Transcript Health Care
Designed by: Sunil kr. Sagar Health Care Designed by: Sunil Kr. Sagar The Health Care Industry Gone are the days when you could walk into the doctors office and he would call you by your first name and ask how you grandfather is doing. Modern method of healthcare and healthcare benefits has increased the paperwork necessary to keep all the records. The medications prescribed, the insurance carrier, type of coverage provided and so on. Fortunately Information Technology has also evolved to keep the computerized records, provide information at the finger tips for both, the attending physician and the patient. Easy identification and transfer of data is critical to the success of any technology upgrade. NEED Medication Error: Scope of Problem • Designed by: Sunil Kr. Sagar Patient impact – Up to 98,000 people per year die of preventable medical errors; serious medication errors leading to death have doubled between 1983 and 2003 – 20% of families report serious medication error during hospitalization – Healthcare facilities experience one error per five doses administered • Hospital Impact – Cost burden: legal staff to handle patient claims; labor costs to process / litigate claims; cost of settlements; insurance costs – Impact on reputation: Increasing awareness of quality of care as an issue of importance to patients • Root cause – 18% of preventable adverse drug effects (ADE’ s) arise from insufficient patient data – Half of all ADE’s result from inadequate availability of drug information – Overtaxed and under-resourced nursing staff frequently fail to accurately verify patient identity and/or medication dose Designed by: Sunil Kr. Sagar Medication Error: Many Causes of Error - Often Process Failure Type of Error Description Prescribing error Incorrect drug selection (based on indications, known allergies, existing drug therapy), dose, dosage form, quantity, route, concentration, rate of administration or instructions for drug use Omission error Failure to administer ordered dose to patient before the next scheduled dose, if any Wrong time Administration of medication outside of prescribed time interval Unauthorized drug Administration of medication not authorized by a legitimate prescriber for patient Improper dose Administration of dose greater or less than amount ordered by prescriber or administration of a duplicate does Wrong form Administration of a drug in a different dosage for than ordered by prescriber Wrong drug preparation Drug product incorrectly formulated or manipulated before administration Wrong administration technique Inappropriate procedure or improper technique in the administration of a drug Deteriorated drug Administration of a drug that has expired or for which the physical or chemical dosage-form integrity has been compromised Monitoring error Failure to review prescribed regimen of detection of problems, or failure to use appropriate clinical or lab data for adequate assessment of patient response Compliance error Inappropriate patient adherence to a prescribed medication regimen Designed by: Sunil Kr. Sagar Market Drivers for IT-based Solutions (Specifically RFID) • Pharmaceutical-initiated – Motivation to leverage RFID for many purposes, including supply chain improvements, FDA-recommended anti-counterfeit efforts, Wal-Mart mandate – > 500% increase in number of drugs over last 10 years -- more than 17,000 drugs marketed in North America; greater need for automated tracking capabilities • Hospital-initiated – Increasing IT spend to reduce operating costs & improve staff efficiency; CPOE (Computerized Patient Order Entry) projects are widespread – Greater awareness of medication error and a desire improve processes – Heightened competition for patients; increased access to and awareness of hospital performance metrics, including quality of care • Regulatory (FDA) – Most prescription and commonly used over-the-counter drugs must be bar-coded with the National Drug Code (NDC) number by end of 2005 – All blood components intended for transfusion must have machine-readable labels identifying collecting facility, lot no., product code, donor blood group & type – Rule will likely be amended to either require or allow for RFID labels Designed by: Sunil Kr. Sagar Medication Error: How RFID Can Help? • Drug Identification – Automatically, accurately and instantaneously can identify any drug – Identification can be made at any level of granularity, down to the “unit dose” – How: RFID can be added to existing drug labeling • Patient Identification – Automatically, accurately and instantaneously can identify any patient – How: RFID can be added to existing patient ID wristbands • Prescription Verification – Nurse-carried RFID-enabled handhelds can verify prescription against patient & drug, time & route The Concept Designed by: Sunil Kr. Sagar It is proposed to introduce a novel cost effective and user friendly RFID based Smart Card solution to integrate the process of availing health care facilities and ease of process in an Hospital. RFID based Smart Card solutions have gained acceptance due to the advantages over bar code \ magnetic stripe solutions in recent times due to: • • • • • • Information stored on the IC chip is very secure and cannot be duplicated. Ability to store multiple applications on the single IC also allows easy manipulation of data. Off line verification allows instant identification of the cardholder for accurate and timely treatment. Mag stripe cards allow read only access on the point of usage locations which makes it very difficult to update the data. Data density is about 200 characters for mag stripe, where as today smart cards can store up to 4MB Smart Cards provide convenience, portability, durability, security, and ability to check forgery. Designed by: Sunil Kr. Sagar Medication Error: Multiple Levels of Error Prevention LEVEL 4 Blood Transfusion Safety • Lab Specimen Tracking • Medical/Legal MAR LEVEL 3 Max Daily Dose • Look-Alike/Sound-Alike Alerts • High-Risk Med Warnings Clinical Action Reminders • Near-Miss Reporting • Order Reconciliation LEVEL 2 Drug Reference • Formulary Comments Literature Review • Nursing Tools LEVEL 1 ‘Five-Rights’ Checker Designed by: Sunil Kr. Sagar RFID & Medication Error “Five Rights” Checking using RFID • Five Rights – Right drug, time, dose, patient & method of administration • Data Requirements – Patient Identification: RFID wrist-bands linked to patient database – Drug Identification: RFID-labeled “unit doses” linked to NDIC (National Drug Identification Code) – Prescription Data: Wireless access to prescription database for time, dose, method of administration • Configuration – Handheld device with RFID reader to check Patient ID, Drug ID – Wireless access to network for access to Prescription Data RFID & Medication Error Higher Level Checking Designed by: Sunil Kr. Sagar • Additional Checks on Prescription & Patient – – – – Prescription falls within range of reasonable dose Drug does not exceed maximum daily does Patient does not have existing allergy to drug Potential adverse drug interaction with other prescriptions • Data Requirements – Access to database of “reasonable” dosages – Access to patient record data (allergies, other prescriptions) • Configuration – Wireless access to key patient/drug databases – Advanced user interface RFID & Medication Error: Technical Challenges Designed by: Sunil Kr. Sagar • Read range – Too close … Small antenna sizes may require reader to be very close to tag – Too far … unintentional reading of RFID tags if the read range is not close enough • CPOE Integration – Computerized Patient Order Entry - electronic prescription input (vs. handwritten) – Projects are underway at many hospitals – Extent of integration - time of data entry vs. time of administration? • Standards & Formats – What RFID data standards will apply? – Consistency with existing medical standards (NDIC) and emerging EPC standards – Tag formats: frequency, read/write RFID & Medication Error: Operational Challenges • Designed by: Sunil Kr. Sagar RFID Labeling – Labeled at the source (drug manufacturer)? At the distributor? At the hospital pharmacy? – Quality control and introduction of error when labeling – Labeling on tiny unit does (e.g. individual pills in “blister packs”) • Existing Processes – Many hospitals use automated dispensing for access control & theft deterrence – Nurses often prepare medications at nursing stations, prior to enter hospital rooms – New process introduction: what to do when an error is detected; false/missed errors? • Costs & Implementation – Cost of RFID vs. Bar-code – Timing: When to implementation – Pilot testing to establish improvement and benchmarks RFID & Medication Error: Future Challenges • Regulatory – FDA has two different proposals to tagging of drugs: RFID for anticounterfeit; bar-coding for medical error – Integration of FDA mandates • Focus – Majority of RFID efforts currently focused on supply chain and retail / CPG applications – Equal effort must be expended on medical / pharmaceutical applications • Collaboration – Many organizations and constituencies involved – Need to coordinate efforts between clinicians, nurses, pharmacists, distributors, manufacturers, regulators Designed by: Sunil Kr. Sagar RFID: Major Improvement Over Bar Code Bar code RFID tag • Identifies class SKU (class of items) • Uniquely identifies individual item • Contains only 12-15 characters of data • Can store hundreds of characters • Readers use lasers/LEDs to scan tag • Receivers scan radio signal from tag • Line of sight required to read tag • No line of sight required Passive RFID Tag Chip Antenna Packaging Designed by: Sunil Kr. Sagar Cross sections of the Health Industry being benefited • In the Pathological Labs • In the blood banks • In the Hospitals – Review patient history – Inventory • Pharmaceutical Companies – Anti Counterfeiting – Pharma Supply Chain Designed by: Sunil Kr. Sagar Special features The RFID based Health care card will contain: • Personal details for identification • Health insurance policy particulars • Medical history • Any other information required RFID Card Capabilities • • • • Serves as an ID card:-The card holder can get the treatment without going through a long process of verifying the identification \ insurance details Serves as medical file:- brief details of the ailment \ treatment can be written into the card Results of all lab tests can be stored Records of prescriptions can be maintained Function of the RFID card 1. The type of policy and coverage being available can be verified by the hospital \ lab.by reading the card 2. The treatment particulars and bill amount can be printed and also written into the card 3. The relative bills can be either downloaded or fed into the computer at the health care company 4. The same will be forwarded to the respective insurance company for payment 5. The reconciliation process between the insurance company and hospital would be automatic Designed by: Sunil Kr. Sagar In the Pathological Labs RFID cards containing the unique Patient ID can be issued to the patients coming for testing for the first time. As per the prescription, the test numbers are assigned against the patient ID and the labels containing the test numbers are pasted into the tubes/plates containing his/her sample. After the test status comes , test tubes/plates are scanned and the status against them is fed into the system. While generating the test report, system attaches the test status of the test numbers to the particular patient ID against which they were originally assigned, and generate the report. When a particular patient comes for collecting the report, his/her RFID card is scanned and matched against the Patient ID mentioned in the report and the same is handed over to the him/her without any possibility of wrong reporting. Whenever the same patient comes for any further examination, his RFID card is scanned and the cardholder's previous medical history is fetched from the database for referencing and the same process can be repeated again. Designed by: Sunil Kr. Sagar In the blood banks The bottles/containers containing different samples of blood are pasted with RFID labels. Whenever any requirement for a particular sample of blood arises, labels on the bottle/container surface is scanned. The scanned and decoded sample specification is displayed on the Hand Held Terminal of the person incharge, matched against the required specifications and then issued for the surgery. Periodically the issual data can be transferred to the host through a serial port communication dock for the necessary stock updation. Designed by: Sunil Kr. Sagar In the Hospitals Doctor/the hospital staff can access the necessary information of the patients using their RFID cards/ Patient Wrist Bands and a mobile computer and use them while carrying out surgery, in ICUs, in their offices, in the clinics, at the point of billing, while forwarding the expenditure statement of the patients to the insurance company, which would enable them to streamline various operations like Review patient history Doctors can download the medical history of the patients from their RFID card and retrieving their information using either a serial port communication dock/through Modem or retrieve online through GSM connectivity on a mobile computer which help them take crucial decisions from remote locations Pharmacy medication administration by nurses/doctors without mistakes : Every hospitalized patient can be given a RFID wrist band tags and the medical/treatment/surgery records can be stored in the computer. Nurses can carry the RF terminals connected wirelessly to the access points to retrieve info from host containing the patient information. They scan the patient RFID wrist band tags and the suggested course of medication flashes on their terminals which can be administered without any possible flaw and then update the patient data using their RF Terminal with regards to the patient's vital information like blood pressure, body temperature, dosage given etc. While making rounds doctors can carry the RF terminals, scan the patient RFID wrist band tags , see and evaluate the necessary information and can decide upon the line of treatment and update the patient data for the future references. While Carrying out Surgery : Surgeons can scan the RFID wrist band tags patient cards before commencing the surgery and retrieve the critical information about the patients online using a RF Hand Held Terminal or a Palmtop with a RF card through wireless connectivity with the host containing the patient information. Designed by: Sunil Kr. Sagar Inventory Incorporation of RFID tags can lead to a much efficient Inventory Control system in the various cross sections of the healthcare industry Some of the key benefits are … • Fast and accurate information dissemination of the shipment leading to a better control over the inventory • Minimize product obsolescence and Maximize the freshness of the stock • Improved control over stock, warehousing and Distribution of Drugs • Better control over reorder levels hence shortening the Reorder Cycle • Effective practice of Just in time inventory control principle • Flawless and speedy performance of periodical cycle counts • Automated invoice generation • Overall cost saving in Inventory Control Designed by: Sunil Kr. Sagar RFID in Pharmaceutical Companies Anti-Counterfeiting Pharmaceutical Supply Chain Designed by: Sunil Kr. Sagar Anti-Counterfeiting Paper selection • • • • Application specific paper (no commodity) Filled with luminescent fibres Invisible in daylight, but fluorescent in red under UV light Flow of paper and even waste will be under strict control Mechanical construction • Paper laminate designed to avert • horizontal fissionability • Printed antenna directly on paper • Tamper proof (mechanical and electrical) • Sophisticated partial cross cutting through • the layers • Tuned bonding strength of certain functional segments of the electronic parts RFID technology features Printing solution • • • Visible printing Invisible printing – Based on transparent ink – Luminescent in red when exposed to UV light – Ink will be under strict control Both printing will be of high quality and accurate registration • • • • • • Operating frequency: 13.56 MHz Anti Collision to allow simultaneous operation with multiple transponders in the field Unique 64 bit serial number, each label will be unique 2k bit (256 characters) Read / Write EEPROM memory Secure access to Read/Write memory (split access rights) Cryptographic authentication, 64 bit security key length Designed by: Sunil Kr. Sagar Pharmaceutical Supply Chain Benefits: Reduce product handling time Reduce errors Reduce shrinkage Improve supply-chain visibility Reduce out-of stock Improve shipment identification More accurate and timely information Reduce costs Provide security against counterfeiting and tampering Designed by: Sunil Kr. Sagar Process flow of a Pharmaceutical Supply Chain Designed by: Sunil Kr. Sagar RFID integrated Process flow of a Pharmaceutical Supply Chain