Hospital automation system RFID-based: technology embedded in smart devices (cards, tags and bracelets)

RFID is a technology being adopted in many business fields, especially in the medical field. This work has the objective to present a system for automation of a hospital clinical analysis laboratory. This system initially uses contactless smart cards to store patient's data and for authentication of hospital employees in the system. The proposed system also uses RFID tags stuck to containers containing patient's collected samples for the correct identification of the patient who gave away the samples. This work depicts a hospital laboratory workflow, presents the system modeling and deals with security matters related to information stored in the smart cards.

An effective method for component activity classification supporting location awareness and user identification

We present an effective method for component activity classification supporting location awareness and user identification at the same time. The system is comprised of three modules: Pressure Sensing Module (PSM), Activity Detecting Module (ADM), and Receiving Station (RS). The ADM having a unique id is a wearable module putting on one's waist-belt, which classifies component activity such as sitting chair, lying bed, sitting sofa, etc. utilizing both user's interaction with household furniture and atomic activities like lie, sit, and stand. We limit transmission range of RF chip in PSM to around 1 m so that we can find the most adjacent furniture to the ADM. It makes possible to find the user's relative location to the PSM, so we can aware of both who and where the acting person is while recognizing his/her activities. We obtained 92.5% of average precision of the activity classification.

Model-based security analysis of the German health card architecture

OBJECTIVES

Health-care information systems are particularly security-critical. In order to make these applications secure, the security analysis has to be an integral part of the system design and IT management process for such systems.

METHODS

This work presents the experiences and results from the security analysis of the system architecture of the German Health Card, by making use of an approach to model-based security engineering that is based on the UML extension UMLsec. The focus lies on the security mechanisms and security policies of the smart-card-based architecture which were analyzed using the UMLsec method and tools.

RESULTS

Main results of the paper include a report on the employment of the UMLsec method in an industrial health information systems context as well as indications of its benefits and limitations. In particular, two potential security weaknesses were detected and countermeasures discussed.

CONCLUSIONS

The results indicate that it can be feasible to apply a model-based security analysis using UMLsec to an industrial health information system like the German Health Card architecture, and that doing so can have concrete benefits (such as discovering potential weaknesses, and an increased confidence that no further vulnerabilities of the kind that were considered are present).

A preliminary investigation into the development of 3-D printing of prosthetic sockets

The socket is considered an element of major importance in the makeup of a prosthesis. Each socket is a tailor-made device, designed to fit the unique geometry of the patient's residual limb. The design and manufacture of a prosthetic socket traditionally has been a manual process that relies on the use of plaster of Paris casts to capture the shape of the patient's residual limb and then artisan fabrication techniques to manufacture the socket. Computer-aided design and manufacturing technologies have overcome some of the shortcomings of the traditional process, but the final manufacture of the prosthetic socket is still performed manually. Rapid prototyping (RP), a relatively new class of manufacturing technologies, creates physical models directly from three-dimensional (3-D) computer data. Previous research into the application of RP systems to the manufacture of prosthetic sockets has focused on expensive, high-end technologies that have proven too expensive. This paper investigates the use of a cheaper, low-end RP technology known as 3-D printing. Our investigation was an initial approach to using a technology that is normally associated with producing prototypes quickly, some of which could not be manufactured by alternative means. Under normal circumstances, these printed components are weak and relatively fragile. However, comfortable prosthetic sockets manufactured with 3-D printing have been used in preliminary fittings with patients.

Prevention of bedside errors in transfusion medicine (PROBE-TM) study: a cluster-randomized, matched-paired clinical areas trial of a simple intervention to reduce errors in the pretransfusion bedside check

BACKGROUND

Transfusion of the incorrect blood component is a frequent serious incident associated with transfusion and often involves misidentification of the patient and/or the unit of blood. The objective of this study was to assess the effect of a simple intervention designed to improve performance of the bedside check and to observe the durability of any effect. The intervention was a tag on blood bags reminding staff to check the patient's wristband. The tag was positioned in such a way that the transfusionist was required to remove the tag to spike the unit.

STUDY DESIGN AND METHODS

The intervention was tested in a multicenter cluster-randomized controlled trial incorporating short-term and long-term follow-up periods. The primary endpoint was the proportion of patients transfused with red cell units for whom the key elements of the bedside check were all correctly completed.

RESULTS

Fifteen matched-paired clinical areas at 12 participating hospitals in six countries were included in the trial. Combining data from all participating hospitals, the bedside check was correctly performed in 37 percent of transfusions during the baseline audit period. There was no evidence of a favorable effect of the intervention immediately after its introduction (pooled odds ratio, 1.09; 95% confidence interval, 0.54-2.17). There was similarly no evidence of a favorable effect after continued use of the intervention for an additional 8 weeks.

CONCLUSIONS

A simple intervention in the form of a barrier warning label on blood bags reminding staff to check the patient's wristband failed to improve bedside transfusion practice. The robust study design developed for this study could be applied to investigate other interventions to improve the safety of bedside transfusion practice.

Radiofrequency identification technology can standardize and document blood collections and transfusions

BACKGROUND

We evaluated the potential for radiofrequency (RF) transponder microchips to standardize and document key steps in the blood collection and transfusion process.

STUDY DESIGN AND METHODS

Using the blood center's standard operating procedures for blood collections, we programmed a laptop computer and 10 multiwrite 256-byte RF microchips to prompt operators to enter data for key steps in blood collection. Before collections, RF microchips were attached to blood collection sets at the blood center. In parallel with actual collections, we added data to the microchips with the computer and a hand-held scanner-programmer. After labeling, we shipped the RF microchip-tagged blood units to the hospital where unit-related data (whole blood number, ABO and Rh, expiration date, special laboratory test results) were uploaded from the RF microchip to the transfusion service's information system. The microchip was subsequently used as a cross-match label for blood unit-recipient matching.

RESULTS

Data were successfully uploaded to the RF microchip at key steps during blood collections. Software programs in the laptop computer and hand-held scanner-programmer successfully prompted operators to enter key data. At any stage in a blood collection, authorized operators were able to review electronic records of prior steps using the laptop computer or by scanning the microchip attached to the blood bag. Unit-related data were successfully transferred to the hospital transfusion service through the RF microchip. These data were successfully incorporated in the RF microchip cross-match label, which was used to confirm recipient-blood unit matching at the bedside.

CONCLUSION

RF microchips can collect key data during blood collections, facilitate information transfer from the blood center to the hospital, and confirm recipient-blood unit matching at the bedside before transfusions.

Using Electronic Wristbands and a Triage Protocol to Protect Mental Health Patients in the Emergency Department

In the emergency department of Mercy Hospital, concerns about possible elopement of mental health patients led to the use of the services of security officers, who were called for an average of 40 patient watches per week. Modified electronic wristbands, paired with a triage protocol, have significantly decreased the need for patient watches and decreased security costs.

Blood bank protocols for large-scale civilian casualty events: experience from terrorist bombing in Israel

Terrorist attacks in crowded places cause multiple casualties that are evacuated by quick succession to nearby hospitals. The study goals were to analyse the issues of patient misidentification and excessive blood request and to develop recommendations for the management of such episodes. A retrospective analysis of nine explosion attacks was performed. In nine consecutive events, 450 casualties were reported by the National Ambulance Service, 82 of whom (18%) died on the explosion site and 368 were admitted to nearby trauma centres. Red blood cell units were typed and cross-matched for 70 patients. Seventy-three per cent of the blood supplied over the first 24 h was administered during the first 2 h. The cross-matched/transfused ratio was 2.52 +/- 1.42, reflecting the overestimation of blood requirement in mass casualty episodes. In the mass casualty setup, blood bank personnel should be alert to a potential mistransfusion or a blood collection error. Unidentified patients are subjected to errors due to only one-digit difference in their temporary identification number. Application of the system using an additional sequential four-digit number printed in bold and large size font for patients at admission reduced the possibility of misidentification. Modern technologies, including error-reduction design wristbands, barcode-based system or radiofrequency identification tags may also increase reliability of patient identification in the mass casualty setup.

Using a fingerprint recognition system in a vaccine trial to avoid misclassification

PROBLEM

The potential for misidentification of trial participants, leading to misclassification, is a threat to the integrity of randomized controlled trials. The correct identification of study subjects in large trials over prolonged periods is of vital importance to those conducting clinical trials. Currently used means of identifying study participants, such as identity cards and records of name, address, name of household head and demographic characteristics, require large numbers of well-trained personnel, and still leave room for uncertainty.

APPROACH

We used fingerprint recognition technology for the identification of trial participants. This technology is already widely used in security and commercial contexts but not so far in clinical trials.

LOCAL SETTING

A phase 2 cholera vaccine trial in SonLa, Viet Nam.

RELEVANT CHANGES

An optical sensor was used to scan fingerprints. The fingerprint template of each participant was used to verify his or her identity during each of eight follow-up visits.

LESSONS LEARNED

A system consisting of a laptop computer and sensor is small in size, requires minimal training and on average six seconds for scanning and recognition. All participants' identities were verified in the trial. Fingerprint recognition should become the standard technology for identification of participants in field trials. Fears exist, however, regarding the potential for invasion of privacy. It will therefore be necessary to convince not only trial participants but also investigators that templates of fingerprints stored in databases are less likely to be subject to abuse than currently used information databases.

Body identification, biometrics and medicine: ethical and social considerations

Identity is important when it is weak. This apparent paradox is the core of the current debate on identity. Traditionally, verification of identity has been based upon authentication of attributed and biographical characteristics. After small scale societies and large scale, industrial societies, globalization represents the third period of personal identification. The human body lies at the heart of all strategies for identity management. The tension between human body and personal identity is critical in the health care sector. The health care sector is second only to the financial sector in term of the number of biometric users. Many hospitals and healthcare organizations are in progress to deploy biometric security architecture. Secure identification is critical in the health care system, both to control logic access to centralized archives of digitized patients' data, and to limit physical access to buildings and hospital wards, and to authenticate medical and social support personnel. There is also an increasing need to identify patients with a high degree of certainty. Finally there is the risk that biometric authentication devices can significantly reveal any health information. All these issues require a careful ethical and political scrutiny.

Proposal of a French health identification number interoperable at the European level

The French ministry of Health is setting up the Personal Medical Record (PMR). This innovative tool has long been expected by French Health Authorities, Associations of Patients, other Health's associations, those defending Individual Liberties and the French National Data Protection Authority. The PMR will lead to improvements in many areas such as Diagnosis (Research and monitoring) Healthcare (Management of emergencies, urgent situations, Temporal health monitoring and evaluation), Therapy (Cohorts of patients for Clinical trials and epidemiological studies). The PMR will foster safe healthcare management, clinical research and epidemiological studies. Nevertheless, it raises many important questions regarding duplicates and the quality, precision and coherence of the linkage with other health data coming from different sources. The currently planned identifying process raises many questions with regard to its ability to deal with potential duplicates and to perform data linkage with other health data sources. Through this article, using the electronic health records, we develop and propose an identification process to improve the French PMR. Our proposed unique patient identifier will guarantee the security, confidentiality and privacy of the personal data, and will prove to be particularly useful for health planning, health policies and research as well as clinical and epidemiological studies. Finally, it will certainly be interoperable with other European health information systems. We propose here an alternative identification procedure that would allow France to broaden the scope of its PMR project by making it possible to contribute to public health research and policy while increasing interoperability with European health information systems and preserving the confidentiality of the data.

Evolution and acceptability of medical applications of RFID implants among early users of technology

RFID as a wireless identification technology that may be combined with microchip implants have tremendous potential in today's market. Although these implants have their advantages and disadvantages, recent improvements how allowed for implants designed for humans. Focus was given to the use of RFID tags and its effects on technology and CRM through a case study on VeriChip, the only corporation to hold the rights and the patent to the implantable chip for humans, and an empirically based study on working professionals to measure perceptions by early adopters of such technology. Through hypotheses-testing procedures, it was found that although some resistance to accept microchip implants was found in several applications, especially among gender, it was totally expected that healthcare and medical record keeping activities would be universally treated in a positive light and the use of authorities (namely governmental agencies) would be equally treated in a negative light by both sexes. Future trends and recommendations are presented along with statistical results collected through personal interviews.

Implant-specific patient identification cards

When planning for a revision arthroplasty, one of the most important parts of preoperative planning is determining what components are currently in place. This information is crucial. The previous operative report is not always available, and when it is, it does not always contain the appropriate information concerning components. This problem can easily be prevented by providing every patient who has an arthroplasty with an implant-specific patient identification card at the time of surgery as described in this article.

[Wrong-site surgery: incidence and prevention]

INTRODUCTION

This paper illustrates how reporting of adverse events can be used to introduce changes in an organization. Starting from reports of incidents on wrong-site surgery, a method to prevent them and its implementation in the Copenhagen Hospital Corporation (H:S) are described.

MATERIALS AND METHODS

The H:S adverse event database, the Danish Patient Insurance Association and international sources were searched to estimate the extent of wrong-site surgery. A method to prevent wrong-site surgery developed by the U.S. Department of Veterans Affairs was adapted for Danish conditions. It was introduced as "The Five Steps" in H:S in May 2005, accompanied by an information campaign.

RESULTS

Wrong-site surgery incidents are rare: reports in the H:S show an occurrence of 1:32,500 surgical procedures, consistent with international figures. Seven root cause analyses were performed and showed a need for a more structured identification and communication process among the members of the operating team. The Five Steps were designed to prevent such problems. None of the Five Steps is in itself new or revolutionary. The crucial parts are systematization of the identification process and increased communication among the members of the operating team. The procedure is not associated with substantial resource utilization and involves more a change in culture than an investment. The method can be widely implemented in hospitals in Denmark without major changes.

CONCLUSION

Wrong-site surgery is a rare but serious adverse event. This paper describes the results of root cause analyses after reports of incidents in the H:S. The analyses showed a need for better and more structured communication and identification of patients before surgical intervention.

State task force develops protocols for wristbands

Statewide initiative launched in wake of adverse event caused by conflicting color codes. New system includes printed information on wristbands, in addition to color coding. Several hospitals voluntarily agree to adopt a uniform color code for wristbands.