Critical Elements and Lessons Learnt from the Implementation of an RFID-enabled Healthcare Management System in a Medical Organization

Healthcare services are complex and life-critical. One mistake in any procedure may lead to irremediable consequences; numerous researchers, thus, introduce information and communication technology to improve quality of services and enhance patient safety by reducing the medical errors. Radio frequency identification (RFID) is considered as one of the emerging tool assist in meeting the challenges of the present situation. In recent years, RFID has been applied in medical organizations for the purpose of managing and tracking medical equipment, monitoring and identifying patients, ensuring that the right medication is given to the right patient, and preventing the use of counterfeit medicine. However, most of the existing literature focuses on demonstrating how RFID can benefit the healthcare industry, whereas little attention has been given to the management issues involved in constructing an RFID project in medical organizations. In this paper, an exploratory case study is conducted in a medical organization to illustrate the development framework and critical issues that should be taken into consideration in the preparation, implementation and maintenance stage of constructing such a project. All the experiences and results discussed in this paper offer valuable and useful insights to steer those who would like to start their journey using RFID in medical organizations.     

A New Method to Guard Inpatient Medication Safety by the Implementation of RFID

Since life is invaluable, the patient safety is always an important issue. How to reduce the malpractices and advance the patient safety is the primary goal of many countries. The current problem is that the hospitals cannot quickly and precisely identify the name of medicine, the position of patient and staff and the servicing time and dosage taken by patients. The application of Radio Frequency Identification (RFID) is rocketing in popularity as varieties of expanded uses. However, due to the investment consideration, there are few cases that practically implement such a technology in healthcare industries. This paper presents a Wisely Aware RFID Dosage (WARD) system, which based on an integration of barcodes and RFID tags, to demonstrate effective and safe patient care environment, for preventing the risk of medication error. Finally, through an evaluation of users’ satisfaction, a reliability of 0.92 and a criterion-related validity of 0.82 show that this system is able to effectively construct the patient-safety-centric environment.     

Low Cost RFID Real Lightweight Binding Proof Protocol for Medication Errors and Patient Safety

An Institute of Medicine Report stated there are 98,000 people annually who die due to medication related errors in the United States, and hospitals and other medical institutions are thus being pressed to use technologies to reduce such errors. One approach is to provide a suitable protocol that can cooperate with low cost RFID tags in order to identify patients. However, existing low cost RFID tags lack computational power and it is almost impossible to equip them with security functions, such as keyed hash function. To address this issue, a so a real lightweight binding proof protocol is proposed in this paper. The proposed protocol uses only logic gates (e.g. AND, XOR, ADD) to achieve the goal of proving that two tags exist in the field simultaneously, without the need for any complicated security algorithms. In addition, various scenarios are provider to explain the process of adopting this binding proof protocol with regard to guarding patient safety and preventing medication errors.     

A Multi-Constraint Scheme with Authorized Mechanism for the Patient Safety

Many research works have attempted to introduce passive RFID technology into medical systems to reduce medical errors. However, most of these proposed works focused on identifying patients and objects. If an RFID based medical system is only good for identifying patients and medical objects but not capable of halting any medical process immediately, then it is not possible to prevent medical errors from happening. Our research focuses on a mechanism to detect and to avoid medical harm before it occurs to patients. In this paper, we propose to incorporate multiple-constraints into the authorization scheme and used this scheme as a basis for implementing a medical management system avoiding medical errors to assist medical staff. Specifically, our scheme ensures that a medical operation is if and only if enabled when the constraints are being satisfied that an “identified patient” is being treated by a “certified medical staff member” within an “authorized area”. In practical environments, our authorization scheme can be applied to various healthcare applications, and we develop a prototype system and test it in three applications: X-ray control, specimen collection, and blood transfusion management. The experimental results show that the system can be used to enable X-ray when the X-ray is in authorized location and operated by authorized operator. For the specimen collection and blood transfusion, the logs showing which medical staff has done specimen or blood transfusion on which patient at authorized location are correctly recorded into Hospital Information System (HIS). The locating process can be performed within 10 to 20 seconds, and the locating error is less than 2 meters.     

Radio Frequency Identification (RFID) in Health Care: Privacy and Security Concerns Limiting Adoption

Radio frequency identification (RFID) technology has been implemented in a wide variety of industries. Health care is no exception. This article explores implementations and limitations of RFID in several health care domains: authentication, medication safety, patient tracking, and blood transfusion medicine. Each domain has seen increasing utilization of unique applications of RFID technology. Given the importance of protecting patient and data privacy, potential privacy and security concerns in each domain are discussed. Such concerns, some of which are inherent to existing RFID hardware and software technology, may limit ubiquitous adoption. In addition, an apparent lack of security standards within the RFID domain and specifically health care may also hinder the growth and utility of RFID within health care for the foreseeable future. Safeguarding the privacy of patient data may be the most important obstacle to overcome to allow the health care industry to take advantage of the numerous benefits RFID technology affords.     

A Reliable RFID Mutual Authentication Scheme for Healthcare Environments

Connected health care provides new opportunities for improving financial and clinical performance. Many connected health care applications such as telecare medicine information system, personally controlled health records system, and patient monitoring have been proposed. Correct and quality care is the goal of connected heath care, and user authentication can ensure the legality of patients. After reviewing authentication schemes for connected health care applications, we find that many of them cannot protect patient privacy such that others can trace users/patients by the transmitted data. And the verification tokens used by these authentication schemes to authenticate users or servers are only password, smart card and RFID tag. Actually, these verification tokens are not unique and easy to copy. On the other hand, biometric characteristics, such as iris, face, voiceprint, fingerprint and so on, are unique, easy to be verified, and hard to be copied. In this paper, a biometrics-based user authentication scheme will be proposed to ensure uniqueness and anonymity at the same time. With the proposed scheme, only the legal user/patient himself/herself can access the remote server, and no one can trace him/her according to transmitted data.     

Deployment of Secure Mobile Agents for Medical Information Systems

Changes in global population and demography, and advances in medicine have led to elderly population growth, creating aging societies from which elderly medical care has evolved. In addition, with the elderly susceptible to chronic diseases, this together with the changing lifestyles of young adults have not only pushed up patient numbers of chronic diseases, but also effected into younger patients. These problems have become the major focus for the health care industry. In response to patient demand and the huge shortage of medical resources, we propose remote healthcare medical information systems that combine patient physiological data acquisition equipment with real-time health care analyses. Since remote health care systems are structured around the Internet, in addition to considering the numerous public systems spread across insecure heterogeneous networks, compatibility among heterogeneous networks will also be another concern. To address the aforementioned issues, mobile agents are adopted. With a mobile agent’s characteristics of easy adaptability to heterogeneity and autonomy, the problem of heterogeneous network environments can be tackled. To construct a hierarchical safe access control mechanism for monitoring and control of patient data in order to provide the most appropriate medical treatment, we also propose to use the Chinese Remainder Theorem and discrete logarithm to classify different levels of monitoring staff and hence, to grant permission and access according to their authorized levels. We expect the methods proposed can improve medical care quality and reduce medical resource wastage, while ensuring patient privacy. Finally, security analysis of the system is conducted by simulating a variety of typical attacks, from which it can be concluded that the constructed remote healthcare information system be secure.     

Deployment of RFID in Healthcare Facilities—Experimental Design in MRI Department

Patient safety has become an important issue due to medical errors. Some health care systems use Radio Frequency Identification (RFID) to identify patients during medical procedures. However, the RFID data readability especially depends upon the environment, an investigation of data reliability and signal loss is essential to making an effective deployment plan. The operation of Magnetic Resonance Imaging (MRI) is the major source of electromagnetic interference in the hospital. Therefore, this research conducts an experimental design of reading performance considering various notable factors in the MRI department. In addition to the readability experiment, this paper also measures the efficiency and reliability of implementing RFID technology in the MRI department using a simulation approach and helps hospitals by providing the measured outcomes.     

Patient safety and medical errors: a focus on care transitions of the vulnerable older patient

The delivery of quality medical care includes the reduction of patient exposure to potentially adverse events that can lead to unnecessary suffering and disability or possibly death. Elderly patients residing in long-term care facilities are often transferred to emergency rooms for evaluation and management of an exacerbation of a chronic medical condition or an acute injury. Studies show that nursing home residents may be at higher risk for experiencing adverse medical events that lead to serious patient safety and quality of care concerns. These risks may be attributable to lack of effective communication among caregivers who help transition patients across acute care settings. This article reviews some of the challenges inherent in a complex system of care as elderly patients traverse healthcare settings and discusses the need to create system wide changes that will help prevent medical errors and improve patient safety for an at risk vulnerable population.     

医学检验中的若干伦理问题及对策

针对目前医学检验中存在的检验医学伦理教育缺乏,部分医务人员未履行告知义务,报告单发放中暴露患者隐私等伦理问题,提出医学检验中应重视检验医学伦理教育、加强检验前质量控制、检验科废弃物应无害化处理、缩短样本周转时间、报告单发放需注意保护患者隐私、患者候检环境应充分体现人文关怀等应对措施。     

精细化管理在呼吸内科病房管理中的应用

随着社会的不断发展和医疗市场竞争的拓展以及越来越庞大的医院规模,导致日常医护流程牵涉的因素越来越多,为了向病人提供更加优质的医护服务,医院科室和部门之间需要通力协作。但实际上目前仍然存在一定的护理内涵不清晰和管理理念落后等诸多现象,使得临床观察与医疗诊断环节的脱节、医疗护理流程不规范或不适当造成不可逆转的小病变大病,无形中延长了治疗周期,增加了医疗费用。为了提高病人满意度和提高员工满意度内外两方面的效果,将流程优化、资源利用、质量及效率与效益结合,实现医院管理的精细化管理是一种有益的尝试。精细化的核心就是以病人为中心,减少相同的、无效的操作环节。近年来,我科室在规范化管理的基础上进行精细化管理,实现基础护理改善,患者满意度得到提高,科室从未出现任何严重的护理差错、事故,护理安全得到充分保证,患者得到优质的护理服务。     

支持临床决策的电子护理记录架构设计

由于病人日常护理产生的数据量大,手工纸质护理记录共享利用困难。电子护理记录对临床护理质量提升及减少护士重复性繁琐劳动具有重要作用,且能够支持病人医疗过程的临床决策。介绍了正在开发的临床电子护理记录系统架构设计,该系统支持病人医护过程中实时联机数据采集和护理决策,实现了不同临床信息系统数据源的整合集成,对医院电子病历应用发展有重要作用。     

医院临床路径系统的设计与应用

临床路径是对疾病诊疗活动的标准化,患者由入院到出院都遵照此标准流程接受治疗。通过开发临床路径系统来推动临床路径在医院的开展,包括路径定义、路径进入、执行路径、路径监管、路径完成和中止等功能,通过系统的应用来减少医疗差错,使患者获得最佳的医护品质。实践表明,临床路径是规范医疗行为、降低医疗成本和提高患者满意度的有效手段,医疗安全与质量指标得到显著提升。     

Cost containment and the physician

The rapid rise in health care costs is receiving a good deal of attention these days. Proposed responses include the deliberate rationing of expensive medical technologies, such as organ transplantation, and a redirection of our efforts toward preventive care. Although preventive care may improve our health, it cannot be assumed to reduce medical costs, since a later death may be as expensive as an earlier one. I suggest that a major and rapidly growing component of medical costs stems from the widespread application of tests and procedures when they are of no demonstrated benefit and may even be harmful. Identifying and curtailing such unnecessary medical care, rather than rationing beneficial technologies, should be the thrust of cost-containment efforts. Fee schedules should be revised so that they neither encourage nor discourage the use of tests and procedures; we should undertake systematic studies to assess technologies and practices; and we should make every effort to discourage the practice of defensive medicine. The involvement of physicians in rationing is not only premature; it is also inconsistent with our role as advocates for the health of our patients.     

Implement the RFID Position Based System of Automatic Tablets Packaging Machine for Patient Safety

Patient safety has been regarded as the most important quality policy of hospital management. The medicine dispensing definitely plays an influential role in the Joint Commission International Accreditation Standards. The problem we are going to discuss in this paper is that the function of detecting mistakes does not exist in the Automatic Tablets packaging machine (ATPM) in the hospital pharmacy department when the pharmacists implement the replenishment of cassettes. In this situation, there are higher possibilities of placing the wrong cassettes back to the wrong positions, so that the human errors will lead to a crucial impact on total inpatients undoubtedly. Therefore, this study aims to design the RFID (Radio frequency identification) position based system (PBS) for the ATPM with passive high frequency (HF) model. At first, we placed the HF tags on each cassette and installed the HF readers on the cabinets for each position. Then, the system works on the reading loop to verify ID numbers and positions on each cassette. Next, the system would detect whether the orbit opens or not and controls the readers' working power consumption for drug storage temperature. Finally, we use the RFID PBS of the ATPM to achieve the goal of avoiding the medication errors at any time for patient safety.     

5S管理模式在护理管理工作中的应用

目的：为探讨规范化护理管理模式,将＂5S＂管理模式运用于护理管理工作中,培养护士自律性,提高护理质量,确保医疗护理安全,达到护患双赢的目的。方法：制定＂5S＂管理活动计划、实施方案、考核标准,并对基础护理质量、护士综合素质等进行检测,患者满意度进行问卷调查,分析差异性。结果：实施＂5S＂管理活动的基础护理质量、物品随意取放率、患者满意度、护理差错发生率及患者满意度等与实施前相比,差异有统计学意义（P〈0.01）。结论：提示＂5S＂管理理论的持久应用,可营造整齐、清洁、美观、安全、舒适的工作环境,减少浪费,减少库存,提高工作效率,增加患者的安全感,提高患者满意度。     

大型三级公立医院门诊分时段全预约体系的建设

目的 随着就医需求的不断增长,优质医疗资源不能充分满足广大市民日益增长的实际需求。如何为患者提供方便,节约患者的等待时间,提高门诊工作效率是患者最关心的问题,也是大型公立医院普遍面临的问题。 方法 基于"互联网+"的大背景,本文通过探讨分时段全预约的就医模式,将每日的就诊时间以半小时为一个单位,根据不同科室的特点,设定每单位时间理论接诊人数,使每位患者的就诊时间能具体到分钟,并通过提供的预约挂号,使得患者在预约时便知晓自己待就诊的时间,具体了解挂号专家门诊时间,减少人员集中和滞留,进一步保障患者的就医安全,实现就诊人群的分流,改善就诊环境。 结果 上海交通大学附属第一人民医院南部结合医院门诊供需现状,继预约挂号之后,提出分时段全预约挂号体系,通过探索和实践,取得了良好的成效。该体系可有效提高门诊预约率,优化门诊患者时间分布,切实方便患者就医。 结论 分时段全预约多渠道模式的实施,有效改变了患者挂号习惯,提高了预约率,同时也改善了就医环境,使得医疗资源得到合理分配,利于医院的长久发展。      

A Novel Approach for Evaluating the Risk of Health Care Failure Modes

Failure mode and effects analysis (FMEA) can be employed to reduce medical errors by identifying the risk ranking of the health care failure modes and taking priority action for safety improvement. The purpose of this paper is to propose a novel approach of data analysis. The approach is to integrate FMEA and a mathematical tool-Data envelopment analysis (DEA) with "slack-based measure" (SBM), in the field of data analysis. The risk indexes (severity, occurrence, and detection) of FMEA are viewed as multiple inputs of DEA. The practicality and usefulness of the proposed approach is illustrated by one case of health care. Being a systematic approach for improving the service quality of health care, the approach can offer quantitative corrective information of risk indexes that thereafter reduce failure possibility. For safety improvement, these new targets of the risk indexes could be used for management by objectives. But FMEA cannot provide quantitative corrective information of risk indexes. The novel approach can surely overcome this chief shortcoming of FMEA. After combining DEA SBM model with FMEA, the two goals-increase of patient safety, medical cost reduction-can be together achieved.     

Equal partners: doctors and patients explore the limits of autonomy

In recent decades medicine--like all social institutions--has fallen from public trust. Managed care has made third-party payers a partner in the physician-patient relationship. Advocate groups, some lawyers, and bioethicists have encouraged patients to demand a greater voice in medical decisions. Physicians and patients are forced to relate to each other in a narrower range, and more of the physician's actions are being dictated and standardized. Physicians are often seen as a threat to the patient's autonomy and believed to be too paternalistic, authoritarian, and too concerned with profit to be reliable partners. A review and synthesis of the literature supports the view that patients prefer to have decisional control over outcomes but leave technical decisions on how to achieve those outcomes to physicians. Good medical care is a process of having one's autonomy respected and knowing when to relinquish it. Promoting patient autonomy as an ultimate value in medicine rather than recognizing it as one value among others (such as caring, trust, and honesty) is an error. The task of medicine is not to banish paternalism, but to preserve kindness and respect for the patient as a person.