RFID tags (Radio Frequency Identification) are used to track assets using a radio signal which can be received and used to determine the exact location of the asset to which they are attached.  Modern developments have now made it possible for RFID tags to be much smaller and even more effective in their tracking function while the cost has also dramatically dropped.  This allows FRID tags to be used in ever more situations and the medical field is a perfect example of how RFID tags can be used to track multiple assets and provide enhanced security and identification protection.

Medications, specimens, laboratory samples and even patients can now be tracked – and tracking time sensitive assets, such as an organ for transplantation, or a patient who needs to be continuously monitored, say someone suffering from Alzheimer’s Disease, is now practical and cost effective.

RFID tags also possess the ability to contain information, including patient data, but also information on dates of manufacture, application, dosage and warning information.  RFID tags also provide the ultimate level of authentication; many medicines used in developing countries are in fact counterfeited by unscrupulous criminals looking to make huge sums of money which many drugs command on the market.  An RFID tag is almost impossible for counterfeiters to replicate, so the presence of such a tag is a good indicator that the medicines are in fact genuine.

RFID tags come in two main forms: a short-range tag, known as an HF tag (High Frequency), and UHF tag (Ultra High Frequency) with a longer scanning range.  HF tags are suitable for use in tracking medical samples and specimens such as blood and tissue samples because they work effectively in proximity to liquids and human samples.  UHF tags are affected by close proximity to liquids and can be affected by close proximity to tissue samples (the human body is primarily made up of water), and it is also important for proper “tuning” of UHF tags in a medical environment because they are also affected by proximity to metals and radiation (some things which are commonly found in hospitals and medical laboratories).

RFID tags being used for patient tracking has caused some controversy in terms of the invasion of patient privacy, however, where patients are at risk to themselves, such as those suffering from dementia or temporary mental incapacity, they are invaluable for securing identification and monitoring patient status.  Certainly, one use of RFID tags appears to have gained the seal of approval from patients when used to track newborn infants – there can be no doubt that the baby you take home from the hospital is the child which you gave birth to with no possibility of hospital mix-ups!

Patient safety can also be significantly enhanced using RFID tags; for instance, when you need to locate a crash cart (a defibrillator) for a patient in cardiac arrest, you need to find it fast.  RFID tags provide the ability to accurately and quickly pinpoint the location of the cart which can be brought into action much faster for patient assistance.

In terms of hospital administration, RFID tags help to automate inventory management and reduce the administration costs of managing a broad range of sometimes, extremely expensive items, many of which are used as commodity stock items but which are in fact, extremely expensive.  Simple scalpels for instance, are a commonly used item in hospitals and medical institutions, however they are very costly and need to be tracked and managed effectively to avoid wasting money.  RFID tags open the door to significant cost savings by ensuring all instruments and equipment are accounted for at the end of an operation or medical procedure.

Asset Labels Tracking the War on Terror

In 2003, the U.S. Department of Defense (DoD) instituted an asset tracking program in order to track DoD property under the control of external contractors.  This arose amidst claims of of contractors misappropriating assets, employing wasteful practices and generally charging exorbitant sums for work which should not have been charged.  Some readers may recall the issues associated with $200 hammers or thousand dollar toilet seats which plagued NASA, and in the realm of defense spending, there were many instances of inappropriate billing by contractors which was met by the extremely large budget of the Dod and ultimately, the taxpayer was footing the bill.

The Unique Identification program (UID) ensures that government property and assets are all marked by a special asset tag – the individual asset is allocated an Individual UID (known as the IUID – the military are renowned for their use of acronyms) and this in turn produces a Unique Identification Identifier (UII).  All equipment delivered to the DoD by an external supplier must bear a UII which comes in the form of a 2D matrix (a barcode), and this in turn feeds into the billing program of the external contractor which must be managed and presented in a format which meets DoD standards.

With the “War on Terror” commencing in 2003, the DoD is taking delivery of equipment throughout the sphere of operations as well as its main logistics deployment establishment established in Richmond, VA.  There are numerous problems associated with ensuring that equipment is delivered and gets to where it is needed most, especially for those operations involving combat and security duty in high risk areas such as Afghanistan.  At the same time, while the focus is on combat and operational effectiveness, it is very difficult to effectively manage equipment and supplies which are delivered direct into the sphere of operations by external contractors.  When you are getting shot at, you are less likely to be concerned with accounting for equipment!

The UII tags remove the need for such intensive management by personnel in the field, and simplifies the entire tracking and inventory management process.  The program has already resulted in savings worth several billions of dollars in the 6 years which it has been in operation, and has also been used as the  basis for billing adjustments with external contractors who otherwise would have billed for equipment and supplies not delivered as well as reversing overcharges.

One application of the UID program has seen enormous savings in the area of containerization.  The  DoD is the largest customer for cargo containers in the Middle East area with enormous amounts of cargo being transported and stored at a variety of ports and externally managed supply centers prior to onward transportation to the “front”.  Cargo containers are extremely expensive pieces of kit, and they are not in fact owned by the DoD – the containerization system relies upon them being leased or rented (typically for a $2,000 per week).  These containers are spread around a huge geographical area, greater than the size of the U.S., and in a large number of disparate locations.  It is vital to track them and establish which are in use and which are nt being used – by ensuring that idle use is minimized, and advising the owner of non-use, significant savings have been incurred by not paying for containers which are in fact, sitting idle in the owners depot or are still on the lease book but in fact, are not being employed.

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Medical ID tags, no matter what form they take, are looked for as part of standard practice by emergency responders and medical personnel.  By alerting doctors and first responders to conditions such as allergy sensitivity, blood group and medications being taken, much time can be saved and there is no doubt that lives have been saved because of the information contained on such identification tags.

Medical identification tags are suitable for many more people than those with an allergy or a condition such as diabetes, in fact there are many more instances where medical personnel need to be alerted and can be easily enough.

If a patient has any of the following, a medical identification tag will assist in identifying both the patient and more importantly, the condition which they suffer from:

• Alzheimer’s Disease
• Atrial Fibrillation
• Diabetes (type 1 and 2)
• Angina
• Low Blood Pressure
• Arrhythmias
• Pacemakers
• Surgical issues e.g. heart surgery, cancer treatment
• Transplant
• Epilepsy
• Medicine Use (especially where multiple prescriptions are being taken)
• High Blood Pressure
• Benign Intracranial Hypertension
• Hypertension
• Low Blood Pressure
• Allergy information

Once a medical responder understands you suffer from a set of conditions or are taking a particular type of medication, treatment options can be much more rapidly assessed.  Vitally, avoiding some treatment regimes is essential for certain types of patient – if a patient is recovering or taking medication as a consequence of a heart condition, then certain standard drugs for pain control must be avoided or else there is serious risk to life.

Medical identification tags are also becoming more “intelligent” – the obvious development with tags was to include patient identifiers such as name, address and next of kin, but with advances in technology, a new generation of smart tags are under development.  Using microchips, much more information can be stored and indeed, there is no practical or theoretical limit to the amount of information which can be stored in this way.

Imagine a scenario where an unconscious individual is admitted to an ER facility, and while the patient is as yet unknown, the medical identification tag contains a chip which holds a copy of the patient’s medical records.  By using the appropriate reader, medical responders can access the entire medical history of the individual including such ancillary information as insurance coverage so they know the bill will be settled prior to treatment being provided!  It has not been unknown for essential treatment to be withheld or delivered after considerable delay while such administrative issues have waited to be resolved – cold comfort to you if you are the patient in this instance.

Development of medical identification tags is flowing into other identification and tracking areas.  RFID technology for instance, has been used for some time to track moveable assets, but the application to people has been discouraged in many instances because of the threat to civil liberties. So far, application has been restricted to those prisoners who are sentenced to house arrest but there are obvious medical applications for those who suffer from dementia for instance.

One thing is clear, the days of a simple metal tag with a blood group imprinted upon it have become numbered – the days of the smart medical tag are almost upon us.

Reading labels on medicines has been identified as one cause of phantom illnesses ranging from serious diseases, such as cancer, to minor ailments such as a bout of flu – the latest is the rise in the number of cases of swine flu which fortunately, turn out to be nothing more than a sniffle.

One warning sign is when the doctor writes on your prescription, “Oink, Oink, Boom!”, which is the sound a flying pig makes breaking the sound barrier!

Medications are big business in the US with billions of dollars spent on drugs which are prescribed or are available over the counter.  By law, every medication must come with a label which highlights what the medicine is to be used for and possible side effects or contra-indications.  Frequent side effects are quoted as headaches, fatigue, dizziness, feeling sleepy or having difficulty concentrating.  All are vague in their nature but when they are coupled with warnings that some patients may suffer from an increased risk of something more serious, a stroke or cardiac episode, the effect of reading the label combined with an overactive imagination can lead people to believe they have something  more sinister.

The culprit is how the mind works, and psychiatrists have identified a condition termed the “nocebo effect”.  This is the opposite of a placebo – a placebo will make you feel better though it may be a pill containing nothing more medical or therapeutic than powdered milk.  Nocebos actually invoke feelings of ill-health even though there is, in fact, nothing wrong with the patient, but before you think this is quackery, nocebos can be fatal!

One example of the effect of a nocebo is contained in a study conducted in the 1960’s.  Patients were given a glass of sugar water and told that this would make them vomit as part of a procedure to study their stomachs.  Though there was nothing in the glass except sugar and water, 80% of those taking the drink did in fact throw up immediately afterwards.

Research into nocebos has been limited, not least because with a study group, illnesses will be induced because of the power of suggestion.  The Framingham Heart Study followed a group of women over several decades who believed they were part of a high risk group for heart attacks.  The result of the study was that those women who believed they were in a high risk group had a fatality rate four times higher than those women in the same risk category but who were not told of this fact.  Fear played a part in bringing about the condition precisely because they had been informed of the fact.

An Italian study into men and the taking of medication, found that those men who read the label on the medicine which had been doctored to warn of “erectile dysfunction”, reported a far higher incidence of the condition.  Reading the label and especially, reading about the side effects and what the medication is designed to prevent does in fact result in a far greater incidence of the conditions warned of than those who remain blissfully ignorant – a case of “Don’t Read the Label!”

Mark Trumper

MRSA is a serious hazard because it is resistant to antibiotics as are an increasing number of bacteria which have historically been treated with them.  The implication for us as humans who are looking to medical science to cure us is clear – if you catch these antibiotic-resistant bugs you are going to have get better on your own!

Prevention is certainly better than cure in this instance and medical labels are riding to the rescue once again.

A major source of transmission of infection takes place where there are concentrations of ill people with a range of different infectious illnesses – going to a hospital will bring you into close proximity with these bugs if not directly, then certainly with doctors, nurses and other staff who are themselves constantly exposed to these bacteria.  This is why personal and environmental hygiene are so important and a great deal of time and money is spent on ensuring everyone washes their hands and does so in a thorough manner (seriously, washing your hands in a “medical fashion” is something which is taught and not at all instinctive as you and I would perform it after a visit to the bathroom).

Now consider this scenario – a nurse is told to give a patient with a bacterial infection a dose of antibiotics to a patient – the pills are in a bottle kept just for that patient and the nurse is conscientious and gives the patient the dose.  They replace the bottle of pills and then wash their hands before moving on to the next patient – there is no way the next patient is catching the bug from this nurse right?

Wrong!

The bug is still on the pill bottle and it will come into contact with other pill bottles or medication or the nurse, or some other person who will the transfer the bug.

Unless the bottle and label of the medication container are themselves acting as antibacterial agents and are eliminating the bugs which come into contact with them.  Increasingly, hospitals and medical facilities are picking up on the use of containers and labels which are manufactured with highly effective anti-bacterial properties built into them.  It has been estimated that 90% of bacterial transfers by medical staff can be cut completely by simply adopting the practice of using an anti-bacterial label, but let’s hope you never have to find out for yourself in practice!