Is anybody using or looking at RFID tags for tracking libray assets?

I guess you’ve already looked at this one , Bob.

Bob,

Have you reviewed the following thread

http://www.ebme.co.uk/forums/ubbthreads.php/topics/7195/1

All the best
Martin

Hi Bob,

The Rigel link on this site also looks quite interesting Rigel Technology although it's likely you've probably read it.

As an aside - a statement taken from this press-release raises a question in my mind:

I wonder where engineering departments stand RE: fitting tags internally, i.e. opening equipment that may be under warranty or whether this is considered as a "modification" and whether there's any research required to validate the technology - to ensure RFID tags cannot induce failures or problems with certain types of equipment when they're in close proximity to active electronics components or sensitive circuitry located within enclosures whether they're being interrogated or not (most enclosures are EMC protected of course).

Can anyone elaborate on the technology, operation or any relevant standards associated with these devices?

Richard,

I was speaking to the guy from Airetrak recently (as mentioned in a previous thread) He assured me that the tags are being used extensively in the US for asset tracking attached to the outside of the equipment. I think this is the most sensible way of attachment. When it is visible - it is a deterrent. I agree we should not be opening devices. It would be a good selling point if manufacturers fitted them whilst in production....

Just a niggle of mine but I was considering that EMC protected devices may not be the best devices for fitting RFID tags internally - fitting an RF transceiver inside effectively what's a conductive "box", over certain parts of the RF spectrum, may not be conducive with transmission of useful RF signal. Also that the idea of fitting any passive or active RF transmitter located in close proximity to the processing or measurement electronics inside a medical device might "put the wind up" a manufacturer's legal, regulatory and QA department until the technology is proven - hence my comment regarding "modification".

Perhaps a standard form-factor (std shape/size/specification) data-tag "socket", might be a solution in equipment of the future, i.e. built-in as you say, John. Lots of useful data could be used to track/manage/maintain the device. Before manufacturers will fit these devices I guess there will need to be various issues addressed RE: standards, both in terms of the type and quantity of data stored, transceiver and tag RF characteristics/capabilities, etc. Rigel's idea seems like a promising one to to me.

The idea of fitting the tag during manufacture is appealing - provided it's a generic tag - like the barcodes on packets of cornflakes etc - so they will work with any detection system.

Otherwise it would be like having to buy your Kellogs cornflakes from Morrisons or Sainsbury because the barcode readers in Tesco and the Co-Op wouldn't recognise them - if you see what I mean - so the idea would fall at the first hurdle.

What range are these things detectable over ?

Roy

Sounds like a great idea to generic tag during manufacturing, you could tag every thing from a flow meter to anaesthetics trolley.

But wouldn’t it tie you down to use Rigel test equipment.

Barcodes can be made and used by any of test Equipment Company. Unless Rigel are willing to give up there brain cell technology to the other companies it can not be fitted at manufacture.

These brain cell have no way to write on them. So if your syringe pump ends up at another hospital, who would they call. No next service date. So it will add another label to the machine that infection control to moan about.

I like the idea of fitting them on the inside, (infection control would like this idea, no room for the bugs to sit). Most medical equipment sit inside a faraday cage to help stop EMF interfering with the PCBs, as Mr R J Ling has already pointed out all the bad points about modification.

A.M

I'm all for a very limited form of standardisation before the decision to incorporate these into devices becomes the device manufacturers domain, i.e let us as consumers decide what's best for us, not the manufacturers of devices or RFID tags necessarily. Typically the RFID tag "route" is likely to be one that's used for tracking high-volume, relatively low value but possibly high risk, medical devices. Therefore it's a cheap solution that's required to assist in asset tracking for purposes of retrieval of equipment loaned out from libraries or for essential maintenance purposes - rather than a wireless-networked "bells and whistles" approach that might add significant costs to devices in terms of design and manufacture.

In engineering production, usually, there's ideas along a similar thread to Rigel's, introduced by different manufacturers using different technologies and eventually one becomes the de-facto standard, i.e. the one that is taken up, becomes prevalent due to uptake from the consumers and cooperation between working groups pushing the standards forward to meet requirements. Thus the "de-facto standard" forms the basis of "formalised" standards in any industry when it's formally introduced across all organisations involved in providing RFID solutions, say, for use in medical equipment devices, for example.

What's initially needed is an "open" RFID standard tailored towards device tracking/maintenance/library systems and then let companies compete over the best way to provide what the customer would like to see implemeted - that's why I asked if there were currently any RFID standards in my earlier post. One problem that I can anticipate is that an isolated RFID tag, that's not capable of extracting pertinent data from a medical device as well as providing tracking by RF, for example, might not be flexible enough (why not build a medical-standard RFID tag into devices at manufacture?).

Device manufacturers who eventually introduce their own RFID tag that can talk to other manufacturers RFID tracking system, that uses an open standard, may produce their own built-in RFID system that can pass-on more data concerning current status and location, plus service and calibration data, etc.

If there were connectivity between medical device and the RFID tag fitted to it then when the device is due servicing or when there's an error-code produced, the RFID tag (intelligent normally "passive" but with the capability of being extremely low-powered and "active", i.e. powered via the "RFIDtag socket" rather than when scanned), when it's interrogated (on a regular basis) could quickly "alert" the maintenance organisation via an RF link and it can be retreived by the equipment library. This overcomes the big problem associated with a failure to report faults (a big governance issue) because they don't know there's a fault or abuse is involved. The RFID tag could also, optionally, be used to flag-up and locate where equipment is located when service intervals or hours usuage have been exceeded.

This could overcome another problem RE: servicing - allowing service organisations to let the equipment flag up when it requires servicing - based on location perhaps? - i.e. devices in certain areas of high usage could have different intervals built into the tag data to allow intervals to be varied accordingly depending upon usage maybe). This allows each device to be retrieved, via RF tracking, as appropriate, in theory - I'm all for avoiding the utter waste of tracking down devices for servicing and flagging faults without reliance on users reporting them.

There's lots of pros and cons about theses things that I could go on about all day. This is why I would initially prefer a more flexible standard form-factor "RFID-socket" on medical device enclosures that can connect to the medical device for "medical standard" low-power and 2-way communications of pertinent data (between an "intelligent" RFID tag and "RFID tag enabled" medical devices themselves) that connect to standard RFID tag hardware of choice initially (allow flexible upgrade of RFID rather than build RFID into devices, whilst the most suitable technology evolves).

Needless to say the provision of low-power and communications between an "intelligent" RFIDtag and the medical device would mean that the data in the RFID tag could be updated and that the RFIDtag function could be configured on or off as required and the equipment details such as hospital, location, etc could be changed via a standard, but secure, interface perhaps.

What I'd propose, if I were involved in design, is a half-way house between a bi-directional medical device network and the simple, passive, relatively "dumb", RFID tag concept. For maintenance bi-directional capability is of little use, practically speaking, but if the RFID tag data can be supplemented with medical device fault status, PM due time, service data, hours operated and the stuff Rigel proposes, i.e, tracking and service records, etc, Then I can see there being many benefits I'm not going to discuss here, due to lack of time and inclination.

Personally speaking I think innovation will come from a more flexible standard, than less, that allows all manufacturers to fit their "solution" to devices and eventually provide a globally compatible RFID tracking system with applications in asset tracking, maintenance and loans but I feel that RFID tags could be designed to actively take service/fault/tracking data from the medical device and actually provide a cheap method of "keeping-tabs" on safety-critical devices that need to be tracked in the clinical environment.

Another application of course is the ability for clinical users to take serial numbers/unique identifiers/batch numbers, etc, from devices using an RF scanner (into a paperless patient management system, of course), rather than search on the equipment each time it's used, which I believe is a pain.

Here's an interesting link in today's news:
http://news.bbc.co.uk/1/hi/technology/6691139.stm

Oh, so it’s not only us delinquents who are being tagged, then?

According to the BBC, the biggest user of RFID tagging is the US military. Why am I not surprised?

When i was at the equipment libraries forum in Blackpool the other week RFID was discussed and it got me thinking .... Really! I hear you saying... I do it occasionally (Think).

Richard said in a previous post:

I think this a very exciting concept - having information of where it is, who it is connected to, what is it doing/delivering, or... which cupboard is it in!

I have yet to see a manufacturer that has built in RFID - I think they have been caught napping (or is that me)

Can anyone out there enlighten me whether they have devices with built in RFID? With the NHS going wireless - it seems like a major market advantage to me.

Yes, you've been caught napping, I'm afraid, John. What about GLIB?

So, two years on, what has become of Rigel's Brain Cells? Has anybody given them a go?

A news item on self powered and small RFID tags. So why are the ones for medical equipment so big?
Robert

I think it's because they may be active, i.e. internally powered, with relatively long life-spans and the ones I've heard of for medical use produce radiated power equivalent to that of a mobile phone for very short periods.

Indeed so.

RFID is available in two flavours; active or passive.

Active tags have an on-board embedded power supply, i.e. a battery, whilst passive tags obtain their power from the reader and can therefore be manufactured in a variety of small sizes.

Active tags have a limited lifetime due to the on-board battery, whilst passive tags have an unlimited lifetime.

RFID infrastructure is also something that needs to be carefully assessed such as operating frequency and reader location etc.

RFID is not a new technology having been used in retail for inventory tracking for some time now.
Wal-Mart have been one of the largest RFID proponents with Tesco and M&S also now using it however, it is new within the medical environment.

As Richard says, the RFID tags used in the article are passive. Whereas active tags require a power source (battery) which obviously makes it larger.

More good stuff about RFID.

I do know the difference betwen active and passive tags , it is hard to express toungue in cheek whilst typing. But if a passive tag can be made this small why can an active one not be made a lot smaller and lower powered? Obviously they will be larger than passive tags but they do seem excessivly large.
These current large active tags would not fit well on an ambulatory syringe driver which by its nature travels around the place and gets "stored safely" in drawers.
It is this types of equipment that would benefit from tagging not large patient monitors etc.
Robert

How about something like this?

I still think a long length of elestic firmly attached to the equipment library shelving is a useable and cheap solution that needs no extenal power.

Robert

For those with no sense of humour this message was sent with my toungue in my cheeek.

I have just been chatting with a syringe pump company person who says they are seriously looking at building RFID in to their pumps as so many people are asking about it. Well they would wouldn't they if they want a sale. But by us insisting on it, we get around the power/size/emf compatability issues if it is built in from the start.

I believe that RFID tagging will be the "next big thing" for the in-house technical support of medical equipment in UK hospitals. It seems to me like the logical next step forward.

It would be interesting to hear from your contact which protocol etc. they are thinking of using, Robert. If each and every manufacturer goes their own way, and introduces their own "standard", we can just imagine the result!

The RFID or Real Time Location System market is still relatively immature. There are several technologies vying for dominance: 433MHz, 2.4GHz, UWB (ultrawide band), infrared, and ultrasound to name the main categories.

It's very difficult to pick technology winners, and that's the main reason why medical device vendors have not built tags into their products.

There seem to be two levels of positioning accuracy requirements in hospitals, zone or area level for basic asset management (where is something), and room level accuracy for advanced asset management (like has that pump been through sterilization), patient and staff tracking.

To date, the best technologies for room level accuracy are infrared and ultrasound. While RF based systems (many of which claim room level accuracy) are good for zone level accuracy.

Besides asset management, some hospitals use RTLS to improve patient throughput in the emergency department and surgery. They can also be used for hospital wide patient flow (especially bed management), observation patient management and infection control.

A big differentiator between many systems, regardless of positioning technology, is whether the receivers are wireless or wired. Pulling power and a network connection (even PoE) to positioning receivers is a big hidden cost of these systems. Vendors like Awarix [url=www.awarix.com]www.awarix.com[/url] have receivers that plug in to wall power outlets like those little room fresheners. Others, like CenTrak [url=www.centrak.com]www.centrak.com[/url] are "lick n stick" battery powered receivers.

As more medical devices become wireless, devices with Wi-Fi radios can be tracked by positioning systems like AeroScout [url=www.aeroscout.com]www.aeroscout.com[/url] and Ekahau [url=www.ekahau.com]www.ekahau.com[/url] without a separate tag.

Interesting stuff. My own forecast is that RTLS will take off in the UK, not for anything useful like asset management, but as a way of demonstrating compliance with ever-demanding government patient management "targets" (throughput, indeed). I always used to like to consider the hospital as a "system". It seems that some would have us go beyond that, and treat the hospital as a "factory" (processing plant?). Is this really progress, I wonder?

I would have thought that Wifi location would win hands down for zone. Problem with most RFID system is that they are new technology, with Wifi your dealing with existing technology and thus have a better idea on their integration and if they will interfere with equipment.

The thing is it's reported that the number of free IP addresses will soon be depleted and the move to IPV6 is thus more urgent. Even if someone doesn't have more than 17891328 assets (including PC's and printers), if most systems migrate to IPV6 can current devices easily be converted to ipv6?

Just in case anybody was wondering:- IPv6. Here's more.

http://news.bbc.co.uk/1/hi/health/7471008.stm

This could upset the apple cart!!!!!!

Presumably systems that use Wifi wouldn't cause as much problems since there's probably Wifi systems already in immediate vicinity and if it was a problem we would have heard by now!

I have just registered on the site as I believe that this is the best forum to have a disucssion about RTLS.

I have recently left the NHS after 10 years to go to a company called ekahau. We do this asset tracking that you have highlighted, and now have it installed in a number of NHS sites, as well as other industries.

As you are all aware the NHS are starting to take up wireless technology, however this type of tech is still very new in the UK.

I have sent a mail to the admin of the site as I certainly dont want to come across as a salesmen (which I would like to add im not, im the techie). However I am more than happy to answer questions, and if you would like us to come to your sites to give you a live demo of the solution providing you feel you have the scope and requirement to use location tracking then I am more than happy to do so.

Welcome to the forum, Jason.

What is the main thrust for having a system such as Asset Tracking. I guess we have to give this the right approach before any organisation would embark into considering such a system and I guess it would not be cheap for such a system to be installed.

Thanks Roger. Singapore eh, your along way from the UK.

Most if not all Hospitals are having to review their asset register on a regular basis to ensure the right quantity of Assets are available for the right uses in the right locations. As such there is alot of emphysis put on the Medical Engineering/Electronics Departments to ensure that this is managed correctly.

There are many EBME Managers out there who are told increasingly that cost have to be cut, and finance departments who advise that if the piece of medical equipement and other assets cannot be accounted for, then it will be written off the asset register along with the original purchase price and that will be cut from the budget for replacement.

What adds to this is, as we all know, are Wards and other departments like to "stock" manage this kit, and will actively hide it in fear that they may not get the pump, monitor or driver when urgently needed. This in turn give false usage levels of equipement. Unfortunately without actual usage reports it can become very difficult to ask for additional kit during the next year spend. Without any justification finance departments will not sign off on new kit. And on the flip side, you may identify that you actually have more of a particular type of device than needed, and as such divert your spend to something else.

A solution like this can be, and is also being used for helping with maintenance of the equipement,as the EBME team can now locate and manage it accordingly.

Below are some points which give you an overview of other uses:

•Bed management - Either ensuring that the right type of bed is available when needed, whether it is being cleaned down, or whether beds are in use
•Ensuring that the right quantity of equipment is used in the right locations, and can be easily located for maintenance. For instance medical equipment such as IV Pumps, Monitors and Syringe Drivers to name just a few. This can also be applied to computers on wheels, which cost a lot of money for the carts, rather than desktop replacements as they are stored in Offices.
•Assisting in Process Management, change control etc, and by reporting usage and throughput of assets and People through the Organisation. This would be used potentially by the Lean Team who may use other technique such as Kaisan and Six Sigma.
•Locating PDA’s or the CfH MCA Tablet for obs at the bedside
•Locating and Managing Wheel chairs
•Staff Security. Should an incident occur, then an alert can be sent from a tag to a central location, this can also be sent to a group of tags as a message and the closest Security member of staff can respond immediately.
•Patient Tracking. Should a Patient decide to leave the Ward to visit the shop for instance or the stretch their legs, and then a Consultant is visiting the Ward and wants to see the Patient, the Ward Staff can not only locate the Patient, but can send them a message to return to the Ward.
•Our E-Client can be run on any Windows device. We can also track certain types of WLAN VOIP Phones
•Assist the finance department in ensuring that the cost of equipment is managed correctly.
•As the system has Virtual Zoning, you can create threshold points, and should the tag either enter or exit that point then an event will take place in the system either causing an alert to be actioned, or another system to be updated.

All these points will help the Organisation at various levels and various departments. Also please beaware that what I work with is purely active wi-fi RTLS/RFID which operates at 2.4Ghz.

oh, by the way on the cost front. Providing a wireless network has been installed correctly, then our solution is completely scalable. so its not big bang all at once, it can be managed on a cost, resource or size basis. but the ROI (went all salemen then) is pretty much seen within the first year.

fyi - we do not require ANY additional hardware for the system to work, and the communication is 2-way so you get battery levels and can send messages providing its that type of tag

Hi Jason,

It is a long way but with internet technology it is never too far to engage in a forum or even business.

RFID wasn't very new technology as I remembered many years back in 2000 when we were trying out Asset Management and one of the US vendors is prepare to put on a trial in the hospital. We are a 1200 bedded hospital and to put up access points everywhere would cost us a bomb. By the time installation was about to start the Company suddenly announced it has gone into bankrucy protection.

But the main question is really how does hospital justify for such an acquisition since it is a million dollar question. What will be the basis of ROI. I guess this equates to dollars and cents and the duration it takes to recover the investment. For your commment.

RFID ... a must have? Or something else that, five or ten years down the line, will become yet another system in the hospital that "doesn't work anymore" (aka yet another half-baked "gee-whiz" scheme and a waste of tax-payers' money)?

Personally, (although I'm interested in the technology) I believe that any money available would be better spent on in-house tech support of medical equipment.

"Lean Team" ... or Fat Price?

I was going to give a rebuttal to each of your bulleted points one by one, but I'll spare you that. So here are just a couple of points in response to your last post:- don't user departments "own" their equipment these days? And ...


... in what way? And, anyway, who gives a damn what those Bean Counters think (...can they fix the kit)?

Have you seen this thread, Jason?

Well I have seen a good number of RFID vendors trying to sell the system to the healthcare sectors. Many hospitals were concerned with the initial cost and maintenance since those active tags will likely to introduce battery replacement after 6 - 12 months. By far, I don't think hospital will be convinced for such a system in the hospital. Perhaps to a small confined department where monitoring of fast depleting inventories are important to them as each time they have to top up sooner than they thought.

Anyone read the recent Jama paper on RFID's?
Electromagnetic Interference From Radio Frequency
Identification Inducing Potentially Hazardous Incidents
in Critical Care Medical Equipment

Remko van der Togt; Erik Jan van Lieshout; Reinout Hensbroek; et al.

JAMA. 2008;299(24):2884-2890 (doi:10.1001/jama.299.24.2884)

http://jama.ama-assn.org/cgi/content/full/299/24/2884

Potentially Hazardous ... someone else making a career out of scare-mongering?

So were mobile phones and Tetra. The passive systems are in the 4 watt range, similar to Tetra. I've seen what a police radio can do to a patient monitor. They were quick to turn them off as it was one of their own in the bed mind.

Would be interesting to here if anyone using RFID systems has experienced similar issues

RFID (did you mean active?) ... police communications ... TETRA ... telemetry ... SMS ... WiFi ... BlueTooth ... GSM etc. All different (horses for courses).

No passive. It's the transmitter/Receiver that's the problem as it is powering the tag it is throwing out up to 4 watts. Can I upload a copy?

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Hi Guys,

Apologies. I would have replied earlier but I have been on site today. I am also reading each reposnse so I may jump around a little.

Roger - As previously mentioned this type of technology (tracking across wi-fi) is very new in the UK, although RFID as a technology has been around for along time. It has taken the NHS years to even accept wireless technology in the Acute environment due to...

1.An assumption that it would interfere with certain types of medical equipement.
2.Initial installation costs were high
3.Justification for wlans was, and is still difficult.
4.Skill set within the NHS is almost none existant, this is purely down to IT departments not investing in staff training etc.
5.The Trust doesn't know why its wants a wlan, and as such the WLAN project will give the perception that it has failed. purely because the purpose of the design it was never really defined.

I have been in ALL of the above positions, and they are very difficult to overcome due to the lack of understanding at the right managment level.

If you look at locating an asset without a tracking solution, then consider the resource to do this.

scenario 1

1. EBME Tech Engineer looking for the asset in Ward A
2. Ward Manager get roped into looking for asset
3. Nursing staff get asked if they have seen the asset, then also start looking.
4. Consultant may have seen the asset in either ward B or ward C, and so the circle continues.

This scenario happens in EVERY hospital in the Country without fail

Hospital solution - Let throw more staff at the problem, and reduce spending on patient care.

Scenario 2

1. Ward A staff need Pump
2. EBME dont have a spare one as they are all "in use" (at this point we all clearly know they are not, they are being stored just in case")
3. Ward A calls Wards B and C, but they have no spare pumps
4. Ward A "identifies" and patient that is not so critical, and as such removes that pump and places it on more critical patient.

This causes a risk of cross contamination, and a risk to BOTH patients.

Again this scenario happens everywhere. I have been to a number of Trust who confirm that this happens.

The bottom line is as Tax payers throwing staff at looking for medical equipement is a severe waste of money, and is a short term fix to a long term problem. So you've found it one week, but lost it again the following week.

You want to be able to prove to the Senior management that you dont have enough equipement or resources. But how can you do that if you cannot show any usage of the equipment.

I am not saying that in all circumstances this type of technology is right. The need for it as a complete investment should be taken into account. Throwing one person into the EBME department doesn't help the IT Dept. locate and manage their kit, it doesn't help Porters find the Wheelchairs that they desperately need. Trusts for years have continually bought more un-needed kit becasue they have no information on use, and employ more staff to find it. but each year the trusts are in the same position. So Staff is clearly not the answer and it hasn't worked yet. So why not look at the potential of something different.

A Band 5 Medical Engineer is what around £20,000. To the Trust with on cost which include Pension, annual leave, desks etc it cost closer to £40,000 for ONE Department. now take into account all those members of staff looking for that asset as well. The Trust is now paying nurses, sisters and other Medically trained staff to look for assets and taking them away from Patients.

A location solution will release those staff to resume their original role.

I'm sure that you understand this, and I fully appreciate the issues you all face having worked in an Acute.

Now seeing and hearing the same statements coming from Hospitals around the country, the Trusts that are taking this up will at least have "reports" that we all know senior managers like, these will confirm why they need to go back to Central Government and ask for more money.

oh and Geoff, I am an Engineer and as much as I agree with the "who gives a damn what those Bean Counters think (...can they fix the kit)?" unfortunately they are also the people who will cut the budget if you cannot locate the kit and justify why you need more.

I am also just reading you link you sent me which I appreicate you doing. I have however just seen the dreaded PFI word. Been there, done it....didn't enjoy it

The life if a tag has just been mentioned by Roger. To get a tag to only last for 6-12 months is quite frankly poor configuration. After nearly 6 months of monitoring a site and the usage of assets and tags, based on a config we installed their tags will last for around 4 years. then the batteries are replaceable.

DAS mentioned about the Jama Paper. Although I cannot directly comment on their report, the technology I work with is purely Wi-fi based, and as such has no impact to us. We have made a statement to that affect.

Again guys I appreciate you giving me time, but please be gentle. I still have the mindset of an NHS person.

... oh dear, that's torn it!

Scenario 1:-

Why is the EBME tech looking for the asset? Let's say it's for PM. He goes to the nurses station and announces what he wants. The ward staff either point him in the right direction, tell him that it's being used, go off and find it, or ask him to come back later. If it's feasible, the tech asks the staff to get the kit sent down to the workshop. OK, so he may have to call in again. If the worst comes to the worst, the biomed dept. sends a note (email) to the ward advising them that PM is due and requesting that the kit be made available. Bottom line is:- it's their equipment, so put the onus on them! What's the problem?

Scenario 2 (solution):- Equipment Library.

Hi Jason,

Good morning, its early in the morning but here we are at noon.

We all know there are many reasons to justify for buying a system like RFID but lets be realistic about it. It is still facts and figures like ROI, etc and have you gotten a reference site where prospective buyers can consult directly with their counterpart (hear directly from the horses' mouth - its never more convincing than that).

Geoff has the point - making the onus on the user department rather than searching endlessly and taking the blame for not having the kit serviced.

Equipment library - any thumbup.

Cheers!

Here's the Jama paper. Easy enough read. I'm with Geoff on the various scenarios though.

Good Morning Guys.

thanks for the responses.

Its really difficult to get the NHS blood out of the vains, and you never really escape, your just given the impression that you make these decissions to move on

Scenario 1:-

Easier said than done. Not one Hospital acutally works the way you suggest. At the end of the day the equipment belongs to the Trust, and not to the Ward/Department, and the job of locating will ALWAYS fall under the EBME dept.

Sending emails to Nurses has never worked as they just dont get the time to address those emails, even if it is for PM.

The onus will always be for EBME in that respect, and who do you think is legally responsible, and will end up in court should an asset not get PM at the right time, and something happens......EBME dept, their manager, their director and Chief Exec. And this DOES happen.

Scenario 2:-

Equipment Library. I totally agree. Happy times. All you need to do is justify the equipement library set up, and how to manage it. What tools are you going to use, how will it take away nurses wasting their time on medical equipment, and as you know you cant employ more staff to manage to library.

Doesn't stop the kit from going missing though. Ward A gets it from library/pool. then keeps it, Ward B does the same, Ward C cant get one. So ward C goes to Ward B and takes theirs in the middle of the night becasue they are desperate, tell Ward B night staff who dont log it down becasue they are short short staffed and busy. But this asset needs PM. You got to get it, no one can locate it, my orignal Scenario 1 takes place, something bad happens, you all end up in court. not so happy times

Also to add, you still have NO usage figures, just now you have kit that is not in the Library where you want it. However if you can prove that the asset is just sat in a ward not being used, then not only can you get it for another ward to use, but you start to have justification for more, or less of that asset and mnore of another. This is better cost management, better resource management, better asset management, and in all honesty will save money.

Roger made what I consider to be a valid point, and yes worldwide we have reference sites, ROI studies, there are even independant studies available which show the pro's and cons, however they all prove the same thing. It is effective to get a solution like this, but it needs to be planned and thought through properly before moving forward. In other words, dont get it because the lights flash and you can see a dot moving on a map.( this is where I prove I am not a salesman...lol)

I had a conversation recently with a very senior Purchasing Manager in the NHS who looks at various solutions for the whole of the NHS, and he made a statement which is soooo true. The NHS operate like lemmings. Once one has taken the plung, the rest will follow, but it take an innovator in the appropriate size Trust for other Trusts of the same size to follow.

Obviously I cant put up reference site info here, and I wont do sales pitch stuff on this forum.

Finding An ROI In RTLS

Scenario 1: I don't want to get into a big argument ... but you're dead wrong. And (on this forum at least), we are tired of hearing about (being threatened with) "Courts of Law".

Scenario 2: yes, equipment libraries are changing the way in which kit is managed in hospitals. But they need staff (and trolleys), not gizmo's. And if there's no money available for the former (which I doubt), what makes you think it will be available for the latter?

OK, so you're not a salesman ... then why are you trying to promote your stuff here? Most of us are already well aware of the pros and cons of asset tracking, I should imagine.

And lastly, why do you persist in taking the p*ss out of NHS staff? Even I know that putting down the (potential) customer is not the best selling strategy.

Meanwhile, do we really care if the odd piece of kit goes missing? John Sandham has just told us that they have too much of it anyway!

Hi Geoff

Scenario 1: Honestly, I am not making this up, these are just the facts from every hospital I have been to. I actually agree with your statements, but the reality is that departments in Hospitals work independantly from each other as they have independent budgets. So they wont always commit the resource to finding kit. Surely you must see that.

Scenario 2: Can you explain trolleys please. I dont understand what you mean by this.

Trusts split money in capital / revenue.
Every year Trust Capital expense gets a hugh boost at the end of financial year, and if they dont spend it they loose it, and wont get as much the following year.
Revenue is year by year, and as such the Trust needs to almost "apply" to get more. but they need justification.
Capital = Hardware / Software, basically any thing that has no year by year cost assosiated with it.
Revenue = Staff etc

It all goes back to justification. Senior managers/directors need proof, and how can you do that if you have nothing to show them. Regardless of what system gets the information, it needs to be able to assist you in black and white. Ultimately isn't that what you need. This is why Trust almost throw money at systems, computers etc. every year. Or employ temp staff on contracts. Do you see that where you are?

And, to date I am not promoting "my stuff" I am having a discussion about the technology available in the industry. Aren't forums about peoples views. argument/counter-argument (pro's/cons) If you can give me a view that has no couter to it, then I am more than happy to accept it, however surely you should be asking me what other sites do, and has it helped. I will be honest. Some cases yes, some cases no. Trusts need to understand their requirements before making a call on their next steps

Although I dont agree with all the views of "lets just get more staff, because that fixes everything" I also believe that if you truely need more staff, at least have something credible to back it up with.

And come on, taking the p*ss out of NHS staff. I started as a temp contractor, became junior engineer to Senior, and left as a senior manager. Why even make that statement Geoff, surely you have progressed in a similar way and understand the up hill struggles you face into getting more resource to help.

Every Hospital does work in different ways, and have different budgets, different styles of management and responsibilites, either for process, staff, and equipment. But fundamentally

EBME are responsilble for Medical Equipement
IT is responsible for computers
Finanace are responsible for money
Press office is responsible for publicity
Nurses are responsible for Patients

and never the twain shall meet.

discuss.... dont just dismiss

Jason,

Scenario 2.

What rubbish. You have all the usage figures you need. Ward requests a pump for a patient for a day. Pump delivered, therefore pump in use. If you want to get pedantic you don't need RFID or similar to record a unit is actually in use, I doubt that any of these systems could do that anyway, not least of which is because you would be modifying the equipment to allow such add on systems to work, you could just record the hours used from the service menu. Most infusion pumps for instance record this.

Hi Das,

whats rubbish? capital/revenue? managment needing justification to employ more staff? can you explain please

Where do you get usage figures from? I honestly dont know.

Because a pump goes to a ward it doesn't mean it is in use permently. It just means its there. the ward may be storing it because they consider that there might be a shortfall in available equipement. If every ward is doing the same, surely your figures would then be in-correct, unless you walk the entire site every day checking to ensure all the assets are in use, oh and where you originally left them of course.

Do you have something that helps with this? to be honest this is not being pedantic, I am trying to understand the various processes.

As I have said, this type of technology may not be right for all, however dont shy away from it unless you have something thats concrete and have no problems with asset management and you have the right quantity of kit in the rights places accrodingly.

when I talk about usage btw, its not how many hours a IV pump for instance was in use, its more about ensuring that the IV pump is required at that location for that period of time. But you need to put the right process in place to manage it.

thanks for you comments

As another question...

What are your thoughts on setting up the equipement library.

Do you only have one central library. that feeds the entire site
Do you have a central that feeds satellite pools/clusters
If so, how do you monitor those satellite pools/clusters
How do you manage the central library. What system is put in place for this management, or do you already have one. Or do you just create a simple access database for inventory managment

Interested to know from your perspective how far down the line you have looked into this, or whether you do it know. Some sites already do it that I have been to, and some dont. the opinion on libraries is mixed tbh

I will go and search the forums for this anyway, but as you guys are good at the counter arguments I thought I would just ask

... actually, no, I haven't.

Sorry, Mate ... I would love to carry on the "debate", but I don't have time for this right now. But, suffice to say, so far I disagree with about 90% of what you are saying.

lol.

no problems mate. thats why we have these discussions

speak soon.

Trolleys

cheers mate.

Your are absolutely right. you do need more of these. I have seen alot of these in shall we say not very good condition.

Do you need them because of condition, or because of quantity? because they go missing? or actually all three?

Better ask JoLee.

Acceptance of RFID system is a long way! In the meantime, system is left to rot! What a waste? Wondering why no one inhouse has developed such a system within the hospital. The answer maybe quite clear, I believe, the needs are not really there. Perhaps people want it but not needing them.

Yeah Roger you are right, acceptance has alot to do with it !

The reason for not developing in house is clear though. It is a specialist field, and Hospitals dont employ specialist in that field, and if they did it wouldn't be a permenant role, as that person would make more comercially, and the cost of that person would be considerable.

I mean Hospitals havent written their own operating system, havent written their own patient systems. These are all written externally then sold to the Hospital. It become too costly for an individual Hospital to do. They may have written something that sits on an SQL box, box thats about it. As soon as that person leaves, then theres no support.

I think the need is there, but you probably think I would say that. On the other hand, there are just some instances where there is no need, its just a want.

EBME is really one part of the puzzle that this technology fits into. Location based services in general fits across all the disaplines in one way or another. And having a solution that will fit most (as no solution fits all), is better than a solution that only fits one, from a cost perspective.

Some of the best (robust, easy to use etc.) hospital information systems, patient records, and maintenance systems, I have come across were indeed developed in-house! Not SQL ... but C. But that was back in the days when there were still some real programmers about.

... OK, but doesn't twain mean two?

It can also stand for "Technology Without an Interesting Name" (so perhaps you're right, after all)!

But, anyway (and of course), I disagree with what you seem to be driving at there. The "Hospital as a System" is a theme that I've used before (and within it, all the staff working together as a team for the good of the patients).

In my "model", EBME is part of Technical Services, which encompasses biomed, "estates", IT and anything else of a technical nature.

<----------Disappointed

did type something, but I deleted it. counted to 10 first

Shame on you "real programmers"

Im not a programmer, but I a know alot, and I know alot who wrote some of the old HIS systems, PAS systems, and many other clinical apps, however they all acknowledge the technology has moved on, and have adapted their skillset accordingly, and they have developed their original designs because the requirements change. Gone are old Acorn computer days etc.

Disappointed? In what way? Pity you can't hit the "undelete" button ... might have been something amusing.

Of course technology evolves. But my (oft stated) point is that we should take what we need, and discard what we don't. Just because something is (technically) possible, doesn't mean that we have to have it (... can someone please pass that message on to our so-called government ... if, that is, you can find anyone there with an ability to listen).

PS: I've got a couple of nice Acorn Electrons, if you're interested.

All departments in Hospitals should work together more effectively, but by the nature that they all have their own budgets already goes against the grain unfortunately.

Your model of EBME is what is happening in your site at the moment, and the model has differentt variantions in other sites.

And even if thats the model you would like to see everywhere, it would struggle to maintain stability and may not work effectively enough. The specialities are completely different.

In fact more common than not they are completely seperate. Other exmaples are IT is under finance, Estates and porters are together at other locations, and biomed and IT are together in others. So the model changes from location to location, which is why it is difficult to ever get a common working methodology under the NHS banner. and ultimately NHS is just a banner, and Hospitals are seperate businesses with a completely seperate speciality from each other. Which is why whats good for you, is not for another. Indeed Consultants work multiple locations day in day out, and are not tied to a Trust, and have no problem referring patients to and from their private practice so that they get more money from the government to treat said patient.

I don't have a "site", Jason. But I do have 34 years experience of the engineering support and maintenance of medical equipment, in many and various "scenarios". In which time I've seen (as in, been involved in) many hospital set-ups, and I know what works well, and what doesn't.

I'm not an NHS guy, but I do support the old-fashioned notion of a National Health Service, funded by the taxpayer, properly managed and and free at the point of need. I also advocate properly conducted equipment PM (not to mention treating people - patients and staff alike - with dignity and respect).

Mate, I've seen 'em come, and I've waived 'em goodbye ... and I shall still be here right until the end.

All this talk of budgets and getting "more money from the government" etc. doesn't really do a lot for me, I'm afraid. Frankly (to my mind), it misses the point (about being a biomed) by a long mile. If we were in it for the money, then we wouldn't be "in it" at all, would we? We would be in IT, or something like that.

ah, I see...

I have to admit can never say what works well and what doesn't. As another "requirement" comes out from the Central office, you adjust the working practices to fit.

After the shambles of the patient data that was un-encrypted on disks came to light, every hospital got told that ALL data had to be encypted before it leaves site. Firstly data leaves site by many methods, and arrives by many methods. So each trust then have to spend hundreds of thousands, if not millions addressing all of these because of an unmanaged incident. However paper based medical notes cant be encrypted, so how do you address that?

Going at a bit of a tangent there, but the point is that Trust always have to change their working practices based on changes in the Worldwide Enviroment, and the new conditions and treatments that appear.

The way that Medical Engineers work now is by far different to that of 30 years ago, and different to 30 years from now. The requirements the top people in the Organisations want from their departments have changed, and the departments need to ensure they have the facilties to make these changes happen

I've seen HA's come and Go, the principle of PCT's come and go, Trusts status's changing to Universities, Foundations, Teaching Trust etc, and its clear that as the more this happens the more Hospitals will be looking to make cost savings and make money. This is the purpose of the Foundation status. They strive to get it so that they can roll their money over to the next financial year without having to start from stratch again.

Bottom line, the technology may not fit all, and you dont have to get it, but use what you can to ensure you are moving to provide better patient care with the appropriate reporting tools. If Biomed Engineers wish to remain as Engineers thats great, and I agree with that, however their Managers cant be, they have to think about the bigger picture rather than just fixing the kit.

RFID/RTLS can help the process that the managers and other staff need across the whole of the Hospital, and addresses patient care, asset management, waiting lists, bed management etc. But if the Hospital has a better processes and tools in place, then clearly RFID/RTLS isn't needed.

If you have these, or are aware of any site doing this well, then I am interested in understanding how they do this.

oh and on this "the old-fashioned notion of a National Health Service, funded by the taxpayer, properly managed and and free at the point of need"

dont get me started on that. So called "holiday makers" that utilise our "free" health care, then go back home. My ex-partner works in radiology and over 50% of the patients are "holiday makers". free for them at least, eh!

oh...rant...sorry

and IT-->Money. If that was the case they wouldn't be in the NHS

What's rubbish was your scenario 1.
I've no problem with justification etc.
As to equipment libraries and equipment going to a ward it's down to how the library is set up and managed. Last one I was involved with required the user to request a pump for a patient for a day. Only areas with own stock on hand were ICU & CCU. And yes we could work out the actual usage as pumps in question had a motor hour counter in the service menu, so was a simple task to take those hours & convert to a usage figure. Usage ranged from over 50% for ICU to under 1% for some wards. This was one of the reasons for setting up an equipment library. Some fairly hefty savings have been made on infusion pumps alone.

As for the technology. I love technology. Just in the right place though. I don't see much use for RFID for asset management. I refer you to Geoff's posts. I did look into it a while back and the expense far outweighed any possible advantages.

Time will tell how this technology influenced people in the healthcare sector (NHS in particular) and whether there is a real need.

I've been told that Chester are using a system designed by Airtrak. Another supplier I'm aware of are aeroscout.
A colleague mentioned another will get details next week for you. Cheers Brian

We are starting a trial with RFID in about 2 weeks, using the company's receivers in some wards and using our own WIFI system. If our own system picks up the signal, it'll save the hospital a small fortune.

Hi, we at Milton Keynes are piloting a system beginning in two weeks... I'll let you know how it goes. The pilot consists of using our own WIFI system which we have throughout the hospital and using 'exciters' from the company. We hope that our own WIFI system will pick up the signal from the tags. We are piloting 2 wards…. One using our own WIFI system only…. The other ward using the company’s detectors (exciters)…..

Hi friend,
u can find these web ID www.harlandsimon.com
e mail: RFID@harlandsimon.com
thanking you
abdul rahim

http://news.bbc.co.uk/1/hi/health/7881807.stm

Another solution for all that lost equipment?

This is an article on the IET site reference RFID and the different types that can be used.

http://www.theiet.org/factfiles/it/rfid.cfm?type=pdf

The only thing with RFID is that it will not stop theft or the forgetful transfer persons. The one to have a look at is the microwave system as you can get a position on the item. Just dont know how it would affect older unscreened equipment that we all have in our hospitals.

Billy

Thanks for that, Billy.


Not a lot of use, then, I would have thought. As surely these must be the two main reasons for "actual" missing equipment (rather than simply being misplaced ... in the back of the cupboard, etc.).

If we are actually talking about deterring theft (and we must use technology), perhaps we should be looking at the kind of systems shops use to set off alarm bells when someone walks out the door with an item s/he has "forgotten" to pay for!

The purpose of the RFID tracking would be in the monitoring of the ins and outs of a piece of equipment from an equipment library.

With the microwave system it can be tracked to a specific position. Good when you are hunting a specific piece of wayard equipment.

As for the alarms on doors, just look at the use they are in shops.

They are probably a step ahead of barcodes as they can be fitted inside the equipment. Nothing visible to remove. That coupled to wide antenna system with zoning it should be quite simple to set up a full tracking system.(Like the factory stores setups)

Initial cost is the only downside, but if it is taken into account the amount of equipment lying in cupboards and the amount of time wasted by techs trying to find equipment for their PPM,s, I am sure it would pay fro itself in a few years.

As for the theft well you will always get that. What is needed is the stocks brought back in the centre of town. Name and shame!!

Billy

OK Billy ... what's this "microwave" system you're mentioning? Not something that Dicky is working on, is it?

Name and ... er, fame (or should that be "blame")?

RFID will happen - and has already been implemented in Hospitals in the USA where the evidence shows major savings in time, and we all know time=money. I am all for RFID - but it is still pricey at the moment. I foresee that all portable equipment will be RFID compatible and we should be talking to our reps to get the message across that this is what we want.

Hi Geoff

The microwave works on 2450MHz and can give you distance to object.

Billy

Just like a microwave oven ... but costing a tad more than £ 30 from Tesco's by the look of it! And those tags (see .pdf) are hardly what you might call little things, are they? Think about how (and where) you are you going to fit one of those to all your favourite medical devices.

Interesting technology, though. It looks like tag battery life is four to five years, and the tag has 8 K of memory. So maybe we could log the kind of data we mentioned before. You know, PM dates and stuff like that.

I wonder what a full implementation (that is, in a typical hospital) would cost? What we need is a trial. How are your finances up there, Billy?

But meanwhile, now I also read that passive radio-frequency tags won't work (that is, cannot be read) when placed on metal. So that means we need active tags, then (as mentioned before).

It seems to me there is far more to all this that meets the eye (as it were). Frankly, I believe that more thought needs to be given to all the radiation (most of it invasive, that is snooping) we already have to put with in our everyday lives, without simply adding to it. I understand that some banknotes now have RFID tags "hidden" in them, for instance. Passive (I presume), but they still will be getting read somewhere (why, I wonder)*. Where's it all going to end? Perhaps people would be more aware of all this if they carried one of these around with them! All these emissions get absorbed by human tissue, do they not (no wonder I'm feeling so rough this morning)!

* The thought occurs that "facial furniture" could be used in a similar fashion. Who knows, maybe it already is! Let's forget ID cards (if we haven't already) and (as Neil has mentioned recently) simply crack on and "chip" everybody! Frankly, with the mind-sets that permeate the "Corridors of Power" these days, I can't really see how we can avoid it.

Hi Geoff

You better watch with this paranoia or you will end up sleeping under a chicken wire screen.

As for the RFID passive would be the best and I am sure that the technology will be available at a reasonable price within a few years. (It will take a few years for the trust to even get anything off the ground anyway)

What's that ... so you reckon my portable Faraday cage is a bit OTT, then?

Meanwhile, has anyone conducted any tests yet with *RFID? Passive versus active tags, how good it works through breeze block, red brick etc., distances and transmitter-receiver (and repeater antennae) positioning ... and all the rest? I can just imagine the "difficulties" in getting such a system commissioned, and up and running. Not to mention how long it would take until ... er, thieves realised how to beat the system (dead-spots et al).

Frankly, I see great scope here for hospitals to spend mega £££'s on installing systems that turn out (yet again?) to be an incomplete answer to an ill-defined problem! That is, buying the "wrong" system, which may very well be obsolete even before it gets commissioned (now, where I have come across that sort of thing before).

Has anyone thought about limited, local systems ... perhaps using more readily available (cheaper, adaptable) technology ... like Bluetooth, for example? Or, put another way, if prototypes were produced, would anybody buy them?

* Should we be using MWID for microwave frequencies?

See to us, we would be looking at logging IN/OUT traffic from an equipment library. Hidden tags, with a hand held scanner all linked to a working equipment management database. Therefore you can tell it is in or out (still leaves the requirement for staff input, but you cant have everything). This way the cost could be kept to a minimum.
I know what you are all thinking why not get the staff to register that they have taken an item and where it has gone. Thats what they would be doing but this is something that works along side, if the computer has'nt registered it being removed then the RFID will, along with a nice still of the culprit.

The other way is like they have in most fridges in hotels, the Led method, you remove it, it registers. (Found out the hard way when I removed everything from a fridge to put my beers in and ended up with everything on the bill. Just adds to your checkout time)

Logging in and out of the Library? Is that all? How disappointing!

In that case, what's wrong with a simple log book ... and (if you need a "secondary backup system", or whatever) ... well, surely you had Tally Tags in the workshop stores up at Spadeadam?

By the way, wouldn't an induction loop built into the door of the Library would be a more "fool-proof" way of going about things? Clocking equipment in and out, that is. Even the best staff in the world will sometimes "forget" to scan, especially when under pressure.

But simply logging in and out is a bit tame, I would have thought. What about locating the device, or at least the status about where it was loaned out to? Back to Tally Tags, I'm afraid.

Sounds like I need to come up there and get these things sorted out for you, Mate! But (before I do that), how does your Library operate ... does the ward collect, or do the (Library) staff deliver?

We haven't got one yet Geoff it's still in the planning stage where it's been for the last five years. I leave you to guess who has been responsible for it!(you did briefly meet him)

How long does it take to "plan" an Equipment Library? Don't tell me "they" are still trying to find a suitable location? For the last five years or so they could have experimented with a "temporary" Library in that building next to you (I guess you know the one I mean). Then, by this time, the art of equipment librarianship might have been well and truly perfected!

Oh, well ... roll on a Happy Retirement, Mate.

Thanks Geoff October 5th is the day.

Just about enough time left to squeeze in setting up the Library, then, Dicky! You know, just to show 'em how it's done, as it were.

So, what's it to be ... drinks in the Mess?

Hi all,

What site in the UK have sucessfully implented RFID tagging?

So, I (for one) would be interested in just what Biff has asked but am not altogether surprised by the lack of reply as I suspect it is still a technology that has not yet found it's day.
We know, in theory, the potential benefits of RFID but has any one actually done it? If so, what uses has it been put to and what outcomes were achieved?

If you check aeroscouts web page there are case studies, the big question is how much equipment and which type do you tag, non-static equipment should be tagged if you are going to use the system, but do you use a minimum value before you tag, questions and more questions. Do you tag for location purposes or theft?

Care to remind us again what those are?

There has been a fair amount of discussion on this topic.

Hint: Mr.Moderator has thoughtfully provided a facility where you can search for earlier topics!

I know RAH in Scotland have successfully implemented an RFID system... But thats the only one i know of in the UK. Jason Britton from Leeds teaching hospital done a talk a few months back.

I recently went and met up with with the guys from EME at Great Ormand Street to look at there fantastic Harland Simon RFID system and F2 Data Base and at this stage can only see if as a total benefit across all departments.

We are about half way through a roll out of a trust wide Ekahau system, and have to say that its proving useful already. Lots of projects on the horizon with it to take forward.
:O)

I believe Maidstone and Pembury have had RFID running for a while - but this is second hand knowledge.
RoJo

We have RFID running here in Newcastle, we used it for our scanners and highly valuable equipment.