Au Fait ( fully informed ) Patient ID Bracelet

1. Au Fait (fully informed) Patient ID Bracelet UshaChulliyil William Dailey Sharon Fleishman Maria Vasquez March 3, 2014

2. Agenda • Background • Technical Overview • Financial Assessment • Measurement and Analytics • Questions

3. Background

4. Real-Time Location System (RTLS) and Patient Flow • Local systems used for identifying and tracking the location of assets and/or persons in real time (KamelBoulos & Berry, 2012) • Implications for healthcare facilities • Accurately track the location of a patient, staff member, or device anywhere within the hospital • Improve “Patient Flow” • the ability to consistently and predictably add value and eliminate waste as patients move through the network of service transitions and sequential queues of healthcare (Mayer & Jensen, 2012)

5. RTLS Healthcare Applications • Quickly locate and communicate with healthcare staff when a patient needs emergency assistance • Patient flow tracking • Diagnose bottlenecks • Monitor implementation of new solutions • Determining how much time a healthcare worker spends with a patient • Security system for newborns and Alzheimer’s patients • If patient is too close to an exit, the doors will automatically lock

6. Components of RTLS • Tag attached to patient, staff member, or device • Can be equipped with panic buttons, motion sensors, or LED screens that display text • In this scenario, the tag for the patient would be the patient ID wristband • Location sensor • Location engine software • Application software • Query and display • Integration with existing systems such as ADT, Radiology Information Systems, Operating Room systems, etc.

7. End-user Dashboards • Various customizable dashboards available for different users • Clinical staff • Patient level dashboard- Integrates information from the EHR and PMS • Asset Management Dashboard • Management and Operations • Summary Analytics Dashboard

8. Demonstrated Results with RTLS • Christiana Care - Patient tracking in Emergency Department (Laskowski-Jones, 2012) • 46% decrease in wait time for low acuity patients • Length of stay (LOS) for low acuity patients decreased from an average of 2.5 hours to 1 hour • 30% decrease in ED LOS for admitted patients • 25% decrease in patients leaving without being seen (LWBS)

9. Options • Frequency at which the location of the asset has to be updated • Shorter intervals such as millisecond updates are much more expensive • Every minute should be sufficient • This reduces the cost and makes the systems more affordable

10. Technology

11. Bluetooth LE vs. RFID

12. Limitations of RFID • Passive and active RFID are sufficient for very rigorous asset management/inventory • However, RFID is not capable of two-way communication applications • Two-way communication applications are necessary for the hospital to reap all the benefits of RTLS • The short range of RFID limits the usefulness in patient flow tracking

13. Future Applications of RTLS via Bluetooth LE • Context specific information pushed directly to patient via voice or LED screen on Patient ID band • Ex. “Welcome to Radiology Mr. Jones. Someone will be with you in 5 minutes or less.” • Motion sensor embedded in Patient ID band • Replace fall prevention devices • Patient Pulse, O2 saturation, and temperature can be obtained via the Patient ID band at regular intervals • Information automatically integrated into EHR • Staff tracking to monitor hand hygiene compliance

14. Trilateration • 1 sensor yields circular solution • good for identifying the particular room • 2 sensors yield up to 2 locations • 3 sensors yield 1 location • location within a space • 4+ sensors yield over-determined single location • very precise location within a space

15. Location Patient Elapsed T 10 s Mr. Spock Northwest hall CT Radiology

16. Location Patient Elapsed T 25 s Mr. Spock Northwest hall CT Radiology

17. Location Patient Elapsed T 15 s Mr. Spock Mid North hall CT Radiology

18. Location Patient Elapsed T 17 s Mr. Spock Northeast hall CT Radiology

19. Location Patient Elapsed T 11 s Mr. Spock East hall CT Radiology

20. Location Patient Elapsed T 10 m Mr. Spock Radiology CT Radiology

21. Location Patient Elapsed T 30 m Mr. Spock CT CT Radiology

23. RTLS via Bluetooth LE at ORSE Hospital

24. Equipment • Programmable Bluetooth LE enabled patient ID wristbands • Each equipped with an emergency button • Bluetooth LE enabled staff ID cards • Bluetooth LE enabled tags for all mobile assets (portable ventilators, IV bags, etc.) • Bluetooth LE receivers placed strategically throughout the hospital • Collect status and location information and transmit it to the hospital’s application server via wifi

25. Ownership of Product • Quality and safety team • Pre- packaged analytic reports • IT

26. Financial Assessment

27. Estimation of Cost/ROI • Patient tags = $150 each • Beacons = $100 each • Three- to six-months implementation • Estimation of cost: $200,000 • Payback within 12 to 18 months is common

28. ROI • Reduced overtime costs • Increased efficiency from block scheduling • Better inventory control • No missing/stolen equipment • Less time lost on searching for equipment • Inventory level reduced • Higher reimbursements from CMS • Hospital Value Based Purchasing

29. Hospital Value Based Purchasing (VBP) • Measurement of hospital performance based on data provided by CMS • Hospital Compare Web site at http://www.hospitalcompare.hhs.gov • Assessment of hospital quality measured in four domains: • Process of Care • Patient Experience of Care • Patient Outcomes • Efficiency

30. Hospital Value Based Purchasing (VBP) • Reimbursement by CMS is dependent on performance score • Portion of reimbursement is considered “At Risk” • Opportunity to “Earn Back” based on prior performance

31. Hospital Value Based Purchasing (VBP) • The higher the score the more reimbursement dollars that can be received • Scores based on quality of healthcare provided and safety • At or above 95th percentile can receive full at risk amount • Above 50th percentile or improvement in score from previous year can receive a portion of at risk amount • Zero net gain for Medicare • Any dollars from withheld reimbursements will be diverted to higher performing facilities.

32. ROI • Reduced overtime costs • Increased efficiency from block scheduling • Better inventory control • No missing/stolen equipment • Less time lost on searching for equipment • Inventory level reduced • Higher reimbursements from CMS • Hospital Value Based Purchasing

33. Hospital Expenses

34. Hospital Expenses - Anticipated

35. Comparison Studies • Pacific Health reported an increase of patient flow by 35% to 40% and double net revenue projections. • Cancer Care has an annual ROI of $181,925 due to the increase of patient flow. • PeaceHealth Asset Management reports an immediate ROI of $600,000; $2.7 million over 10 years.

36. Measurement and Analytics

37. Case Study • St. Vincent’s Hospital, 372-bed nonprofit acute care hospital in Birmingham, AL • Operations manager could not direct resources fast enough to sustain high patient throughput • They implemented real-time updates about patient location by the tag system already in use

38. Case Study - Results • Patient volumes have increased from a high of 6.88 bed turns per month to an average 8.20 bed turns per month sustained over the first five months of use. • Increased patient volume accounted for an estimated $5.5 million increase in revenue • Over the first six months of implementation, the amount of time during which the hospital diverted ambulances dropped from an average of 3,000 hours (per six months) to just 300 hours

39. Measurement • Phase 1 • Money saved on misplaced devices within the hospital • Identifying bottlenecks • Phase 2 • Measuring effectiveness of solutions implemented to improve bottlenecks • Patient Satisfaction scores • Hand hygiene compliance

40. Patient Location Dashboard • Designed for use by clinical staff • Integrated with EHR & PMS http://www.versustech.com/rtls-benefits/patient-flow/

41. Asset Management Dashboard http://www.versustech.com/rtls-solutions/asset-management-hospital/

42. Analytics Dashboard • Designed for management and operations • Configurable at the user-level http://www.versustech.com/rtls-benefits/healthcare-executives/

44. Hand Hygiene Compliance

45. Questions

46. References • KamelBoulos, M. N. & Berry, G. (2012). Real-time locating systems (RTLS) in healthcare: a condensed primer. International Journal of Health Geographics, 11, 25. • Laskowski-Jones, L. (2012). RTLS solves patient-tracking emergency. Health Management Technology, 33(3), 24–25. • Mayer, T. & Jensen, K. (2012). The business case for patient flow. Unique approaches to patient flow improve the patient experience and the bottom line. Healthcare Executive, 27(4), 50, 52-3.

47. References • Gallup Consulting. “Hospital Value-Based Purchasing and HCAHPS Executive Summary.” (November 2010) Retrieved from: https://cc.readytalk.com/ cc/download/schedule/4lt847el9of2 • Drazen, E. Rhoads, J. “Using Tracking Tools to Improve Patient Flow in Hospitals.” Issue Brief. California Healthcare Foundation. (April 2011). Retrieved from: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/U/PDF%20UsingPatientTrackingToolsInHospitals.pdf

48. References • Centers for Medicare & Medicaid Services. “Hospital Value-Based Purchasing.” (2013, Aug 19) Retrieved from: http://www.cms.gov/Medicare/ Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/hospital-value-based-purchasing • Shah, S. “7 Do’s and Don’t’s to Maximize a Hospital’s Return on Investment.” (2012, Mar 4). Retrieved from: http://medcitynews.com/2012/03/use-these-7-dos-and-donts-to-maximize-a-hospitals-rfid-return-on-investment/

49. References • Goedert, J. “Hospital Realizes Benefits, ROI with Automated Patient Tracking.” Health Data Management. (2004, November). Retrieved from: http://www.radianse.com/news-healthdatamgmt-nov2004-patient.html • California Healthcare Foundation. “Using Tracking Tools to Improve Patient Flow in Hospitals.” (2011, April) Retrieved from: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/U/PDF%20UsingPatientTrackingToolsInHospitals.pdf