Abstract
The use of Radio Frequency Identification (RFID) technology in the health care industry has increased in the last three decades and has been effective in managing inventory and assets, tracking of products and patients, and identification of patients. This paper reviews the history of RFID, its application in the healthcare environment, as well as its benefits to the industry and the barriers to adoption of this technology. It also discusses the security and privacy issues associated with the technology in the healthcare industry. Finally, it presents a justification of the solutions which are already in place for the security concerns.
Introduction
Today, many hospitals as well as health care facilities are adopting the use of Radio Frequency Identification (RFID) technology to help improve their ability to accurately identify as well as track patients, their personnel, patient samples, medical equipment, as well as, blood products. Its previous use has proved that RFID technology increases safety in treatment by improving efficiency. It also helps prevent identity theft and reduces bureaucracy and therefore cutting costs. Other than its use in hospitals, it is also used in cases where mass casualties to improve the effectiveness treatment as well as transportation of patients by the first responders.
Background
Radio Frequency Identification (RFID) technology has been in use for several decades. The most outstanding industry which has adopted RFID technology is the healthcare especially in managing and tracking inventory, patients and assets. For a very long time, the healthcare industry as well as, its service providers have been skeptical of its use since they are uncertain of its returns on investment. However, today most organizations that provide healthcare are considering adopting the technology for various applications.
Development of RFID technology began as early as 1945 when an espionage tool was invented to transmit incident radio waves although it did not have an identification tag (Landt 2001, 3). The next landmark was made in 1948 when Harry Stockman presented a paper, “Communication by Means of Reflected Power” asserted that more research has to be done explore useful applications (Landt 2001, 3). The first modern RFID which utilized passive radio transponder that had memory was developed in 1973. It had 12-bit tags and operated at a speed of 915 MHz (Landt 2001, 3). Since then, more developments have been made to improve the capacity, applications and the speed of RFID technology.
RFID technology comprises three key elements which include the RFID tag, reader, as well as the back-end database which connects records with tag data which has been gathered by readers. The readers cross-examine tags to determine their contents using radio signal for broadcasting. In response, tags transmit back resident data which usually has a distinctive serial number. The back-end database is in charge of cross-conferencing the tag’s unique serial number with a database record allowing describe the object where the tag is attached. According to Fisher and Monahan (2008, 47) adoption of RFID system in the health care industry s still not widespread, but is fast becoming standard for health care facilities applied in tracking inventory as well as identifying patients.
Vendors who provide these technologies are controlled by regulatory forces. These regulations greatly impact quality of care as well as, services provided to patients as they determine the standards applicable in practice. The major health care compliances include Joint Commission on Accreditation of Healthcare Organizations (JCAHO) established in 1951and Health Insurance Portability and Accountability (HIPAA) of 1996. These compliance standards ensure consistency in the application of RFID, thus making it easy to make health plans and hospitals, pharmacies as well as healthcare personnel to process claims plus other transactions electronically. The healthcare system employs RFID technology in several processes which include tracking patient treatment information which has several different types of insurance that require claims which are in specific formats, as well as details.
Application of Radio Frequency Identification (RFID)
Some of the RFID technology applications which have significant potential advantages to the industry including, tagging of patients wristbands with identifications as well as care information in addition to managing medications distributions (Hansen & Meissner 2007). This is done using non-sensor technology to assist in monitoring patients remotely using implants thus providing inventory control and preventing theft. It offers an information system which can be used to track and manage hospital assets together with equipment, help improve patient safety and coordinate the processes of clinical trials of new drugs as well as decrease counterfeiting of pharmaceutical products and any medical errors which may occur. Thus, it helps reduce costs by improving the health care organization’s efficiency.
Pharmaceutical Applications
Inventory management
Health care equipment and drug manufacturers as well as distributors use RFID in their supply chain to improve their visibility and achieve precise account of inventory. Healthcare practitioners have to maintain buffer stocks to avoid stock outs and therefore, they have to keep visibility of customers. Increased inventory visibility helps reduce total inventory costs.
Drug Counterfeiting
Drug manufacturing companies, hospitals, as well as, hospitals use RFID technology to prevent drug counterfeiting. According to the United Parcel Service of America (2005, 2) the World Health Organization approximates the global pharmaceuticals counterfeit to be 5-8%. Counterfeit drugs significantly affect people’s lives since it prevents patients from obtaining required medication. RFID or Electronic Product Code (EPC) tags are used to detect products which are counterfeit or fake, as well as, products which have been tampered with or adulterated. It can also be used to detect unacceptable products either because they are expired, recalled, discarded or even returned.
Clinical trials
The approval process for pharmaceutical drugs is thorough and dependents on accurate documentation. During the trial phase for new drugs, it is important to accurately track patient usage of such drugs. RFID technology helps improve the tracking of new drug usage all through the clinical-phase testing protocols (Hansen & Meissner 2007). The technology improves tracking and accountability of the drug approval process during the clinical testing phase.
Hospital and medical device application
Patient tracking
Patient tags that have RFID chips provide patient identification as well as location assistance which are often required to achieve patient safety especially critical medical attention is needed.
Asset and medical device tracking
Medical device companies use RFID to identify every unit by serial number. They use the technology to help improve visibility into returns which enable quick redeployment (Hansen & Meissner 2007). Medical device companies are therefore able to know as soon as possible when unused products may be returned.
Surgical instruments as well as other medical devices have to be correctly cleaned and packaged after every use. RFID tags on the instruments as well as readers which are attached on the sterilization chambers including storage cabinets are used to validate proper cleaning and also assist in locating needed instruments. Smart tags are often placed on the medical devices and readers installed in hospitals doorways to help medical staff quickly locate critical medical equipment and without delay determine its appropriateness for use.
Errors that may be present in a product can be traced from manufacture to use and therefore be accurately tracked to attain preventative maintenance on such equipment.
Product tracking
RFID is used in health care facilities to track radioactive isotopes all through the facility from storage up to transport as well as from administration up to its disposal (Hansen & Meissner 2007). Readers and tags are used to automate tracking and in so doing saving resources as well as time. RFID tags which have write/read capabilities are used to detect seal integrity for a whole container as well as individual packages. This tag is used to record time in addition to period of seal loss, thus making it possible for problems which may occur during shipment to be detected.
Inventory management
Hospital operating rooms usually have huge amounts of inventory. RIFD technology is used to provide visibility in the supply chain and prevent unauthorized purchase of medical items by effectively managing the medical products ordering process. This technology provides accurate account of every inventory level. It can be used to offer diagnosis of inventory management problems and therefore help implement corrective solutions. Hospitals use it in supply chain management allowing their suppliers to manage product orders as well as inventory levels. RFID technology is therefore used by suppliers to provide medical equipment and drugs on timely basis. It ensures that proper processes as well as metrics are put in place in every hospital inventory level.
Benefits of RFID applications
RFID technology provides information and communication as well as productivity. It helps identify, track and identify medical equipment and drugs and patients. Thus, it provides asset tracking, ensure safety and prevent losses of medical devices and drugs. It is also useful in inventory management, monitoring of medical equipment and drugs including the supply chain, and maintenance, management of rental equipment and coordinating operations and process within health care facilities and the supply chain of hospital equipment and drugs.
Asset management
RFID technology can locate mobile assets constantly. This ensures asset optimization making it possible to cut down on procurement and rentals, and as a result, significantly reduce the valuable time that medical personnel spend on ordering for medical equipment. According to BlueBean Company (2007) searching for medical equipment consumes the nursing staff’s working time by 10-30% while servicing these items may take them as much as 8 hours. Adoption of the RFID technology allows nurses and doctors to spend more time with patients rather than spending much of their time searching for equipment. The technology also enables the hospital locate critical staff easily. Its ability to locate mobile assets also has significant financial impact since it enables efficient management of staff, equipment, bed, as well as, systems capacity. The biomedical department of a hospital or other health care facilities can locate equipment that they use for preventative maintenance. The technology makes it easier to purchase medical equipment and pharmaceutical drugs, thus, reducing the capital expenditures as well as equipment leases. Thus, the technology makes it possible to achieve cost-effective management of its mobile assets, and in real time. RFID application provides users with visual representation of the assets and this allows them identify and navigate location of each asset user advanced search capabilities. It allows users to record as well as store historical data and at the same time provide easy access to the data since it has powerful reporting in addition to analysis features.
Patient care management
RFID technology is used in health care facilities to identify patients as well as know where each patient is at every time. This improves patient safety together with bed placement. RFID tags which are attached to patients enable tracking of patients and therefore know each patient’s exact location in real time. This helps know when a patient is in a potentially dangerous area within the facility. It also alerts the hospital’s personnel when an infant is not in the childbirth unit or when an elderly or frail patient has left the health care facility. Patient identification helps verify that the doctor/nurse is dealing with the right person, applying appropriate procedures and in the right place as is provided for in JCAHO. RFID tags are also useful in identifying laboratory specimen. Thus it provides physicians with the ability to locate patients while conducting their routine rounds. This in turn improves the workflow of the nursing staff, nurses, as well as, other caregivers and increases quality care and treatment for patient.
Inventory management
RFID applications enable health care organizations identify what they have in their current inventory including where the inventory is to be consumed, thereby, reducing out-of-stock situations. It ensures that the amount of consumables does not get billed to any patient. In addition, it increases efficiency in the supply chain and it is easy to know exactly the supplies which the organization has. RFID tags are placed on inventory cases as well as items. It therefore becomes easy to automatically locate an item as it moves through different areas. This helps health care facilities or hospitals procure less inventory as it enables the organization identify inventory to be ordered, and limit loss of supplies. It also optimizes the utilization of inventory within the facility and improves inventory replenishment.
Other benefits
It also helps realize the full utilization of assets as well as resources. This includes improving productivity and utilization of the health care organization’s assets, facility, staff, patients, suppliers plus customers.
RFID technology is also useful in making informed decisions including executive-level decisions as well as liabilities. Compliance standards set by JCAHO and HIPAA ensures that decisions made by any health care service provider or supplier are conventional (BlueBean Company 2007). It also ensures that proper decisions are made during budgeting and that companies comply with HIPAA and JCAHO provisions in the supply chain. The technology also makes it easy to conduct product recalls as it tracks products’ movement and usage in the supply chain.
Barriers to adoption of RIFD Technology
RFID technology adoption by the healthcare industry has been slow since its pay off is long-term and could take longer time before the company finally realizes its impact.
Major barriers to RFID technology adoption results from earlier high technology cost (United Parcel Service of America 2005, 6). Benefits from RFID generally take long. Health care organizations are therefore waiting for prices for adoption of the technology to drop and become more affordable for investment. Economic difficulties that most organizations in the health industry experience force them to allocate less funds in their budgets for their information systems. Companies therefore prefer new technologies which have demonstrated compelling business cases, as well as, short paybacks on their investments in information systems. Health care organizations are skeptical on the possibility of achieving the returns that RFID technology promises.
Most companies in the health care industry are reluctant to invest in RFID technology since its adoption requires modification of existing organizations’ business processes for them to attain its full benefits. This is normally very difficult as it involves alterations in technology investment strategies. For example, a hospital that needs to tag medical devices, as well as, place readers in its doorways has to make an initial deployment and a modification in protocols for tracing assets. Adoption of RFID technology will require initial training. Coordination and effort required during the training to increase the overall efficiency of the organization will also need additional resources.
Another barrier to adoption of RFID technology results from the fact that applicable standards are still not available. Electronic Product Code (EPC) that can provide considerably more data capacities for the 96-bit EPC tags have not been developed conventionally. Electronic Product Code can permit more information to be captured as compared to the present Universal Product Code (UPC) which is only capable of containing information in just 12 bits (United Parcel Service of America 2005, 4). Electronic Product Code will allow more detailed as well as salient information to be captured up to the item level. This will enable RFID to be programmed in such a way that it will be able to hold information like an item’s size, serial number, price, distribution touch points, as well as manufacture date.
RFID security and privacy issues
Armstrong and Culnan (1999, 11) believe that privacy is one’s ability to control the conditions for which private information is collected as well as how it is used. Adoption of RFID applications comes with new set of challenges. Security risks that come with RFID technology are associated with the probable failure of the system because of a range of security attacks which may include injections, eavesdropping as well as denial of services. On the other hand, privacy issues include the capability of the system to permanently save as well as link persona information via spatial in addition to temporal extension of data regarding information collection activities. Bishop, Holmes and Kelly (2005) report that a survey done by the California Health Care Foundation demonstrated 67% of the general public are concerned about the privacy of their medical records.
Security issues
Unauthorized tracking of RFID tags is the major security. RFID tags which can be read throughout the world cause risks to personal information confidentiality and corporate security. Continuing efforts to track the movement of medical products along the supply chain requires that Electronic Product Code (EPC) be embedded on medical products. Some RFID applications have cryptographic tags which have weakened encryption schemes that may not have the capacity to resist sophisticated attack.
Privacy issues
In some cases, the individual who buys the medical product may not be aware of the presence of RFID tag on the product (Bishop, Holmes & Kelley 2005). Since the tag can be read from a distance, sensitive information can be gathered from the individual without his or her knowledge and consent.
Again, consumers pay for these tagged products using credit cards or loyalty cards. This makes it possible to figure out the identity of the consumers since it is easy to read the globally unique identification tagged on that item especially if the reader is aware of the destination of the item, and also has loyalty card data as well as credit card data (Hansen & Meissner 2007, 5).
Justification for suggestion some solutions for security concern
FIP Principles
Fair Information Practice (FIP) principles have been applied to address information security concerns. The security/integrity principle requires that business associates as well as covered entities ensure protection of patient’s gathered information from any illegal access. According to the HITECH Act, covered entities have to take responsibility for activities their business partners (Fisher & Monahan 2008). Health care facilities and providers have to abide by HIPAA Security Rules which include administrative, technical as well as physical protection requirements. This implies that such organizations have to implement robust security mechanisms as well as protocols which can effectively ensure data integrity, while transmitting data throughout RFID tags, middleware, readers along with databases as the system allows entrée to authorized entities. Developing and implementing of written security policies together with procedures reinforces security safeguard mechanisms and ensures that organization’s staff conform to the requirements. The HITECH Act requires that health care organizations implement applications which provide security breach notification. This ensures security breaches that may occur in the system.
FIP’s principle of security is appropriate since these measures have to be audited as well as verified by an independent authority to establish whether the mechanisms put in place are effective and meet the standards of HIPAA and the Health Technology for Economic and Clinical Health (HITECH). This principle allows the regulating authority (Federal Trade Commission) to detect violations of security protocols and mechanisms. Organizations which are found to have adopted information practices which are inconsistent with the information policies are penalized, and sanctioned so that they comply with the practices that ensure patient’s personal medical information.
Faraday cage method
Kumar (2003) defines Faraday cage as an enclosure which is formed using a conducting material or could as well be formed by mesh of the conducting material. This method is effective in ensuring patients’ information confidentiality since it denies any outside static electrical fields signals. Thus, it can block any security attacks on any patient’s personal medical information as well as system’s information.
Encryption
In encryption, patients’ personal medical information is transformed into a form which is unreadable to any unauthorized persons to attain information security and privacy. An RFID tag is locked so that it does not reveal its identification or serial number until the owner unlocks it. This method is suitable since it does not block the hospital staff from tracking patients. The method makes use of metaID as an identifier which allows the application to track individuals even when the tag is locked. Besides, re-encryption method can be employed to limit the likability through the use of various public keys in cases where RFID tags are implanted in consumers. Engberg, Harning and Jensen (2004, 76) concur that tags can accurately establish that an RFID reader has the right authority to read even though it does not necessitate the tag to disclose any identifying information in the verification process.
Conclusion
Radio Frequency Identification (RFID) technology although has not been widely adopted in the healthcare industry due skepticism by healthcare service providers and organizations, has proved to be effective in previous case studies. It ensures efficiency and effectiveness in patient care and treatment, inventory management and hospital assets management. However, there needs to be more improvement in technology to reduce the security and privacy risks which still weigh down its applications.
Reference List
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