Untapping RFID’s Potential

AS ADVANCES IN RADIO FREQUENCY IDENTIFICATION GAIN DOD'S INTEREST—TECHNOLOGY CHALLENGES REMAIN ON THE CLOSE-IN HORIZON.

Radio Frequency Identification (RFID) technology allows health care administrators and logisticians to automate the visibility and management of pharmaceutical inventories, equipment and other materiel, and track patients and high-value objects through transit.

Organizations that use this technology point to reduced operating costs, improved efficiency and visibility of the supply chain, reduced theft, faster decision-making at the point of data capture and other returns on investment (ROI) as part of their business case studies.

While the initial results of select service pilot programs have provided ROIs similar to those realized in civilian institutions, issues of standards and other enablers must be resolved before DoD can expand the technology for broader applications.

PRIVATE SECTOR PROJECTS

There is a potential usefor RFID technology throughout every department of a medical facility. One area of interest is the supply-chain management of pharmaceuticals.
 
“Texas Instruments (TI) believes that RFID is the most promising technology available to create a safe and secure pharmaceutical supply chain as well as ever-increasing return on investment and improved business processes,” said Rafael Mena, RFID engineer, Texas Instruments RFid. “When combined with a secure tag and data infrastructure, RFID raises the level of confidence that a product is genuine by determining the authenticity of the packaging, and by providing automated traceability to create an itemized electronic pedigree [ePedigree], or record, that an item has passed through authorized entities. Authentication can be carried out both on-network [linking to a data base] and off-network [using a digital signature],” he added.

Beyond the pharmacy, RFID technology is also touted to bolster inventory management of other materiel.

The Heart Hospital Baylor Plano in Texas implemented an RFID-enabled inventory management system in March 2007 that stores, tracks and manages almost all of their most expensive cardiovascular devices and supplies. “The system, developed by Mobile Aspects with TI’s RFID technology, has the potential to save the hospital about $2 million a year in lost or misplaced equipment,” predicted Mena.

TI and its industry partner, ClearCount Medical Solutions collaborated for another innovative use of RFID technology. The SmartSponge System from ClearCount, uses high-frequency RFID tags from TI to automate the process of managing surgical sponges during surgery.

“The sponges are permanently affixed with passive RFID tags smaller than a dime, helping prevent ‘retained surgical items,’ protecting patient safety,” pointed out Mena.

Passive RFID tags, as noted by Mena, do not have a power supply and must rely on the power emitted by an RFID reader to transmit data. If a reader is not present, the passive tag cannot communicate any data. Whereas active RFID tags have a built-in power supply (usually a battery) and electronics that perform specialized tasks, and can communicate in the absence of a reader.

According to Steve Fleck, co-founder and chief technology officer of ClearCount, “Unlike other technologies, ClearCount’s RFID-based SmartSponge System allows users to simultaneously count and differentiate between types of sponges. Additionally, since RFID does not require a line-of-sight between the reader and tags, there is no need to physically separate sponges or orient the tags in any way to scan them. This minimizes the handling of soiled sponges by nursing staff.”

A second vendor, Motorola, has two major product lines to enable RFID technology. The first product portfolio consists of fixed-, mobile- and handheld RFID readers. “There is also an emerging new market for a converged mobile computer, or handheld computer, that could read bar code or RFID tags up to about 20 feet,” said Bill Hartwell, vice president, Government Markets Division.

Barcode stickers referred to by Hartwell are ubiquitous throughout DoD medical facilities. However, bar coding systems and RFID are two different technologies and traditionally have different applications— which often overlap. The major difference between the two is bar codes are line-of-sight technology, where a scanner has to “see” the bar code to read it. This means the inventory taker or other logistician must orient the bar code toward a scanner for it to be read. RFID, by contrast, doesn’t require line-of-sight hardware.

Hartwell continued, “The mobile computer could also be used as a PDA or cell phone, so it is a very powerful converged device for data capture for that mobile worker, whether it is a doctor, a nurse or supply-chain specialist.”

While Motorola supports a number of RFID pilot projects throughout the department, it is worth noting that the company also supports bar code data capture technology projects, including one with Veterans Affairs.

The VA is tracking patients using bar code data capture technology and also using the technology to provide on-line, real-time updates wirelessly to the patient’s medical record. “This was a very important application that was developed by a company called Care Fusion which is now owned by Cardinal Health. The VA is a big user of this application. It allows the health care provider to give the right individual the right medication at the right time. It gets the health care professional out of the paper world and having to rely on their memory to ask: Did I give patient X a certain medication at a certain dose an hour ago?” he added.

These and other successes have caught the attention of the military medical community.

DOD DEVELOPMENTS

The Air Force’s requirements for RFID technology are focused on applications rather than RFID technology itself. “We are looking at existing gaps in our ability to manage assets, lab specimens, and pharmaceuticals within the facility, as well as the in-transit visibility and inventory tracking and accountability of assets shipped from one location to another,” pointed out Dave Baker, chief, clinical engineering, AFMSA/SGRM, Fort Detrick, Md.

To support this vision, the service “has completed pilot projects at Kelly USA [former Kelly Air Force base] on the wholesale side of medical logistics,” said Baker. He also noted that the Air Force has “looked at the RFID technology to augment our current bar coding system for tracking patient movement items within the aeromedical evacuation system, from storage, to use on patients, through the redeployment.”

The Air Force is also examining the use of active and passive RFID tags.

“We have just finished the live portion of a pilot project for tracking medical equipment assets using totally passive tags at Wright-Patterson Medical Center,” recalled Baker. The service has an additional pilot project in the planning stages that expands from just asset tracking to tracking lab specimens, medications and possibly patients. “This pilot project is also going to look at detailed cost benefit in all functional areas, and will likely use a mix of technology including passive, active and real-time location,” said Baker.

The Navy medical community is taking stock of its RFID efforts to date, to ensure its programs are harmonized with those of the other services and that it implements this technology within a business case framework. “We are aware of numerous RFID initiatives where Navy medicine is an active participant to include: pilot projects on ships, patient tracking, ‘smart cabinets’, in-transit tracking, and other applications,” remarked Miguel Pagan, Office of the Navy Medicine CIO. “What we are trying to do is build a framework that can accommodate our requirements from both business and policy compliance perspectives,” he added.

Two recent Navy automatic identification technology (AIT)-supported pilot projects that are responding to current service medical requirements have included a mass-casualty exercise at Navy Regional Medical Center, San Diego, and enabling the deployment of a 10-bed expeditionary medical facility (EMF) at the Naval Expeditionary Medical Support Command, Williamsburg, Va. “The mass casualty drill successfully tracked patients, equipment and clinicians at Balboa,” recalled Tom Lippert, PML-500’s ILS coordinator, Naval Medical Logistics Command, “while the event at Williamsburg was, to our knowledge, the first to utilize automated information data capture technology to actually show a positive return on investment by reducing the lift required to deploy the EMF from two aircraft to one,” he added.

A third RFID pilot project was demonstrated on board USS Nassau (LHA-4). “We showed that RFID can be used to receive and put away supplies much quicker,” said George Ganak, (formerly Navy AIT office) now systems engineer, Product Manager-Joint, AIT. This was a stepping-off point to take the proof-of-concept to a dedicated medical facility. “What we are looking to do next is to complete the same project on one of the hospital ships, to bring the products on board and instead of storing them in passageways, move them into the appropriate stowage locations and improve overall inventory accuracy,” he concluded.

“As another benefit, the project will also strengthen the frontend of a product’s life cycle and could enable the ePedigree, which would involve the identification of specific high-value products, allowing someone to receive it at a military treatment facility, read the AIT media, then send that information back through a communications tool to the manufacturer, in order to authenticate that what was received was actually what was sent,” he concluded.

While the Army Medical Department is not using RFID with its pharmacy program, the organization is in the process of reviewing its capabilities. A department pharmacy consultant “has met with a company that provided good information about RFID and its ability to prevent drug theft. However, our consultant notes the biggest issue is that not all pharmaceutical companies are utilizing RFID,” reported Jaime Cavazos, senior public affairs supervisor, MEDCOM public affairs.

VISIONS FOR TOMORROW

The Air Force’s primary experience with RFID technology has centered on asset management and asset tracking. The service is looking to expand its use of RFID technology to broader applications. “The ultimate goal would be to tie all asset and supply information back to the patient information within the electronic medical record,” said Baker.

He recalled that when his division first presented the concept and potential applications of RFID technology to the Air Force surgeon general, “he quickly saw potential value on the clinical side in being able to instantly determine that all supplies and equipment for a particular surgery were ‘in the operating room with all scheduled maintenance complete.”
 
The Navy has a similar vision for RFID. “This technology would tell the logistician when a physician, physician’s assistant, nurse, medic or corpsman uses something. We will be able to ship them a replacement without them having to look up a stock number, an identification code or other information— they can focus on practicing medicine,” stated John DePasquale, program manager, Medical Logistics, Telemedicine and Advanced Technology Research Center (TATRC).

The extent these and other expectations are met is dependent on technology developments.

HURDLES TO WIDER USE

While RFID appears to be meeting the litmus test of reliability in evolving service pilot projects, other criteria including security interfaces, interoperability and standards must be resolved prior to wider department implementation. “The Air Force Medical Service is already working to address a standard specification for interface to existing systems, and the next big hurdle would be meeting all of the information security requirements imposed by the DoD. This must be a collaborative effort between the vendor and the DoD,” suggested Baker.

One of the Navy’s major concerns surrounding RFID is that some emerging RFID systems are proprietary and do not communicate with others. “Whether by vendor choice or poor design, there are solutions that cannot speak with other systems. If you look at the DoD policies regarding interoperability and the in-transit visibility requirement, that approach is clearly unacceptable,” said Pagan.

As with other emerging technologies, the end-users, vendors, engineers and other stakeholders seek the issuance of standards early in the technology’s life cycle. So too, with RFID.

At a Penn State University Center for Supply Chain Research and TATRC-sponsored conference in May 2007, RFID in military medicine was discussed. The overwhelming consensus was that the community currently lacks standardization. “This was brought up by both speakers and participants as well,” recalled TATRC’s DePasquale. He noted the conferences attendees represented DoD, the Food and Drug Administration, industry and other organizations, and “there was almost universal consensus that one of the major bumps in the road to acceptance and the wide spread use of this technology is standardization.” ♦

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