When the country’s first case of the deadly Middle East Respiratory Syndrome came to Community Hospital in Munster, Ind., in late April, the hospital used technology normally associated with tracking wheelchairs and infusion pumps to make sure the health care workers who were exposed to the patient didn’t cause the disease to spread. Because staff routinely wear real-time location systems (RTLS) badges as part of their nurse call system, the hospital was able to quickly identify 50 staff members who came in contact with the contagious patient and send them home until it was certain they hadn’t contracted the virus.

“The ability to document who interacted with who, it allowed the hospital to manage the situation,” says HT Snowday, the president of Versus Technology, which provided Community Hospital with its real-time locating system. “They were prepared. They did the hard work. We were proud to be a part of whether they had good information to act on.”

Staff and patient safety is just one of the many benefits of RTLS. The technology can also be used to track assets, monitor equipment temperatures, document patient wait times and can even track whether or not employees are washing their hands. In the era of the Affordable Care Act, employing a technology that is geared toward improving operational efficiencies seems like it would be a no-brainer for hospitals. Yet, for many facilities, the systems are closer to the bottom of a long list of priorities.

“Right now, the U.S. market is still emerging, but I would estimate the market to be approximately 10 to 15 percent penetrated depending on the form of measurement,” says Adam Peck, director of marketing for CenTrak, which provides RTLS hardware, including asset, staff, and patient tags, as well as the battery operated locating components, solely for health care organizations. “One of the reasons we’re seeing a lack of adoption is because it’s often viewed as a ‘nice to have’ and not always as a ‘must have.’” Peck says enterprise installs may be at about 5 to 10 percent, while departmental installs may account for another 20 to 25 percent.

Joe Van De Graaff, research director at KLAS Research, which released a report on RTLS early adopters at the end of 2011, estimates that about one in five of the thousands of hospitals KLAS speaks with have an RTLS system already installed. “Some of the large systems we speak with are starting to look at how [they] can create efficiencies [within their] operations,” Van De Graaff says. “Some of that’s going to translate into RTLS.”

About a year and a half ago, the Department of Veterans Affairs entered into a five-year, $543 million contract with HP Enterprise Services to provide RTLS for tracking assets, sterile processing and patient flow at more than 150 medical centers and seven outpatient pharmacies across the country.

For the project, HP chose to collaborate with some of the big players in the industry, including CenTrak, Intelligent InSites and WaveMark, to perform development, integration, implementation, testing, training, and support functions.

Debbie Elgot, HP Enterprise Services’ RTLS solutions portfolio manager for the U.S. public sector, says it’s still too early to say how the RTLS system has impacted the VA. Van De Graaff says the VA contract was more of an indication that use of RTLS matters to some big health care systems, but hasn’t led to much wider adoption.

“I think it created some good visibility, but there hasn’t been a strong trigger from what we’ve seen,” Van De Graaff says. RTLS providers say that facilities should look at the big picture when considering where the systems fit in, because in addition to tracking equipment, the technology can also be used to ensure patient safety and boost satisfaction, and prevent cuts to Medicare reimbursement rates.

“Healthcare systems are getting the opportunity now, and also it’s almost economically mandated that they look for ways to improve operational efficiency and at the same time improve patient experience,” says Marcus Ruark, vice president of Products and Strategy for RTLS software provider Intelligent InSites. “A few years ago, hospitals were very focused on electronic health records and the clinical side of delivering care. Now they’re getting a chance to address, more than ever, the operational side.”

Alphabet soup
While some may consider RTLS and radio frequency identification (RFID) interchangeable, they are actually quite different. RTLS tags are read automatically and constantly, while RFID is more passive, and are read at fixed points — kind of like the GPS on a smartphone versus electronic toll pass systems. RFID tags can’t confirm where a particular portable X-ray unit is — it can only tell you where it was last checked in, so it’s more commonly used for inventory control and disposable items, whereas RTLS is generally used to track staff, patients and larger pieces of equipment.

With RTLS, battery-operated emitters throughout the hospital provide accurate location data at certain levels, and the captured data works with the software programs. The software can be compared to the iPhone’s personal assistant, Siri, which uses the Internet — or the location data — to figure out where an asset is. RTLS systems use several different types of technology, including infrared, offered by companies such as CenTrak and ultrasound, which is the primary technology that Sonitor Technologies uses. CenTrak’s Peck says that ultrasound technology can have issues with battery life and that the speakers and receivers can be more difficult to clean for infection control purposes.

However, Anne Bugge, president and CEO for the Americas for Sonitor, says ultrasound is the most accurate technology to use for positioning, but their product also uses Wi-Fi for course positioning, or the approximate area, as well as low-frequency radio. “No technology unto itself can cover everything,” Bugge says. While some RTLS equipment manufacturers use Wi-Fi networks, others, such as Awarepoint, use a different wireless network called ZigBee, a low-power wireless technology that can be used to send data over short distances. Some software providers, such as Intelligent InSites, have an open platform, and can take data from anywhere. “We work with every RTLS and RFID hardware solution out there,” Ruark says. “We’re agnostic or neutral to which underlying technology is in use.”

‘Shrinking’ budget and intangible benefits
One of the most easily measured returns on investment for RTLS is the cost savings associated with keeping track of equipment. The Agency for Healthcare Research and Quality recently studied two hospitals that are part of the Texas Health Resources health system and used CenTrak’s RTLS systems to monitor the location of major equipment. The agency found that one hospital saved nearly $1 million on equipment costs in the first year, including $285,000 on rental equipment, $100,000 on budgeting for “shrinkage,” or purchasing more equipment than necessary when items go missing, and more than $600,000 in procurement-related expenses. The other, newer hospital, didn’t budget any money at all for shrinkage.



At Our Lady of Lourdes Regional Medical Center in Lafayette, La., which installed CenTrak technology three years ago, the hospital had a subcontractor conduct a “value added” analysis, looking at time saved in locating equipment, right sizing inventory, and theft prevention. This year, data indicatedthat through a time and salary analysis, the hospital had a “soft savings” of $180,000 on searches alone.

“Staff time saved by the ease with which we look for items in the hospital converts to money saved, and sometime lives saved,” says Terry Broussard, the hospital’s vice president of support services. There are also advantages that it’s difficult to connect to a dollar value. Broussard says an alert goes off if a large item, such as a bed, is left in the hallway for 30 minutes. This alert helps to keep the hallways free of clutter that may block emergency access or egress and has led to better inspection ratings.

With Medicare reimbursement being tied to patient satisfaction scores, better known as HCAHPS scores, there are ways that RTLS can play a part in improving patient satisfaction and quality of care. If doctors and nurses are spending too much time tracking down equipment or documenting clinical milestones, they’re not spending as much time as possible directly caring for their patients – possibly leading to lower satisfaction scores, Peck says.

In 2013, the Texas hospital examined by Agency for Healthcare Research and Quality ranked in the 95th percentile or higher on patient satisfaction ratings for promptness of response to call bell, pain control, and wait time in the emergency department before being admitted to the hospital, all things that hospital officials connect to RTLS. Location information can also be used to assess hand-hygiene compliance via a staff member’s badge and sensors integrated into soap dispensers. For example, an alert can be triggered if a staff member leaves one patient’s room and then goes into another without washing their hands.

Chris Allen, director of sales operations at RTLS provider Radianse, says hospitals should also look at the safety components. The company has been working with a hospital in New York that has had incidents of assaults on staff members. Tagged badges can be used in the event that a staff member is attacked, and can sense the difference between someone bending to tie their shoes and being knocked to the ground. “That’s a big driver for the adoption of these types of technologies because they can be leveraged for improvement,” CenTrak ‘s Peck says.

Patient centered
Hospitals have been concentrating on setting up electronic medical records systems, and tracking technology can be integrated with the software, says Joe Pleshek, president and CEO of Terso Solutions, which uses passive RFID for the inventorying of high-value materials, such as heart valves. Terso’s cabinets are integrated with third-party software systems, so RFID information can be sent to the partner system and be married with the patient’s ID and integrated into the EMR.

Tracking for something of even greater value can also utilize RFID. The technology can be used to tag infants and make sure they’re paired with the mother’s wristband, says Mickael Viot, marketing and business development manager for DecaWave.

Advice on install
When considering whether to install a system, hospital leaders need to look at the big picture. “The return on investment is tied to the scope of what you do,” says Dr. Paul Frisch, chief of Biomedical Physics and Engineering at the Memorial Sloan-Kettering Cancer Center in New York City and president of the RFID in Healthcare Consortium. “A hospital has to plan to do a large-scale, institutional type of solution.

“A lot of hospitals are waiting to see what happens, and there are concerns that the technology will change over time,” Frisch says. “None of that has really happened.” The cost of the investment depends on the size of facility. Some systems use existing Wi-Fi networks, which can have some limitations, while others with dedicated antennas require you to build up an infrastructure, Frisch says. Many facilities start with cabinets for implants and using passive RFID tags for high-value supplies, along with surgical instruments and sponges.

“I think most hospitals are probably doing those first because those are the lowhanging fruit,” Frisch says. “It’s a little easier to justify.”

The cost of an RTLS system also varies significantly depending on how it’s used. According to the Agency for Healthcare Research and Quality, costs will usually be higher in an older facility, because walls, more abundant with less open floor plans, may limit the range of systems, and so more monitors, or “bases,” may need to be purchased. Our Lady of Lourdes included the cost of its system in the capital budget, while ongoing costs are included in the operating budget. Tags can have a useful life of one to five years, while the systems themselves can last around 10 years, estimates Peck.

“By that time, technology will have improved so much, that it probably makes sense to upgrade the infrastructure [or] system by then,” Peck says. “Still, it probably could last 20 to 25 years and still work great.” Sonitor’s Bugge, agrees that even if asset management is most important at the moment, hospitals should also consider a system that manages workflow.

“As they make that decision, they should be looking into the future as well and make sure they’re investing in a system that has the capacity to expand as their own needs expand,” Bugge says. Total cost of ownership is another important aspect to consider, including the initial cost and the cost of maintenance and services, she says. “Batteries, for instance, can be very expensive if they’re short lived,” Bugge says.

Broussard, at Our Lady of Lourdes, recommends that facilities review both the vendor and the technology and ensure that they have the capability to easily create alerts, so there’s less of a need to go back to the vendor every time a tweak needs to be made. For example, Broussard says he was easily able to put a tracking badge on the keys to the narcotics storage cabinet, go into the system’s web interface and get it to issue an alert if someone leaves with the keys in their pocket.

Broussard likens a system that doesn’t provide the ability for facilities to tailor it to their own needs to using Excel and contacting Microsoft every time you wanted the spreadsheet to calculate something. Some systems are not so flexible and the tools that are available when you go live are what you are stuck with, Broussard says. Broussard recommends using tracking systems to determine the viability of sharing assets between facilities within the same health care system, and says his hospital system has just started to look into that.

“That’s where you really see bang for your buck,” Broussard says. “If you have 15 IV pumps at one facility and at most they use five a day, you can bring them to the other facility.”

Pleshek of Terso suggests starting with a pilot and then creating a roadmap to decide what the system can eventually do. Phyllis Carlin, an IT analyst at MD Buyline, says implementation should involve multiple disciplinary areas across the hospital, including nursing staff, IT, and clinical engineers.

In the majority of cases, the biomedical engineering department “owns” the system because it has such an impact on their ability to,find equipment for preventive maintenance, Carlin says. But involving
representatives from all areas that RTLS impacts — including nursing, sterile processing, the OR, ED,and information technology — is vital.

“Everyone has a different perspective that needs to be considered in the early stage planning when an organization decides on their vision, objectives and goals,” Carlin says. “The group has to arrive at consensus regarding which applications to start with. In the case of equipment tracking, you have to come up with a process to manage requests for tagging additional assets and govern which assets get tagged.”

The system will also gather important data that will help facilities managers and C-suite executives make important business decisions, such as how many infusion pumps to purchase, how much they can reduce rentals of a particular equipment, and what areas of the hospital have the greatest utilization of certain equipment.

“Involving the right stakeholders in the decision-making process is critical to the project’s success — short-term and long-term,” Carlin says. “Because the potential for an RTLS is limitless, planning for a new RTLS project is a very complex process. If you don’t get it right on the front end, it will limit your ROI and benefits.” Carlin says facilities typically have to address infrastructure issues first, and whether they will use an existing wireless network or implement a dedicated one. After that decision has been made, then the supporting system hardware needs are dictated by the software applications the hospital decides to start with.

“It’s not a black and white decision and it requires a lot of careful, thoughtful planning,” Carlin says. “It just can have such far-reaching impact on an organization,” Carlin says. “You need to have that broader vision to see what could be down the road.” Carlin notes hospitals should also market the system internally, especially if it involves the sensitive issue of staff tracking. “The sad stories I hear of customers who haven’t been successful — that can be avoidable with the right kind of executive buy-in and involvement,” Carlin says. “There can be pushback on staff tracking. It can be done; it just has to be handled delicately.”