, y coordinates. By placing an antenna on a TUG unit that can read asset tags, the TUG can map asset locations. The company’s HOMER is a specialized robot that does nothing but track assets. “As HOMER moves along, it is constantly sending out signals and reading the tags’ unique codes and signal strength, so a single mobile antenna gets multiple readings simultaneously as it moves along,” Seiff says.
TUG and HOMER can work together to locate items and then transport them to departments where they are needed, such as service and repair or materials management/sanitation. “Often, if you’re looking for an asset, it is because you want to use it. Biomeds need to recover equipment to do their jobs,” Seiff says.
Weighing the Economics
To decide which system will best help biomeds and others to do their jobs, facilities must evaluate which objects it wants to track and determine what sort of infrastructure will work best. Correctly estimating beforehand how many access points will be needed will produce a more accurate estimate that will allow for better planning.
“The typical cost of an asset location management system for a 1 million-square-foot hospital wanting to track about 2,500 devices falls between $300,000 and $700,000. Wi-Fi systems will fall in the lower end, and RFID systems will be higher,” Gillette says.
He estimates that much of this cost is applied to installation. “If you’re buying an RFID system running at 433 MHz, installation is about half the cost of the system,” Gillette says.
Pricing varies by company and covers a broad range. In addition to hardware and software costs, a system can be priced according to the number of tags tracked or tag licenses needed, the number of access points or location reading points, or even per square foot.
Tags have been coming down in price and now average about $40 each; many expect their cost to continue to drop. “Some companies have tags that allow you to replace your own batteries, making them more efficient. The alternative is sealed tags that must be replaced, at a cost, when the battery dies,” Gillette says.
The cost of the system may limit how extensively it is applied at first. At the very least, hospitals do not tag items less valuable than the cost of the tags. “Most of the time, tags are applied to more expensive equipment, but if you are going to spend time looking for it, then time may be more valuable,” Seiff says.
For this reason, some of the return on the investment, often seen within 1 year, is not straightforward, but can still have a great impact in more than one department, particularly biomed, materials management, and nursing. More efficient tracking of equipment permits more personnel to know where the equipment is, which allows them to use it more efficiently. Once people can begin to rely on finding equipment, fewer people will hoard it, fewer replacements will be needed, fewer rentals will be required (or lost), and workflow will run more productively.
Check out 24×7’s online Buyer’s Guide for a list of asset tracking companies.
Biomeds will be able to achieve their goals of finding equipment, improving utilization, maintaining regulatory compliance, improving productivity, reducing patient stays, increasing patient revenue, moving more patients through the facility, and improving safety. In other words, they will keep the needle out of the haystack.
Renee DiIulio is a contributing writer for 24×7. For more information, contact .