It is clear that RFID technology offers some exciting prospects and some clear advantages over bar coding, the technology with which it is often compared. The capability for remote and real-time tracking of expensive assets, sophisticated devices, precious resources and patients offers potential opportunities limited only by traditional thinking and custom. However, as with the implementation of any new technology, it is important to ensure that it is addressing a clear business and/or clinical need.

The paper sets outsome of the potential benefits of the technology but it is helpful to think about what might be the key issues affecting the successful implementation of RFID technology in a health environment.

Apart from the generic factors necessary for the success of any change initiative - theengagement of users, support of senior management, strong project management and benefits realisation - there appear to be three issues.

1. Safety and Reliability

As the paper sets out there is great potential in theuse of RFID to support patient-centred processes. The ability to track an individual and link their physical presence and condition to other knowledge about them could present a major saving in time. Linked with integrated care pathways, this could also reduce a range of medical errors including errors in prescribing, support patient compliance with drug regimes and improve patient safety simply by being able to locate the patient and/or the appropriate clinician more quickly than would otherwise be the case.

However,it will be critical to be able to understand the potential risks and limitations of the technology in order to improve reliability and to assureusers and encourage them to place their confidence in the technology. As is already well known from the implementation of new technology and working practices in other settings, it will only take one incident that might be relatively trivial in itself but have potentially serious consequences, for confidence to be eroded. Examples might be the insecure transportation of RFID tags or errors in tag-reading as a result of environmental factors (e.g. metal doors) which could produce anomalous results. These risks are easy to manage once they are understood.

2. Cost

As the technology becomes more widespread so the unit cost of tags and readers will continue to fall and we would expect to see the development of a range of other associated hardware. But as the paper points out, to generate the full benefit of the technology will require clear, systematic thought from the outset about the whole end-to-end processes.

As an example, in the retail industry delivering the potential benefits of faster customer checkout processes together with automated creation of incredibly valuable stock control and customer information, can only occur when there is a whole system change with suppliers playing a critical role in ensuring their products are accurately coded and compatible.

It must also be noted that the technology is still new and, as one of the paper's references points out, the pace of change with new RFID technologies remains high. This implies that not only does flexibility need to be built in to any RFID implementation but also that upgrading will be a common occurrence in the early part of RFID implementations, with the associated additional learning and costs. There is a parallel with the experiences in the use of developing biometric technology.

RFID implementations rarely stand alone - they become part of the IT infrastructure. The various components - tags, networked readers, intranets (and/or LANs and WANs) and back-end servers - will need to work with certain technical standards and IT infrastructures may need enhancements to facilitate a RFID implementation.

3. Privacy

Rightly or wrongly there is a perception that RFID tagging is 'big brother' when it is used to track individuals, even when these individuals may be patients in need of constant monitoring or clinicians who are vital to a patient's care.

However we readilycarry around many different forms of identification at present but these are generally invisible to others. RFID tagging to uniquely identify individuals is being implemented on the basis of providing authorised access for the appropriate clinicians and carers to health records for that individual, as reported in the paper about the work at Hackensack University Medical Center in New Jersey. However, any proposals for widespread implementation of RFID tags for such purposes may be greeted with scepticism from many and outrage from civil libertarians on the basis of the ease with which such a system could be abused.

This "big brother" issue is already the subject of technological debate. Quoting Dr Humberto Moran, chief executive of Open Source Innovation, a software charity based in the UK, ZDnet reports that open standards and software would allow for greater transparency and help diffuse the 'Orwellian' reputation that radio tags and the associated tracking technology have attracted. Indeed without access to any back office systems to decode, a coded identification on the tag is, in itself, meaningless.

In conclusion, it appears that RFID technology has the potential to drastically decrease the occurrence of medical errors, to decrease the time needed to locate precious resources and to dramatically improve asset management. In addition, and with a whole system approach and integration with other health care applications, there is the exciting potential of delivering more efficient patient care through higher levels of compliance with care pathways.

In order for some of this potential to be realised, implementations of RFID technology will need to avoid being oversold and objectively demonstrate the lessons learned from early implementations by increased and improved reliability and safety. In addition, whilst RFID technologies have been around for some time, the pace of change of RFID technology standards needs to stabilise and a clearer picture needs to emerge about where RFID technology delivers most benefits. With this will come a more coherent approach to what is entailed in an integrated RFID implementation and the associated costs and benefits.

Finally, the RFID tagging of patients and other categories of people needs to clearly demonstrate that the benefits considerably outweigh the concerns over the intrusion of personal privacy and confidentiality issues. That is achievable through open and transparent communications.

Tony Eardley / John Farenden
Tribal Consulting