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									    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                         Designed by: Sunil Kr. Sagar

                                 Medication Error:
                                 Scope of Problem
•   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
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      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
                                                               Designed by: Sunil Kr. Sagar
                             The Concept

     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
•   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
                                                            Designed by: Sunil Kr. Sagar
                       RFID & Medication Error
                        Higher Level Checking

• 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
                                                           Designed by: Sunil Kr. Sagar
                       RFID & Medication Error:
                        Technical Challenges
• 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.
   – 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
   – Tag formats: frequency, read/write
                                                                       Designed by: Sunil Kr. Sagar
                           RFID & Medication Error:
                           Operational Challenges
•   RFID Labeling
     – Labeled at the source (drug manufacturer)? At the distributor? At the hospital
     – 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
     – New process introduction: what to do when an error is detected; false/missed

•   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 anti-
     counterfeit; 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

• 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


                                             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 \
   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
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
                                                                  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

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

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
                                                                                     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
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
                                                          Designed by: Sunil Kr. Sagar


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
• 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
• Flawless and speedy performance of periodical
    cycle counts
• Automated invoice generation
• Overall cost saving in Inventory Control
                                Designed by: Sunil Kr. Sagar

Pharmaceutical Companies

          Pharmaceutical Supply Chain
                                                                                        Designed by: Sunil Kr. Sagar

                                                       Mechanical construction
                                                       •     Paper laminate designed to avert
                                                       •     horizontal fissionability
                                                       •     Printed antenna directly on paper
                                                       •     Tamper proof (mechanical and
                                                           •      Sophisticated partial cross
Paper selection                                                   cutting through
•      Application specific paper (no                      •      the layers
•      Filled with luminescent fibres
                                                           •      Tuned bonding strength of
•      Invisible in daylight, but fluorescent in red
       under UV light                                                 functional segments of the
•      Flow of paper and even waste will be                       electronic parts
       under strict control
                                                       RFID technology features
Printing solution                                      •      Operating frequency: 13.56 MHz
•      Visible printing                                •      Anti Collision to allow simultaneous operation
                                                              with multiple transponders in the field
•      Invisible printing
                                                       •      Unique 64 bit serial number, each label will be
     –       Based on transparent ink                         unique
     –       Luminescent in red when exposed           •      2k bit (256 characters) Read / Write EEPROM
             to UV light
                                                       •      Secure access to Read/Write memory (split
     –       Ink will be under strict control                 access rights)
•      Both printing will be of high quality and       •      Cryptographic authentication, 64 bit security key
       accurate registration                                  length
                                                           Designed by: Sunil Kr. Sagar

                             Pharmaceutical Supply Chain

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

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