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This is where bar coding and RFID technologies can be applied in complementary ways to address these challenges, which are more related to the clinical work- fl ow required to establish patient context than pure technology.


Clinicians are responsible for ensuring the devices are set up properly to enable data acquisition. And a compo- nent of the workfl ow requires PPID. The steps to scan the patient’s bar-coded wristband and to confi rm patient identifi cation are very important. But equally important is the step where the right devices must be confi rmed for a specifi c patient – especially when wireless devices, such as smart IV pumps, are used. This point-of-care workfl ow is referred to as positive patient association (PPA), which ensures the right devices are associated to the right patient. As a comparison to something


Brian McAlpine is director of strategic products at Capsule. For more information on Capsule solutions: www.rsleads.com/105ht-208


more common, this is loosely analogous to the medica- tion administration workfl ow (often referred to as “Five Rights”) that helps ensure that the right drug is admin- istered to the right patient at the right time. The optimal workfl ow is highly dependent on the type of clinical care area (ICU, OR, ED, etc.), the number and type of medical devices requiring connectivity to the EMR and the design of the device-connectivity applica- tion. There is no one-size-fi ts-all method of managing PPID and PPA. In some cases, such as in medical surgical care areas, there may be a requirement for a nurse as- sistant to collect data every four hours via a single spot- check monitor. In this use case, a single bar-code scan of the patient’s wristband and a confi rmation of the patient ID is all that would be required to enable the vital signs data to be sent to the EMR. In other use cases, it can be far more complex. By examining the PPA workfl ow more closely, and considering the number of devices requiring integration on a per-patient basis is increasing, then it starts to become more obvious that a workfl ow designed exclusively around bar coding can be challenging. The more things a clinician is required to scan, and also remember to scan, the more the workfl ow becomes an issue. Breakdowns in clinical workfl ow can lead to workarounds being created on the spot2,3 – and this contributes to potential errors. Technologies, such as ultra-high-frequency (UHF) passive RFID, have been proposed to complement the use of bar coding. When bar coding has reached its prac- tical limits for enabling the best workfl ow, RFID can be used to automatically sense all of the medical devices and the patient, thereby reducing the manual bar-coding steps required. Instead of applying a bar code to everything, inexpensive passive RFID tags can be applied. By auto- matically identifying or sensing the devices in proximity


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to the patient, the clinician can be proactively prompted to confi rm the patient-to-device association. This can reduce the number of steps required and simplify the overall workfl ow. Hospitals should think of auto-ID technologies as tools that can be applied to enable the right clinical workfl ow in each care setting. It is recommended that when evaluating solutions for medical device connectivity, the following areas be assessed as a best practice: • Determine the scope of your connectivity project, both short and long term. Recognize that eventually you will likely have to expand the scope to enterprise- wide connectivity. Evaluate vendors based on their ability to scale to very large implementations.


• Assess the range of devices that are candidates for connectivity. Determine if your vendor can provide connectivity “out of the box” or if they will have to develop compatible device drivers for some of the devices on your list. Also assess the method of con- nectivity for each device type, recognizing that there will be a variety of required connections, including serial/RS-232, wireless (typically Wi-Fi in devices such as IV pumps), and network-connected gateways (typically used for devices such as patient monitors and IV pumps).


• Based on the set of medical devices you intend to inte- grate in each care setting, assess the clinical-workfl ow impact when clinicians are required to set up devices to enable connectivity and determine the optimal workfl ow that can be achieved for managing how patients will be positively identifi ed and for how (and where) patient context (PPA) will be established.


• Assess the role of auto-ID technologies, such as bar coding and RFID. Work with your connectivity vendor to determine where each technology can be used and how the best workfl ow can be achieved.


• Recognize that your care environment is dynamic in terms of the number and types of medical devices, as well as the skill and training levels of the clinicians who need to deal with device connectivity-related issues.


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1. The Joint Commission. Critical Access Hospitals: 2011 National Patient Safety Goals, http://www.jointcom mission.org/cah_2011_npsgs/.


2. Kobayashi, M., Fussell, S. R., Xiao, Y., & Seagull, J. (2005). Work coordination, workflow, and work- arounds in a medical context. CHI Late Breaking Results. New York: ACM Press. (Accessed via Internet at: http://citeseerx.ist.psu.edu/viewdoc/download?do i=10.1.1.71.6384&rep=rep1&type=pdf).


3. Halbesleben, Jonathon R. B.; Wakefi eld, Douglas S.; Wakefi eld, Bonnie J. (2008). Work-arounds in health- care settings: Literature review and research agenda.


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