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NiceWatch Enterprise-HL7 messaging software enables hospitals to simplify patient admittance, patient identification, patient exit administration, laboratory orders, and more.

RFID smart wristbands positively identify patients and enhance their safety.

Enhancing Patient Safety with RFID and the HL7 Organization

To streamline, automate, and improve accuracy in healthcare, regulatory personnel have turned to the automatic identification industry.

By Lee Patty

The healthcare industry has undergone a wide range of regulatory changes, patient safety challenges, and third-party pressures to improve the security, safety, and identification of patients, specimens, medications, and procedures. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) has placed demands on healthcare institutions to provide secure methods of collecting and communicating patient information. The FDA has also issued regulations providing FDA acceptance criteria for electronic signatures, data tracking, as well as patient and laboratory specimen identification.

The Agency for Healthcare Research and Quality, an agency within the U.S. Department of Health and Human Services, funded a 1999 study that discovered between 44,000 and 98,000 patient deaths occur each year due to medical errors. This staggering number places preventable medical errors as the eighth leading cause of death in the U.S. alone; ahead of motor vehicle accidents, breast cancer, and AIDS. These errors are also reported to cost a large hospital more than $5 million per year. These are costs that raise the total cost of healthcare for everyone.

To streamline, automate, and improve accuracy within the healthcare market, regulatory personnel have turned to the automatic identification industry for help. Leveraging the wide range of benefits that barcoding and RFID have brought to other industries, the healthcare industry quickly sought to implement and benefit from these technologies. Healthcare institutions have used RFID for years for asset tracking on high value equipment. For example, if a caregiver hides a piece of equipment in a closet so they know where to find it for their next use, others are limited in the ability to use the equipment. This forces the hospital to purchase extra equipment to compensate for missing units and has a devastating effect on critical point-of-care. RFID asset tags enable hospital personnel to find critical care and other high value equipment quickly.

Many organizations, such as professional societies, hospital networks, industry consortiums, and patient safety groups, have pushed to use barcodes and RFID to improve patient and medication administration safety. In many cases, hospitals are audited for accreditation through organizations, such as The Joint Commission, who created patient safety goals. The accreditation of that hospital depends on proper patient safety compliance.

Proper patient care is the top priority. An easy way to improve patient care is by ensuring that staff can easily identify patients before providing treatment or medication. Wristbands with barcodes and/or RFID chips embedded in them provide reliable readability of the patient's medical record or patient visit number and are a perfect way to ensure easy patient identification. Clearly imaged text, including patient name, DOB, medical record number, and other identifiers, such as printing a picture of the patient on the wristband, give caregivers an important visual of the information they need to verify the patient's identity.

However, many problems with patient identification occur at night when the caregiver has little light in a hospital room to properly identify the patient. This is where RFID shines. An RFID chip in the patient's ID wristband enables the caregiver to enter a room at night (or during the day) and positively identify a patient without turning on a light or without waking up the patient. Unlike barcode technology, which requires line-of-sight, even if the arm of the patient is hidden under a blanket, the RFID chip is readable without moving the patient. This is a benefit to the caregiver because the identification of the patient requires less effort and it provides positive identification to enhance patient safety.

Patient identification is not the only hot area of many patient safety initiatives. Specimen identification is also a large contributing factor to patient safety. Many medical errors occur every year as a result of incorrect lab tests or reported results. In the past, hospitals have used barcode technology to identify specimens taken for clinical tests. Recently, technology providers have released RFID products that include rewritable 13.56 MHz RFID chips embedded into a test tube to enable high volume laboratories to correctly identify specimens with greater accuracy than they would with barcode labels.

Integration challenge

Hospital environments typically have many disparate IT systems that may need to invoke some form of barcode or RFID smart labeling. This is a function of departmental decision making that takes place in many hospitals. Hospital IT buying is usually a decision by committee that results in dozens of different systems from different vendors that may not have interfaced easily to one another years ago.

To solve this interoperability problem, the healthcare industry came together to create a method that would allow disparate Admit, Discharge, and Transfer (ADT); Hospital Information Systems (HIS); Laboratory Information Systems (LIM); Pharmacy Information Systems (PIS); and other systems to communicate with one another. To do this, they needed to create a standard of text based messaging that would eliminate database or API level integration between the systems; and push this standard to the vendors of healthcare IT systems for implementation. The result of this effort was the creation of an organization called HL7 (Health Level 7) and an ANSI accredited messaging standard with the same name. HL7 was founded in 1987 with the first version of the HL7 standard becoming ANSI accredited in 1999.

HL7 is a widely adopted, global messaging standard for healthcare applications and providers. The messaging interface enables healthcare, insurance, and supplier institutions and disparate software applications to communicate with each other in a common language. The HL7 standard group's healthcare institution functions and operations into common transaction sets and assigns an event to the identified transactions. Each event will then have a common set of data components that are expected by all supporting IT systems. For example, any patient ADT (Admitting, Discharge, or Transfer) tasks that happen in a hospital are classified under the ADT Transaction Set in the HL7 standard. Subordinate to the transaction set, if a hospital admits a new patient, an HL7 event A01 (Admit/Visit Notification) is created and sent to predefined hospital IT systems to facilitate lab orders, pharmacy orders, billing, and more. If the hospital discharges the patient, an A03 (Discharge/End Visit) event is created. These two events are two of 62 different events that can be communicated between the hospital's IT systems to communicate ADT activities.

In the past, each of these IT systems would need its own interface for the barcode and RFID printers, encoders, or software to drive the hardware. This forced the integrators to understand the individual programming languages of the different hardware or software. It also promoted expensive and redundant efforts to enable barcode and RFID control over hardware. Using standardized software tools that support HL7 (Health Level 7) messaging to enable bolt-on integration for printing and other RFID systems enables all hospital systems to converge on a single point to invoke RFID encoding and decoding hardware and printing systems.

These software tools exist today in the form of HL7 messaging server software that becomes a middleware between applications that are HL7 compliant and ones that are not. For example, NiceWatch Enterprise-HL7 edition is a centralized global messaging and label printing middleware software that integrates printing and RFID encoding of wristband, charts, and admittance forms into HIS, LIS, PIS applications, and others. HL7 compliant middleware software provides dramatic cost savings and clear ROI on integration of barcode and RFID systems in healthcare.

Patient safety solutions using RFID in healthcare environments have a small amount of penetration today. Even for barcode technology, numbers as low as 20% are used to describe the penetration into hospitals. Because of government regulations and industry pressures, patient safety is a top priority for all healthcare organizations. Most believe that a technology solution is the key answer to improving patient safety while maintaining privacy and security of patient information. The tools exist today in the form of HL7 messaging software, RFID enabled printers, and RFID enabled patient ID wristbands that enable any organization to improve patient safety. Lives depend on it.

Lee Patty, Vice President-Marketing of Niceware International, LLC (http://healthcare.nicewareintl.com), has over 13 years of experience in the automated identification and data collection industry and is an active member of HL7. He heads the Niceware Healthcare initiative and is responsible for the development and marketing of patient safety software solutions that use barcode and RFID identification and marking technology in an HL7 compliant IT environment. Mr. Patty can be reached at lee.patty@nicewareintl.com