Roundtable: RTLS

Real-time locating systems continue to be a hot topic in healthcare. A RTLS system can help locate medical devices, track patients, assist with handwashing goals and more. TechNation contacted several companies within the RTLS sphere to find out more about the latest offerings and features.

Participants in this Roundtable article on RTLS are:

• Kapil Asher, senior director of enterprise IoT solutions, global head of healthcare and education practices, Kontakt.io
• Ron Borden, head of operations, Vizzia Technologies
• Jeanne Kraimer, senior product marketing manager, Midmark RTLS
• Jeff Stiffler, director of healthcare product marketing, Cognosos
• Mike Zimmer, manager, solutions engineering, FSI

Q: How can RTLS improve preventive maintenance schedules?
Asher: RTLS significantly enhances preventive maintenance (PM) schedules by introducing efficiency, precision and predictive capabilities. Key benefits include:

• Streamlined Device Locating: RTLS enables biomedical engineers to instantly locate devices needing preventive maintenance by leveraging real-time location data. Engineers can apply filters for devices closest to upcoming PM deadlines (or those currently unutilized), preventing unnecessary interruptions to in-use devices and optimizes time spent locating assets​​.
• Optimized Equipment Fleet Size: RTLS helps hospitals optimize their equipment fleet size by identifying underutilized equipment and redistributing or decommissioning them. This reduces the number of devices, resulting in fewer PMs, cost and time savings while maintaining the same level of service quality.
• Utilization-Based Maintenance: RTLS systems analyze asset utilization data throughout a maintenance cycle. For instance, if a device is used only 10% of the time, it may require less intensive maintenance compared to one used 75-80%. Such insights facilitate the adoption of Alternative Equipment Maintenance (AEM) strategies instead of routine PMs, reducing resource strain without compromising functionality​​.
• Predictive Maintenance Models: Integrating AI and RTLS data allows for predictive maintenance based on usage patterns. This approach proactively addresses potential issues before they arise, reducing equipment downtime and enhancing overall reliability. Predictive maintenance also minimizes unnecessary maintenance cycles by employing “just-in-time” interventions, aligning with actual device needs rather than fixed schedules​​.

Borden: Vizzia continues its emphasis on innovation by collaborating with clinicians and technology leaders to further enhance its InVIEW software platform. The company has recently released several new integrations that power today’s smart hospital, to include computerized maintenance management system (CMMS) applications. APIs with AIMS and Nuvolo improve preventive maintenance (PM) workflows and location syncing. The real-time locating of valuable medical devices for critical firmware updates or product recalls greatly assists biomedical engineers with asset management across multiple healthcare facilities.

Kraimer: Biomedical technicians spend more than 200 hours per year searching for equipment in need of maintenance. Equipment they know they should have is nowhere to be found, jeopardizing the integrity of PM routines. With RTLS, filterable dashboards help staff drill down to specific equipment on specific floors or wings to identify the locations of equipment in need of maintenance. This increased visibility to the entire fleet offers a more organized and structured approach to locating equipment. When RTLS is interfaced with the hospital’s CMMS, technicians can also receive visual cues or alerts for assets that are past their PM date, helping proactively manage equipment.

Stiffler: RTLS systems offer significant potential to streamline maintenance and reduce associated burdens. While seemingly straightforward, accurately locating and accounting for 100% of inventory often presents the most significant challenge. Beyond simple location tracking, RTLS platforms provide valuable data on asset utilization and historical location patterns. This rich data empowers organizations to make more informed maintenance decisions, optimizing schedules and resource allocation.

Zimmer: Having a last-known location associated to a piece of mobile medical equipment assists BMETs in finding the equipment. Less time looking, more time ensuring the device is in top notch condition and available for patient use. These time savings have a cumulative effect, of course, increasing operational efficiency across the team and inventory utilization.

Q: What protocols or standards should BMETs follow when integrating RTLS with hospital equipment?
Asher:
Regulatory and Safety Standards

• HIPAA Compliance: While RTLS for asset tracking and PM management does not usually require patient data, it is necessary to ensure any data collected by RTLS is handled per HIPAA regulations to protect data security.
  SOC2 Type 2: This compliance demonstrates that the system has undergone rigorous third-party audits to safeguard sensitive patient and facility data.

Open Standard Network and Communication Protocols

• Bluetooth Low Energy (BLE): Adopt BLE for cost-effective, low-power communication between RTLS tags and gateways. BLE is open standard and provides flexibility to BMETs to choose tracking devices from multiple vendors rather than a single monopolistic vendor limiting choices in form factors and other environmental specifications (size, weight, adherence methods etc.)
• Wi-Fi Standards: Ensure data backhaul from readers utilizes ubiquitous infrastructure like Wi-Fi rather than a proprietary parallel network that can prove to be expensive and cumbersome to install and maintain.

Data Integration Protocols

• RESTful APIs: Leverage REST APIs to integrate RTLS data with asset management or maintenance systems, enabling real-time updates on equipment location and status.
• CMMS Integration: Ensure compatibility with computerized maintenance management systems (CMMS) using standard integration methods (e.g., API or file import/export).
• HL7 and FHIR: Use HL7 or FHIR standards for integration with hospital information systems, including electronic health records (EHRs).

Borden: It’s important to establish user standards, naming and data protocols. Oftentimes, different hospital units or teams have colloquial or abbreviated names for assets that may or may not align to the biomed or IT team’s nomenclature. This tends to cause confusion and difficulty locating the correct asset or medical device throughout the hospital system – defeating the purpose of tracking them overall. We recommend getting on the same page with the name of each asset tracked so every hospital team can look at the dashboard and understand where or what is missing, what is in-service, and where the nearest needed medical device or asset is located. This reduces the time spent searching and maximizes that asset’s utilization.

Kraimer: Asset tag configuration is a critical implementation step but should really be considered early in the search for an asset tracking solution. A customer-success minded RTLS partner can help health systems understand their options. Some key considerations we often experience in the field:

• Attach tags to equipment using a trial-and-error method. Start with a small batch to identify the most effective attachment location and method for each equipment category. The type of tracking technology used is also a consideration for placement. With some technologies, tags need to be fully exposed to be detectable. Other technologies, such as Bluetooth Low Energy (BLE), can be covered, however the tag cannot be surrounded by metal. Otherwise, signal strength can be affected. Once you have a controlled and regulated approach, then you can scale it to the entire fleet.
• Understand cleaning protocols to ensure tags stay operational for their expected lifespan. Knowing your tag’s ingress protection (IP) rating and acceptable cleaners that won’t degrade its plastic can help inform both where on a device the tag should be attached and long-term workflow for care and cleaning.
• Designate appropriate staff to proactively replace asset tag batteries. Low battery reports emailed on a standard cadence are helpful to stay on top of this critical task. We also recommend that battery replacement for RTLS tags be done during the PM process, to lessen the number of ad hoc battery changes that must be done.

Zimmer: This may best be answered by someone in the RTLS arena; however, BMETs should ensure that the network infrastructure in use at their facility is compatible with whichever solution they are moving forward with. Additionally, the solution may not always need to be an active RTLS tag, oftentimes low-cost passive technologies may be leveraged to support workflows.

Q: Can you describe a scenario where RTLS improved equipment utilization or operational efficiency?
Asher: Kontakt.io partnered with a national health system to deploy the industry’s largest RTLS project across 180 facilities and 30 physical locations, impacting 500,000 assets and 41,000 licensed beds. Using Kontakt.io’s asset management solution, the health system is seeing a 10X annual ROI of $40 million, a 75% reduction in rentals, and a 14.5% reduction in nurses’ time searching for devices.

Borden: GE Healthcare estimates that the utilization of medical equipment averages only 42%. RTLS has increased utilization rates to approximately 75%. Piedmont Healthcare is the largest provider in Georgia with 25 hospitals caring for more than 4 million patients. Piedmont’s use of RTLS has increased device utilization by 20% and increased worker productivity by 90%.

Kraimer: One of our long-standing customers increased their pump utilization by 133% while decreasing pump inventory by 33%, thanks to RTLS. Originally, the hospital set out to replace an aging fleet of IV pumps, planning to purchase even more than the number in the current fleet. But after conducting a manual study, they learned their existing inventory had only a 30% utilization rate, which is actually very common. Despite these numbers, staff voiced concerns about having too few pumps. These contradictions were clear drivers in their decision to implement RTLS, which gained them evidence-based data to help inform and right-size their fleet. Knowing that RTLS would help nurses find pumps when they needed them, they decreased their pump acquisition from 900 units to 600, saving them more than $1 million in expenses.

Stiffler: A customer success story demonstrated a remarkable 92% reduction in annual equipment loss after implementing our platform. This significant improvement not only alleviated clinician frustration stemming from equipment unavailability and time-consuming searches but also translated to substantial cost savings. The 92% decrease in equipment loss represents a significant financial recovery that can be redirected towards other critical priorities within the healthcare system.

Zimmer: Two use cases spring to mind. Many of our customers will integrate their RTLS solution to FSI’s CMMS. This integration will refresh the last-known location of medical devices on the asset record, as well as update the asset’s location on a floorplan (viewable within FSI’s solution). This leads to the aforementioned increase in operational efficiency when performing maintenance on the devices.
Secondly, I know that many health systems will leverage either active or passive tracking technologies to support their equipment distribution processes and teams. Oftentimes there are designated clean and dirty rooms – these spaces can be monitored by RTLS solutions so that when a certain threshold of dirty equipment in the designated dirty room is reached a request is sent to Central Supply to pick them up, sanitize them, partner with BMETs if they need to be PMed and make available for use. This kind of solution naturally assists in balancing the utilization of the devices within a particular fleet.

Q: What are primary concerns or challenges with RTLS implementation?
Asher: Implementing RTLS in a hospital to track assets and equipment presents several technical, operational and organizational challenges. These include:

• Infrastructure limitations: Hospitals have complex layouts with thick walls, metal equipment and electronic devices that can interfere with the wireless signals (for example, RFID, Wi-Fi, or Bluetooth) used by RTLS.
• Integration with existing systems: Hospitals often rely on multiple legacy systems for asset management, patient care and operations. Integrating RTLS with these systems can be technically challenging and time-consuming.
• Staff training and adoption: Hospital staff need adequate training to use RTLS effectively. Without proper education, the system may be underutilized or misused.

Borden: It starts with selecting the appropriate technology platform that will support both current and future use cases for each healthcare facility. Once the RTLS solution has been selected, it’s critical to have an onsite support partner that can properly and fully implement all the components (i.e., hardware installation of sensors and tags, and software integrations). Followed by the training of clinical and technical staff on how to leverage the data analytics dashboards and reporting tools.

Kraimer: One challenge we sometimes see in health systems is they fail to plan for RTLS coverage in areas where they really need it, resulting in assets “disappearing” from tracking dashboards. Detailed planning and strategy meetings with your RTLS partner will help account for all areas in need of coverage, especially maintenance areas. Another consideration is having a process for tagging rental equipment to help prevent loss. Resources and budgets are already thin, so it is critical that rented devices stay within defined boundaries of the hospital to avoid excess spending. Be sure to set up alerts for when certain rental equipment gets close to an exit or unauthorized areas.

Stiffler: Real-time location systems (RTLS) face several key challenges during implementation. The most obvious is ensuring the infrastructure installation provides sufficient facility coverage while minimizing disruption to patient care. With that said, considerable planning goes in before the first sensor is installed to ensure the teams have addressed platform interoperability, cybersecurity and connectivity. Once the platform is up and running, one of the more underappreciated challenges is addressing change, especially if the platform is helping introduce a new process or PAR management. Lastly, the system must deliver on the outcomes it was established to address.

Zimmer: Healthcare organizations need to understand the value a RTLS solution provides at a deep level and make sure to have the means to measure that value realization. The concern or feedback I hear from many customers is that the implementations are costly and difficult to justify to senior leadership within their organization. This understanding of the return on investment helps mitigate that pushback.

Q: Do you have suggestions for improving RTLS or their integration into biomedical workflows?
Asher: To improve RTLS integration into biomedical workflows:

• Open standard technology: The biggest advantage of BLE is its open-source protocol. This is the only technology that allows interoperability between tags and the location service infrastructure. BLE lets users choose tags from multiple vendors and does not lock them within a monopolistic ecosystem. This creates a price and technological competition that benefits the customers. Moreover, modern network infrastructure, such as lighting, tablets, TVs, etc., all have BLE capabilities, allowing the creation of a dense location service infrastructure that is unmatched by any previous generation asset tracking technologies. BLE is also inherently a low power-consuming protocol that enjoys a longer battery life compared to all other active technologies, making maintenance of the system easier. Combined with cloud software, BLE truly can meet most HTM requirements from a data-sharing point of view.
• Ease of Deployment and Maintenance: Deploy quickly with minimal disruption, integrate into existing network infrastructure and automate monitoring and maintenance.
• Scalability: Leverage the same solution platform for additional use cases, such as staff safety, patient flow optimization and hand hygiene compliance. Build on a cloud-managed, enterprise-grade architecture to expand usage to thousands of beds across multiple facilities without hidden fees.

Borden: Smart hospitals are integrating RTLS into more of their existing workflows. The Vizzia InVIEW software platform integrates seamlessly with several applications to streamline workflows and enhance safety. Key InVIEW integrations include Epic, Microsoft Entra ID, Get Well 360, Lynx Systems and Workday HR.

Kraimer: The CMMS is a foundational asset tracking interface for your RTLS, since that’s where biomedical teams primarily work. Technicians can assign RTLS tags directly in the CMMS, avoiding double-entry of data into the locating system. In turn, the RTLS provides real-time location information, which is reflected in the CMMS’ “RTLS location” field. This allows biomedical techs to locate assets much quicker, saving them steps in their daily workflow. We’ve heard of health systems investing in software development to build this interface on their own, because they didn’t realize their RTLS and CMMS vendors could work together. At Midmark RTLS, we interface to a long list of CMMS vendors and continue to add new interoperability partners.

Stiffler: RTLS platforms can significantly enhance biomedical workflows through automated par leveling. By continuously tracking the location and availability of medical equipment, the system can optimize PAR levels based on utilization. This eliminates manual counts and ensures optimal inventory levels on each unit, minimizing stockouts and reducing the risk of delays in patient care. Furthermore, automated PAR leveling frees up valuable staff time for more critical activities.

Zimmer: Healthcare organizations that are evaluating RTLS solutions could benefit from additional due diligence on what their options are. The technologies are always evolving and there may be more options available than they first suspect. Furthermore, RTLS providers should prioritize their tool’s interoperability with other solutions that their customers already have in place. For example, ensuring that their API’s and technical resources are apt to build connections to a CMMS, EMR or security solution.

Q: What else should TechNation readers know about RTLS products?
Asher: Kontakt.io offers an all-inclusive, AI-enabled RTLS platform that covers medical devices, clinical space, staff workflow and patient flow to better orchestrate the entire end-to-end care delivery operation. The platform uses RTLS to contextualize the movements of patients, staff, and equipment, leveraging RTLS with existing systems like EMRs. Using AI, it transforms data into action that reimagines how hospitals manage resource allocation, capacity and care delivery operations and coordination.

Borden: The continued development of advanced RTLS solutions and sophisticated use cases is significantly increasing the value-prop for healthcare providers to reduce costs and improve care. The top two use cases beyond asset management include staff safety alerts and hand hygiene compliance. In 2024, a groundbreaking new $2 billion pediatric hospital deployed RTLS to streamline workflows and enhance care delivery.

Kraimer: RTLS should be a hospital-wide initiative, not a one-off use case. We often see biomedical and nursing teams addressing their RTLS needs separately, out of separate budgets. Biomed chooses one RTLS to manage assets, but the health system later finds that the level of accuracy doesn’t quite fit the clinical needs to automate nurse call, manage patient flow or improve caregiver safety. This lack of planning is a waste of resources and can be costly. As a solution, hybrid technology all within one RTLS system is quickly emerging as a locating trend that not only provides innovative solutions but also meets the goals of multiple stakeholders. At Midmark RTLS, we use infrared (IR) to deliver the room-certain precision where it’s needed most (typically patient care areas), while offering BLE for near-room accuracy elsewhere to create a cost-effective, facility-wide RTLS deployment.

Stiffler: The RTLS market is undergoing rapid transformation, driven by advancements in technology and evolving business models. Traditional RTLS systems relied on IR and ultrasound technologies and operated on-premises, requiring substantial upfront capital investment. These legacy systems are facing competition from newer technologies like Bluetooth Low Energy (BLE) and AI, which are increasingly delivered as cloud-based services (SaaS). This shift towards SaaS models significantly reduces upfront costs. Furthermore, newer technologies simplify installation by minimizing the need for extensive wiring. Many solutions now utilize plug-and-play devices or leverage AI algorithms to achieve comparable results with up to 50% less hardware deployment. Lastly, some platforms that utilize AI can provide coverage outdoors, a feat that’s long escaped most RTLS platforms.