Abstract
Objective
To control the workflow for surgical patients, we in-cooperate radio-frequency identification (RFID) technology to develop a Patient Advancement Monitoring System (PAMS) in operation theater.
Methods
The web-based PAMS is designed to monitor the whole workflow for the handling of surgical patients. The system integrates multiple data entry ports Across the multi-functional surgical teams. Data are entered into the system through RFID, bar code, palm digital assistance (PDA), ultra-mobile personal computer (UMPC), or traditional keyboard at designated checkpoints. Active radio-frequency identification (RFID) tag can initiate data demonstration on the computer screens upon a patient’s arrival at any particular checkpoint along the advancement pathway.
Results
The PAMS can manage the progress of operations, patient localization, identity verification, and peri-operative care. The workflow monitoring provides caregivers’ instant information sharing to enhance management efficiency.
Conclusion
RFID-initiate surgical workflow control is valuable to meet the safety, quality, efficiency requirements in operation theater.

I like the concept that the article presents, but take a look in the methods section and note the presence of “palm digital assistance (PDA)”. That made me a little suspicious about the age of the article. Even though it was published in December 2011, it was received by the journal December 4, 2009; received in revised form August 16, 2010; accepted August 27, 2010 and finally published more than a year later in December 2011. So it took two years from the time the article was received until it was published. This just fuels my opinion that methods used to disseminate medical and scientific information is completely outdated.

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1. Computer Methods and Programs in Biomedicine Vol. 104, Issue 3, Pages 435-442, December 2011

I’ve been interested in the use of RFID technology in healthcare for quite some time. I think there’s real value in the use of RFID secondary to the ability to encode significant amounts of information in the tag. The information contained in an RFID tag could potentially include a patient’s medication regimen, allergies and medical condition. The value become obvious when you consider the possibilities during medication administration in the acute care setting.

The article has a great list of reasons why RFID should at least be considered a viable alternative to BCMA.

Barcoding presents challenges, however, especially with regard to barcode medication administration (BCMA).

• Barcoding requires human compliance—in order to perform its function, a barcode must be scanned and that requires a human to pull the trigger. If a human elects to bypass the process and not use the barcode scanner, there is little that can be done about it.
• Barcodes require line-of-sight scanning. To identify a patient, for example, the care provider must locate and scan the patient’s wristband. If the patient is asleep and resting on that hand, that means disturbing, and possibly waking, the patient.
• The scanner cannot verify that the barcode scanned is actually physically attached to the item it represents. There are well-documented instances of users producing surrogate copies of barcodes and scanning those surrogates, rather than scanning the barcodes actually affixed to the appropriate items (Koppel, et al., 2008).
• Barcode scanners cannot tell the difference between scanning 10 different instances of the same barcode (e.g., scanning 10 different medication vials) or scanning the same barcode 10 times (e.g., scanning the same vial 10 times). This means that people can “cheat” the system, and a user who loses track of where they are in a scanning process cannot tell if they have already scanned an item. It should be noted that the FDA has proposed a serialized National Drug Code (NDC) implementation that would improve this issue.
• When a large number of items must be scanned, users experience fatigue that may result in failure to scan some items, or increase the probability of the user taking shortcuts.
• Barcodes rely on print quality: a damaged barcode may not scan.
• Data is fixed at the time the barcode is printed; it cannot be updated.
• Barcode scanning typically requires a flat surface with high contrast. Barcodes on irregular surfaces (such as on a foil-wrapped suppository) or on surfaces without good printed contrast (such as an IV bag) are difficult to scan.
• On some packaging (notably IV bags), the container has multiple barcodes, and the provider cannot always tell which one they should scan.
• Barcode scanning of medications relies heavily on barcodes containing the NDC for which there is not a well-maintained definitive reference list.”

RFID technology in healthcare is in its infancy even though it’s an older technology, but in my opinion now is the perfect time to be exploring its use. Waiting for the technology to mature in healthcare means you’ve already missed the boat. In addition, having your hands in technology during it’s development offers the opportunity to influence future direction.

Here’s a cool video demonstrating some possible uses for RFID technology in healthcare. I especially like the part where the patient’s profile is automatically pulled onto a tablet pc once the patient has been positively identified via an RFID scanner in the tablet.

On a side note, I’ve seen articles popping up all over the internet this week talking about Apple’s use of the iPhone and iPod touch as a RFID transponder, and according to the Patently Apple website “the RFID antenna could be placed in the touch sensor panel, such that the touch sensor panel could now additionally function as an RFID transponder.” Details on the patent from Apple can be found here.

I have a small collection of RFID web clippings and articles that can be found in a shared Evernote Notebook. I haven’t been collecting information for long and the notebook is quite limited, but feel free to browse. If you know of a good article relating RFID to healthcare don’t hesitate to point me in the right direction.

From the VeriChip website:

Health Link is the connection between you and your personal health record. Health Link utilizes a tiny,passive microchip (the nation’s first and only microchip cleared for patient identification by the U.S. Food & Drug Administration) and a secure, private online database that links you to your personal health record. Your Health Link is always with you and cannot be lost or stolen. It provides emergency room doctors and nurses with your vital medical and emergency contact information, allowing them to treat you rapidly, accurately and safely during an emergency.

The Health Link microchip

What you need to know about Health Link:
• Health Link allows ER doctors and nurses immediate access to your personal health record and emergency contact information during an emergency.
• ER doctors and nurses use Health Link as a tool to help treat you rapidly, accurately and safely based on your current medical information.
• Your personal medical and emergency contact information is easily updated through Health Link’s secure, online database.

About the size of a grain of rice, the microchip is inserted just under the skin and contains only a unique, 16-digit identifier. The microchip itself does not contain any other data other than this unique electronic ID, nor does it contain any Global Positioning System (GPS) tracking capabilities. And unlike conventional forms of identification, the Health Link cannot be lost, stolen, misplaced, or counterfeited. It is safe, secure, reversible, and always with you.

I’ve mentioned before that I think RFID would make a great way to track a patient’s EMR. Well, now you can do just that. That’s some pretty cool technology.

As recently as 2007, a debate over chip privacy and safety versus having critical medical data instantly at hand (as it were) was featured in a PLoS Medicine exchange.  In it, Halamka asserted, “Implantation of RFID devices is one tool, appropriate for some patients based on their personal analysis of risks and benefits, that can empower patients by serving as a source of identity and a link to a personal health record when the patient cannot otherwise communicate.””

Radio-frequency identification (RFID) refers to small electronic devices that consist of a small chip and an antenna. They are capable of carrying quite a bit of information. To retrieve the information an RFID device must be scanned much like a barcode. However, the device can be scanned independent of position relative to the scanner and may be read up to 20 feet away.

I’ve always felt that RFID devices would make a great way to maintain a patient’s electronic health record (EHR). Important information like allergies, medical conditions and current medications would be a valuable resource for healthcare professionals during the hospital admission process. Approximately 28% of a healthcare professional’s time is spent looking for information. This is especially true in emergency departments where patients may not even be able to answer questions secondary to their condition. RFID devices can be small, easily taking up no more room than a credit card.

Of course these devices aren’t without issues. Securing the information on the RFID would prove difficult, but may be possible by eliminating a large portion of the patient’s identification such as social security number, account numbers or insurance information. Keeping the information up to date would also be difficult as the data would require input from several sources. A centralized database to house the information would be best, but that is an entirely different post.