“The Good, the Bad, and the Ugly”

Truths About Creating a Single Communication Highway

By Beth Bandi

This is the second installment in my series of articles designed to help you lay the groundwork for successfully designing, planning, implementing, and ultimately launching a well-executed Real Time Location System (RTLS). The first article dealt with the “Six Critical Success Factors”. This article addresses “The Good, the Bad, and the Ugly” truths about creating a single communication highway.

I have witnessed firsthand over the last 15+ years the evolution of RTLS single communication highways. This in no way, shape, or form makes me an RTLS expert, but it does give me enough information worth sharing and worth looking at. Where are hospitals getting bogged down today when it comes to choosing RTLS tracking systems? Should they have all tagging solutions on one single highway or multiple highways? What’s hot and what’s not?

To begin with, let’s examine the evolution of RTLS, just so we have a reference point. The first true RTLS active systems in hospitals were infrared-based (line-of-sight, like your remote control) and were integrated with nurse call systems. These systems were designed to assist nurses and/or caregivers with enhancing in-room patient communications through location of staff members, seamless call cancellations, and documentation that patients did indeed receive a higher level of care.

The upside to this system was better visibility of the care team, quicker patient response times, and a way to document in-room patient response and care. The downside was that it was very expensive and costly to maintain, was prone to caregivers being non-compliant about wearing the tag or “big brother,” and had technical issues of not being “seen” with the tag on because the light source was shielded. The result was a system perceived as too costly for tracking nurses only, without the benefit of a fast ROI. Thus, facilities could not justify the rollout of an enterprise system.

The next logical step to increase the odds of a faster ROI was to add more tag types to the infrastructure, such as asset and patient tags. Though welcomed with open arms, there were still severe limitations: the “size” of the tag or form factor; poor battery life (less than 6 months); and server limitations that did not allow coexisting, multiple tag types on the same infrastructure, thereby slowing transaction times to a crawl.

Because of these limitations, the hospital industry was very apprehensive and slow to adopt these systems, greatly hampering the expansion to hospitals’ enterprises. The “Wow Factor” was there, but the cost barriers prohibited rapid adoption. New manufacturers came to the forefront with “new and improved” systems, but limitations persisted and there were no real market leaders. Again, the hospital market lagged in adopting a single communication highway – why pay money for something that didn’t solve their issues and added nothing to the bottom line!

Circa 2002, wireless pioneer Cisco took the hospital market by storm with the adoption of Wi-Fi. Cisco’s mantra was “One single information highway takes all”. Since then, technology giants, such as Cisco Systems, Nortel, and Meru, have dominated the healthcare space with the notion that “everything that is Wi-Fi-enabled can leverage communications off of an 802.11 a/b/g/n, etc.” Finally, the industry had a “true standard”. Hospitals went from adopting bleeding edge technology to complete standardization and domination of how communications were routed from point to point without building and rebuilding separate and disparate networks.

Think about it - leveraging existing wireless 802.11 networks - WOW! This concept allowed true cost reductions since hospitals no longer had to go through the redundancy of building a separate tagging highway. To the “tagging” world, this was utopia - just add your tag to the network, attach it to equipment, patients, and staff, and off you go. Not so fast though - there was still much to learn and pioneer.

Four main issues surrounding early adopters, with regards to tagging on an 802.11 networks, still remained. First, the bandwidth and its limitations as to how many tags could jump on the network at one time without major latency issues had to be resolved. Imagine - a tag “wakes up” or goes in motion, logs into the network, receives information back from the network, accepts that information, and responds back via the network – all of which takes time. As such, these systems would never be recommended, or acceptable, for use in infant and patient wandering systems, as well as security-focused equipment tracking program. These security-oriented systems are protecting tagged patients and are designed to protect egress areas, such as elevators, stairwell doors, etc. through special tag reader/controllers. Tags that enter these areas must react in real time in order to send information via the tag reader/controllers to maglocks and door contacts in order to lock down the egress point and instantly notify care teams when a breach occurs. Wi-Fi based tagging systems leverage off of existing Access Points (APs) are not technically capable of instantaneous lockdown.

Second, the size and form factor of the 802.11 tags. These tags were close to the size, and weight, of a hockey puck, not to mention their price tag of $120 per tag since they were basically two-way radios.

Third, battery life – tag batteries lasted less than 3 to 30 days. And with bandwidth limitations, as mentioned above, batteries were drained even faster.

Last, but not least, was “room discrimination”. Room level locations were not precisely available using this system. The best granularity with a VOIP grade network was around 8’ to 12’. Since the RFID signal bleeds through structure/density, someone or something could either be on one side of a wall or in a hallway, hampering the ability to provide positive in-room location and affecting workflow, utilization, tracking, and management outcomes.

It’s almost 2011 – what do we have today? To break it down, let’s use an analogy of traveling on the interstate highways. Multiple cars, trucks, semi-tractor trailers, etc. share a system of many highways. Each has their own way of getting from point A to B; no right or wrong highway exists. However, consider the notion that only one option – one highway, one road - exists. Just imagine the congestion and bottlenecks that would ensue!

This is the exact issue hospitals face today when deciding whether to use a single communication highway versus multiple, “best of breed” approaches. IS and Nursing Departments are pushing current R&D initiatives because they are continually requiring more and more leveraging of their existing applications and communication networks. Manufacturers are listening and are constantly evolving and developing new and exciting R&D roadmaps in order to comply with these mandates. RTLS systems are being pushed to be more flexible with greater tag choices, have longer battery life, provide room discrimination versus zonal location requirements, integrate with existing applications, and perhaps leverage off each other’s tagging networks (hybrid networks) in order to ease congestion of using one single communication highway.

That leaves us with one more question and brings us back to the beginning of this article: What is the recommended path for solving the dilemma of whether to use one communication highway or multiple ones? My suggestion, when investigating whether to leverage an existing highway (802.11xx) or bring multiple communication highways (IR/RF, Ultra Sound, Zigbee) into a hospital, is to first address “The Six Critical Success Factors”, which were covered in my first article and are further defined below.

Before taking that leap onto the “tagging highway”, the recommended basic fundamentals or building blocks for facilities to follow are:

1. Enterprise-wide Coverage - Knowing the location, status, and movement of equipment, staff, and patients improves productivity and reduces capital expenditures. You will never achieve goals of workflow and productivity improvement without an enterprise system because hospitals are very complicated and do not function in a linear (manufacturing) capacity. Once you tag someone or something, what do you want to do with the location data?
   
   
2. Location Accuracy - How close is close? Zonal, room level, sub-room level – all critical factors when determining the type of RTLS system or systems you choose. Good rules to follow: One, when dealing with patients, the closer the better - room/sub-room level. This is key in high throughput areas such as the ER, OR, ICU, and Med-Surge Departments. Two, when dealing with equipment for tracking and maintenance purposes only, zonal (within 25’) will be sufficient. But, if you want to tie utilization of equipment into the mix, room level will be required.
   
   
3. Installation and Maintenance - Installation considerations are a main factor in both the initial cost and ongoing success of an RTLS program. The best and most successful tracking programs are ones that have a dedicated group assigned to the program. These individuals make up different disciplines, such as IS, Bio-Medical, Security, and Nursing.
   
   
4. Interoperability - RTLS programs should be supported by standards-based technology (i.e., open API - Application Programming Interface) in order to provide location and status information to end-users and third party application partners. Integrating RTLS systems into existing HIS, ADT, Maintenance, RIS, ERIS, OR, and Bed Management are a current and future trend; however, some RTLS manufacturers have spent time and money creating “best of breed” applications, thereby eliminating the need for some integration. Nevertheless, having open architecture API RTLS systems offer great flexibility and are a must when choosing system partners.
   
   
5. Financial Risk - Remove the financial barrier by partnering with companies that provide shared risk acquisition models. Most of the RTLS system manufacturers and integrators offer “trial or pilot programs”, giving hospitals the ability to “kick the tires” of a system without the full financial commitment upfront. It also gives the facility much needed experience and exposure as to how flexible the system is and performs, and whether they like the manufacturer/system integrator who will be installing and maintaining the system for years to come. This is a good way to form a non-threatening relationship that either blooms into a full marriage or parts ways.
   
   
6. Use the Keep it Simple Stupid (KISS) Method - To understand the time and money it takes to maintain an RTLS program, look at the low-hanging fruit that must be managed first:
   • Critical Assets - IV pumps, Wheel Chairs, Beds, C-Arms, Mobile Computers
   • Patient Care Staff Members, Housekeeping and Transport, Maintenance Teams
   • Patients in the ED, OR, Med-Surge
   • Infants and Pediatrics

   These four categories are typical in most RTLS programs and are areas that cause and require the most time, energy, headaches, expense, and liabilities to the bottom line of a hospital.

The last 15 years have been very exciting ones for RTLS systems, which are finally being adopted in hospitals as “must haves”. Let’s not forget, though, to give thanks to all of the “bleeding edge” pioneers that have spent unheard of amounts of time and money trying to figure out the best ways to achieve true shop floor management within their facilities. Now is the time to really push the industry to the next level by implementing the right RTLS system(s). Remember, no two highways are the same; but whether it’s one or several, the achieved deliverables and outcomes must be thought through, executed, and administered with confidence.

Coming up in Part 3 - “The Alternatives of Creating Separate but Integrated Tagging Highways”.

In This Newsletter

EDI Wins eBay Modular Data Center “Project Mercury”

2010 Lessons Learned

Project Spotlight

New Project

Data Center Energy Practitioner Program

Interested in a Complimentary Data Center Assessment?

High-Density Cooling

Ten Flaws of Data Center Air Flow

The Good, the Bad, and the Ugly

Count on Us Award

What’s Hot for 2011?

EDI's Newest Associate

Intriguing Lives Outside of EDI

EDI on Winning Project Team of 2010 National Design-Build Award

EDI Out & About

In 2010

November 13-15: Jim Harrison and Shane Fischer attended the BICSI Fall Conference & Exhibition in Las Vegas.

October 3-6: Rob Nash-Boulden and Gary Cudmore attended AFCOM in Las Vegas.

November 5: Rob Nash-Boulden attended the Phoenix Business Journal’s Healthcare of the Future Roundtable in Phoenix.

November 14-18: Don Kinser and Howard Wageman attended the Healthcare Design 2010 conference in Las Vegas.

November 14-18: Rob Nash-Boulden and Gary Cudmore attended the 7x24 Exchange Conference in Phoenix.

In 2011

February 20-24: EDI will be attending the 2011 HIMSS Annual Conference & Exhibition in Orlando.

March 13-16: EDI will be attending the ASHE 2011 PDC Summit in Tampa. Don Kinser, Chairman and President of EDI, will present a session on “Legislation, Trends, and Our Current Healthcare System: Key Factors Affecting the Future of Healthcare Technology” on Tuesday, March 15, from 3-4 PM.