In various industries like Retail, RFID has not taken off the way it was expected to. What are your views on the usage of RFID in healthcare?
Let us first talk about RFID in retail. In retail, RFID can be applied to the pallet or the carton or the items in it. RFID has already taken off in a big way in its application on the pallet—where the pallets are tracked from the manufacturing floor to the distribution centre to the warehouse. Companies like Wal-Mart and some big European companies such as Tesco are already using RFID. So in retail, I would say the tracking at the pallet level has already been a success. And companies and suppliers are able to automatically track the inventory without any human intervention. Now, if you look at the other levels i.e. case level and the item level the technology is now coming out to enable that. The case level is progressing along nicely and in certain industries such as apparel, individual shirts and jeans are now being tracked at the item level. So, I would say in retail, we have already had some successes. We have got to the pallet level and now there is intense research being done on case and item level in labs like ours.
I would say overall that retail is coming along nicely. Now let us look at healthcare. Here, the problem is a bit more challenging because every hospital has a very unique IT infrastructure. That means all the hospitals do not share the same standardised databases or security systems or networking architecture or computing platform. And that makes RFID in healthcare more challenging and that is why it has taken a little bit longer to get RFID into healthcare. But, it is already starting to happen. Our lab is involved in development of variety of research projects which are resulting in the development of different systems. One of the systems we have developed for healthcare is called SpecimentrakTM. SpecimentrakTM system is the system that is being used to track medical specimens. And of course, what happens is that even though we may have implemented it for one hospital, going from one to the next to the third to the fourth takes some customisation. It cannot just plug ‘n play because of the same reason I have mentioned that the IT infrastructure of different hospitals is different. And that’s what slows down the scaling up for RFID across different hospitals for a given application.
Another application we have been developing is called ‘Pediatrak TM’ that tracks babies in the hospitals so as to prevent theft of babies as well as to monitor various activities about the babies. This is a bit more challenging in the context of the healthcare system in the US because here we are regulated by certain laws such as privacy laws of HIPAA. Some of those US-based requirements make any technology implementation whether it is RFID or another IT-based technology a bit challenging. Of course these technologies are to protect to the privacy of the patient which is very important.
Nevertheless, progress is being made in healthcare. There’s another system we are developing is called ‘RadiologyTrak TM’ that is meant for tracking X-ray plates. Here the problem (and the opportunity) opportunity is that sometimes the identity of two different people gets exchanged or their X-ray plates get exchanged. In this context, one can put RFID tags on the wrist band of the patient and RFID tag on the X-rays so that you can keep tracking things at every step so that errors don’t happen. And yet another area we are working on is called Patient ID and Patient Information. For example, in an RFID tag of the patient you can store an ID and the ID can be connected to the entire patient record. So if you want to pull out a patient record you know all the information is connected to the RFID tag. Or, you can think about eventually putting certain types of information about the patient such as the medication, blood pressure, weight and height and so forth can be put directly on the RFID tag. What that does is that if a patient walks with that information into the hospital then the RFID infrastructure automatically reads the data from the tag and the patient does not have to keep sending out all this information again and again which in the US is a very big problem. So there are a lot of interesting opportunities and I think the healthcare system is looking aggressively at this. There is one more system that we are developing which is PharmaceuticalTrakTM that tracks pharmaceutical medicines in supply chain with the objective of preventing counterfeit.
Is current technology available meeting the requirements?
In certain cases ‘Yes’ and in certain cases ‘No’. For instance, in Specimentrak, the current RFID technology is meeting the requirements very nicely. We have used very low frequency RFID tags with mobile hand-held readers. But for certain other, more complicated applications, current technology I would say still needs more work. If you wish to track the location of the baby but in combination suppose you wish to track with the same RFID tag the oxygen, blood pressure, body temperature and all the variables of the baby at the same time with the single tag, then that technology either may not be available or may be too expensive. So, there are certain things where we need to do lot of preparation.
What challenges does a tracking medical device bring to RFID?
Let us look at tracking of medical devices, where the work is going on and what are the types of medical devices that need to be tracked. Tracking medical devices needs to have a reason. There has to be some benefit since there will be some cost. The cost of tracking should be justified by an appropriate benefit. For example, there are some types of medical devices that government needs to know actually where they are. So, for devices that you are required to track, you either track them with a human being every day or you track them automatically with RFID. In this scenario, the cost justification is easier because to have somebody track the cabinet manually daily is a very expensive proposition. So that is one class of tracking requirements for medical devices.
There is another class of medical devices which are implantable devices inside the human being where you want to query the device, you want to ask the device a simple question like what is the status of the battery—this is because for some of the devices you have to change the battery every so often. So, if you could query the device for status or problems via RFID, or if the device had some problem and it could communicate that wirelessly to a remote monitoring location a wireless sensor networks, then the device becomes an intelligent device and may not need to be removed from the body.
Another type of RFID requirement in hospitals is used for locating a device. For example, consider a hospital that has four or five ECG units in a 200-bed. These devices being expensive, hospitals do not purchase them in large numbers. And when a nurse or a doctor uses this device in a patient room, sometimes due to the rush to see the next patient, they’ll leave it there and the next nurse comes in when the shift changes and wants to use the device but can’t find it and they send someone to find it. Hospitals typically use a few extra units of these devices for such a situation. If you could track exactly which room the device is in at every instant in time through say AA cell phone, then the hospital may not need as many ECG units and by finding the unit when it’s needed, may actually save more money and lives. So finding asset locations is another justification for investment in an RFID system.
What are the research opportunities in RFID for medical devices, equipment and medicines?
There are a lot of research opportunities. If you look at all possible devices, medicines and patients and every possible mobile asset in the hospital, you’ll notice that a very small number of them actually have an RFID tag. The opportunity exists in terms of identifying what all can be tagged. And this can be linked to the business benefits, but before you do that, you have to make sure that the technology works. If not 100 per cent, then at least up to a reasonable level. The research opportunities are pretty significant. For example, we talked about the implantable devices. The first generation of RFID tags gave you the ID, the second generation has been giving information about the status via sensors—for example, the RFID tag can give you vital statistics like blood pressure from within the body? So, the opportunity here is in making RFID tags have many different sensing capabilities, the third could be what is called controlling RFID. For example, could an RFID tag send a signal to an insulin injecting pump attached outside to the human body? Finally, if these smart tags could be made really small and injected into the human body, you could use a cell phone to send instructions and receive data remotely. Imagine an RFID tag travelling through the human body such as in Sci-Fi movie Fantastic Voyage. In biotechnology, bioengineering and healthcare, RFID has a lot of interesting research opportunities.
There have been reports about RFID interfering with a device’s functioning. What are the quality and safety precautions to be taken when it comes to RFID in medical devices?
The analogy I would draw here would be about a cell phone interfering with the functioning of another cell phone. The fact is they do not necessarily need to interfere with each other – for example how many times have you made a cell phone call from a room with another person on their cell phone and had interference? Probably none. . This happens because there is something called frequency bands. Each frequency band is very intelligently allocated and managed. And so, you could have a large number of phone conversations going on at the same time between the cell tower and many cell phones because the communications systems manage the bands very efficiently. It’s the same thing with RFID. If the RFID reader is designed in the correct fashion, it can read hundreds if not thousands of tags at the same time. If there is a device in the room that is getting interference from an RFID reader, it could be that either the device or the reader has not been designed correctly. If the design is correct, it would not interfere.
What are the risks / issues involved in RFID tags for critical care equipment?
I would say the same thing again. Suppose you want to use some critical care equipment and RFID in the same vicinity, you should run tests with the RFID readers to make sure that there is no interference. What we would do in our lab (UCLA RFID Lab) is we would measure the different frequencies and signal strengths and we would see whether there is interference or not. If indeed there is interference, then one needs to figure out who is it that has developed the flawed design. I would like to give an example of analogue cell phone networks and today’s digital networks. If you took old analogue network phone and put in the same room with a digital network cell phone, they may interfere because they are completely different technologies. It is pretty straight forward in today’s day and age the way frequencies are shared in say the cellular networks or the Wi-Fi space to redesign old technology. Generally, it should be noted that if the medical equipment is old then the electronics of the medical device may need a redesign to make sure that it operates on the same principles as the RFID reader and then you’d see that the interference can be avoided.
If you look back a few years, RFID has evolved pretty quickly. Where according to you is RFID headed in the future?
There are several areas where innovations are happening and will continue to happen. Five years ago, the hand-held readers had a read range of only 5-6 feet. Today, these readers have a read range of 20-25 feet. The read range has gone up five times. In the next five years I expect the size of the tags to go down; the ability to read large number of tags to increase, the speed of reading to increase and the memory in tags to increase. Also, we would be able to put more sensors on a single device to perform specific functions like monitoring a patient’s vital statistics. The idea is that as RFID technology gets smaller and as you can integrate more and more sensors into a single tag, more stuff would be possible. I also think that technologies like nanotechnology will be contributing heavily into the reduction of the RFID tag size even smaller. The idea is to look at what happened in the semiconductor industry with Moore’s law. I look at a similar type of a trend here in the RFID space. I think we will follow a very similar trend. The virtuous cycle of price decline resulting in increase in business applications and tag volumes, resulting in turn in further decrease in prices, will continue for a long time, putting downward pressure on tag prices. I won’t be surprised if RFID tag manufacturing price on the low starts to see the 1 penny level in the next five years.
Because of this convergence RFID could be placed in pretty much any device. I foresee a lot of changes coming to both the embeddable and the non-embeddable side of the medical equipment marketplace. It’s the R&D that is going to drive the costs down, improve the quality and reduce the size. This is what will allow people to do more with RFID. Hitachi has already developed tags that are thinner than a human hair. It is costly right now since it is relatively low volume, but who knows what we would be able to do in the future?
Is the latest technology in RFID able to overcome the information security challenges?
Information security is an important challenge. In the US, HIPAA regulates who can look at a healthcare record. It is very restrictive as to who can and who cannot look at a record. When you start putting patient information into a tag, then there is going to be concern in any hospital as to who can read the tag. A lot of hospitals have overcome this problem by assigning a random I.D. number to the tag and reader looks it up in the enterprise database behind a firewall and until the system (governed by HIPAA) does not know who it is that’s querying it will not divulge the information. Hence the data related to specific patients is protected.
Any other comments?
RFID has progressed a lot in many different disciplines. For example, in the aerospace industry RFID is being used to track aircraft parts. It is being used by the automotive industry to track cars in storage facilities after they are assembled and ready to be shipped . It is being used by the shipping industry to track containers as they move across the planet. So, RFID is already being used in a lot of different industries and the healthcare industry will have to learn from the other industries. The important thing is that to have a successful system, you have to put technologies together and make them work. A lot of technologies are already in place and the healthcare profession can benefit in a big way. The opportunities in healthcare are really large.
I was in Washington a couple of weeks ago, and the city is abuzz with talk about President Obama’s stimulus package, which includes US$ 20 billion for healthcare IT. I look at this as an opportunity to modernise the paper-based infrastructure in the United States and move it towards the path of modernisation that has encompassed every other industry in the world. A paperless healthcare system will make it much easier for us to provide RFID technology and integrate it into the infrastructure of the healthcare system. The benefits will be ten-fold and cost of tags could see a non-linear decline in price beyond even what we have been predicting. So, I am very excited about the future of RFID in healthcare and am seeing a significantly rapid increase in interest in our RFID Program from healthcare organizations.