Creative Uses of Active RFID

BIDMC implemented enterprise-wide Active RFID asset tracking over 5 years ago.

Initially this was done to reduce theft of wheelchairs, optimize the use of high inventory multi-departmental equipment such as ventilators/ekg machines/iv pumps, and reduce the time searching for devices in the emergency department.  

Over the years, we've deployed thousands of tags and enabled tracking over 2 million square feet of BIDMC buildings.

My staff recently reviewed the utilization of Active RFID technologies to understand how broadly they have been adopted.

Their conclusion - the technology is highly functional, frequently used, and effective.

A few examples:

Radiology tracks lead aprons for JCAHO compliance.

The Emergency Department is using a temperature sensing RFID tag to monitor a refrigerator for JCAHO compliance.

Currently, there are 201 active users of the management software which enables viewing of tracked assets.
Clinical staff relies on that software to locate equipment with limited quantity and high demand - dialysis machines, scanners, and Arctic Sun temperature management systems.

Clinical Engineering continues to use RFID for locating equipment due for preventative maintenance.

As our wireless network has evolved, we've upgraded our access points and geolocation software.  At this point we provide highly accurate location services based on triangulating wifi signal strength.

As with many technologies that are robust and easy to implement, the creative possibilities for geolocation are numerous.   The examples above are just a few of the ways in which we're using the technology to improve quality, safety and efficiency.

Cool Technology of the Week

Today's post is not about current cool technologies, but those that were cool.   I feel nostalgic for my IBM XT with a 5 megabyte hard drive, my Motorola brick phone, my 5 1/4 floppy collection, my Atari console and my Epson dot matrix printer.   There was a time when all of these technologies were uber-cool - only cutting edge technologists were willing to take the risk on early, unproven products.

The Boston Globe recently posted a cool technology retrospective using this classification

Ancient: seen in museums only, unusable, unfixable
Antique: unusable, unfixable
Vintage: usable, old, ironic, cool
Outdated: still available in stores, but barely used

It's amazing how fast cool technologies become outdated technologies.    I was in a meeting of technology leaders yesterday and only one person had a Blackberry, lamenting that his organization had not yet moved on to something more modern.

What's your favorite vintage, formerly cool technology?

Our Cancer Journey Week 29

Kathy completes radiation therapy on July 31.   On that date she moves from cancer patient to cancer survivor.    I have only two more posts to write about this segment of our journey - Week 30 and Week 31.

At this point, radiation therapy is going well.  Kathy feels bone pain under the radiation site and the skin of her left breast is slightly tender/irritated.   The fatigue of each day limits her nighttime endurance and she longs for sleep at 9pm.   However, being a survivor makes it all worthwhile.

Kathy has been reading several interesting New York Times articles about cancer as she prepares for the next stage - health maintenance and monitoring for recurrence.    The role of survivor comes with its own emotions and responsibilities.

The past 29 weeks have taken their toll.   Kathy still has limited hand strength and can only walk short distances because of the Taxol induced neuropathy.   We could speculate that she did not need the taxol and that adriamycin/cytoxan would have been enough.   We could speculate that new advances in therapy, personalized to the patient's and tumor's genome, will soon eliminate the need for Taxol.   We could speculate that new testing methods would have detected her breast cancer before it became Stage IIIA and required aggressive chemotherapy.

However, all such speculation is unproductive.   She's a survivor and that's what matters. We've both learned that asking 'what if' questions about the past can only lead to frustration.    We live in the here and now, looking forward to a future in which she is cancer free and her neuropathy resolves over time.

Kathy, the survivor, is ordering 5 tons of second cutting Timothy Hay for our alpaca and llama herd which arrives August.   She has plenty of time to plan for the future because she's a cancer survivor.

Computer Assisted Coding

In the past, I've highlighted candidates such as "analytics", "HIE", and "gamification" for the hottest technology concepts of the year, the "Plastics" of 2012.   Recently, I've seen a new strong contender - "Computer Assisted Coding"

With ICD10 looming on the horizon, companies such as m-Modal, Dolbey, 3M, and Optum are offering applications that process the structured and unstructured data associated with an inpatient hospitalization or outpatient encounter into suggested ICD9 or ICD10 codes.

Using linguists, informaticians, natural language processing experts, and proprietary algorithms, each company promises to increase the efficiency of coders, provide a audit trail of the logic used to code each case (very useful if CMS/RAC asks for justification), and more accurately code case complexity.    Better documentation with accurate coding may even lead to reimbursement increases because the severity of illness of the patient and the nature of the treatment rendered is more completely described.

We're speaking with each of the major vendors of computer assisted coding products to understand their interface requirements, the nature of the clinical data they require as inputs, and their integration into workflow.

Workflow is a tricky question.

Suppose that a patient visits an emergency department after a finger injury.   Accurate ICD-10 coding requires laterality (left or right), open or closed fracture, simple or compound etc.     If the provider dictates a note that contains the text "fracture of the index finger at the PIP joint" there may not be enough detail to accurately code the injury.   Some computer assisted coding products intervene at the documentation point instructing the clinician what is needed to minimally specify the patient's condition or procedure.   Others ingest all the inputs from documentation created by caregivers and recommend possible codes.   Getting the data in right to begin with generates more accurate codes, but some clinicians will be fatigued by the alerts that prompt them during the documentation process.

I've studied some of the interoperability required to connect EHRs to Computer Assisted Coding products.   Some ingest print dumps or PDFs of text documents.  Others require HL7 2.x messages (ORU messages for structured data, MDM messages from unstructured data).   None yet accept the CCD or Consolidated CDA, although the Meaningful Use 2014 edition will require that EHRs export clinical summaries using CDA standards, not HL7 2.x

ICD-10 has spooked the industry with tales of 50% loss in coder productivity.   Computer Assisted Coding may just be the silver bullet.

More to come as we pilot it.

The BIDMC Mobile Device Security Initiative

For several years BIDMC has had an administrative policy requiring special security safeguards for mobile computing devices that connect to the data network.   Many of these devices are locally administered or personally owned.   Given state and federal regulatory changes, increased use of consumer devices to access/store data, and increased visibility of privacy related incidents, we believe that policy alone is inadequate to assure mobile devices have proper security safeguards.

As part of our Summer of Compliance activities, we are taking active technology and process steps to enhance mobile device security.

Here's an excerpt of what we'll be sending to all staff:

"Below are minimum requirements for mobile devices connecting to the BIDMC network.   Rather than rely on policy alone, we will be installing these configurations on devices connecting to our data network.   We have already begun phasing in some of these such as passwords on devices using Exchange Activesync and will continue until all mobile devices connecting to the BIDMC network are compliant.  

Password protection – The device must require a password or equivalent security feature before it can be accessed.  

Timeout – The device must be set to timeout and require re-entry of the password if not used for over 15 minutes.

Anti-Malware Protection – Laptops must have an up-to-date anti-virus software application installed.   The device’s operating system and third party applications such as Adobe, Microsoft Office, Java, and others must be properly patched.  

Unnecessary Software and Services – Wireless interfaces and applications such as Bluetooth must be disabled when not needed.   [

Encryption – The data must be encrypted.   Massachusetts law requires this if the device contains information protected under the State’s data privacy regulations.   HIPAA provides safe harbor if the entire storage disk is encrypted and there is a pre-boot authentication.     In a communication next week, I'll outline our aggressive mobile device encryption program.

Custody – The mobile device should be kept in your possession when traveling or in an uncontrolled environment such as a hotel room.   Prevent unauthorized persons from accessing sensitive content stored on the device or using it to access the BIDMC network.

Backup Protection – Protected health information or other confidential BIDMC data should ONLY be backed up using BIDMC data storage resources, e.g. your home directory.   Using public Internet cloud storage services to backup BIDMC sensitive information is prohibited.  "

I welcome feedback on your experience implementing such policies and technologies.   It's clear to me that healthcare organizations have no choice but to reduce personal choice and personal freedom in order to keep our patient data safe.