Implementation and Integration of Real Time Location Systems at County Memorial Hospital sylvrfaeree Managerial Applications of Information Systems—MIS535
DeVry University
2015

Table of Contents
Abstract 3
Company Background 3
Business Problems 3
High Level Solution 4
Benefits 4
Approach 5
Overview of Real Time Location Services 5
Technology to Augment the Solution 6 Versus Advantages 6 Cisco IoE Location Aware Solutions for Healthcare 7 Hill-Rom Clinical Workflow Solutions 7 Centrak Clinical Grade Visibility Solutions 7
High Level Implementation 7 Hardware and Software 7 Personnel Training and Understanding 8
Overall Recommendations 8
Conclusion and Summary of Project 10
References 11

Implementation and Integration of Real Time Location Systems at County Memorial Hospital
Abstract
The issue to be addressed is the lack of tracking processes for staff movement, patient flow through the facility, and the resulting inefficiency and lower quality of patient care.
Company Background
Rural County Memorial Hospital was founded in central Rural County in 1951. Since its founding RCMH has grown into an award winning acute care facility dedicated to quality patient care. The facility’s goal has always been to provide health services for the residents of Rural County and the surrounding areas. Rural County Memorial Hospital was the first hospital in the state of South Carolina to receive LEED (Leadership in Energy and Environmental Design) certification for in-patient facilities, which sets them apart as an environmentally friendly facility.
Rural County Memorial Hospital recently completed a $22 million expansion which included a 4,700 square foot addition, including a new state of the art operating room suite, expanded emergency department and increased its acute care bed capacity from fifty-six to eighty-one total beds. Rural County Memorial Hospital includes multiple medical specialties from orthopedic surgery, hospitalist care and OB/GYN to cardiac diagnostic services
Rural County Memorial Hospital is currently using Meditech, an electronic medical record (EMR). The EMR is used for all of the charting, physician orders, lab result reporting, and radiology reports.
Business Problem
Rural County Memorial Hospital has no process for tracking staff movement through the hospital. The facility also has limited processes for tracking the flow of patients through the various areas of care, such as transport of a patient from the Emergency Department waiting room, through triage, radiology and on to admission or discharge. The only process for patient tracking currently in use is verbal communication from one staff member to another.
The impact of the lack of tracking processes culminates in higher wait times and bottlenecks in certain areas. Another impact is caused by inefficiency in the movement of nurses and other clinical staff through their respective areas, resulting in staff members who feel overwhelmed, overworked and frustrated by the end of their shift. The lack of efficient movement of staff and patients results in less effective, lower quality patient care.
High Level Solution
In order to identify and minimize bottlenecks in the flow of patients through the facility, improve the efficiency of staff movement and raise the quality of patient care, I propose Rural County Memorial Hospital consider the implementation and integration of a complete real time location system. Real time location systems work through the use of radio frequency identification and/or wireless internet connections. The systems are capable of being integrated into the Meditech Electronic Medical Records software system.
The use of real time location systems will enable Rural County Memorial Hospital to identify inefficiencies in the flow of patients causing bottlenecks, which will allow management to take steps to improve the flow of patients through the facility. Real time location systems will also give management the opportunity to observe clinical staff movement, which will provide a starting point in improving the efficiency of movement of staff.
Benefits
There are several benefits to be reaped by Rural County Memorial Hospital with the use of real time locating systems. Through tracking the flow of patients through the facility, management will be able to identify and improve several aspects of patient care. As patients move through the different departments of the hospital, management will be able to view the amount of time each patient spent in each department, which will enable the identification of where bottlenecks are happening, and enable mangers and staff to create solutions to each bottleneck area thereby decreasing patient wait time and increasing the quality of patient care.
Tracking the movements of clinical staff members will enable management and staff to be aware of how much time staff members spend in patient care, how best to save steps (for example making a single trip to the supply room versus multiple trips) which will help to make the staff more energetic, thus increasing the level of patient care. The ability to track staff members will have the added benefit of reducing the time spent by other staff members in calling, looking for and/or paging for a staff member who is needed.
Approach
Determine the appropriateness of implementing real time locating system and the best option to achieve the stated goals. Through the use of comparing the options, ease of implementation, integration compatibility with current Electronic Medical Records software system, determine which type real time location system best fits the needs of Rural County Medical Hospital. Once the best fit has been determined, request proposal and presentations from the specific vendors.
Overview of Real Time Location Services
Real time locating systems are used in healthcare to track the movement of staff as they move through their respective areas of the hospital, as well as keeping track of the flow of patients through the facility. RTLS work through the use of radio frequency identification tags and sensors mounted in strategic locations. The RFID tags can be either active (meaning battery operated), or passive (only activated as they pass in the vicinity of a sensor).
The use of RLTS for the purpose of tracking the movements of clinical staff members, includes the use of active RFID badges assigned to each member and worn on (or near) their identification badges. These badges send signals back to the computer software system, enabling other staff members to be able to locate them in the event the staff member is needed. The system can also be used to track the staff members’ movement through the day, and reviewed by managers and the staff member, with the purpose of identifying patterns of inefficient movement, such as multiple trips to the supply room instead of only a single trip.
Using RLTS to track the flow of patients through the various areas of the facility includes the distribution of disposable RFID tags to each patient as they enter the facility, either through the emergency department, surgical department or through admissions. The patient tags would trigger an event in their respective file of the EMR when they pass through the sensors.
Technology to Augment the Solution
In the research for this proposal project, several options were found which provide real time locating systems specifically for healthcare facilities. The following are the services which stand out in the field. 1. Versus Advantages Suite. Versus Advantages Suite offers a number of options including staff and patient locator badges and tags, automatic nurse call cancellation when a nurse enters a patient’s room, “bi-directional” integration and sharing of data with EMR systems (including Meditech), and the use of electronic whiteboards. The system also includes analytic software allowing management to view reports for the purpose of improving processes (Versus Technology, Inc., 2014) 2. Cisco IoE Location Aware Solutions for Healthcare. Cisco offers staff and patient locator badges and tags, analytics, inventory management control, temperature and humidity monitoring and alerts, and integration for electronic whiteboards. 3. Hill-Rom Clinical Workflow Solutions. Hill-Rom offers staff and patient locator badges and tags, automated nurse call cancellation, monitoring of hand hygiene for infection control, electronic whiteboard, integration with “smart beds” for monitoring of bed status for patient safety, and integrates with EMR (including Meditech) (Hill-Rom Services, Inc., 2015) 4. Centrak Clinical Grade Visibility Solutions. Offers staff and patient locator badges and tags, monitoring of hand hygiene for infection control, temperature and humidity monitoring and alerts, automated nurse call cancellation and EMR integration. Centrak uses battery operated sensors, which do not require room shut down or extensive infection control processes. (Centrak, 2015).
High Level Implementation
In order for Rural County Memorial Hospital to implement and integrate a real time locating system, there are several factors to be considered: the hardware and software to be installed and the training and understanding of its personnel.
Hardware and Software
The hardware and software to be installed will depend greatly on the system chosen to use. In general, all of the systems have software which is capable of being integrated into Meditech, Rural County Memorial Hospital’s current Electronic Medical Record system. The hardware portion of the system would consist of the sensors to be installed throughout the facility, in areas to include: patient rooms, nursing stations, intensive care and emergency room bays, operating rooms, waiting rooms, lounges, etc. There would also be the badges to be worn by each staff member, and the tags to be given to patients. The systems work with either radio frequency, Wi-Fi, infrared or a combination thereof. Dependent on the system chosen, Rural County Memorial Hospital would also need to consider the installation of additional hardware to enable the badges, sensors and software to communicate with each other.
Personnel Training and Understanding
When explaining to clinical staff members that they will be asked to wear badges which have the capability to track their movements, there is a could be some concern and possible resentment among some who may be worried about management using the tracking as a form of “big brother”. It will be important for management to reassure their staff that the goal is not that of head hunting, but one of improving the care that patients receive and of helping the staff to save steps, thereby lessening their level of exhaustion by the end of their shifts.
It will also be necessary to implement training sessions for the staff in understanding and working with the system software. Staff members will need to learn to read and understand how the system shows information of staff and patient locations. Admitting staff will need training on the distribution of patient tags as an extra step in the admission process. It will also be important for the admission staff to be able to explain the purpose of the tags to patients as they are admitted, and the importance of the patients keeping the tags on them at all times during their stay.
Overall Recommendations
Celebration Health (Stanley Healthcare, 2015) has identified nine factors for a health facility to consider when making decisions regarding new processes in order to create positive patient outcomes: * Patient Communication * Patient Identification * Proper Patient Medications * Prevention of Patient Infections * Patient’s Fear of Loss of Control * Personnel Competence * Patient’s Fear of Being in a Strange Environment * Patient’s Fear of Lack of Care and Respect * Patient’s Fear of Pain
These are the factors that management of Rural County Memorial Hospital should consider before making any steps toward adding new infrastructure or processes. The following is a summary of the recommended steps management would follow in deciding to implement a real time locating system within their infrastructure. * Decide on the needed features appropriate for the facility based on the extent to which management wishes to employ initial tracking and reporting. * Using the floor plans of the facility, and the knowledge of patient flow through the facility, create a rough outline of where the sensors should be placed. * Contact the vendors representing the three systems which have the best fit and greatest flexibility, to enable growth and further implementation if needed at a later time. * Have the vendors prepare presentations of the features available from each of their product lines. * Using the information attained from the vendors, coupled with the features deemed most appropriate by management, decide on which product to implement within the system.
Conclusion and Summary of Project
The goal of this proposal was to outline the possibility of implementing a real time locating system within the infrastructure of Rural County Memorial Hospital, with the intent that this implementation would improve the efficiency of staff movements, identify bottlenecks, improve patient flow through the facility and raise the quality of patient care. The return on investment for these systems can be identified not only in the tangible benefits, such as higher reimbursement rates due to less time that patients spend moving from the emergency room waiting room through admission and discharge, but also in intangible benefits such as more enthusiastic, energetic staff and a higher level of patient care.

References
Centrak. (2014). The smarter RLTS. Retrieved from the Centrak website: http://www.centrak.com/wordpress/wp-content/uploads/2014/09/Smarter-RTLS-4pg.pdf
Cisco Systems, Inc. (2014). IoE—Location Aware Solutions for Healthcare Overview. Retrieved from the Cisco Systems, Inc. website: http://www.cisco.com/c/en/us/solutions/collateral/enterprise-networks/connected-mobile-experiences/solution_overview_c22-723174.html
Drazen, E. & Rhoads, J. (2011, April). Using Tracking Tools to Improve Patient Flow in Hospitals. Retrieved from California Healthcare Foundation website: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/U/PDF%20UsingPatientTrackingToolsInHospitals.pdf
Hill-Rom. (2013). Clinical Workflow Solutions. Retrieved from the Hill-Rom website: http://www.hill-rom.com/globalassets/en/worflow_and_communications/cws_brochure.pdf
Kamel Boulos, M. N., & Berry, G. (2012, June). Real-time locating systems (RLTS) in healthcare: a condensed primer. International Journal of Health Geographics, 11:25. doi:10.1186/1476-072X-11-25
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Okoniewska, B., Graham, A., Gavrilova, M., Wah, D., Gilgen, J., Coke, J., . . . Ghali, W. (2012). Multidimensional evaluation of a radio frequency identification wi-fi location tracking system in an acute-care hospital setting. Journal of the American Medical Informatics Association, 19, 674-679. doi:10.1136/amiajnl-2011-000560
Stanley Healthcare. (2014). Resources: Celebration Health. Retrieved from the American Hospitals Associations website: http://www.aha-solutions.org/resources/stanley/stanley-2014-1016-cs-celebration.shtml
Versus Technology, Inc. (2014). Real-time Locating Solutions. Retrieved from the Versus Technology, Inc. website: http://www.versustech.com/thank-you/Versus-brochure.html?submissionGuid=1617e221-107a-4f78-936e-e58a86f52e0a