Design and Development of an RFID-based HIS – A Case Study

2.1. Basic of RFID

RFID is a promising, emerging and advanced technology which can automatically identify a physical object without line-of-sight interaction (Kwok, S. et al., 2007). RFID technology captures and transfers data from an item of equipment to a reader via radio signals within a certain read range. In recent years, the applications of RFID technology has manifested various and sophisticated trends beyond ships and airplanes identification. A typical RFID system is an integrated collection of components including a tag, antenna, reader and software. An RFID tag is attached to an item which needs to be tracked and identified. The tag can transmit information concerning the object to the RFID reader via an antenna. Then, the reader reads the information stored and forwards it over a suitable communication channel, such as a network, to an application software running on a computer.

Nowadays, an increasing number of organizations utilize RFID technology to optimize their business, including the U.S. DoD, Metro AG, Wal-Mart, Gillette and Tesco. The top 100 suppliers of Wal-Mart were all required to adopt RFID technology in 2005 (Romanow, K. & Lundstrom, S., 2003) and one of Wal-Mart's distribution centres in Texas was dedicated to handling all the company's RFID tagged pallets and cases. Metro AG has implemented their first item-level RFID project in a store located at Rheinberg and Dusseldorf (RFID Journal, 2003). They attached RFID tags to every Gillette razor blade, Kraft cream cheese and Proctor and Gamble (P&G) shampoos. With the RFID-enabled systems, it not only enhances stock replenishment operations but also benefits customers, because the shopping carts are allowed to update shopping lists automatically with a self checking function.

The application types of RFID usually rely on radio frequency (RF), which can be normally classified into four types: Low Frequency (LF, 125 to 134 kHz), High Frequency (HF, 13.56 MHz), Ultra High Frequency (UHF, 860 to 960 MHz) and Microwave (2.45 GHz). LF is mostly used for access control and animal tagging and it is not very susceptible to liquids and metals. HF is the most suitable for applications in transcontinental connections without the requirement of a long reading range. UHF tags are the cheapest to produce and they are used extensively in supply chain applications, such as pallet and case tracking. UHF tags can be read at long range. However, compared to LF, an HF or UHF tag is more susceptible to opaque materials. Microwave tags have higher transfer rates than UHF tags but are more susceptible to opaque materials than UHF tags.

2.2. RFID in Healthcare Industry

More and more organizations have started utilizing RFID technology to improve their efficiency and effectiveness. The healthcare industry has no exception. The healthcare industry contributes around 14 percent of the world's gross domestic product (Garfinkel, S. & Rosenberg, B., 2006). Most healthcare organizations are facing patient identification problems. In general, an HIS can be separated into two parts – the Management Information System (MIS) that satisfies the administrative requirements, and the Clinical Information System (CIS) that satisfies the clinical requirements. HIS needs to enable authorized users to collect, store, process, communicate and retrieve patient and administrative information, with the aid of computers and communication facilities (Association, 2008). However, as investigated, a typical hospital has an error of at least five percent in the records of the master patient index. One of every twenty patients has an error in his or her medical record number.

The high rate of medical error, raises public concerns, therefore creating the need for the healthcare industry to adopt functional and innovative technology to improve the current system so that operational efficiency and effectiveness can be enhanced. Ultimately, healthcare services need to be improved and patient's data correctness needs to be guaranteed. Thus, RFID technology is becoming an important tool in the healthcare industry.

Survey results on RFID applications in healthcare are provided on the website of RFID in Healthcare, where most of the hospitals were reported to apply RFID in tracking and tracing patients and staff. More than 50% of the applications involved tracking individuals (such as patients and medical staff) and medical equipment. The most common application is in tracking and tracing patients, and in patient identification. In fact, there have been many sucessful applications of RFID in item tracking and tracing, such as work-in-process, equipment, food, books, small children and animals (Brown, D., 2007; Gandino et al., 2007; Kelepouris, 2007; Kwok et al., 2008). Currently, there are mainly eight types of RFID applications in healthcare, including tracking individuals, patient identification, tracking equipment or assets, tracking and matching blood samples, becoming part of an electronic medical record, tracking items in the general supply chain, tracking pharmaceuticals and in product authentication.

Although RFID technology offers tremendous benefits to the healthcare industry, there are still some challenges to be faced, such as interference concerns, privacy and ethical issues, and standards.

A hospital, is a special and critical environment, where various radiation-emitting devices, including microwave sterilizers, MRI units, and X-ray, and pacemakers machines are regularly used (Garfinkel, S. & Rosenberg, B., 2006). Some electromagnetic interference has the potential of preventing the operation of RFID devices. It has been proven that long range RFID readers are riskier than short-range readers. RFID readers should be kept away from critical healthcare equipment. It is better to use a short range reader than long range reader if possible (Garfinkel, S. & Rosenberg, B., 2006).

After using RFID, it becomes possible to collect more detailed information outside the hospital, hence the privacy issue appears. However, it is difficult to define precisely. Some experts (Brown, D., 2007) see the privacy issues in two scenarios: the first one occurs when tags are transferred to the unsuspecting and uninformed public; the second one occurs when people themselves are embedded with chips or find themselves required to carry tagged documents.

Since there is a growing trend in applying RFID technology in the healthcare industry, new standards should be developed for these new capabilities. The central challenge for the healthcare industry is not only in the development of the security protocols, encryption methods, reducing the physical size or in more ubiquitous devices, but in the development of the standards and policies and human computer interfaces that help to provide the appropriate visibility, use, and control of information (Garfinkel, S. & Rosenberg, B., 2006).

4.1. Analysis of the Needs of Patients and Medical Staff

In order to investigate the patient requirements and medical staff needs, a survey was conducted. More than 140 interviews were successfully completed, involving interviewees of different ages, gender, education levels and occupations. The findings are presented, and explain how the public views the current medical services, and the recognition of RFID technology and hospital information system are discussed, and conclusions drawn.

Based on the survey responses, as illustrated in Fig. 1 and Fig. 2, one can observe that almost half of the interviewees had no knowledge of RFID and the hospital information system, but there are a number of people who have an interest in the new technology.

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Fig. 1.

Recognition of RFID reported by interviewees

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Fig. 2.

Recognition of HIS reported by interviewees

The collection of data was by personal interviews, e-mail surveys, Windows Live Messenger surveys, Tencent QQ surveys, and web page surveys which are available at http://www.my3q.com/survey/337/michelle_chau/29185.phtml.

There were nine aspects of improving current hospital services highlighted; they are waiting time in the Out-Patient and Emergency Department, time spent on collecting medicines from the pharmacy, time spent on the admission and hospitalization procedure, fees, hospital environment, accuracy of the diagnosis, medicine and services provided, medical service quality and the quality of drugs, and recreational facilities. In this research, the desire for improving current hospital services is clear. The top three are: accuracy of the diagnosis, medicine and services provided (78%), quality of drugs (64%), and waiting time at the Out-Patient and Emergency Department (54%), as shown in Fig. 3.

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Fig. 3.

Fifty-four percent of respondents rated 5 for waiting time at the out-patient and emergency department

On the other hand, there were nine aspects highlighted for improving the medical staff's work, including workload, efficiency and effectiveness, time spent on manual record work, salary, equipment, training, communication among colleagues, recreation facilities, and financial assistance. Among the current medical staff and post medical staff, the top three aspects of most concern were: efficiency and effectiveness (70%) which is shown in Fig. 4, time spent on manual record works (55%), workload (49%).

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Fig. 4.

Seventy percent of respondent rated 5 for efficiency and effectiveness

According to the responses concerning confidence in using the new RFID-enabled HIS in the hospital, 24% were certainly confident in using the new RFID-enabled HIS and 60% mentioned that they would be confident in using the new system if they could know more about the system. However, it is also found that 16% of respondent had no confidence in using it (Fig. 5). Referring to the safety concerns in using RFID, 52% believed RFID is safe to humans.

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Fig. 5.

Sixty percent of respondents wanted to know more about the system before using RFID-enabled HIS

To summarize, one can understand that this research can be considered as a demand pull project. The survey results showed that the hospital should have a new customizable and sustainable system, which can change and improve the current operation processes, and fulfill the highly rated expected improvements for patients and the medical staff. The focuses are on the effective usage of hospital information, efficient collecting of information, and the operation of the dispensary, so as to enhance the hospital effectiveness, efficiency and accuracy.

4.2. The Design of the RFID-enabled HIS

RFID-enabled HIS consists of RFID wristbands, RFID tags, PDA handheld devices, RFID reader and antenna, WIFI network platform and software. The RFID wristband includes patient information, such as name, blood type, allergies and other critical information for identification, which can be associated with treatment and payment. The specifications are an NXP chip, 14443a agreement and 1k bytes capacity. The RFID reader, which contains a receiver, transmitter and microprocessor, is used to send and receive RF to and from the tag via antennas. A PDA, which has an RFID reader installed inside to read the patient's RFID wristband, is the handheld device designed for medical staff, so that medical staff can retrieve useful information quickly and view a patient's medical record by using PDA in a real-time manner. Ultimately, medical staff can issue prescriptions, confirm drug prescriptions, check medical records and so on anytime and anywhere. Moreover, PDA can also work as an intercom for emergency situations. The specifications of the PDA used in this case study were handwriting enabled, consistent with the sealing standard, Microsoft® Windows® CE 5.0 (CE.NET) embedded operating system, consistent with IEEE802.11b (WLAN). With the aid of the WIFI network, the locations of tagged assets, medical equipment and patients become visible to the managerial team and medical staff. Thus, the staff can retrieve patients' medical records by using the PDA and locate the patients immediately if an emergency occurs.

The proposed hospital information system provides data switching between the information centre and the system front-end application. The architecture of the RFID-enabled HIS was also established to integrate with the existing system. As illustrated in Fig. 6, it shows that data was collected, processed, stored and transformed into useful information for medical services in the hospital. The hospital-wide RFID-enabled HIS infrastructure was designed as depicted in Fig. 7. The RFID readers should position at strategic points and RFID tags attached to patients or equipment.

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Fig. 6.

RFID Integration with Existing HIS

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Fig. 7.

Infrastructure of RFID-enabled Hospital Information System

By using the new system, relevant medical processes will be changed to incorporate RFID technology. For doctors, they can retrieve and update the diagnostic information of patients in various stages; input consultations; enter prescriptions and so on. For nurses, they can query the inspection reports selected, such as type-B ultrasonic, CT, and other different testing reports; execute medical advice; record and check the vital signs of patients etc. Both doctor and nurses can check the patient basic information, such as name, gender, address, diagnosis and other basic information. They can also check and search surgery schedule, check diagnosis list; check examination reports and so forth.

4.3. Solution for Improvement: Out-patient and Emergency Transfusion System

Currently, the existing HIS has contributed to paperless workflow and environmental issues have been addressed with the implementation of HIS to the management of patient information, however, some critical safety issues have not yet been enhanced. Although HIS has made a great contribution, transfusion accuracy has yet been enhanced. Regarding the existing transfusion workflow which contains human verification, thus frequent accidents in the wrong transfusion of fluid due to human error can happen. This scenario will happen more easily during an emergency. Therefore, there is a need to ensure all transfusions can be performed correctly, i.e. the right fluid transfused to the right patient.

The Out-Patient and Emergency Transfusion System is integrated with the existing transfusion procedure inside the hospital, so that medical staff can carry out the same procedure but with an unprecedented accuracy. This system makes use of RFID and PDA to assist in the transfusion procedure, and to ensure the accuracy of any transfusion performed in the hospital. The generic workflow is illustrated in Fig. 8. By using this system, all the transfusion procedures, including the transfusion fluid, the patient and medical staff who perform transfusion are strictly monitored. It also can provide a proactive alert when the staff attempts to make a wrong transfusion.

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Fig. 8.

Generic Flow Chart of Out-Patient and Emergency Transfusion System

4.4. Solution for Improvement: Automated Body Checking System

Currently, patients always have to queue up for a physical examination with a long waiting time. However, the physical examination also increases the workload of nurses at the front desk as they need to cope with the repetitive operational procedures, such as payment handling, record printing and so on. As a result, patients are required to wait at the reception and for the physical examination.

The new workflow for checkup system is shown in Fig. 9. At the beginning of the checking, the system will identify if there is patient record, if not patient needs to register, and if yes then the wristband information will be initialized. An RFID wristband will be dispensed to the patient and he or she will go to the checkup kiosk located near the entrance of the checking centre and will be identified via the RFID wristband. The patient can choose the check mode, print the checking procedure and pay for bill. After settling the bill, the RFID wristband of the patient will be scanned by the automated checking kiosk and the patient will follow the instructions shown on the checking procedure. Once it is done, the record will be recorded in system in a real-time manner. A doctor can query the body check record, issue a recommendation, and authorize the generation and print the report.

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Fig. 9.

Flow Chart of Automated Body Checking

4.5. Solution for Improvement: Drug Dispensing System

In the existing system, dispensers check the drugs according to the delivery notes from suppliers, and the drugs are then placed on predefined shelves. The dispenser prints the drug labels and sticks them on the corresponding packets. A doctor prescribes the medicine for the patient and meanwhile the patient information will be stored in the central computer system. After that, the dispenser gets the patient information from the system and collects the drugs from the shelves based on the prescription. Another dispenser will check the collected drugs. Finally, the patient obtains the medicine after name calling and identification. It is proven that human errors can happen in the complex dispensing processes. Fig. 10 shows the workflow of the new RFID-enabled Drug Dispensing System.

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Fig. 10.

Work Flow of RFID-enabled Drug Dispensing System

4.6. Evaluation of the RFID-enabled HIS

The RFID-enabled HIS simplifies the traditional workflow. It enables the least manual involvement and streamlines the operation flow. For doctors, the waiting time for the patients' test results is saved, by about 15.8%. For nurses, the time spent on handling manual records and paperwork has decreased by 87%, which significantly enhances working efficiency, so that they can serve more patients. Such saving of time is extremely significant for hospitals as it can accelerate the processes when an emergency occurs. After a 3-month pilot run of the new system in DOFGH, the accuracy of the procedures was improved by at least 80%. It is expected that the time for retrieving patients' medical records and locations will be decreased by approximate 80% and 50% respectively.

With the aid of the RFID-enabled HIS, the first and perhaps the most obvious benefit is that the medical error rate and medical malpractice rate have been reduced by 5.7%. By making use of RFID technology to automatically identify a patient, the accuracy of patient identification has been enhanced by 13.2%. Both the errors of misdiagnosis or delay in a diagnosis have been cut down remarkably.

After making use of the RFID-enabled HIS and the RFID wristbands, one can see that the manual procedures between the HIS information centre and patients have been eliminated. The related digitalized patient information can be directly retrieved. Ultimately, simplifying the retrieval processes can increase the working efficiency of medical staff and release their pressure.

Before using the RFID-enabled HIS, an out-patient took about two hours to wait for the lab test result. However, due to the improved workflow, which has automated on-site ordering, retrieval from the on-line storage and automated transfer to the analyzer, it now takes only 7 minutes. On the other hand, medical staff can save time so that they can focus on analyzing abnormal and critical issueses. Due to these improvements, patients' satisfaction increased from 76.6% to 81.4%.