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NINE TECH TRENDS
Healthcare IT advances are pulling together to manage an expanding universe.
BAR CODING AND RFID - by Mark Hagland

Hospital and health system leaders who are just getting used to the idea of bar coding everything will have to get ready for another adjustment. Industry experts see a split screen in the future: bar coding and active radio frequency identification (RFID).
For many uses, such as tracking physical assets and the flow of patients and personnel, active RFID is expected to push aside passive RFID and bar coding. For others, such as medication management, bar coding is still a key technology, and it's an important supplementary tool for some purposes.

Wireless technology can be expected to evolve rapidly in the care management arena.
The technology itself is helping move implementation forward: It is getting better, more sophisticated and cheaper every day. The cost of active RFID systems has fallen precipitously, for example, and the price of RFID readers also is dropping. Depending on the quantity and system involved, a typical active RFID tag may run in the "few tens of dollars," as one expert put it.

A passive RFID tag may cost only 25 to 40 cents; of course, active tags have far greater power, versatility and range (across a room or even a facility) than passive tags (a few feet). Both types of RFID tags have advantages over bar coding, which requires line-of-sight reading by a scanner. And as more hospitals and health systems put in wireless networks, hospital leaders will recognize their great potential. At present, several organizations use active RFID for asset management, but only a handful use it to track patients and clinicians. That number looks set to rise dramatically with several start-up vendors entering the market.

Future possibilities
The fact that bar coding is already being required in hospitals will, over time, strengthen the case for wireless solutions, contends Vivek Subramany, an industry analyst in the San Antonio office of Frost &  Sullivan. "There are situations where bar coding will take precedence because it's mandated, particularly in budgeting," Subramany says, but RFID has a technological edge. He tells vendors to market RFID as a supplement for bar coding.

Even for medication management, active RFID has clear advantages over bar codes, which must be scanned on the surface of the object itself. In patient management, too, locating, tracking and reading are more advanced and immeasurably easier with RFID tags that can be read at a distance, Subramany says. In fast-paced hospitals, this may be a key consideration and one that speaks to optimal resource utilization, he adds.

Further down the road, "a combination of basic RFID technologies with sensor technologies--using nanosensors that will monitor the different biometrics from your body and also implanted devices"--will hold the greatest potential, says Luis Taveras, a partner in the Health and Life Sciences Practice at Accenture's Chicago office. In the not-toodistant future, he says, "We can have a post-cardiac patient being at home, and we're monitoring that patient remotely, checking all the vitals--blood pressure, temperature, level of activity, depth of respiration, all those things." And some day, patients will be discharged very soon after procedures and treatments because clinicians will be able to monitor their condition remotely in real time.

IT leaders lay groundwork Some IT leaders are cementing their wireless infrastructures into place now, anticipating that by the time they're ready to implement active RFID systems in two to three years, costs will be more manageable. Kent Hargrave, CIO at 337-bed Overlake Hospital Medical Center, Bellevue, Wash., sees active RFID as just one tool in a big toolbox of wireless enablers. By later this year, he and his colleagues will be implementing a handsfree system from Cupertino, Calif.-based Vocera Communications for wireless voice communication among clinicians, as well as bedside medication management using PDAs (and initially, bar coding). "As RFID becomes a little more cost-effective in two years, we'll RFID patient wristbands," he says.
The hospital is already set to begin an active-RFID pilot for clinical equipment management, wheelchairs and smart pumps in particular, a move that Hargrave sees as a stepping-stone. "Hospitals are doing the equipment management thing first to get the confidence and experience to do patient management with RFID," he says. "It's easier to begin by managing 100 known items rather than 200,000 patients a year."

The real challenge lies in building the hospitalwide infrastructure and overcoming all the attendant back-office hurdles, says Jeff Bernstein, senior network engineer. Overland already has RFID in admitting, but "the integration of everything" is a bigger task, he says. "People saying they're doing RFID is one thing, but integrating it as a holistic solution under a common umbrella is another." Adds Hargrave, "We need the back-end infrastructure to support whatever we do for patient management," be it typing in a number or scanning an RFID chip or bar code.
St. Vincent's Hospital, a 338-bed facility in Birmingham, Ala., is also integrating multiple technologies, focusing on creating a wireless infrastructure to support patient and personnel management. It already has patient wristband management and medication management in place via bar coding. Last fall it piloted active-RFID tagging of patients in the cardiology unit.

Like Overlake, St. Vincent's is using a mix of technologies. It implemented RFID/infrared tracking from Lawrence, Mass.-based Radianse and is also using technology from San Mateo, Calif.-based AeroScout Inc. (formerly Bluesoft Inc.). St. Vincent's has room-level tracking of patients in radiology and the GI and cath labs. An electronic board at the nurses' station in each of those units indicates where patients are physically, and where they are in their care process (e.g., waiting to be seen in radiology).

St. Vincent's also wants to tie everything together, including Vocera badges, so patients, clinicians and medial equipment will be locatable and trackable. Informational boards will be installed at every nurses' station by this summer, and work will continue on infrastructure-building. "The enterprise layer that sits on top and understands the transactional component will be there, and as we work through these pilots, we then will have a better understanding of how much and what types of RFID technologies we will put into that layer," says Steve Anderson, director of the Center for Advanced Technologies at St. Vincent's. "The technology keeps changing, and our goal is to have an enterprise layer to leverage multiple technologies instead of being stuck with just one technology deployed across the organization."

Vendors take position
Vendor executives are aware of the desire to leverage multiple technologies as they position their companies to take advantage of the coming active-RFID boom. For example, Richard Barnwell, CTO of Framingham, Mass.-based PanGo Networks, says that the key is "to try to leverage a regular Wi-Fi network that's already in place, and to consider locationing as an additional service that you can run over that existing network."

In Barnwell's view, the capital costs of building multiple wireless systems are too high without some strategic leveraging. Beth Israel Deaconess Medical Center in Boston selected PanGo to avoid "going down a completely proprietary path for a reader infrastructure," he says. "What we decided was that the most compelling business case can be generated when you use the wireless LAN/Wi-Fi/IEEE 802.11 family of standards.
The simple test is, does the company require any additional hardware to be installed over and above using tags to make their solution work?"

Portland, Maine-based Parco Merged Media prides itself on achieving a level of granularity that allows for very tight tracking of tags. CEO and co-founder Scott Cohen says the trend is toward greater granularity, "and that will require a certain kind of infrastructure." He believes that Parco is well positioned because its system allows for fewer RFID receivers per distance of transmission. There will be a shakeout among RFID vendors in the next few years, Cohen says, and firms unable to demonstrate efficiency and accuracy will be out.

A combination of interoperability, infrastructure, cost-effectiveness and workflow integration will determine success for vendors, contends Suneil Mandava, CEO of Mobile Aspects, Pittsburgh. "Some organizations are having to spend two to three million dollars just on the infrastructure costs for some systems, but we can go in and outfit a hospital for a couple of hundred thousand dollars," he says. "So the financial barriers are starting to drop away."

Hospitals are willing to spend the money now for wireless systems because of a strong focus on patient safety, but vendors must create interoperable systems to prove their value, Mandava says. "We've developed an HL7 system, so we can integrate with medical records, with billing systems, all the various IT systems of the hospital." The ability to use any hospital PC to track patient, personnel and equipment flow will be critical, he says.

Ultimate goal: patient care
Whatever approach is used, evidence is growing that RFID implementation will improve patient care, says Michael Dempsey, CTO and president of Radianse. Its work with Mass General has already yielded an academic study of RFID use, and more will certainly be coming, he says.

Jeffrey Bauer, Ph.D., of the Denver office of First Consulting Group thinks progress may be slow at first. "By five years, I'd expect to see a fair amount of RFID in healthcare, but it will first go toward inventory control and antitheft." In a couple of years, RFID chips will be richer and denser, he adds.
With all the excitement and energy in evidence, widespread implementation of active-RFID in patient care is a given. It's only a matter of time.

(extraído da publicação Healthcare Informatics, focada no estudo de TICs para Healthcare) Fevereiro 2005

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