Using RFID for Cath Lab Inventory and Usage Data Capture

Halsey Bagg, MSHS, CHE, Director Cardiology Services, St. Elizabeth Medical Center; Co-Coordinator, Mohawk Valley Heart Institute, Utica, New York
Halsey Bagg, MSHS, CHE, Director Cardiology Services, St. Elizabeth Medical Center; Co-Coordinator, Mohawk Valley Heart Institute, Utica, New York
There is a lot of buzz circulating about RFID right now. What is RFID and how does it help hospitals and, specifically, cath labs? Radio Frequency Identification, or RFID, is a means of identifying a specific object through the use of a unique identifier. Identifying information resides on a freckle-sized computer chip that is generally contained on a tag or label. Soon, label makers will begin to incorporate this technology into printed labels themselves. The two primary types of RFID tags currently available are active tags and passive tags. Active tags are designed to track movement and location for high-value, permanent items, and are frequently used for asset tracking (e.g., medical equipment, furniture, and computers). Passive tags are more often used for consumable items (e.g., balloons, stents, and pacemakers). The low cost of the tags (about 40 cents each) makes this an ideal application for consumables because they can be thrown away with the packaging. There are two categories of RFID systems used in hospitals today: asset tracking and consumables tracking. This article focuses primarily on a consumables tracking system, as illustrated by the following case study. Background Located in Utica, New York, St. Elizabeth Medical Center collaborates with Faxton St. Luke’s Healthcare to provide cardiac services organized under a hospital corporation called the Mohawk Valley Heart Institute (MVHI). Each year, the MVHI performs over 1,400 PCIs and 3,600 diagnostic caths. There is one diagnostic cath lab at St. Luke’s Hospital and two diagnostic/interventional cath labs at St. Elizabeth Medical Center. In May 2005, a company called WaveMark, the developer of an inventory control system based upon passive RFID tags, presented to St. Elizabeth Medical Center (SEMC) a proposal for improving inventory control in the cath lab. There was an initial hesitancy based upon the barrage of proposals that are constantly being presented to cardiology services. In the past, various vendors had proposed bar code inventory control systems that would allow scanning of inventory upon receipt and again upon usage, but there was never any interest from the hospital in purchasing one of these systems. There was knowledge of other cath labs using these bar code systems without a lot of success because of the labor required to actively scan items. However, the initial skepticism was immediately removed when it was learned there would be no scanning required and WaveMark wanted to use St. Elizabeth Medical Center’s cath lab as a test site. SEMC agreed to participate, as the risk was low and at the very least the cath lab’s inventory control clerk would learn computer skills and a perhaps some new inventory control concepts. Use of the RFID System The initial trial began in July 2005. SEMC installed network and power lines in the designated locations. Two shelving units were delivered to the hospital and installed in the storeroom and in one of the cath labs. The device manufacturers had already begun placing the RFID labels on angioplasty balloons and coronary stents, so that after the shelves were plugged in and tested, all that had to be done was to physically place the boxes on the shelves. The RFID tags that are on the boxes have a unique number that is recognized by the antenna in the WaveMark shelving. The antenna captures the item’s ID and transmits the information to a computer server at WaveMark. The database is refreshed every twelve minutes, and users can access the inventory data via a web browser at any time. User names and passwords ensure that data access is on a strictly need-to-know basis. SEMC’s cath lab now tracks 23 product families and has 730 tagged items on the shelves. SEMC uses an average of 430 items per month, so stock is being turned about six times a year. The site test is now complete and the device manufacturer is no longer placing the RFID labels on its supplies. The cath lab inventory control clerk now does on-site tagging of items. Placing the RFID labels on the items takes about twenty minutes per day, significantly less time than previously spent doing daily counts. The cath lab inventory control clerk, formerly unfamiliar with computers, has become proficient in using the reports. She accesses the WaveMark replenishment report daily to produce an order for the purchasing department. The replenishment report includes items that are in transit to the hospital, so that only the items needed are ordered. When initially setting up the system, the target inventory level was set based upon the inventory clerk’s gut feel. With one year’s accumulation of data, it is now possible to produce a reliable report on maximum daily usage for any given item size, which allows SEMC to develop more accurate target inventory levels. The total number of angioplasty balloons for the sponsoring device company was originally set at 165. By following the analytically produced new targets, the total is now at 101. Interestingly, some of the Stock Keeping Units (SKUs) actually have a larger suggested target size than was originally anticipated, but overall inventory reduction comes to 33%. SEMC’s cath lab inventory control clerk also uses WaveMark to keep the cath lab room stocked, since she can now see via the system which items were used in a case and can quickly replace those items between cases. There are no issues with patient confidentiality (the Health Insurance Portability & Accountability Act, HIPAA) due to the fact that no patient information is involved. The WaveMark inventory control system works very well for products on consignment, especially for items that have short shelf lives, such as drug-eluting stents. The WaveMark system stores each item’s expiration date. Users can see how many items will expire in 30 days (default) or any other timeframe, and where those items are located. The vendors consigning the products, as well as the hospital, have access to real-time inventory levels. Some of the vendors have policies that allow credit for items that do not perform well during a procedure. It can take weeks to get that replacement item and match it with the credit due. With the current system, the vendor and the hospital have a shared database of credits and returns. Another appreciated feature is the ability to download reports into a MS Excel spreadsheet, which allows for calculations of the total dollar value of inventory at any one time, or the cost of inventory for any period of time. WaveMark does not charge for any capital equipment or information technology system purchase. Instead, hospitals pay a monthly user fee for access to the data. This frees the hospital from responsibility for equipment maintenance and system upgrades. WaveMark is responsible for data accuracy and reliability. In March 2006, SEMC became one of the first customers of WaveMark. This decision was predicated on WaveMark’s ability to install a point of service (POS) reader in the control room that would verify usage, and its promise to interface the POS reader to the hemodynamic monitoring system. The POS reader was installed in March 2006, and since then, the technologists and nurses have been verifying usage of items leaving the WaveMark cabinet by waving the item in the vicinity of the POS reader. In August 2006, the interface with the hemodynamic monitoring system was completed. Each time an item leaves the WaveMark shelf, it is in a pending status. The item stays in this pending status until someone waves it in the vicinity of the POS reader. Any item in the pending status after the procedure in over is immediately known to the inventory control clerk, who then gets involved with determining what has happened to it. Using the WaveMark reports helps capture use of a stent or balloon during the procedure for more accurate billing and/or locating items that have been misplaced. Figure 1 is a screen capture image of a website report showing the pending items at one point in time. This new way of using RFID to control inventory has been an exciting addition to the St. Elizabeth Medical Center cath lab. SEMC is now able to reduce inventory and better control the use of items that do not perform well during a procedure, while reducing the manual work of inventory tracking. The Mohawk Valley Heart Institute is now considering placing a cabinet at the St. Luke’s cath lab so the expensive inventory can be managed without using precious clinical time or adding an inventory control position. This product has potential for many other areas of the hospital, such as the electrophysiology lab, operating room or any other area where there is consumable inventory of high value.