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Posted on January 2, 2005 by  & 

RFID in Healthcare in 2005

Radio Frequency Identification RFID is the use of radio frequencies or thereabouts to read data electronically that are stored in small devices called tags. These tags may take the form of cards, tickets, key fobs, badges, necklets, wrist or ankle bands and even implants. RFID does not usually require the tag to be the right way round or even to be in sight and you can "read" many at a time even when hidden in a product or package. All that adds up to automation - getting rid of the human and the associated costs, errors and delays. Take one thousand RFID tagged items and throw them through a doorway and the electronics in that doorway will usually read the identity code of all of them in the blink of an eye. Try that with barcodes!

Remote rewriting

There is more. RFID tags are often "read write" meaning that they can have some of the data stored in them rewritten by a remote electronic device called an "interrogator". That means one can update repair, warranty and maintenance information for example.

Ubiquitous enabling technology

Like paper, RFID is an enabling technology seen almost everywhere. It is on reindeer in the Arctic for proof of ownership and management and on penguins in the Antarctic for research. In healthcare it is mainly used for error prevention, because duty of care to the patient and avoiding major lawsuits is often seen as more important than improved stock control, which is the different priority for retailers and their suppliers when using the tags.

Electronic handshake for error prevention

The tag talks to the interrogator electronically and, if the interrogator is not satisfied, it prevents a procedure taking place or alerts staff. It keeps an electronic record, useful for subsequent investigations including litigation. Examples of this are the 30 million tags fitted so far to AstraZeneca Diprivan syringes used in the operating theatre. In seven years there have been no dosage errors thanks to this automated procedure. MBBS of the UK tags surgeon's tools so they can be automatically monitored going into and coming out of theatre. In the US, for example, 1500 patients yearly have something erroneously left in them by operating staff and preventable medical errors cost $17 billion a year according to the US Institute of Medicine. Innovision of the UK and Colder Products of the US have RFID handshakes in couplings such as Luer connectors for vital fluid. These prevent errors and record what was done. Regenesis Biomedical recently launched a device that accelerates the healing of wounds using radio frequency and the company was to have made its return from selling and leasing the equipment. However, the company noted the concern in hospitals that the electrodes should be kept sterile and never applied to more than one patient. There was also a need to keep a record of what was done. Regenesis Biomedical therefore completely changed its business model and it earns income largely from selling RFID enabled sleeves to go on the electrodes. It is these that touch the patient and if clean ones are not in place the machine alarms and cannot be used. If necessary, evidence from the computer can be presented in court to show that the correct procedure took place.

Security and safety

RFID is useful for security and safety. RFID cards, pendants and key fobs let only the authorized member of staff into secure areas such as drug storage and they do it without any need to put things down or let go of a patient. In Mersey General Hospital, UK, the nurses have RFID pendants from ELPAS of Israel with a button they can press if attacked or have a crisis with a patient. This tells the rescue team where they are, not just that they have an emergency.
In the US there are 25,000 mother baby mismatches yearly and there are similar, less publicised problems in Europe. New born babies are often taken out of sight of the mother straight away, yet just one breast feeding from the wrong mother can give that baby HIV AIDS. There are 25,000 reported mother baby mismatches yearly in US hospitals according to the US Institute of Medicine. One can only guess how many unreported ones occur. The potential for distress and litigation is enormous so electronically matched RFID wristbands from Precision Dynamics of the US and X-Mark of Canada are fitted to mother and baby the moment the child is born: they can then be matched and identified unambiguously in all subsequent procedures. Some versions work at a long distance, signalling an alarm if babies are being stolen or the disoriented elderly are wandering into the street. Indeed some will lock the doors ahead of the patient in danger.

Non-compliance in taking medication

Another problem being tackled with RFID is non-compliance, meaning when patients do not take their medicine correctly. They may choose the wrong time or amount or finish early. This creates resistant strains of bacteria, lost sales and profits for pharmaceutical companies, a waste of time for medical staff and, above all, suffering by patients.
Non compliance depends on affliction but it averages about 50%, potentially resulting in 50% corrupt data in drug trials and a non linear effect on patient condition. For example, Newsweek has quoted work showing that, if an AIDS sufferer takes their medication wrongly 5% of the time, they reduce their chance of suppressing the virus by 50%. Indeed, the US National Pharmaceutical Council finds that medication non-compliance costs the US $100 billion and 125,000 deaths yearly. It is responsible for 10% of US hospital admissions - $31 billion yearly and 380,000 patients. It is responsible for 23% of US nursing home admissions - $15 billion yearly and 3.5 million patients.

Monitoring compliance

It is not currently possible to monitor if a patient actually swallows medication in the right amount and at the right time but RFID with sensors on blisterpacks and plastic bottles does the next best thing. It records how many tablets were taken and when. With blisterpacks from Information Mediary of Canada and Cypak of Sweden (via MeadWestvaco of the US) the breaking of a blister is recorded and the identification of the pack and the recorded data can be loaded wirelessly into the physician's computer. Aardex does much the same thing with plastic bottles that have a load cell in the bottom and future versions being developed by First Choice of Sweden, Wizzard Software and iVoice of the US can call out messages such as "Not now!" and "Come back and take your second pill!" as appropriate. As costs come down, these packs will be disposable and supplied generally. iVoice recently patented the high speed remote downloading of customized voice messages into drug packages.

Compliance worsening

The problem will not go away, indeed, there is some evidence that it is getting worse with people living longer and going on lifetime drug regimes for Parkinson's disease other diseases of the central nervous system etc where the patient does not necessarily get prompted to take his drugs by feeling ill at the time. Indeed, the patient may be ill prepared mentally to manage complex regimes of medication and may not control his hands properly.
According to the Archives of Opthalmology, increased longevity means that eye disease is actually increasing among the elderly with the figure having risen to almost 50% that acquire one of three chronic eye diseases. Another study showed that 100 million Americans have problems reading instructions because they are either blind, partially sighted, shaking, dyslexic, illiterate or are subjected to poor printing. The UK National Health Service finds that unclear packaging and labeling is responsible for 25% of medication errors.

Automating research and testing

The ability to automate with RFID is exploited in millions of test tubes tagged by Texas Instruments of the US, TAGSYS of France and Hitachi of Japan. Because short range is acceptable with such applications, these tags are at or near the size of a silicon chip and are embedded in the base or the cap of the test tube and are read by "smart shelves" in drug development and blood testing. The earlier problems from wet, curved or damaged barcodes are overcome.
Maco Pharma of France tags blood bags and they are linked to tagged patients to prevent errors. Doctors at Portsmouth General Hospital in the UK find that tagging blood samples and blood bags removes tedious procedures where staff are difficult to retain and errors are high. They also find that speeding up the procedures saves 8-15% of cost and errors of blood administration are reduced. The doctors have set up a company Proxximity to make appropriate RFID tags and systems. Massachusetts General Hospital in the US is also active in this area.

Giving freedom to high risk patients

Patients at great risk are implanted with RFID tags, by Digital Angel of the US, that look like grains of rice and hold a full medical record needed in emergency, including when the patients are back in society. Indeed, RFID grants the disoriented elderly and high risk patients greater freedom, something to be borne in mind when privacy advocates argue that RFID should be banned because it infringes freedom. Indeed, by preventing errors and making medical staff more productive, RFID has already saved thousands of lives.

Anticounterfeiting and drug traceability

It used to be thought that RFID tags, because they can be covert eg buried in a product or package, would be useful for anticounterfeiting and that is certainly true. However, in a seminal report in February 2004, The US Food and Drug Agency FDA advocated RFID for tackling the increasing problem of drug counterfeiting in a different way - by providing a total audit trail from cradle to grave that they call "pedigree". This mimics the way Europeans trace authenticity of great works of art by having certificated records of their whole history. The Europeans call this provenance.
US Consultancy Accenture has coordinated a team of US pharmaceutical manufacturers, distributors and retailers figuring out how to do this and for that matter how to meet the mandate of Wal-Mart that item level Type 2 (narcotic) drugs be RFID tagged. Wal-Mart's motives are rather different and revolve around cost reduction and prevention of theft. Soon the plastic bottle of pills in the home and even the blisterpack will be RFID tagged and this has led companies such as PA in the UK and Cardinal Health in the US to develop RFID enabled medicine chests, storage refrigerators and hospital dispensing trolleys that reduce errors, theft and cost. Pharmacists are showing great interest because such capabilities help them to do stocktakes faster and prove compliance with ever more onerous regulations as well as enjoying the abovementioned benefits.
According to SMi and industry statistics, the pharmaceutical industry lost $2 billion to the sale of counterfeit drugs and an additional $7 billion to reimportation in 2003. Unless pharmaceutical stakeholders and regulatory agencies improve pharmaceutical security practices, the market could use up to $68 billion annually to illicit drug practices by 2009 according to these sources.
Aid agencies are also interested. According to the UN, in parts of South America and Africa 40% of drugs are counterfeit, indeed the average for the world is found to be 7-10% resulting in hundreds of thousands of deaths yearly.

Different approach in Japan

In Japan, there are other priorities for RFID in healthcare. They have chips from Miyake and Yoshikawa in the white sticks of the blind and sight impaired and tagged pavements and walls electronically communicating with the the sticks to help the subject to navigate the streets.
Experiments have taken place with similar systems from Toppan Printing navigating the electric mobility vehicles of the disabled along the pavements and through hospitals. The "foot key" of Miyake consists of a tag in the shoes of the disoriented patient that locks doors ahead of him if he is in danger. This is achieved by RFID interrogators buried in the floor. Whereas barcode readers usually have delicate moving parts, all RFID tags and interrogators are free of moving parts and many can be buried in concrete or moulded into the plastic a product such as a plastic bin or pallet as is made. Wal-Mart and Albertsons in the US, which have major pharmacy chains, have mandated RFID on or in all pallets and transport cases arriving from suppliers in future to save cost and improve customer service.

Holistic management of assets and people

Increasingly, RFID will enable holistic management of a healthcare facility using tags on almost every person and item give both identity and status (overheated, unauthorised movement .....) in real time with automated responses where appropriated. In this quest, the latest hot areas for RFID in healthcare include tagging most assets and linking all the "islands of automation" being created today by using many different wireless systems as appropriate such as RFID, RFID with sensors, ZigBee, Near Field Communication NFC and WiFi.
Already some hospital laundry and records are tagged for rapid traceability by Texas Instruments, Datamars and Sokymat of Switzerland and tags with batteries in them locate defibrillators in 3D (where and on which floor) thanks to WhereNet.

New RFID technologies

So called Ultra Wide Band UWB is now approved in the US and likely to be approved in Europe for RFID where high microwave frequencies can pass vast amounts of data and radio locate at low cost in the hospital environment. Parco Wireless in the US and Ubisense in the UK have such products. Several universities and research centres are working on location using RFID with a single beam of radiation ie a single interrogator instead of the bulky and expensive multiple interrogator systems used today. Then we may have low cost hand held locators identifying exactly where a tagged product resides.
Another development is the printing of the whole RFID tag ie the transistor circuit previously in a silicon chip and the antenna. This should save cost and the tag will be more robust and thinner, even directly printed on a product so there is no adhesive of cost of application. Organic ID of the US and Poly IC of Germany promise such capability in respectively 2005 and 2006. We shall see.
Range is also improving with several companies talking of working RFID systems at one kilometre and Telegesis of the UK demonstrating one at 700 meters today that is used to monitor secure areas against intrusion by terrorists. It has a battery in the tag, because the lower-cost, smaller tags without batteries do not usually work at more that 10 meter's range. The battery does more than increase range: it manages sensors.
Then there are tags with no silicon chip as in the AstraZeneca application but now miniaturised into metallised plastic ribbon, like a banknote security stripe (Flying Null and Link-Sure of the UK and research in Massachusetts Institute of Technology and Dai Nippon Printing in Japan) and other tiny configurations where they can be used on items that are gamma ray sterilised because that destroys silicon chips in conventional RFID tags. We can certainly expect great progress with RFID in healthcare in the very near future.

Further information

For more read
"The Smart Label Revolution"
"Smart Tagging and Smart Packaging in Healthcare"
"Thirty RFID Case Studies in Healthcare"
Attend the conferences "Intelligent and Smart Packaging", Orlando Florida January 25-26, 2005 and "Smart Labels USA" June 2005
All details on External Link
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