Evaluating RTLS Technology: Success Criteria for Hospitals

•   By Raymond Lowe •   Email: Raymond.lowe@providence.org

•   Providence Health and Services •   IS Director Saint Joseph Medical Center

•   CA Regional Director IS Operations

Today’s Presentation •   About Providence Health and Services •   Introduction; Problem and Solution •   RTLS Technology Options •   Key Healthcare Requirements for RTLS •   Healthcare IT Infrastructure •   RTLS Experience at Kaiser Permanente

–   Case Study 1: RTLS for Enterprise Asset Tracking •   Now Planning at Providence Health & Services

–   RFID Environmental Controlled Rooms and Patient Tracking •   Summary and Conclusions

Introduction

•   Real-time Location Systems (RTLS) are an increasingly important strategic capability for hospitals

•   Managing assets and patients in a hospital is an enormous task

–   Enterprise-wide asset management –   Patient tracking

The Problem

•   How to gain visibility for resource tracking? –  Mapping Resources (Assets, People) –  Monitoring the Status of Resources –  Measuring Resource Utilization –  Evidence Based Business Improvement

The Solution

•   Real-time Location Solution (RTLS) –  Location, status and utilization of resources –  Departmental functionality Improvement –  Enterprise efficiency improvement –   Improve quality, reduce cost and risk of

care

Wi-Fi

UHF+IR

UHF

USD

WSN/ZIGBEE

UWB

In-Building Zone (100m -30m) (30m -10m)

In-Room (3m -1m)

Precision (1m -0m)

Hig

h M

ediu

m

Low

LOCATION RESOLUTION

CO

ST

/ CO

MP

LEX

ITY

Technology Options Have Multiplied

Hospital IT Infrastructure

Key Healthcare Requirements

•   Accuracy •   Reliability •   Planning, Deployment and Operational

Concerns •   Ongoing Maintenance •   Cost

RTLS Cross Functional Considerations

Clinical & Financial Needs

•   Knowing location, status and movement of things is what RTLS is all about –   Must provide enterprise-

wide coverage –   Must offer room-level

location accuracy throughout an organization

IT Needs

•   What ongoing upkeep is required?

•   Will are interference concerns? –   Select a low maintenance

solution –   Must co-exist with LAN’s,

WLAN’s (Wi-Fi), network-enabled and wireless equipment

Deployment Lessons Learned

•   Understand actual installation, configuration and testing of the system –   How and where are receivers actually installed? –   How will this integrate or interfere with existing

systems? –  What is deployment time? –  Will it provide location accuracy that meets the

requirements of all your constituents (clinical, biomed, materials management)?

Cost Lessons Learned 3 main components: 1. Actual labor + hardware and software

–   Significant variable in receiver installation –   Power and network connections – how connections are made

greatly impacts costs –   Receiver density required to achieve positioning accuracy

2. Ongoing maintenance and support costs

3. Purchase can be packaged as a capital purchase, lease or rental –   How RTLS is packaged can greatly impact future costs and the

degree of risk you may assume over the life of the system

RTLS – A Phased Rollout

Validate Adopt Integrate Institutionalize Optimize TIME

VALUE

Business Improvement Revenue Cycle Mgmt

Clinical Workflow Beyond the Care Facility

Enterprise Workflow (Six Sigma) Patient Flow Throughput

Staff Efficiency

Departmental Apps Biomed / Clinical Engineering

OR / ED Central Services / MM

Security

Asset Management Shrinkage

Rental Utilization

Validate Adopt Integrate Institutionalize Optimize

PHASE ONE

PHASE TWO

PHASE THREE

PHASE FOUR

Accounts from the Real-World Kaiser and Providence

•   Case Study: 802.15.4 Zigbee network Enterprise asset tracking at Kaiser Permanente

Los Angeles Medical Center (opened 3/31/2009)

•   Use Case Planning: 802.11 Wi-Fi Network Environmental room controls and patient tracking

system in Providence Health and Services – Roy and Patricia Disney Family Cancer Center (1st Qtr 2010)

Kaiser Los Angeles Medical Center

RTLS at Kaiser LAMC Zigbee 802.15.4 Sensor Network

•   Commenced RTLS in 2006 –   400,000 Square Feet –   2,000 Assets Tagged

•   Primary asset categories include: –   Ventilators, Pumps, Transport Monitors

•   2nd Hospital Installed (12/2008) –   800,000 Square Feet –   2,000 Assets

•   Federated searching of assets between facilities to manage inventory between sites

RTLS Goals for Kaiser LAMC

•   Reduce lost, stolen, misplaced equipment •   Increase equipment utilization to reduce capital

budget •   Enhance staff productivity, efficiency and

satisfaction •   Reduce time searching •   Increase patient care time •   Increase efficiency of PM process •   Improve equipment request response time

How it Works 802.15.4 Zigbee Network

Kaiser RTLS How Did We Do?

Clinical and Financial Needs

•   Room level accuracy throughout the enterprise

•   Reduction in staff time searching ( saved ~1.5 hours per employee per shift)

•   Reduced shrinkage (lost, stolen, misplaced)

•   Increased utilization (no idle or hidden equipment, missing asset alerting, improved PM cycles)

Deployment •   As soon as sensors plugged in,

they form wireless network (no planning, no disruption)

•   Install completed in 12 days

Kaiser LAMC RTLS How Did We Do?

Planning •   Did not require any pre-

installation RF surveys or detailed system design

•   Sensors plugged into standard electrical outlets

•   As soon as they’re plugged in, they begin forming the wireless network

Ongoing Maintenance •   RTLS in operation for over 2

years •   Zero IT maintenance

involvement during this time •   System maintains positioning

accuracy and high reliability – self-healing, self-calibrating

Providence Health & Services Disney Family Cancer Center

PH&S DFCC 802.11 Wi-Fi Network

•   Roy and Patricia Disney Family Cancer Center (DFCC) •   Provides Radiation and Medical Oncology Services •   Opens 1st Qtr 2010 •   IT Installation planned for Fall 2009 •   RFID integration with system integrator application for

room environmental, setting, automated check in and patient tracking within facility

Use Case 2: DFCC

PH&S DFCC Goals for Patient Tracking

•   Active RFID card issued to patient •   Use 802.11 Wi-Fi network •   RFID environmental controlled rooms for music,

lighting, temperature •   RFID location information – allow staff to view patient

location information in bldg. •   Integrate with Avaya Phone Systems •   Desktop Messaging •   Nurse Call notification

Concerns When Using Wi-Fi

•   Designing a Wi-Fi network to support RTLS (802.11a vs 802.11g vs. Zigbee) can require expensive Wi-Fi redesign and deployment

•   Ongoing support will require dedicated monitoring, system administration and possibly specialized support agreements

Open Questions with Wi-Fi •   Will additional RTLS hardware and Wi-Fi APs be

needed to accomplish our patient tracking goals? •   What will it actually cost (in time and expertise) for on-

going maintenance? •   Who provides the trained individuals to keep it

calibrated? •   How will added RTLS traffic affect our Wi-Fi network? •   Will increased “noise” Wi-Fi RTLS tags generate

degrade communications performance?

Conclusions

•   RTLS must be inexpensive to deploy and must retrofit easily into existing buildings

•   IT must get cross-functional evaluation team to outline use cases – clear clinical and financial ROI

•   Underlying technology has an impact that can affect price and cost of ownership

•   Technology also influences positioning accuracy and reliability

Summary

•   At Kaiser, Zigbee network provided rapidly installed enterprise coverage, returned clinical and financial value, and did not require IT support (no interference, no maintenance concerns)

•   At Providence, Wi-Fi network will be used for departmental patient tracking solution. Still to be proven, as deployment is not complete.

Bottom Line

•   RTLS technology allows us to rethink how we provide care

•   RTLS allows the enterprise to do more with less

•   RTLS allows us to personalize care for our patients