"The right patient, the right drug, the right dose, the right route, the right time." These are the standards that the healthcare industry refers to as the "Five Rights of Medication Safety" for patients receiving treatment in hospitals.

A number of healthcare facilities are now relying on bar-coded patient identification bracelets as part of their plan for ensuring that these five rights are upheld. But hospital workers are noticing that bar-code bracelets make some patients uneasy, and some report that scanning the bar codes does not always integrate smoothly into typical care routines.

"To get information from a bar-code bracelet, a healthcare worker needs to be in physical contact with the patient, the bracelet needs to be positioned just so, and then the bar code needs to be scanned with a device that looks very much like a gun," says Steve Everest, president and CEO of Springfield, Missouri-based Creative Healthcare Systems.

"You also may have to wake a patient up or otherwise disturb them to scan a bar-code bracelet. Our MedGenix users, who often work with very young and elderly patients in community hospitals, clinics, and long-term care facilities, wanted an automated technology that was less intrusive than bar-code bracelets. RFID fit the bill perfectly."

Small Chips, Big Benefits

Radio frequency identification (RFID) technology uses microprocessors as small as one-third millimeter wide that are equipped with radio transmitters. When used for patient ID purposes, the chips are typically embedded in plastic wristbands. The chips can also be attached to plastic or paper tags. Each RFID chip stores about 2 KB of information about a tagged object or individual—allergies, blood type, medications, and so on. The chips transmit data wirelessly to an RFID reader, without having to come into direct physical contact with—or even immediate proximity to—the reader.

To RFID-enable its MedGenix Health Information System, Creative Healthcare Systems joined forces with Houston-based integrator SIS Technologies. The integration project began in February 2004 and was finished by April. The resulting RFID-enabled system is called MedGenix e-MAR.

At the heart of the MedGenix e-MAR system is a Sun Microsystems Sun Fire V880 server running MedGenix application software. Patient treatment information is stored on the server in an IBM Informix relational database. Patient ID bracelets with embedded RFID chips are produced on a Zebra RFID network printer for a cost of about a dollar a bracelet. Each bracelet contains a unique patient number assigned during the admission process.

The bracelet is scanned using an RFID scanner attached to a Sun Ray ultra-thin client, which a nurse typically rolls in on a cart and places within several feet of the patient. The MedGenix e-MAR application communicates with the patient's medication profile in the database and displays the appropriate medication dosing information for the current time period. The e-MAR software performs all the necessary checks and displays any alerts before the nurse administers the medication.

The entire process is fast, foolproof, and secure: Only authorized users have access to the specific information they need to care for each specific patient.

Setting the Standard

Everest and SIS Technologies COO John Reed agree that Sun's commitment to open standards made the integration process easy, smoothing the addition of RFID capabilities to MedGenix, which already runs on and is optimized for a Sun platform.

"For the integration, all we did was add some programming code that enabled the reader to read the patient's wristband, as well as add the capability to connect the patient records that are stored on the MedGenix system to the visit ID so MedGenix could bring up the patient record when the RFID bracelet was scanned," says Sean Clark, RFID solutions director at SIS Technologies.

"The integration with the wristband printer was also accomplished by adding some additional programming code in order to write the visit ID to the wristband."

Clark says the only problem his team encountered during the integration project was that the read range—the distance that a tag can transmit information to a reader—of the short-range RFID tags came up a little shorter than expected. "The tags we used were supposed to have a read range of around 6 inches. We were only getting a read range of 3 inches," says Clark. "We figured out that was the reader's fault, not a problem with the tags.

"So the reader you use does play a big part in the operation of the system. However, for healthcare-related applications a long read range is not wanted for privacy reasons, so this wasn't an issue—just more of an observation that might be important in other projects."

Sun's standards-based RFID solution is an end-to-end offering that includes hardware, software, services, and best-in-class alliances. Sun was a leading member of and advisor to the MIT Auto-ID Center—the driving force for automated identity standards and the precursor to the current standards body, EPCglobal.

"The great thing about open standards is that you can add on any other standards-based technology to an existing system with no muss and no fuss," says networking design consultant Jerry Neil. "Using solutions that comply fully with the accepted industry standards ensures that you'll be able to get long-term returns on your technology investment."

Reed says that during an RFID integration project, SIS Technologies takes full responsibility for the entire process, from system architecture, deployment scheduling, and working with vendors to keeping the project on track without adversely affecting normal operations. The result is a fully functional RFID solution carefully tailored to a customer's specific needs.

"The project went so quickly and so well that I'd like to say I was amazed, but I really wasn't," says Everest. "I expected it would be pretty painless."

Keeping Pace with Patient Needs

The response to MedGenix e-MAR has been tremendous, says Everest.

MedGenix customer hospitals are planning a host of interesting projects, he says. One involves keeping family members of surgery patients updated in real time as to the status of their loved one. "The patient will be identified with a number, of course, to protect privacy, and information will be updated as the patient passes by a series of RFID readers. Family and friends will be able to tell at a glance whether the patient is in surgery, moving towards the recovery room, in the recovery room, and so on."

Everest also pointed out that RFID does a great job helping healthcare professionals handle so-called elopement risks—situations in which a patient wanders off or attempts to escape against caregivers' orders, or when children are removed from a facility without proper clearance.

"An RFID ID bracelet can be set up to issue an alert when specific patients pass a predefined perimeter," says Everest. "As a parent, I really appreciate that. This technology offers so many ways to keep patients safe and to ease family concerns."

That's the beauty of RFID, says Mike Haymaker, global healthcare industry manager at Sun. "There's an enormous range of opportunities for RFID technology in healthcare—in patient care, supply chain optimization, asset tracking and management, prescription drug matching and tracking, billing, and workflow," he says.

"For example, RFID can be used to track when a certain medical device is wheeled into a patient's room, triggering a billing charge for use of the device. While they're at it, hospitals can use the system to track how employees go about their work—moving equipment, caring for patients, and so on—in order to look for ways to streamline workflow. And in neonatal care, RFID is already being used to make sure babies go home with their rightful parents, or that they're not taken out of the nursery without proper permission. The possibilities for this technology are wide open."