OVERVIEW OF TECHNOLOGY

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1 RFID IN HEALTHCARE Rachael Myers University of Central Arkansas Pleasant Ridge Road Apartment 126 Little Rock, AR (501) Mark E. McMurtrey Department of MIS - COB 305-O College of Business University of Central Arkansas 201 Donaghey Ave. Conway, AR (501) markmc@uca.edu ABSTRACT Radio Frequency Identification (RFID) is a technology that uses radio signals to automatically obtain information regarding a physical object s identity. The healthcare industry has implemented this technology in an increasing number of applications since Applications of RFID technology as they relate to healthcare include monitoring patients, physicians, medications, and medical devices. RFID technology provides numerous advantages to the healthcare industry. However, multiple concerns accompany these advantages including high implementation costs, potential privacy violations, and technological issues. Ultimately, it is vital for all organizations to conduct a cost-benefit analysis to ensure an acceptable return on investment. OVERVIEW OF TECHNOLOGY Radio Frequency Identification (RFID) is a technology that uses radio signals to automatically obtain information regarding a physical object s identity. It is used to track and manage a variety of objects including animals, individuals, and inventory items. It does not require human intervention because a line of sight is not necessary for the retrieval of information (Castro, Lefebvre, Lefebvre, 2013). RFID technology was originally developed in the 1940s. It is currently used in many industries such as retail, food, manufacturing, and education (Gupta, Kundu, Codanda, 2015). Today, businesses are continuing to discover new applications for RFID technology and its related benefits. Starting in 2000, the healthcare industry began to implement an increasing number of applications for RFID. Thus, there have been many improvements in areas such as patient care and safety, utilization of resources, equipment tracking, and reducing processing times. However, many organizations are questioning its use due to concerns regarding patient privacy,

2 the complexity of its technology, and high costs of capital investment (Gupta et al., 2015). In 2003, the Department of Defense and Wal-Mart announced their implementations of RFID systems. Both entities began using RFID tags to assist in their interactions with major suppliers. This was a critical year for RFID technology, because this created a heightened awareness in the potential applications and benefits of RFID systems. Other industries began to speculate about the possible advantages of adopting the technology (Raviprakash, Prabu, Alagumurthi, Soundararajan, 2009). The RFID system is made up of three primary components. These components include RFID tags, RFID readers, and RFID middleware. RFID tags are attached to a physical object. They have a microchip and an antenna. This allows the data stored in the tag to be communicated through electromagnetic radio waves to RFID readers (Castro et al., 2013). RFID tags are grouped into three different types including passive tags, active tags, and semi-active tags. Passive tags acquire energy from radiofrequency signals transmitted by the RFID reader. Active tags work by using an embedded battery. This increases memory and functionality. A semiactive tag communicates with RFID readers like passive tags, however, an internal battery can be used to support additional modules (Hu, Ong, Zhu, Liu, Song, 2014). RFID readers are responsible for transferring received data to the RFID middleware. Once the middleware captures the data, it is filtered and processed. The middleware groups and manages the large amounts of data collected by RFID readers. The processed data is then routed to enterprise applications located within the organization (Castro et al., 2013). Readers can capture data in two different modes. In active mode, the RFID reader is a handheld device that is mobile. In healthcare, it uses a wireless connection to retrieve information about the patient, medication, medical device, or staff member. In passive mode, readers may be fixed in corridors or rooms. The tags are read as they pass through these areas within the healthcare facility (Hu et al., 2014). ADVANTAGES AND APPLICATIONS Hospitals are not often considered leaders in regards to their efforts to adopt new information and communication technologies (ICTs) such as RFID. Hospitals do not typically make this a priority, and projects related to the implementation of ICTs often fail (Castro et al., 2013). The availability of greater technology using computers and related software has led to higher expectations in regards to patient care and safety. Many individuals believe that technology should streamline care, assist in decision making, prevent errors, and offer performance feedback. This would lead to a reduction in the risks of harm associated with medical care (Ajami, Rajabzadeh, 2013). ICTs such as RFID can greatly benefit healthcare organizations by reducing costs and streamlining both clinical and administrative processes. Many healthcare processes are known for their waste and inefficiency, so these technologies could present a plausible solution to this issue. Further, RFID systems offer opportunities to increase healthcare quality, minimize medical errors, decrease expenditures, and ensure compliance with governmental requirements (Castro et al., 2013). It has been suggested that application areas in which RFID can be most beneficial to healthcare facilities include identifying patients, delivering medications, tracking patients and staff in real-time, tracking assets such as medical equipment and pharmaceutical inventory,

3 management of blood products, increasing security of newborns, and minimizing errors related to blood and drug administration (Acharyulu, 2007). Tracking medical equipment is a pressing issue in healthcare. Expenditures on medical equipment and medical devices are rising globally. In 1998, expenditures on such items were $145 billion. In 2006, expenditures had increased to $220 billion. Managing and acquiring these assets creates a further cost burden which continues to rise due to its direct correlation with these expenditures (Castro et al., 2013). These costs are expected to continue rising in the healthcare field. It is estimated that they will grow to 20% of U.S. gross domestic product by Many factors have contributed to the rise in healthcare expenditures. These factors include the increasing prominence of chronic conditions and population aging (Roper, Sedehi, Ashuri, 2015). RFID tags provide a more efficient way to track inventory of medications and durable medical equipment acquired through medical expenditures. The tags can provide information regarding current inventory, and they enable easier access to information regarding consumption rates. This enables management to make necessary adjustments to inventory rates more easily (Mehrjerdi, 2010). Recent studies have shown that RFID enabled systems can decrease costs related to inventory purchasing, carrying, and shortages by up to 30 percent. A study conducted in a prominent hospital network located in Florida revealed savings of percent in their radiology department. At the time of study, no other changes were made to their business processes (Gupta et al., 2015). RFID tags can store data related to product identification numbers, manufacture dates, prices, locations, and inventory on hand. RFID readers can quickly read all information. The readers can store high volumes of data. Thus, it can easily improve a hospital s operational efficiency. In turn, this enables the healthcare entity to achieve a valuable competitive advantage (Mehrjerdi, 2010). Generally, RFID systems have many useful characteristics such as increased dependability, increased accuracy and reliability of collected data, and even enhanced security benefits such as theft reduction (Mehrjerdi, 2010). Efficiency in hospitals, patient centers, and emergency rooms can be increased due to the vast amounts of information which can be stored in RFID tags. These tags can integrate magnetic strips and existing barcodes to store data regarding patient demographics, patient medications, procedures performed, and expert opinions. Additionally, RFID tags enable healthcare providers to locate patients more easily and their medications within the facility (Mehrjerdi, 2010). RFID provides solutions for issues related to staff management. RFID systems provide valuable information regarding which areas of the healthcare facility are busiest at different times throughout the day. When too many workers are placed in one area, operational costs become excessive. However, if there are not enough workers in one area at a given time, service levels and patient satisfaction decrease. RFID enables management to make the most efficient use of workers, minimizing operational costs and increasing patient satisfaction (Gupta et al., 2015). RFID has multiple applications for pharmacies including tracing counterfeit medications and automating the distribution of medicine (Mehrjerdi, 2010). Recent studies have shown that an alarming percentage of medications manufactured in countries such as Columbia and Mexico are counterfeit medications. These drugs pose a substantial risk to a patient s health and safety if

4 administered (Gupta et al., 2015). Worldwide, an estimated 10% of pharmaceuticals delivered are considered fraudulent. RFID technology allows healthcare facilities in these countries to detect and dispose of tampered drugs (Raviprakash et al., 2009). RFID technologies can also assist pharmacies in the event of medication recalls. Between 1997 and 2002, the Food and Drug Administration s Office of Compliance recalled 1,230 drugs. This is an overwhelming 3.9 recalls per week. Using RFID systems, the medications can be located and pulled from the shelves with more speed and efficiency (Raviprakash et al., 2009). RFID technology can be greatly beneficial when implemented in pathology labs. These labs typically require extensive, time consuming clerical work. Medical supplies, patient information, and the storage and documentation of blood and urine samples require abundant amounts of manual documentation. Adding to the problem, these labs are frequently understaffed. By placing RFID tags on individual samples and supplies, RFID systems can minimize clerical work and the employees required for its completion (Gupta et al., 2015). A study conducted in 1988 showed that RFID systems assisted in reducing the rates of medication errors by an astonishing 55 percent. At that time, RFID systems used within the hospital pharmacy had the ability to detect medication errors in less than 15 minutes. This resulted in improved patient safety. It also provided an enormous cost benefit, as the average cost associated with a single medication error can be between $4,000 and $12,000 (Mehrjerdi, 2010). Sadly, preventable medical errors contribute to the deaths of between 44,000 and 98,000 people each year (Ajami et al., 2013). RFID systems can provide additional error reductions in areas such as medical diagnosis and locating medical equipment (Mehrjerdi, 2010). It has been reported that hospitals in the U.S. waste up to $50,000 monthly due to unwanted equipment rentals. These rentals are a result of misplaced equipment that could easily be tracked and located using RFID technology. This expense does not include the time-consuming and costly efforts of attempting to locate the original equipment (Roper et al., 2015). Many critical issues have been successfully handled using RFID technology. For example, RFID systems have been used in infant hospitals to avoid mismatching the baby with its mother. It has also provided increased security in these hospitals and helped to prevent kidnapping attempts. Other critical issues handled by RFID systems include the dispensing of correct drug dosages, ensuring correct surgical methods, and identifying patients with impaired cognitive functioning (Gupta et al., 2015). RFID technologies can also be integrated into home health care for elderly patients. RFID chips can be placed on commonly used household items such as toothbrushes and medications. This enables the tracking of a patient throughout the day to ensure that they are completing daily activities. RFID technology can also be used to identify items that are touched by patients using an RFID glove developed by the University of Washington. Further, RFID smart beds can monitor an individual s weight and movements with temperature sensors and cameras. The bed s temperature sensors can provide important information regarding the behavior of the patient (Mehrjerdi, 2010). RFID has many advantages over using traditional barcode systems. RFIDs last longer, they can be used again, and the RFID reader can read multiple RFID tags at once. Additionally, there is no line sight required. This is not the case with barcodes (Fescioglu-Unver, Choi, Sheen, &

5 Kumara, 2014). RFID tags can effectively undergo X-rays and heated sterilization used on medical items. They are not easily damaged, and they can still be used even when they are dirty. These tags read much faster than barcodes, too. RFID tags can be read at a 100-1,000 tags per second rate (Mehrjerdi, 2010). Research conducted on the benefits of RFID using a balanced score card technique has shown it can increase business performance, customer relationships, business growth, and financial performance. However, many entities are hesitant to integrate this technology because of the unclear benefits specific to each industry. It is recommended that each business conducts a costbenefit analysis before implementation, including return on investment assessments. Benefits are likely to vary from industry to industry. Benefits may also vary based on geographical locations (Fescioglu-Unver et al., 2014). KEY CONCERNS Key concerns related to the adoption of RFID systems include return on investment, the total cost of ownership, interoperability and integration, and ease of adoption considerations (Acharyulu, 2007). Adopting the technology requires involvement of top management. Other examples of relevant concerns include integrating the technology with existing IT systems, deciding which practices should use RFID, and proper staff training (Mehrjerdi, 2010). Each of these factors should be considered by companies planning to adopt RFID systems. One of the major disadvantages associated with RFID applications is the cost associated with implementing the technology. These costs are not limited to financial concerns. There are hardware, software, installation, and systems integration costs. Additionally, staff must be trained on how to properly use the technology. This has proven to be costly and time consuming (Castro et al., 2013). Implementing RFID technology within the organization would require the reorganization of workflows and processes, too. Redesigning current processes will change the way personnel perform their duties. Doing so would likely create ample resistance to change among employees. Implementing RFID technology can also create highly complex technical issues (Castro et al., 2013). According to a recent study, implementation costs related to RFID can range from $10 million and $16 million for large hospital organizations. These costs do not include regular maintenance and the costs of software upgrades (Gupta et al., 2015). Additionally, RFID tags are more expensive than barcodes. In 2009, the average tag cost was about 25 cents. Further, RFID tags have not proven to be very reliable. Reports have shown that these tags fail to work properly 20 to 30 percent of the time (Attaran, 2009). Many patients might initially refuse to take part in RFID systems due to privacy concerns or their unfamiliarity with the technology. This could create additional costs for the hospital, as they might find it necessary to provide lectures or informative brochures to minimize patient concerns (Mehrjerdi, 2010). Many individuals have voiced opinions regarding identity and privacy security. This concern is more prominent in the healthcare industry due to the nature and sensitivity of patient information. When adopting RFID technology, hospitals must ensure their compliance with federal privacy regulations. Many of these regulations in the U.S. are mandated under the Health Insurance Portability and Accountability Act (Castro et al., 2013)

6 RFID systems are vulnerable to privacy attacks because there is no line of sight required to read RFID tags. Consequently, tags can be read without the owner s knowledge. Security attacks can occur by listening or interfering with RFID reader communication. Sometimes, fraudulent messages can be sent from tags to readers (Fescioglu-Unver et al., 2014). Some of the techniques that can be used to decrease the risk of security threats include encrypting data, protecting the data with a password, and including features that can permanently remove data (Mehrjerdi, 2010). Because RFID systems use radio frequency waves to communicate, the tags and readers generate an electromagnetic radio frequency field. Electronic devices used in healthcare can be adversely affected by this field. This can cause potential life threatening issues if devices are not working properly (Fescioglu-Unver et al., 2014). Although the U.S. Food and Drug Administration (FDA) has not reported any adverse incidents at this time, hospitals must ensure the proper function of their medical devices when using RFID (Castro et al., 2013). Other technological concerns include tag collision, reader collision, false negatives, false positives, and problems that might occur when working near objects such as metals and liquids. Tag collision occurs when many RFIDs are operating within close range. RFID systems can negatively interfere with each other. Reader collision occurs when multiple RFID readers read the same tag simultaneously. False negatives and positives occur when there is an unrecognized tag or when tags are falsely recognized (Fescioglu-Unver et al., 2014). CONCLUDING THOUGHTS In conclusion, the implementation of RFID systems within the healthcare industry can provide many benefits in a variety of applications. This technology can obtain a large amount of data from physical objects using radio signals. It has the potential to solve many service and cost efficiency issues within healthcare facilities. Some of its most promising applications include monitoring patients, physicians, medications, and medical devices. It can also deter theft and reduce inventory costs. It can streamline many complicated administrative and clinical processes. However, there are many valid concerns to consider before implementing this technology. Some of these issues include costs of implementation, technological complexities, interference with medical devices and equipment, patient privacy, and resistance to change in both employees and patients. It is vital for all organizations to conduct a cost-benefit analysis to ensure an acceptable return on investment. Benefits of RFID will vary from industry to industry, and healthcare facilities should develop a thorough awareness of what the technology can and cannot do. Ultimately, the benefits of implementing the technology must be greater than its substantial costs

7 References Acharyulu, G. V. (2007) RFID in the Healthcare Supply Chain: Improving Performance Through Greater Visability. ICFAI Journal of Management Research, 6 (11), Ajami, S., and Rajabzadeh, A. (2013) Radio Frequency Identification (RFID) technology and patient safety. Retrieved from Attaran, M. (2009) Keeping the promise of efficiency: RFID s trends and its renewed popularity. Industrial Engineer, 41 (3), Castro, L., Lefebvre, E., and Lefebvre, L. A. (2013) Adding Intelligence to Mobile Asset Management in Hospitals: The True Value of RFID. Journal of Medical Systems, 37 (5). Fescioglu-Unver, N., Choi, S. H., Sheen, D., and Kumara, S. (2014) RFID in production and service systems: Technology, applications and issues. Information Systems Frontiers, 17 (6), Gupta, G., Kundu, T., and Codanda, A. A. (2015) An Integrated Conceptual Framework for RFID Enabled Healthcare. Independent Journal of Management & Production, 6 (4). Hu, L., Ong, D. M., Zhu, X., Liu, Q., and Song, E. (2014) Enabling RFID technology for healthcare: Application, architecture, and challenges. Telecommunication Systems, 58 (3), Mehrjerdi, Y. Z. (2010) RFID-enabled healthcare systems: Risk-benefit analysis. International Journal of Pharmaceutical and Healthcare Marketing, 4 (3), Raviprakash, A. V., Prabu, B., Alagumurthi, N., and Soundararajan, V. (2009) RFID: Rx to Healthcare Industry. ICFAI Journal of Supply Chain Management, 6 (2), Roper, K. O., Sedehi, A., and Ashuri, B. (2015) A cost-benefit case for RFID implementation in hospitals: Adapting to industry reform. Facilities, 33 (5/6),