A vision of the future Will Mobile Indoor Location Become a Commodity? Will RFID Technologies Start to Integrate with Mobile Location? Will RTLS Tags Become Integrated into Devices? Scott Phillips Principal, RFID Portfolio Manager Kaiser Permanente HIMSS 2014 IEEE and RHCC/Intelligent Hospital February 23, 2014 Conflict of Interest Disclosure Scott Phillips has no real or apparent conflicts of interest to report Learning Objectives Assuming ubiquitous adoption in Healthcare for RTLS, Passive RFID and mobile indoor location, understand the future financial requirements. Increase understanding of the feasibility and benefits of an enterprise location infrastructure designed for many use cases. Increase understanding of the feasibility and benefits of embedded tags and the importance of infrastructure standardization. Kaiser Permanente • • • • • • • • 7 regions serving 8 states and the District of Columbia 9.1 million members 17,000 physicians; 175,000 employees (including 48,000+ nurses) 38 hospitals (co-located with medical offices) 600+ medical offices $53 billion annual revenue $1.8 billion invested in our community 68 years of providing care Decision: Work with suppliers to embed RTLS tags into medical equipment. What is RFID? Radio Frequency IDentification is technology that uses communication through the use of radio waves to transfer data between a reader and an electronic tag attached to an object. Types of RFID Examples Passive Supplies Specimens Pharmacy Active / Real-time Location Systems (RTLS) Assets Patients Mobile Indoor Location SmartPhones Tablets GPS Specimen Temperature In-Transit Tracking Visual Current RFID Use Cases at Kaiser Permanente 1. Active RFID (RTLS) 2. Passive RFID • Asset Tracking • Retained Foreign Objects • Equipment Maintenance • Medication (Pilot) • Rentals • Lab Specimens (Pre-Pilot) • Temperature Monitoring Active RFID Tag Adoption 160,000 37 of 38 Hospitals & 337 of 600+ MOBs 140,000 120,000 • Infant Safety 3. Mobile Location • Patient Activity (Pre-Pilot) • Wayfinding (Pre-Pilot) Implementing 100,000 80,000 Active RFID Geographical Activity 60,000 40,000 Production 20,000 0 Total Asset Tags ~147,000 Temperature Sensors: ~6,000 Wireless Location Coverage: ~32,000,000 Sq Ft Future Examples - More Infrastructure x3 Asset Tracking – Enhanced Location Accuracy Nursing and Clinical Technology can quickly find needed equipment by knowing the exact room the equipment is in. Accuracy enables advanced equipment/patient workflows as well (e.g. par levels). Medication Tracking Nurses can track the location of on demand medications in transit; plus know when and where they are delivered to. Mobile Indoor Wayfinding Members can find the facility using GPS, and then once indoors navigate using indoor location to their doctor’s appointment. Today Exploratory Summary – More Infrastructure x3 Use Case Today’s Infrastructure Requirement Tomorrow’s Infrastructure Requirement Sensors Type(s) Asset Tracking 2-3 meters Room, bay, alcove, more exact coordinates and interactions RTLS Infant Safety Unit exit points Unit exits and beyond RTLS Retained Foreign Objects (RFO) Proximity/Wand OR bed level, OR room level, supply room, supply chain Passive Medication Tray counts Pharmacy, medication rooms, patient rooms, en route Passive Mobile Indoor Wayfinding N/A Enterprise with points of interest and area triggers Mobile (Consumer Wi-Fi, BLE?) Patient Activity N/A Highly accurate distance for very short walks (e.g. <20’ ) All Could the Future be Room Level or Better for 3 separate location networks? If not, what rooms would be excluded? Room Level or Better RFID Infrastructure x3 Future hospital floor with room level coverage x3 Room with multiple sensors and RFID tags Room Level Location Networks x3 - Estimated Location Network Active RFID / RTLS Passive RFID Mobile Location Coarse Location Yes No Yes Room Level Location (All) Yes Yes Yes Unit and Building Perimeter (All) Yes Yes Yes Temperature Monitoring (All) Yes Yes No ~$500K ~$340K ~$150K ~$23K $23K ~$20K Financial Approximations Average Hospital Per Year • Room Level or Better Hardware • Installation and Support Costs • Full Network Infrastructure • Ubiquitous Tags (except Mobile) • RFID Technology Refresh Average Medical Office Per Year • (same as above) Option 1: Large Provider Potential Annual Investment for 3 Location Networks (e.g. 38 hospitals, 600 MOBs) ~$75M+ Option 2: Same Large Provider Annual Investment with Network consolidation and embedded RTLS Tags. ~$37M Note: These are not actuals. This is merely an illustration with rough approximations which includes several assumptions around widespread use case adoption, coverage requirements, location accuracy and future support costs for all three infrastructures. Sensor Consolidation Feasibility and Benefits Traditional Implementations Future Opportunities 1. Consumables Passive RFID 1. Passive Remains + assist RTLS? 2. Assets RTLS proprietary networks 2. RTLS – Standardized? 3. Mobile Absent of Indoor Location 3. Will Mobile Dominate? -> Consumer Wi-Fi + BLE? Feasibility • Which technology(ies)? Bluetooth Low Energy (BLE) looks promising for mobile and retail applications. iPhones are sensors too. Could it be used for more? Benefits • One Infrastructure = Cost savings. • Industry growth through greater use and adoption. • Increases attractiveness for suppliers to “design in”. Embedded Location Feasibility and Benefits Progress - Examples Feasibility • Kaiser Permanente is deploying select • Lacking a comprehensive gauze with passive RF tags built in by RTLS standard for sensors and the suppliers. tags. • 6+ Years Ago, Kaiser Permanente Clinical Technology Identified this as a Benefits future requirement for RTLS tags. • Reduces initial and ongoing • Today Kaiser Permanente is starting costs for “tags”. to address this issue with its strategic • Doesn’t fall off. medical device manufacturers. • Small/Zero form factor. • Intel announced an initial step • Mobile indoor location applications are emerging – using mobile embedded location already. Note: It is expected active tags will always be required for medical equipment that doesn’t have a battery (e.g. standard wheelchairs) Future Recommendations Be Prepared and Contribute: • Encourage the advancement of standards for embedded RTLS, making it possible for standards to emerge more quickly enabling industry-wide embedded RTLS. • Where possible, encourage blending RTLS with passive and mobile, which can increase the value of the infrastructure/sensors through reuse. • Learn from mobile; plan for mobile users and encourage greater use of additional onboard sensors for enhanced location accuracy (e.g. accelerometers, pedometers). • Help encourage integrated GPS location with indoor mobile location for use cases such as seamless door to door wayfinding (e.g. home to parking lot to doctor’s appointment). Driving Value in the Present • In the meantime, we will continue to use the technology to create the most value: – – – – – Make it easier for clinicians to do their jobs Service more patients Reduce the cost of equipment and supplies Optimize asset utilization Drive positive patient and family experiences • Things to Consider – What is the return on investment, given the facility’s current state? – What technology best addresses the know use cases and the future use cases? • Passive • Active • Mobile Summary / Lessons Learned If ubiquitous location infrastructures are adopted (x3), the financial benefits from consolidation are operationally significant. A technology approach that results in a single RFID / Location infrastructure for all use cases which maximizes sensor reuse is likely to lead to the lowest long term cost. Location is embedded in mobile devices already for GPS, and is an emerging reality for indoor location. RTLS could accomplish the same providing standards are available. Single Network + Embedded Tags = Increased Value and Faster Industry Adoption.