Forget Everything You Know About Healthcare Real-Time Location Solutions (RTLS)

Bluetooth® Low Energy technology is about to shake things up. (In fact, it’s already started!)

Two clinicians look for items in a stockroom using a mobile computer with RFID sled attached.
by Your Edge Contributor
December 15, 2021

This blog post was written by Jag Padala, Chief Technology Officer, Tagnos, a Zebra Ventures portfolio company.

The benefits of a real-time location solution (RTLS) within healthcare are not difficult to justify. Medical equipment can easily be tracked, loss of equipment can be reduced, preventive maintenance can be improved, and recalls can be implemented a lot more quickly and reliably. RTLS enables nurses to find equipment, call out for help using RTLS badges and even locate nearby staff. Patient delays can be tracked, and the flow of patients can be improved.

However, the prevalence of RTLS in hospitals is spotty, and the penetration is low despite the variety of technologies available to provide RTLS locating and tracking functions. Zebra’s latest Healthcare Vision Study found interest among decision-makers to be high – about three-quarters say they plan to use location technologies to better track equipment and specimens, improve patient flow and security, and create more dynamic workflows, among other things. Yet, only a small percentage of hospitals have actually implemented RTLS to date.

Though it’s hard to pinpoint the exact reason for the laggard adoption, I can confirm that a number of RTLS implementations do not live up to expectations and slowly fall by the wayside.

Over the years, hospitals have tried out various solutions with various degrees of success, including Zigbee, Wi-Fi, infrared (IR) sensors, both active and passive radio frequency identification (RFID), ultrasound and more. Some technologies, such as Zigbee, have been discontinued while others such as IR and RFID have risen in popularity.

At Tagnos, we have helped customers implement Wi-Fi, IR, and RFID solutions for different use cases. Wi-Fi is good for zonally accurate asset and staff tracking. IR and RFID are dependable and work reasonably well for room level accuracy.  When implemented well, both can be extremely effective in solving use cases such as quicker operating room (OR) and emergency room (ER) turnovers, better on-time starts, and faster equipment locationing.

The Problems with Legacy Solutions and Promise of Bluetooth® Low Energy in Hospital 4.0

One reason a lot of RTLS projects do not take off is because of the need for additional hardware. However newer networks from Cisco, Juniper and other vendors have built-in location capabilities. And there are several compatible tags that can be attached to equipment or people, making RTLS implementations a lot easier to get off the ground these days.

A lot of the legacy solutions also have tradeoffs in costs. Sometimes it is in the purchase, implementation, or ongoing maintenance costs of the sensing hardware. Other times, it occurs in the cost and maintenance of the tags. Further, these RTLS solutions do not leverage any existing infrastructure in the hospitals. All the medical equipment needs to be tagged with the sensors compatible with the chosen location technology platform, and the sensing devices, if not Wi-Fi, need to be specifically put in for the express purpose of the RTLS systems.

But that’s exactly why Bluetooth Low Energy (BLE) RTLS solutions are starting to show real promise.

They offer a Hospital 4.0 value proposition akin to what Industry 4.0 brings to manufacturing. When equipment, staff, and patients can be tracked, holistic solutions can be developed to help with patient flow, facilitate the delivery of better care, drive better outcomes, and foster higher patient satisfaction. When the location information is merged with clinical data, flows such as patient discharge can be better orchestrated. For example, a patient discharge typically needs medications from the pharmacy, a transporter with a wheelchair or trolley, and a nurse who can print discharge instructions and get the room ready for the next patient as soon as the current patient is headed to the discharge area. All these signals can be gleaned from location information extracted from BLE-tracked medicine deliveries, wheelchair movements, printer activity, and discharge confirmation reports.

Plus, BLE is already matching up with Wi-Fi based location solutions in terms of accuracy. The primary mode of location for both BLE and Wi-Fi use cases is currently a received signal strength indicator (RSSI). When a tag is close to a BLE beacon, the RSSI sensitivity is large, so the distance can be measured more accurately. However, as the distance between the tag and the sensor increases, the sensitivity decreases. This causes the location accuracy to stay relatively low, with a possible error of 5 meters in both the BLE and Wi-Fi cases.

However, with new BLE revisions, new components such as radio direction finding (RDF) can be leveraged to enhance the location capabilities. Using this the accuracy can be as good as 1-2 meters which could provide room level accuracy.

Things to Consider When Implementing BLE in Your Hospital

Room level sensors: For now, BLE will need to rely on room-level sensors to provide room-level accuracy for tracking. However, we expect room-level sensors that can enhance the accuracy of location services to be available soon. When paired with facility-wide BLE available through the networking infrastructure, this solution could be used for patient tracking to improve OR turnover, for example.

Proximity: One of the key advantages of BLE is that it is not as limited in usage and availability as Wi-Fi-based coverage. In addition, the BLE devices – being able to communicate with the network – are also capable of communicating with each other. This can provide unique solutions such as proximity detection. Proximity can be used for contact tracing, staff interaction heatmaps and the location of nearby BLE devices, such as printers.

In addition, capable BLE apps can also act as data collection points to place BLE tags in certain areas. If a person with a BLE app walks into a room and picks up a BLE beacon on medical equipment tucked in a cabinet and not visible to other sensors, the BLE app can now work as an additional sensor to transmit the location of the tag in the cabinet. And if a nurse needs to print discharge instructions for a patient, the nearest BLE printer can be easily located.

- Tags: With the open standards of BLE, it will be possible to get access to a wide variety of BLE tags in various form factors. The tags could have a longer battery life than traditional Wi-Fi based tags.

 -Leverage smartphones, tablets, and laptops as BLE tags: Almost any mobile device will be capable of running a BLE-enabled app, so it can double as a tag. Hospital-issued clinical smartphones can essentially be used as location tags as well, so staff interactions could easily be measured. A large number of IT-owned laptops can be turned into BLE tags using a simple plug-in, which will immediately enable location sensing on the laptops with no additional requirement for hardware.

The Rise of BLE May Come Sooner Than You Think

The multi-faceted applications of BLE could trump Wi-Fi or RFID-based location systems and become more prevalent in healthcare and other settings very soon in certain applications. Tagnos, as a hardware-agnostic solution provider, is integrating with Zebra’s cutting-edge cloud-based platform to deliver the RTLS capabilities hospitals need to improve equipment and inventory management, improve patient flows and care, create more dynamic workflows, and improve staff efficiency, safety and compliance – all the things decision-makers told Zebra they’re aiming to achieve in the “Smarter, More Connected Hospitals” global report.

If you’d like to talk through your current challenges and better understand your current RTLS options, you can reach out to me via LinkedIn or schedule time with either a Zebra or Tagnos representative. Together, we’ll make sure you have the right location technologies in place to meet your operational goals.

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Your Edge Contributor
Zebra will occasionally publish insights from members of our partner community, our customers and other subject matter experts across the global industries we serve on the Your Edge blog. Background information about each individual author can be found at the bottom of their contributed blog post.
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