Radio Frequency Identification (RFID) technology, pioneered by the likes of WalMart, could have its most tangible public impact in the retail sector, where quick and simple item scanning can streamline logistics and inventory management.
In the healthcare sector, where RFID could have implications beyond supply chain management, RFID's impact might be less obvious, but it could be equally powerful.
In mass retailing, passive RFID tags, which emit signals that can be scanned simultaneously, at a distance and out of line-of-sight, provide a unique identity for individual items. This approach delivers more detail than scanning larger batches or loads and eliminates the need to scan each item separately.
Active tags, which contain an internal battery and can both read and write data on the chips they contain, can be read over longer distances and enable the development of potentially more sophisticated applications.
Systems using passive tags are rapidly entering the pharmaceutical market to aid the fight against the circulation of counterfeit drugs. In December 2005, for example, Pfizer began tagging Viagra shipments in the USA, having seen around five million counterfeit doses enter that market in 2005. With each bottle uniquely identified and located, spotting the exceptions that indicate illicit copies of branded drugs becomes easier.
Similar technology could help improve the efficiency of drug inventory and medical device management within the hospital supply chain. Indeed, many compelling arguments for RFID deployment in hospitals are emerging, and it is in the emergency room that patients might first start to notice this technology.
An area where patients might start to feel the benefits of RFID is in the tagging of items on crash trolleys, where a diverse range of equipment and drugs must be in place and ready to use to deliver timely care to patients suffering cardiac arrest.
Chris Ranger, head of safer practice at the UK's National Patient Safety Agency (NPSA), says: "Between November 2003 and June 2005 there were eight incidents in the UK of problems related to crash trolleys, where the relevant equipment was not on the trolley or drugs were out of date. It was not due to negligence. There are three different items on those trolleys, and there are processes to check that they are in place, but it is a difficult task, especially in an emergency room."
Tagging these items so that they can be read simultaneously would simplify the process of identifying missing or out-of-date items. Compared with increasingly popular barcode systems, RFID would improve efficiency by shortening scan times and ultimately improve the quality of a patient's treatment. "With barcoding, you still need to read each item, so RFID is better in this instance," Ranger says.
Such tools could also be used to ensure the preparedness of ambulances, ORs and recovery rooms. The tagging of patients too is seen as a key application for RFID. Patients can be tagged with unique codes, reducing or eliminating medical errors such as the administration of the wrong medication or surgical procedure.
"A key thing that can go wrong is patient identification," says Ranger. "Assumptions can be made that lead to a patient being given someone else's medication or to sample pots being mislabelled. Technology could play a part in putting this right."
At the NPSA, Ranger saw two studies commissioned that compared the manual checking of patients' IDs with ID checking using auto-identification technology. What emerged was a strong case for RFID as part of the 'preferred toolkit'. Given the number of points in a hospital through which a patient passes, a combination of RFID and barcoding may evolve.
Ranger says: "In some instances, an identification barcode is the most appropriate technology, but RFID may be a much more powerful tool. With regard to patient safety, we realise that one technology won't provide the answer, but RFID is increasingly interesting in this application."
Given the growing use of RFID in the pharmaceutical supply chain, there is also a compelling argument for extending that technology through to the patient. "RFID is very important for linking the supply chain the patient, and people sometimes forget this," says Ranger. "For example, if a patient has an adverse reaction to a drug, it can be traced back to the offending batch, which can be examined to see if a counterfeit drug was the cause."
The tagging of both patients and staff in hospitals is now the subject of increasing debate, in part because it could facilitate not only the identification of individuals but the tracking of their movements.
This has a number of potentially beneficial implications. In an emergency, an appropriate clinician could be more easily located and summoned on the basis of their proximity. Technology developers have also been working on systems to track patients, such as those with conditions that impair mental functioning, who could become confused or lost.
Verichip, for example, developer of the first implantable RFID chip, provides tools for infant protection, asset tracking, access control and wander prevention. These tools use a passive tag under the skin, which interacts with a database containing patient-specific information.
Surgichip is another company developing patient tags, although specifically for the purpose of avoiding patients being wrongly identified and given the wrong surgical procedures. The system uses RFID to initiate a three-step verification process, covering patient identification, critical data relevant to the procedure and the site of the operation. These three elements are electronically documented to provide a secure audit trail for any given procedure.
In Europe and the UK, the tagging of patients and staff is relatively undeveloped. Patient tagging is more advanced in the USA, where the advantages of tagging have been proven.
Ned Simpson of the Healthcare Information and Management Systems Society (HIMSS) says: "It is already commonplace in healthcare here in the USA. Systems to prevent baby infant abduction are pretty standard. Every maternity ward has a kind of RFID system that locks the elevator if a tag goes near it. RFID contact-less ID systems for door locks are among the many forms of the technology that are common. New functions, such as the ability to locate staff and patients, as well as devices, are very exciting."
Simpson adds: "Indoor positioning and location systems are taking off, as they have a good ROI and the active tag technology is robust. Greater tagging of patients and staff is not far away, as there is a potential ROI for RFID to automate this process and cut the turnaround time in a busy OR and to quickly get another patient in."
Though the potential ROI on RFID is becoming clearer in some applications, the cost of implementation nevertheless remains a major barrier to wider adoption of the technology. Tags have long been regarded as expensive, particularly those with active chips, and this has been a strong disincentive to early adoption, particularly as tags represent only part of the cost.
Jay Srini of the University of Pittsburgh Medical Centre says: "People are now asking for supply chain automation for high-value devices. The cost of the tag is less important if the value of an item is higher. However, there are still up-front capital costs.
In the USA, Medicare reimbursement is falling, and many hospitals were built 20 or more years ago, so the investment goes into updating the hospital infrastructure. Also, while the cost of the tag is a factor, so is the cost of the investment in systems to manage the data and use it effectively."
However, many expect RFID to eventually show cost benefits, and a growing number of pilot implementations have been growing in value over the long term. These pilot schemes along with experience in the USA – where more extensive use is made of RFID, in the form of infant security systems and access control devices – show that investment in RFID systems is frequently recouped, albeit over the long term.
"An active RFID tag on a medical device has a great pay-off," says Simpson. "Hospitals won't lose devices, so they won't over-buy or need to rent additional devices. Early adopters tried inexpensive tags, but now they are moving to more expensive tags, which may cost as much as $50, because the better ROI more than pays off the price of the tag."
The debate over how expensive RFID solutions are changes when factors other than the initial investment and running costs are taken into account. For example, the potentially high cost of malpractice or negligence claims, which could be reduced or even eliminated with a more accurate technology in place, cannot be discounted.
"A report from the Institute of Medicine on adverse drug events suggests that, each year, these cause a number of deaths equivalent to two jumbo jets crashing, so this issue has very high visibility at the moment," says Srini. "If there is a significant malpractice impact, then even a few occurrences justify the expense of investing in a more reliable system."
In cases where it can prevent adverse events and accuracy is very critical, moving to RFID becomes a matter of patient safety, and it can eliminate malpractice costs.' RFID could also positively impact costs and patient safety by ensuring that fewer unnecessary procedures are performed. The tagging of prosthetics and implanted devices, such as replacement hip joints or pacemakers, would allow devices to be quickly identified without the need for exploratory surgery, should a problem emerge with any particular model.
Over time, the cost issue will be addressed. Technology developers are working to bring down tag prices, and innovative payment structures are evolving, such as the subscription-based, pay-as-you-go service offered by Waveform. However, once concerns are overcome, other factors may still cause inertia over RFID technology implementation.
OVERCOMING MARKET INERTIA
To be readily adopted, RFID must offer clear and distinct advantages over existing technology. In some applications, however, the incumbent technology does a good enough job to deter the switch to RFID. Barcoding, for example, is a well-established technology for device and patient tagging. With such a system already in place, the marginal benefit of RFID may not justify the upfront capital costs required to change technologies.
"HIMSS has stated that barcodes work for the administration of medication, which is an error-prone function," says Simpson. "Barcoding is a mature technology, and it is a cheap way to bring down the number of errors. Delaying barcoding a year to wait for RFID may lead to more mistakes with medication administration, so we say people should not delay."
RFID offers greater efficiency, given that tags can be scanned out of line-of-sight and at a distance, and can interact in a more sophisticated manner with databases of patient information. However, barcoded tags successfully address the major problem of mismatching patients and medication.
Adoption would, therefore, depend upon RFID significantly outperforming barcodes or an institution taking a long-term view of its cost profile. "Barcoding is accepted now, but people need to know more about RFID," says Chris Ranger. "If RFID can improve efficiency, then there is a cost return in the long-term."
Another challenge to RFID is the sheer pace of its development. With tags becoming smaller, readers more sophisticated and the potential applications of RFID expanding, healthcare facilities are justifiably concerned about entering the market too early and which vendor to choose.
"No one wants to be at the 'bleeding edge' or be a ladder for others. But they want to see examples of good implementation and to know that the specifications of the tag and the technology around it will not change," says Jay Srini. "The industry wants to see consolidation among vendors, with companies able to deliver on all facets of RFID, but we won't be at the tip point of consolidation in the near future. People are still exploiting niches, albeit ones that overlap."
Such concerns may, however, abate over time, just as worries about patient privacy have started to subside. With its information stored on tags and its potential for tracking individuals, some initially saw RFID as a 'big brother' technology impinging on privacy and personal freedom. Concerns still remain, but patients seem increasingly accepting.
Ranger says: "The cost of RFID relative to barcodes is high, and there are also issues surrounding the acceptability of patients being tagged, although if you explain why they are being tagged, they are often pleased that so much care is being taken. The acceptability argument is diminishing, so things have changed there, and the costs of RFID are also coming down."
WHEN, NOT IF
Indeed, every day, RFID is becoming more of a reality in healthcare. Over the coming years, a shift towards auto-identification tools such as RFID is expected, fostering further innovation.
"Adoption will accelerate," says Srini. "In some instances, it will be slow to displace barcoding, but in some applications, such as infection control, there will be rapid adoption of RFID. In identifying objects that have been touched by an infected patient, for example, it could help tackle the spread of MRSA in hospitals. There is certainly a bright future for this technology."
At the UK's NPSA, Ranger also feels that it is a question of when, not if, RFID will become a mainstay of healthcare technology. "It is difficult to put a timescale on the adoption of RFID in the UK," she says. "The NHS is slow to adopt new technologies."
"People are aware of barcoding, but RFID is only at the edge of their awareness, so its advocates need to show the market what it can do. We need more experience of the technology."
Simpson agrees: "It is as important as PCs. The US is a driver of the global healthcare equation, so we need new and clever ways to deliver the service. RFID will be an important part of this development."
Although the patient may not always perceive the role of RFID in the delivery of care, it is certain that it will soon play a crucial part in that process on both sides of the Atlantic.