Real-time locating systems (RTLS) can be viewed as an amazing technology, but have also been the topic of some frustrating stories. However, once the growing pains subside RTLS can be of great benefit to an HTM department.
RTLS is described as a technology that can be used to automatically identify and track the location of objects or people in real time, usually within a building like a hospital. This technology can help find “lost” pieces of medical equipment, can help with hand hygiene programs and more.
TechNation reached out to RTLS experts to get their take on this technology and how it can benefit our readers. The members of the panel participating in the roundtable article are ZulaFly Managing Partner, Stephanie Andersen; CenTrak Chief Commercial Officer, Wil Lukens; Versus Senior Product Manager, Brett McGreaham; and Sonitor Technologies Vice President of Marketing and Commercial Operations, Sandra Rasmussen.
Q: What are the latest advances or significant changes in RTLS in the past year?
Andersen: Health care has moved from RTLS asset management being the first application being implemented to patient workflow. Asset management provided a hard dollar ROI to fund additional RTLS projects, but facilities now are putting the emphasis on taking better care of their patients, seeing more patients in the same timeframe and therefore increasing their bottom line. RTLS has also evolved past just locating assets or people. RTLS is an extremely strong data analytics tool with a powerful rules engine to help build better process and help a facility become more efficient. The new software vendors with patient workflow are extremely advanced utilizing the RTLS technology
Lukens: The interoperability of Healthcare IT as a whole has made a significant impact on RTLS solutions as well. With multiple applications working together, including systems like nurse call, electronic health records, capacity management, bed management, asset/inventory management, and computerized maintenance management, RTLS is able to provide actionable location and condition data across a health care enterprise. In addition to system connectivity, newer technologies are beginning to play a role in RTLS such as Bluetooth Low Energy (BLE). The combination of RTLS and BLE technologies enable solutions such as wayfinding and other event-based triggers that may help streamline numerous clinical processes. The complexity of locating assets, patients and staff to improve efficiencies in the health care environment is beginning to require a fully integrated combination of diverse technologies. BLE is just one piece of the puzzle used to support the utility of a facility’s enterprise location services strategy. Across a health care organization, varied use cases for RTLS involve a different level of location accuracy; from simple estimated location all the way through to clinical-grade room-, bed-, bay-, or chair-level requirements. As mobile health continues to introduce innovative ways to help health care facilities engage patients and improve outcomes, we have seen RTLS grow to integrate these solutions and achieve maximum benefit.
McGreaham: Decisions for RTLS are being driven by multi-functional teams who are evaluating the technology for hospital-wide impact on patient care, not just department-level initiatives, such as asset tracking or temperature monitoring. Hospitals and even whole IDNs, are looking to standardize on a technology that can provide multiple RTLS use cases – full solutions for asset management, patient flow, smart hand hygiene, etc. – including software, hardware, and consulting services for performance improvement. Technology-wise some multi-platform capabilities include Wi-Fi locating as well as wireless sensors. Facilities can use their current infrastructures to locate assets, staff and patients on a general level (e.g., third floor, west wing) with the precision locating where necessary to drive par-level asset management and patient flow applications. The next generation of hardware features a USB power port, which can be used, for example, to create a battery-free BLE wayfinding network.
Rasmussen: The biggest advances in RTLS are in its adoption beyond asset tracking and more holistically now across the continuum of care. Through their own and their peers’ experiences, health care providers better understand the value RTLS brings to operational efficiency, patient care and satisfaction and ultimately their financial bottom line. As a result, they are proactively looking for ways to fully leverage the indoor positioning and event related data RTLS delivers to not only track assets but, more importantly, to improve the quality of care being delivered, increase staff workflow efficiency, improve the overall patient experience and cut costs. Another significant advancement is the ability to deploy wireless RTLS and to use standard D cell batteries to power location transmitters. This facilitates maintenance of the system and reduces device maintenance cost significantly.
Q: How will those changes impact equipment maintenance?
Andersen: Clinical engineering departments/biomed and rental companies can now find the equipment much quicker to PM when it has been tagged, especially if they choose to integrate the preventative maintenance info to the RTLS system. Now those performing the PM, not only have their list to PM, but know where it is. This is a huge time saver. RTLS can also trigger alerts and notify staff if a piece of equipment that is past it’s PM date, has entered a patient room. Battery life of a tag is also lasting longer, so that they are now getting changed every 1-2 years at a minimum. This enables the battery to be changed when it is PM’d – now just touching the device once instead of twice.
Lukens: The evolution of RTLS to a larger enterprise location services initiative, enabled by a multitude of technologies and system integrations, not only allows equipment that is due for maintenance, testing or inspection to be located quickly but also transforms the process from reactive to proactive via real-time alerts on imminent maintenance or upgrade requirements. RTLS also provides historical maintenance and utilization reports, allowing teams to strategically schedule maintenance procedures during off-peak hours – decreasing equipment downtime that is likely to impact the clinical teams.
McGreaham: The benefit of the multi-platform sensory network is that you immediately have enterprise-wide visibility into your equipment fleet via your existing Wi-Fi network, which will narrow the search for equipment. By adding precision locating in certain areas, your search time is virtually eliminated, allowing for higher up-time, lower cost on preventive maintenance, and lower risk for non-compliance. We’re seeing clients drastically reduce their capital spend and equipment inventory, by as much as 40 percent, because RTLS allows the hospital to better utilize a smaller fleet. This means less equipment to maintain for clinical engineering teams. Our clients who use par-level asset management, which alerts distribution when inventory runs low on units like ICU, report that nurses no longer “hoard” or hide equipment. That means no more searching ceiling tiles or cabinets for IV pumps and other highly used assets.
Rasmussen: As more and more use cases become the norm, scalability, total cost of ownership and aesthetics become critical attributes that can significantly impact maintenance. For example, in some cases existing infrastructure can be used to go from room to sub-room level accuracy.
Q: How can a HTM department benefit from a RTLS?
Andersen: When they get a call for “I need to order more pumps,” they now can do a quick search and see if there are any that are already available without walking the floor and before ordering more. They can quickly understand the utilization rates of equipment they have, thus being able to budget more accurately and spend money wisely.
Lukens: RTLS allows clinical engineering to focus on core functions rather than administrative tasks like searching for equipment. Additional efficiencies are realized as equipment utilization rates are improved which reduces the number of redundant assets needed. Less equipment translates into less time spent monitoring uptime and current status as well as a reduction in storage and maintenance costs. From a patient safety perspective, HTM can be confident that the equipment in-use has been properly cleaned and is not currently due for maintenance or part of an active recall.
McGreaham: Facilities are being asked to do more with less, and the more efficiently they can run their operations, the better HTM staff can do their jobs, the more satisfied they are. With RTLS, clinical engineering no longer spends inordinate amounts of time doing rounds searching for equipment. Location data can be integrated into their current software system for the management of preventive maintenance dates and recalls, so everything clinical engineering needs is in one system.
Rasmussen: Know how to right-size their inventory to get the most out of their assets and minimize the number of lost or missing equipment by knowing the exact location of each and every piece of equipment. Reduce the risk of fines and/or avoiding the cost of non-compliance by the exact disposition and status of each and every piece of equipment.
Q: What are the most important features/technologies to consider when purchasing RTLS for a health care facility?
Andersen: A stable platform that is designed for growth, flexibility and future-proofed. Vendors that not only provide a great software solution, but have a user interface that is easy to use, detailed reporting out of the box, and the knowledge that they should work with the customer to build new features that are needed. Work with vendors that are constantly updating and revolutionizing their product. They are using the latest and greatest technologies and always listening to their customers and adding new features. Pay close attention to the new up and coming software solution providers. RTLS has been in the health care market for approximately 15 years with only a 15-20 percent penetration rate. These new software companies have looked at what is missing in the market and have built solutions to fill those gaps and beyond.
Lukens: There are a number of items to consider when purchasing RTLS that can handle the rigors of today’s health care environment. I recommend a focus on location accuracy, update speeds, reliability of tags and infrastructure, scalability, and integration capabilities.
McGreaham: First and foremost, understand the long-term goals your hospital has for this technology. RTLS has many applications beyond asset tracking. Your health system is, no doubt, looking for ways to improve operations and enhance the patient experience. With RTLS-driven workflow applications in the emergency department, operating room and inpatient units, hospitals can improve the delivery of patient care, increase capacity, and enhance the patient experience. Different RTLS technologies offer different levels of locating precision, and not all lend themselves to these additional applications, which require a high level of reliability and accuracy. You’ll want to ensure the system you purchase is scalable for multiple applications. For example, start with the relatively low investment of tracking assets with Wi-Fi, then expand your location precision in areas where you want par-level asset management or patient flow applications. You’ll also want to consider an RTLS that is interoperable with other systems. Integrations to asset management systems, and even EMRs, are becoming essential in today’s health care landscape.
Rasmussen: The key features include accuracy, location update rates, reliability, scalability and aesthetics.
Q: What else do you think TechNation readers need to know about RTLS?
Andersen: You do not have to be a large hospital or senior care facility to implement RTLS. Hardware costs continue to come down and most companies are offering subscription or financing options to help all sizes of facilities. Understand what your goal of implementing an RTLS system is, and prioritize the phases of a new solution. It will help staff buy-in if rolled out at a pace that is not overwhelming so that they see the value, and help build the business case for continued RTLS expansion. Senior leadership needs to promote RTLS and the continued use of wearing tags by staff and/or patients, and tagging equipment so it does not become “optional” and no longer utilized once implemented.
Lukens: RTLS is more than a way to “find your stuff.” Enterprise location services are becoming a health care utility that enables true data intelligence gathering to increase workflow efficiencies, improve patient care and reduce costs.
McGreaham: We encourage any facility considering RTLS to think about the total cost of ownership (TCO) for the system. It’s important to understand not only the initial price, but also what it will cost to implement additional infrastructure for advanced applications. TCO can also include batteries, battery waste, and staff time to manage the RTLS network. And, don’t neglect to do due-diligence with references. Talk with other RTLS users about their experiences, and request on-site visits to see exactly how the technology works. Request a return on investment (ROI) analysis and ask what kind of ROI other hospitals have achieved with the technology. Finally, the choice to purchase RTLS can often be made easier when clinical engineering teams position the technology as one that enhances patient care. The right RTLS vendor can help you explain how the technology improves patient safety and supports nursing for improved patient satisfaction.
Rasmussen: Hospitals will continuously need to innovate and look for opportunities for continuous improvement in their processes and their quest to deliver the best, comprehensive care and patient experience. RTLS and other medical technology providers will need to outpace these requirements to deliver value. We believe there is still a long run way of innovation for ultrasound-based RTLS and that many more use cases will be uncovered as the technology evolves and, therefore, it is well positioned to best meet current and future health care needs.
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