The use of

The use of RFID technology to improve patient safety and the identification and privacy issues of Study

Yue-Chuan Wang, Jun-Hao

Liu

Chi-Chen Wu

a

Taipei Medical University,

Institute of Medical Informatics, Taipei Medical University Hospital

david.w9938 @ msa.hinet.net

Summary

Patient safety issues in recent years, countries in the world is being concern and attention during medical procedures, the considerable proportion of adverse events or medical errors,部份 from the individual's negligence or technical Buliang, but more a part from the system The potential errors (latent failure), but these errors or omissions that can be prevented; Therefore, Taiwan must

establish a good environment for patient safety should first realize that people make mistakes, and discard the superficial blame culture towards system improvement-oriented way of thinking to improve [1].

Prevent medical errors or the wrong patient identification is the first step.

Medical staff during the course of medical treatment, according to standard operating procedures to confirm the identity of patients; the other hand, we need an amendment to the security situation led to the error mechanism to identify and improve patient safety; in the Posts study, we not only use RFID technology to successfully build a set of security for RFID systems operating room prototype system implementation is more done by a questionnaire survey were recruited most of the medical staff and patients on RFID contribution applied to patient safety and satisfaction possible even table; but how choices between patient safety and privacy, how patient safety systems and transparent to expose the patient to choose between privacy, it is our deep thinking and efforts to serve the future will provide a more complete system solution.

Keywords: RFID radio frequency identification, patient identification, patient safety

Abstract

Recently, the issue of patient safety draws more and more attention and being widely discussed all over the world. During the process of medical treatment, there's certain percentage of medical mistakes caused by human negligence or mal practice that can be prevented. Nevertheless, some of such mistakes are found from the system's latent failure. Therefore, before building up good

environment for patient safety, it's necessary to be aware that human mistakes are inevitable and also, the attitude of reproachful culture should be discarded and oriented towards system improving.

The first step to prevent effectively medical mistakes is patient identification. In the process of medical treatment, medical professionals follow the SOP (Standard Operation Procedure) to identify patient's identity. On the other side, we need a more secure mechanism for correction when mistakes taken place to identify and improve the quality of patient safety.

In this study, we develop successfully a prototype of patient safety system applied in operation room by using RFID technologies; moreover, from the evaluation of questionnaires done by medical professionals and patients after system implemented, most of them are satisfied with the system contribution and agree that it's feasible to improve patient safety with RFID technologies. Though, how to choose between patient safety and privacy, how to decide appropriately between transparent patient safety system and the disclosure of patient's privacy is worth for us to be excogitative and make more efforts in order to design a better system solution in the near future.

Key Words: RFID (Radio Frequency Identification), Patient Identify, Patient Safety

Description:

Domestic and international survey of medical adverse events or medical errors, including higher rates: for the wrong medicine, but medical management led to the infection, surgery or postoperative complications, such as patient falls cause serious injury. Professionals engaged in medical care are highly professional well trained, but attributable to adverse events, and more for health care process, with the correct disposition of the body in patients with incorrect or improper disposal of used in the correct patients was found.

Medical adverse events, driving the wrong patient, wrong site or open surgical error, is caused by medical malpractice in medical institutions, medical teams or individuals to combat the greatest reputation.

Although a long time, the medical units attached considerable importance to this

subject, but "To Error is Human", in the process of medical care among covered the

patient identification, such as surgical site confirmed that, should the operation of a team work, as long as process is not well recognized as a part of the action, adverse events may occur.

Early the medical information system can only provide transactional support, but with the development of information technology, recent years have developed to the clinical and decision to support, through information systems, timely,

necessary and timely provision of health care tips.

This study is widely discussed in recent years by the use of RFID (Radio Frequency Identification) RFID technology, combined with the hospital information system related to health care, in health care workers to manually identify the patients involved in the work process, to reduce human errors identified health care

workers with tips related to patients, physicians and even into the operating room for error and alert systems, to improve patient safety purposes; another study by the physicians, patients wear electronic tags, so the system built on hospital-wide, specific personnel mobile process, locations, will be complete by the system and track record, which may be derived from the issue of privacy and autonomy, is also one of the topics investigated in this study.

Literature:

Department of Health Patient Safety Committee participation, according to the American Medical Association of accreditation (Joint Commission on Accreditation of Healthcare Organizations, referred to as JCAHO) 2004 年六月 made the seven patient safety goals [13], setting the Republic of China 93 years, the annual patient safety goals and implementation strategies:

1, to avoid medication errors.

2, the implementation of hospital infection control.

3, to prevent surgical site, wrong, wrong patient error and surgical procedures.

4, to prevent patient identification errors.

5, prevention of patient falls.

The Department of Health medical team identified each year from 1987 to 2001

the commission received a medical identification number increased from 147 to

406, which according to informed analysis of causes, nearly a quarter (24%) due to poor health, and surgery-related ( 15%) dominated; other countries in the world according to the results of extensive research, acute in-patients in about 3% to 16.6% of medical adverse events had occurred (adverse event), is worth noting that about 30% to 50% adverse events were the researchers think it can be prevented or avoided.

Taiwan in 2003, also for hospital staf (recall 4510 copies) research found that in the past year, the respondents had experienced adverse events or treated with about 5 percent have had such experience , and the other in diferent capacities (doctors, nurses, pharmacists and other medical staff) there was no significant diference, if the respondents experienced adverse events in the type of medical, surgical or surgical site or patient as surgical errors accounted for 3.4%, and foreign reporting broadly similar.

Chinese Orthopaedic Association has conducted a questionnaire survey for the membership showed that 36.9% of physicians surgical error occurred listening to others, including driving the wrong patient, wrong site or open surgical error; but only 2 percent in the patients before surgery physicians surgical site marking.

Thus, health care for the patient identification process, the operating room safety, all should attach great importance; and the operating room is the highest probability of occurrence of medical malpractice work place, so they definitely need medical process by process of "confirmation" process to be prevention.

We also found the whole process, from the patients arrived at the operating room to the real operation began, a number of standard specifications to confirm patient identification, surgical procedures and surgical site of action, but they confirm the operation of movement by people, there opportunity to produce errors, because 』 『 To Err Is Human; So this study, the recognition ability of RFID to produce a set of security for RFID systems operating room, a combination of RFID and voice systems to automate the recognition instead of manual identification, reduce medical errors likelihood of occurrence.

RFID

Radio frequency identification system works the way is to use RF radio frequency signals to transmit data wireless communications, and then through the ID

identification to identify, track, manage objects, even people and animals can be

identified by. RFID by the sensor (Transceiver, also known as RFID Reader) and label (RFID Tag) composed of two parts, via wireless transmission, without physical access to data can be exchanged, and no directional data exchange requirements.

RFID system [8]:

(1) tag (Tag): can be designed bracelet to wear on the wrist or other types of patients. Can RFID do not need additional batteries to achieve small size, low cost and long lifetime. Can be made into active or passive, applied to diferent distance requirements.

Figure 1, the electronic tag (Tag)

(Photo Source: web.media.mit.edu / ~ Fletcher / tags / )

(2) reader (Reader): use of high frequency electromagnetic energy and signal transmission, and use a wired or wireless communication systems and application integration, reader antenna sends out a certain frequency of the RF signal generated when the tag into a magnetic field sensor current to gain energy, sending out its own code and other information to be read and decoded reader sent to the host computer for processing [7].

(3) applications (Application): Application client can make use of encryption and decryption means of achieving the efect of secrecy, and the digital data is subject to change, liquidity and other benefits, and with the Internet, PC, PDA, Wireless, and future information appliances, etc. for automated integration of applications.

^Figure 2, RFID Application RFID Applications

RFID has to write and access data, small size and diversity of shape, environmental resistance, can be reused, with penetrating, large memory capacity and other characteristics [5], it has widespread applications, it is also a non-contact sex, no direction, permanent use, and strong weatherability

characteristics, so very suitable for harsh environment Xia automation and related

applications, including: recycling Guan Li, cargo management, material handling, waste management, access control, medical management, Jiao Tong transport animal chip, automatic control, such as the joint ticket.

Materials and methods:

(A) RFID system components:

Study Area ^:

We are in a hospital in Taipei to study needle test, the use of active tags in the operating room medical personnel and patients to identify, called the RFID system and operating room safety for the operating room scheduling and systems

integration.

Method and architecture:

Figure 3, RFID Security, and the system diagram of the operating room Tools and methods:

Tools: the use of active tags make medical personnel and patient identification card (bracelet), and patients to do facial recognition and image type systems to confirm patient name.

Technology: the use of RFID technology, supported by TTS voice synthesis.

Integration: The combination of surgical scheduling system to retrieve schedule set within a row of operation (personnel from time to time) and the operation note.

Function: This feature by the system error text and voice prompts,

to ensure that the right physician, the patient, at the right time,

arrangements (or arrangements) in place of the implementation of the

correct surgical operating room, so you can check the process of

strengthening the traditional man- .

Figure 4, RFID systems operating room safety promotion Application:

Applications medical personnel cards combined, patient cards, RFID detection systems, hospital information system, combined with the back- end Legacy database, the operating room the entire process to formalize the standard specifications, while the artificial voice, and text messages to warn system, the initiative to inform medical personnel of the error.

Operation of the process:

When the RFID Security, and boot the operating room, the system automatically with the operating room scheduling system to connect, to obtain the operating room schedule that day, when patients and doctors into the operating room, the system for induction into the active RFID tag s name and photo, confirmed the discovery of an error, the system

immediately to remind health care workers and to inform the proper way voice operation room location.

Figure 5, the system confirmed that doctors and patients

If patients and doctors through the system checked and verified, then start the download procedure note (first identified mechanism), the system will be shown in the operating room both face the computer screen image, and to voice recognition on both sides told The correct operation , the next will be asked to type the patient name health care workers, when the confirmation, the system will be surgery scheduling system operation attention, in order to voice mode Playback again, then a doctor and then to confirm the surgical site ( The second recognized mechanism), may

commence only after confirmation by the surgery.

Figure 6, the system confirmed that doctors and patients, the physician again to confirm and mark the surgical site

Recognized mechanisms:

(1) confirmed by:

Active detection system with health care workers must respond.

Security for RFID systems operating room settings in the operating room through RFID sensor system to detect wear in the body of doctors and patients active RFID tags, to identify persons entering the operating room, the operator must login to the system can continue operation.

(2) to confirm the media:

Face recognition and medical imaging systems integration.

The system integrates the operating room scheduling system, capture the day open house room scheduling information, when the patient, physician, surgical, surgical site ... and so set the conditions for full compliance, the operation can only begin.

(B) build FRID and privacy of survey research

Subjects: Surgery for the Department of the hospital doctors, nurses and hospital (excluding severe and isolated), emergency (including Observance), out-patient over the age of 18 have decided to self-seeking behavior of patients.

Response:

(1) to be collected from the structured questionnaire.

(2) Adoption of RFID system implementation consistent explanation.

(3) completed a random sample of 150 outpatients, 100 inpatients, 50 emergency department (including Observance) patients, 26 surgical department physicians and 20 nurses.

Data collection processes:

93 years since the Republic of China on July 1 ~ 7 cases from members of the

team at the hanging

Room No. by registration number, randomly selected after the waiting line when

Explanation and questionnaire system.

Surgical department medical personnel by the time the roster was arranged after the random selection

Systematic description and questionnaire.

Results:

(A) RFID system components:

With the operation of the system, we clearly achieved several goals:

(1) efficient personnel control.

Operating room is highly regulated space, in which the activities of personnel, in addition to medical staf, the included patients, patient families, cleaning staf, administrative staf, etc. .., the system capacity through the recognition by the initiative to replace passive artificial identification, efective control of personnel at the appropriate time and place there.

(2) standardization of medical supervision process steps.

Often with the medical care process steps in the cognitive and learning difer, but there the same medical treatment, diferent versions of the operating procedures of the situation, by the aid of this system, we will dispose of these specious unity into a standardized procedure step , at the same time by the system to monitor the health workers are treated

together in standard procedures.

(3) automated identification system.

The traditional identification mechanism, whether identification card, IC

card, Bar Code, these processes must be done through human action, to

improve the error probability, the system to automate the identification of

ways to precisely identify ways to address the lack of human recognition.

(4) reduce human error in surgery pre-operation number.

Surgery pre-operation has been a busy and complex, through this system, we will remember the original pre-operational procedures manual, to a standard electronic processes, by the system to remind health workers are active place, the patient, whether the afected part correctly, can reduce human error in surgery pre-operation number.

(5) more friendly clinical warning system.

The system uses artificial speech synthesis system, real-time synthesized speech and prompts related information, can be a substantial increase in staf awareness.

(B) build FRID and privacy of survey results

Table 1: Number of questionnaires received (N = 346)

Identity Number of people

Department of Surgery, MD Attending more than 11 Resident 15

Nurses 20 Patients Out of 150

Emergency (including Observance) 50

100 hospitalized

Table 2: RFID used to identify patients with the degree of recognition

Identity Forward Negative No comments

Surgical Department of physicians More than 830 attending

Residents 1230

Nurses 1802 Patients Out 137 112

Emergency (including Observance) 4613 Hospital 9252

Forward: strongly agree, agree Negative: do not support, oppose

Table 3: Patient Safety and importance of patient privacy

Identity Patient Safety Patient privacy Depending on the circumstances

Department of Surgery, MD More than 830 attending Residents 1131

Nurses 1612 Patients

Out-patient 874 419

Emergency (including Observance) 4334 Hospital 8785

Table 4: Health care workers most concerned about the question (multiple topics)

Concerned about the issues MD Nurse

The accuracy of the system and replace 2618 The feasibility of implementing a specific area 24 18 Pronunciation (including speed) to improve the 2015 smooth The impact of medical equipment 17 14

Table 5: Patients most concerned about the question (multiple topics)

Concerned about the issues Out Emergency Hospital

Security system to ensure 1,394,895

Possible degree of invasion of privacy 1,344,589 Wear comfort 1,054,092

The impact on daily life 933 390

Survey results and discussions:

A hospital due to medical staf through SARS crisis, deployment of the system combined with video, voice, and tips, the expression of support and positive attitude, and will be the main consideration of patient safety, the accuracy of the system, implementation of efective assessment and whether in whole or in part replace the current confirmation process is more concerned about other issues, Tags tend to combine the design is related to identification or authentication of the card or document, set the size of the system tend to set in a specific region (such as operating rooms, emergency room and related inspection (inspection) inspection departments, isolation wards); In addition, the medical staf on speech synthesis

technology degree and the speed of sound smooth salty believe there is still room for improvement on the RFID may cause doubts about the impact of medical equipment on hospital-wide deployment of this system is more reservations or disagree with the opinions on the Bar Code to RFID to replace the existing identification was optimistic about impartiality.

2 do not distinguish between patients according to medical treatment, the

diferences are more significant, hospitalization or ED patients were more

concerned about the proposed system out-patient and related issues will

be discussed advantages and disadvantages. Obviously, patients with

more severe concern about patient safety issues more important than

privacy; the medical treatment of other patients in this system may be

highly concerned about the extent of invasion of privacy and no significant

diference; hospital patients wear RFID bracelets on comfort, hospital

During the life of (such as bathing) and other concerned issues, higher than the emergency room, outpatient.

3 This study limitations:

The questionnaire designed for patients without a hands-on display of the operation of those surveyed on the RFID systems can not fully understand, the other questionnaire sex, age, level of education is not satisfied that the scope of this investigation.

Discussion and conclusion:

Medical error reduction and patient safety maintenance has become the world's most important health care issues, in Taiwan has always occurred several serious medical errors, more food for thought from the institutional review not only those who simply blame mistakes; personal thought so and can not avoid the same tragic incident, we should realize that medical mistakes should not only

attributable to the individual, as health care providers each member, should be in patient safety and quality of the premise and considerations, actively complicity to improve.

The systems that voice software to read patient scheduling system database and timely synthesis of play, smooth playback of room for improvement, we are operating room patient safety through the promotion of RFID prototype of the build, confirmed that RFID applications in hospital the feasibility of patient identification; but there is still a lot to expand the use of the next level to be considered, such as: How and medical health care information system (HIS)

integration, used in out-patient surgery, the need to provide more relevant patient medical information inquiries ( medical records, testing (testing) inspection, care plans, etc.), emergency operation of combined emergency medical services and so on.

In RFID, the current surrounding and supporting the cost of service remains high,

the system voice quality, as well as more controversial is the introduction of RFID

privacy issues, and future consideration of the work required to make Tags and

control and other issues yet to be enhanced by these problem has both increased

demand and application of surface to meet the relevant technology refined, the

norms and regulations will result in an efective solution, I believe its excellent

functions and features, will replace the bar code Zhu Jian (Bar Code) technology .

The future, through the characteristics of RFID will be more deeply into our lives, but RFID is more widely used in medical institutions will be: If hospital, emergency hospital patient tracking, high-alert drug control, used in the medical

management area Local space personnel identification and control, and materials management.

This study attempts to promote patient safety by operating room prototype's success, extending this set of applications in all medical units in the independent sector to take the initiative and automatic mechanism, the identification of people, things, places, on the proper nature, in order to prevent negligence had made an error, taking into account the need of privacy, does promote and achieve the primary goal of patient safety.

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[13] In 2004 JCAHO patient safety goals,

http://www.jcaho.org/.