2009 Fourth International Conference on Systems and Networks Communications A Short Overview of the RFID Technology in Healthcare Antti Lahtela Department of Computer Science University of Kuopio P.O.Box 1627, FIN-70211 Kuopio, Finland antti.lahtela@uku.fi II. R ESEARCH Q UESTION AND M ETHODS A constructive literature review method was used in this paper where the main contribution is to give a general overview of the RFID technology in healthcare. The research questions are: • How is RFID used in healthcare? • What kind of results have been found? This paper is a part of the research project MaISSI (Managing IT Services and Service Implementation) in the University of Kuopio, Department of Computer Science, Finland. The work in our research project has been divided into eight subprojects (pilot projects) and the implementation of the automated identification system for the medication care process (AIMC) is one of the pilot projects. The AIMC will use the bar code technology for medication identification and the RFID technology for patient identification and nurse authentication. This is the reason why we are investigating different kinds of RFID systems in healthcare. Other MaISSI pilots are focused on improving IT service management processes such as problem management and release management. [5] Abstract—The RFID technology is a growing phenomenon among separate automated identification technologies. As a technology, it is used from the early 1940’s, but just in the last decade, the IT (Information Technology) community and the healthcare sector have been taking more action on studying and developing the technology to correspond their requirements and needs. In this paper, we represent a short overview of the RFID technology in healthcare. We will focus on the technology itself, how it is used in different parts of healthcare and what kind of results have been found. Keywords-RFID; Healthcare. I. I NTRODUCTION Healthcare is under continuous development and changes. Improving patient safety, nursing efficiency and quality of treatments brings productivity to separate healthcare processes. To achieve this, healthcare has turned towards IT and its applications, as these are noted to bring efficiency for healthcare professionals. [1] To improve healthcare and always notable patient safety, new systems and methods from the IT are deployed. Such as bar code medication administration, electronic health records systems and computerized provider order entry systems has been shown to enhance patient safety. Additionally, use of IT in different operations in a hospital environment is noticed to improve nursing efficiency and therefore decrease healthcare expenses. [2] [3] [4] Identification is on one of the critical parts in healthcare. It has an important role: patients need to be identified, different kind of devices, materials, equipment, objects and instruments need identification as well as medications. There are many targets among healthcare that need identification for registration, tracking and monitoring purposes. For example, misidentified patient or medications can cause serious, or even fatal, errors in medication care. This is the reason why it is important to study and research how the RFID technology is used in healthcare and find out what kind of results have been found. This paper is organized as follows: the next section describes research question and methods. Section III concentrates on the RFID technology itself and Section IV shows how the technology is used in healthcare. Section V is conclusion. 978-0-7695-3775-7/09 $26.00 © 2009 IEEE DOI 10.1109/ICSNC.2009.77 III. RFID RFID (Radio Frequency Identification) [6] is a technology for automated identification with radio waves. It has three main parts: an RFID identifier (a tag, also called a responder), an RFID reader and a data system for data processing. RFID tags, including an antenna and a data chip for information storage, are commonly installed on targets that need to be identified, but they can also supply information, for example from the Internet. The content of the chip can be read/written with an RFID reader which often is mobile or fixed and connected to a data system. [6] The technology is comparable to the bar code technology where a reader reads the information from a bar code. The RFID technology has some benefits comparing to the bar code technology, for example the reader can read/write tags data without a line of sight, the information of a tag can be rewritten where the bar code is unchangeable and the RFID reader can read several RFID tags simultaneously. [6] Other benefits of the RFID technology are its reading range, easy data transmission between the tag and the reader, reusability and data security. [7] 158 152 165 Figure 1 describes a simple case of an RFID system in healthcare. A nurse is using a laptop with an RFID reader and a data system for data processing. With the system, the nurse identifies a patient who is carrying an RFID tag. The tag contains an individual identifier which is read by the RFID reader. The reader sends the data of the individual identifier for the data system. The data system can be connected, for example to a database where the corresponding information to the individual identifier is stored. The data system can also be connected to a host/server, the Internet or another information system. Finally, the information is returned to the data system and for the nurse. Figure 1. Additionally, researchers at the University of Aarhus in Denmark, working with close collaboration between patients and clinicians, developed a context-aware RFID system. The system used RFID tags on patients and clinicians, while other applications of the system were adapted to the context in which they were running. The objective of this study was to develop hospital infrastructure and applications. [9] Intel, Autentica, Cisco Systems and San Raffaele Hospital in Milan Italy have piloted RFID for enhancing blood transfusion safety. In the system, patients and healthcare professionals were identified by using RFID-enabled wristbands while blood bags used re-writable RFID tags. The purpose of the system was to supervise blood donations and transfusions. The data was exchanged between transfusion center and RFID readers over wireless access points in various wards of the hospital. [10] WISH (Wireless Information Systems for Healthcare) is an RFID and Wi-Fi -based system for healthcare. WISH is used for reducing medication errors during medication administration and automating the work routines of healthcare professionals. The WISH is used by a nurse who logs into the system and starts his/her routine rounds at the hospital wards. At the patients’ room, the nurse uses a PDA (integrated with an RFID reader) to read the patient’s tag. The PDA is connected to the electronic health record system, from where the nurse can have the patient information about prescriptions and treatment. [11] In a project, organized in Taiwan, the RFID technology was used together with the bar code technology to identify patients and their medications during medication administration. A dispenser, located at hospital medication storehouse, was used to pack medications ready into doses. Each dose contained a bar code which referred to the information about medications. At ward, patients were using RFID tags for identification. During medication administration, a nurse used a hand-held PDA for patient and medication identification. The PDA made a data comparison whether the right patient was having right medications. The system showed to improve medical quality and to reduce medical mistakes. [12] At Harvard Medical School, Beth Israel Deaconess Medical Center, the RFID technology and the bar code technology were used as a hybrid system where RFID tags were used for tracking IV pumps, equipment, ventilators, patient beds, electrocardiogram (EKG) devices and employees. Passive tags were used to identify some of patients, Neonatal Intensive Care Unit babies and mothers milk containers. Bar codes were used for medications, most patients and healthcare professionals identification. This study led project researchers to predict that RFID will eventually replace bar codes in the near future, when the technology becomes more economical. [13] In a Taiwan hospital, RFID was used for locating and tracking SARS (Severe Acute Respiratory Syndrome) in- A simple RFID system in healthcare. IV. RFID IN H EALTHCARE The RFID technology is not a new technology in healthcare. There are different kinds of RFID applications for healthcare professionals for avoiding errors or risks that could endanger the patient safety. Here are some interesting RFID projects in healthcare and some notable issues concerning to the subject: In a study, made at the University College Hospital Galway in Ireland, RFID handheld devices and wireless networks were used for scanning patients’ RFID wristbands for identification. Once the patient identification was ensured, the handheld device and the system sent the patient information over the wireless network for data processing. This eased the patient identification process and hasted access to get the patient information. [8] 166 153 159 fected patients. The LBMS (Location-based Medicare Service) system also raised an alarm, when a new SARS infection occurred. In this study, the RFID technology was found to have the potential to operate efficiently for helping healthcare professionals to increase patient safety. [14] Woodwards Laboratories have developed a hygiene monitoring device that uses RFID to identify users. The iHygiene system is designed for both healthcare and the food industry and it is capable of monitoring that the organization hand hygiene policies are followed. The system consists of RFID tags placed on badges, gel dispensers equipped with RFID readers and computers with data systems. The iHygiene system collects information about the user each time he washes his hands. The system also generates reports of the hygiene and checks that proper hand hygiene is maintained. [15] The RFID technology is increasingly being used in everyday scenarios ranging from tracking and inventory control to patient management in healthcare. The RFID tag’s very low price at high volumes and the benefits compared to the bar technology are a big factor behind this widespread phenomenon. Additionally, the RFID technology promises to help and automate many supply chain processes, and it has been shown useful in other areas such as in baggage handling and in aircraft maintenance. A common factor for all of these applications is that they benefit from dedicated RFID middleware that provides reader management functionality, routing and data processing. Also, RFID holds the promise to eliminate many existing business problems by bridging the costly gap between the real world of logistics and business units and the virtual world of IT systems. [16] [17] RFID data security is one issue that needs observation in critical environments. Recognizing threats and responding to them is important, for example in hospitals. Maybe the most typical problem for the RFID technology is that the signal of the system is reaching over the intended area or an intruder is eavesdropping the system. [18] Other well-known RFID security and privacy threats are: [19] • Spoofing. Attacker or attackers can generate ”authentic” RFID tags writing properly formatted data on rewritable or blank RFID tags. • Tracking. RFID readers in separate strategic locations can record unwanted sightings of unique tags. • Sniffing. Tag reading may happen without the knowledge of the tag bearer. • Replay Attacks. Attacker or attackers can intercept and retransmit queries using RFID relay devices. • Denial of Service. In DoS attack the RFID systems are prevented from functioning properly. Different studies about RFID and healthcare show that the RFID technology brings benefits to the healthcare sector. Figure 2 summaries these benefits. It is noticed that if healthcare and non-healthcare professionals use RFID, it will eliminate paper-based documenting, increase efficiency and productivity, improve patient safety, bring cost savings, prevent medication errors and reduce patients waiting time. [20] Figure 2. Benefits of RFID in healthcare. [20] Healthcare has also own requirements and limitations for RFID. Patients, healthcare professionals, medical equipment and healthcare applications set a list of issues that need to be notified by the technology. Based on the studies, represented earlier in this section, figure 3 summaries these requirements. V. C ONCLUSION In healthcare the future seems challenging as the population, especially in western countries, is ageing and at the same time people are provided with better and more extensive health services. This is bound to increase the cost of medical care and new methods are needed to both cut cost and make the work more cost efficient. In order to be able to deliver the service people are used to, healthcare processes have to become more efficient and less burdening for healthcare professionals. In order to create more efficient healthcare processes, IT and its use in healthcare has been studied extensively. 167 154 160 Figure 3. Requirements and limitations for the RFID technology from separate healthcare sectors. One promising technology that can be used to both streamline processes and make them more secure is the RFID technology. It can be used for many operations in healthcare (figure 4): patient identification, material identification, equipment identification, device identification, medication identification, access control, location and information transmission. Ultimately, the technology increases patient safety and brings efficiency for work of healthcare professionals. It can be noticed that most of the systems are focusing on patient identification. Figure 4. Additionally, there are other automated identification technologies, such as the bar code technology and the NFC (Near Field Communication) technology, that healthcare can deploy. For example, NFC which is a newcomer in healthcare could be used for patient and medication identification during medication administration. The NFC technology is also available in mobile phones where the reader is placed in to the phone’s shell. This gives to NFC a big benefit, compared to the RFID technology, because now the ”reader” can be used also for communication. [21] RFID in healthcare ACKNOWLEDGMENT This paper is a part of the research project MaISSI (Managing IT Services and Service Implementation) at the University of Kuopio, Department of Computer Science, Finland. MaISSI is funded by the National Technology Agency TEKES, the European Regional Development Fund (ERDF) and ten partner companies. R EFERENCES Finally, the RFID technology shows a way to automate identification processes. In healthcare, many studies and projects show that it can both improve patient safety as well as streamline healthcare cost thus decreasing expenses and workload of healthcare professionals. In this paper we presented a research that was aimed to finding how RFID is used in healthcare and what kind results have been found. [1] R. Perrin and N. Simpson, “Rfid and bar codes - critical importance in enhancing safe patient care,” Journal of Healthcare Information Management, vol. 18(4), pp. 33–39, 2004. [2] R. Kaushal and D. Bates, “Information technology and medication safety: What is benefit?” Quality and Safety in Healthcare, vol. 11, pp. 261–265, 2002. 168 155 161 [17] C. Floerkemeier and M. Lampe, “Rfid middleware design: addressing application requirements and rfid constraints,” in sOc-EUSAI ’05: Proceedings of the 2005 joint conference on Smart objects and ambient intelligence. New York, NY, USA: ACM, 2005, pp. 219–224. [3] E. Oren, E. Shaffer, and G. JB., “Impact of emerging technologies on medication errors and adverse drug events,” American Journal of Health-Systems Pharmacy, vol. 60, no. 15, pp. 1447–1458, 2003. [4] L. Moody, E. Slocumb, B. Berg, and D. Jackson, “Electronic health records documentation in nursing.” Computers, Informatics, Nursing, vol. 22, no. 6, pp. 337–344, 2004. [18] A. Juels, “Rfid security and privacy: a research survey,” Selected Areas in Communications, IEEE Journal on, vol. 24, no. 2, pp. 381–394, Feb. 2006. [5] University of Kuopio, Deparment of Computer Science, “The maissi project,” 2008-2010, in Finnish, available http://www.uku.fi/maissi. [19] M. Rieback, B. Crispo, and A. Tanenbaum, “Is your cat infected with a computer virus?” Fourth Annual IEEE International Conference on Pervasive Computing and Communications, 2006. PerCom 2006., p. 10 pp., March 2006. [6] RFID Journal, 2002-2008, referred 2.5.2009, available http://www.rfidjournal.com. [20] B. Chowdhury and R. Khosla, “Rfid-based hospital realtime patient management system,” Computer and Information Science, 2007. ICIS 2007. 6th IEEE/ACIS International Conference on, pp. 363–368, July 2007. [7] L. Cheng-Ju, L. Li, C. Shi-Zong, W. Chi Chen, H. ChunHuang, and C. Xin-Mei, “Mobile healthcare service system using rfid,” in Proceedings of the 2004 IEEE International Conference on Networking, Sensing and Control, 2004. [21] A. Lahtela, M. Hassinen, and V. Jylha, “Rfid and nfc in healthcare: Safety of hospitals medication care,” Pervasive Computing Technologies for Healthcare, 2008. PervasiveHealth 2008. Second International Conference on, pp. 241– 244, Feb. 2008. [8] A. Aguilar, W. van der Putten, and F. Kirrane, “Positive patient identification using rfid and wireless networks,” in HISI 11th Annual Conference and Scientific Symposium, November 2003. [9] J. E. Bardram, “Applications of context-aware computing in hospital work: examples and design principles,” in SAC ’04: Proceedings of the 2004 ACM symposium on Applied computing. New York, NY, USA: ACM, 2004, pp. 1574– 1579. [10] J. Dalton and S. Rossini, “Using rfid technologies to reduce blood transfusion errors,” white Paper by Intel Corporation, Autentica, Cisco Systems and San Raffaele Hospital, 2005. [11] W. Yu, P. Ray, and T. Motoc, “A rfid technology based wireless mobile multimedia system in healthcare,” e-Health Networking, Applications and Services, 2006. HEALTHCOM 2006. 8th International Conference on, pp. 1–8, Aug. 2006. [12] F. Wu, F. Kuo, and L.-W. Liu, “The application of rfid on drug safety of inpatient nursing healthcare,” in ICEC ’05: Proceedings of the 7th international conference on Electronic commerce. New York, NY, USA: ACM, 2005, pp. 85–92. [13] J. Halamka, “Early experiences with positive patient identification,” Journal of Healthcare Information Management, vol. 20(1), pp. 25–27, 2006. [14] S.-W. Wang, W.-H. Chen, C.-S. Ong, L. Liu, and Y.-W. Chuang, “Rfid application in hospitals: A case study on a demonstration rfid project in a taiwan hospital,” hicss, vol. 8, p. 184a, 2006. [15] Woodward Laboratories, 2004, referred 2.6.2009, available http://www.woodwardlabs.com/pdfs/iHygiene Press Release.pdf. [16] M. Kodialam and T. Nandagopal, “Fast and reliable estimation schemes in rfid systems,” in MobiCom ’06: Proceedings of the 12th annual international conference on Mobile computing and networking. New York, NY, USA: ACM, 2006, pp. 322–333. 169 156 162