Knowing where equipment and medical devices are located within a health care facility makes life easier for everyone on the staff. And, it helps HTM professionals be more efficient when it comes to their high-priority tasks. There have been some growing pains dating back to the first introduction of real time locating systems (RTLS), but the fast pace of technology advances makes RTLS a valuable tool in 2018.
TechNation reached out to several experts in the RTLS world to find out more about the latest advances, cost of ownership and more. Participating in this roundtable article on RTLS are ZulaFly Managing Partner Stephanie Andersen, Intelligent Locations Vice President of Sales Jake Bartnicki, GE Healthcare Senior Program Manager of Service Technology Matthew Cannell, Manager of Solution Architecture for Midmark-Versus Barry Cobbley, Connectiv Co-Founder and CTO Tommy Lee and GE Healthcare Global Marketing Director-Digital Solutions Jatinder Sihra.
Q: What are the latest advances in RTLS in the past year?
Andersen: We have seen advances in the hardware that facilities are looking at to collect data. The value that ZulaFly brings to any client solution is our ability to take in data from multiple systems, into a single customer. Not only does the customer no longer need to replace their existing hardware, they do not need to standardize either. This allows for leveraging best-of-breed technology to deliver each use case. We have also seen a huge increase in the drive for a strong workflow software application. Facilities of all kinds are looking to understand bottlenecks, drive efficiencies and provide a better patient experience. We see this mostly in clinics, EDs and ORs with the consistent message of understanding where patients are spending their time, automating the “what’s next” process and then introducing un-biased analytical reports to increase efficiency. The other consistent movement we have seen is to a cloud-hosted model. We offer both a cloud-hosted solution along with on-premise for the customers that want to have the data on-site or hosted through their own data center. The cloud-based solution allows for an easier implementation and better support process while reducing the amount of hardware the customer needs to procure and maintain.
Bartnicki: RTLS has come a long way in the past 12 months. Using new and exciting technologies, like Bluetooth Low Energy, to decrease the cost of legacy systems really stand out in my mind as the greatest leap forward in the industry. RTLS has the potential to alleviate some of the revenue pressure on hospitals that choose to implement it, so finding a technology that allows for adding additional use cases will be important for hospitals to realize incremental savings.
Cobbley: In recent years, more health care organizations have sought to gain campus-wide visibility to mobile assets with existing Wi-Fi infrastructure. Wi-Fi locating is now being paired with accurate room-level technology in areas where it is critical to analyze equipment utilization and manage PAR-level inventory. This pairing of solutions results in lower total cost of ownership, a key consideration for health systems that struggle to manage assets across multiple facilities. In the outpatient environment, many are deploying RTLS solutions to enhance patient flow, especially in busy ambulatory clinics. Further, smaller, wrist-wearable badges offer next-level convenience for patients and staff.
Lee: IoT has influenced RTLS vendors to begin utilizing communication technologies in innovative ways such as low-energy Bluetooth, Wi-Fi, ultrasound, etc.
Sihra: The Encompass platform, a wireless solution developed by GE Healthcare and Zebra Technologies and introduced in 2017, is poised to make the benefits of RTLS accessible and affordable to a much broader range of care providers. This approach, built upon open standards and Bluetooth Low Energy and Wi-Fi technologies, eliminates the classic objections to proprietary hard-wired locating systems. By combining Bluetooth Low Energy with the hospital’s existing Wi-Fi infrastructure, Encompass can be installed in a matter of days instead of months and with no need to open ceilings or drill into walls to run cable. As a cloud-based application, the location system is accessible to authorized staff from any computer or mobile device with Internet access. This means staff can find equipment from wherever they are, instead of having to first find a computer loaded with custom locating system software.
Q: What factors should HTM consider to determine cost of ownership?
Andersen: Besides the obvious costs associated with software and hardware, there is also time invested from the facility to ensure that the system is being utilized, hardware is maintained and that efficiencies are being gained by frequent review of the information the software will provide. It’s important that there is a soft dollar ROI, along with the hard dollar ROI when using an RTLS solution. No longer is staff searching when equipment is up for preventative maintenance or looking for hours on end for equipment that has been recalled. With RTLS, you can see where equipment is in real-time, not only does staff save time to give back to patient care, rentals will be returned on-time, and the facility can minimize additional risk with equipment past the PM date being used in patient areas. With HTM’s commitment to this type of solution, they will spend less time searching, see a hard dollar ROI on equipment they are no longer purchasing because it cannot be found, and will be able to locate equipment within seconds when needed.
Bartnicki: In many cases, institutions
have to piece together software and hardware packages making it difficult to calculate the total cost of ownership. The system should be able to “pay” for itself if used to its full potential, so HTM professionals should look at the total cost of installation and whether or not the initial investment can accomplish the long-term RTLS vision of the institution without unnecessary added expense. Ideally, the system can easily measure KPI’s and other metrics from the data collection giving an unbelievable amount of value to an organization.
Cobbley: To gain a better understanding of initial investment and ongoing solution costs, there are two important considerations. First, if your care space needs room-level or chair-level locating, there may be additional hardware requirements that are not factored into a vendor’s preliminary scoping and pricing. Not all solutions deliver the same level of location granularity in their baseline offerings. Likewise, the rate at which badges and tags report location information should be compared, along with battery life. Some solutions claim long battery life but at the expense of less-than-real-time location reporting. Second, ongoing costs can quickly inflate the total cost of ownership. Some solutions require annual license fees for tags, per-user fees, system recalibration fees, or high badge replacement costs. Other solutions require special batteries that must be recycled as hazardous materials, also driving added expense.
Lee: HTM should view RTLS as another tool to integrate into a modern CMMS that will help hospitals take in all aspects of cost of ownership when deciding the value of a solution. HTM should consider whether they can leverage any of their existing network ecosystem to reduce the upfront cost of implementing an RTLS solution. RTLS could also be viewed as a tool to help reduce costs in other areas, such as asset and work management.
Sihra: The ultimate benefits of a cost-effective RTLS deployment are clear:
Q: What are some of the latest innovations in RTLS?
Andersen: From a software perspective, we have the ability to take in data from BLE, RFID, RTLS and a nurse call solution to name a few, into a single customer, giving the customer the flexibility to pick the best means of capturing data to meet their use cases and goals of a new solution. By using RESTful APIs the customer has access to all of the data to pull into an ESB, data warehouse or BI tool very easily instead of creating SQL queries. Also, customers expect a user-friendly solution and experience that utilizes current technology allowing for flexibility when making changes easily to accommodate customer requests. We are also seeing an increase in cloud-hosted temperature monitoring solutions everywhere from blood banks, and pharmacies to every medication fridge throughout an entire hospital. Customers now expect the ability to be notified a limitless number of times until the issue with a medication fridge is resolved, or the functionality to notify anyone, anywhere via an individual’s preferred method of communication. Expectations are now much higher, and our software is designed to meet those needs.
Bartnicki: Real time location services can be a foundational strategy in decreasing both operational and capital budgets for an institution. Personally, I believe the most important innovation is using this technology to solve many problems hospitals face in terms of location services. From asset and patient tracking to wayfinding and hand hygiene monitoring there has to be a focus on data collection and analysis so we can use data to innovate and help make better decisions.
Cannell: The opportunities to innovate around RTLS are endless, however it is important that the innovation solves a business need and provides a timely return on investment. Leveraging open standards like Bluetooth Low Energy enables innovation and rapid deployment, as most modern mobile devices have those capabilities already.
Cobbley: Many health systems are leveraging the raw location data captured by RTLS and merging it with other data sources such as the EMR, scheduling, population health or financials to create additional insight into operations and the correlation with outcomes. Cross-referencing multiple data sources enables health systems to enhance patient care, maximize efficiencies and support cost containment measures.
Lee: RTLS is not only being used for medical equipment, but personnel and patients as well. The latest iterations are being used by patients to navigate their way around hospital campuses, to and from different appointments, and then back to their original destination. Naturally, these types of solutions can also allow hospitals to track guests as well.
Q: What are the different types of RTLS technology and what are the benefits of each?
Andersen: Although there are different types of technology, the most important place to start for a facility thinking about a new RTLS implementation is understanding the goal of a RTLS solution and what they are looking to accomplish. By understanding those two items first, this will then help drive technology that is right to accomplish those goals. A good software provider will be able to take in data from any hardware vendor chosen along with bringing in data from disparate systems such as nurse call, capital asset management or any EMR to maximize the customer investment. By choosing the right software vendor, they are able to provide unbiased feedback on best of breed hardware to accomplish the customer’s goals. It’s important to keep in mind that once the RTLS infrastructure is in place, it becomes more straightforward to grow the solution. Having a close relationship with a software vendor that will work with the customer to determine phases of implementation, will ensure the customer is taking full advantage of the solution.
Bartnicki: RTLS technology has been in use for a number of years. As with every technological advancement, it only gets better, faster and cheaper. RFID/Infrared is an expensive and labor-intensive option to install, but has the ability to locate very granularly. Wi-Fi can leverage the infrastructure already in place, which is a plus, but does not give the granularity needed to fully realize the benefits of an RTLS system. Bluetooth Low Energy (BLE) is a relatively newer technology, but gives users a very flexible solution that is easy to install and layer on many types of use cases without additional hardware installations. As with everything, there are positives and negatives to every type of technology, so choosing one that is easy to grow and expand should be high priority.
Cannell: There are many RTLS technologies available, and most function in a similar way (e.g. provide location to tagged options). Often the difference lies in the use cases that can be implemented based on locate specificity. Typically, the more use cases desired, the higher the investment on maintenance – both initially and over time. RTLS technologies that leverage open standards (such as Bluetooth Low Energy and Wi-Fi) have significant advantages over proprietary technologies, as they leverage a customer’s pre-existing Wi-Fi network investment and technology that is available on most modern mobile computers.
Cobbley: There are many RTLS technologies (infrared, RFID, Wi-Fi, ultrasound, etc.) and each have their pros and cons. In addition, some technologies are used in different ways or in different combinations by different vendors. The main concern for health systems looking to improve operations with RTLS should be choosing a technology that can reliably and cost-effectively achieve room-level or better location, which requires locating signals that do not pass through walls or ceilings. For example, radio-frequency based solutions such as RFID or Wi-Fi are unsuitable for anything more than zone-based location.
Lee: There are many different types of RTLS technology such as newer versions that utilize Wi-Fi, low energy Bluetooth and ultrasound as well as the more traditional versions like RFID tagged or sensor driven solutions. All RTLS solutions have their pros and cons, but it is more important to find one that is a good strategic fit for each organization, not just the shiniest new toy on the shelf. Additionally, it is important to ensure that the RTLS solution has, and supports, a robust modern API for integration into modern CMMS applications. Ideally, the RTLS solution should also have URL-driven cross-launch capabilities so that overlapping capabilities (e.g. live mapping) can be significantly reduced.
Q: What else do you think TechNation readers need to know about purchasing and using RTLS?
Andersen: You can start small! The entire solution does not need to be purchased to get started. Starting small also helps with alert fatigue so that staff do not become inundated, but allows staff to ease into how to use it while learning the benefits. Soon, they’ll have suggestions and ideas as well! Understand what the “must have” priorities are and start there.
Bartnicki: As much as I wish implementing an RTLS solution was turnkey, it is not. There are many hospital stakeholders that need to be involved to ensure success. It is important not to select a vendor, but rather a partner that will help build and execute an RTLS vision/plan that fits the present and future needs of an organization.
Cannell: RTLS technology purchasing decisions should be outcome-driven. All too often, decisions are made based on location-based specificity, irrespective of that specificity being a requirement to meet the use case. This can lead to overspending on technology, long implementation projects, costly and time-consuming system updates, and a dramatic annual maintenance investment (e.g. replacing tags often).
Cobbley: Often a health system’s RTLS journey starts with selecting the hardware-software infrastructure. However, many technology projects meet significant challenges due to unexpected change management issues that have very little to do with hardware or software. Technology implementations affect people’s roles, behaviors and processes, all of which can undermine outcomes. Failing to plan for the impact on work culture leads to user frustrations, disengagement and potential investment failure. A second consideration is vendor accountability. When an RTLS solution is provided by separate hardware and software vendors, technical performance issues frequently fall into a gray area where neither believes the issue is within their product’s boundaries. This lack of clear accountability typically results in project delays and escalated implementation costs.
Lee: It is important to find a tool that is a good strategic fit for your organization. Something that fits your needs for location update frequency, network connectivity, and power consumption, just to name a few factors and not just focus on the newest and most advanced solution available.
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