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Title and Description
RFID at the Istituto Nazionale dei Tumori
Reviewed/ candidate case
Quality reviewed case
Short description
Since 2005 Istituto Nazionale dei Tumori, a centre of excellence in oncology treatment in Italy, uses an RFID application for tracing blood infusions to improve patient safety
Objectives and purpose
The pilot intended to ensure the traceability of vital transfusions, thus increasing patient safety, saving time usually spent tracking blood bags, and enhancing compliance with auditing processes.
Detailed description
Founded in 1925, the Fondazione Istituto Nazionale dei Tumori (henceforth Istituto) is widely recognised as a top tier Scientific Research and Treatment Institution (IRCCS); in fact the organisation has achieved excellence nationally and internationally in the field of pre-clinical and clinical oncology. More than 350 research projects are currently under way, many of these being undertaken with prestigious international institutions, in addition to various collaborative projects with universities and health organisations. The Istituto admits approximately 14,000 acute-care patients (39% from outside Lombardy region) and about 12,000 day-hospital patients, every year. There is an annual average of 900,000 outpatient treatments and more than 15,000 surgical treatment. This pilot project has been implemented in the Allogenic Bone Marrow Transplantation ward (TMO).
The ward uses 9.1% of the total number of transfusion units – 1,177 out of 12,985 throughout the entire Istituto –, but they account for 26% of total value of managed blood bags: i.e. the average value of blood units they use – at roughly €200 a piece – is much higher than the average of other departments; therefore the potential impact in terms of higher efficiency and effectiveness is much deeper.
HP, Fondazione Politecnico di Milano and the Istituto co-developed the RFID pilot platform. Hardware components include 3 HP iPAQ handheld devices equipped with RFID antennae, one desktop with a cradle to synchronize with the handhelds, and an RFID printer. RFID tags are used for blood bags, patient wristbands and staff cards. All professionals in the TMO ward are using the system; nurses are the heaviest users. When patients are admitted, their names are checked against the data in the registers of the central information system by using handheld terminals (each morning the handheld are placed on the cradle and updated with the list of patients), fitted with RFID antennae. The nurse then gives the patient a wristband and initialises the tag bedside, so that the patient can be safely identified. Doctors and operators then use PDAs to transmit and acquire information, by means of RFID labels affixed to each bag by the Transfusion Centre as it is assigned. The nurses receiving each bag use their PDAs to record the time of arrival and read the patient’s wristband to match the data, thus ensuring that the correct transfusion bag has been received. The transfusion operator also uses the PDA to identify himself by means of a badge, and then continues with the procedure, recording both the starting time and the finishing time of the process, together with a set of useful data relating to it. The new RFID system makes transfusion absolutely safe: if there is a conflict between the data read from the bag and the patient’s wristband, the system immediately issues a visual and acoustic alarm, and halts the application. Staff in the Transfusion Centre has been provided with an RFID printer to issue the new labels to tag the blood bags delivered to TMO ward. The staff is now also able to receive electronically information from the ward about the transfusions performed and to monitor the status of delivered blood bags. When the patient is discharged the staff is responsible for deleting information embedded in the disposed wristbands.
Funding
HP offered funding for innovative projects to which the Istituto succesfully applied
Interoperability and standards
For details on standards please scroll down and check "Details on technology"
Timescale
Start of planning
2005
1st milestone
In summer 2005 the R&D foundation of the Polytechnic University of Milan, and the Istituto started a partnership to apply for funding that HP EMEA was making available for innovative projects. It won the attention of HP EMEA and a project was started in September 2005
2nd milestone
Between September and December 2005, Fondazione Politecnico di Milano and HP consultants analyzed processes and workflows and HP labs assessed the suitability of RFID tags and frequencies to the blood bank environment, which requires materials that can stand refrigeration, boiling, gamma-rays sterilization and prevent radio-waves absorption.
3rd milestone
· Between January and June 2006, the three partners developed the solution, and performed testing and debugging. · From June 2006, 6 physicians and 13 nurses were trained and started to use the technology.
Start of routine operation
2007
Evaluation
Ongoing
Characteristic of the application
Country
Italy
Part in the healthcare chain
Facilities and logistics
Level of Implementation
Single site
Technology
Customised solution
Details on Technology
The developed application, custom developed by Fondazione Politecnico di Milano and HP on the Microsoft.NET platform, consists of four main elements (see Figure 2): 1. The transfusion management application running on PDAs enabling the staff to perform patient check-in, patient identification, self-identification, blood bag identification, bedside cross match. 2. TMO ward client application to download to the PDA the admitted patient’s data and to download from the PDA the data on performed transfusions. 3. Transfusion Centre client integrated with EmoNet system (an application developed in the late 1990s by Insiel to connect regional blood banks) for seamless print of standard and RFID labels simultaneously on the two printers. 4. HTTP daemon filling the XLM exchange file on the ward client and managing EmoNet’s database seamless alignment via the internal communication network.
Results
Outcomes
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Wider impact
· Total traceability of the transfusion process. · Improved safety of patients and medical staff involved in the transfusion process. · Non-invasive technology for patients, with increased and improved capacity for intervention where patients are unable to interact with the medical staff. · Enhanced process awareness by staff. · Enhanced capability of process monitoring and controlling, through establishing a continuous flow of information between the departments involved. · Increased "brand" recognition for the ward and the Istituto as a whole, due to the degree of innovation that the RFID solution introduced.
Success factors
The TMO pilot project was a challenging one: it was very innovative in a traditionally conservative environment, such as healthcare; it had to involve multiple stakeholders; and most of all it dealt with vital and very private information. The success factors that enabled to tackle those issues were: · Putting forward a bold strategic vision to take advantage of HP funding, despite the traditional resistance of public sector environment. · Involving of all stakeholders, from senior executives down to nurses operating in the ward and encourage a proactive attitude. · Creating a project team, including Fondazione Politecnico di Milano (project manager, consulting and technology assessment partner) and Hewlett-Packard (technology partner) that enabled to combine know-how, good practice and coherent methodology. · Developing a pilot that was as user-friendly as possible and built on the existing standardized processes, instead of infringing on day-by-day routines of medical professionals. · Taking care of interoperability with existing systems, instead of pushing for a rip-and-replace approach. · Providing training and helpdesk to end-users in time for the launch of the application.
References
References and dissemination
Research for this case study was conducted by Massimiliano Claps, Research Director, IDC EMEA Health Industry Insights on behalf of the Sectoral e-Business W@tch. Sources and references used: · Interview(s) with Ing. Elena Sini, CIO of Fondazione IRCCS Istituto Nazionale dei Tumori, September 18th, 2007, Milano · Websites: · Fondazione Istituto Nazionale dei Tumori, http://www.istitutotumori.mi.it · National Ministry of Health, http://www.ministerosalute.it · Fondazione Politecnico di Milano, http://www.fondazionepolitecnico.it/pagine/pagina.aspx?&L=EN · HP, http://h20247.www2.hp.com/PublicSector/cache/83502-0-0-107-199.html
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