15 Oct 2009

Sample Essay: Radio Frequency Identification Technology in Healthcare

Introduction

Radio frequency identification is a system of technology that includes the use of electromagnetic or electrostatic coupling in the radio frequency segment of the electromagnetic spectrum to distinctively identify an object, animal, or person. Radio frequency identification is increasingly becoming useful in health institutions as an alternative to the bar code. A Radio frequency identification system consists of three components which are the antennae, the transceiver often combined into one reader and the transponder which is the tag. The antenna emits radio frequency waves that transmit a signal which activates the transponder. When activated, the tag transmits information back to the antenna. The information is used to alert a programmable logic controller that an action should occur. The action could be as simple as raising an access gate or as complicated as providing an interface with a database to carry out a money transfer. Low frequency Radio frequency identification systems range from 30 KHz to 500 KHz and have short transmission range of generally less than six feet. High frequency Radio frequency identification systems on the other hand have a range from 850 MHz to 950 MHz and 2.4 GHz to 2.5 GHz and offer longer transmission ranges of more than 90 feet. In general, the higher the frequency, the more expensive the system.

Radio-frequency identification (RFID) utilizes an automatic identification method, relying on storing and retrieving data using transponder. The technology requires some extent the support of an RFID reader and an RFID tag.  An RFID tag is an object that can be applied to or incorporated into a product, animal, or person for the purpose of identification and tracking using radio waves. Some tags can be read from several meters away and beyond the line of sight of the reader. Most RFID tags contain at least two parts. One is a circuit used to store and process information and other specialized functions. The second is an antenna for receiving and transmitting the signal.

There are generally two types of RFID tags, the active RFID tags, which contain a battery and passive RFID tags, which have no battery. The tags communicate by responding to instructions and generating signals that must not create interference with the readers, as arriving signals can be very weak and must be distinguished. The backscattering and load modulation techniques can also be used to manipulate the reader’s field. Typically, backscattering is used in the far field, whereas load modulation applies in the near field within a few wavelengths from the reader. (Simon garfinkel and Henry Holtzman. 2005)

Passive RFID tags have no internal power supply. The tiny electrical current induced in the antenna by the incoming radio frequency signal provides just enough power for the CMOS integrated circuit in the tag to power up and transmit a response. Most passive tags signal by backscattering the carrier wave from the reader. Therefore the antenna has to be designed both to collect power from the incoming signal and also to transmit the outbound backscatter signal. The response of a passive RFID tag is not necessarily an ID number but can be a chip that contains non volatile data. (Sohraby. M (2007) Wireless Sensor Networks)

Passive tags have practical read distances ranging from about 11 cm (4 in) with near-field up to approximately 10 meters (33 feet) with far-field and can reach up to 183 meters (600 feet) when combined with a phased array. Basically, the reading and writing depend on the chosen radio frequency and the antenna design/size. Due to their simplicity in design they are also suitable for manufacture with a printing process for the antennas. The lack of an on board power supply means that the device can be quite small. Commercially available products exist that can be embedded in a sticker, or under the skin in the case of low frequency RFID tags.

Unlike passive RFID tags, active RFID tags have their own internal power source, which is used to power the integrated circuits and to broadcast the response signal to the reader. Communications from active tags to readers is typically much more reliable than those from passive tags due to the ability for active tags to conduct a session with a reader.

Due to their on board power supply, active tags may also transmit at higher power levels than passive tags, allowing them to be more useful in environments with humidity and spray or with RF-dampening targets which contain mostly water.  In turn, active tags can be larger due to battery size and more expensive to manufacture due to price of the battery. However, the potential shelf life of an active tag can be many years.

Many active tags today have operational ranges of hundreds of meters, and a battery life from several months to 10 years. Active tags may include larger memories than passive tags, and may include the ability to store additional information received from the reader.

Special active RFID tags may include specialized sensors. For example, a temperature sensor can be used to record the temperature profile during the transportation and storage of perishable goods and radioactive materials.

Semi-passive tags are similar to active tags in that they have their own power source, but the battery only powers the microchip and does not power the broadcasting of a signal. The response is usually powered by means of backscattering the RF energy from the reader, where energy is reflected back to the reader as with passive tags. An additional application for the battery is to power data storage. If energy from the reader is collected and stored to emit a response in the future, the tag is operating active.

Whereas in passive tags the power level to power up the circuitry must be 100 times stronger than with active or semi-active tags, also the time consumption for collecting the energy is omitted and the response comes with shorter latency time.

The enhanced sensitivity of semi-passive tags places higher demands on the reader concerning separation in denser population of tags. Because an already weak signal is backscattered to the reader from a larger number of tags and from longer distances, the separation requires more sophisticated anti-collision concepts, better signal processing and some more intelligent assessment of which tag might be where. For passive tags, the reader-to-tag link usually fails first. For semi-passive tags, the reverse (tag-to-reader) link usually collides first. Semi-passive tags have three main advantages: greater sensitivity than passive tags; longer battery powered life cycle than active tags; they can perform active functions such as temperature logging under their own power, even when no reader is present for powering the circuitry. Most semi-passive tags use the 2.4 GHz frequency which has shown to be less reliable in RF challenged environments where frozen items, dense metal, and other elements that are hostile to RF are found. This is far less common with fully active tags that broadcast at the 433 MHz frequency. (Chemical & Engineering News magazine. August 04 2008)

Radio frequency identification in Health care

Health care providers are recognizing the benefits of adopting (RFID) technology into their operations, in order to enhance health care service delivery. The availability and use of inventive new RFID-enabled information technology applications are helping providers to track medical equipment and supplies more efficiently, verify the authenticity and administration of drugs, and improve patient safety and security, such as by using RFID-enabled identification bracelets for newborns and patients.

RFID becomes useful in health care for instance where both patients and staff are constantly on the move, hospitals face significant challenges in managing the cautious and attentive process of patient care. Also, with patients often scheduled for several, consecutive procedures, knowledge of their location helps greatly improve the patient-care process and helps manage schedules. Locating medical staff is also important. And it is both ways: in case of emergencies in which a particular physician is required immediately and also to locate and help the staff in case they need assistance themselves.

Tracking of medical devices and other assets also make us of RFID. These equipments include medical devices like infusion pumps, portable x-ray machines, and patient monitoring devices, as well as other movable assets such as wheelchairs, gurneys, and stretchers. Inability to quickly search for missing equipment results in the loss of productive hours: instead of attending to patients, nurses spend their time seeking the devices. The capability to locate goods immediately saves much time cuts the money spent on replacing lost equipment.

RFID tags are also being attached to people, such as newborns whose security in the hospital can be better ensured with an RFID wristband. Additionally, radio frequency IDs can track clinicians within the hospital so they can be reached quickly in an emergency; emergency departments can use it to follow patient charts and improve efficiency; the operating room can use RFID to reduce wrong-site surgery or other patient identification errors. Other various uses is the ability to positively identify patients, prescribe and check drug interactions at the point of care, quickly checking a patient’s blood type, matching newborn infants with their parents, and triggering a lock-down after the unauthorized removal of an infant from a secured area. (Radiology in Hospitals. 2003)

RFID is also used for quality assurance applications. This may include improved instrument tracking for infection control purposes. Some vendors supply RFID-enabled trays that can be tracked through central sterilizing departments.

RFID technology can be used for inventory to monitor access to facilities or secure areas, or to monitor patterns of activity. RFID systems can also be designed to enhance security and safety.

A tag may contain information about products or people, their physical location in real time, and other information such as lot number and expiration date for medical supplies and drugs, patient allergies or blood type, and more. When transmitted to a reader within the facility, the information can be stored in a database or used by staff.

In the past, most health care facilities have kept track of their various resources and patients manually, or through the use of bar coding. RFID is a tool that can further enhance and supplement these efforts. Supply chain applications which include high-cost items like pacemakers, defibrillator, and artificial joints. The supply chain for these items is complex, and they are often supplied on consignment. They also require a high degree of traceability from the supplier to the patient. (Fisher, Jill A. 2006).

Quality assurance applications may include improved instrument tracking for infection control purposes. Some vendors supply RFID-enabled trays that can be tracked through central sterilizing departments.  Although there are potential long-term benefits of RFID, it appears that widespread adoption of the technology for supply chain applications is still a long way off. This may even be true in the retail industry, where large companies, such as WalMart have already invested considerable capital in RFID projects.

Health-care providers around the world have been using or testing RFID technology in a variety of contexts for several years. For example, RFID technology has successfully been used to tag pharmaceutical products to reduce the risk of counterfeit medications use in the United Kingdom. (Radiology in Hospitals. 2003)

RFID is also proving to be very useful in identifying patients, increasing safety and reducing incidents of mistaken identity during critical surgery. It is being successfully used to locate patients needing extra care, such as the elderly, or patients suffering from Alzheimer or memory loss. Medical equipment is being more rapidly located and tracked within health-care facilities, leading to more effective use of resources. Waste management has also been improved through the use of RFID by being able to track toxic wastes by tagging them.

In February 2004, the U.S. Food and Drug Administration recognized the potential of RFID information technologies to combat counterfeit pharmaceuticals and to provide more effective fulfillment of U.S.-mandated drug pedigree requirements. In the same year FDA issued a report recommending that drug makers use RFID to track bottles of the most commonly counterfeited drugs, with eventual extension to more drugs over time. (Science Direct journal. 2006).

Hand-washing compliance to reduce the spread of infections has seen the advent of an automatic hand sanitizing system which uses RFID to monitor how well health-care workers wash their hands. The wash cycle automatically starts when the caregiver’s hands are placed into the machine’s cylindrical cavity. Infection due to health care affect nearly 2 million people yearly in the U.S., and are responsible for approximately 80,000 deaths each year, according to a guide published by the Centers for Disease Control and Prevention (CDC), in collaboration with the Infectious Disease Society of America (IDSA) and the Society of Health care Epidemiology of America (SHEA). The transmission of disease causing organisms often occurs via the contaminated hands of health-care workers. When washing hands, a caregiver wearing an RFID badge is identified by the machine’s RFID interrogator. The device records the date and time, as well as the beginning and end of the wash cycle, and then communicates that information to the database. If a caregiver removes the hands before the 10-second cycle finishes, the interrogator transmits this information to the back-end database. (Fisher, Jill A. and Monahan, Torin. 2006).

In Texas University Medical Center researchers have recently began using RFID to manage the supply of chemicals and other materials used in biological research. The Center is using two storage cabinets fixed with RFID interrogators. Items stored inside the cabinets have RFID tags attached to them. Every authorized researcher at the university has been issued an RFID key card carrying a unique six-digit ID number that is used to open the lock. The interrogator reads the key card’s ID number and the item tags in the cabinet before and after it has been opened, enabling the software application to calculate what has been removed, and to update the on line inventory data. This information is accessible via the Web by university administrators, researchers and suppliers, and generates e-mail messages to the school’s accounts payable department and to the person who removed the items. Besides recording each transaction, the system helps suppliers know immediately what supplies have been used, what needs to be paid for and what needs replacing. (Texas university magazine. 2007)

A well-known medical practice with diagnosis and treatment facilities scattered across the U.S. piloted an RFID system to allow medical practitioners to better manage specimens of patient tissue. Deployed at endoscopy facilities, the tissue samples are tagged and tracked from the moment they are collected until they are delivered to the pathology laboratory for analysis, a series of steps characterized as crucial. The pilot lasted five months, and the demonstrable benefits included accurate data communication and verification, as well as improved efficiencies in specimen management.

In Malaysia, the government and three medical institutions are testing an RFID system for tracking blood bags, with the ultimate goal of eventually equipping more than 300 other government and private hospitals and clinics. The system combines blood bag tagging with smart cabinets to enable automated, efficient track-and-trace visibility. Eventually the system, if successful, will be used to manage Malaysia’s entire blood bank, which includes 500,000 transfusions annually. The expected benefits include improved blood bag identification, inventorying, and logistics. Cross-matching, in which a recipient’s blood type is matched to available donated blood, will be streamlined. Internal blood management processes will also be made more efficient.

A Southeast Asian RFID systems provider has introduced RFID-enabled products designed to help health-care providers track pharmaceuticals and monitor drug administration, to make sure that correct doses are given. The company’s intelligent medicine-dispensing system combines RFID tags and readers, work flow software, electronic medical records (EMRs) and a central database in an integrated solution. This enables nurses and doctors to view patient records, update them in real-time, and double-check prescription dosages at the moment they administer them. The systems can also automatically send prescriptions to pharmacists.

An acute-care and teaching hospital in New Jersey is implementing an RFID-enabled patient record management solution. Seeking increased efficiency and compliance with Insurance Portability and Accountability Act (HIPAA) which places heightened importance on patient information management, the hospital has targeted its Sleep Centers, which provide comprehensive evaluation and treatment for patients experiencing sleep-related problems. The Centers manage 5,000 patient files. Each file is tagged with an RFID tag, allowing it to be tracked from the moment it is created for a new patient until the file is retained in storage. RFID readers are positioned in key locations around the center to enable automatic tracking and encoding of the tags as they are moved from one place to another. Reads and writes to the tags are dynamically updated in the central database, ensuring real-time, accurate location data. (Science Direct journal. 2006).

Doctors at the University Of Texas Southwestern Medical Center, working with engineers from the University of Texas, Arlington, have developed innovative RFID-based medical technology to detect gastro-esophageal reflux disease, caused by stomach contents moving up the esophagus. The condition, commonly referred to as esophageal reflux or GERD, is estimated to affect as many as 19 million people. The new solution combines RFID with sensor technology to measure and transmit data from within a patient’s body. A dime-sized RFID chip is inserted into the esophagus, where it remains pinned until a physician removes it. Equipped with an electrical impulse sensor, the chip measures particular impulses that indicate the presence of acidic or non-acidic liquids in the esophagus. These collected measurements are transferred from the RFID chip to a wireless receptor hanging around the patient’s neck. (Bureau. B. S Prabau and Gadh.2008)

Critics of Radio Frequency Identification System

Few topics have elicited such strong views among the privacy community, medical practitioners, ethicists, consumer and civil rights groups, technologists, and public policy and lawmakers than proposals for using any type of technology to automatically and remotely identify and track human beings without their consent.  These fears include: furtive identification of individuals by known and unknown parties, without their prior knowledge or consent.

Systemic tracking and surveillance of individuals by known and unknown parties, without prior knowledge or consent; The construction of histories and profiles about individuals and their interactions, without  the individual’s prior knowledge or consent; Correlation of acquired data with contextual and other information obtained elsewhere; Unwanted or incorrect inferences about the individual derived from the data; Unauthorized revelation of personal and private facts and disclosure to others; The inherent imbalance of power and potential for undesirable social engineering, control and discrimination on the basis of RFID-generated data.(David. M. 2007)

Although the National Stroke Association has recognized that RFIF implants play a critical role in  assisting medical professionals in responding to stroke patients controversy remains when it comes to the same implants on children.

Apart from the theological disquiet, many critics find it hard to believe whether insertion of chips would actually protect lost or kidnapped children because implantable tags don’t have any GPS capability, so they only would work when chipped kids are brought into an emergency room. If readers are widely adopted at hospitals, then there is some logic to thinking that missing children could be recovered if they are brought in for medical care. But even so, the odds that chipped yet missing children would be brought into such hospitals are very slim.

There have also been scattered claims of RFID being a potential mutagen due the radioactive rays emitted. (Gilbert A. 2003)

Conclusion

In health care, RFID has the potential to achieve improvements in both supply chain productivity and patient safety applications. However, the technology is more likely to be successful if evaluated for closed-system applications first, where deployment and subsequent changes are within the control of the individual organization. The introduction of a new technology like RFID often causes a stir of interest and excitement about its capabilities. However, RFID will likely go through a stage where initial enthusiasm is tempered by practical cost-benefit considerations. The outcome of these will be appropriate deployment of the technology. Well-developed standards already exist at different technology levels, including the protocol, communication, and data levels. Using the existing ISO specifications, data can be encoded to RFID tags to guarantee continuity worldwide. This approach also ensures that RFID will be able to co-exist with current barcode standards, which will likely be required for the foreseeable future. The ISO-based RFID standard is also independent of technology, so the data structure can be coded to any of the accepted frequencies and protocols under ISO18000. (Patricia. Toni.2008)

References

– Frequency Identification (RFID) in Europe. (March 2007).steps towards a policy framework

http://eurlex.europa.eu/LexUriServ/site/en/com/2007/com2007_0096en01.pdf.

-Gilbert A. (2003). Privacy calls for RFID regulations. Health care journal. Pp-24

-New scripts, chemical & engineering news magazine.  (August 04 2008) vol. 86 no. 31,

-Fisher, Jill A. (2006). Emerging Surveillance Regimes in Hospitals.  (pp. 77-88).

-Fisher, Jill A. and Monahan, Torin. (2006).Tracking the Social Dimensions of RFID Systems in Hospitals.  176-183

-Simon Garfinkel, “Adapting Fair Information Practices to Low-Cost RFID System,” in Simon Garfinkel and Beth Rosenberg.  RFID: Applications, Security, and Privacy, New Jersey: Pearson Education, 2005, p. 522.

-Bearing point (2007). RFID in Health care: Poised for Growth Publication. p. 32-35

-Prabau and Gadh (2008) Radio frequency Identification: Beyond Bearing point. p. 12

-David. M (2007). Implantable may be easy but does it mean it is Ethical. Editorial Electronic Design 17-18

– Patricia. Toni (2008) Handbook of Informatics for Nurses & Healthcare Professionals: Hebda. Prentice hall. New York.   p. 27

– Sohraby. M (2007) Wireless Sensor Networks: Technology, Protocols, and Applications. John Wiley. New York. p. 12-18

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