May 10, 2013

Stop Saving the NHS: new book

Stop Saving the NHS cover (small).jpgWell I have done it. My book Stop Saving the NHS and Start Reinventing it has been published in Kindle and paperback. It's aimed at NHS leaders and managers, but will probably interest anyone who is interested in the shape of 21st century healthcare.

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September 30, 2006

RFID: mark of the beast?

Picture of Turkish angora kittenMad sorties across the sitting room on legs spinning like Tom's chasing Jerry in a Hanna-Barbera cartoon. Constantly supervising his hosts while giving them lots of affection: a Turkish Angora kitten has arrived at home. The breeder had him RFID tagged, which will identify him and may renunite him with us if he gets lost. It also helps the vet to maintain her records.

The thought of humans tagged in this way fills us with horror. Some allude darkly to the "mark of the beast" referred to in the Bible's book of Revelations. Others aren't concerned about eschatology and worry about tags on high street goods: could they be used to track us or our credit card use? Or could criminals target homes by scanning trash for the tags on the packaging of expensive new appliances, like TVs or mediacentres?

A previous post reported the ease with which encrypted data held on RFID tags on prototype passports had been accessed—so there is cause for concern. I recently chaired a seminar at Intellect, the UK IT industry's trade body. Delegates agreed that RFID tags should store only an ID number—which anyway is the original concept. Related patient-based data should be stored on more secure IT systems. This may give the anxious some comfort.

Mind you, some members of the Baja Beach Club in Barcelona are happy to be tagged with a subcutaneous Verichip for ease of entry and card and cash free payment. Cool for cats, maybe?

August 31, 2006

RFID: is the tag tipping?

rfid-tag.jpgToday there are two reasons to be anxious about RFID: that it may live up to expectations and that it may not.

Civil libertarians are concerned about a wide deployment of RFID and the security of data on tags, and with reason it seems.

In the recent edition of PC Pro, Paul Trotter looks at their concerns. Security experts working with Dutch TV quickly intercepted and cracked encrypted transmissions from a prototype passport’s RFID tag. This allowed access to personal information stored on the tag—a worrying development for the US, where RFID-tagged passports will be available in the next few months.

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March 23, 2006

Healthcare IT 2006

I apologise for not posting recently. I spent the first part of this week at Healthcare IT 2006, the annual conference and exhibition in Harrogate UK, listening, presenting and visiting suppliers.

This year the event lacked energy. Major suppliers were missing, as were exhibition visitors—I have never known the halls so deserted. Perhaps the purpose and format of the event must be revised, because it risks falling into terminal decline—which would be a great shame.

In the next few postings I will write about a debate in which I took part and a few interesting things I noticed on suppliers’ stands.

Rod from Informaticopia was at the event and here is his entry in the official blog about a tutorial I gave on RFID in healthcare.

January 10, 2006

Human effect of RFID

rfid-tag.jpgThe recent debate on CPOE brings to mind some of the human and cultural issues surrounding the introduction of new technologies and RFID in particular. Although the focus of RFID applications has been on tracking and tracing of goods and assets, the side effect is that you often end up tracking the activities of people.

Some years ago an RFID enabled weighbridge system was installed at a waste plant in North London to which several local authorities subscribe. The system works by fitting long-range active tags in the cab window of the waste collection vehicle so that entry can be gained to a weighbridge on entry and exit.

Before the RFID system was introduced the whole procedure was manual and slow. The new system allows data on quantity of waste disposed of, time, vehicle, authority, to be collected automatically saving time through the site and automating the billing process. However, the system was introduced with little regard for the waste collection operatives on the vehicle who viewed it with suspicion and saw it as a spy in the cab.

For some the reaction to this intrusion on their normal working practices was to prise the RFID tag off the window and throw it away. It took a little while for it to dawn on the operatives that the consequences of the system were in fact beneficial for them; they could get through the site quicker on each return and finish their rounds earlier. Still, it would have been better to bring the staff into the project from the outset.

See this article on the innovative use of RFID in healthcare.

December 17, 2005

RFID: what is it?

rfid-3.jpgMany articles on assume that readers know what Radio Frequency Identification (RFID) is. Items tagged with RFID can be uniquely identified at a distance using wireless emissions.

This published article gives an overview of healthcare applications of RFID.

There is also a good entry here on Wikipedia.

Image by kind permission of Precision Dynamics Corporation, California, USA.

December 13, 2005

RFID: closed or open loop?

RFID applications can be defined as closed or open loop.

Closed loop is where the item to which the RFID tag is attached is continuously recycled in a process, and the cost of the tag is amortised over many process cycles--making it a cost efficient way of deploying RFID technology.

Generally, if RFID can be deployed in an application where the performance gains are relatively clear cut it is often not too difficult to establish a cost benefit and business case. Often the standards issue and the type of technology is immaterial, particularly if the pay back is within 12 to 18 months--often the case for closed loop applications.

Many healthcare applications can be identified that fall into this category, including asset management (medical equipment, IT, beds, chairs, trolleys etc), patient tracking and identification (for procedures and medication), security and access control (for patients and staff).

In the open loop case, as with retail supply chains, the aim is to attach the RFID tag to the item at the beginning of its journey or process and wave goodbye to it. Bar codes have been deployed in this mode for over three decades and their cost effectiveness is well established. This cannot currently be said of RFID open loop applications in general and trials are still in progress.

The healthcare sector needs to understand that different RFID technologies and Auto ID (remember Automatic Identification encompasses linear, 2D barcodes and many other allied technologies for capturing information automatically) both have their role to play in diverse applications.

December 12, 2005

RFID: healthcare waiting for the holy grail?

RFID-1.jpgIt seems the healthcare sector continues to adopt a wait and see approach to RFID (Radio Frequency Identification) whilst the private sector deploys it in ever more diverse applications--not just tracking goods and assets, but also people and processes.

RFID comprises a wide range of technologies operating at different radio frequencies, using different operating principles (location finding, active/passive) and with a variety of available functions (writing as well as reading data, sensing, security, range).

In the supply chain arena there has been fast progress in the development of a global standard for RFID in retail supply chains (EPC Global), however standards are often used as an excuse for complacency. Continuing development of the technology, its diversity and ongoing development of standards will always mean that the healthcare sector will never find the holy grail of one technology with one standard set of characteristics that will fit all possible applications.

The healthcare sector needs to get a grip and begin to trial and deploy RFID where it has proven itself in industrial applications ranging from asset management through process control to logistics and supply chains. In these applications RFID has demonstrated for more than two decades a cost benefit or improved performance that increases customer satisfaction. There are many parallels and lessons for healthcare.

Photo by kind permission of Zebra Technologies Europe Ltd.

RFID: guest author introduction

Dr Carol David Daniel is a consultant with over 15 years experience in advising private and public sector organisations on Auto ID/RFID and its deployment for supply chain and asset management.

Carol will write for as a guest contributor.

December 04, 2005

Patient safety and wristbands

I went to a meeting organised by "Intellect" (the UK's trade association for the IT industry) recently. The National Patient Safety Agency (NPSA) launched an intitiative to increase awareness of the importance of patient wristbands in patient safety. Incorrect patient ID is thought to be one of the main causes of "patient safety incidents".

Chris Ranger, the NPSA's head of safer practice, used the case of Graham Reeves, who had his remaining healthy kidney removed by mistake, to illustrate the potentially tragic consequences of human error in healthcare.

Even those NHS trusts that use patient wristbands do so inconsistently: some blue for men and red for women and some the opposite, for example!

Barcodes have been used for some time in healthcare and are still a reliable stalwart for wristbands, but please see this amusing anecdote posted on the E-Health Insider website (look at the first comment at the end of the article)about how clinical staff can "innovate" with them.

Both Chris Ranger and Alison Terry of the National Audit Office mentioned RFID as a technology with the potential to improve patient safety, either by allowing more confident patient-ID or by helping to prevent wrong patient, wrong site errors.

The NPSA has launched a briefing paper (PDF) on the use of patient wristbands.

The NPSA says, however, that wristbands do not remove clinicians’ responsibility for checking patients’ identity. They are an important way of validating identification particularly when a patient is unable to provide their own details.

Like all aids to identification, barcodes and RFID carry the risk that we "believe" them; cross checking against the patient notes, or--as in the case of a Wi-Fi tag pilot in Birmingham Heartlands Hospital--with a photo on the EPR, is still essential.