The NHS National Programme for IT (NPfIT) may provide core IT systems, but it cannot make staff use them. As long as computers and care processes remain separate, NHS staff will see recording care as secondary to providing it.
The five rights of patient care are often given as right patient, right drug, right dose, right route and right time. By further integrating the digital and healthcare worlds, radio frequency identification (RFID) offers a way to maintain those five rights and to join-up care and processes.
Drug and patient identification errors remain a problem. The National Patient Safety Agency (NPSA) estimates that treatment errors occur in about 850,000 of the annual 8 million admissions to UK hospitals. The cost to the NHS in terms of extra bed days is about £2 billion a year. The NPSA also estimates that many treatment errors are caused by incorrect patient identification.
Birmingham Heartlands Hospital’s ENT Department trialled the use of WiFi tags to reduce errors in medical procedures. Patients were tagged on arrival and their digital photograph added to an electronic record. The photograph allowed the clinical team to confirm they have the right patient and the electronic record ensures they perform the right procedure.
But a combination of active and passive tags could allow staff, assets, patients, consumables – in fact, almost anything – to be tracked.
High Street retailers who use passive RFID tags to manage supply chains are claiming cost reductions equal to about 5 per cent of sales. In the same way, better management of stock on wards and in departments like theatres and A&E could potentially save the NHS millions of pounds.
The pharmaceutical industry is testing RFID as a means of managing supply chains and preventing the distribution of illegal and counterfeit drugs. A trial with UK pharmacies led by Aegate, which ended in January 2005, tagged 180,000 medicines. A UK-wide launch is expected soon.
The schemes can be extended to equipment, too. Real-time asset tracking of medical equipment such as oximeters, IV pumps, EKG machines and wheelchairs could also result in large savings by reducing the number of units needed.
Peter Whaites of Xtag, manufacturers of an active tag RFID system using building-wide sensors said that active tags are often better than passive for these kinds of applications: “The building is looking for active tags all of the time, while with passive tags you have to walk close to an electronic trip wire to wake the tag up.”
Active tags on objects and people that enter a RFID reader’s field can set off an alert or automatically initiate other events or processes.
In theory, tags on pharmaceuticals that uniquely identify a drug and its dose could be combined with electronic prescribing—part of NPfIT’s Care Records Service—to prevent medication errors and reduce drug interactions. Furthermore, the same tags could, for example, automatically trigger the ordering of a special diet or a series of blood tests appropriate to a drug regime.
Georgetown University Hospital in Washington DC is already doing just this, by using RFID to check and verify blood transfusions, something many other organisations do with bar codes. "Bar-code identification solutions are very valuable to institutions like GUH," explains Dr S. Gerald Sandler, Director of Transfusion Medicine. "However, RFID technology offers the promise of improving the efficiency and reliability of conventional double checks for matching blood transfusions with the correct patient."
Passive tags are generally a lot cheaper than active tags, and can be deployed in their own way. Swiss company MBBS has developed a passive RFID tag for metal instruments that could associate their use with specific patient procedures. Such information could be used for audit and infection control—particularly valuable in the fight to control MRSA.
Furthermore, if the price of passive tags continues to fall, manufacturers may tag all goods, enabling comprehensive care pathways to be set up and automatically monitored.
Recording and managing interventions
The combination of tagged people and objects offer many opportunities for innovation. For example, Nice University is using RFID in its “Meals at Home” pilot. The delivery driver reads tags on the meal tray and on the patient’s card with a PDA reader to confirm delivery of the right meal.
In the case of some patients, the driver can be the only person they see regularly, and can be a reliable daily check. If the patient is unwell when the driver calls, the delivery driver can also record that information and an SMS message is then sent to the patient’s doctor and relatives when PDA data are uploaded.
Manufacturers are already extending RFID by attaching sensors to tags, enabling changes in pressure, temperature, humidity and mechanical stress to be monitored. In the US, Auburn University’s Detection and Food Safety Centre is developing a tag that can even detect bacterial growth.
Such non-invasive monitoring could, for example, warn orthopaedic surgeons that a hip or knee prosthesis is about to fail, or reassure clinicians that reagents and drugs have been properly stored.
Cypak in Sweden is taking sensing even further to create what Stina Ehrensvärd, one of the company’s founding directors, calls “intelligent RFID”. Using conductive ink, RFID is combined with a microprocessor, memory and a sensor and incorporated into pharmaceutical packaging. This enables events – such as the opening of a blister pack by a patient – to be recorded for later analysis.
Originally intended for use in clinical trials, Cypak now sees its packaging as having a wider application – for example, in the monitoring of psychiatric patients.
Enthusiasts think there is no reason to hang back. Dr Carol D Daniel, who has recently helped to set up the RFID Centre in Bracknell, said: "The NPSA has identified a 10% mismatch between required and delivered treatment to patients. In the private sector, such an error rate would never be tolerated or in fact be commercially viable.
"However, I have seen little evidence that the NHS recognises and takes seriously enough the importance of AutoID and RFID."
RFID has the potential to reduce errors, automate administration and produce a comprehensive record of care. The technology is already developing and may eventually evolve into one of a spectrum of wireless techniques that could further integrate computers and care.
Healthcare and Public Sector Consultant