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Right patient, Wrong Site—Right Technology?

rfid-healthcare-reader.jpgAnother tragic wrong site error in the UK remarkably similar to the Graham Reeves case referred to in this FHIT entry on patient safety.

That entry also notes that Radio Frequency Identification (RFID) may help to prevent this kind of right patient, wrong site error. The UK's Birmingham Heartlands Hospital is piloting RFID and W-Fi tagging and linking them to a picture of the patient on the EPR. I do not know the details of this pilot, but I would be surprised if it is a panacea, because the possibility of human error is not eliminated.

I listened to a talk the other day about the implementation of RFID in a hospital in the Netherlands. It confimed what I already knew: RFID application is still as much an art as a science. Even when readers are suitably located, tag and antenna alignment is still a problem. In addition, even if RFID could be used to trigger alerts, say in the operating theatre, they would have to compete with ambient stimulae and the noise of anaesthetic equipment, staff coming and going, respirators etc.

I am convinced that radio technologies are important in the evolution and integration of healthcare IT; I am still to be convinced that RFID will be any more than one of many of them.


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This is a rare event. All rare events are the result of a sequence of much less rare events (the probabilities of error multiply) - and the solution is to reduce the probability of all the steps by a relatively small (and cheap) amount. RFID's might help a bit with some steps but are not a cheap solution. No, this is a probem caused by sloppy process design not lack of technology.

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