TRIMEDX President of Clinical Asset Management Jim McCoy was recently featured in a 24x7 magazine article about the evolution and future of real-time location services (RTLS) for medical equipment. McCoy discusses how RTLS can streamline processes and ultimately enhance patient care. The full article, as it appeared Sept. 14, 2023, is below.
Real-time location systems (RTLS) have evolved rapidly in recent years, becoming a key tool in hospital’s arsenals. These innovations have not only streamlined hospital efficiencies but have also played a crucial role in enhancing patient care and safety.
Below, six individuals with a vested interest in the medical RTLS segment—Rom Eizenberg, chief revenue officer of Kontakt.io; Scott Hondros, vice president of customer excellence and strategic consulting, CenTrak; Howard Hatcher, chief technology officer of Vizzia Technologies; Jim McCoy, president of clinical asset management, TRIMEDX; Byron Webster, CEO of smart position Inc. USA; and Timothy Wildman, chief solutions officer at Sonitor Technologies—reveal what HTM professionals need to know about RTLS solutions.
24×7 Magazine: What’s the hottest thing in RTLS right now and how far have these technologies come?
Rom Eizenberg: To date, RTLS has gone through almost three iterations. The last iteration/generation, still offered by some vendors, came out in the early 2000s. Their architecture is based on on-premise computers and servers, and proprietary radios. Those products do a good job, but they only work with the specific vendor’s technology infrastructure that you purchase. This is very costly and complex for smaller hospitals with 200 beds and below, which comprise most of the U.S. health systems. As a result, over the past 15 years, RTLS in healthcare has been the domain of the few rich, large hospitals.
Today, a new RTLS generation is emerging, powered by open Bluetooth technology.
Driven by an open standard, Bluetooth low energy, or BLE, is being adopted by every new access point, from Cisco to Juniper Networks to other vendors. This makes RTLS much more affordable, forcing vendors to innovate and bringing the negotiation power back to health systems.
Howard Hatcher: Agreed. More equipment manufacturers are introducing a variety of inexpensive BLE devices. In fact, the Vizzia IoT Lab at the University of New Mexico is testing several new sensors to ensure they can achieve the clinical-grade requirements that hospitals demand for room-level accuracy as opposed to zone-level.
Timothy Wildman: BLE is definitely the hottest thing in RTLS right now. This technology has extended battery life and dramatically reduced costs, driving them down from more than $2,000 per room to $500 per room. The technology’s main use is in applications where room-level or high-accurate location (e.g., more than 99%) is not required. Examples include asset tracking and “moment-of-duress” applications, which are increasing in healthcare facilities [due to violence]. Moment of duress is defined as a system which provides no tracking and only provides the identity of an individual and their location when the duress button is pressed.
Byron Webster: RTLS technologies have evolved significantly in recent years, driven by advancements in hardware, software, and communication technologies. Some key trends and developments in the field include integration with the Internet of Things, improved accuracy, scalability, improved battery life, [the proliferation of] cloud-based solutions, and security. With the increasing use of RTLS in critical applications, security has become a paramount concern. So, encryption and authentication mechanisms are being implemented to protect location data from unauthorized access.
Jim McCoy: Within the last few years, RTLS technology has made significant strides, enhancing location data accuracy, reducing technological complexity, and significantly lowering costs. As a result, there’s a renewed interest in using RTLS for more applications in healthcare.
The most promising application is for the tracking and management of the thousands of medical devices hospitals have throughout their facility. RTLS technologies have evolved to now be able to track thousands of tagged clinical assets with a high degree of accuracy without financially or operationally burdening the healthcare organization. What was once a cost-prohibitive technology can now be leveraged to drive down capital and operational costs through more efficient medical equipment management, while simultaneously support improvements in device availability and overall patient care experiences.
Scott Hondros: Two things come to mind. At CenTrak we have a “clinical-grade,” or room-level, locating technology that has been well-established within our solutions for years. We’re looking forward to greater developments in the realm of multi-mode and BLE that can offer pinpoint-location accuracy required to drive healthcare’s most advanced automation use cases.
We’re also at a point in our society where the conversation surrounding artificial intelligence and machine learning is happening now more than ever. The crisp data insights we’re able to capture with accurate location technology at CenTrak empowers our customers, supports healthcare professionals, and helps facilitate better patient outcomes. The data generated isn’t solely being used to see where a patient or piece of equipment is in real time, but also for robust historical analytics, to identify bottlenecks and uncover predictive trends for enhanced clinical workflow and improved patient experiences.
24×7: How does RTLS affect the cost-effectiveness and resource management of medical equipment in healthcare facilities?
Wildman: The use of RTLS in resource management of medical equipment is divided into two categories: asset tracking and asset management. The value of asset tracking is to allow individuals to find and locate equipment in real time. This can improve the utilization of staff who may be searching for equipment—for instance, nursing, maintenance, inventory control. Equipment utilization should also improve because equipment can be located faster.
Asset management is a level up from asset tracking in that it automates and measures the true utilization of assets. This is accomplished through the monitoring and proactive notification that require human intervention to improve asset utilization. These features include, but are not limited to, Periodic Automatic Replacement (PAR) level asset management on a unit floor, asset elopement to reduce asset theft, and equipment status—i.e., “clean,” “dirty,” “in use,” etc.
Webster: RTLS greatly improves cost and resource management of medical equipment in healthcare. Here are three key benefits:
- Asset Tracking and Utilization Optimization: RTLS enables healthcare facilities to track the real-time location of medical equipment such as infusion pumps, wheelchairs, ventilators, and more. This tracking ensures that equipment is efficiently utilized and not lost or misplaced, reducing the need for costly replacements or rentals.
- Reduction in Equipment Loss and Theft: By providing constant monitoring and alerts for equipment movement, RTLS helps prevent theft and unauthorized removal of valuable medical devices. This reduces the need to repurchase stolen equipment, which can be a significant cost savings.
- Preventive Maintenance: RTLS can track the usage and maintenance history of medical equipment. It sends alerts when equipment is due for maintenance or calibration, reducing the risk of breakdowns, costly repairs, and ensuring equipment is always in working condition.
McCoy: Each year, health systems spend a quarter of their capital budgets on purchasing new medical equipment, yet clinicians and equipment teams still spend hours per shift searching for needed devices. Additionally, several utilization measurement methods have shown the average utilization rate for medical equipment in hospitals is only 40% to 50%. So, there is a challenging paradox where hospitals have more equipment than they use, yet it never seems to be where it’s needed.
With the ability to track medical equipment in real time, hospitals can start to paint a picture of where and how their medical devices are used and how they migrate over time. From a labor productivity standpoint, this data can be used to help frontline workers easily locate and secure essential medical equipment for immediate patient needs. Additionally, equipment management and clinical engineering teams can reduce time-consuming, manual processes and adopt more efficient equipment management processes that drive faster service turnaround times, more accurate PAR room levels, and lower labor costs. Plus, TRIMEDX internal studies show that RTLS technologies can reduce the search
Hondros: By using RTLS tags to ensure the correct equipment is in a patient’s room when a staff or clinician enters, providers can maximize their time and, ideally, see more patients throughout the day with higher-quality interactions. Instead of spending time looking for equipment, staff members/providers can immediately focus on the patient’s needs. Efficiently managing mobile medical equipment provides insights that directly enhance patient care, clinician scheduling, and equipment cost savings.
Eizenberg: On average, U.S. hospitals utilize [less than half] of their medical equipment. Even so, hospitals still over-purchase or rent more than they need because of “missing equipment” that is misplaced or hidden, costing them billions of dollars. Nurses and biomeds spend hours looking for ready-to-use equipment each week, resulting in a loss of productivity. RTLS can show the location and status of medical assets and let hospitals create streamlined workflows and automated processes. So, hospitals can optimize supply and demand, eliminate waste, and save costs.
Hatcher: As the average number of devices per hospital bed has increased to 15, utilization rates of medical equipment only average 42%. After a RTLS solution is deployed in a hospital, utilization rates of equipment typically increase to 75% or greater. This results in a reduction of the rental fleet size and lower equipment purchases. The additional benefits include reduced search time by nurses, who spend up to one-hour per shift looking for equipment, and biomeds trying to locate devices for PMs and product recalls.
24×7: Can you provide examples of medical devices where RTLS is particularly beneficial, and how does RTLS enhance their functionality?
Hatcher: Expensive, movable medical equipment that is well suited for RTLS includes IV pumps, respirators, ventilators, crash carts, and portable radiology devices. These high-value devices are in demand by nurses and doctors in an acute care facility. Having the right quantity and availability in clean storage for clinicians to utilize increases staff satisfaction and enhances patient care.
Eizenberg: Definitely IV pumps. Hospitals use IV pumps for 90% of their patients. So, the availability of this equipment is mission-critical. RTLS helps nurses quickly find nearby, available IV pumps whenever patients need them, improving patient outcomes. It uses real-time data to get insights into how IV pumps are being utilized, where they’re most needed, and how many pumps the hospital needs. It helps manage PAR levels and reduces unnecessary equipment purchases and rentals. Other assets benefitting from RTLS include wheelchairs, hospital beds, respirators, and Tele Pack.
Wildman: Nurses often spend a lot of time searching for high-demand assets like bladder scanners. Locating devices through their phone significantly saves nurses time, especially during the current nursing shortage. While both stationary and movable medical equipment (MMEs) can be tracked, MME like infusion pumps, sequential compression devices, and wheelchairs are more commonly tagged with RTLS than stationary equipment. These devices, often stored in PAR locations, have crucial statuses and a higher risk of being taken out of the building. The primary benefit of RTLS for MME is automating asset management for high utilization.
Webster: For starters, infusion pumps—RTLS tracks the location and status of infusion pumps, sends alerts for maintenance, and helps nurses and clinicians quickly locate the nearest available pump, improving patient care and reducing downtime. Also, RTLS can enhance the functionality of wheelchairs and patient transport devices, ventilators, defibrillators, mobile medical carts, patient monitors, surgical instruments, and mobile medical equipment like C-arms.
McCoy: The most impactful use of RTLS is managing mobile medical equipment.
Over 90% of hospital medical equipment is mobile and can be moved throughout the facility or between facilities. The ability to find mobile equipment that is constantly moving around has long been a challenge for nurses and clinicians. As a result, many hospitals have invested in resources like MME teams that constantly roam the halls looking for available devices to meet PAR-level needs. RTLS provides the technological capabilities these teams desperately need to easily monitor and replenish PAR rooms, ensuring clinicians always have equipment access. This can also help solve the erroneous perception of equipment scarcity that leads to over-purchasing or over-renting.
Hondros: RTLS can drive an enormous amount of value that is passed onto clinicians, patients, procurement teams, and support staff across the organization. Knowing the utilization of each device when considering purchases and rentals can have a tremendous impact on the bottom line of a health system or facility. RTLS can show what’s in a room, how it’s leveraged, and if it has been properly cleaned.
24×7: What are the top issues that hospital leaders are looking for your RTLS solution to address?
Wildman: Increasing staff and equipment utilization. After all, higher utilization leads to lower costs. For staff, this can be measured in overtime pay, staffing ratio to patients, and more. And for assets, this can be measured in lower capital or operational expenses by purchasing less replacement equipment and/or reducing the rental budget.
Eizenberg: Besides asset tracking and management, hospitals look for RTLS solutions to protect staff safety, monitor hand hygiene compliance, see how patients flow and eliminate service bottlenecks, prevent patient elopement, and improve patient experience. Essentially, they are looking to optimize operational efficiency and enhance experience.
Hondros: In the post-COVID environment, resourcing and staffing challenges have grown and increasingly land on the shoulders of frontline staff. By offering frontline workers a staff duress solution, healthcare systems are utilizing RTLS badges as a support tool as well as a recruitment and retention plan for nurses. By leveraging staff duress badges, healthcare professionals can send an alert notification quickly and subtly with their real-time location to the facility’s security team. Moreover, healthcare facilities and leadership are seeking to reduce costs without cutting corners. We’ve seen the ways RTLS can help inform decisions for the utilization of MME. Device reallocation and cost-avoidance are crucial amid financial uncertainty. Clinical throughput is also a “big mover” to make an impact on the bottom line. CenTrak’s Workflow application is custom-tailored to clinical workflow, such as surgical, oncology, and the emergency department. Clinicians can see more patients and improve care quality, and hospital leaders support these solutions when they recognize the ROI and impact.
Webster: The top issues that hospital leaders typically look for RTLS solutions to address include asset management, patient safety, workflow efficiency, infection control, equipment maintenance, regulatory compliance, data analytics, security, and more. Also, Enhancing the patient experience is a key goal for hospitals. RTLS can help by reducing patient wait times, improving the accuracy of medication administration, and ensuring timely responses to patient calls. Overall, hospital leaders are looking for RTLS solutions that offer a holistic approach to addressing their challenges, enhancing operational efficiency, and providing a strong return on investment. Even so, priorities can differ between hospitals based on their individual needs and situations.
McCoy: The most pressing challenges that healthcare leaders face today are labor shortages and costs, as well as overall financial health. At TRIMEDX, we strive to help our clients develop innovative and adaptable solutions to address these challenges by leveraging our robust combination of people, processes, and technologies. Technology is only one piece of the puzzle, and it doesn’t solve problems on its own. RTLS technology can significantly enhance a clinical asset management solution, but we’ve seen that without the proper people and processes to effectively manage the solution, the full potential will go untapped.
Hatcher: Healthcare workers face personal safety risks, staffing shortages, and burnout. Staff safety is top of mind for hospitals leaders, as workplace violence is four times more common in healthcare than in other professions. Vizzia offers a silent staff duress alarm, which provides room-level accuracy to immediately report the exact room location to designated security personnel, enabling them to provide immediate help.
24×7: Are there any new applications or application programming interface (APIs) that your company has added to its platform?
Webster: APIs have significantly transformed the way RTLS technologies interface with medical devices; electronic medical records (EMRs); and Systems, Applications, and Products, or SAP applications; creating more seamless and integrated healthcare workflows. Here’s how APIs have influenced these interactions:
1. Integration with Medical Devices- Data exchange: APIs enable RTLS solutions to integrate with a wide range of medical devices, such as infusion pumps, patient monitors, and ventilators. This integration allows real-time tracking data from these devices to be seamlessly communicated to the RTLS system.
- Alerts and notifications: RTLS APIs can trigger alerts and notifications based on the location and status of medical devices. For instance, if a device is nearing its maintenance due date or if it’s moved to an unauthorized area, the API can send alerts to relevant personnel, ensuring timely action.
- Patient safety: When integrated with medical devices, RTLS can enhance patient safety. For example, it can alert healthcare providers if a ventilator is disconnected or if a patient’s vital signs are out of the normal range.
- Automated data entry: APIs facilitate the automatic transfer of real-time location and status data from the RTLS system into the patient’s electronic medical record. This eliminates the need for manual data entry, reducing the risk of errors and improving data accuracy.
- Enhanced patient care: EMR integration allows healthcare providers to access location information within a patient’s record.
- Supply chain management: Integrating RTLS with SAP applications streamlines supply chain management. APIs enable real-time tracking of medical devices and inventory, ensuring that supplies are available when and where needed.
- Resource allocation: SAP integration with RTLS data helps healthcare organizations allocate resources efficiently. Whether it’s personnel, medical equipment, or supplies, real-time location data assists in making informed decisions about resource allocation, improving overall operational efficiency.
- Data accessibility: APIs provide a means for extracting real-time location data from the RTLS system, which can be used for data analytics within EMR and SAP platforms. This data can be analyzed to derive valuable insights, identify trends, and make informed decisions about patient care and operations.
- Compliance and reporting: The integration of RTLS data with EMR and SAP applications can simplify compliance with regulatory requirements. APIs enable the creation of reports and documentation necessary for audits and inspections.
5. Workflow Optimization:
APIs allow healthcare organizations to create customized workflows based on real-time location data. This can help optimize patient flows, improve asset management, and enhance resource allocation.
Hatcher: Vizzia continues to integrate our InVIEW data analytics platform into other hospital workflow solutions, such as electronic health records and the leading CMMS providers. To support our trusted partner status, Vizzia recently earned System and Organization Controls 2 Type II compliance certification. This compliance milestone demonstrates Vizzia’s commitment to its clients by ensuring that their mission-critical data is trusted and secure.
Hondros: Earlier this year, CenTrak launched WorkflowRT, a scalable cloud-based solution that automates workflow and communications to alleviate the burden of manual documentation required throughout each phase of clinical care. The automation features—patient self-check-in, extended wait time notifications, family text messaging for proactive status updates, and real-time location display boards—eliminate non-value-added tasks. The software offers historical metrics that empower decision-makers to improve healthcare systems, reducing patient wait times, giving clinicians more time with patients, and enhancing staff and patient satisfaction.
McCoy: Our approach to RTLS is to maximize the flexibility and functionality of the technology to enhance the clinical asset management solutions we provide to our clients. We can work with any RTLS provider hospitals use, integrating and utilizing their asset location data. By integrating RTLS data with our CMMS and analytics platforms, we can infuse and strengthen the insights and recommendations we provide to clinical engineering and MME teams, as well as directly to healthcare leaders, to help them make the most objective and data-backed decisions.
Wildman: In addition to Sonitor Ultrasound (SonitorULE) high precision locating, we have launched two new infrastructure technologies this year: SonitorBLU and SonitorMobile. The first, SonitorBLU, is a BLE solution reducing infrastructure costs to below $500 per room. The second, SonitorMobile, uses an IOS- or Android-based phone to provide high-precision location tracking. We’ve also introduced a series of RTLS-based applications, including staff rounding and duress, asset tracking and management, environmental monitoring, and hand-hygiene monitoring for Leap Frog compliance.
Eizenberg: Our solutions are cloud-based and designed to be API-first, which we believe should be the current standard for RTLS. At Kontakt.io, we deliver more than 20 different use cases to digitally transform workflows, resources, and processes across three main domains:
- Assets: Asset tracking and management
- Staff: Staff safety, staff workflows, hand-hygiene compliance, transport management, etc.
- Patients: Patient flow, patient elopement, indoor navigation, patient room display alerts, etc.
Each of the use cases builds a brick of value and yields quick ROI to optimize efficiencies and make the lives of staff and patients better. Step by step, as hospitals launch more use cases and get more data, they will eventually gain full visibility of how patients, staff, clinical spaces, and assets interact along the care delivery journey from patient intake to discharge.
24×7: What’s next on your solution roadmap, which will improve operational efficiencies?
Hondros: CenTrak’s intuitive software applications will continue to move to a cloud-based platform from on-premises servers, which provides the end user with simplified installation, reduced IT maintenance, and automatic upgrades and enhancements. Also upcoming is a redesigned product line of multi-mode tags and badges that are compatible with BLE networks, extend battery life, and simplify maintenance activities—offering several operational efficiencies for end-user support staff who are responsible for managing the facility’s RTLS.
Eizenberg: We are constantly innovating our solutions and thinking beyond just RTLS. One big focus is to:
- Integrate data lakes and large data processing capabilities to drive better decisions
- Integrate AI process mining to scan through millions of interactions, processes, and resources along the care delivery journey. Bringing all this data together and using machine learning-powered analytics to cut through the noises will have a meaningful, far-reaching impact. It can help predict hospital capacity and better orchestrate care operations and systems.
Hatcher: Vizzia has conducted a successful machine learning pilot at a state-of-the-art, 500-bed acute-care trauma hospital in California. The pilot yielded substantial operational improvements across several inventory KPIs to include up to a 52% improvement in key out-of-stock metrics and reduced overstock rates by up to 20%.
Wildman: Later this year, Sonitor will introduce a cost-cutting infrastructure component for Sonitor Sense ultrasound technology. Then, in 2024, we’ll release a backward-compatible next-generation infrastructure, a groundbreaking development that we’ll unveil when the time is right. Sonitor’s strategic goal is to continually reduce the cost of RTLS so that it becomes a standard infrastructure that’s as common as Wi-Fi.