The Economics, Practical Applications and Constraints in Enterprise-Wide RFID adoption in the Healthcare Industry

Emmanouil Theocharopoulos

SupervisorProfessor Gregory Yovanof

MSc in Management of Business, Innovation and Technology

18/10/2012

Presentation Outline

• Introduction to RFID• Basic Building Blocks of RFID• Types of RFID Tags• RFID Classes• RFID Frequencies and their Characteristics• Barcodes vs. RFID Comparison• EPCglobal and ISO RFID Standards• Electronic Product Code and EPCglobal RFID Approach• The Internet of Things • Implications of IoT to RFID Implementation in Healthcare • Major non-Healthcare RFID Applications • Non-Healthcare related RFID Applications per Sector • EMC / EMI and RFID in Healthcare • RFID Privacy and Security Concerns • FDA Guidance Policy on RFID and Pharmaceuticals • RFID Deployments in Healthcare and their Privacy Impact • Greek Privacy Laws and Data Protection Authority • RFID Privacy Enhancing Technologies • Use Cases in a Smart Hospital • Drivers & Obstacles for RFID Application in Healthcare • SWOT Analysis and Strategies for RFID Deployment in a Greek Public Hospital • The case for University Hospital of Heraklion• Results and Conclusions

Introduction to RFID• RFID is the reading of physical tags on single products, cases, pallets, or re-usable containers that emit radio signals to be picked up by reader devices

• Not a new technology. Its history traces back to WWII

• During the 1960s RFID was first considered as a solution for the commercial world

• The first commercial applications involving RFID followed during the 70s and 80s. These commercial applications were concerned with identifying some asset inside a single location

• In 1998, researchers at the Massachusetts Institute of Technology (MIT) Auto-ID Center began to research new ways to track and identify objects as they moved between physical locations

Basic Building Blocks of RFID

Passive

Active

Types of RFID Tags

• Passive tags do not have an on-board power source so they have to ‘scavenge’ power from the reader in order to run the digital logic on the chip and issue a response to the reader. They can therefore only operate in the presence of a reader. The communication range is limited by the need for the reader to generate very strong signals to power the tag, which therefore limits the reader-to-tag range

• Semi-passive tags require the tag to use battery power for the digital logic on the chip, but still use harvested power for communication. Semipassive tags are far more reliable and have greater read ranges than purely passive tags, but they also have shorter lives due to their reliance on battery power are more fragile, and are significantly more expensive

• Active Tags have an active radio frequency (RF) transmitter (i.e. they are capable of peer-to-peer communication) and the tags use batteries to power the logic chip and to communicate with the reader (i.e. they do not use harvested power). Read range increases and reliability improves. Active tags can be read while moving at up to 100 miles an hour

RFID Classes

Band LF

Low

frequency

HF

High frequency

UHF

Ultra high

frequency

Microwave

Frequency 30–300kHz 3–30MHz 300 MHz–3GHz 2–30 GHz

Typical RFID

Frequencies

125–134 kHz 13.56 MHz 433 MHz or

865 – 956MHz

2.45 GHz

2.45 GHz

Approximate

read range

less than 0.5

meter

Up to 1.5 meters 433 MHz = up to 100

meters

865-956 MHz = 0.5

to 5 meters

Up to 10m

Typical data

transfer rate

less than 1

kilobit per

second (Kbit/s)

Approximately

25 Kbit/s

433–956 = 30 Kbit/s

2.45 =100 Kbit/s

Up to 100 Kbit/s

Characteristics Short-range, low data

transfer rate,

penetrates water but

not metal.

Higher ranges,

reasonable data

rate (similar to

GSM phone),

penetrates water but

not metal.

Long ranges, high

data transfer rate,

concurrent read of

<100 items, cannot

penetrate water or

metals

Long range,

high data

transfer rate,

cannot

penetrate

water or

metal

Typical use Animal ID

Car

immobilizer

Smart Labels

Contact-less

travel cards

Access &

Security

Specialist animal

tracking

Logistics

Moving

vehicle toll

RFID Frequencies and their Characteristics

Barcode RFID RFID Benefit Example

Line of sight

Requirement

Required Not Required

(some exceptions in case of

water or metal)

No need to orientate scanned

items

Number of items that can

be scanned

One Multiple Very fast inventory scan

Automation & Accuracy Manual read errors and prone

to miscanning

Fully automated and highly

accurate

Error free inventory count

Identification Only series or type Unique item level Targeted recall

Data storage Limited codes Up to several kB of data Real time data access in any

location

Distance Less than 3m Up to 100m Very fast inventory scan with

minimal human participation

Interference May be subject to obstruction

from dirt or damage

Metal and liquid can interfere

with some frequencies

No need to orientate scanned

items / Very fast inventory

scan

Human Labour Required / High Moderate for handheld readers

only. Non required for fixed

readers

Low / no labour costs.

Protection against fraud Low High Protection against fraudulent

misuse

Barcodes vs. RFID Comparison

EPCglobal and ISO RFID Standards

Electronic Product Code and EPCglobal RFID Approach

The EPC was developed with goals both mundane and magnificent; from tagging cases of milk to the vision of an "Internet of Things."The Internet of Things refers to uniquely identifiable objects (things) and their virtual representations in an Internet-like structure. It is foreseeable that any object will have a unique way of identification in the coming future, what is commonly known in the networking field of computer sciences as "Unique Address1", creating an addressable continuum of computers, sensors, actuators, mobile phones; i.e. a thing or object around us. Having the capacity of addressing each other and verifying their identities, all these objects will be able to exchange information and, if necessary, actively process information according to predefined schemes, which may or may not be deterministic

The Internet of Things

Implications of IoT to RFID Implementation in Healthcare

• Requires constant and reliable internet connections

• Highly sensitive information about products, involved companies, individuals and patients can be compromised

• Data or Services can be faked for criminal reasons

• More complex system which can fail at different levels

• Requires redundancies and additional security

• In 2003, Wal-Mart issued a mandate that its top 100 suppliers will be using RFID tagged pallets on delivery

• By April 2007, 600 Wal-Mart suppliers were using RFID

• In 2008, Wal-Mart announces its first real compliances ‘penalties’ for failure to tag products

• In 2004, the FDA published a compliance policy guide for industry on implementing RFID studies and pilot programs

• In 2005, Pfizer announced its plans to place RFID tags on all bottles of Viagra intended for sale in the United States

• In 2009, Airbus distributed RFID requirements to suppliers of parts for its A350 aircraft, and will use EPC RFID tags to manage the configuration of A330 and A340 planes, as well as to track tools

• In 2010, Boeing announced a partnership with Fujitsu to develop a full turnkey RFID solution known as the Automated Identification Technology (AIT) Retrofit Package, designed for managing aircraft parts through repair, maintenance and inspection processes. The system is expected to be made commercially available in 2012, following a year of testing by the two partner companies

Major non-Healthcare RFID Applications

Non-Healthcare related RFID Applications per Sector

EMC / EMI and RFID in Healthcare

• EMI (electromagnetic interference) is the disruption of operation of an electronic device when it is in the vicinity of an electromagnetic field (EM field) in the radio frequency (RF) spectrum that is caused by another electronic device

• Any radio frequency transmitting device has the potential to electronically interfere with the operation of another electromagnetic device

• In healthcare facilities, EMI occurs when electromagnetic devices interfere with medical equipment, potentially causing equipment malfunction

• Electromagnetic compatibility (EMC) is the opposite of EMI. No interference caused by its Electromagnetic (EM) environment and it does not emit levels of EM energy that cause EMI in other devices in the vicinity

• Some studies have demonstrated that RFID tags and readers could interferer with some medical equipment and pacemakers in very close proximity

• ANSI/HIBC 4.0 recommends that the 13.56 MHz High Frequency (HF) be adopted for healthcare item level tagging specifically because its smaller read range is less likely to result in EMI with medical devices

• Surreptitious identification of individuals by known/unknown parties, without their prior knowledge or consent

• Systemic tracking and surveillance of individuals by known/unknown parties, without prior knowledge or consent

• The construction of histories and profiles about individuals and their interactions,without the individual’s prior knowledge or consent

• Correlation of acquired data with contextual and other information obtained elsewhere

• Unwanted or incorrect inferences about the individual derived from the data

• Unauthorized revelation of personal and private facts and disclosure to others

• The inherent imbalance of power and potential for undesirable social engineering,control and discrimination on the basis of RFID-generated data

• Unauthorized access, theft, and loss of RFID-based personal data held by custodians

• Unauthorized interception and access to protected information stores by unknown parties, due to poor information security practices

• The cloning of RFID identification data and possibility of unauthorized access to physical and logical resources, and of identity theft

•The negative consequences upon the individual of all the above activities

• The inability of individuals to find out about the collection and misuse of their data, and to remedy any errors or abuses

• The lack of confidence and trust by individuals in the information management practices of organizations

RFID Privacy and Security Concerns

• A manufacturer, re-packager, re-labeler, distributor, retailer, or others acting at their direction will attach RFID tags (chips and antennae) to only immediate containers, secondary packaging, shipping containers, and/or pallets of drugs that are being placed into commerce

• The drugs involved will be limited to prescription or over-the-counter finished products•

• RFID will be used only for inventory control, tracking and tracing of products, verification of shipment and receipt of such products, or finished product authentication•

• The tags will not contain or transmit information for the healthcare practitioner

• The tags will not contain or transmit information for the consumer

• The tags will not contain or transmit advertisements or information about product indications or off-label product uses

FDA Guidance Policy on RFID and Pharmaceuticals

Technology

Deployment

Examples Privacy Impart

Tagging things Bulk pharmaceuticals

Inventory and assets

Medical equipment and instruments

Electronic IT devices

Surgical parts

Books, documents, dossiers and files

Waste and bio-hazards management

In general, identifying and tracking inventory and

objects does not involve collection, use or retention of

personally identifiable information.As such, tagging

things has little or no impact on privacy.

Tagging things linked

to people

Medical equipment being used by patients, visitors or staff

Readers, tablets, mobile and other IT devices assigned to

staff

Smart cabinets

Devices, garments, or rooms assigned to patients

Blood samples and other patient specimens

Patient files and dossiers

Individual prescription vials

If the RFID-tagged item travels with an individual,

then extensive tracking and monitoring of the item is

in effect the same as tracking and surveillance that

individual.

Unauthorized identification, tracking, surveillance, and

profiling of individuals are very serious privacy issues.

In addition, security issues related to RFID tags,

including skimming, eavesdropping, interception,

interference, tampering, cloning and misuse, can also

impact individual privacy.

Tagging people Access cards assigned to staff or visitors

Health-care employee identification cards

Patient health care identification cards

Ankle and wrist identification bracelets

Implantable RFID chips

The privacy impact of tagging people is extremely

high and elicit strong views among the privacy

community, medical practitioners, ethicists, consumer

and civil rights groups, technologists, and public

policy. Protests are not uncommon.

RFID Deployments in Healthcare and their Privacy Impact

Greek Privacy Laws and Data Protection Authority

In Greece, data and privacy issues are regulated by applicable laws 2472/1997, 3471/2006 and 3418/2005 , the EU Data Protection Directive 95/46/EC and monitored by the Hellenic Data Protection Authority. The general rules and guidelines for data controllers, as lay out by the DPA and the applicable laws are :

• They must process only the data which are necessary for one or more specified purposes, they must make sure that they keep data accurate and up to date and they must retain data only for as long as is deemed necessary for the purpose of the collection and process thereof

• In order to carry out the data processing, the Controller must choose employees with relevant professional qualifications providing sufficient guarantees in terms of technical expertise and personal integrity to ensure such confidentiality

• The Controller must implement appropriate organizational and technical measures to secure data and protect them against accidental or unlawful destruction, accidental loss, alteration, unauthorized disclosure or access as well as any other form of unlawful processing

• If the data processing is carried out on behalf of the Controller, by a person not dependent upon him, the relevant assignment must necessarily be in writing.

• The Controller must respect the data subject's rights to information, access and objection.

• They must meet their obligations vis-à-vis the DPA (notification, granting of permit)

• They must be kept informed on any Decisions, Directives or Recommendations issued by the DPA that may be important to them

RFID Privacy Enhancing Technologies

Use Cases in a Smart Hospital

Patient Identification

A patient identification error may lead to improper dosage of medication to patient, as well as having invasive procedure done. Other related patient identification errors could lead to inaccurate lab work and results reported for the wrong person, having effects such as misdiagnoses and serious medication errors.

Blood Tracking

A UK survey of 27 hospitals found that 1 in 1,501 blood transfusion samples were taken from the wrong patient or labelled with the wrong patient’s identification details prior to transfusion. Blood is often given under circumstances of extreme urgency and distraction. Patients are unconscious during the transfusion and cannot state their name, and caregivers in the operating rooms may not "know" the patient as well as nurses on non-surgical floors.

Use Cases in a Smart Hospital

Smart Operating Theaters

The aim of the system is to make sure surgeons carry out the right procedures on the right patients every time. The Hospital will also use the system to ensure patients are given the right prescriptions and to identify patients with infections to help stop the infection spreading. Patients are tagged on arrival. Photographs are taken of them and digitised into an electronic record. A wireless network tracks each patient and brings up his/her record at key points within the hospital, such as the operating theatre.

Use Cases in a Smart Hospital

Anti-Counterfeiting

Drug counterfeiting is an increasing problem as counterfeit drugs reduce patient safety, as they can contain dangerous substances; and pharmaceutical companies lose tens of millions of dollars to the counterfeit drug trade each year. This problem is being taken seriously and in February 2004 the U.S. Food and Drug Administration (FDA) published a report encouraging the use of RFID to combat it and urging the drug industry to adopt the technology.

Use Cases in a Smart Hospital

Tracking Equipment, Patients, Staff and Documents

Amongst all the imaginable use cases, RFID is certainly best suited for tracking applications. The technology enables an automated and fast tracking of assets, equipment or people. Efficient tracking in a hospital offers plenty of interesting perspectives. Allows for better equipment utilization, improved efficiency and allows medical staff to spend more time in patient care, rather than on locating equipment and other menial duties.

Use Cases in a Smart Hospital

Use Cases in a Smart Hospital

Smart Cabinets

RFID enabled solutions to manage supply chains are also useful after products enter inventory at a hospital. RFID smart cabinets create real-time visibility of the tagged items within them, which enables hospitals to track their inventories of medical devices and other assets. Many cabinets have built-in or optional access controls, such as locks, that are designed to secure high-value items or restricted assets (narcotics, for instance). Refrigerated cabinets are available for storage of pharmaceuticals and other heat-sensitive items.Key features in smart cabinets software include screens, creation of reports, alarms and Web-integration.

Use Cases in a Smart Hospital

Neonatal Care

An RFID system works by having an active, tamper-proof RFID tag attached as an ankle bracelet on the baby’s leg. The tag constantly checks in with readers, reporting every ten seconds that it is present and functioning. The system is tied into the hospital’s security system, set to activate security cameras, trip electronic door locks, and shutdown elevators for a lockdown of the facility in the event of an alarm. The bracelet is also designed to set-off an alarm if it is loosened or cut-off from the newborn’s ankle. The system also includes a mother-to-baby electronic matching feature. If the baby and mother tags do not match the system will generate an auditable alarm and sends a message to the system.

Use Cases in a Smart Hospital

Access Control and Theft Prevention

The most widely use of RFID is found in access control. RFID cards and readers are used to allow access to rooms and buildings to authorized members of staff and visitors. Additionally, RFID tags can be used for access to PC workstations using integrated card readers. RFID tagging and tracing can also prevent and notify on the event of Hospital assets theft or unauthorized removal from Hospital premises.

Use Cases in a Smart Hospital

Patient Monitoring

The RFID patient monitoring solution enables nurses to record, save and browse the results of patient measurements, such as blood pressure and oxygen saturation, at bedside, using a lightweight PDA or laptop computer equipped with an RFID reader. As part of the process, a nurse first identifies herself or himself using the employee smart card, thereby gaining access to the system.Next, the nurse identifies the patient by reading an RFID tag on that individual's wristband. Then, the nurse identifies the specialized monitoring device to be used, such as a blood pressure cuff, which is equipped with an RFID tag.

Drivers for RFID Application in Healthcare

Response options 7, 8 or 9 indicate an important factorResponse options 4, 5 or 6 indicate a factor with unclear importanceResponse options 1, 2 or 3 indicate an unimportant factorSource : European Commission - DG INFSO - 2009

Obstacles for RFID Application in Healthcare

Response options 7, 8 or 9 indicate an important factorResponse options 4, 5 or 6 indicate a factor with unclear importanceResponse options 1, 2 or 3 indicate an unimportant factorSource : European Commission - DG INFSO - 2009

SWOT Analysis for RFID Deployment in a Greek Public Hospital

OPPORTUNITIES

Growing need and focus on reducing costs and improve

utilization

Greek Government focus on IT and e-government

Large potential for improved patient care, reduce

paperwork and mandate tasks

Large potential to reduce medical errors

Potential for collaboration with other European Hospitals

for exchange of know-how and share costs

THREATS

Concerns over privacy

Threat of non-compliance/insubordination from Greek

health workers, as other recent examples have

demonstrated

Care must be taken to adhere to all applicable laws and

guidelines on data protection

RFID implementation requires a supporting IT system

and business processes changes in an environment and

culture notorious for its bureaucracy

Cash-strapped Greek state might be unable to fund the

initial investment required

STRENGTHS

Ease of use, small size and advanced features

Automation has led to more efficient healthcare systems

Allows staff to concentrate on patient care rather than

mundane tasks (tracking paperwork, assets)

Allows for automated monitoring of patients

Provides an automated and secure method for access

and IT control

Provides a first level of control against theft and

misplacement of hospital assets

Has proven capabilities for providing additional security to

newborns

Proven capabilities against counterfeiting

A number of well publicized successful RFID deployments

Numerous EU RFID initiatives

STRATEGIES

→ Implement RFID in phases with emphasizing the

initial stages to improved patient care, safety and

reduced workforce paperwork

→ Seek partnerships and collaborations with other

European Hospitals

→ Involve and inform the public and healthcare staff

on benefits and motivations

STRATEGIES

→ Involve and inform the public and healthcare staff

on benefits and motivations

→ Implement RFID in phases with emphasizing the

initial stages to improved patient care, safety and

reduced workforce paperwork

→ Re-engineer redundant and bureaucratic

processes

→ Seek EU funds, partnerships and collaborations

with other European Hospitals to reduce costs

→ Adhere to EU and Greek privacy laws and

guidelines

WEAKNESSES

No common/consolidated RFID standards

Poor interoperability between different RFID solution

providers

Most RFID/ICT solution providers use incompatible

proprietary technologies

Electromagnetic Interference can be an issue/concern

Metal and liquid can interfere with some frequencies,

unless specialized tags are used

Some RFID industry standards and visions can be seen as

over engineered/complex

Cost and ROI is still a concern

STRATEGIES

→ Seek partnerships and collaborations with other

European Hospitals and in particular with Hospitals that have already experience in RFID deployment → Implement proven solutions (don’t re-invent the

wheel)

STRATEGIES

→ Implement proven solutions (don’t re-invent the

wheel)

→ Involve and inform the public and healthcare staff

on benefits and motivations

→ Implement RFID in phases with emphasizing the

initial stages to improved patient care, safety and

reduced workforce paperwork

SWOT Strategic Options Matrix

The case for University Hospital of Heraklion

• The University Hospital of Heraklion (UHH) is one of the largest regional hospitals in Greece. It was inaugurated in 1989 and it serves not only the population of Heraklion, but the whole of Crete

• The University Hospital of Crete is closely connected to the Faculty of Medicine of the University of Crete where the university clinics and the laboratories operate. The Hospital offers a complete range of health care services and departments such as pathology, cardiology, hematology, oncology, rheumatology, clinical immunology etc

• UHH has approximately 750 patient beds and has over 179.000 outpatients and emergency admissions every year

• The Hospital also performed approximately 7.000 emergency and scheduled surgeries in 2011

• The total number of patients per year is approximately 250.000

• The Hospital covers a built area of 60.837 square meters and it has approximately 2.000 members of staff

Recommended Phased Approach for RFID Implementation at UHH

12 Readers x 4 Floors for the Clinics Buildings4 Readers x 3 Floors for the Administration Building 15 Readers x 2 Floors for the Main Corridor Building

Total of 90 Readers + 20% Tolerance Grand Total of 108 2.4 GHz RFID Readers

RFID Coverage of UHH with 2.4 GHz Readers

ITEM QUANTITY PRICE TOTAL

2.4 GHz MOUNTED RFID READERS 108 300 € 32.400 €

2.4 GHz ACTIVE RFID TAGS 5000 15 € 75.000 €

INTSTALLATION/INFASTRUCTURE 1 50.000 € 50.000 €

RFID PRINTERS/WRITERS &

SOFTWARE 1 75.000 € 75.000 €

TOTAL 232.400 €

ANNUAL MAINTENANCE COSTS 25,000 €

Cost Estimation for Phase 1 Implementation

Estimated number of tags required for Phase 1

2.000 reusable wrist tags for patients2.000 for the UHH employees1.000 for tagging assets

Return on Investment for Phase 1

• Estimating and calculating the financial Return on Investment (ROI) for the RFID implementation in a public non-profit Hospital is a challenge due to the nature of public Hospitals. For example, the efficiency improvements on staff workload will not lead to reduced numbers of staff or salary expenditures, at least in the short term. However based on reported results, ROI is expected within a year

• Efficiency gain is important to a Greek Public Hospital, as the Greek NHS is faced with increased patient traffic due to the financial crisis in the country. Patients that in previous years would seek medical assistance in private clinics are now visiting the public Hospitals in order to reduce the costs of healthcare

• Wayne Memorial Hospital in Goldsboro, in the U.S. which is a 316-bed facility, reported a realized capital expense reductions of $327.147 in the first year of implementing an RFID tracking system which a cost of just over $300.000

• The Massachusetts General Hospital, reported a 400% ROI in just six months after implementing an RFID system for tracking assets and Hospital supplies

• The Hospital also reported an 8% increase in patient safety, a 20% increase in charge capture, 30% increase in clinician fulltime equivalent time, and a 70% reduction in stock outs

• Pantai Hospital Ipoh, in Malaysia, an understaffed Hospital tasks, due to chronic scarcity of skilled caregivers has reported that with the use of RFID they have managed to automate routine giving nurses time to provide quality patient care, savings of approximately 10.000 hours annually in nursing care

• Birmingham Heartlands Hospital in the UK, which implemented an RFID-based system called "Safe Surgery System" in two of its surgical wards, reported that due to the patient through-put improvements the system paid for itself in six months

• All Hospitals reported medical staff satisfaction for the new systems

Results and Conclusions

• Based on the results and the findings, RFID deployment on a large Greek Public Hospital such as the University Hospital of Heraklion is a worthwhile investment

• Privacy and security concerns need to be addressed and the project needs to involve all members of staff

• The public needs to be informed and educated

• Attention must also be paid to the Greek and European legal framework due to the sensitivity of the data involved

• The patient benefits need to communicated clearly and the big-brother myths must be addressed.

• As the reduction of costs, resources wastage and misuse of funds is currently high in Greek Government agenda, the strategic objectives targeting cost effectiveness can be as well be derived from such implementation thanks to a potential reduction of overbuying and or replacement, unnecessary rentals, and underutilization of hospital assets as the results have shown that benefits are derived from RFID implementation

• The new RFID enabled processes provide information on assets availability rate, utilization rate, and real-time localization

•Finally, RFID deployment will reduce manual intervention, the opportunities for human error or negligence which ultimately improve the accuracy of patient identification, the patient identification for medication safety and the critical information concerning the patient, which ultimately improve patient care, save lives and avoid unnecessary suffering

Thank You For Listening