By Tom Inglesby

	Image courtesy of Sculptor Developmental Technologies, Inc.

Radio frequency identification — RFID — is a well-tested technology in many industries. Major companies, such as Wal-Mart and the Department of Defense (DoD) have mandated the application of RFID to track shipments. That muscle eventually will cause other segments to test the waters of RFID for shipment and product tracking.

A pilot program, known as an electronic pedigree or ePedigree, was started in 2005 to track the popular pain killer OxyContin from the production line to the distributor and dealer. One reason was to prevent forgeries, another to track illicit sales (black market sales of OxyContin are among the highest in the country). RFID Update, an industry publication, explains that the system uses either RFID or barcoding to record each drug bottle's distribution history as it makes its way from manufacturer, through the wholesalers, down the supply chain, and, eventually, to the pharmacist's shelf. At every point in the chain, a bottle's shipment and receipt information is recorded, making a "certified chain of custody" which can be verified on-demand.

RFID Update adds, "The pharmaceutical industry has historically had a hard time fortifying its diffuse distribution networks from the infiltration of counterfeit drugs. Such drugs can slip into distribution at any of the thousands of small wholesalers around the country, and are then unwittingly sold as the real thing. The industry is drained of revenues, and, more frighteningly, customers consume pills that are not what they seem."

RFID makes sense because it allows the reading and writing of a small amount of information directly onto a tag attached to the object, whether it's a pallet of cases, a case of bottles, or a single dose blister-pack. Unlike many other products, the high prices for drugs can justify the item-level tagging cost required to make the system work.

Audit Legislation
Several states have legislation requiring some form of auditing for drugs; Florida's became effective this year. The Florida Department of Health designated SupplyScape, Woburn, Mass., as the first certificate authority for electronic drug pedigrees. Used to sign electronic pedigrees, these compliant digital certificates increase drug security and reduce cost throughout the drug supply chain, allowing trading partners to securely and automatically authenticate the pedigrees for their drug products.

Drug distributors and pharmacies must verify that each drug supplier has the proper license to distribute drugs — that is, they are licensed by Florida or another state as appropriate. Without the benefit of Florida-approved digital certificates, companies distributing pharmaceuticals are faced with manually confirming, or authenticating, the integrity of each drug's chain of custody back to the manufacturer, while the manufacturer is faced with servicing these manual authentication requests.

At the hospital level, pharmacies will be able to use the embedded data in the RFID chips on medicines — if they are equipped with the necessary readers and databases. This becomes what often is referred to as "the chicken-egg issue." Many hospitals cannot afford to implement the technology required to take advantage of the technology being made available in the marketplace. A lot of information is floating around that cannot be accessed without moderately sophisticated equipment; justifying that equipment isn't easy if the value of the data isn't known. How much more would patient safety improve if RFID tags could be read at the bedside, automatically updating the electronic records, informing the pharmacy and doctor of the administration, and detailing the charges on the patient's account?

RFID For Asset Tracking
Where RFID has made inroads in the hospital environment is in asset tracking, especially the high-value, portable or concealable items that can "walk off" without notice. Like the retail store's security screening system that catches tagged items as they move through a doorway, healthcare facilities can implement an exit RFID screening system to catch high-cost items inadvertently leaving the building. The same tags, called passive tags because they have no power of their own, can also be used to locate that equipment in a relatively small area, such as a storage room. If you want to find the equipment in the building, there are a variety of methods using active tags, those with a battery power supply, by using a handheld signal generator/reader or active wireless systems that "bathe" an area with signals and read the location of, and ID from, all tags in the area.

Brad Sokol, CEO of Fast Track Technologies, Chicago, Ill., is an RFID consultant and analyst. He explains, "A lot of people are talking about asset management right now, and most technologies that are being used on asset management are wireless or 802.11 compliant tags. They are active tags; they have a battery and they transmit a radio signal like RFID. If you want to look at just location and where something is, active is very good because it gives you the location within about 10 feet on either side. If you want to know granularity — in other words, know where it is within inches — then you need passive RFID. The key problem with passive is that, at best, you get a 10-foot range, where active, with a battery, you can get 100-foot range. Since there are pluses and minuses to each, the optimal solution would be to implement both."

He adds, "It costs less to implement an active system because it can use existing wireless networks in the building and the transmitting stations or readers are less expensive, but the tags are much more expensive. That expense means you want to make sure that you have high-margin products as well as life-saving products tagged with active tags. They can range anywhere from $20 to $60 a tag. Twenty dollars is on the low side by the way, very low, with an average of about $30 per tag more common.

"With passive, the reader or transmitter of information are much more expensive but the tags are very inexpensive — averaging about 30 cents today — which means you can tag a lot more items in the hospital. You don't need a high margin product to justify a tag."

Tracking Beyond Equipment
Equipment isn't the only thing that can be tracked with RFID. Patients and their medical records, for example, can have a tag attached, on the wristband in the case of a patient or on the clipboard or file folder in the case of the patient's chart. Sokol notes, "Currently patients are tracked by either active tags or passive tags. Documents in a hospital are being tracked with passive because it is cheap."

Although pharmaceuticals are tagged at some companies, at least at the pallet and case level, according to Sokol, "There are only 20 medicines that are currently being RFID tagged through the whole supply chain. That means, while RFID is available now, barcoding will not go away. The key reason is that roughly 70% of your supplies from the manufacturer are barcoded. In the total supply chain, it costs a hundredth of a cent to barcode something, while the RFID tag costs 30 cents — a huge difference."

The next stage in RFID applications in healthcare will augment the patient tracking and pharmaceutical tracking, adding CPOE or other electronic medical record management aspects to tighten up the audit trail. Again, Sokol sees expense as an issue. "What you are looking at is a phased-in approach for RFID, and as long as barcodes can keep up with the labeling requirements — and they are getting more intensive every day — barcodes will still be there as well. The FDA has come out and said, 'Either way we need to have some kind of traceability on pharmaceuticals.' The DoD has said, 'We need RFID on critical items.' DoD just entered its second phase of tagging items as of October 2006."

Looking Ahead
As with most technology, RFID isn't just a case of buy some equipment and plug-'n'-play. "First and foremost, you have to adjust the various processes," claims Sokol. "You don't implement technology for technology's sake; you need to establish the process. It is critical to have a radio frequency survey done of your hospital to find the areas of possible interference and the areas where hot spots will give you maximum range for reading. Most people overlook doing a site survey in advance of doing an implementation. Some people tend to just buy the equipment and start throwing it up without realizing what those interference points might be. By the way, you have to do that with passive tags as well as active because you could have spurious emission of certain frequencies that will prevent readability of your passive tags."

The future? Sokol sees it this way, "Much will depend on three factors: investment in IT infrastructure, government funding or supplemented funding for patient health records, and greater bandwidth. You are going to see a total penetration of active asset management tracking for life-saving devices as well as high-margin or high-priced products. I anticipate there will be a full penetration into that marketplace in the next five years because 95% of hospitals already have some kind of WiFi system."

He goes on to say, "The next thing that you are going to see depends on the regulations and mandates, but it probably will be patient tracking with both technologies, active and passive. That is really what is driving the patient safety aspects. After that? I'd say records management — tagging record boxes initially, followed by individual papers."

Then come some of the more innovative ideas. "You will start seeing RFID used for instrument and hazardous waste tracking," says Sokol. "It will depend on what happens with inspection regulations and infection control as for the instrument tracking. If the technology comes down to where it is low enough in cost per unit per item that they can show a substantial reduction in infections and adverse events, these two uses have a chance of taking over from pharmaceutical tracking as must-have applications."