Health Care

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Health Care
Designed by Sunil kr. Sagar
RFID
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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.
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NEED Medication ErrorScope of Problem
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
• 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
• Root cause
• 18 of preventable adverse drug effects (ADE s)
  arise from insufficient patient data
• Half of all ADEs result from inadequate
  availability of drug information
• Overtaxed and under-resourced nursing staff
  frequently fail to accurately verify patient
  identity and/or medication dose

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Medication ErrorMany Causes of Error - Often
Process Failure
Designed by Sunil Kr. Sagar
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Market Drivers for IT-based Solutions
(Specifically RFID)
Designed by Sunil Kr. Sagar

• Pharmaceutical-initiated
• Motivation to leverage RFID for many purposes,
  including supply chain improvements,
  FDA-recommended anti-counterfeit efforts,
  Wal-Mart mandate
• gt 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
• 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
• 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

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Medication ErrorHow RFID Can Help?
Designed by Sunil Kr. Sagar

• 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
• Patient Identification
• Automatically, accurately and instantaneously can
  identify any patient
• How RFID can be added to existing patient ID
  wristbands
• Prescription Verification
• Nurse-carried RFID-enabled handhelds can verify
  prescription against patient drug, time route

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The Concept 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.
Designed by Sunil Kr. Sagar

• RFID based Smart Card solutions have gained
  acceptance due to the
• advantages over bar code \ magnetic stripe
  solutions in recent times due to
• 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.

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Medication ErrorMultiple Levels of Error
Prevention
Designed by Sunil Kr. Sagar
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
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RFID Medication ErrorFive Rights Checking
using RFID
Designed by Sunil Kr. Sagar

• 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

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RFID Medication ErrorHigher Level Checking
Designed by Sunil Kr. Sagar

• Additional Checks on Prescription Patient
• 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

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RFID Medication ErrorTechnical 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

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RFID Medication ErrorOperational Challenges
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)
• 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?
• Costs Implementation
• Cost of RFID vs. Bar-code
• Timing When to implementation
• Pilot testing to establish improvement and
  benchmarks

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RFID Medication ErrorFuture Challenges

• Regulatory
• FDA has two different proposals to tagging of
  drugs RFID for anti-counterfeit 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

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RFID Major Improvement Over Bar Code
Designed by Sunil Kr. Sagar
Uniquely identifies individual item Can store
hundreds of characters Receivers scan radio
signal from tag No line of sight required
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Cross sections of the Health Industry being
benefited
Designed by Sunil Kr. Sagar

• In the Pathological Labs
• In the blood banks
• In the Hospitals
• Review patient history
• Inventory
• Pharmaceutical Companies
• Anti Counterfeiting
• Pharma Supply Chain

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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
• 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
• The type of policy and coverage being available
  can be verified by the hospital \ lab.by reading
  the card
• The treatment particulars and bill amount can be
  printed and also written into the card
• The relative bills can be either downloaded or
  fed into the computer at the health care company
• The same will be forwarded to the respective
  insurance company for payment
• The reconciliation process between the insurance
  company and hospital would be automatic

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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.
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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.
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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
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Inventory
Designed by Sunil Kr. Sagar

• 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

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Designed by Sunil Kr. Sagar
RFID in Pharmaceutical Companies
Anti-Counterfeiting Pharmaceutical Supply Chain
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Designed by Sunil Kr. Sagar
Anti-Counterfeiting

• Mechanical construction
• Paper laminate designed to avert
• horizontal fissionability
• Printed antenna directly on paper
• Tamper proof (mechanical and electrical)
• Sophisticated partial cross cutting through
• the layers
• Tuned bonding strength of certain
• functional segments of the
  electronic parts
• RFID technology features
• 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

• Paper selection
• 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
• Printing solution
• Visible printing
• Invisible printing
• Based on transparent ink
• Luminescent in red when exposed to UV light
• Ink will be under strict control
• Both printing will be of high quality and
  accurate registration

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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

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Designed by Sunil Kr. Sagar
Process flow of a Pharmaceutical Supply Chain
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Designed by Sunil Kr. Sagar
RFID integrated Process flow of a Pharmaceutical
Supply Chain