RFID in the healthcare supply chain: usage and application

Healthcare Supply Chain Reliability: The Case of Medical Air Transport

The principal task of national healthcare systems is to provide health services that are safe, accessible, high-quality and people-oriented. To ensure the continuity of healthcare, support activities related to patient transfer and logistics are necessary. Effective implementation of transport processes is a factor affecting the possibility of medical intervention, in terms of both planned and life-saving care. The reliability of the healthcare supply chain is a key factor in patient health. In our research, we have used the method of a single case study of a public regional hospital in Poland providing comprehensive medical services. The aim of the research is to identify the factors that affect the reliability of the healthcare supply chain in relation to the interhospital air transport of patients. Our qualitative research using process mapping reveals what factors affect the reliability of interhospital medical air transport. The analysis of 100 interhospital medical air transport cases has allowed us to create a general procedure related to the movement of patients between the facilities of the healthcare system in Poland. Our research shows that the key factor of reliability is the coherent and integrated cooperation of institutions involved in transport processes.

Biomedical IoT: Enabling Technologies, Architectural Elements, Challenges, and Future Directions

This paper provides a comprehensive literature review of various technologies and protocols used for medical Internet of Things (IoT) with a thorough examination of current enabling technologies, use cases, applications, and challenges. Despite recent advances, medical IoT is still not considered a routine practice. Due to regulation, ethical, and technological challenges of biomedical hardware, the growth of medical IoT is inhibited. Medical IoT continues to advance in terms of biomedical hardware, and monitoring figures like vital signs, temperature, electrical signals, oxygen levels, cancer indicators, glucose levels, and other bodily levels. In the upcoming years, medical IoT is expected replace old healthcare systems. In comparison to other survey papers on this topic, our paper provides a thorough summary of the most relevant protocols and technologies specifically for medical IoT as well as the challenges. Our paper also contains several proposed frameworks and use cases of medical IoT in hospital settings as well as a comprehensive overview of previous architectures of IoT regarding the strengths and weaknesses. We hope to enable researchers of multiple disciplines, developers, and biomedical engineers to quickly become knowledgeable on how various technologies cooperate and how current frameworks can be modified for new use cases, thus inspiring more growth in medical IoT.

Development of a machine learning-based real-time location system to streamline acute endovascular intervention in acute stroke: a proof-of-concept study

BACKGROUND

Delivery of acute stroke endovascular intervention can be challenging because it requires complex coordination of patient and staff across many different locations. In this proof-of-concept paper we (a) examine whether WiFi fingerprinting is a feasible machine learning (ML)-based real-time location system (RTLS) technology that can provide accurate real-time location information within a hospital setting, and (b) hypothesize its potential application in streamlining acute stroke endovascular intervention.

METHODS

We conducted our study in a comprehensive stroke care unit in Melbourne, Australia that offers a 24-hour mechanical thrombectomy service. ML algorithms including K-nearest neighbors, decision tree, random forest, support vector machine and ensemble models were trained and tested on a public WiFi dataset and the study hospital WiFi dataset. The hospital dataset was collected using the WiFi explorer software (version 3.0.2) on a MacBook Pro (AirPort Extreme, Broadcom BCM43x×1.0). Data analysis was implemented in the Python programming environment using the scikit-learn package. The primary statistical measure for algorithm performance was the accuracy of location prediction.

RESULTS

ML-based WiFi fingerprinting can accurately predict the different hospital zones relevant in the acute endovascular intervention workflow such as emergency department, CT room and angiography suite. The most accurate algorithms were random forest and support vector machine, both of which were 98% accurate. The algorithms remain robust when new data points, which were distinct from the training dataset, were tested.

CONCLUSIONS

ML-based RTLS technology using WiFi fingerprinting has the potential to streamline delivery of acute stroke endovascular intervention by efficiently tracking patient and staff movement during stroke calls.

Measuring Sensitivity and Precision of Real-Time Location Systems (RTLS): Definition, Protocol and Demonstration for Clinical Relevance

The ability of a Real Time Location System (RTLS) to provide correct information in a clinical environment is an important consideration in evaluating the effectiveness of the technology. While past efforts describe how well the technology performed in a lab environment, the performance of such technology has not been specifically defined or evaluated in a practice setting involving workflow and movement. Clinical environments pose complexity owing to various layouts and various movements. Further, RTL systems are not equipped to provide true negative information (where an entity is not located). Hence, this study defined sensitivity and precision in this context, and developed a simulation protocol to serve as a systematic testing framework using actors in a clinical environment. The protocol was used to measure the sensitivity and precision of an RTL system in the emergency department space of a quaternary care medical center. The overall sensitivity and precision were determined to be 84 and 93% respectively. These varied for patient rooms, staff area, hallway and other rooms.

A systematic literature review on supply chain risk management: is healthcare management a forsaken research field?

Purpose

This paper aims to present a systematic literature review (SLR) to investigate how supply chain risk management (SCRM) is applied to the healthcare supply chains and which improvement opportunities are being missed in this segment.

Design/methodology/approach

This SLR used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method to answer three research questions: (1) Which are the main gaps concerning healthcare supply chain risk management (HCSCRM)? (2) What is the definition of HCSCRM? and (3) What are the risk management techniques and approaches used in healthcare supply chains?

Findings

The authors present a complete summary of the HCSCRM body of research, investigating research strings like clinical engineering and high reliability organizations (HROs) and its relations with HCSCRM; (1) This research revealed the five pillars of HCSCRM; (2) The authors proposed a formal definition for HCSCRM considering all the literature blocks explored and (3) The authors generated a list of risks present in healthcare supply chains resulting from extensive article research.

Research limitations/implications

The authors only reviewed international journal articles (published in the English language), excluding conference papers, dissertations and theses, textbooks, book chapters, unpublished articles and notes. In addition, the study did not thoroughly investigate specific countries' particularities concerning how the healthcare providers are organized.

Originality/value

The contribution of this article is threefold: (1) To the best of authors knowledge, there is no other SLR about HCSCRM published in the scientific literature by the time of realization of authors’ work, suggesting that is the first effort to fulfill this research gap; (2) Following the previous contribution, in this work the authors propose a first formal definition for HCSCRM and (3) The authors analyzed concepts such as clinical engineering and HROs to establish the building blocks of HCSCRM.

Integration of TTF and network externalities for RFID adoption in healthcare industry

Purpose

Despite the extensive adoption of radio-frequency identification (RFID) technology across many industry supply chains, the extent of adoption in healthcare is far behind the earlier expectation. The purpose of this study is to better understand the current RFID adoption in healthcare by looking beyond the existing body of work using both the task-technology fit (TTF) framework and network externalities theories.

Design/methodology/approach

A survey is employed in this study, and the structural equation modeling (SEM) technique is used to test the hypotheses of the proposed model.

Findings

The findings are twofold. First, both TTF and network externalities exert a positive impact on the RFID adoption in the healthcare sector; and second, no synergistic effect can be found between these two for further increasing the adoption. This is different from what the extant research found on other technology adoptions across various supply chains.

Originality/value

This paper provides contributions to both researchers and practitioners. For researchers, this study enriches the body of knowledge of RFID adoption by being the first to apply the network externalities and TTF theories to predict the adoption of RFID in healthcare. For healthcare practitioners, to make the RFID adoption easier and more effective, any initial applications of RFID tools should be centered on those for which there is a more natural application. Further, for those who propose an RFID adoption should start with a product that has a sizable adoption community; this may help persuade senior management to make the adoption decision.

Lean implementation in healthcare supply chain: a scoping review

Purpose

The purpose of this paper is to identify the lean production (LP) practices applied in healthcare supply chain and the existing barriers related to their implementation.

Design/methodology/approach

To achieve that, a scoping review was carried out in order to consolidate the main practices and barriers, and also to evidence research gaps and directions according to different theoretical lenses.

Findings

The findings show that there is a consensus on the potential of LP practices implementation in healthcare supply chain, but most studies still report such implementation restricted to specific unit or value stream within a hospital.

Originality/value

Healthcare organizations are under constant pressure to reduce costs and wastes, while improving services and patient safety. Further, its supply chain usually presents great opportunities for improvement, both in terms of cost reduction and quality of care increase. In this sense, the adaptation of LP practices and principles has been widely accepted in healthcare. However, studies show that most implementations fall far short from their goals because they are done in a fragmented way, and not from a system-wide perspective.

RFID as a New ICT Tool to Monitor Specimen Life Cycle and Quality Control in a Biobank

Background

Biospecimen quality is crucial for clinical and translational research and its loss is one of the main obstacles to experimental activities. Beside the quality of samples, preanalytical variations render the results derived from specimens of different biobanks or even within the same biobank incomparable. Specimens collected along the years should be managed with a heterogeneous life cycle. Hence, we propose to collect detailed data concerning the whole life cycle of stored samples employing radio-frequency identification (RFID) technology.

Methods

We describe the processing chain of blood biosamples that is operative at the biobank of IRCSS San Raffaele, Rome, Italy (BioBIM). We focus on the problem of tracing the stages following automated preanalytical processing: we collected the time stamps of all events that could affect the biological quality of the specimens by means of RFID tags and readers.

Results

We developed a pilot study on a fragment of the life cycle, namely the storage between the end of the preanalytics and the beginning of the analytics, which is usually not traced by automated tools because it typically includes manual handling. By adopting RFID devices we identified the possible critical time delays. At 1, 3 and 6 months RFID-tagged specimens cryopreserved at -80°C were successfully read.

Conclusions

We were able to record detailed information about the storage phases and a fully documented specimen life cycle. This will allow us to promote and tune up the best practices in biobanking because i) it will be possible to classify sample features with a sharper resolution, which allows future utilization of stored material; ii) cost-effective policies can be adopted in processing, storing and selecting specimens; iii) after using each aliquot, we can study the life cycle of the specimen with a possible feedback on the procedures.

Assessing the use of Radio Frequency Identification technologies as an alternative for insurance costs in hospitals

OBJECTIVES

This research assesses the use of Radio Frequency Identification (RFID) technologies as an alternative for insurance costs in hospitals.

METHODS

Despite the advantages of RFID, this technology has not been applied in most hospitals due to implementation costs and amortization of RFID. In this paper, we intend to model the total profit of hospitals in three scenarios namely, application of RFID technology in the hospital, without applying RFID technology in the hospital and insuring patients and equipment in the hospital.

RESULTS

We analyzed the aforementioned situations over a period of time to find out how they affect the profit of the hospital. Based on this analysis we concluded that if applying RFID technology is costly, it will be feasible for advanced hospitals with more beds. In the scenario of insuring patients and equipment, if insurance organization takes over a small portion of the cost of the mistakes and oversights, insuring patients and equipment will not be feasible for the hospital, and it is better to apply RFID technology Instead.

CONCLUSIONS

RFID is among the technologies applied to reduce mistakes of the personnel in hospitals. Moreover, applying this technology has led to a decrease in the number of personnel required in hospitals. This study models total profit of hospitals in three aforementioned scenarios. Based on analyzing these models we conclude that if applying RFID technology is costly, it will be feasible for advanced hospitals with more beds.

Management of surgical instruments with radio frequency identification tags

Purpose

– To prevent malpractices, medical staff has adopted inventory time-outs and/or checklists. Accurate inventory and maintenance of surgical instruments decreases the risk of operating room miscounting and malfunction. In our previous study, an individual management of surgical instruments was accomplished using Radio Frequency Identification (RFID) tags. The purpose of this paper is to evaluate a new management method of RFID-tagged instruments.

Design/methodology/approach

– The management system of RFID-tagged surgical instruments was used for 27 months in clinical areas. In total, 13 study participants assembled surgical trays in the central sterile supply department.

Findings

– While using the management system, trays were assembled 94 times. During this period, no assembly errors occurred. An instrument malfunction had occurred after the 19th, 56th, and 73th uses, no malfunction caused by the RFID tags, and usage history had been recorded. Additionally, the time it took to assemble surgical trays was recorded, and the long-term usability of the management system was evaluated.

Originality/value

– The system could record the number of uses and the defective history of each surgical instrument. In addition, the history of the frequency of instruments being transferred from one tray to another was recorded. The results suggest that our system can be used to manage instruments safely. Additionally, the management system was acquired of the learning effect and the usability on daily maintenance. This finding suggests that the management system examined here ensures surgical instrument and tray assembly quality.

Measuring the benefits of tracking medical treatment through RFId

Purpose

– Radio frequency identification (RFId) technology has a great potential to improve process efficiency and effectiveness. However, because of the variety of application areas and achievable benefits, structured assessment models are needed to support managers in the adoption decision. The purpose of this paper is to describe a structured method to support the evaluation of the benefits enabled by RFId technology in medical treatment support in the healthcare industry. The method, and its application to an Italian case study, are deeply illustrated so as to increase the knowledge available to decision makers.

Design/methodology/approach

– The research underlying this paper has modelled the relationship between the technology and the performance driver of the target process, and then between the performance driver and the measurable key performance indicators of that process. This knowledge, focused on the healthcare industry but still quite general, has been formalised into 12 causal maps. Starting from these maps, a six-step procedure to prioritise the analysis, tailor the maps and adapt (or develop) analytical models to estimate the benefits is presented. The overall method and its application to an Italian case study are deeply illustrated so as to increase the open available knowledge to decision makers.

Findings

– The findings are twofold: first, the knowledge represented by the causal maps; and second, the findings of the case study, which shows that efficiency benefits can cover the operative expenses of RFId adoption, but need to be integrated with effectiveness benefits in order to fully justify the investment costs.

Originality/value

– The paper provides a contribution for both researchers and practitioners. As the former are concerned, the paper is a first attempt to fill the existing lack of structured approaches concerning the evaluation of potential benefits of RFId for product traceability within a healthcare facility. As for the latter, the presented method has been developed to practically support all those managers who are evaluating whether to adopt RFId technology in their organisation or not. This contribution has a relevant practicality, as it helps decision makers to address their decisions relying on a sound conceptual baseline, and on objective evaluations.

Real-time instrument detection in minimally invasive surgery using radiofrequency identification technology

BACKGROUND

A key part of surgical workflow recording is recognition of the instrument in use. We present a radiofrequency identification (RFID)-based approach for real-time tracking of laparoscopic instruments.

METHODS

The system consists of RFID-tagged instruments and an antenna unit positioned on the Mayo stand. For reliability analysis, RFID tracking data were compared with the assessment of the perioperative video data of instrument changes (the reference standard for instrument application detection) in 10 laparoscopic cholecystectomies. When the tagged instrument was on the Mayo stand, it was referred to as "not in use." Once it was handed to the surgeon, it was considered to be "in use." Temporal miscounts (incorrect number of instruments "in use") were analyzed. The surgeons and scrub nurses completed a questionnaire after each operation for individual system evaluation.

RESULTS

A total of 110 distinct instrument applications ("in use" versus "not in use") were eligible for analysis. No RFID tag failure occurred. The RFID detection rates were consistent with the period of effective instrument application. The delay in instrument detection was 4.2 ± 1.7 s. The highest percentage of temporal miscounts occurred during phases with continuous application of coagulation current. Surgeons generally rated the system better than the scrub nurses (P = 0.54).

CONCLUSIONS

The feasibility of RFID-based real-time instrument detection was successfully proved in our study, with reliable detection results during laparoscopic cholecystectomy. Thus, RFID technology has the potential to be a valuable additional tool for surgical workflow recognition that could enable a situation dependent assistance of the surgeon in the future.

The construction of a hospital disease tracking and control system with a disease infection probability model

With relatively short latency and rapid propagation, viral diseases could be transmitted through the air to medical personnel or the public during the incubation period. To reduce the possibilities of spread, this research creates an infection probability model based on the settling velocity and concentration distribution of infectious droplets. Then, radio frequency identification (RFID) technology is employed to track the travel history (time, date and place) of the infected patients. A tree structure algorithm and an infection probability model are applied to trace the transmission routes, discover the correlations between carriers and suspected cases, and finally calculate the infection probability on the basis of time interval. In case of an epidemic outbreak or once an infected case is confirmed, the disease tracking and control system could be initiated by accessing RFID logs to plot the carriers' time of onset and to trace possible routes of transmission via tree diagrams. The disease tracking and control system developed in this research can assist hospitals in assessing the risk of infection among medical personnel, as well as in prompt implementation of infection prevention and control measures, in order to reduce hospital acquired infections and provide a safe health care setting.

Increased situation awareness in major incidents-radio frequency identification (RFID) technique: a promising tool

INTRODUCTION

In mass-casualty situations, communications and information management to improve situational awareness is a major challenge for responders. In this study, the feasibility of a prototype system that utilizes commercially available, low-cost components, including Radio Frequency Identification (RFID) and mobile phone technology, was tested in two simulated mass-casualty incidents.

METHODS

The feasibility and the direct benefits of the system were evaluated in two simulated mass-casualty situations: one in Finland involving a passenger ship accident resulting in multiple drowning/hypothermia patients, and another at a major airport in Sweden using an aircraft crash scenario. Both simulations involved multiple agencies and functioned as test settings for comparing the disaster management's situational awareness with and without using the RFID-based system. Triage documentation was done using both an RFID-based system, which automatically sent the data to the Medical Command, and a traditional method using paper triage tags. The situational awareness was measured by comparing the availability of up-to date information at different points in the care chain using both systems.

RESULTS

Information regarding the numbers and status or triage classification of the casualties was available approximately one hour earlier using the RFID system compared to the data obtained using the traditional method.

CONCLUSIONS

The tested prototype system was quick, stable, and easy to use, and proved to work seamlessly even in harsh field conditions. It surpassed the paper-based system in all respects except simplicity of use. It also improved the general view of the mass-casualty situations, and enhanced medical emergency readiness in a multi-organizational medical setting. The tested technology is feasible in a mass-casualty incident; further development and testing should take place.

Real-time location and inpatient care systems based on passive RFID

RFID technology meets identification and tracking requirements in healthcare environments with potential to speed up and increase reliability of involved processes. Due to this, high expectations for this integration have emerged, but hospital and medical centers interested in adoption of RFID technology require prior knowledge on how to squeeze RFID capabilities, real expectations and current challenges. In this paper, we show our lab tested solutions in two specific healthcare scenarios. On the one hand, we analyze the case of a medical equipment tracking system for healthcare facilities enabling both real-time location and theft prevention. Worth-noting aspects such as possible EMI interferences, technology selection and management of RFID data from hospital information system are analyzed. Lab testing of system reliability based on passive UHF RFID is provided for this case. On the other hand, we analyze and provide a solution for care and control of patients in a hospital based on passive HF RFID with the result of a fully functional demonstrator. Our prototype squeezes RFID features in order to provide a backup data source from patient's wristband. It also provides an offline working mode aiming to increase application reliability under network fail down and therefore, improving patient's safety. Considerations regarding lessons learned and challenges faced are exposed.

Computational exposure assessment of electromagnetic fields generated by an RFID system for mother--newborn identity reconfirmation

Radio frequency identification (RFID) is an innovative technology currently applied in a large number of industrial and consumer applications. The spread of RFID technology does not correspond to a parallel increase in studies on its possible impact on health in terms of electromagnetic field (EMF) exposure. The aim of this paper is to estimate, by computational techniques, the EMF generated by passive RFID systems for mother-newborn identity reconfirmation. The computation was performed on realistic models of newborn and mother for three different reader positions. The compliance with EMF exposure guidelines was investigated as a function of the change in reader-tag specifications (magnetic field threshold and maximum distance of the reader to awake the tag) and time of use of the reader close to the body. The results show that attention should be paid to the identification of the optimal reader-tag technical specifications to be used in this type of application. That should be done by an accurate exposure assessment investigation, in particular for newborn exposure. The need to reduce the exposure time as much as possible indicates the importance of specific training on the practical applications of the RFID (DATALOGIC J-series, Bologna, Italy) device.