RFID in Healthcare - An Enabling Technology

The wheel is an enabling technology. It can be useful as a steering wheel, a car wheel or a water wheel for example, each providing a very different benefit. The wheel can be enhanced with shock absorption, brakes and so on. RFID is also an enabling technology. It saves lives, prevents errors, saves costs and increases security. It removes tedious procedures and provides patients with more freedom and dignity. For example, it reduces the amount of personal intervention by staff because it automates procedures such as protecting the disoriented elderly from danger and matching patient to treatment.

Like the wheel, RFID can also be enhanced. In this case it is by such things as sensors, batteries to increase range and circuits that let the RFID “tag” be located at a distance – so called real Time Locating Systems RTLS. The sensors can be used in RFID enabled smart packaging that records when patients take medication and how much they take and provides prompts to help them comply with instructions. For example, if an AIDS sufferer takes their medication wrongly 5% of the time, they reduce their chance of suppressing the virus by 50%. 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.

Sensors in RFID labels can detect if drugs have been overheated. The US Military found that it was throwing away 90% of its drugs unnecessarily when the expiry date was reached. This was because these drugs had been kept cool and unopened. They were good for another year or two.

The market for RFID tags and systems in healthcare will rise rapidly from $90 million in 2006 to $2.1 billion in 2016. Primarily, this will be because of item level tagging of drugs, mainly for anti-counterfeiting but also for logistics, including better recalls, and RTLS for staff, patients and assets to improve efficiency, safety and availability and to reduce the number of misplaced and stolen assets.

Radio Frequency Identification (RFID) is the use of radio frequencies, or thereabouts, to read information on small devices, called tags, at a distance. In healthcare, the tags take many forms including badges, pendants, labels, cards and even implants. Compared with alternatives such as barcodes, magnetic stripes and written or printed labels and documents, RFID has few problems of obscuration, orientation or reading many at a time at high speed. Some RFID tags can even have data electronically written on to them at a distance – a warranty or repair record, a shipment manifest and so on. This extra feature is currently preferred for supply chain tagging – pallets, cases and item level because, today, central computer systems cannot always be accessed reliably and in a timely fashion.

Counterfeit pharmaceuticals kill hundreds of thousands of people yearly. Aaron Graham, Chief Security Officer of Purdue Pharma says that drug counterfeits are currently valued at US$39 billion and will rise to $75 billion in 2010. Not surprisingly then, over the next ten years, the largest use of RFID in healthcare will be labels on drugs at item level and the infrastructure and services to support this throughout the supply chain and in healthcare facilities. The primary purpose of this will be anti-counterfeiting by establishing the full history of that package at all times – called pedigree. This will be underpinned by scientific analysis of the drugs inside the package. The unique electronic identification and its processing is called mass serialisation. It employs tranches of numbers issued by EPCglobal to the so-called Electronic Product Code EPC. The US is driving this and its Food and Drug Administration will legislate if progress is inadequate in its view.

The frequency employed is as yet uncertain because Ultra High Frequency UHF tags have been delivered to Wal-Mart on millions of Type 2 drugs in the last year (primarily for anti-theft and for stock control) but Pfizer, AstraZeneca, GlaxoSmithKline and others are fitting millions of HF tags on similar packages under FDA guidelines for anti-counterfeiting. They prefer HF because it can give a higher percentage of successful reads and no ghost reads and the tag is smaller.

What is certain are the supply chain benefits of this automated unique identification method. The pharmaceutical industry currently absorbs $2 billion yearly in recalls caused by overstocked and out of date products. The efficiency of the 1500 or so recalls carried out every year can certainly be improved, as can the cost. Indeed, most aspects of the healthcare supply chain can be improved with RFID.

The second largest application of RFID in healthcare by value will be Real Time Locating Systems for staff, patients, visitors and assets. Here the systems and support cost more than the tags, partly because many of the tags are reused. These tags cost from 20 to 100 dollars depending on sophistication. Some record threatening behaviour, many have an alarm button to fetch help to the exact signalled location. Some tracked people movements in hospitals in Taiwan and Singapore during the SARS outbreak.

The favoured forms of RTLS in healthcare are (1 ) So-called zonal (cell ID) systems where interrogators are fixed throughout a building to ensure the tag is never out of range and (2) Systems parasitic on the facility’s WiFi network, so they do not have to emit their own radio frequencies. This is called radio fingerprinting – the tag senses several emitters and the software computes the location knowing where those emitters are.

Parasitic WiFi systems can be low in cost of purchase and ownership because they use pre-existing wireless networks. They have been installed in about 100 hospitals in the last year, since they became generally available. They do not add to the many radio signals in hospitals that might affect drugs or shut down life support systems. However, they need remapping regularly, they can be inaccurate and they must not overload a network used for life saving. Sometimes the hospital WiFi system will need extensive additions before a good result is achieved.

Error prevention will remain one of the biggest uses of RFID in healthcare. Basically, an electronic handshake prevents the wrong procedure taking place and the RFID system may even record what actually happens. A disposable passive RFID wristband may “talk” to the RFID label on the blood bag, for instance. 40 million RFID enabled AstraZeneca Diprivan ® syringes have prevented dosage errors in Japan and Europe.

The relative importance of different applications within the healthcare sector is shown in table 1. Pharmaceuticals are involved in a relatively small number of high volume schemes whereas other applications largely consist of many small schemes, often disproportionately profitable for suppliers because of the specialist knowledge and products required.

Table 1 Split of
in the IDTechEx RFID Knowledgebase of 2100 cases of RFID in action in 76 countries www.rfidbase.com

APPLICATION	NUMBER OF CASE STUDIES AS A PERCENTAGE OF ALL RFID APPLICATIONS	COMMENT
People tagging	26%	Mainly patients for error prevention followed by staff for location/ alarm
Assets	16%	Mainly fixed assets and valuable consumables for preventing theft and misplacement and for rapid location
Pharmaceuticals	13%	Trials and one rollout in 2005 for anti-counterfeiting and one large application and many trials for error prevention
Blood	4%	Error prevention mainly
Other	41%	Cards, key fobs, pendants and badges for secure access, health records and payment. Supply chain management eg pallets, cases and vehicles

Table 2 shows the main purposes for which RFID has been and will be used in healthcare

YEARS	UP TO 2004	2005 - 2010	2011 ONWARDS
Main uses	Error prevention of products (drug dose, correct blood and treatment, mother/ baby mismatch etc)Patient tagging for error preventionLocating staff/ staff alarmsLocating assets	Error prevention of products now including autorejection of wrong luer connections and partsPatient tagging for error preventionLocating staff/ staff alarms/ tags that record incidentsLocating assets/ speedy, accurate stocktakingTheft preventionCost controlRecording procedures (eg for defence of lawsuits)Drug trials compliance monitoring/ promptingBehavioural studies to optimise operations Pharmaceutical anti-counterfeiting	Error prevention of products Patient tagging for error preventionLocating staff/ staff alarmsLocating visitors/ visitor alarms/ virtual queuingLocating assets/ speedy, accurate stocktakingTheft preventionCost controlRecording procedures(eg for defence of lawsuits)Drug trials compliance monitoring/ promptingPatient compliance monitoring/ prompting ( taking drugs)Behavioural studies to optimise operationsPharmaceutical ant-counterfeitingTrack and trace of most medicines, consumables and assets

Source IDTechEx

For more attend “RFID Smart Labels Europe” London Sept 19-20 2006 www.smartlabelsEurope.com
Read “RFID in Healthcare 2006-2016” www.idtechex.com