This month, TechNation asked several industry insiders to share the latest regarding asset tracking technologies. Participating in the roundtable article are Kontakt.io Senior Director of Healthcare Enterprise IoT Solutions Kapil Asher, Cox Prosight Product Director Jaiganesh Balasubramanian, Vizzia Technologies Clinical Support Manager Miranda Baras, Capital i CEO Tony Danko and Midmark RTLS Director of Hardware Research and Innovation H.T. Snowday.
Q: What are the different asset tracking technologies?
Asher: There is a wide variety of asset tracking technologies in the market and the selection of the right technology depends on the use case and the business requirements that need to be solved. We focus on tracking technologies that are most used in a health care environment below:
- Bluetooth Low Energy (BLE): Using BLE location sensors attached to medical devices, this technology can be used with any open source BLE “scanners” the health system may have already invested in to provide location services.
- Wi-Fi: Battery operated location sensors that utilize specific Wi-Fi access points capable of providing location services.
- Proprietary Active RTLS: Battery operated location sensors that utilize a proprietary RF protocol like 900MHz, providing location services in conjunction with add-on technologies like InfraRed.
- Passive RFID: Passive location sensors powered by external scanners providing location services only when tags pass a particular chokepoint.
Baras: Real-time location systems (RTLS) utilizes a combination of wireless technologies such as: radio-frequency identification (RFID); Wi-Fi; Bluetooth Low Energy (BLE); ultrasound; and infrared. More equipment manufacturers are introducing a variety of inexpensive BLE devices. The Vizzia IoT Lab at the University of New Mexico is testing several new sensors to ensure they can achieve clinical grade requirements that hospitals demand for room level accuracy versus zone level.
Danko: Some of the different asset tracking technologies commonly used in HTM are Radio-Frequency Identification (Passive RFID and Active RFID), Barcoding, Real-Time Location Systems (RTLS), Global Positioning System (GPS), NFC (Near-Field Communication), Ultrasound and Acoustic Technologies, Bluetooth Low Energy (BLE), Infrared (IR), Cloud-Based Software and IoT Platforms.
Snowday: Technology, such as a real-time locating system (RTLS), can bring new efficiencies to teams tasked with having the right equipment at the right time. Asset tracking and management specifically is a foundational use case for RTLS, which provides location information and utilization insights. It’s important to consider that different technologies have varying levels of locating precision. Ask yourself … Do you need to know the exact location of the asset in question or will general location suffice? An infrared (IR) sensory network provides highly accurate room, bed and chair-level location data. IR locating technology is definitive location data – it’s a 1:1 relationship between the tag and sensor. Assets rarely need to be located to the definitive room level, so choosing IR is more about what you want to do with RTLS in the future when considering automating nurse call or optimizing patient flow. As an alternative, BLE uses an algorithm to estimate an asset’s location. With an appropriate density of sensors, a near-room location – within three meters – can be achieved. Equipment tags emit BLE signals to multiple plug-in BLE sensors. The network of sensors detects and transmits location coordinates to determine and display a location in the cloud-based software, making it low maintenance yet secure. There’s also leveraging a typical hospital Wi-Fi Internet network; however, it typically provides only zone-level location information. Wi-Fi networks with more access points are better able to estimate locations, yet because these signals pass through walls and ceilings, the location data is estimated, not definitive.
Q: What are the advantages and disadvantages of the different asset tracking technologies?
Asher: 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. While Wi-Fi can provide many advantages of BLE, like utilizing existing network infrastructure, it requires licenses to utilize those capabilities. The biggest disadvantage of Wi-Fi is battery life. Wi-Fi demands high power consumption, requiring constant battery replacements by HTM departments. It is not unusual for health systems to abandon a Wi-Fi based tracking system because of time-consuming battery management. Proprietary Active RFID, as the name suggests, this technology locks the health system into a closed ecosystem that does not work with other tag suppliers. In addition, there is the need for an overlay network and location sensors in the ceilings, requiring power and network cable drops in various areas of the building and making the deployment expensive. This technology outperforms Wi-Fi in terms of battery life longevity but is not as good as BLE. Passive RFID technology is as good as the last time the tag passed a chokepoint. The data from this technology is not real-time and, in many HTM use cases, not very useful. Like proprietary active RFID, this also requires expensive installation and cable drops. The only advantage of passive RFID is that the tags are battery-free and never require any replacement, making them maintenance-free. Ultimately, the use case requirements should dictate the choice of technology. HTM leaders should select an asset tracking solution that is easy to maintain and provides a high return on investment (ROI).
Balasubramanian: RTLS technology is a vital part of any hospital’s infrastructure. Effective RTLS will help your hospital in its journey to become a leader in the health care industry. As such, it is important for providers to consider which RTLS option is correct for their needs. Wi-Fi-based RTLS technology utilizes pre-existing wireless access points to track assets. The primary benefit of a Wi-Fi-based system is that it uses a hospital’s pre-established infrastructure, eliminating the need for additional infrastructure costs. Infrared, or IR, RTLS technology is powered by technology that is like a television remote. A major benefit of IR is that it can be significantly more accurate than other RTLS technologies. Ultra-wideband is a radio-based form of RTLS technology that aims to provide short and stable tracking technology. The leading benefit of UWB RTLS technology, by far, is location precision. Ultrasound identification is a RTLS technology that utilizes simple, inexpensive badges and tags to transmit and communicate locations using microphones. On average, ultrasound can track assets within 3-5 meters. Bluetooth technology is common across all sorts of devices. On top of ease of use, it’s far and away the most diverse form of RTLS technology. BLE provides asset tracking advantages like geofencing, zonal coverage, choke point coverage and maintenance management – among a variety of others.
Baras: When selecting specific technologies for these use cases, it is crucial to align the technology choice with the specific requirements and desired level of location certainty. Technologies such as RFID, Wi-Fi and BLE typically provide estimated location information, which is suitable for less demanding applications where proximity or general location is sufficient. On the other hand, technologies like infrared (IR) and ultrasound (US) offer more precise and certain location data, making them well-suited for use cases that demand high accuracy and reliability.
Danko: RFID advantages are high accuracy, efficiency, long read range (Active RFID), Durability. Disadvantages are cost, interference, limited range (Passive RFID). Barcoding advantages are cost-effective, simplicity, widespread adoption. Disadvantages are line-of-sight required, manual scanning, limited data capacity. RTLS advantages are real-rime tracking, high precision, versatility. Disadvantages are cost, complexity, interference. GPS advantages are global coverage, real-time tracking, versatility. Disadvantages are limited indoor accuracy, dependence on satellite signal, power consumption. BLE advantages are low power consumption, cost-effective, ease of deployment. Disadvantages are limited range, accuracy. Cloud-Based Software and IoT Platforms advantages are centralized management, data analysis, scalability. Disadvantages are dependent on other technologies, cost of implementation.
Snowday: IR is appealing to health systems because of its high granularity. Not only does it empower comprehensive workflow solutions, but biomedical teams specifically can leverage the precise location data to reduce time spent searching for equipment. One consideration for tag placement is that IR tags do need to be exposed for sensors to pick up their signal. IR can also have an expensive upfront installation cost for a typical wired solution or ongoing labor and maintenance costs if choosing wireless. BLE is gaining popularity because it’s more cost effective and easy to install – think days not months – without disrupting patient care or going down the path of a construction project. Its near-room accuracy is satisfactory for meeting goals like tracking equipment where you need a general location. It allows for tag size and placement flexibility, which is useful when considering how the equipment can be placed in conditions where the tag may be hidden from view such as in cabinets, misplaced in the laundry or even accidently disposed of in the trash. Wi-Fi locating is beneficial when health systems want to piggyback on existing infrastructure. However, it’s the least accurate of the locating technology. The difference can be as much as the software showing an IV pump is located in room 204 on the second floor, but because Wi-Fi penetrates structure, it’s actually located in the room above, 304 on the third floor. Regardless of the technology used for asset tracking, biomedical teams reap the benefits productively and financially. They can find equipment needed for preventive maintenance faster, create more organized and informed approaches to their daily workflow and how they communicate with clinical teams, reduce costly unnecessary equipment expenditures and optimize inventory fleet with more insight into utilization and movement history.
Q: What are some of the newest features available?
Asher: Modern RTLS systems offered by Kontakt.io are packed with features that not only address traditional biomed asset tracking but also offer a comprehensive IoT platform that integrates various environmental sensing capabilities such as temperature, humidity, air quality, light, motion, air pressure and carbon monoxide. The data is freely available with open-source integration protocols that can be used by facilities management and security systems. Combined with built-in RF and InfraRed sensors, Kontakt.io provides the industry’s most accurate room-level location certainty in asset tracking. Another trend is the use of AI to redefine RTLS’ capabilities. We can use AI to analyze patterns and predict trends, scan for hidden waste and inefficiencies, protect devices and networks from malicious attacks, and integrate with user applications to get insights within seconds.
Balasubramanian: RTLS 2.0, as it’s been termed, offers significant advantages and improvements over legacy RTLS solutions. RTLS 2.0 allows hospitals to deploy a platform solution and unlock several uses cases including asset tracking, staff duress and workflow, environmental monitoring, patient wandering/elopement/workflow without the need to constantly add more infrastructure. The newest features include the ability to integrate with other health IT systems like asset management or EMR/EHR without significant cost hurdles eliminating the silos which exist in these systems today.
Baras: The Vizzia InVIEW data analytics platform continues to integrate with other key hospital workflow solutions such as CMMS and EMRs. To ensure that mission-critical data is secure, Vizzia recently achieved the System and Organization Controls (SOC) 2 Type II compliance certification. Vizzia has also conducted a successful machine learning (ML) pilot that yielded substantial operational improvements across several inventory KPIs to include up to a 52% improvement in key out-of-stock metrics and reducing overstock rates by up to 20%.
Danko: Artificial intelligence (AI) and machine learning are being used to analyze the data collected from asset tracking systems. This enables predictive analytics, anomaly detection and optimization of asset management processes. Some asset tracking systems are also incorporating environmental sensors (e.g., temperature, humidity, accelerometers) to monitor the conditions of assets and measure utilization based on device movement parameters.
Snowday: At Midmark RTLS, we believe innovation fuels success. Though we have been successful in the on-premises nature of our business for the last 30 years, we were the first RTLS partner to lead to the cloud, where we believe the future of RTLS technology is headed. This allows a true enterprise solution for health care systems with multiple facilities, while avoiding the burden on IT. With BLE locating technology, we were able to remove the network complexity through a simple yet sophisticated RTLS architecture. Through this innovation, we’ve been able to track equipment as it moves across facilities so biomedical teams can better manage their inventory and reduce costs. Location specific notifications and inventory distribution are other improvements in advanced asset tracking technology. For location notifications, staff can be notified in-the-moment when a piece of equipment leaves or enters an unauthorized area. These real-time notifications help reduce loss and better manage capital expenses. To achieve improved inventory distribution, each unit in a facility can choose the level of inventory they need to operate efficiently, and their RTLS can monitor it. When the number of assets for a designated area falls out of the selected range, an automatic alert can be sent to biomedical teams, creating a more proactive inventory management approach.
Q: How can asset tracking systems help a health care facility save money?
Asher: Asset tracking systems help a health care facility save money in major ways:
- ROI on asset utilization – Asset tracking solutions provided by Kontakt.io help health facilities significantly increase asset utilization, eliminating the need to purchase buffer quantities of IV pumps or beds and wheelchairs. We are also saving hospitals hundreds of thousands of dollars by reducing rental equipment and preventing the loss of small devices.
- Improvement in productivity – Although a soft, intangible return on investment, helping biomed engineers search for medical devices for PMs in seconds improves their efficiency significantly. The time saved is utilized to stay on top of PMs, satisfy Joint Commission mandates on 100% PM compliance, and repurpose extra time to learn new skills.
Balasubramanian: Asset tracking systems can help reduce search time for equipment for nursing, clinical engineering and biomedical teams. Improvements translate into the various teams focus more on care, equipment maintenance and replenishment. Asset tracking can help improve utilization of equipment, hence reducing yearly repurchasing of equipment not needed and reduction in rental costs. In addition, it can help reduce loss of equipment by alerting when equipment leaves a building or has been left unattended. Asset tracking can help improve and automate various asset workflows including preventive maintenance, rental returns and replenishment.
Baras: As the number of devices per hospital bed has nearly doubled to 15, utilization rates of medical equipment only average 42%. After an RTLS solution is deployed in a hospital, utilization rates of equipment typically increase to 75% or greater. This results in a reduction of the rental fleet size and lower equipment purchases. The additional benefits include reduced search time by nurses who spend up to an hour per shift looking for equipment and biomeds trying to locate devices for PMs and product recalls. A 350-bed hospital can save on average $487,000 annually and 255,000 hours.
Danko: One of the most difficult data points to capture is asset utilization. A good asset tracking system will enable health care facility staff to easily locate available assets and reduce the need for over-purchasing or renting equipment, leading to significant cost savings.
Snowday: With increased asset visibility and real-time location data, biomedical teams can right-size their inventory more effectively. One Midmark RTLS customer in Michigan reduced capital expenses by $1 million because they were able to determine that they didn’t need additional equipment; they just needed to use what they had more effectively. They downsized their fleet from 900 IV pumps to 600, and their utilization rate jumped by 133%. Another large cancer center improved OR cardiac case start times by 25% with the real-time asset location data. They were able to more efficiently prepare operating rooms with the high-demand surgical equipment, allowing them to reduce surgery delays.
Q: What should an HTM/biomed department look for when purchasing an asset tracking system?
Asher: There are four factors that a biomed department should consider while choosing an Asset Tracking system: total cost of ownership, ease of installation and maintenance, use case scalability and location accuracy. Kontakt.io is best suited to meet all these criteria. Since we are based on open standards such as Bluetooth Low Energy and Wi-Fi, we can leverage the economies of scale achieved by these technologies into our products, making them less than a third of the cost of other RTLS providers. Being cloud-managed, Kontakt.io eliminates the need for physical or virtual servers and databases, reducing the burden on the IT teams. Our room-level accuracy sensors are completely wireless, eliminating the need for additional power or data cable pulls. Finally, open standards systems also offer biomed the flexibility to choose IoT sensors from multiple vendors, breaking the shackles of monopolistic RTLS systems. This is very helpful in scaling the RTLS platform to incorporate niche use cases that are beyond the scope of HW product development by the vendor. For example – leak detectors, vibration sensors, or specific mechanical or environmental condition monitors.
Baras: It’s important to have a clear understanding of the challenges facing your health care facility and all the various clinical uses cases that need to be included (i.e., devices, patients and staff). Typically, RTLS solutions fall into two broad categories of hardware and software. Look for a full-service partner that can provide onsite support for installation, training and ongoing maintenance. Talking with several biomed leaders at other ‘go live’ facilities will provide keen insights on lessons learned.
Danko: When an HTM department is considering purchasing an asset tracking system, it is important to consider the return on investment. By conducting and demonstrating a positive ROI, the department will be better positioned to gain approval for capital investment. It is also important to evaluate the support and training the asset tracking provider offers. A system that has limited support and training will frustrate the organization and render the system ineffective over time.
Snowday: Midmark RTLS approaches real-time locating with three components:
- Software. RTLS is a journey, not a destination. Your RTLS solutions should be scalable so that they grow with your RTLS goals over time. RTLS doesn’t focus solely on solving singular problems, but instead takes location-based information and applies it to similar challenges and goals such as increasing asset visibility and management, patient and staff safety and workflow capacity.
- Hardware. RTLS technology success is grounded in accuracy. Different locating technologies offer different levels of granularity, and it’s important to determine how accurate your location information needs to be. Locating people and locating equipment may not necessarily need to be the same level of granularity.
- Service. The key to RTLS success is just as much about the right partner and process as much as it is the technology. From success coaching to best practice implementation to analytics education, a dedicated and clinically versed RTLS partner is what makes all the difference in a sustainable RTLS program that drives results. A partner can help you channel RTLS data into continuous process improvement and workflow efficiencies.
Q: Is there anything else you would like to share with TechNation readers?
Asher: As RTLS becomes more affordable, fast-to-deploy and agile, we see significant market growth. Hospitals of various sizes are now rolling out RTLS solutions, many of which are working with Kontakt.io. Many companies are working towards integrating multiple use cases and analytical dashboards into our robust location services platform, which is developed on the principles of open-source protocols. We are democratizing data sharing so end-users can benefit from real-time location in multiple facets of patient care, including staff location, patient throughput, environmental condition monitoring and wayfinding. At Kontakt.io, we champion open and APIs, and we believe that should be the standard for RTLS today.
Balasubramanian: There has been considerable technological evolution over the last few years with BLE leading the way. BLE provides significant cost savings while providing improved battery life of tags and ease of deployment and maintenance. Investing in an extensible IoT platform should be considered compared to a purpose-built asset tracking solution. A platform will provide extensibility to other problems the facility wants to solve in the future including wayfinding, staff duress, environmental monitoring and patient flow solutions without a significant reinvestment. With caregivers and clinicians on the go, a solution that provides the staff the mobility and visibility in the palm of their hands would be important to realize broader benefits.
Baras: Health care workers face personal safety risks, staffing shortages and burnout. Staff safety is top of mind for hospital leaders, as workplace violence is four times more common in health care than in other professions. Vizzia offers a silent staff duress alarm which provides room-level accuracy to immediately report the exact room location to designated security personnel, enabling them to provide immediate help.
Danko: Asset tracking systems are a great management tool provided your department invests the time maintaining and monitoring the asset tracking devices. I have seen too many times throughout my career an asset tracking systems that dies on the vine and having to recapture the devices within the first three to five years.
Snowday: When choosing an RTLS, it’s important to consider not just short-term but long-term goals as well. How are best practices established? Does your facility want to leverage your RTLS investment and use the sensory network for patient flow or staff safety? Selecting which needs and initiatives you want RTLS to support in the future will help you make the right decision today.