VA Real Time Location System (RTLS) Overview Zack Smith, MS

(1)

v

VA Real Time Location System (RTLS) Overview

Zack Smith, MS

VISN 1 RTLS Program Manager, VHA RTLS Asset Tracking Co-Chair

Andrew J. Mazotas, MS, PMP

Clinical Engineer, National VHA RTLS PMO

(2)



_Overview



Applications



Asset Tracking



Cath Lab Supply Management



Sterile Processing Workflow



Temperature Monitoring



_{Governance and Deployment}

(3)

Veterans Affairs

“To care for him who shall have borne the battle and for his

widow and his orphan.”

(4)

Healthcare Efficiency

Transformational Initiative

• Improve Patient Care

• Improve Staff Efficiency

• Improve Staff Satisfaction

• Optimize Inventory and

Equipment

• Improve Managerial Decision

Support

Patients Staff Medical Equipment Supplies

VA RTLS Goals

(5)

Largest direct care

healthcare system in

U.S.

• 8.3M+ Veterans cared for each year

• 152 Medical Centers

• 1400 Other Facilities

• $5.6B+ of Medical Technology

RTLS Infrastructure with multiple applications to be

deployed VA-wide Dec 2012 – Dec 2017

Veterans Integrated Service Networks (VISNs

)

(6)

Healthcare RTLS Use Cases - Examples

Asset Tracking _ManagementBed Biological _Implants Blood Bank _WorkflowDietary

Emergency Department

Workflow

EMS Workflow Hand Hygiene _{Records Tracking}Hard Copy Non-Biological _Implants

Organ Tracking Transplants Outpatient Care Patient Workflow Pathology Specimens Patient Elopement and Wandering Patient Fall Notification Pharmaceuticals Primary Care Patient Workflow Research Sterile Processing Workflow Supplies Tracking

(7)

• Niche Solutions in Single Hospital

–

Mobile Assets

– Active Wi-Fi + IR

–

Immobile Assets

– Passive UHF

–

Cath Lab Supplies

- Passive HF

–

Instruments

- 2D Barcodes

–

OR Staff/Patients

– Active 900MHz + Ultrasound

–

Hand Hygiene Staff

– Active 433MHz + LF

–

Long Term Care –

Ultra Wide Band

• Example Issues

–

Redundant

–

Costly

–

Interactions difficult

7

(8)

8

Tag 1

Tag 2 IR Beacon

Vendor A IR Beacon Vendor B 433MHz Access Point Vendor A 900MHz Access Point Vendor B

RTLS: Lack of Interoperability

(9)

RTLS = Real Time Location System

Veterans Affairs Applications

RTLS Active

Tag

Here it

is!

Base Asset Tracking (AT) Cath Lab Supply Management (CL)

Temperature Monitoring (TM)

Sterile Processing Workflow (SPW)

Developing Emergency Dept.

Workflow (EDW) Hand Hygiene (HH)

Patient Elopement and Wandering (PEW)

Surgical Workflow (SW)

VA RTLS Overview

(10)

VA RTLS Overview

National

Data

Repository

GUI/

Database

Readers

Tags/badges/

markings

(11)

In Development with IEEE

1) Tags

Location Sensor Communication Technology Telemetry Pushbuttons Batteries

2) Location

Sensors

Tag Communication Exciters/ Beacons Interrogators Handhelds

3) Location

Engine

Ranging Techniques Position Algorithms Middleware Integration

4)

Middleware

Tag, Location Sensor, Location Engine Management Location Data Management Application Integration

5)

Applications

User Interface Business Rules Alerts/Actions

VA RTLS System Model

(12)

Sensor Tag Sense

RTLS

Location Item

Operations

RTLS Conceptual Data Model

Output

Associations

Tracking Transaction = Item and Location association over Date/Time

Business Rules Communications

(13)

• Real Time

–

Current Item Location

–

Correlated status

–

Business Rules/Communications

• Retrospective

–

Workflow analysis to improve

business processes

• Predictive…

13

(14)

RTLS

(15)

AT: Components

• Software

–

Intelligent InSites (+ AEMS/MERS Interface)

–

OATSystems

• Active Hardware

–

CenTrak Tags

–

CenTrak Supplemental Hardware

• Passive Hardware

–

Vizinex + Emerson and Cuming Tags

–

Impinj + Motorola Portals

–

Motorola Handhelds

(16)

RTLS Asset Tagging Standard

• Tag Type

(Active, Passive, N/A)

By Equipment Type

(e.g. Infusion

Pump)

–

2,838 Equipment Types

–

Minimal National Standard (may be exceeded)

–

Default to Active unless:

Bolted to Ground, Impedes Function, Non-Clinical Tool, Too Small, Vehicle

(17)

RTLS: Blended Technology Example

1

7

Passive Tags Servers Portals Scanner Wireless Active Tags Exciter Network

(18)

Servers Workstations Active Tags VA Network Wi-Fi 900MHz Infrared Low Frequency Exciters/Beacons Sensory Infrastructure

18

(19)

AT: Software

(20)

(21)

21

Location in RTLS Actual Location

(22)

(23)

23

(24)

24

Position A B Position 10m 5m 1m Room Beacon Locating Precisely

RTLS: Accuracy Assessment

(25)

• Certainty-based accuracy at the room-, bed-, bay- and chair-level

Clinical-Grade Locating™

Asset Tracking

Bed/Bay Level Accuracy

(26)

Device Photo Purpose Power

Gen2IR Monitor

- Room-level ~4 years Battery

Gen2IR Virtual Wall

- Bed-level location / Room Level

~2.5 years Battery

Low Frequency Exciter

- Chair-level location - Egress detection ~2 years Battery 900MHz Star - Coordinates w/ Virtual Walls - Alternate to Wi-Fi PoE

WiFi Access Point

- Zone coverage; low-resolution locating

Wired

(27)

Multimode technology

Location Sensing / Communication Supplemental Excitation WiFi 900 MHz Gen2IR

(Infrared) Low Frequency

4 Technologies

Also used as supplemental

27

Asset Tracking

(28)

Light Bulb: An Illuminating Standard

2

8

Edison Screw

(29)

–

Accuracy By Room Type

(e.g. ICU Bay)

By

Application

(e.g. Sterile Processing Workflow)

–

Defines minimal broad initial

implementation

–

Enables multiple RTLS Applications

(30)

30

Pump

Patient Room Dirty Utility Clean Utility

Pump RTLS Status

Available

In Use

Dirty

A101 A102 A103

Was it really “In Use” or “In Patient Care Area”?

More data

• Output from device

• Association of Patient and Device

Location

correlates to

Status

(31)

v

RTLS Temperature

Monitoring (TM)

(32)

TM: Components

• Software

–

Intelligent InSites

(+ AEMS/MERS interface)

• Active Hardware

–

CenTrak Temperature Tags

–

CenTrak Temperature and

Humidity Tags

(33)

TM: Technology Overview

Servers Workstations w/ InSites Software Active Temperature Tags VA Network Wi-Fi 900MHz Sensory Infrastructure

Indicates the flow of information from tag to user

(34)

Manufacturer: CenTrak • NIST traceable calibration

• 0.75C standard accuracy (0.5C typical) • Leverages Wi-Fi or 900 MHz

• Instant button‐initiated measurement • On board storage of data

• Multi‐year battery life

• Configurable reporting rates • Low battery condition alerting

Dimensions: 1.6 x 2.5 x 0.7 inches Battery: 1/2 AA Li battery Single Probe Options: → -20C to 50C → -100C to -20C → -200C to -100C Equipment

TM: Tags

Environmental

(35)

v

RTLS Cath Lab Supply

Management (CL)

(36)

• Software

–

Intelligent InSites

(+ GIP, CART-CL, Patient and Hemodynamics Interfaces)

–

Wavemark

• Passive Hardware

–

Wavemark Tags

–

Wavemark Smart Cabinets

–

Wavemark XPOS

–

Wavemark Tagging Station

(37)

Locking

Door

Mobile

Cabinet

Hanging

Cabinet

Standard

5-shelf

Standing

Bin

Requirements (other than Mobile)

Power: Standard 110 Volt AC, 15 Amp socket (200 Watt maximum cabinet power)

Data: RJ45 Ethernet data jack required.

HF1500

80 in (w/ wheels) x 44.5 in x 21 in

HF-D1500

(shelf and hanging) 80 in (w/ wheels) x 44.5 in x 21in HFS1500 40 in (w/ wheels) x 44.5 in x 21 in HFH1500 80 in (w/ wheels) x 44.5 in x 21 in HFM1500 67 in (w/ wheels) x 52 in x 31 in 8 Hr Battery 37

CL: Smart Cabinets

(38)

Manufacturer: Wavemark

Standard: ISO 15693

Operating frequency: HF 13.56 MHz

Spine Tag

Dimensions: 1.5” x 2.0” Used for foil packaging

Hanging Tag

Dimensions: 1.75” x 2.38” x .5” Used for hanging products

Standard Square Tag

Dimensions: 1.69” x 1.69” Used for most tagging

(39)

v

RTLS

Sterile Processing

Workflow (SPW)

(40)

SPW: Components

• Software

–

Intelligent InSites

–

Censitrac (ITS)

• Instrument Tracking System (ITS)

–

2D Matrix Stencils

–

Workstations

–

Marking Stations

–

Handheld scanners

–

Printers

• Other Hardware Being Explored

–

Active and Passive Tags

–

Passive Portals and Handhelds

(41)

v

Governance and

Deployment

(42)

(43)

VA

RTLS

1 ₂ 3 4 5 6 7 8 9 10 11 12 15 16 17 18 19 20 21 22 23

VA RTLS Governance

National, VISN, and Local Programs:

• RTLS Committee

• Application Workgroups

• Asset Tracking

• Sterile Processing Workflow

• Cath Lab Supplies

• Temperature Monitoring

• Developing Applications

• PM Workgroups

• Risk

• Change Control

(44)

VISN RTLS Program Phases

Program Initiation Pre-Procurement Facility Projects Operations & Maintenance

Enhancement Projects

• Pre-Site Assessment • Site Assessment • Pre-Implementation • Design • Implementation Planning • Implementation • Acceptance Testing • Training • Project Close

(45)

VISN Implementation

Task Order Award

Contract Close

Period of Performance (PoP)

Facility A Facility B Facility D Facility C Facility E Facility F Facility G Facility Kickoff Facility Close-out

(46)

National Schedule

Acquisition Schedule

FY12 Technology demonstrations: V10, V11

FY13 V1, V5, V8 (ITS), V17, V19, V21, V23 (Phase 1), CMOP (Phase 1), National Data Center (NDC), ESE, NDR

FY14 V20, V22, V3 (Phase 1), V6, V16, V23 (Phase 2), CMOP (Phase 2)

FY15 V3 (Phase 2), V7, V8, V15, V18, CMOP (Phase 3), optional pilots

(47)