RFID is rapidly adopted

Primarily, growth in the global healthcare market for RFID tags and systems will arise because of item level tagging of drugs and Real Time Locating Systems (RTLS) for staff, patients and assets to improve efficiency, safety and availability and to reduce losses.

RFID is an enabling technology that saves lives, prevents errors, saves costs and increases security. It removes tedious procedures and provides patients with more freedom and dignity.

For example, it reduces the amount of personal intervention by staff because it automates procedures such as protecting the disorientated elderly from danger and matching patient to treatment.

In addition, RFID is now used in smart packaging that records when patients take medication and how much they take and provides prompts to help them comply with instructions. All this has been pulled together in the report RFID in Healthcare 2006-2016 by IDTechEx. It gives 72 case studies, extensive supplier profiles, technology analysis and detailed ten-year forecasts.

TAGGING
The tagging of blisterpacks and plastic bottles used by patients is primarily a US phenomenon driven by the need for improved anti-counterfeiting but there will be great improvements in theft deterrence and improved stock control and recalls. RFID is the use of radio frequencies to read information on small devices, called tags, at a distance.

In healthcare, the tags take many forms including badges, pendants, labels, cards and even implants. Compared with alternatives, RFID has few problems of obscuration or orientation. Many tags can be read at a time. Some RFID tags can have data electronically written onto them at a distance. This extra feature is currently preferred for supply chain tagging – pallets, cases and item level because, today, central computer systems cannot always be accessed reliably and in a timely fashion.

Sometimes an RFID tag includes sensors to record tampering or overheating etc and these are used on blood and medication. Some RFID tags contain a battery to manage these sensors or enhance range. Long-range tags are increasingly designed to be located in real time, without having to pass near an electronic interrogator.

DRUG ANTI-COUNTERFEITING
Over the next ten years, the largest use of RFID in healthcare will be labels on drugs at item level and the infrastructure and services to support this throughout the supply chain and in healthcare facilities.

The primary purpose of this will be anticounterfeiting by establishing the full history of the package at all times – called pedigree. This will be underpinned by scientific analysis of the drugs inside the package. The unique electronic identification and its processing is called mass serialisation and it will employ tranches of numbers issued by EPCglobal to the so-called Electronic Product Code EPC. The specification for the air interface will be ISO 18000. The US is driving this and its Food and Drug Administration will legislate if progress is inadequate in its view.

The frequency employed is as yet uncertain because Ultra High Frequency UHF tags have been delivered to Wal-Mart on millions of Type 2 drugs in the last year (primarily for anti-theft and for stock control) but Pfizer and GlaxoSmithKline are fitting millions of HF tags on similar packages under FDA guidelines for anticounterfeiting.

HF FAVOURED
Most of the interested parties, such as system integrators and the many drug companies that have carried out trials, favour High Frequency (HF) at present. They find it more tolerant of metal and water, with more predictable and controllable in range and, most important, small enough to fit on the smallest drug packages. Whichever frequency prevails, the labels will be read-write for the next few years despite the risks to data synchronisation. This is because those managing the supply chains and healthcare facilities do not trust the availability and integrity of their computer networks to do everything on line. However, this has a cost. Password protection of rewriting is provided in all the new UHF chips (ISO 18000 Gen 2) and in the Texas Instruments HF chips. However, the end game must be RFID printed directly onto packages or applied as labels at a total cost below two cents and that almost certainly means the simpler read only type.

For now, a silicon chip is needed in RFID tags to meet the agreed, complex specifications. Using such chips, equivalent item level tags are about one cent more expensive at HF but if some continue to succeed in obtaining royalties under patents for UHF RFID and HF gets the cost reduction attention paid to UHF (e.g. printing the antenna) then that price difference may vanish. TAGSYS has obtained the early orders from the leading drug companies for its level drug tagging because its systems have exceptionally high read integrity (percentage of successful reads and freedom from false reads). Item level anti-counterfeiting labels will also give paybacks from faster stock counting, better supply chain management and theft deterrence.

It is, however, a constantly evolving story, as UHF tags operating at near field offer new advantages for item level tagging. These options are analysed in the IDTechEx report.

REAL TIME LOCATING SYSTEMS
The second largest application of RFID in healthcare by value will be Real Time Locating Systems for staff, patients, visitors and assets. Here the systems and support cost more than the tags, partly because many of the tags are re-used. The tags cost from one dollar to 100 dollars depending on sophistication.

Some record threatening behaviour, and many have an alarm button to fetch help to the exact location. The favoured forms of RTLS in healthcare are:

• So-called zonal (cell ID) systems where interrogators are fixed throughout a building to ensure the tag is never out of range and

• Systems parasitic on the facility’s WiFi network, so they do not have to emit their own radio frequencies. This is called radio fingerprinting – the tag senses several emitters and the software computes the location knowing where those emitters are.

Zonal systems mainly operate at 433 MHz or 2.45 GHz and the WiFi is at 2.45 GHz. Open standards are not essential for the systems that provide their own emissions and they can more readily perform other tasks such as secure access, high accuracy location (particularly at Ultra Wide Band UWB) and error prevention. However, parasitic WiFi systems can be cheaper over life and there are no worries about electrically interfering with other electronics such as life support systems and this seems to be gaining them market share in the healthcare RTLS business. A new chip from G2 Microsystems in Australia seems to have overcome the cost and power problems of WiFi RTLS tags.

ERROR PREVENTION
Error prevention cuts across both of the above applications – item level drug tagging and RTLS. It will remain one of the biggest uses of RFID in healthcare. Basically, an electronic handshake prevents the wrong procedure taking place and the RFID system may even record what actually happens, for future reference e.g. in lawsuits. However, RFID error prevention systems are also being set up in their own right. For example, a disposable passive RFID wristband that “talks” to the RFID label on the blood bag to prevent error is not anti-counterfeiting or RTLS. Indeed, the largest use of RFID in healthcare so far by numbers of tags is the 40 million used for error prevention on AstraZeneca Diprivan syringes. Interestingly, these do not employ a silicon chip – the largest element of cost in conventional RFID tags.

We shall see a slow move to chipless tags over the next ten years but they will remain a minor percentage of the expenditure of RFID tags for healthcare until later. RFID is a remarkably versatile enabling technology and its uses in healthcare will widen rapidly. It is, in a sense, the ultimate Local Area Network connectible, being cheaper and more versatile than any other, even disposable in an increasing number of cases.

RFID is already extensively used in hospitals and it is starting to be used in other healthcare environments, including care homes and in the area of self help. In all these contexts there is considerable scope for further use of RFID.

The IDTechEx RFID Knowledgebase is by far the world’s largest collection of RFID case studies – over 2,000 cases are included. Eight per cent are healthcare applications and it is not expected that this will increase greatly despite the very rapid adoption of RFID in healthcare. The relative importance of different applications within the healthcare sector is shown in the Table 1. When this is set against the value of the different market sectors, it is seen that pharmaceuticals are involved in a relatively small number of high volume schemes whereas other applications largely consist of many small schemes, often disproportionately profitable for suppliers because of the specialist knowledge and products required.

Table 2 shows the main purposes for which RFID has been and will be used in healthcare. This table shows when these applications will be large: their commencement has been far earlier.

RFID in healthcare is not, and never will be, the biggest application of RFID but its special requirements, unquantifiable benefits (safety, security, reputation, brand protection etc) and sometimes tolerance of longer paybacks for such reasons can often lead to very profitable and worthwhile business for suppliers. Extensive benchmarking in the business leads to rapid dissemination of the multiple benefits to users of given schemes and great pressure on the laggards to catch up.

PRIVACY ISSUES
There are many privacy issues in the healthcare industry. However, they are managed under national legislation and guidelines of good practice and RFID is not a particularly significant component any more than the barcodes that are sometimes replaced. Although some privacy advocates have concerns about the tagging of patients and they will also be concerned about the tagging of visitors when that occurs, this is in some contrast to the views of the patients themselves. Surveys have shown that patients realise that tagging reduces the chance of errors and can enhance privacy and dignity. For example, the wrist or ankle tag can be read electronically without burrowing under the bedclothes.

The tag on disorientated elderly people automatically sets of an alarm if they are approaching somewhere dangerous, obviating the need for staff to be near them at all times – the often oppressive traditional approach. Personal data stored in an RFID-fed server behind a firewall is far more secure than the clipboard at the end of a bed. When, more rarely, personal medical data is stored in the tag itself as with high risk patients having an RFID implant the size of a grain of rice, it is in scrambled form. It is instantly accessible to an authorised device in an emergency and therefore saves lives. The alternative is often written documents that are easily mislaid and can be read by anyone.

IMPEDIMENTS
The primary impediments to rollout of RFID in healthcare are limited budgets, inertia, lack of education, high cost of many RFID systems, limited number of companies providing systems integration (one stop shopping) and lack of trials and proven business cases for some types of application. However, this situation is changing very rapidly.

• For the report RFID in Healthcare 2006- 2016 see www.idtechex.com or email info@idtechex.com

• This article adds to the information contained in RFID and smart packaging in healthcare published in the May 2006 edition of The Clinical Services Journal.

Diary dates

• RFID Smart Labels Europe and Active RFID Europe, 19-20 September 2006, London, UK www.smartlabelseurope.com
• Active RFID Summit USA, 14-15 November, Atlanta, USA www.activerfidsummit.com
• Printed Electronics USA 2006, 6-9 December, Phoenix, USA www.printelec.com
• RFID Smart Labels USA 2007, 20-21 February, Boston, MA, USA www.smartlabels.com