RADIO FREQUENCY IDENTIFICATION (RFID)

I N HEALTHCARE

BENEFITS, LIMITATIONS, RECOMMENDATIONS

A HIBCC White Paper

HEALTH INDUSTRY BUSINESS

COMMUNICATION S COUNCIL
FOREWORD

This paper was created by individuals representing the global affiliates of the Health Industry
Business Communications Council (HIBCC). It is intended to inform the global healthcare industry
about the application, benefits and challenges of Radio Frequency Identification (RFID) in healthcare.
It also presents basic RFID concepts and discusses existing standards to help the reader develop a
reasonable understanding of RFID and its suitability for specific healthcare applications.

HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 1

TABLE OF CONTENTS

I. INTRODUCTION 3

II. TECHNOLOGY OVERVIEW 4

A. RFID COMPONENTS 5
B. PASSIVE TAGS 5
C. ACTIVE TAGS 6
D. COMMON RFID FREQUENCIES FOR SUPPLY
CHAIN AND ASSET MANAGEMENT 6
E. RFID IN THE CONTEXT OF ENTERPRISE
INFORMATION MANAGEMENT 7
F. SOFTWARE AND MIDDLEWARE 7
G. INTEROPERABILITY BETWEEN DIFFERENT
RFID TECHNOLOGIES 7

III. RFID STANDARDS - WHERE, HOW AND WHY THEY

ARE APPLIED 8
A. ISO 18000 SERIES 8
B. APPLICATIONS LEVEL STANDARDS -
INFORMATION AND DATA 8
C. DIFFERENCES BETWEEN THE ISO-BASED AND
EPCglobal APPROACHES TO RFID 9

IV. BENEFITS OF RFID IN HEALTHCARE 10

V. LIMITATIONS OF RFID 10

VI. WILL BARCODING BE SUPERSEDED BY RFID? 11

VII. APPLICATIONS OF RFID IN HEALTHCARE 11

A. SUPPLY CHAIN AND ASSET AND MATERIALS
MANAGEMENT 11
1. Orthopeadics Implants Example 11
2. Cardiac Catheterization Laboratory Example 12
B. PATIENT SAFETY AND QUALITY ASSURANCE
APPLICATIONS 12

VIII. CONCLUDING REMARKS AND RECOMMENDATIONS 13

IX. ABOUT HIBCC 13

X. ABOUT THE AUTHORS 14

XI. REFERENCES 14

HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 2

I. INTRODUCTION barcoding processes has been created. Using
product identification standards developed by the
Radio Frequency Identification (RFID) is the new International Organization for Standardization/
breed of Auto-ID technology that promises to International Eurotechnical Commission
deliver the next wave of productivity (ISO/IEC), this ISO-based solution offers a direct
improvements to supply chain and other migration path from barcoding to RFID that is
processes where tracking of products and assets or practical and easily achieved.
identification of people is required.
Another organization, EPCglobal, is currently
While RFID technology is being called a "new" promoting a different approach. It involves
technology, in fact, its applications have been in replacing the actual item identification with a
existence for more than a decade in one-chip fee-based, coded serial number, which would be
configurations and even longer in lesser placed on every RFID tag. Important supply chain
integrated technology. Well-known and proven information would therefore not reside directly on
applications that use radio frequency technology the tag, but instead on databases that would be
include: connected via EPCglobal's proprietary network
that mimics the World Wide Web. This approach
Security cards used for control of access
would require significant investment by supply
to buildings and secure areas
chain participants for integration fees, hardware
Electronic tolling for roads and software to make the system work. It does not
Automatic ticketing systems achieve any benefits over the decentralized
Returnable container tagging ISO-based approach, which relies on the inclusion
Animal identification of this data directly on the tag.
Item identification
While there are obvious benefits to implementing
RFID has gained more publicity in recent times RFID, expectations concerning its benefits may be
because of its potential to improve supply chain inflated and interest may have already peaked.
processes. Contributing to the current wave of This assessment of the technology’s maturity -- as
interest in RFID are retail industry pilot projects, measured by the “Gartner Hype Cycle Curve” --
such as Wal Mart's use of RFID for supply chain indicates that within the business community RFID
improvements. This increased publicity has led to “Peak of Inflated Expectation” has been reached
further RFID research and development activity and will be followed by a “Trough of
and the introduction of a number of commercially Disillusionment” by the end of 2006. Initial enthu-
available RFID systems and solutions. siam will be thereafter be tempered by practical
cost-benefit considerations. *
RFID offers more advanced resource and patient
tracking capabilities than manual or barcode
efforts. In fact, it is already being used by some
organizations for select applications. Examples of
this include wristbands for patient identification,
processes for implantable medical devices, and
RFID-enabled sterilization trays. Other
applications include those that protect
manufacturers from counterfeiting and product
tagging for asset management. There are also
regulatory pressures by U.S. Food and Drug
Administration (FDA) and other agencies to
explore RFID and other technologies to help
improve patient safety. Figure 1 - Gartner Hype Cycle Curve

To help the healthcare industry implement RFID * The 2004 paper, “Prepare for Disillusionment with RFID”
into its current practice, a solution that uses presents this view of RFID in relation to the Gartner Hype
standards that have already been developed for Cycle (see References).

HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 3

Implementation of a successful RFID solution II. TECHNOLOGY OVERVIEW
requires considerable investment in:
Systems design, engineering, and physical Barcode technology relies on optics, and therefore
integration requires "line of sight," meaning that the barcode
Business process redesign and must be visible to the reader. Conversely, RFID
implementation tags can be invisible to the reader because they
IT data management integration transmit information on demand using radio
waves. A tag consists of a microchip applied to a
The current technology options have not reached a miniaturized antenna, which carries a "unique tag
point of economic viability for widespread ID" but can be programmed with other
adoption at the individual item level for Fast information. RFID offers advantages over
Moving Consumer Goods (FMCG). While there is barcode technology when:
speculation that the cost of RFID tags will soon Invisible (or no line of sight) reading is
drop to $0.05 per tag, this is not achievable in the required. For example, products within a
short term and could not be sustained by major box can be individually read or located
chip manufacturers to generate sound return on with no line of sight to the reader.
investment. At the current price of greater than Multiple items must be read
$0.20 per tag, with many early adopters reporting simultaneously.
the cost per tag including handling at $1.00, RFID
Read and write capability is required on
applications cannot be sustained by low-cost,
the data carrier.
high-volume items in the supply chain.

Manufacturing processes may also need to be

modified to include RFID tags on individual items,
since it is unlikely in the short term that the tag can
simply be embedded in an existing label. This
would significantly increase manufacturing costs
for basic items, and it is unlikely that savings due to
productivity improvements would achieve a return
on investment for the supplier or applicator of
technology.

Nevertheless, there are some promising short-term

applications for RFID, and successful
implementation with business benefits is likely
where certain conditions are met. For example:
"Closed-system" applications where
productivity and working capital
improvements for an individual Figure 2 - RFID tag communicates with a mobile reader
organization's internal processes can result.
Specialized, high-cost equipment,
where reduced loss and obsolescence may RFID is not merely a computer chip and antenna
lead to significant financial benefits. placed on a product, but rather it is an entire
High-cost items or applications that infrastructure that requires investment in many
require a high degree of traceability. components and systems to make it work. This
These items include medical devices such as includes hardware, middleware and software
pacemakers, defibrillators, and other components.
implanted prostheses.

HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 4

A. RFID COMPONENTS individual items in the supply chain. For this
Any RFID system comprises a tag, which holds reason, the focus of this paper is geared toward
data about an item; a reader, which will read the passive tags.
data stored on a tag; and software/databases that
act on the information. B. PASSIVE TAGS
Typically, passive tags are made up of several
A reader can be stationary or mobile, simple or components, consisting of an integrated circuit
smart. It will typically need to be connected to a (IC)--or computer chip--as a module, and an
network, especially within an infrastructure that antenna, all packaged in a tag casing. Data is stored
captures data from different sites. In this scenario, on the chip, which is physically carried inside the
the network of readers will be served by a host module. The module is responsible for connecting
server, which will manage all data transfer between the chip (and data) to the antenna. Tags can also
the readers and a central database. Depending on consist of an inlay, on which the antenna is printed
the project requirements, the infrastructure can and the chip is glued or bonded. The antenna is the
vary, but the principles remain the same. interface to the reader and therefore to the outside
world. Figure 4 shows a typical tag using a module
Figure 3 shows a simplified schematic of a typical and an antenna.
multi-reader RFID system infrastructure.

Figure 4 - Illustration of a typical RFID tag

Tag packages come in a number of styles, which

vary depending upon the tag's intended use. These
include round tags, which come in different sizes,
as well as tags in tubes or cylindrical packages
made out of glass or ceramic. Tag configurations
Figure 3 - Schematic of an RFID-enabled system can vary, so different tags may respond in different
ways--or not at all--to readers. In fact, it is
Deciding which type of tag to use determines to a reasonable to assume that every tag will be
large extent the rest of the infrastructure required in different in its response to a given reader. As the
an RFID system. Tags can be either passive or tag size and shape change, so does its resonance to
active. Active tags include an internal power the reader. Therefore, tag/reader configuration
supply. An example of an active tag is the "e-tag" may require some tuning.
used in vehicles for automatic toll collection.
Passive tags do not contain an internal power This is not the only condition where retuning needs
source. Their power is derived from the creation of to occur. Changes in the field between reader and
an electromagnetic field by the reader when it is tag can occur due to environmental conditions.
brought in proximity to the tag. This The functionality of the system may show
electromagnetic field needs to generate sufficient performance within a field that differs from any
energy to "power up" the tag, and create the "laboratory trial."
communication channel between the tag and
reader. Most passive tags signal by backscattering the
carrier signal from the reader. This means that the
Because passive tags do not have a power supply, reader has to be designed to both collect power
they are generally smaller in size, lower in cost, and from the incoming signal and also to transmit the
more suitable than active tags for tagging outbound backscatter signal. The response of a
HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 5
passive RFID tag is not just an identification are considered in overall chip and tag design. This
number. The tag chip contains nonvolatile is referred to as the air interface. The ISO/IEC
Electrically Erasable Programmable Read-Only 18000, Information technology - Radio frequency
Memory (EEPROM) for storing data. Lack of an identification for item management defines the
onboard power supply means that the device can parameters for different frequencies. The
be quite small: commercially available products common frequencies defined by these standards for
exist that are the size of a grain of rice. Passive tags item management are:
have practical read distances ranging from 0.3 inch Parameters for air interface
to greater than 3 feet for UHF tags. Due to their communications below 135kHz (LF)
simplicity in design, they are also suitable for ISO/IEC 18000-2 applies for small devices
manufacture with a printing process. and low distance reading.
Parameters for air interface
The other variable in tag design is regarding the communications at 13.56MHz (HF)
chip, which holds the data. Typically, low-capacity ISO/IEC 18000-3 applies for products,
chips can store up to 128 bits of data, enough for the wristbands and containers as a
item's product code or serial number. For most universal frequency.
supply chain applications, this amount of data is Parameters for air interface
sufficient, since additional product information is communications at 2.45GHz (Microwave)
contained within organization databases. Since this ISO/IEC 18000-4. Microwave is not typical
product information is available through the for healthcare applications.
organization only, data between sellers and buyers
Parameters for air interface
needs to be synchronized so that both parties are
communications at 860MHz to 960MHz
using consistent identifiers.
(UHF) ISO/IEC18000-6 applies for long
distance reading, as it would be used in
High-capacity chips can store up to several
transportation.
hundred bytes, and would be used in applications
that require more data to be written to the tag. For Parameters for air interface
example, specimen containers sent to a communications below 433MHz ISO/IEC
pathology lab may include detailed patient 18000-7 does not yet apply to healthcare
information, which can be written to the tags. applications. They are used primarily for
freight containers.

C. ACTIVE TAGS Since every frequency has different physical

Active RFID tags have an internal source used to features, not every air interface is practical for the
power ICs and generate the outgoing signal. They whole range of applications that may apply in asset
generally have longer range and larger memories management and supply chains. For example,
than passive tags. At present, the smallest active Ultra High Frequency (UHF) is extremely sensitive
tags are about the size of a coin. They have read to water and high humidity, which absorbs higher
ranges of 30 feet or more, and a battery life of up to frequencies. Conversely, High Frequency (HF) is
10 years. less sensitive in these environments. However,
UHF offers a much greater reading distance, if the
Active tags are not adequate for tracking single conditions are properly set. HIBCC has established
items of lower value and generally can not be used the following frequencies for typical RFID
in an autoclave. Active tags are beneficial where applications.
intelligent features are required, such as data Product tagging: HF 13,56 MHz (or LF
logging by using integrated sensors for <135KHz under mutual agreement)
temperature and pressure. Product packaging: HF 13,56MHz (or
UHF, under mutual agreement)
Transport Labeling: UHF 860-960MHz (or
D. COMMON RFID FREQUENCIES FOR SUPPLY HF 13,56 MHz, under mutual agreement)
CHAIN AND ASSET MANAGEMENT
The frequency and parameters at which a chip
communicates with a reader are also variables that

HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 6

E. UNDERSTANDING RFID IN THE CONTEXT
OF ENTERPRISE INFORMATION MANAGEMENT
RFID is merely one component of an enterprise-
wide system. It needs to work in harmony with
other systems within the enterprise, specifically
within the Information and Communications
Technology (ICT) infrastructure. It does not replace
any of the existing systems, but it may improve the
performance and productivity of the entire system. Figure 6 - Illustration of the role of middleware in the
interface between RFID readers and enterprise applications
Figure 5 illustrates a typical hospital's ICT
infrastructure. This diagram helps put RFID in the
Tag reading needs to be organized in a
context of the entire system.
meaningful way in order to make it practical.
Middleware applications organize the reading of
many tags and pass information to the
organization's information management systems in
a sequential way to prevent "collision" from
occurring. There may also be applications that
require communication from the information
management systems back to the tag. This can
happen when an item has been used or consumed,
and data to indicate the consumption of the item
needs to be written to the tag. In this instance, the
middleware would need to have a bi-directional
interface.

G. INTEROPERABILITY BETWEEN RFID

TECHNOLOGIES
RFID technologies have been largely advanced by
technology companies, which means that their
intellectual property is protected by patents. There
Figure 5 -Enterprise Systems Architecture Example has been some attempt to standardize,
particularly in air interface protocols. But this still
does not always make chips developed by
F. SOFTWARE AND MIDDLEWARE different companies interoperable.
Typically, an RFID enabled system will require
middleware to enable its function with the Interoperability across frequencies is also
organization's enterprise systems. The role of RFID complicated. Some vendors claim to have
middleware is to serve as the interface between developed readers that can read multiple
software for the reader and applications within the frequencies. These readers are programmed to
organization that use the data received from interrogate through all standard frequencies and
transactions with RFID tags. protocols until a "handshake" with the tag is
achieved. However, this type of reader is slow, and
The reader software interprets the signals from the would be problematic in situations where multiple
chip within the RFID tag, and translates them into a tags need to be read simultaneously.
data string. For example, the product
identification may be the data string that resides on Other variables that present difficulties for
the chip, and this data is interpreted by the interoperability are size, shape and design of the
software. tag antenna. Readers need to be tuned to a
specific tag design and in general do not easily

HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 7

accommodate design variations. Therefore, in open in the standard include:
systems where there may be a variety of Who Talks First (WTF). Determines
frequencies, protocols, and tag antenna design, whether the tag starts transmitting as soon
interoperability is extremely complicated. as it is remotely powered by the
interrogator--Tag Talks First (TTF), or if it
EPCglobal is attempting to standardize the waits for a command from the reader
frequency, protocols and tag design for before starting the transmission--Reader
consumable products for use in its system. Due to Talks First (RTF).
pressure from chip manufacturers, this approach is Tag Unique Identifier (UID). A binary
also being merged into the ISO/IEC regulatory value that ensures worldwide uniqueness
framework. But trials to date have been for the tag. This identifier is at the chip
performed only for pallet-level tracking to level, and is assigned by the IC
warehouses and distribution centers. Applying this manufacturer. For this reason, it is not the
approach for single items, particularly unique product identifier that may be
medical products, will be difficult because: assigned by a product manufacturer for the
Products of different sizes will require supply chain tracking purposes.
different tag antenna designs. Memory size. Indicates the minimum and
Products made of or packaged in metal can maximum memory size that can be
cause interference with the tag. accessed using read and write functions. A
Products containing fluids can present minimum sized chip contains typically 96
challenges for UHF-RFID. Bit, which is enough memory for a serial
number. But a chip with larger capacity--
128 or 256 Bits--or more could carry
III. RFID STANDARDS -- WHERE, variable data and even data resulting from
transaction processes.
HOW AND WHY THEY ARE APPLIED
Command structure and extensibility.
Describes the structure of the command
A. ISO 18000 SERIES code from the reader to the tag and
The most common standard utilized in relation to indicates how many positions are available
RFID for item management is the ISO/IEC 18000 for future extensions.
series (Information technology - Radio frequency
identification for item management). The ISO/IEC 18000 does not address requirements for
following common RFID frequencies and the system specification, application,
parameters for communication across the air implementation, and information and data
interface offer best features for product, package architectures.
and transport tagging:
Part 1: Reference architecture and
definition of parameters to be standardized
B. APPLICATIONS LEVEL STANDARDS--
Part 2: Parameters for air interface INFORMATION AND DATA
communications below 135 kHz (LF) While ISO 18000 addresses protocols and
Part 3: Parameters for air interface parameters relating to air interface, it does not
ommunications at 13,56 MHz (HF) address the overall interoperability of RFID
Part 6: Parameters for air interface systems within the enterprise, and the applications
communications at 860 MHz to 960 MHz for which RFID would be deployed. There are
(UHF) specific standards that could also be included in the
design and development of RFID systems.
This technical standard was created for developers
and system integrators to achieve communication Item level identification coding takes place at the
across the air interface for specific frequencies application level. HIBCC recommends following
between the IC in the RFID tag and reader. It the applicable ISO/IEC standard, which in the case
includes parameters for physical and media access of ISO 18000 defines the coding structure for the
control, protocols and collision management identification of items, products and logistical
parameters. Some of the protocols that are defined units. This enables the creation of a virtual

HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 8

relationship between the tag and the item to which
it is attached. This relationship needs to be
identified by the information management
systems.

Most RFID applications for item management will

only require a "license plate" coding for the
product or logistical unit, and any product details
will reside in information management systems.
Therefore, the role of the RFID system is simply to
identify the item, and then pass the data to the
information management systems.

The manner in which application data is stored and

organized on the RFID tag, and the protocols for
transferring data from the tag to the Figure 7 - ISO Schema, RFID for the supply chain
application, also need to be defined. ISO/IEC management levels (Source: ISO 17363)
15961 and 15962 address this requirement:
ISO/IEC 15961 - Information technology
- Radio frequency identification (RFID) for C. DIFFERENCES BETWEEN THE ISO-BASED
item management - Data protocol: AND EPCglobal APPROACHES TO RFID
application interface. The ISO approach to RFID implementation is based
Focuses on the interface between the upon healthcare product supplier migration from
application and the data protocol processor, existing barcode or 2-D symbologies to RFID. This
and includes the specification of the transfer can be accomplished by leveraging approved ISO
syntax and definition of application standards and using Data Identifiers (DI) to code
commands and responses. It allows data important medical supply chain data, such as
and commands to be specified in a lot/batch number, serial number, and expiration
standardized way, independent of the date. As the product moves through the supply
particular air interface. chain, this important data can be captured directly
ISO/IEC 15962 - Information technology from the product and used in information
- Radio frequency identification (RFID) for management systems. This approach is similar to
item management - data encoding rules and that which has been used in barcoding applications,
logical memory functions. and has proven over time to be robust, reliable, safe
Focuses on encoding the transfer syntax, as and cost-effective.
defined in ISO/IEC 15961, according to the
application commands defined.

HIBCC guidelines for identification coding are

included within ISO application guidelines for
RFID for Supply Chain Applications based on these
technical standards:
Figure 8 -The ISO approach is based on simplicity and
ISO 17367 RFID for product tagging direct access to information. The ISO tag is self-contained
ISO 17366 RFID for product packaging with all required information.
(Complementary Barcode Standard ISO
22742)
A contrasting approach being promoted by
ISO 17365 RFID for transport units EPCglobal requires placing a fee-based, coded
(Complementary Barcode under ISO 15394) serial number on every RFID tag, which would
ISO 17364 RFID for Returnable Transport replace the actual information. Important supply
Items (RTI) chain information would therefore not reside
ISO 17363 RFID for freight containers directly on the tag, but on databases that would be
(does not apply for healthcare directly). connected via EPCglobal’s network that mimics the
World Wide Web. This proposed service, called
HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 9
the Object Naming Service (ONS), does not Barcode labels are "read only," while RFID
currently exist, and will likely present practical tags can have both read and write capability,
issues and challenges. It would require that vari- making them more versatile.
able data such as lot/batch and expiration data be Unlike barcode scanning, which requires
referenced and maintained on databases that that labels be individually read, groups of
would have to be continually accessed via ONS. RFID tags can be read simultaneously,
thereby enhancing productivity.
Using "smart shelves," which have RFID
readers embedded within them, it will be
possible to obtain real-time inventory
status by using RFID tags.
The U.S. Food and Drug Administration
(FDA) is evaluating the use of RFID tags for
verifying product pedigree. This can be
accomplished by encrypting information in
the tag to eliminate counterfeiting of
products, such as drugs and high-cost
medical devices.
Critical data such as temperature
monitoring for sensitive products like blood
can be automatically logged using RFID tags.
RFID tags allow for invisible but resistant
marking for special applications, such as
wristbands.
Unlike barcoding, there is no line of sight
Figure 9 -The EPCglobal approach requires numerous steps required to read an RFID tag. The use of
to access information. Because the EPCglobal tag contains RFID tags permits reading orientation
a coded serial number, it must be cross-referenced to yield
directly through materials like boxes and
the required data
textiles.
The complexity and cost of the EPCglobal approach Some proponents have suggested extremely broad
has recently led to its rejection by the Joint possibilities for RFID, such as EPCglobal's
Automotive Industry Organization (JAI), which is promotion of an "Internet of things," in which
composed of the major automotive industry "every single object would be connected to the
associations in the United States, Europe, United Internet through a wireless address and unique
Kingdom and Japan. The group announced its identifier."
intention to support alphanumeric data and open
standard symbologies, like those utilized in the From a more realistic perspective, the primary
ISO-based approach. benefit of RFID at its current maturity level is its
potential for productivity improvement, and thus
Despite obvious differences, both the ISO-based reduction in deployed working capital. The most
and EPCglobal approaches conform to the same air obvious areas are those in which barcode
interface specifications defined by ISO/IEC 18000. technology has limitations.
Consequently, both systems are interoperable.

IV. BENEFITS OF RFID IN V. LIMITATIONS OF RFID

HEALTHCARE
There are a number of challenges posed by RFID
Proponents of RFID cite many potential implementation in healthcare:
advantages over existing and conventional Auto-ID Cost. RFID is still expensive, not plug-
technologies, such as barcoding, that can improve and-play, and has not yet proven its
supply chain and other processes. For example: reliability in large-scale implementations.

HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 10

 Environmental conditions. Tag reliability VII. APPLICATIONS OF RFID IN
can be impacted by humidity, metal HEALTHCARE
surfaces, and more. Current RFID tags
cannot withstand extreme temperatures
RFID applications in healthcare could include:
without temperature-resistant housing. For
that reason, using them for items like Supply chain applications. This includes
surgical instruments is complicated. high-cost items like pacemakers,
defibrillators, and artificial joints. The
Limited application. It is difficult to
supply chain for these items is complex,
apply and read RFID tags on metal and
and they are often supplied on
fluids. This currently limits tag application
consignment. They also require a high
to cardboard, paper and plastic packaging.
degree of traceability from the supplier to
Technology incompatibilities. the patient.
Interoperability between different RFID
Patient safety applications. This may
standards--for example, the ability for a
include improved patient identification
single reader to read tags from multiple
using RFID tags in patient wristbands.
frequencies--is not available at this stage,
and will be technologically difficult to Quality assurance applications. This may
achieve. include improved instrument tracking for
infection control purposes. Some vendors
supply RFID-enabled trays that can be
tracked through central sterilizing
VI. WILL BARCODING BE departments.
SUPERSEDED BY RFID?
A. SUPPLY CHAIN AND
Barcoding will continue to be used in the future, ASSET AND MATERIALS MANAGEMENT
and will co-exist with RFID. As with all Use of RFID for supply chain applications will
technologies, each will be utilized in the functions likely be implemented by manufacturers and
for which it offers the highest benefit/cost ratio and distributors of high-cost medical devices that
comparative advantage. require a high degree of traceability. This includes
implanted devices such as pacemakers,
Consideration of the following will help defibrillators, artificial joints, vascular stents, and
determine which technology is used: intraocular lenses. Because of their high cost, these
The marginal cost of including a barcode devices are typically supplied to hospitals on
on a product label. For low-cost items sold consignment, which means that the hospital does
in high volumes, barcoding is still a viable not purchase them until they have been used.
and cost-effective option.
There will always be applications that do 1. Orthopaedics Implants Example
not require many items to be read Orthopaedics implant suppliers typically supply
simultaneously. In these cases, RFID offers products on a "loan set" arrangement. This
only a small benefit over barcoding. involves a supplier lending the instruments
Barcoding is a mature technology, and its required to perform a procedure, along with a full
scanning reliability has proven to be high in set of implants, to the hospital for a specific case.
broad-scale implementations. By contrast, Below is an example of how the loan set process
RFID is relatively immature, and is yet to be works:
proven in widespread usage. 1) Surgeon books patient for procedure, and
Because some members of the supply chain instructs hospital to order loan set for procedure.
may not have the capability to implement 2) Hospital orders loan set from supplier
RFID, a second means of identification 3) Supplier assembles loan set and records lot/
would need to be applied to all RFID-tagged serial numbers of all items supplied.
products. This is not necessary for barcoding 4) Supplier has loan set delivered to hospital. Loan
or other 2D options. set is often "split," meaning that multiple logistical
units make up one loan set. When a loan set is split,
the non-sterile surgical instruments are placed in a

HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 11

separate logistical unit than the sterile implants. Staff members swipe their identification badges to
5) Hospital receives loan set and sterilizes access the supply cabinets, input patient
components. information, and remove devices needed for the
6) Hospital performs procedure, and records details procedure. All devices are tagged with an RFID
of implants and other items used in the procedure. tag. The items used are logged, and the system
7) Hospital returns remainder of loan set to records who retrieved the items and for which
supplier. patient. If the item is returned-or even moved to
8) Supplier receives loan set and scans all items that another cabinet-the system records its
remain. By deduction, they determine which items whereabouts. In this way the catheterization lab
have been used. always has an accurate inventory and charges
9) Hospital prepares purchase order to send to loan patients only for equipment used. The cabinets
set supplier. also track the expiration dates of stocked
10) Supplier invoices the hospital for loan set products.
components used.
This application, however, is dependent on all
Each supplier stocks a large amount of inventory; medical device suppliers tagging their products
the effort required to manage the logistics is also using the same technology and standards
significant. including frequency, antenna design, etc.
Currently, manufacturers of these devices are not
Using RFID tagging on the loan set implants can attaching RFID tags to their products; hence,
lead to substantial improvements to supplier hospitals implementing this kind of system need to
productivity and inventory, thereby improving the apply the tags to the products when they are
working capital deployed. This is because received, or else require that the distributor of the
processing the returned portion of a loan set takes a products do this post-manufacture.
considerable amount of time and effort. RFID
enables suppliers to simultaneously read all tags on B. PATIENT SAFETY AND QUALITY
the implants returned, determine the implants used ASSURANCE APPLICATIONS
in a procedure and make returned implants Another area in which RFID may benefit
re-available quickly. healthcare is in improvement of patient safety. This
may include patient bracelets embedded with RFID
In this example, the benefit of RFID is the ability to tags. RFID tags that have "write" capability can
simultaneously read many tags. With barcode have key information written to the tag, including
scanning, the supplier would need to scan each drug allergies, blood type and other important
implant individually. This is time-consuming, and patient data.
ties up inventory that could otherwise be available
for distribution to other customers. Quality assurance within hospitals is also a key
area of concern, particularly for infection control.
This example is also a closed-loop application, since Surgical hospitals generally have a Central
it serves only the organization that has Sterilizing Services Department (CSSD) to sterilize
implemented the solution. All development with surgical instruments and other devices for use by
this application is within the control of the supplier hospital operating rooms.
concerned.
Each sterilization "batch" needs to be
2. Cardiac Catheterization Laboratory appropriately identified. Surgical instruments and
Example devices are placed in trays, which are then
A U.S.-based vendor of RFID for healthcare sterilized using an autoclave machine. Once the
applications is implementing RFID reader- items have been sterilized, the trays are assigned a
equipped cabinets within cardiac catheterization batch number, and the serial number on each
laboratories. Each cabinet is also equipped with an instrument in the tray is related to this batch
embedded computer and an SQL-based number. This way, if an infection resulted from the
application. The system is linked to the hospital's surgical procedure, the instruments used in the
physical security system. procedure can be recalled for further
examination and testing.

HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 12

This application is particularly useful for technology is more likely to be successful if
identifying individual instruments that may be evaluated for closed-system applications first,
subject to Creutzfeldt-Jakob disease (CJD). Risks where deployment and subsequent changes are
associated with an infection can be more within the control of the individual organization.
accurately addressed. This can also lead to cost
savings in the case of a CJD outbreak. If the patient The introduction of a new technology like RFID
and surgical instruments can be identified, then the often causes a stir of interest and excitement about
elimination of surgical instruments can be confined. its capabilities. However, RFID will likely go
through a stage where initial enthusiasm is
However, tracing individual instruments to tempered by practical cost-benefit considerations.
specific trays is very challenging. Instruments The outcome of these will be appropriate
cannot be barcoded. While new symbologies, such deployment of the technology.
as 2-D symbologies can be etched to metal surfaces,
the scanning reliability is variable, and the expense Well-developed standards already exist at
is high. Furthermore, each individual instrument different technology levels, including the protocol,
needs to be scanned to the tray, to form a link communication, and data levels. Using the
between the instrument and the tray, a labor- existing ISO specifications, data can be encoded to
intensive process. RFID tags to guarantee continuity worldwide. This
approach also ensures that RFID will be able to
The CSSD process is ideally suited to RFID. If each co-exist with current barcode standards, which will
instrument was embedded with an RFID tag, and likely be required for the foreseeable future. The
the tray in which the instruments are placed ISO-based RFID standard is also independent of
retrofitted with a RFID reader, instruments can be technology, so the data structure can be coded to
identified and logged the moment they are placed any of the accepted frequencies and protocols
in the tray. However, this is also a very challenging under ISO 18000.
proposition given current limitations with RFID
technology: Healthcare organizations considering RFID-
The IC within commercially available enabled solutions should carefully address the
RFID tags is based on the conventional following questions:
Complementary Metal Oxide Do you have needs for automatic data
Semiconductor (CMOS). Unless developed capture that barcoding does not address?
to military specifications, CMOS is not able Will RFID deliver greater benefits than
to withstand the high temperatures of the existing, more mature technologies like
autoclave process. Claiming several barcoding?
benefits over CMOS is Micro Electro The key benefit of RFID that will deliver
Mechanical Systems (MEMS), which is productivity and inventory improvements is
currently in research stage and is expected the ability to read multiple tags
to be commercially available in 2007. instantaneously. Will your organization
MEMS-based RFID claims to withstand benefit from this important feature? If not,
extreme temperatures. then barcoding or 2-D symbologies may
Embedding RFID tags to metal objects is present a less expensive alternative.
a challenge because its antenna design and Are there environmental and other factors
reader configuration need to be that may impact the reliability or success of
customized. This can be very costly, and your RFID implementation?
the reliability is unknown.

IX. ABOUT HIBCC

VIII. CONCLUDING REMARKS
AND RECOMMENDATIONS The Health Industry Business Communications
Council® (HIBCC®) is an industry-sponsored,
In healthcare, RFID has the potential to achieve ANSI-accredited standards development
improvements in both supply chain productivity organization. Our primary function is to facilitate
and patient safety applications. However, the electronic communications by developing
HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 13
appropriate standards for information exchange problems using those standards. Solutions include
among all health care trading partners. automatic point-of-use data capture systems in
high-cost procedure areas within hospitals, so that
Our broad mission has consistently expanded to medical devices are captured and tracked directly
meet industry requirements and has involved to the patient. He is an active member of Standards
HIBCC in a number of critical areas, including Australia Committee for the development of
electronic data interchange message formats, bar e-commerce messaging standards and product
code labeling data standards, universal numbering identification and a member of the HIBCC technical
systems, and the provision of databases that ensure committee.
common identifiers. Contact him at [email protected].

Our current major activities have emerged as a HEINRICH OEHLMANN is the Vice President of
result of this broadening focus: Technology for EHIBCC. Products of his initiatives
Standardized manufacturer, customer, and are the DIN V66401 and HIBC "Unique
product identification codes, including the Labeler Identification Mark -UIM" for small and smallest
Identification Code (LIC), Health Industry Number medical devices, ISO-powered HIBC RFID tag
(HIN®), and Universal Product Number (UPN®) technical specification, and the documentation DIN
and the Health Industry Bar Code (HIBC) V66403 "System Identifiers" for interoperability
Standards between HIBC, ISBT, ASC and EAN/UCC. He is
Computerized EDI protocols in ASC X12 also a member of the HIBCC technical committee.
approved message formats Contact him at [email protected].
Participation in national and international
organizations working to further enhance
electronic communications standards. XI. REFERENCES
Perhaps most important, HIBCC is a nonprofit ANS 2 HIBC Health Industry Barcode Supplier
organization that plays a major advocacy and Labeling Standard.
educational role in the health care industry and Canvin, John. "Joint Automotive Industry
serves as the forum through which consensus can Statement on EPC." March 2006.
be reached as it electronically transforms itself for
twenty-first century commerce. EHIBCC TC. "ISO-powered HIBC RFID solution."
January 2004.
EPCglobal Object Naming Service, Version 1.0 -
X. ABOUT THE AUTHORS EPCglobal Ratified Specification. October 4,
2005.
LUIS FIGARELLA is co-chair of the HIBCC Guenter, Erich. IBM. Frankfurt, Germany.
Auto-ID committee, and a member of the technical Messing, Dr. Olaf. ASICON. Tokyo, Japan.
committee. He is an Auto-ID consultant, as well as
co-founder of StereoImaging, a manufacturer of NiemeyerStein, Werner. NiemeyerStein
stereoscopic-video surgical microscopes, and Engineering. Bremen, Germany.
Extremetix, a provider of Print-at-Home ticketing. Oehlmann, Dr. Harald. "What is a smart label?"
Formerly he was employed with RVSI/ID Matrix September 2002.
and United Parcel Service, where he participated in Woods, J. "Strategic Planning SPA-23-1513: Prepare
the development of the both the Data Matrix and for Disillusionment with RFID."
MaxiCode 2-D symbologies. He is a Professional June 29, 2004.
Engineer and Patent Agent.
Contact him at [email protected]. ISO/IEC 18000-x. "RFID Air Interface Protocols."
ISO/IEC 15961,2. "RFID Data Protocol."
KIRK KIKIREKOV is the President of HIBCC AU.
ISO/IEC 15963. "RFID Unique Tag ID."
He founded it to support suppliers and providers
in the Australian Healthcare industry in Vieider, Guenther. Interactive Logistics
implementing HIBCC standards, and has worked Consulting. Milan, Italy.
to implement innovative solutions to common
HEALTH INDUSTRY BUSINESS COMMUNICATIONS COUNCIL 14