More and more surgical facilities are discovering what FedEx has known for years: It's good to keep tabs on your moving targets, be they patients or packages. Just as there are benefits to using bar codes and radiofrequency identification chips to track shipments and follow the movement of merchandise, patient-tracking systems using this same technology can make it easier to manage and improve patient flow through your facility. Here's some of what you can expect from an electronic tracking system:

• Shorter wait times. You can create solutions to common problems with patient wait times and bottlenecks. In a hospital where I helped implement an electronic patient tracking system, we set the computer to dial the pager of the registration manager whenever a patient was waiting for more than 15 minutes. You can program systems to send automatic alerts in other situations as well, such as when a patient is late, has not been moved to a procedure room when planned or has not left a waiting area or procedure room when planned.
• Better throughput. You can record all patient flow times for each visit. By analyzing this data, you can measure the workloads in various areas throughout the day and balance staffing and resources accordingly for maximum efficiency and throughput. One hospital increased use of its procedure rooms by 20% after implementing its electronic patient tracking system.
• Happier docs. The system can notify surgeons when patients and staff are ready and in place.
• Less data entry. Electronic tracking eliminates the need for staff to enter patient movement times, thereby freeing them up for other tasks.
• Real-time recordkeeping. Many tracking systems tell you not only where patients are, but what their status is in the continuum of care. You can use this information to your advantage in many ways. For example, you can ensure that patients are correctly identified during medical procedures and fully recorded for billing purposes. Some systems let you automatically transfer notice of events to financial systems for accounts receivable or reimbursement.

Cost considerations
Most medium-sized surgery departments (5 to 10 ORs) could be set up for about $90,000 to $100,000. About one-third of the cost will go toward the hardware, one-third for software and one-third for installation support. On top of that, you've got to purchase tracking chips. Per-chip costs vary depending on the solution you select, but they typically run about $25 each, not counting the plastic wristband. Tracking chip technology tends to get smaller and cheaper over time, so prices may be on the decline.

Design, implementation and maintenance of the system will depend on which provider you choose. Some are primarily integrators; they'll assemble the equipment and software, install the software on your computer hardware and train your staff. In this arrangement, you can purchase the actual chips and antennas separately or purchase them from the system integrator. Other vendors provide a turnkey solution that includes all hardware, software, training and support. As with other computer services, electronic tracking systems require ongoing technical support to cover periodic upgrades, replacement parts and troubleshooting, which could add about 20% annually to the initial cost.

One challenge with the tracking chips is that, because they're metallic, they can't be worn near certain diagnostic equipment such as MRIs. An even bigger hurdle is the risk of losing wristbands with the chips attached. At about $25 a pop, the cost of losing a chip every once in a while can add up. Patients should be told to leave their wristbands upon leaving, but they may forget or not notice the request. White Memorial Medical Center in Los Angeles purchased about 100 tags when it first implemented an electronic patient tracking system and lost most of them in the first month due to inadequate procedures to retain them. They eventually added an alarm system at the parking lot, similar to a department store's anti-theft devices at its exits. An automated solution may not be necessary if you set up a reliable collection system and train staff to gather wristbands upon patient discharge.

Bar codes or RFID chips?
Of hospitals that had a patient tracking system, a recent study found that about 20% used an electronic system (such as RFID) and about 80% used a bar-code system.

Bar codes are a familiar methodology, but they require proactive participation by staff to scan the correct page or tag, and they depend on staff to do the scanning promptly when needed. Electronic systems track patients reliably throughout the continuum of care without the labor cost of data entry. An electronic chip placed on a patient's wristband or shoelace broadcasts its location to a computer system that records the chip's location constantly, allowing users to retrieve the information in real time or for later analysis as needed. These systems are accurate in identifying the location of an individual patient with varying degrees of specificity, depending on the design and equipment selected. For example, you can configure the system to identify only what room a patient is in or where a patient is within the room. Best of all, electronic tracking systems don't depend on employees remembering to enter information.

The best known technology for patient tracking is radiofrequency identification; other tracking systems use ultrasound or infrared signals. The differences among the technologies boil down to a tradeoff between cost and location accuracy. An RFID chip costs more, but it's more accurate in reporting an exact location. If you wish to determine only which room a patient is located in and not the specific location of the patient within the room, go with a less-costly and less-precise technology.

What else you'll need
The exact equipment requirements and their cost depend on a particular facility, but many outpatient surgery centers already have the necessary computer hardware. Here's what else you'll need:

• Tracking chips. The easiest way to implement an electronic tracking system is to attach a chip, or chip holder, to the disposable plastic identification wristband given to each patient. It can be attached by a Velcro strip or other mechanism or molded into the wristband, and it can be recycled when the patient returns the band. Chips can also be attached to a patient's shoelace, as they are on marathon runners' shoes. Some patient tracking systems also let you add a chip to employees' badges so you can track staff locations during the workday.
• Software. Tracking software operates the system, gathers information from the chips' signals and displays it in a useful form. Administrators, clinicians and in some cases, even patients' family members may be able to look up a patient's precise location and status within the continuum of care from desktop or laptop computers and displays mounted on walls in facility hallways and waiting areas. Your software can also store data for future analysis.
• Antennas. These are installed to receive signals from the chips. The antennas can be interconnected with the use of typical phone wire or connected without a wire by Wi-Fi. The number of antennas depends on the desired accuracy of patient location and the size of the area to be tracked. They're unobtrusive and may be placed in ceilings, hallways or individual rooms.

An ideal arrangement for organizing the patient tracking information is to connect the chip ID to the patient's record. When a patient first arrives to register, he receives a wristband and the identification number of the tag is entered with the medical record number or another patient ID number (the only data entry required), so the wristband can be identified with that particular patient. This method ties the patient tracking record to the rest of the patient's data.

Electronic Tracking Systems: Assessing the Options
Awarepoint Corp.
Awarepoint T2P1 Patient Tag
www.awarepoint.com
FYI: Install this real-time location system anywhere in your facility without disruption, says the company. Patented sensors plug into electrical outlets to form the wireless Awarenet mesh network, and RFID tags track patients' locations throughout the care continuum. Awarepoint's T2P1 Tag endures standard autoclave cycles at temperatures up to 135 ?C, as well as immersion in common liquid sterilization methods.
Pricing: Per-asset, per-month leases are dependent on total square-footage coverage and the number and types of tags purchased.

Radianse
Radianse Reveal Patient Tracking
www.radianse.com
FYI: Patients wear an active RFID tag on a small wristband that communicates wirelessly to wall-mounted Radianse receivers, which are connected to the facility's existing network. A software algorithm calculates the patient's location to room-level accuracy, and a feature called "Smart Sense" lets you program situational awareness into the system that tells you whether patients are where they're supposed to be. Radianse provides the full package, including hardware, software, installation and training.
Pricing: Starts at $600 per licensed bed, including receivers, software and patient tags.

Tagnos
Patient Flow Management
www.tagnos.com
FYI: You choose the tracking technology — RFID and ultrasound are the most popular options — and Tagnos says it will deliver the complete solution, including hardware, software, installation and ongoing service. An electronic tag clips onto a patient's wristband and automatically tracks the patient's location and status without requiring any manual user input. Tagnos also lets both the facility and the patients' physicians and family members track their whereabouts remotely via a Web-based, HIPAA-compliant "dashboard" solution, which you can place in the lobby or waiting room.
Pricing: $50,000 to $99,000, depending on the size of the installation.

Versus Technology
VISion Enterprise Locating and Automation Solutions
www.versustech.com
FYI: Versus offers the full continuum for its dual infrared and active RFID real-time location system, including the initial consulting, its own line of badges and tags, multiple software and reporting suites, certified implementation and training specialists and 24/7 support teams. Small, circular sensors are installed in the ceiling and reusable Versus badges relay ID signals every 3 seconds to the nearest sensor. The system yields real-time, bed-level location data for each patient, says Versus, which facilities can use for immediate diagnostic or historical trend comparisons.
Pricing: $50,000 to $150,000.