A Profile of PVA Capabilities with Remote Time Location Systems (RTLS) Profile of PVA Capabilities PVA is a woman owned small business headquartered in Burlington, NC. For over 15 years, PVA has performed the role as a systems integrator for complex information technology (IT) projects and telecommunications solutions on a global scale. Expertise includes designing, implementing, integrating, and managing wide area (WAN) and local area (LAN) networks, Knowledge Management Systems, Data Center environments, Content Management systems and network management platforms. A broad base of client segments include the US Government, Global network providers, business enterprises, and the HealthCare Industry. As a certified Business Partner of Alcatel-Lucent, a global partner of OpenText Content Management Systems, an Infoblox partner, and a partner for many other solution providers such as Emerson Network Power and Intelligent InSites, PVA brings a full systems approach to address many of the critical information needs within the HealthCare Industry. 1
ABSTRACT Healthcare is at a cross roads. The combination of economic down-turn, reduced reimbursement rates, rising complexity of regulations, and uncertainty of the future has placed extra strain on hospital management, employees, and associated medical staff to accelerate their efforts to change. Although quality and performance improvements have been areas of focus in hospitals over the years, operational excellence, breakthrough process redesign, and establishing organization-wide cultures of change and continuous improvement have become strategic imperatives throughout healthcare. These strategies require an optimum blend of people, process, and technology to deliver the kinds of cost, quality, and capacity improvements required for the future. This paper will discuss current trends in process improvement initiatives at hospitals and the role that a single enterprise-wide real-time visibility platform can play in performance improvement by automatically capturing location and sensory data throughout the hospital and seamlessly integrating the information into the appropriate clinical or non-clinical system. REAL TIME LOCATION SYSTEMS (RTLS) IN HEALTHCARE Knowing where patients are as their care journey progresses through the hospital, capturing the time and location of care delivery events and activities, and locating the nearest available piece of critical medical equipment are just a few of the potential applications for Real Time Location Systems (RTLS). RTLS uses a breadth of technologies to enable real-time, automatic sensing of location of people and objects. Most of the technologies grew out of Radio Frequency Identification (RFID) which uses radio waves to communicate with and locate battery-operated "tags" that are attached to the people and objects being tracked. Tags are similar to aircraft transponders or GPS systems which provide location and unique identification information, plus the ability to transmit and receive other condition-based data. RTLS systems used in Healthcare have matured into a few basic formats including WiFi-based, RF/Infrared, ZigBee (Mesh), and Ultrasound. They each have their strengths and weaknesses and as such there is not one RTLS technology that optimally addresses all real time location applications from a price/performance stand point. Ideally, an enterprise-wide strategy would focus on a platform that supports a breadth of RTLS technologies and can be interfaced to a myriad of clinical and non-clinical hospital applications and databases. For example, WiFi-based technology can be used to provide zonal location for assets and non-critical people tracking, RF/IR or Ultrasound can be used for patient room-level critical applications, and ZigBee can be used where ease of installation is paramount. 2
REAL TIME LOCATION SYSTEM (RTLS) DESIGN An essential element of the RTLS solution is the Intelligent InSites RTLS software platform. The software provides visibility, and is commonly referred to as an Enterprise Visibility Platform. This software system manages the flow of information associated with location, condition, and event documentation throughout a complex healthcare facility or network of facilities. It can provide the backbone to enable "visibility" information to reach the appropriate system (EHR, Bio-medical, Asset Management, Nurse Call, Security, etc.) or directly Network Management Platform RTLS & Asset Management Platform Intelligent InSites RTLS Software Platform OmniAccess Wireless Network Controller VitalSuite or 5620 Service Aware Manager (SAM) Wireless Network (WLAN) Wireless Network (WLAN) OmniAccess Wireless Access Points OmniSwitches Routers Local Area Network OmniAccess Wireless Access Points Infrared, Zigbee, & Ultrasound Tags WiFi Tags and Client devices Cloud Based Services WiFi Tags and Client devices PVA Real Time Location System (RTLS) Notional Design to individuals through portals and specific applications (equipment location, patient status kiosks, temperature or hand-wash compliance). At the core of the InSites Enterprise Visibility Platform is a comprehensive middleware layer and flexible application platform that supports a breadth of RTLS and sensor devices and interfaces with a growing list of existing software, communication, and building systems and applications. The end result is a single software platform that cost effectively provides the means to automatically capture and integrate real-time activity and event data into systems used to support workflow and other operational process improvements. 3
The sensor wireless network utilizes the OmniAccess access points. These unique access points support multiple channels and can be configured in a mesh design to provide redundancy for connectivity to the WiFi tags or client devices as well as the wireless OmniAccess controller. These access points support Adaptive Radio Management which allows the wireless network to adapt to environmental changes, quality of service conditions, and traffic demands. The access points are auto-sensed by the controller which minimizes any installation efforts. The OmniAccess controller consolidates the access points for connection to the facility local area network for connection to other resources. It also provides management capabilities and reports to look at various conditions on the network such as utilization, packet traffic and losses, and RF conditions. Embedded in the controller software is the ability to plan and design a precise wireless network based on specific floor plans and to deploy the configuration from a single portal. This system design has been integrated with other major RTLS technologies including, RF/Infrared, Zig-Bee, Ultrasound, and Passive RFID for more precise tag locating with less than 1 meter of variation. It also interfaces with a breadth of facility monitoring systems, including temperature & humidity, fire alarms, doors & windows, video, and elevators and security monitoring systems, including access control, motion sensing, door locks, visual alarms, and audible alarms. Additionally, the system has also been interconnected with existing nurse call, telemetry, fall detection, and infant protection systems in hospitals and senior care facilities. This breadth of connectivity is important as healthcare continues to be a very complex industry with significant diversity from hospital to hospital as to IT systems and strategies, especially as it relates to non-clinical systems. ASSET MANAGEMENT Asset Management is the ideal starting point with RTLS solutions. First, optimized asset management with enterprise RTLS can provide measurable hard-dollar cost savings and return on investment. Second, from an organizational change management perspective, tracking assets is less disruptive and easier to accept than tracking people. Third, starting with asset management provides a solid foundation for leveraging enterprise RTLS to enhance other processes, such as patient flow. In terms of current process improvement trends, an asset management system can address all three process improvement areas: eliminating waste (Lean), reducing variability (Six Sigma), and improving capacity (workflow). Waste is evident in excess inventories of equipment and in the time required for staff to hunt down and locate equipment. This waste shows up on the bottom line of a hospital through excess equipment rental cost, extra labor cost, and working capital in the inventories of excess medical equipment. By implementing an RTLS-based asset management system, variability can be reduced by having the right mobile medical equipment at the right place and at the right time. Variability can also be reduced by combining condition information with location to ensure that equipment is clean and maintained to appropriate revision level and preventative maintenance schedules. Ultimately, the variability of equipment utilization can be dramatically reduced when real-time location information can be combined with equipment management processes. 4
Asset tracking also impacts workflow and capacity. When critical equipment is not available when required, delays in care delivery occur. This is true throughout the hospital including the emergency department, operating rooms, patient rooms, diagnostic and other procedure departments. Delays in any area can cascade throughout the hospital and have significant impact on the overall capacity of the facility. For example, several years ago the emergency department of a major urban hospital quadrupled in size and as a result they found that they were continuously tracking down equipment and kits required to diagnose and treat the variety of patients that were seeking medical care. Their biggest challenge had been situations where there were only 3 or 4 pieces of equipment or diagnostic kits associated with a given disease state and they could have been left behind in any one of 60 or more examining rooms. By implementing an RTLS-based asset tracking system they were able to reduce equipment search time from 20 minutes to 2 minutes. The 18 minutes saved corresponds with additional patients seen and less bottlenecks in the ED examining rooms and correlates to greater capacity of patients treated. A large hospital in Dallas implemented an RTLS system that covers more than 1.6 million square feet across multiple buildings and departments. Their first application was for asset tracking of over 6, 000 tagged items. The system is used by both clinical and operations staff and features software applications and the InSites Enterprise Visibility Platform from Intelligent InSites. The flexible InSites Enterprise Visibility Platform was chosen instead of a single RTLS system in order to leverage previous investments in hardware, software, and processes and to accommodate a breadth of future real-time location and sensory applications. The CFO at the hospital shared that they are achieving hard-dollar cost savings exceeding $1, 000, 000 per year from the RTLSbased asset tracking system. This overall savings includes reductions in rental costs, shrinkage loss and thefts, and inventory right-sizing. With the success of their asset tracking system as a basis to gain senior leadership support, they have plans to expand RTLS and real-time enterprise visibility into supporting patient flow initiatives house-wide and in the OR and ED. Additional future applications include IT equipment deployment and tracking, replacement of older infant abduction and patient wander prevention systems, a hand washing compliance solution, and monitoring of temperature and other regulated conditions. 5
CONCLUSION As hospitals determine process improvement as a strategic imperative, it will be critical to embrace an enterprise-wide focus to overall reduce fragmentation of services and departments. As organizations elect to formally pursue Lean and Six Sigma as their quality improvement methods of choice, they will need to address waste, variability, and continuity of care across their organizations in order to deliver high quality care in a cost effective manner with sufficient capacity in order to be sustainable in the future. Similar to an Enterprise Resource Planning (ERP) system in manufacturing, an Enterprise Visibility Platform can provide the backbone to ensure that real-time information regarding the location and condition of assets, people, and care delivery events can be captured and utilized in applications throughout the organization. Having real-time actionable information about patients, staff, and critical assets is essential for hospitals to better manage their resources and deliver high quality care at the lowest possible cost. 6