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Designed by: Sunil kr. Sagar
Health Care
Designed by: Sunil Kr. Sagar
The Health Care Industry
Gone are the days when you could walk into the doctors office and he
would call you by your first name and ask how you grandfather is doing.
Modern method of healthcare and healthcare benefits has increased the
paperwork necessary to keep all the records. The medications prescribed,
the insurance carrier, type of coverage provided and so on.
Fortunately Information Technology has also evolved to keep the
computerized records, provide information at the finger tips for both, the
attending physician and the patient.
Easy identification and transfer of data is critical to the success of any
technology upgrade.
NEED
Medication Error:
Scope of Problem
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Designed by: Sunil Kr. Sagar
Patient impact
– Up to 98,000 people per year die of preventable medical errors; serious
medication errors leading to death have doubled between 1983 and 2003
– 20% of families report serious medication error during hospitalization
– Healthcare facilities experience one error per five doses administered
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Hospital Impact
– Cost burden: legal staff to handle patient claims; labor costs to process /
litigate claims; cost of settlements; insurance costs
– Impact on reputation: Increasing awareness of quality of care as an issue of
importance to patients
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Root cause
– 18% of preventable adverse drug effects (ADE’ s) arise from insufficient
patient data
– Half of all ADE’s result from inadequate availability of drug information
– Overtaxed and under-resourced nursing staff frequently fail to accurately
verify patient identity and/or medication dose
Designed by: Sunil Kr. Sagar
Medication Error:
Many Causes of Error - Often Process Failure
Type of Error
Description
Prescribing error
Incorrect drug selection (based on indications, known allergies, existing drug
therapy), dose, dosage form, quantity, route, concentration, rate of administration
or instructions for drug use
Omission error
Failure to administer ordered dose to patient before the next scheduled dose, if
any
Wrong time
Administration of medication outside of prescribed time interval
Unauthorized drug
Administration of medication not authorized by a legitimate prescriber for patient
Improper dose
Administration of dose greater or less than amount ordered by prescriber or
administration of a duplicate does
Wrong form
Administration of a drug in a different dosage for than ordered by prescriber
Wrong drug preparation
Drug product incorrectly formulated or manipulated before administration
Wrong administration
technique
Inappropriate procedure or improper technique in the administration of a drug
Deteriorated drug
Administration of a drug that has expired or for which the physical or chemical
dosage-form integrity has been compromised
Monitoring error
Failure to review prescribed regimen of detection of problems, or failure to use
appropriate clinical or lab data for adequate assessment of patient response
Compliance error
Inappropriate patient adherence to a prescribed medication regimen
Designed by: Sunil Kr. Sagar
Market Drivers for IT-based Solutions (Specifically RFID)
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Pharmaceutical-initiated
– Motivation to leverage RFID for many purposes, including supply chain
improvements, FDA-recommended anti-counterfeit efforts, Wal-Mart mandate
– > 500% increase in number of drugs over last 10 years -- more than 17,000 drugs
marketed in North America; greater need for automated tracking capabilities
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Hospital-initiated
– Increasing IT spend to reduce operating costs & improve staff efficiency; CPOE
(Computerized Patient Order Entry) projects are widespread
– Greater awareness of medication error and a desire improve processes
– Heightened competition for patients; increased access to and awareness of hospital
performance metrics, including quality of care
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Regulatory (FDA)
– Most prescription and commonly used over-the-counter drugs must be bar-coded
with the National Drug Code (NDC) number by end of 2005
– All blood components intended for transfusion must have machine-readable labels
identifying collecting facility, lot no., product code, donor blood group & type
– Rule will likely be amended to either require or allow for RFID labels
Designed by: Sunil Kr. Sagar
Medication Error:
How RFID Can Help?
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Drug Identification
– Automatically, accurately and instantaneously can identify any drug
– Identification can be made at any level of granularity, down to the “unit dose”
– How: RFID can be added to existing drug labeling
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Patient Identification
– Automatically, accurately and instantaneously can identify any patient
– How: RFID can be added to existing patient ID wristbands
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Prescription Verification
– Nurse-carried RFID-enabled handhelds can verify prescription against patient
& drug, time & route
The Concept
Designed by: Sunil Kr. Sagar
It is proposed to introduce a novel cost effective and user friendly
RFID based Smart Card
solution to integrate the process of availing
health care facilities and ease of process in an Hospital.
RFID based Smart Card solutions have gained acceptance due to the
advantages over bar code \ magnetic stripe solutions in recent times due to:
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Information stored on the IC chip is very secure and cannot be
duplicated.
Ability to store multiple applications on the single IC also allows easy
manipulation of data.
Off line verification allows instant identification of the cardholder for
accurate and timely treatment.
Mag stripe cards allow read only access on the point of usage locations
which makes it very difficult to update the data.
Data density is about 200 characters for mag stripe, where as today
smart cards can store up to 4MB
Smart Cards provide convenience, portability, durability, security, and
ability to check forgery.
Designed by: Sunil Kr. Sagar
Medication Error:
Multiple Levels of Error Prevention
LEVEL 4
Blood Transfusion Safety • Lab Specimen Tracking • Medical/Legal MAR
LEVEL 3
Max Daily Dose • Look-Alike/Sound-Alike Alerts • High-Risk Med Warnings
Clinical Action Reminders • Near-Miss Reporting • Order Reconciliation
LEVEL 2
Drug Reference • Formulary Comments
Literature Review • Nursing Tools
LEVEL 1
‘Five-Rights’ Checker
Designed by: Sunil Kr. Sagar
RFID & Medication Error
“Five Rights” Checking using RFID
• Five Rights
– Right drug, time, dose, patient & method of administration
• Data Requirements
– Patient Identification: RFID wrist-bands linked to patient database
– Drug Identification: RFID-labeled “unit doses” linked to NDIC
(National Drug Identification Code)
– Prescription Data: Wireless access to prescription database for time,
dose, method of administration
• Configuration
– Handheld device with RFID reader to check Patient ID, Drug ID
– Wireless access to network for access to Prescription Data
RFID & Medication Error
Higher Level Checking
Designed by: Sunil Kr. Sagar
• Additional Checks on Prescription & Patient
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Prescription falls within range of reasonable dose
Drug does not exceed maximum daily does
Patient does not have existing allergy to drug
Potential adverse drug interaction with other prescriptions
• Data Requirements
– Access to database of “reasonable” dosages
– Access to patient record data (allergies, other prescriptions)
• Configuration
– Wireless access to key patient/drug databases
– Advanced user interface
RFID & Medication Error:
Technical Challenges
Designed by: Sunil Kr. Sagar
• Read range
– Too close … Small antenna sizes may require reader to be very close
to tag
– Too far … unintentional reading of RFID tags if the read range is not
close enough
• CPOE Integration
– Computerized Patient Order Entry - electronic prescription input (vs.
handwritten)
– Projects are underway at many hospitals
– Extent of integration - time of data entry vs. time of administration?
• Standards & Formats
– What RFID data standards will apply?
– Consistency with existing medical standards (NDIC) and emerging EPC
standards
– Tag formats: frequency, read/write
RFID & Medication Error:
Operational Challenges
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Designed by: Sunil Kr. Sagar
RFID Labeling
– Labeled at the source (drug manufacturer)? At the distributor? At the hospital
pharmacy?
– Quality control and introduction of error when labeling
– Labeling on tiny unit does (e.g. individual pills in “blister packs”)
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Existing Processes
– Many hospitals use automated dispensing for access control & theft deterrence
– Nurses often prepare medications at nursing stations, prior to enter hospital
rooms
– New process introduction: what to do when an error is detected; false/missed
errors?
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Costs & Implementation
– Cost of RFID vs. Bar-code
– Timing: When to implementation
– Pilot testing to establish improvement and benchmarks
RFID & Medication Error:
Future Challenges
• Regulatory
– FDA has two different proposals to tagging of drugs: RFID for anticounterfeit; bar-coding for medical error
– Integration of FDA mandates
• Focus
– Majority of RFID efforts currently focused on supply chain and retail /
CPG applications
– Equal effort must be expended on medical / pharmaceutical
applications
• Collaboration
– Many organizations and constituencies involved
– Need to coordinate efforts between clinicians, nurses, pharmacists,
distributors, manufacturers, regulators
Designed by: Sunil Kr. Sagar
RFID: Major Improvement Over Bar Code
Bar code
RFID tag
• Identifies class SKU (class of items)
• Uniquely identifies individual item
• Contains only 12-15 characters of data • Can store hundreds of characters
• Readers use lasers/LEDs to scan tag
• Receivers scan radio signal from tag
• Line of sight required to read tag
• No line of sight required
Passive RFID Tag
Chip
Antenna
Packaging
Designed by: Sunil Kr. Sagar
Cross sections of the
Health Industry being benefited
• In the Pathological Labs
• In the blood banks
• In the Hospitals
– Review patient history
– Inventory
• Pharmaceutical Companies
– Anti Counterfeiting
– Pharma Supply Chain
Designed by: Sunil Kr. Sagar
Special features
The RFID based Health care card will contain:
• Personal details for identification
• Health insurance policy particulars
• Medical history
• Any other information required
RFID Card Capabilities
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Serves as an ID card:-The card holder can get the treatment without going through a long
process of verifying the identification \ insurance details
Serves as medical file:- brief details of the ailment \ treatment can be written into the card
Results of all lab tests can be stored
Records of prescriptions can be maintained
Function of the RFID card
1. The type of policy and coverage being available can be verified by the hospital \ lab.by
reading the card
2. The treatment particulars and bill amount can be printed and also written into the card
3. The relative bills can be either downloaded or fed into the computer at the health care
company
4. The same will be forwarded to the respective insurance company for payment
5. The reconciliation process between the insurance company and hospital would be
automatic
Designed by: Sunil Kr. Sagar
In the Pathological Labs
RFID cards containing the unique Patient ID can be issued to
the patients coming for testing for the first time.
As per the prescription, the test numbers are assigned
against the patient ID and the labels containing the test
numbers are pasted into the tubes/plates containing his/her
sample.
After the test status comes , test tubes/plates are scanned
and the status against them is fed into the system.
While generating the test report, system attaches the test
status of the test numbers to the particular patient ID against
which they were originally assigned, and generate the report.
When a particular patient comes for collecting the report,
his/her RFID card is scanned and matched against the
Patient ID mentioned in the report and the same is handed
over to the him/her without any possibility of wrong reporting.
Whenever the same patient comes for any further
examination, his RFID card is scanned and the cardholder's
previous medical history is fetched from the database for
referencing and the same process can be repeated again.
Designed by: Sunil Kr. Sagar
In the blood banks
The bottles/containers containing different
samples of blood are pasted with RFID
labels.
Whenever any requirement for a particular
sample of blood arises, labels on the
bottle/container surface is scanned.
The scanned and decoded sample
specification is displayed on the Hand Held
Terminal of the person incharge, matched
against the required specifications and then
issued for the surgery.
Periodically the issual data can be transferred
to the host through a serial port
communication dock for the necessary stock
updation.
Designed by: Sunil Kr. Sagar
In the Hospitals
Doctor/the hospital staff can access the necessary information of the patients using their RFID cards/ Patient
Wrist Bands and a mobile computer and use them while carrying out surgery, in ICUs, in their offices, in the
clinics, at the point of billing, while forwarding the expenditure statement of the patients to the insurance
company, which would enable them to streamline various operations like
Review patient history
Doctors can download the medical history of the patients from their RFID card and retrieving their
information using either a serial port communication dock/through Modem or retrieve online through GSM
connectivity on a mobile computer which help them take crucial decisions from remote locations
Pharmacy medication administration by nurses/doctors without mistakes : Every hospitalized patient
can be given a RFID wrist band tags and the medical/treatment/surgery records can be stored in the
computer.
Nurses can carry the RF terminals connected wirelessly to the access points to retrieve info from host
containing the patient information.
They scan the patient RFID wrist band tags and the suggested course of medication flashes on their
terminals which can be administered without any possible flaw and then update the patient data using their
RF Terminal with regards to the patient's vital information like blood pressure, body temperature, dosage
given etc.
While making rounds doctors can carry the RF terminals, scan the patient RFID wrist band tags , see and
evaluate the necessary information and can decide upon the line of treatment and update the patient data for
the future references.
While Carrying out Surgery : Surgeons can scan the RFID wrist band tags patient cards before
commencing the surgery and retrieve the critical information about the patients online using a RF Hand Held
Terminal or a Palmtop with a RF card through wireless connectivity with the host containing the patient
information.
Designed by: Sunil Kr. Sagar
Inventory
Incorporation of RFID tags can lead to a much efficient
Inventory Control system in the various cross sections
of the healthcare industry Some of the key benefits
are …
• Fast and accurate information dissemination of the
shipment leading to a better control over the
inventory
• Minimize product obsolescence and Maximize the
freshness of the stock
• Improved control over stock, warehousing and
Distribution of Drugs
• Better control over reorder levels hence shortening
the Reorder Cycle
• Effective practice of Just in time inventory control
principle
• Flawless and speedy performance of periodical
cycle counts
• Automated invoice generation
• Overall cost saving in Inventory Control
Designed by: Sunil Kr. Sagar
RFID
in
Pharmaceutical Companies
Anti-Counterfeiting
Pharmaceutical Supply Chain
Designed by: Sunil Kr. Sagar
Anti-Counterfeiting
Paper selection
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Application specific paper (no
commodity)
Filled with luminescent fibres
Invisible in daylight, but fluorescent in red
under UV light
Flow of paper and even waste will be
under strict control
Mechanical construction
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Paper laminate designed to avert
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horizontal fissionability
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Printed antenna directly on paper
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Tamper proof (mechanical and
electrical)
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Sophisticated partial cross
cutting through
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the layers
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Tuned bonding strength of
certain
functional segments of the
electronic parts
RFID technology features
Printing solution
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Visible printing
Invisible printing
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Based on transparent ink
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Luminescent in red when exposed
to UV light
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Ink will be under strict control
Both printing will be of high quality and
accurate registration
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Operating frequency: 13.56 MHz
Anti Collision to allow simultaneous operation
with multiple transponders in the field
Unique 64 bit serial number, each label will be
unique
2k bit (256 characters) Read / Write EEPROM
memory
Secure access to Read/Write memory (split
access rights)
Cryptographic authentication, 64 bit security key
length
Designed by: Sunil Kr. Sagar
Pharmaceutical Supply Chain
Benefits:
Reduce product handling time
Reduce errors
Reduce shrinkage
Improve supply-chain visibility
Reduce out-of stock
Improve shipment identification
More accurate and timely information
Reduce costs
Provide security against counterfeiting and tampering
Designed by: Sunil Kr. Sagar
Process flow of a Pharmaceutical Supply Chain
Designed by: Sunil Kr. Sagar
RFID integrated
Process flow of a Pharmaceutical Supply Chain