Smart Healthcare 2003:
conference review

Technology for Healthcare

The conference opened with Raghu Das of IDTechEx giving a comprehensive review of RFID technologies and their applications to healthcare. One of the key drivers is the issue of compliance by patients on medication – costs to the US are estimated at $100 billion and 125,000 deaths per year (US National Pharmaceutical Council).

Improved functionality is in stages:

Chipless
0.1 to 20c
High volume applications, many tags one reader. Read only.

Passive chip
4 to 100c
Chip powered by the reader

Semi-active chip
$3 to $50
Battery powers chip when needed

Active chip
$10 to $50
Battery always on. Long range, real time location, sensors. Emits signal continuously for positioning.

Tags that are more than skin deep

Richard Seelig, MD Vice President Medical Applications, Applied Digital Solutions Corporation and Verichip Corporation, gave a demonstration and presentation of the Verichip implanted RFID tag.

Verichip claims to be ‘the first and only embedded sub-dermal miniaturised radio frequency identification device (RFID)’, although the use of RFID in the veterinary market is widely used. Each Verichip chip is about the size of a grain of rice and contains a unique verification number, which links to a database accessed by the operator (or the individual who has been chipped).

Verichip was motivated by the tragic events of ‘9-11’, where rescue work was hampered by the inability to identify bodies. As a demonstration, its founder Richard Seelig had a chip implanted in himself in a simple procedure which takes just a few minutes under local anaesthetic.

Count them in, count them out – tagging metal instruments and equipment

MBBS from Switzerland have developed a simple tagging facility aimed at the medical sector. Richard Bloss of MBBS explained that the key advantage of their technology is the ability to totally and hermetically embed tags into metal. Tags can therefore be incorporated into all medical instruments and devices. The technology is further enhanced by linking it to a completely open and standard compliant software system, which can be read either on their readers or other manufacturers’ readers, including PDA’s.

Smart packaging in healthcare and lessons from other industries

Peter Harrop of IDTechEx diverted slightly from RFID to explore some of the other technologies and developments. The broad definition of smart packaging was taken to include active packaging, anti-counterfeiting features, tamper evidence and special effects from inks and laminates.

Dr Paul Butler of University of Oxford and Crown Cork & Seal followed by focusing on some of the smart packaging materials technologies, and discussing their impact on packaging choices. The world is changing demographically. By 2040, developed countries will contain between 30% and 70% of dependent elderly, but with longer lifetimes, improved health, greater mobility and changing expectations. The key change point in life will be governed by dependency, not by age. In the future we will want products to be always at hand – fresh, safe to consume, at the right temperature, easy to open and fun! These stringent requirements will be met by: smart polymers as packaging materials, controlled release drug delivery systems, smart inks and labels, time temperature indicators and sensors for food quality.

Interactive packaging for drug trials

Following these forward looking overview presentations, Jakob Ehrensvard, CEO of Cypak Pharma AB Sweden, presented a real life example, where a niche application has been identified which can stand the current cost limitations. The ‘disposable paperboard computer’ means that a computer can be integrated into packaging. This extends the power of the Internet to low-end items, makes a static item interactive, can add security functionality and gather time related information.

Jakob demonstrated an interactive blister pack, which is being used in clinical trials. The pack is configured to alert the user when the medication is due to be taken. Removal of a pill from the blister triggers another alarm, which is disabled when the user answers a question printed onto the pack. The time of each operation and the answers are stored, to be uploaded later via the Internet to a secure site.

Big brother is watching you – RF tagging for improved security in hospitals

Elpas, an Israeli company, have developed a system aimed at solving growing security problems within hospitals. This was demonstrated by Ofer Yourexel, VP Marketing and Sales. Constant communication, real time location, data collection and dissemination for staff, patients (especially babies, elderly or psychiatric patients) and equipment are enabled.

Aiming to provide the ultimate in reliability, Elpas recommend the combination of three different technologies. An optimal installation would have an IR reader in each room, an RF reader covering ‘zones’ of 4-5 rooms and a LF transponder triggering an alarm or actuating door opening on each exit. They claim that this configuration will give 100% accuracy in locating an individual or object. All tags are active and battery powered. Frequencies used depend on the application and the country of installation. Monitoring intervals can be configured to between 1 second and 1 minute. More frequent monitoring will clearly drain batteries faster. Tags are chosen for the application and are priced at $50 to $100 per tag.

Pete Marsh, Technical Director of Wirral NHS Health Informatics Service, described a real life example of the Elpas system within the Accident and Emergency Department of Wirral NHS Hospital. The project was specified in 1998 in response to two – apparently unrelated – requirements. The hospital management was required to provide audit information (patient flows, waiting times, work flows etc) and the A&E staff wanted an attack protection system (panic buttons).

Tagging in devices – improving clinical diagnosis in urodynamics

This was followed by a presentation by Chris Tooley of Mediplus Ltd, UK. Mediplus have developed an innovative product to diagnose urinary incontinence. The current procedure is invasive and the equipment costs are over £20k with ongoing consumable costs of up to £16 per patient. The new method, devised by Mediplus and being developed for them by Innovision, incorporates a pressure sensor and an RF tag on a catheter, linked to a portable patient unit. The tag communicates with a PC, which downloads the data (time and pressure readings) when the procedure is complete. Most significantly, the tag is disabled after use so that each probe can only be used once. It will bring the cost of the electronics down to around £2k with a much less invasive probe.

Tracking of documents

Acumen and Telegesis are two small companies who have collaborated to deliver a complete solution in document, item or people tracking. Their expertise is complementary, with Acumen specialising in tracking software for legal documents, patient case notes and off-site storage companies and Telegesis providing the R&D capability in wireless data capture, RFID and telemetry systems. Ollie Smith, Business Development Director, Telegesis (UK) Ltd and Nicholas Gomersall, Managing Director, Acumen Business Solutions Ltd described the Aware Tracking Solution.

Logistics management in action

Matrics claim to be one of the few companies with real commercial systems installed. The company was founded in 1999 by scientists from the US National Security Agency and shipped its first products in 2002. Matrics’ tags are passive, non-battery, 900 MHz UHF and can carry up to 96 bits. Orientation does not matter as there is a double dipole arrangement on the chip and cost is typically below 50c, reducing to 25-30c for tens of millions of units. Range is up to around 6 m.

Liz Churchill, Director of Marketing and her colleague John Shoemaker demonstrated use of their tags with a bag of 34 assorted items. Within a few seconds of passing through a gate, the reader recorded 3 readings on each one. This type of system would enable manufacturers and distributors to meet pressure from retailers. Wal*Mart will require pallet and case level tracking by 2005. This can represent a considerable task – one pharmaceutical company has estimated that they handle 25 million cases per year, just within OTC products for their top three customers.

Healthcare Applications

The second day of the conference focused more specifically on applications in healthcare, rather than on technology, and was chaired by David Rodrick, Industry Liaison Manager, NHS Information Agency UK. He gave an overview of the NHS structure and its strategy to deliver IT solutions at all levels, within the constraints of a very large organisational structure and operational pressures. However, commitment and, in particular, funding has been made available at the highest level and is to continue.

Chips are good for your health

There are many reasons to promote the use of RFID in healthcare. James Urie, Business Development Manager of Innovision Research & Technology focused on error reduction and presented some sobering statistics on the subject. Errors in a large-scale operation such as the NHS are not uncommon, but can have more serious ramifications than in other business areas. Adverse events in NHS admissions occur in about 10% of cases, equivalent to approximately 850,000 people per year. 25% of these are specifically due to medication errors.

These examples illustrate the need for tracking of patients, specimens and equipment in a way that is supportive to current working practices. James pointed out that although bar code technology offers a good solution, it suffers from limitations and RFID is a better choice in many cases. However, the initial feasibility and design phase is absolutely critical.

Positive Patient Identification Solutions

Precision Dynamics Corporation claim to be a global leader and pioneer in automatic identification wristbands, with a 70% share of the US healthcare market. Their first patient ID wristband, using barcoding, was introduced in 1984 and an RFID version was launched in 2000.

Irwin Thall explained that RFID means that medical staff can scan a patient without disturbing them and also enables read/write of all that person’s personal medical data and history. Use of the Smart Band system in the emergency room means that data can quickly be transferred as an electronic patient chart.

RFID for safer blood transfusions

This was followed by a presentation by Dr Sunny Dzik, Co Director of the Blood Bank, Massachusetts General Hospital, USA. 20 million blood transfusions per year are performed in the USA, mostly unplanned as a result of surgery, trauma or burns. While errors in pharmaceutical medication are more common than transfusion errors, the results are usually innocuous. Blood transfusion errors are usually dangerous.

Scrutiny of the blood transfusion process over the last 20 years has focused mainly on donor screening, collection and testing within blood transfusion centres. Little attention has been given to the patient type testing, blood issue and administration processes. These processes take place either in hospitals or in the field, where problems frequently occur.

A major study, Serious Hazards of Transfusion (SHOT) Annual Report 2002 showed that by far the most common hazard is ‘incorrect blood transfused’, which is much greater than the risk of infection from the transfused blood.

Errors are increasing within hospitals. This is considered to be due to the loss of specialised phlebotomists for sample collection and the decentralisation of the process. Another frequent problem in large hospitals is mixing up patients with similar names.

Sunny described a pilot study being initiated in his hospital in collaboration with Precision Dynamics Corporation and Lattice Corporation. The study will commence in the Operating Room, which is a good test bed for several reasons. There is a large volume of blood under urgent conditions, the patient is asleep and so cannot identify themselves, the healthcare team do not usually know the patient, and distraction is common.

The current procedure is paper based and requires nurses administering the transfusion to cross check patient name, number, blood type on the printed label and the patient chart before the blood is used. In practice, this crucial step is often omitted. The test procedure will provide RFID short-range readers in each operating room with a tag embedded in the blood bag label. Checking will be much quicker and more convenient.

Making the healthcare systems work less hard…

Proxximity Systems is a start up company, established by Dr Paul Schmidt as a result of his frustration that medical staff have to spend so much of their time doing administrative work which could be automated. Paul described the company’s development of the BioTag – a test tube incorporating a ‘memory chip’ containing patient, sample and test information. BioTag is available on all the standard sample tube types, without any visible change to the user.

Rodger Paylor of Portsmouth Hospitals NHS Trust described the motivation for tagging from the other side – the equally frustrated Pathology Laboratory Manager. Portsmouth Hospital has one of the most automated pathology labs in the UK, following a major investment in laboratory equipment since 1997. Although test volumes have doubled between 1997 and 2002 (from 200,000 to 400,000 tests per month), these demands have been met without increasing laboratory staff numbers.

Developing European standards

DRIVE (Drug in Virtual Enterprise) is an EU funded project which developed and piloted a medical product supply chain management system within a hospital in Italy and was described by Alberto Sanna, Scientific Institute H San Raffaele (HSR), Italy and DRIVE Project Manager. The project involved a number of organisations in the supply chain from pharmaceuticals manufacture through to healthcare delivery.

Alberto showed a video in which a patient was issued with a smart wristband on reporting to a hospital reception. Later a nurse was able to read the wristband and issue tagged medication from a tagged drug trolley. We also saw how medicines and other consumables were booked into the hospital database system on arrival, by labelling the boxes with a label printed at the point of use.

RFID in the Pharmaceutical industry: early experiences and future opportunities

Ian Haynes, Technology Specialist, AstraZeneca plc UK described the use of RFID with pre-filled syringes of the anaesthetic Diprivan - one of the earliest examples of a large scale tagging application in healthcare. The product was launched in 1996 and now represents sales of 4.5 million tags per year. Diprivan is administered by infusion pump during surgery as one of a cocktail of three drugs. Its specific purpose is to keep the patient asleep and its rate of infusion must be dynamically monitored and controlled. AstraZeneca developed a patented pharmacokinetic model for Diprivan to maintain the blood concentration level of Diprivan.

As an early adopter of RFID technology in pharmaceuticals, AstraZeneca is keen to encourage development and adoption of standards. The company is also working on 12 new packaging related projects. Issues of interest include patient compliance, lifestyle, anti-counterfeit, lot size 1, patient information, lifecycle management and cost effectiveness.

Smart glucometer improves diabetics quality of life

Dirk Leman, RFID Product Manager, Melexis NV Belgium introduced a medical device application. Melexis is a chip manufacturer specialising in the automotive sector, with expertise in sensor and actuator development. They were contracted by IEM GmbH to develop a product which addressed the problem of glucose measurement. Diabetics using personal glucometers must purchase measuring strips. The low cost strips have a production ‘offset’ which must be entered into the glucometer to calibrate it. This is done for each batch of strips. The manufacturers provide the offset figure, but it requires some dexterity, good eyesight and intellectual skills to manipulate the glucometer. These are skills which are particularly problematic in the target market – many diabetics have poor eyesight, are elderly or are children.

The solution uses tagged strips and a battery powered reader mounted on the glucometer. No skills are needed and the system is intuitive – the strip simply needs to be swiped across the reader. The smart glucometer is currently undergoing licencing and will shortly be on the market.

Size is everything

Lorna Garrett, Business Development Manager, Hitach Maxell Japan and Andrew Dolman, Business Development Manager, introduced their product, which has been optimised for size. Climarque are Hitachi’s UK system integrator for their ‘coil on chip’, which is a 2.5mm2 chip in which the antenna coil is mounted directly on the surface of the IC. Packed into the chip is a 1 kbit EEPROM memory, providing a read range of around 3 mm, a data transfer rate of 26.48 kbps, using a frequency of 13.56 MHz. Hitachi offer the Coil-on-Chip in bare and encapsulated form and claim that it is excellent for reading and writing through skin and offers good characteristics embedded in metal.

With Climarque, Hitachi have piloted a project (Intelliaid) with hearing aids. The project involves GN ReSound, one of the world’s largest audiology equipment manufacturers and Amplivox Ultratone, a major UK hearing aid dispenser company. Bespoke database software has been developed which enables each hearing aid to be tracked through the supply chain and for its maintenance history to be recorded.

EMID Tags in Pharma

Mark Gostick, Business Development, Flying Null described their technology. Flying Null have developed a proprietary magnetic material based tag, which works similarly to a barcode. However, tags can be read magnetically rather than optically, removing the need for line of sight. This technology fills a gap for product tracking and authentication solutions, where read only features are required. Typically FN tags are 10-50 times cheaper than silicon based technologies offering equivalent performance.

People, Pills and Potions – RFID – Meeting the Challenges of the Healthcare Industry

The last session of the conference was given by Mark Gillott, European Development Manager, Phillips Semiconductors. Mark gave an overview of the issues, challenges and opportunities for RFID in healthcare. He pointed out that each application requires a different solution – one size does not fit all. Frequency selection and RFID technology must be carefully considered and appropriate back end software systems are crucial.

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