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Innovations in Real Time Location Systems (RTLS) for Defense Health
Healthcare Provider Challenges
2http://www.centrak.com/intro-to-rtls/
Innovations in Real Time Location Systems (RTLS) for Defense HealthAgenda
– The Business Problem
– What is RTLS in Healthcare?
– How RTLS Works
– Market Trends
– Real Life Benefits from RTLS – Impacts on Healthcare Delivery
– Imagining the Future
– Call to Action
3
The Business Problem
An estimated $17 - $29 billion dollars in health care costs are attributable to medical errorsSource: www.commonwealthfund.org, citing Institute of Medicine
Increasing hand hygiene compliance from poor (<60%) to excellent (90%), each level of improvement was associated with a 30%-90% reduction in the risk of MRSA acquisition.
Every $1 spent on hand hygiene promotion could result in a $23.7benefit
World Health Organization (WHO), Institute of Hand Hygiene
“How Far Do Nurses Walk?” Study, found that the 146 nurses studied walked an average of 4–5 miles during a 12-hour shift
A 2006 study published in MEDSURG Nursing
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Estimates suggest that hospitals routinely procure 10% to 20% more equipment than actually needed so that staff may find it when needed.
What is RTLS in Healthcare
RTLS is…
Technological solution to locate/track assets (Infusion Pumps, Wheelchairs,…) and people (Patients, Providers, Staff,…) in real-time. Location and condition-sensing technologies (LCSTs) enhance situational awareness.
RTLS Consists of…
• Tags
• Location Sensors
• Location Engine
• Middleware
• Applications
RTLS Can Provide…• Optimized business and clinical
workflows
• Enhanced patient safety
• Improved patient throughput and staff and equipment use
• A way to protect perishable assets
• Ability to monitor critical areas of the hospital
• Awareness of equipment utilization
5
RTLS supports…
• Improved asset tracking
• Automated Cath Lab Supply Management
• Safer Sterile Processing Workflow
• Automated Temperature Monitoring
• And provides the basis for countless additional use cases
How RTLS Works: TechnologyTracks and Identifies Location in Real Time
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Industry Trends – Gartner Hype Cycles
2011- Trough of Disillusionment- RTLS no longer “a shiny object”- Technology not meeting business expectations**note: many technologies die in the Trough ofDisillusionment
2015- Slope of Enlightenment- RTLS maturing- Business understands how to benefit from
technology- Becoming a commodity – an expected part of
the infrastructure - Gartner predicts 2-5 years from full adoption
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Benefits Realization from RTLS
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Quality + Efficient Cost= High Value
So What? Expected Benefits
Technology solution, paired with staff acceptance and utilization, can provide benefits to the quality and safety of Veteran care
Improve Staff Efficiency Improve Patient Care/Patient
SafetyImprove Managerial Decision
Support Optimize Inventory ManagementImprove Patient and Staff
Satisfaction
" Drive process improvement" Real-time transparency of
medical supplies
" Staff productivity
" Reduce delays in care" Reduce risk of patient injury /
infection
" Cath lab supply usage can be mapped to outcomes
" Compliance with hazard recalls
" Improve data quality " Decrease operational costs
" Review average and peak utilization across the enterprise
" Maximize equipment utilization" Avoid unnecessary rental costs
" Minimize lost or misplaced items
" Better visibility to expiringsupplies
" Consistency of service " Operational efficiency
" Reduced wait times
Patient
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ClinicalPeopleAssets and Suppliess and Supplies
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Assets and Supplies Use CasesAsset Locating and Management
High-demand healthcare equipment is often hard to locate, leading to delays in patient care and reduced staff productivity. Goal is to track all equipment using a combination of active and passive tags
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Outcomes:! Quickly locate needed equipment
! Improve staff productivity! Improve patient care
! Reduce recall turnaround time! Optimize inventory – monitor peak and average utilization! Reduce rental expenses! Reduce time and expense conducting annual inventory! Monitoring assets related to workflows
Asset Tracking – Benefits Realized
“When we need a piece of equipment, we can easily find it. If you are looking for something that isn’t where it should be, you can find that. Veteran care is not delayed.”
– Patricia Topham, Acting Associate Director for Patient Care Services and Nurse Executive, Saginaw VAMC
“The best cost improvement, in my opinion, is the time saved for completing annual inventories. The time spent inventorying assets has been more than cut in half and that is a big cost saving.”
- Angela O’Dell, Biomedical Support Specialist/Facility RTLS Program Manager, Battle Creek VAMC
“Equipment such as infusion pumps and suction machines move from one room to another. Prior to RTLS, we spent a lot of time looking around and asking everyone where the equipment is. Now when inspection time comes, we go through RTLS and go directly to the location and the item is available. It’s a huge time saver.”
– Sam Ganti, Chief of Biomedical Engineering, Danville VAMC
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Cabinets do the countingAffix tag to item, wave item at the point of care to capture usage
Assets and Supplies Use CasesCardiac Cath Lab Supply Management
Monitor the usage of medical supplies necessary for critical patient procedures
Solutions in these areas provide real time transparency for designated items that are “off the shelf”, used in a case, or missing. The solution can support par level maintenance to ensure maximum efficiency and availability of a wide range of hospital supplies.
Outcomes:– Improves quality of care by ensuring right supplies
available– Reduces inventory cost by managing par levels &
providing data on specific items used– Enhances safety by– Improving compliance with hazard recalls– Monitoring expiration of high-cost supplies
– Cath lab supply usage can be mapped to outcomes
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Cardiac Catheterization (Cath) Lab – Benefits Realized
“When we got RTLS, it helped right off the bat having everything we needed. With the ‘smart’ cabinets, we know everything we have and exactly where it is. When there are 50 to 60 different types of catheters alone, this makes a huge difference in finding things faster during patient procedures.”
- Tom Lewandowski, Lead Cardiovascular Technologist
“An inventory process that previously took me three hours now takes seconds with RTLS.”
– Angela Hernandez, Inventory Manager for Cardiology, VAAAHS
“Bottom line, with RTLS I know we will never implant a recalled or expired product in a patient, ever. The quality checks and controls RTLS puts in place are critical for patient safety. Would I go back to the way we did it before? No way!”
– Barbara Clarke, Cardiology Nurse Manager, VA Ann Arbor Healthcare System
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Assets and Supplies Use CasesSterile Processing Workflow
Automates sterile processing business processes from distribution to point of care helping to ensure safety of staff and patients
Issue: Missing or unsterile instruments, or delayed reprocessing of limited equipment, adversely impact quality and safety of care
Outcomes:– Enhances patient safety- helps ensure trays are clean,
correctly assembled and complete– Prevents delays in surgery or diagnostic procedures– Provides reasonable assurance processes were followed
according to manufacturer instructions
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Sterile Processing Services (SPS) – Benefits Realized
“Patient safety and infection control is critical. Before RTLS, staff used to have to write everything down—every item they processed, every step they made—and it took hours to days to track items down if we had a recall. Now with RTLS, every item is traceable and we can recall it with the press of a button. We know exactly where those items are and can stop a recall before it ever leaves SPS or comes near a patient.”
- Kristen Lemke, Assistant Chief for SPS at Battle Creek
“RTLS includes photosso we can quickly see product nuances, such as a tiny hook on a dental instrument, and approved substitute items for a medical tray. The photo also helps us identify and remove damaged instruments. With more than 3,000 different types of instruments, that is a lot to memorize. But with RTLS, you can be accurate with the touch of a button.”
- Karla Sandell, Network Chief Logistics officer
“Every single request for new instruments this year did not have to be a new purchase. With RTLS, we had better information into utilization and inventory.”
– Javier Alvarado, Chief of Sterile Processing Services, Battle Creek VAMC
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Assets and Supplies Use CasesMonitoring of Temperature and Humidity Levels
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ClinicalPeopleAssets and Suppliess and Supplies
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Staff and Patient Use CasesHand-Washing Compliance
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Staff and Patient Use CasesInfectious Disease History
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Staff and Patient Use CasesPatient Flow
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Staff and Patient Use CasesWayfinding
" Guide patients from their homes through normal GPS navigation and into and within the HDO’s facilities
" Wayfinding moves from information desks, static digital signage and passive self-service kiosks to a more personal, engaging and interactive digital experience
22
23
Suereceives
reminder day of
surgery
Sue is given directions to the hospital, traffic routes and parking options
At the hospital, wayfinding app guides them to the waiting area
where they will be kept up to date on
where Sue is
Sue receives RTLS tag at admission
Sue can now select family
members and friends that will
be notified of her status and
whereabouts
Family and friends of Sue use the link in her message to get directions to the hospital, and
download wayfinding app
Sue now visible to hospital’s
RTLS and can be notified of
wait times
At the hospital, the wayfinding app guides
Sue to admission
Personal, Engaging and Interactive Digital ExperienceBetter Patient and Visitor Experience, Reduced Wait Times…
Example ROISavings in equipment and staffing costs + higher patient & staff satisfaction
– Texas Health Resources– Rental equipment: savings of $285K/first year
– Budgeting for “shrinkage”: savings of $100K/first year
– Procurement-related expenses based on better utilization of equipment: savings of >$600K/first year
– Faster room turnaround: from 47 minutes to 40 minutes.
–Wake Forest Baptist Health– Automated temperature monitoring: savings of $970K/year
– Asset management: savings of $2M/year
– Increased staff productivity: over $2M/year
– Eliminating the need to purchase redundant systems and avoiding unnecessary costs: $3.5M/year
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Building on the RTLS InfrastructureMore Real-Life Examples
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Imagining the Future
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Imagining the Future
! Tags are getting smaller and cheaper
! Manufacturers are looking into embedding tags into devices and assets which will potentially reduces initial and ongoing costs of tags, should have small/zero form factor, and be part of the device eliminating the risk of tag fall off or loss
! Mobile Indoor Location (Wayfinding); Push notifications based on location
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“Situational awareness is the engine behind various "hospital of the future," "digital hospital" and "smart patient room" initiatives. It is at the heart of the real-time healthcare system (RTHS)”
Gartner, Situational Awareness Is at the Heart of the Real-Time Healthcare System Published: 22 August 2014Analyst(s): Barry Runyon, Vi Shaffer
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ClinicalPeopleAssets and Suppliess and Supplies
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" Smart Equipment
" Wearable / Biosensors
" Ingestables / Nanochips
" Mobile Imaging 3&142-5 6.-57&.-." ;&'(-)'5 L-@&0($,5 1$)('$,():" ;@?.($2$:(%&25 G&'&5 ',&%9():" <$L(2-5 2&L5'-.'." <$L(2-5 (1&:():" <$L(2-54@?.(%&2." 7$142(&)%-5 1$)('$,():" M($.>,0-(22&)%-" A)D-%'($)5 %$)',$2" J(.-&.-5 G-'-%'($)
29
Clinical Data – Beyond the Episode of Care
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30
Implantable glucose sensor for diabetes
The Connected Patient
31
Clinical Data
Eric Topol, MD predicts that there will be
“terabytes of data about you, which will
someday accumulate, from the womb to
tomb, in your personal cloud, stored and
ready for ferreting out the signals from
the noise, even to prevent an illness
before it happens”2
“Physicians will make treatment decisions
based on the chest pain a patient is
experiencing at the moment—from data
being delivered real-time via mobile
device to provider—rather than from
symptoms several days prior reported
during an office visit several days later.”1
1 Derek Newell, Four ways real-time data will change healthcare, http://www.ilhitrec.org/ilhitrec/pdf/HIMSS_June2013.pdf2 Topol, Eric. (2015). The Patient Will See You Now: The Future of Medicine Is in Your Hands. Basic Books.
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Man's Fitbit helps doctors save his lifeUSA TODAY NETWORK - Elizabeth Armstrong Moore,, Newser -- 10:19 a.m. EDT April 9, 2016
33
( (NEWSER) – It happens every day—someone going about his or her ordinary schedule has a seizure, gets looked over by a doctor, and hopefully lives to tell about it.Only in the case of a 42-year-old man who went to the emergency room at Our Lady of Lourdes Medical Center in New Jersey immediately following a seizure, the data tracked on his Fitbit helped inform doctors of the appropriate course of action to take to save his life, those docs report in the journal Annals of Emergency Medicine.
It's the first time a fitness tracker has been used like this, reports Gizmodo. The key question in this case was whether the irregularly high and erratic heartbeat (atrial fibrillation) he suffered three hours prior to the seizure—which they wouldn't have known about had it not been for the man's tracker—was chronic or episodic.If chronic, resetting his heart rate via rhythm conversion, essentially shocking it back to normal, could dislodge a clot, cause a stroke, and possibly kill the man. But the Fitbit revealed exactly when he had a spike in heart rate and that it was abnormal, and his tracker from that day even reveals (through the subsequent slowing of his heart rate) when the drug diltiazem was administered.
"Not all activity trackers measure heart rates, but this is the function of most value to medical providers," says one of the authors, per the Huffington Post, which notes that the devices aren't medical but may be used in this way more in the future as they become more reliable. (This couple found out they were expecting thanks to the woman's Fitbit.)
She later experiences temporary numbness in her face and slurred speech
Sue wakes up feeling fine Sue is treated in a hospital
No baseline information collected
Biometric devices measure elevated blood pressure – factors into downstream stroke risk algorithms
No data collected on potential TIA
Care team not alertedNo feedback loop to patient
Time lost discovering Sue, calling 911, finding Sue’s location and transporting her to the hospital
Sue has a stroke while “out and about”
Smart watch detects slurred speech and vital signs recorded
Sue sent to hospital for evaluation –location awareness determines closest facility
GP notified and provided link to video chat via smart phone
Time lost due to unprepared care team and differential diagnosis process
Care team prepared and orders CT scan prior to stroke
Nurse notified of patient location, status and biometrics – immediate care provided
Sue has a stroke while in the hospital
Time to thrombolytics too long
Time to thrombolytics reduced
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Call to Action
1. Consider the business case for RTLS at your facility
2. Look for lessons learned from other Health Delivery Organizations that implemented RTLS
3. Identify the logical starting point–Tracking assets–Locating people
4. Think of impactful use cases
35
References
– Gartner Hype Cycle for Healthcare Provider Technologies and Standards, 2011, Published: 4 August 2011, Analyst(s): Barry Runyon
– Gartner Hype Cycle for Healthcare Provider Technologies and Standards, 2015, Published: 2 July 2015, Analyst(s): Barry Runyon
– Gartner Situational Awareness Is at the Heart of the Real-Time Healthcare System, Published: 22 August 2014, Analyst(s): Barry Runyon, Vi Shaffer
– RTLS for Dummies, January 1, 2009, Ajay Malik
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Accelerating Next
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