Why hospitals can't afford 'lost and found'

Radio frequency identification (RFID) tags and real-time location systems (RTLS) offer big savings and ROI for hospitals and hold the promise for big improvements in patient safety. They also happen to be really cool.

But few facilities are availing themselves of the technolgies' asset and patient tracking capabilities. There's simply too much else to do.

"It's not in a lot of budgets," says John Hoyt, executive vice president of HIMSS Analytics.

According to recent surveys, barely 17 percent of hospitals have operational asset tracking/management systems in place, and fewer than 3 percent have plans to purchase the technology or are in the process of having it installed. The mandates of meaningful use and the looming specter of the ICD-10 switchover have hospitals stretched thin just trying to comply with the things they've got to comply with.

But in, say, 2015 or 2016? After MU, and after ICD-10? Is that when many more provider organizations will finally have the incentive and financial wherewithal to pursue large-scale RTLS deployments?

Hoyt says there could be one more "after": Perhaps after purchases related to bundled payment reform have been made, asset and patient tracking (and the numerous other applications of RFID tags, some of which are still being thought up) will finally find some substantial traction.

"If hospitals are pursuing some bundled payment arrangements, we expect that to be a little mini bubble after the big bubble," says Hoyt. "I would say it's like fourth of four. You might see it after that."

RFID/RTLS has a lot to offer, but primarily only to large hospitals. Physician practices and critical access hospitals don't have much need to tag and tack every piece of expensive medical equipment they own, Hoyt says.

"The value in these things comes by the large physical organizations," he says. "They get so big, stuff gets lost. But an 80-bed hospital, if they have to have this, what's wrong? The place isn't that big! Go find it!"

Still, when it comes to, say, academic medical centers, the need is acute. "We've done studies, when I did consulting, and some of the stories are just laughable," says Hoyt. One facility, he says (perhaps exaggerating only slightly), discovered via asset tracking that it had "116 more IV pumps than it really needed."

As the CEO of one RTLS vendor once said, "There's not a chance in the world that there's a manufacturing plant out there that has three times as much equipment as it needs."

Unfortunately, says Hoyt, "lean manufacturing is not on people's minds when nurses need an IV pump or a wheelchair, and they hide it so no one else from another unit comes and takes it."

But that's just what goes on in hospitals, and that's just the problem asset tracking technologies can tackle, saving big money in unnecessary and redundant expenditures.

"It solves problems for large physical plants," says Hoyt. That said, it's "not a smaller organization issue, and it's not a thing on their radar."

Asset tracking may be the more widely used application for these technologies, relatively speaking, but patient tracking has a big future, too, says Hoyt.

"Patient tracking is wonderful," he says. "It's too bad more hospitals don't do it."

It's not so much that patients get lost. It's that families are anxious when their loved ones are in transit between tests and haven't been heard from for several hours. "Patient tracking information systems actually say, 'Exam completed, waiting for result,' stuff like that. It is really a wonderful tool for family satisfaction," says Hoyt.

Again, the vast majority of facilities are much more concerned with meaningful use and other mandates than with installing systems such as those.

"But in highly-competitive environments, where there are hospitals just beating each other's brains out for market share, one way to win friends and influence people is to have a more satisfying family experience," says Hoyt. "Data has shown that that's a real family pleaser, especially in pediatrics."

The implementation costs of RTLS and other wireless tracking systems aren't cheap. But they're not exorbitant either.

True, "you have to have sensors on every little device" that send a signal out, says Hoyt. But "that's no longer Star Wars. We do that all the time."

Also, "you have to have antennas that receive the signals," he adds. "Well, those same antennas are already receiving signals. So if you don't have to install a bunch of additional antennas, then the core infrastructure is there. It's now just a matter of going and finding everything to tag it."

The ROI can be difficult to calculate sometimes, when disparate systems are set up in different departments (better to deploy enterprise-wide) comes from more than just saved money on unnecessary purchases. Indeed, it goes beyond finances: There are also undeniable benefits to patient safety.

There's physical asset tracking  ("where is the IV pump?") and there's also asset tracking for depreciation and maintenance.

"Every IV pump has to be sterilized and cleaned on a regular basis, so I need to find the things to do that maintenance," says Hoyt. "That's important. The Joint Commission will stare you down on that big time. When they come into a hospital they'll pull all those logs and they'll pore through them to make sure preventative maintenance is done on time."

Another huge, and as-yet mostly untapped, opportunity for these technologies has to do with physiological monitoring  -  everything from respiration to pulse to oximetry to temperature.

"Where does that eventually fit? It eventually fits this growing market of eICU: electronic ICU, where I can install this stuff  -  and cameras, and microphones  -  in your ICU and the physicians monitoring happen to be a few hundred miles away," says Hoyt. "That's serving rural healthcare really well, and it's a growing business."

Indeed, interfacing with EMRs is another big horizon for these wireless technologies.

At Stage 7 of the HIMSS Analytics EMR Adoption Model (EMRAM), "we expect hospitals to have some direct data capture from physiologic or cardiac monitors," says Hoyt. "We don't have a requirement of a percentage, because it's so new, but we would look askance at a hospital that has no physiological monitors running directly to the database."

In the meantime, however, the few hospitals that are even thinking about deploying enterprise-wide asset and patient tracking systems are probably keeping their plans a bit more modest.

"There is interest," says Hoyt. "There is clearly a future there. We're at the beginning, probably, of some sort of explosion in that area."

If cash-strapped hospitals are holding off for a couple years, newly built facilities are making sure they're well equipped.

We had a recession in 2008, Hoyt points out, "but you know what never had a big tilt? Hospital construction."

"When hospitals are building new physical plants, they're planning on capturing more of this data electronically into the networks, and maybe having eICUs. When you're replacing a physical plant or gutting a unit, it is a given that you would be building more of this stuff into that."

Soon, Hoyt says, once those minor chores like meaningful use and ICD-10 are squared away, other organizations should be following suit: "I think we're looking at the beginning of a long and gradual slope up."

Mike Miliard

Managing Editor of Healthcare IT News

Follow Mike on Twitter @MikeMiliardHITN