AN INTEGRATED CONCEPTUAL FRAMEWORK FOR RFID ENABLED
HEALTHCARE
Gaurav Gupta
Indian Institute of Management Calcutta, Indian
E-mail: gauravg13@email.iimcal.ac.in
Tithishri Kundu
Medical College, Kolkata, India
E-mail: tithishrikundu@gmail.com
Appachu Appanna Codanda
Indian Institute of Management Calcutta, Indian
E-mail: codandaaa2016@email.iimcal.ac.in
Submission: 03/07/2015
Accept: 22/07/2015
ABSTRACT
Radio
frequency identification (RFID) technology is a wireless communication
technology that facilitates automatic identification and data capture without
human intervention. Since 2000s, RFID
applications in the health care industry are increasing. RFID has brought many improvements in areas like
patient care, patient safety, equipment tracking, resource utilization,
processing time reduction and so on. On the other hand, often deployment of
RFID is questioned on the issues like high capital investment, technological
complexity, and privacy concerns. Exploration of existing literature indicates
the presence of works on the topics like asset management, patient management,
staff management, institutional advantages, and organizational issues. However, most of the works are focused on a particular issue.
Still now, scholarly attempts to integrate all the facades of RFID-enabled healthcare
are limited. In this paper, we propose a conceptual framework that represents
the scope for implementation of this technology and the various dimensions of RFID-enabled healthcare and demonstrate them in detail. Also, we have
discussed the critical issues that can prove to be potential
barriers to
its successful implementation and current approaches to resolving these. We also discuss
some of the regulatory initiatives encouraging its adoption in the healthcare industry. Also, we have highlighted the future research opportunities in this
domain.
Keywords: RFID;
healthcare; conceptual framework
1. INTRODUCTION
Radio
Frequency Identification (RFID), originated in 1940s,
can be defined as an electronic tagging technology designed to assign an electronic identity to any object with the help
of radio waves. It is deployed in various
industries like manufacturing, retail, education, food, printing,
pharmaceutical, healthcare, and many others (HONG et al., 2011; HOU; HUANG, 2006; WANG; CHEN; ONG, 2006)
Since 2000s, there
is an increasing trend to integrate RFID technology in the healthcare industry
to combat problems like preventing drug counterfeiting, tracking medical
equipment, better patient management, efficient workflow management (KOLESZAR, 2004). Especially the revised
mandate issued by Wal-Mart in 2003
triggered interest among researchers and practitioners in the deployment of RFID in both logistics and healthcare. In a
recent report titled Market Opportunity for RFID Smart Cabinet Systems in
Healthcare (2015) by Frost & Sullivan, RFID market for healthcare and pharmaceuticals in
Europe was estimated to be 12% of the total market for RFID technology across
industries.
Existing literature indicates the
significant number of scholarly works on the issues like asset management (BRITTON, 2007; KIM et al., 2008; PULLEN; ATKINSON; TUCKER,
2000) staff management (WANG; CHIANG, 2010), patient management (RHODES; RESNICK, 2005), institutional advantages (MEHRJERDI, 2010; WAMBA, 2012), privacy issues (KATZ; RICE, 2009; SMITH, 2006; XIAO et al., 2006), organizational issues (BRADING, 2009; TING et al., 2011), and so on. However, most
of the studies have dealt with a particular
issue. A few attempts try to incorporate
all the dimensions of RFID using a single framework. In this paper, we have
proposed a framework that incorporates all the dimensions of RFID-enabled healthcare like the scope of the applications, functional aspects,
barriers, and Advantages. We have presented several real life examples of successful implementation of RFID. Also, we have provided the future research
opportunities lie in the context of RFID-enabled
healthcare.
The
remainder of this paper is organized as follows. In the next section, we present
a summary of RFID technology. Then we propose a conceptual framework and
detailed demonstration of all its dimensions. We then discuss the critical
issues related to RFID deployment and how they can be handled. The paper concludes by discussing the contribution and
future research avenues.
1.1.
RFID Technology
Radio
frequency identification (RFID) technology is a wireless communication
technology that facilitates automatic identification and data capture without
human intervention. It has the advantage of being able to capture information
without the need for the identification module and the probe to be in the line of sight. This allows for its implementation in various non-conventional
usages like invasive RFID chips for perpetual patient identification and
monitoring. An RFID system comprises three components:
·
Tags - It consists of a transponder with a digital memory device. On
the basis of powering techniques, it can be classified into three categories:
active tags, passive tags, and semi-passive tags. In an active RFID tag, the power source is embedded in it as an on-board
battery. On the other hand, the signal of an external reader supplies power to
the passive tags. The design of a semi-passive tag lies between active tag and passive tag where a passive tag
must be turned on by a reader to transmit data despite the presence of embedded
battery in it. A tag is used to store and
transmit the information about the object it is
attached with.
Figure
1: Medical RFID tag[1]
·
Tag reader - Tag reader, often denoted as
‘interrogator’, contains a transceiver, decoder, and antenna. A tag reader is controlled by a microprocessor
for communicating with the tags. The
antenna attached with tag reader helps to transmit data from tags. The captured
data is then passed to a computer through application software for further
processing.
·
Application Software - Application software is considered as the central controller of an
RFID system. It allows users to actually tie
electronic identity and to share the information with others (ATTARAN,
2006). Data collected from tags is passed through cable or wireless to host
computer systems that can be any device, like laptop or desktop computer, mobile device,
etc. Based on the intended function, this
data is then processed by the relevant software application.
The
pictorial diagram given below represents the function of RFID technology (WOOD; ALVAREZ, 2005):
Figure 2: Function of RFID Technology
Source: Wood and Alvarez (2005)
2. METHODOLOGY
Based
on extant scholarly works, here we propose an integrated conceptual framework for
RFID-enabled healthcare. In this context,
the scope of RFID technology is centrally
positioned. It provides the natural synergistic progression to barcode-based
tracking applications in healthcare functions. In
addition, the framework comprises three different dimensions described
below:
·
Functional
aspects- It signifies the various ways of RFID application.
·
Barriers-
Factors that hinder the implementation of RFID in this specific technology.
·
Advantages
The
proposed framework is represented in
figure 3. The scope of this technology along with its dimensions is discussed in detail in the following subsections.
Figure 3: Conceptual framework of RFID-enabled healthcare
systems
2.1.
Scope of the RFID-enabled
health sector
Exploration
of existing literature reveals that there are three primary areas in the
healthcare sector that show prevalent applications of RFID technology (WAMBA; ANAND; CARTER, 2013):
·
Asset
management
·
Patient
management
·
Support
staff and activity management
2.2.
Asset Management
Asset
management signifies the maintaining of the medical instruments in proper condition and providing the best
service to the patients admitted in the hospital. The condition of the medical
equipment and patient service level are crucial factors in health care. RFID
facilitates to maintain the service level and to track the conditions of
equipment (YAO; CHU; LI, 2010).
According
to a recent study, medicines manufactured in countries like Mexico and Columbia
face a huge drug counterfeiting. Tampered drugs have
an adverse effect on human health. Also,
producers face an enormous economic loss
due to the production of altered medicines. RFID helps to detect the presence
of these unacceptable drugs.
2.3.
Patient management
The
employment of RFID technology has a significant
impact in the area like Patient management. First of all, it helps to store
patient history. Using the patient history, doctors easily can diagnose the
suitable medicines for patients. In addition,
many a times, change of doctor in charge does not affect the patients’
treatment as new doctors can easily be aware of the patient’s medical history.
Thus, it enhances patient recovery and safety. Several
real life instances have justified this fact. In 2003, it showed its potential
to combat with a dangerous infectious
disease like SARS by providing better patient care in Taipei Medical University
Hospital of Taiwan (WANG; CHEN; ONG, 2006).
Also,
it facilitates to avoid mismatching and to provide security against theft
especially in case of infant hospitals. Several
critical issues like selection of proper surgical method, identification of
patients to maintain proper drug dosage, identification of patients with
impaired cognitive functioning, designing automated care intervention pathways
etc. have been successfully handled using RFID.
2.4.
Support staff and activity management
For staff management related issues, RFID brings in
better efficiency in the workflow management by improving the labor productivity. Over
allocation of workforce can raise
the operational cost. On the other hand, under employment
of the staffs can bring down the service level. The optimal number of support
staff can be allocated to each station
that leads to the optimal usage of human
inventory.
RFID, when used in equipment tracking, helps
nurses to cut down on treatment start time and thus helps deliver quality
medical care. Better time utilization by bringing down the processing time along with manual error
reduction is also possible with the aid
of this technology (ORANJE; SCHINDLER, 2009). Also,
it manages medical waste efficiently by closely monitoring and tracking waste
disposal procedures.
2.5.
Functional Aspects
Our
investigation into existing scholarly works reveals the presence of four
important functional aspects of RFID technology applied in healthcare:
·
Patient
and medical equipment tracking
·
Identification
·
Automation
design
·
Emergency
support system design
2.6.
Patient and medical equipment tracking
Patient
and medical equipment tracking is the most widely accepted application of RFID
in healthcare. Usage of RFID tags, deployment of RFID-enabled robots for tracking patients,
and medical equipment are already in practice in many developed nations. As an
example, RFID tags bring down the specimen labeling errors in the pathology
laboratory.
Also,
loss due to theft is reduced because of tracking. Pathology labs require clerical work with
regards to storage and systemic documentation of blood, urine samples, patient
data and medical supplies. However, these pathology labs tend to remain
inadequately staffed. RFID technology will benefit them by reducing manual
documentation and also by making the inventory and data management more
streamlined.
2.7.
Identification
Prior
to RFID, barcode-based inventory identification had inherent scanning problems
that led to the creation of incorrect
inventory records (DEHORATIUS; RAMAN, 2008). These manual
processes also led to issues like medical examination mismatches and adverse
drug events (ÇAKICI; GROENEVELT; SEIDMANN, 2011). Deployment of
RFID encompasses preventing medical errors in critical scenarios like
reconfirming the newborn identity, identifying the disaster victim identity,
and so on. Besides, security concerns can be improved through the implantation
of an RFID tag into human molars.
RFID-enabled
computer systems can also be utilized to perform a set of myriad actions to prevent
medical errors. Medical errors are prevalent in
administering right amount of dosage to patients, the type of medication,
keeping track of medical history of the patient and delivery of appropriate
medication to the correct patient at the proper time (PETERS; PETERS, 2007). RFID-enabled automated systems provide an efficient solution
to substantially reduce such medical
errors.
2.8.
Automation design
Automated
care and safety design is achieved using RFID. As an example, a
self-pill-dispenser reminds patients about their medical dose (YAO; CHU; LI, 2010). From the
perspective of workflow management, several manual works like the determination of patient discharge time,
reservation for regular checkup can be achievable through automation.
In
such a way, the system becomes more efficient and effective. Presently, the end
customer reads the information mentioned on the labels of medical packages, and if the information is
insufficient or incomprehensible, then it
leads to confusion and hence medical
error. RFID tags are increasingly being adopted by pharmaceutical companies in
label design. This along with precise and
appropriate drug information helps reduce errors in supply chain and also ensure
proper drug information disbursal.
RFID
tags ensure accurate data collection with minimal human intervention. This along with its continuous tracking and
monitoring capability has also been used against counterfeiting of drugs in the
pharmaceutical supply chain. Drug counterfeiting is a significant issue
plaguing developing countries across the world where drug-counterfeiters exploit
their lack of access to basic medication.
RFID
technology is significantly secure and difficult to replicate, both at hardware
and software levels, as compared to conventional batch tracking technologies. To crack down on counterfeiting, government
agencies too are slowly adopting real time tracking using RFID technology to
identify and track batch information of medicines right from their source.
2.9.
Emergency support system design
At
the time of emergency or major casualties, RFID technology helps improve
patient safety through appropriate surgical procedure adherence and hygiene
monitoring. In addition, usage of RFID
prevents the chance of blood type mismatch in the
case of blood transfusion. Also,
RFID helps ensure timely availability of medical equipment while simultaneously
reducing the average inventory levels of such equipment.
Critical care can thus be delivered immediately, thus helping save numerous
lives.
2.10.
Advantages
We
have classified the advantages of RFID
deployment in health care in three categories:
·
Financial
advantages
·
Operational
advantages
·
Management
advantages
2.11.
Financial advantages
Implementation
of RFID technology has reduced the labor cost, operating cost drastically
through better maintenance of the equipment and proper inventory utilization. Also, manpower requirement goes down with the
help of automated procedures. RFID technology also increases inventory
certainty and hence enables lower average inventory leading to a reduction in operating costs (BAYSAN; USTUNDAG, 2013).
According
to a recent study[2],
incorporation of RFID Kanban systems brings down overall inventory ordering, shortage, carrying and purchase costs by as
much as 30%. Even without changes
in business processes accompanied with RFID implementation, a study in the
radiology department of a major hospital network in Florida, estimated annual
cost savings of around 18.33% over the earlier barcode systems (ÇAKICI; GROENEVELT; SEIDMANN, 2011).
2.12.
Operational advantages
Operational
Advantages include elimination of patient misidentification, reduction in
procedural error, reduction in medication error, improvement of service
efficiency, enhancement of workers’ productivity, better resource utilization,
reduction of clinical risk, proper time scheduling for the medical
professionals, and so on. Unlike barcode scanning based periodic inventory
review mechanisms, RFID enables adoption of continuous inventory review policy (ÇAKICI; GROENEVELT; SEIDMANN, 2011).
Thus, it paves the way to achieve greater
patient satisfaction and consistent quality care assurance. The survey conducted by HIMSS (Healthcare Information
and Management Systems Society) suggests that “Computerized Provider Order
Entry” (CPOE) systems like bar code or RFID systems Management will be
beneficial (PAUL, 2004). In this context,
George Anderson, senior category manager, Leeds Teaching Hospitals NHS Trust, commented that “Top-up mechanisms vary from visual top-up in baskets through to bar-coded
inventory control, with the Trust now looking into RFID stock control to
identify and track movement of stock through the process”[3].
2.13.
Management advantages
From
a management point of view, improved
coordination among healthcare workforce
is the main advantage of RFID deployment.
Recently University Hospital in San Antonio incorporates RFID in
their existing practice to devise an automated, improved workflow processes[4].
Also, improved patient satisfaction and quality assurance portrays a better
image of management and stakeholders in social paradigm. In addition, higher operational efficiency
facilitates management to get rid of additional costs regarding coordination,
monitoring, tracking, etc.
2.14.
Barriers
Exploration
of literature suggests that there are several issues that can be major
obstacles in the way of RFID
implementation. These are demonstrated
below:
·
Technological
complexities
·
High
capital investment
·
Privacy
concern
2.15.
Technological complexities
Ngai
rightly identified that technological limitations of RFID can be an impediment
to its successful deployment in the context of healthcare because of
reliability concerns, operational complexity, adverse impact on the operations
of medical devices, and lack of accepted industrial standards (NGAI et al., 2009). Due to lack of unified industry standards, RFID tags
and their readers are prone to interference with critical medical devices like
a pacemaker, etc.
Moreover,
active RFID tags primarily due to their high costs and passive RFID tags due to
their short range, have affected its slow adoption in the healthcare industry.
Not just the hardware, the software aspects of this transition has also been
impediments to its adoption. The underlying software infrastructure and
archived data would need to be migrated
from legacy barcode-based systems to the RFID-ready
system.
2.16.
High capital investment
According
to a healthcare study, integration costs of RFID lie between $10 and $16
million for a larger health care organization (HOSAKA, 2004). Also, high maintenance and upgradation cost
related to the hardware, software, additional servers, databases, and
middleware signifies the intensity of huge capital investment in RFID
technology (THOMPSON, 2004). It dissuades
health organizations to introduce RFID in their existing practice. Stakeholders
of the healthcare organizations often maintain pessimistic stance to the
adoption of RFID due to the huge initial capital expenditure and uncertainty of
Return on investment often
2.17.
Privacy Concern
Deployment
of RFID systems gives rise to an ethical dilemma related to privacy concern (WICKS; VISICH; LI, 2006). When used for
staff management, it raises concerns of constant movement tracking through
RFID-based location tracking and strict monitoring protocols. RFID provides
opportunities to marketers to develop their own
database comprising the personal data of patient including not just their
medical data but also their identifiable social data and that too without even
seeking for their permission.
Both
implantable and externally attachable RFID tags allow monitoring of sensitive
health parameters and permits the possibility of
this information being shared with third parties. The access of sensitive
private information using tags and tag readers raises concerns of surveillance
and violation of basic privacy rights. Recently, the US Govt. had to publish a
website release, related to Obamacare, in response to the public uproar about compulsory RFID implants
and their perceived sharing of personal health data with the government[5].
3. DISCUSSION
RFID
brings many advantages in the domain of
health care especially handling the
issues related to asset management and patient service. However, successful implementation on
a large scale depends on several critical factors like usability, scalability, availability, integration, interoperability,
security, authorization, and sustainability maintenance expense (KUO; CHEN, 2008).
RFID
implementation can be in the form of either replacement of conventional
tracking technologies such as a barcode
or as a novel application of technology
instead of manual tracking processes. Both of these would need displacement of
earlier organizational processes and thus its adoption would be governed by the
minimality of the organizational transformation needed along with simplicity
and adaptability of the new technology and the associated processes.
Technical
errors regarding data reading and data storage can be detrimental to the
patients’ safety. Therefore, proper functioning of RFID tag plays a crucial
role. Until now, most of the RFID systems are not compatible with the existing
hospital digital system. Technical knowledge of health care professional to use
RFID is not up to the standard. Often RFID system provided by the technology
vendors is not compliant with the current medical regulation, thus leading to
the higher clinical risk (FISHER; MONAHAN, 2008). The absence of clear and stringent industrial
standard is another concern.
Rigorous
technological tests should be conducted
before the deployment of RFID in any healthcare organization. Collaboration
between organizations and technology vendors can bring customizability as well
as the compliance with the medical regulations. Proper knowledge management
system and training programs should be conducted to educate the healthcare
professionals about the appropriate usage
of the technology.
Currently “Health Industry Business Communications
Council (HIBCC)” is working on the establishment of common standards for
healthcare system specialization with the help of International Organization
for Standardization (ISO) and Electronic Product Code (EPC) standard.
Health Insurance Portability and Accountability Act (HIPAA) can be instrumental
in resolving the issues of privacy concern.
Several
cases of success have been associated with RFID application in
healthcare. Hospitals like Hospital St. Louis,
the largest hospital in Luxembourg, Masaryk Oncological Institute in Czech
Republic, and Wayne Memorial Hospital in USA have achieved better
patient management, equipment tracking, better resource utilization, and better
workforce management through the successful implementation RFID technology in
healthcare[6]. For the sake of long-term benefit, small
organizations are also showing interest
in RFID adoption. Therefore, it is evident that the investment in RFID
technology is rising.
4. CONCLUSION AND FUTURE RESEARCH DIRECTION
In this paper, we have proposed an integrated
conceptual framework to represent different dimensions of RFID-enabled healthcare
like functional aspects, barriers, and advantages. We demonstrate the key
factors of successful deployment in the specific domain and current
initiatives.
The
deployment of RFID in healthcare offers a plethora
of opportunities to the researchers and practitioners. For the sake of higher
value creation in the context of the RFID-enabled
healthcare value chain, there is a dire need to
examine how process reengineering and modification is possible. Scholars
have already mentioned that replacement of barcode scanning with RFID presents
significant cost advantages when integrated with business process reengineering
(ÇAKICI; GROENEVELT; SEIDMANN, 2011).
Also, future research needs to examine the
impact of additional factors like the influence
of stakeholders, the attitude of healthcare professionals and patients to the
RFID integration. Privacy concerns regarding invasive RFID applications in
healthcare has dampened the pace of its adoption. Studies aimed at recognition,
conversance and mitigation of such issues shall help build a knowledge base
accessible by both researchers and practitioners.
Cost–benefits analysis, ROI analysis for
incorporating RFID technology into different areas like asset management,
patient management, staff management, and process related issues should also be addressed in future scholarly works. The
assessment related to the performance of RFID applications in different health
care problems can be an area of interest for many researchers.
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