Evaluation of real-time location systems in their hospital contexts

https://doi.org/10.1016/j.ijmedinf.2012.07.001Get rights and content

Abstract

Objective

The purpose of the research was to assess real-time location systems (RTLS) that have been implemented in U.S. hospitals. We examined the type of uses to which RTLS have been put, the degree of functionality of the various technologies and software, and the organizational effects of implementing RTLS.

Methods

The project was a 3-year qualitative study of 23 U.S. hospitals that had implemented RTLS for the purpose of tracking assets, personnel, and/or patients. We observed the systems in use and conducted 80 semi-structured interviews with hospital personnel and vendors. In order to protect the confidentiality of the hospitals and vendors in our sample, we conducted an aggregate analysis of our findings rather than providing evaluations of specific technologies or hospital case studies.

Results

The most important findings from our research were (1) substandard functionality of most real-time location systems in use and (2) serious obstacles to effective deployment of the systems due to the material and organizational constraints of the hospitals themselves. We found that the current best use of RTLS is for asset tracking, but importantly it requires whole-hospital deployment as well as centralized control of the system, preferably by materials management or biomedical engineering departments.

Discussion

There are serious technological, material, and organizational barriers to the implementation of RTLS, and these barriers need to be overcome if hospitals are to maximize the potential benefits of these systems.

Conclusion

In addition to considering the available technological options, hospitals must assess their unique environments, including the myriad material and organizational constraints that will affect the success of RTLS implementation.

Highlights

► Hospitals have been investing in real-time location systems (RTLS) to track assets, patients, and staff. ► The benefits of implementing RTLS have been characterized as increasing efficiency, improving safety, and reducing operational costs. ► The technological capabilities of RTLS – though improving – continue to underperform in hospital contexts. ► There are technological, material, and organizational barriers to successful deployment of RTLS that hospital administrators need to account for in their implementation plans.

Introduction

Hospital real-time location systems (RTLS) are designed to identify and locate tagged equipment, personnel, or patients as they move through hospital facilities [1], [2]. Tracking equipment has the potential to allow hospitals to manage inventory better, including streamlining the process of routine preventive maintenance, thus improving the availability of needed items and reducing equipment rentals [3], [4]. Tracking hospital personnel aims to document and improve clinical processes, including identifying routine breakdowns in care provision, assigning providers to patients automatically, and disciplining clinicians or other staff who are underperforming in their roles [5]. Tracking patients holds the promise of locating them if they get “lost” as they are moved to various departments within a hospital, verifying their identities before medical procedures, and improving discharge processes to provide quicker turnover of beds [6]. Given these varied uses of the systems, the benefits of implementing RTLS have been characterized as increasing efficiency, improving safety, and reducing operational costs [7], [8], [9], [10].

According to a 2008 survey of U.S. hospitals, 15% of administrators indicated that their hospitals already had RTLS in place and another 43% expressed their intent to purchase a system within the next two years [11]. The largest hospital technology vendors have now entered the market with their own RTLS hardware or software. In spite of impressive industry interest, however, RTLS have had difficulty finding their niche, leaving hospitals and vendors struggling to develop uses based both on perceived needs and the evolving capabilities of the technologies themselves [12].

The current landscape of RTLS offers a variety of choices for hospitals that are interested in implementing these systems, but there is little information about the best technologies or best uses for RTLS that will justify hospitals’ investment. This paper reports on the results of a 3-year qualitative study conducted at 23 U.S. hospitals. The purpose of the research was to assess the uses to which RTLS have been put, the degree of functionality of the various technologies and software, and the organizational effects of implementing RTLS. Our findings indicate that there are serious technological, material, and organizational barriers to the implementation of RTLS and that these barriers need to be overcome if hospitals are to maximize the potential benefits of these systems. In addition to reviewing the findings of our study, we provide recommendations for best practices in both decision-making about RTLS systems and in implementation and use.

Section snippets

Background

Hospital real-time location systems – also known as “indoor-positioning systems” and “real-time awareness solutions,” depending on the vendor – incorporate various types of hardware with a software interface [13]. In essence, these systems work by having a hardware tag – which can be placed on a piece of equipment or a person – that communicates its location through a network of sensors that triangulates its position. The data from this network are then mediated by a software interface so that

Methods

The aim of the research was to investigate the social and organizational dimensions of identification and tracking systems in U.S. hospitals. We documented the types of RTLS hospitals use, the purpose of the systems, and their accuracy and functionality. The project was conducted between March 2007 and April 2010 with two distinct data collection periods to assess potential changes to available technologies and hospitals’ experiences with RTLS. The methods for the project required site visits

Results

The most important findings from our research were (1) substandard functionality of most real-time location systems in use and (2) serious obstacles to effective deployment of the systems due to material and organizational constraints of the hospitals themselves. This section will review these findings, including a description of the best uses of RTLS we observed as well as what factors enabled the most successful implementations of the technology. Because this is intended to be a review of the

Discussion

It is revealing that during the majority of our observations of RTLS in hospitals, administrators, clinicians, and non-clinical staff pressed us for details about other hospitals’ experiences with tracking technologies. They were primarily interested in finding out how other hospitals are able to leverage their RTLS for the most accurate tracking, the best software functionality, and the elusive “hard ROI,” a monetary return on investment. In essence, this illustrates the collective

Conclusion

Gains have been made with RTLS technology, yet even should vendors further improve the accuracy of their systems’ tracking functions and software capabilities, there will remain obstacles for RTLS to operate seamlessly and with clear purposes in hospitals. Hospitals have a host of material and organizational constraints that affect the performance of new information technologies [12], [49]. Hospitals tend to consist of old buildings that are often arranged in complex, unintuitive

Author contributions

The authors contributed equally to the design of the study, the collection and analysis of the data, and the writing of this manuscript.

Competing interests

There is no conflict of interest.

Summary points

What was known before the study?

  • Hospitals have been investing in real-time location systems (RTLS) to track assets, patients, and staff.

  • The benefits of implementing RTLS have been characterized as increasing efficiency, improving safety, and reducing operational costs.

What the study has added to the body of knowledge?

  • The technological capabilities of RTLS – though improving – continue to underperform in hospital contexts.

  • The specific context of

Acknowledgments

This material is based upon work supported by the U.S. National Science Foundation under grant numbers 0642797 and 0907993. NSF had no role in designing the study, collecting or analyzing the data, or writing the manuscript.

References (51)

  • S. Davis

    Tagging along: RFID helps hospitals track assets and people

    Health Facil. Manage.

    (2004)
  • A.-M. Vilamovska et al.

    Study on the Requirements and Options for RFID Application in Healthcare. Identifying Areas for Radio Frequency Identification Deployment in Healthcare Delivery: A Review of Relevant Literature

    (2009)
  • M. Glabman

    Room for tracking: RFID technology finds the way

    Mater. Manage. Health Care

    (2004)
  • G. Calvaneso

    Where's your equipment when you need it?

    Health Manage. Technol.

    (1999)
  • P.H. Frisch et al.

    Beyond inventory control: understanding RFID and its applications

    Biomed. Instrum. Technol.

    (2010)
  • I.C. Chang et al.

    Pervasive observation medicine: the application of RFID to improve patient safety in observation unit of hospital emergency department

  • L. Revere et al.

    RFIDs can improve the patient care supply chain

    Hosp. Top.

    (2010)
  • C. Thuemmler et al.

    Radio frequency identification (RFID) in pervasive healthcare

    Int. J. Healthc. Technol. Manage.

    (2009)
  • Y.Z. Mehrjerdi

    Radio frequency identification: the big role player in health care management

    J. Health Organ. Manage.

    (2011)
  • A.M. Wicks et al.

    Radio frequency identification applications in healthcare

    Int. J. Healthc. Technol. Manage.

    (2006)
  • HIMSS (Healthcare Information and Management Systems Society)
  • J.A. Fisher et al.

    Tracking the social dimensions of RFID systems in hospitals

    Int. J. Med. Inform.

    (2008)
  • RFID Network

    RTLS Market Overview

    (2010)
  • V.N. Carrasco et al.

    Real time location systems and asset tracking: new horizons for hospitals

    Biomed. Instrum. Technol.

    (2010)
  • R. Krohn

    The optimal RTLS solution for hospitals: breaking through a complex environment

    J. Healthc. Inf. Manage.

    (2008)
  • B.K. Schuerenberg

    Keeping tabs with RFID

    Health Data Manage.

    (2005)
  • J. Degaspari

    Keeping track: barcodes and RFID tags make inroads in hospitals

    Healthc. Inform.

    (2011)
  • E. McGrady et al.

    Emerging technologies in healthcare: navigating risks, evaluating rewards

    J. Healthc. Manage.

    (2010)
  • M. Bouet et al.

    RFID in ehealth systems: applications, challenges, and perspectives

    Ann. Telecommun.

    (2010)
  • Y.-C. Chung et al.
  • R.A. Perrin et al.

    RFID and bar codes: critical importance in enhancing safe patient care

    J. Healthc. Inf. Manage.

    (2004)
  • J. Raper et al.

    A critical evaluation of location based services and their potential

    J. Location Based Serv.

    (2007)
  • S. Kumar et al.

    Stage implementation of RFID in hospitals

    Technol. Health Care

    (2010)
  • J.A. Fisher

    Indoor positioning and digital management: emerging surveillance regimes in hospitals

  • T. Monahan et al.

    Surveillance impediments: recognizing obduracy with the deployment of hospital information systems

    Surveill. Soc.

    (2011)
  • Cited by (71)

    • Using a real-time location system to measure patient flow in a radiation oncology outpatient clinic

      2018, Practical Radiation Oncology
      Citation Excerpt :

      In theory, such systems can operate with a high level of precision, allow tracking of multiple resources as they travel within a facility, and automate data capture. In reality, successful implementations of these systems for quality improvement programs in outpatient clinics are quite rare.10 Complicating issues include a lack of understanding of system capabilities, low levels of technological acceptance, and the sheer burden of the volume of data generated without clear utility.

    View all citing articles on Scopus
    View full text