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A U G U S T 2 010

Advoca'ng...  Pa'ent  Safety,  Real  Time  Visibility,  and  Opera'onal  EfficienciesTM

PRESIDENT’S  CORNER
IN THIS ISSUE RFID  in  Healthcare  Consortium  
The past three months have demonstrated great growth in the
Letter from the president RFID in Healthcare Consortium as we continue to strive in our efforts
RFID in healthcare consortium.............P.1 to raise awareness and research into the deployment of wireless
technologies in healthcare. Our partnership with RFID Journal Live in
Letter from the editor...........................P.2 April 2010 was widely attended and has helped build the foundation for
a forum in which industry leaders, innovators, and healthcare
professionals can come together and discuss the potential uses and
The missing key “a killer app” Part I.....P.3
benefits of these technologies while bridging the gap in understanding
the unique needs and challenges of the healthcare environment. Over
Integration of RFID Positional Information the ensuing year, we will seek to further build on these successes as we
with Clinical Device Data....................P.4 partner with the Healthcare Information and Management System
Society (HIMSS) at the upcoming 2011 national conference and further
Book Review: The Checklist Manifesto by engage with our international partners in identifying new educational
Atul Gawande....................................P.6 and research opportunities to support our common mission.
Improving knowledge in the area of RFID, RTLS and wireless
Which Asset Tracking System Guarantees communications amongst healthcare professionals has and will
Hospitals Superior ROI?......................P.7 continue to allow for improvements in our ability to integrate new
technologies into the clinical setting and to offer the advantages in
RFID Efficiency throughout Pharmaceutical safety, efficiency, and cost-effectiveness that these technologies have
Manufacturing....................................P.8 provided in other industries. However, success will require engagement
of not just business and thought leaders, but the continued education
Supplementing Fall Prevention Tools with a of the end user. Our ultimate goal is to identify the potential of
Falls Detection System.......................P.10 technology to improve the healthcare landscape, with the hope that
systematic adoption will improve processes and the ability of the
clinician to focus on safe and effective patient-centred care.
Integrating RFID in Hospitals as Part of the
Healthcare Chain..............................P.11 We are excited as the RFID in Healthcare Consortium attracts
many new and energetic members. Through a group of individuals with
References........................................P.12 a wide variety of expertise and backgrounds, the RFID in healthcare
consortium continues to stand at a crossroads where we are able to
uniquely respond to the challenges that exist with the adoption and
integration of new technology into healthcare systems. While more
institutions than ever are adopting wireless methods of caring for
patients both at home and in the hospital, adoption is inconsistent
across systems and the economic realities are often difficult to assess.

R F W A V E S! ! 1
These issues arise from both a dearth of systematic healthcare communities may freely contribute, interface,
research into the field and of awareness on the part of discuss, and debate the issues that we face. Over the
the end user about the potential these ensuing months, through a number of
technologies hold. Furthermore, concerns activities, including surveys,
remain regarding issues ranging from newsletters, and live sessions, we will
electromagnetic interference with existing « Our ultimate goal is seek to build the discussion to foster a
healthcare technology to the costs of greater tomorrow in healthcare.
to identify the
deployment of these wireless systems. However, none of this will be possible
These issues are real and require open potential for without the continued support of our
forums amongst all of us to properly technology ... improve colleagues, members, and
engage in discussion if we hope to realize collaborators. Thus, we look forward to
the future that these technologies would processes and the finding new avenues in which to work
appear to offer. ability of the clinician with you toward these common goals.
With these successes and persisting to focus on safe and Thank you for your continued support
issues in mind, we look forward to your effective patient- and interest. ∞
support as we continue to build the
Consortium into a forum in which all centred care...» Suraj Kapta, MD
members of the RFID, RTLS, wireless and

LETTER  FROM  THE  EDITOR


Mobile  Technology  is  Revolutionizing  Healthcare Considering the shortage of medical professionals
and the enormous workload imposed upon them, these
Hospitals are considered one of the most user-friendly, mobile devices will revolutionize patent
challenging and complex environments because they care and safety. They will enable medical personnel to
provide immediate, continuous services 24/7. In order monitor patients on-the-go; access patient records in a
to meet the inherent challenges associated with secure and highly efficient manner; enter diagnoses;
providing non-stop care, an ever-increasing number of and remotely modify patients’ treatment plans.
healthcare professionals are turning to technology to Moreover, physicians could have remote, real-time
collect, store and transfer information electronically. access to bedside monitoring systems to ascertain a
The introduction of iDevices such as the iPod, patient’s status by collecting a range of information
iPhone, and more recently, the iPad into the healthcare such as their EKG, BP, heart rate, pO2, pCO2, etc.
arena have brought about a new paradigm for clinical To date, the advantages of these mobile devices
decision making. Medical practitioners can now use have not been fully studied. However, early indications
some of these devices, and a wide range of third party are that they will become indispensable and necessary
iMedical applications, to store medical references, to achieve leaner operations; more efficiently use a
search for the latest publications on medical topics, clinician’s time; and improve response time, care
view clinical images, check drug reference, and much delivery and ultimately increase patient safety. The
more. bottom line - hospital operations can be redesigned in
During the last year, healthcare facilities have integrate these new technologies to ensure quality
started adopting these products. The iPhone, for patient care and safety. I'm very optimistic about the
example, has been implemented in various hospitals in benefits of integrating these devices into the healthcare
North America, including the Mount Sinai Hospital in system. As more hospitals continue to adopt these
Toronto, Canada, and the Memorial Hermann in technologies, new applications and opportunities will
Huston, Texas, in order to conduct a wide range of surely rise. ∞
tasks including, accessing EMR, medical literature,
statistic, and to facilitate internal communication and
patient monitoring. The outcomes of these
implementations have been optimistic and promising. Linda R. Castro
Medical professionals consider these mobile devices a Editor-in-Chief
break-though in communication since they allow them
to be in contact with their patients and medical staff in
real-time, no matter where they are in the hospital,
through a secure, wireless environment.

R F W A V E S! ! 2
The  missing  key  “a  killer  app”  Part  I was a runaway success, which was later transplanted
with Lotus 1-2-3. It was such a useful tool but only
by Mayank Trivedi
available on Apple and PCs. My job in those days as a
I became interested in RFID/RTLS systems a few systems programmer on IBM mainframe required me to
years ago. My 20+ years of experience running process tons of performance data from dozens of
healthcare software companies gave me instant vision of mainframes everyday. Being frustrated by the limitation
the benefits attainable through the integration of this of Lotus 1-2-3, I wrote a version for the mainframe for
technology, including improved patient safety, workflow my personal use.
efficiencies, asset and specimen tracking, etc. I got to
The spreadsheet and then the word processor
know the industry from a dizzying array of acronyms,
sealed the fate of the personal computer as the staple
buzz words and technologies. We have 1D barcode, 2D
for businesses. Individual users though, still had very
Data Matrix, passive RFID, LF, HF, UWB, battery
little to justify the expense and the learning curve
assisted tags, IR-RF, Ultra Sound-RF, Dual RF, WiFi and
(VisiCalc not withstanding). But the Internet changed all
the list goes on. There are rumors of nano technology
that. The proliferation of the Internet finally raised the
with nano antennas, nano-batteries and nano-tags.
stature of the PC itself as the essential hardware for this
Further, there are temperature sensors, cryogenic
killer app.
sensors, vibration sensors, motion sensors, light
sensors, tamper resistant tags, tags the size of buttons The Internet and Email was invented in the 1970’s,
for laundry, paper-thin tags and embedded tags. however, it was not publicly available. Even after it
Definitively, there is a large array of choices and became accessible to the general public, most people
possibilities. had no use for it or did not know about it. Then came a
killer app. Not just a killer app, but also an enabler of
But with so many smart people trying for so long,
humongous proportions—the web browser. The browser
why has RFID not become a staple of healthcare
was invented in 1994 and made the Internet a must-
industry like barcode is today? Sure, there are early
have. The Internet spread across the globe like a wild
adopters who have had their successes and case
fire. I remember driving through a farm valley outside of
studies. But why is it not an industry essential today?
Bratislava, capital of newly free ex-Soviet bloc country of
Slovakia in 1996, and seeing billboards advertising the
TECHNOLOGY ADOPTION
Internet.
This industry seems to be taking a typical
So what does this mean for RFID? Why has RFID
technology evolutionary path. All technology from TV,
not become a ‘must-have’ for every hospital despite
Computers, Cell phone, GPS and Internet itself have
taken a similar path. Each was an invention that decades of innovation and successes in other
struggled until two things happened: The technology industries? Where is this industry on this well-defined
had to get mature enough to be reliable, and had to path that every technology takes to mass market?
deliver solutions to the end users. The final key to the
puzzle is a killer app! RFID HARDWARE / RTLS

Computers were around for decades or more, yet There is a dizzying array of incompatible
largely unknown to the masses. The computer industry technologies available today, and nanotechnology holds
exploded with the home computer revolution, a great promise in the near future. The hardware
revolution where everyone would possess and use a technology has matured, but has way to go before a
computer. The two machines that almost ignited such a single set of standard emerges a winner - ala the famous
revolution were the IBM-PC (1981) and the Apple VHS vs. Betamax battle (Blue Ray vs HD-DVD in recent
Macintosh (1984). The problem was the lack of any days).
killer apps. The industry kept harping that the
machines were very useful; everyone could use them. Hospitals consist of complex environments, which
With functions from storing recipes to storing bank need multiple types of RFID technology. For instance,
balances. Never mind that the recipes are better stored for patients and high value assets like medical devices,
on a notebook and bank balances noted on the ledger. we need active tags. For inventory management we
need lower cost passive tags. We need temperature
Arguably, the earliest killer app was a program sensors, cryogenic tags, laundry tags, paper thin tags,
called “VisiCalc” (1979). VisiCalc was the first tamper detection tags for fixed assets, and we need all
spreadsheet, before even anyone used the word this to work without emitting EMI that can interfere
spreadsheet. In fact, the phrase killer app itself was with medical equipment or patient’s heart pacemakers.
coined in retrospect from the success of VisiCalc. The Moreover, I do not yet see the event horizon when
concept was simple in hindsight; the program opens a barcode technology will vanish from use.
screen containing rows and columns of cell, much like a
rather large ledger. INDUSTRY LANDSCAPE
VisiCalc revolutionized the business planning and
finance arena. Complex financial calculations that took Today no single vendor provides all these solutions.
hours to work out could be done in matter of minutes. It There is no one stop shopping for your entire RFID

R F W A V E S! ! 3
infrastructure needs like there is for computers (Dell, on, primarily from RFID hardware vendors. Hospitals
HP etc). The computer industry matured, and went from who have implemented these systems with success are
dozens of computer makers with competing offerings now looking beyond the basics. What else can I do with
that did not inter-operate well, to just a few this location data?
companies that manufacture everything from
What is your killer app? What will
desktops, laptops, tablets, servers, networking
make you say, “I need this!”? Is it
equip men t, as well as p rin ters. T h is « What is your killer asset tracking, patient safety or
consolidation happened in response to the
app? What will make something else? Or is it all of those
end users need for standardized hardware
you say, “I need on a single system? This is a
from a single vendor. I believe that RFID will
groundbreaking time for our
go through the same path and eventually will this!”?... what will industry, and I can't wait to see
evolve to where all these types of tags are
emerge as our "killer what will emerge as our "killer app"
inter-operable and available from the same
app" launching RFID launching RFID as a "must have"
vendor.
category for healthcare. Obviously
as a "must have" there is lot more in applications but
Like PC, RFID/R TLS is an enabling
technology. It is not a solution and like a PC category for that is for the next column. I
or iPhone, it will become a "must have tool" welcome your responses to this
only when there are one or more killer apps critical question. ∞
that customer cannot live without.

APPLICATION SOFTWARE About  the   author:  Mr.  Trivedi   is   a  22-­years   veteran  of  healthcare  
IT   with   keen   interest   in   bridging   leading   edge   technology   and  
The simple answer is that there is no ‘killer app’ healthcare.   He   is   Chief   Executive   OfAicer   of   Indralok   Healthcare  
yet. Asset tracking is the darling of every vendor and it Systems,   which   provides   hardware   independent   enterprise-­class  
has given foothold in the market. But there is larger location-­aware   software   solutions   to   improve   operational  
promise of RFID technology, which is not yet realized or efAiciency,   workAlow   automation   and   patient   safety.   Before  
delivered. It is not yet clear whether there is a single founding  Indralok,  Mr.  Trivedi   was  Founder/Chief  Executive  OfAicer  
killer app like VisiCalc or whether a critical mass of of  Sysware   Healthcare   Systems,   a   leading  provider   of  laboratory  
applications like the Apple iPhone's App-store will be the information   systems.   Under  his   leadership,   Sysware   grew  in   to   a  
key. multinational   company   with   over   150   employees   in   3   countries  
End user experience by far has been with single and  was  acquired  by  Eclipsys.  
application like asset tracking, patient tracking and so

Integration  of  RFID  Positional  Information  with   nursing operations and materials management and
Clinical  Device  Data   increases the potential for increased costs via redundant
equipment purchases and/or leases. RFID systems can
by Paul Booth, MS, and Paul Frisch, PhD provide real time location information for devices and
Using RFID to provide location information alone help with this process. While knowing the location of
does not maximize the potential advantages that RTLS specific asset types is good, knowing the use status of
systems can provide to clinical applications in a the asset alongside the location is ideal. As the infusion
healthcare institution. Many times it is the integration pumps talk to their host server via the hospitals wireless
of location information with relevant data from other infrastructure and provide a wealth of information
clinical systems that provide the caregiver with more relevant to the operations and status of individual
efficient and potentially safer methodologies in providing pumps, the required status information can be
patient care. In our institution, one such example of extracted from the server and incorporated with location
this integration is in combining data from our smart information from the RTLS system. Through the
infusion pumps with real time location information for automated combination of the data from the two
nursing, patient safety, materials management, systems, in this case location data and infusion pump
financial, and clinical engineering applications. “in use” data, the information is presented in real time
on a singular display to facilitate optimized location of
NURSING APPLICATIONS the nearest available infusion pump.

The ability to locate equipment in a timely manner PATIENT SAFETY


is critical for nursing operations. Historically, nurses
have resorted to hoarding equipment when faced with The current generation of smart infusion pumps
the possibility of having a local shortage of a needed utilizes programmable formulary datasets to insure that
asset. This process leads to inefficiencies in both infusions are correctly set within acceptable parameters
for the respective drugs being administered.

R F W A V E S! ! 4
These formularies are updated on a regular basis and for the device in the first place and there was no
it is critical from a patient safety perspective to ensure guarantee that the subsequent attempt to locate the
that every pump is operating on the latest formulary device later on would in fact be successful. Through
version. The process by which the pumps acquire the combining the data, the devices that require PM can
formulary and subsequently are activated is both an now be prioritized based on their real time use status
automated and a manual process. The formulary is and their respective locations. This system allows the
automatically sent to the individual pumps via the technician to more effectively manage their time as well
wireless network and receipt of the download is as to address the important patient safety component of
verified and recorded. To then activate the downloaded their operation of ensuring that the pumps are all
formulary, the pump needs to have its power serviced within their required PM interval.
manually cycled and only then is the process
completed. While the process is straightforward, with CONCLUSION
a large pump distribution over a medical campus, it is
a challenge to identify all of the pumps that need to be RTLS systems alone provide valuable information
cycled and then to locate the ones that have been to clinicians and supporting personnel regarding the
missed. To accomplish this goal, the formulary location of equipment. To effectively maximize the
information, stored in the infusion pump server, is effectiveness of this information and to truly enable
combined with location information from RFID to personnel to maximize their process efficiency, this
provide a listing and location of pumps that have information must be augmented with supporting data
either not been uploaded with the current dataset or from the individual devices that are being located. As
have not be recycled to activate the current dataset. we have seen, only when we have the right tools that
Only with this combined information can the enable us to go beyond the boundaries of current
questionable pumps be accurately and timely located processes can we look for new ways to improve
to insure uniformity of the formulary across the operations and maximize our quality of patient care.
institution. Combining Location with device specific data is one of
those enabling tools. ∞
MATERIALS MANAGEMENT AND FINANCE
About  the   author:  Paul   Booth  is  currently  the   Section  Head  of  the  
Equipment pur chases and distribution is Biomedical   Systems   group  of  Biomedical   Physics  &  Engineering  at  
constantly a challenge, with the administration trying to Memorial   Sloan-­Kettering   Cancer  Center.  Paul   Booth  has   Masters  
find the optimal balance between purchasing or leasing Degrees   in  Computer  Science  and  Electrical  Engineering   from   the  
the minimum number of devices while ensuring that the Stevens   Institute  of  Technology,  a  Masters   Degree  in  Finance   from  
clinical needs of the institution are met by always Texas   Tech   University,   and   a   Bachelors   Degree   in   Electrical  
having equipment available. Through the integration of Engineering   from   Bucknell   University.     He   is   currently   working  
location information and use statistics, a more complete towards   his   PhD   in   Technology   Management   from   the   Stevens  
picture of the equipment distribution, use patterns, and Institute   of   Technology.   His   speciAic   areas   of   research   include  
utilization statistics can be taken. While overall use microprocessor   design,   display   integration,   robotics,   and   RTLS  
statistics can be identified from the pump server alone, methodologies.
when we combine this information with location, we can
break down the utilization profile down to the unit level. Paul   Frisch   is   currently   an   Assistant   Attending   and   Clinical  
This process allows us to identify bottlenecks in the Member   in   the   Department   of   Medical   Physics   and   Chief   of  
system and more effectively distribute resources Biomedical   Physics   &   Engineering   at   Memorial   Sloan-­Kettering  
throughout the institution. Specific areas can be Cancer   Center.       In   addition   he   has   an   appointment   as   Visiting  
identified and targeted to optimize the process of Assistant   Professor   in   the   Department   of   Bioengineering   at   the  
redistributing the pumps to needed areas. From a State   University   of   New   York   at   Binghamton.   Paul   Frisch   has   a  
financial perspective, we are now able to examine use Doctoral   degree   in   Biomedical   Engineering   from   the   State  
statistics throughout the day, week, or year to get an University  of  New  York   at   Binghamton  and  Masters  and  Bachelors  
accurate assessment of number of pumps required to degrees   in  Electrical  Engineering  from  the  State  University  of   New  
satisfy the clinical needs of the institution. York   at  Stony  Brook.  He  currently   serves  on   the  technical   advisory  
boards  of  CISCO,   Philips  Medical  Systems,  Health  Systems  Solutions  
CLINICAL ENGINEERING and  acts   as   the   Chief   Technical   OfAicer   for   the   RFID   Consortium.    
He  has   published  more   than  35  reviewed  publications  and  several  
Clinical Engineering operations can be streamlined
book   chapters.   His   speciAic   areas   of   research   include  
through combining information from individual
electromagnetic   Aield   induced   gene   expression,   robotic   surgery,  
systems. When devices are due for PM, they can now be
and   clinical   applications   of   wireless   technology.   Previous  
effectively located anywhere in the system through
experiences   include   research   in   human  biodynamics   investigating  
RFID. This information alone however tells the
human  response   to   transitory   acceleration,   such   as   crash-­impact  
technician nothing about the status of the device.
and  aircraft   ejection   and   robotic   applications   in   pharmaceutical  
Historically, many devices due for PM have been located
development.
only to find the device in use and unable to have the PM
performed at that time. Wasted time was spent looking

R F W A V E S! ! 5
Book   Review:   The   Checklist   Manifesto   by   Atul  
Gawande
By Emily Sopensky, co-founder RFID in Healthcare
Consortium
The kitchen is the heart of the home. At least it
was when I was growing up. Before I was old enough to
ride a bicycle, I was already reaching for the measuring
spoons and sifting the flour. Then, when out of college,
working and living in a one-bedroom with a kitchen the
size of a postage stamp, I served gourmet meals to
friends. (Only the best of friends were invited for the
handpressed duck citroen, a two-day labor of love.)
Judging from the cookbooks that line my
bookshelves, you might appreciate how much I enjoy
cooking. You would be half right. I enjoy the adventure
of cooking; I enjoy finding a good recipe. I enjoy
anticipating the first taste as the food is cooking. I enjoy
proof that the recipe works.
However, I’d rather not follow the recipe slavishly.
After years of practice and experimentation, I am
comfortable modifying a recipe on the fly. Rarely, does
the cook go wrong.
<Ok. Maybe some experiments are trashcan
doomed. But I confess, my experiments are solely self-
inflicted. When I do cook for more than one, the balance “freedom and discipline, craft and protocol,
cookbook is open.> specialized ability and group collaboration.” While
following a recipe slavishly is not interesting to most,
My fascination with controlling fate in the kitchen saving lives is.
is matched only by my interest for Atul Gawande’s best-
selling, brilliantly focused treatise on checklists. Yes, A prolific and well-respected surgeon with
that’s right. Checklists. Harvard’s Brigham and Women’s Hospital, Dr.
Gawande’s credentials embrace the academic, surgical,
Dr. Gwande’s short book relates his exploration of public health and journalistic worlds. He is on the staff
a simple proposition in medically saving lives: We have of The New Yorker and an associate professor at
an abundance of information but, as he writes in his Harvard Medical School and the Harvard School of
book, “the volume and complexity of what we know has Public Health. He is the director of the World Health
exceeded our individual ability to deliver its benefits Organization’s Global Challenge for Safer Surgical Care.
correctly, safely, or reliably. Knowledge has both saved As recent as April 15, 2010, the THE CHECKLIST
us and burdened us.” For example, the World Health MANIFESTO: How to Get Things Right (Metropolitan
Organization classifies more than 13,000 different Books; January 4, 2010, was sixteen on the New York
diseases and symptoms, and gives procedures for Times Bestseller Hardcover Nonfiction list. That’s pretty
dealing with them. According to Gawande, research has amazing for any how-to book written by and for
consistently demonstrated that nearly half of the annual surgeons. (It dropped to 28 by the end of April.) His last
150, 000 deaths following surgery are avoidable. book, BETTER: A Surgeon’s Notes on Performance, was a
Technology in the surgical suite adds another New York Times bestseller and one of Amazon.com's ten
dimension of complexity. best books of 2007.
Recognized as an expert in patient safety, Gwande Despite Dr. Gawande’s star status, his research,
was tapped by the World Health Organization to lead a initiative and experiments with checklists were
global project to find ways to reduce deaths in surgery. rewarded only after following protocol experiments with
Because many of the avoidable deaths occur because of adequate trials, (Trial sites included Tanzania, Delhi,
miscommunications among the surgical team, Gwande and New Zealand.) but the WHO now has a basic
focused on methods to ensure better communication checklist for operating theaters that is accepted by most
among team members. The checklist was a natural who have worked with it.
solution. But in such simplicity lies complexity.
Researching checklists that work, Gwande visited For anyone who has worked with RFID systems, it
airplane manufacturers and construction sites, learning is easy to see the value of a workable checklist. RFID
that there good checklists, like that in the cockpit are a systems require sophisticated knowledge of engineering,
melding of science and high art. He learned that physics, psychology (people and how they interact and
checklists must allow for people to learn and adapt; to use a system). Underestimating the value of good
planning can wreak havoc on a company’s net profit.

R F W A V E S! ! 6
As with any complex system, investing in a good principal, Leo Rohlinger, writes in the next issue of RF
systems integrator is paramount in ensuring that an Waves. See his checklist of what makes a good client.
RFID system works well and is reliable. Many successful
RFID systems integrators often find themselves
educating their clients, to the point that the cost of such About   the   Author:   Emily   Sopensky   is   co-­founder   of   the   RFID  
on the spot education is embedded in the way they Healthcare   Consortium.   Emily   began   her   involvement   with   radio  
work. Understanding the technology and the systems, frequency   identiAication   in   1996   with   Texas   Instruments   (Dallas,  
learning how to be a well-informed, engaged client is Texas).  As   an  active   member  of  IEEE   and   board  member   of  IEEE-­
only good business for both the client and integrator. USA,   she   chaired   the   Airst   two   international   IEEE   technical  
conferences   on   RFID.   Currently,   she   is   intrigued   by   the   complex  
Kitchens vary in design, utility, and personality, as issues   regarding   the   use   of   wireless   devices,   including   RFID,   in  
do RFID systems. Let a successful systems integrator health  care  delivery.
give you a recipe for your installations success. InCode

Which   Asset   Tracking   System   Guarantees  


Hospitals  Superior  ROI? Liquids and Metals
Learn  how  Cath  Labs  can  keep  track  of  stents  and  high  cost   Liquids and metals are more difficult to scan particularly at
inventory  using  new  RFID  technology the higher frequency of UHF (860-960MHz) because
liquids absorb the signal, whereas metals block the signal.
By Ronald Pulvermacher Consequently, HF is a good choice for these types of
products and until recently was a big driving factor on
There are several solutions on the market that help which technology to chose for tagging product. A
people track their supplies, but how does one know multitude of companies now manufacture UHF tags
what solution fits best with their targeted application? specifically to be attached to metal and liquids that still
This article should help you sort it all out. provide adequate read ranges. This has changed the
decision making process and opens the door further for
There are three main solutions to track inventory UHF applications.
in a room: Smart Cabinets, Smart Shelves, and Entire
Room Inventory Management. Let’s take a look at some
of the characteristics and benefits of each of these three HF (13.56MHz) v.s. UHF (860-960MHz) tags
HF is a mature technology, which was originally used for
solutions:
access control ID cards. It uses the magnetic field from the
tag and therefore has read ranges of less than 1 meter.
Smart Cabinets UHF is the technology where most of the development has
been in the last few years because of the mandates set by
High value inventory or goods that need to be
Wal-Mart and the Department of Defense (DOD). These
locked and accessed with a personal ID card are well
tags are being applied to pallets, cases, and more recently
suited for cabinets. Some examples of such items are on each individual item. For example, clothing stores are
tissue samples, organs, cancer therapies, and surgical beginning to tag each apparel item and scanning entire
kits. These cabinets are normally connected to the department stores in hours. The number of vendors
Internet and the database is hosted off site. The producing UHF tags is increasing rapidly, pushing
cabinets can be room temp or refrigerated cold storage. technology up and prices down.
They are normally leased on a per month basis to
eliminate a large capital expenditure for the hospital.
Repairs and maintenance are then provided by the
cabinet supplier. However, reading tags attached to The shelf has a short read range antenna under or
liquids, metals, and metalized Mylar bags can be along the back of the shelf. These shelf readers are
challenging. The presence of these materials absorb, normally connected to the Internet and the data is
reflect and suppress electromagnetic fields, creating hosted off site. They also are normally leased on a per
potential interference and affecting read rate reliability month basis. When an item is taken off the shelf, the
(See side bar). Some typical companies that system knows that it has been removed. If an item is
manufacture these solutions are Terso Solutions, transferred to another shelf in another room, the system
Mobile Aspects, and Wavemark. can automatically transfer the inventory. During a
Smart Shelves surgery procedure, an additional checking out station is
set in the room to assign inventory to the patient for
Shelves are similar to cabinets in that they billing. A similar individual station is used to assign
automatically scan the items that are on them. They labels during check-in if the product does not come in
typically use High Frequency (HF) instead of Ultra-High pre-tagged. Wavemark is an example of a company that
Frequency (UHF) tags (See side bar). offers Smart Shelf systems.

R F W A V E S! ! 7
Entire Room Inventory System

When a room has a lot of items to store and there Summary


are cabinets wall to wall, it is a very good candidate for In all cases, it is more convenient if suppliers apply
an Entire Room Inventory System. the RFID tags before the item arrives at the health
In Cath Labs and Surgery Rooms, the cabinets are care facility. All of these systems significantly reduce
often built into the walls. the risk of using expired
This system can utilize inventory. Where items need to
the existing cabinets be under locked for security,
using either a handheld cabinets are the clear choice.
scanner or tethered When there are limited items to
antenna reader to check track, then Smart Cabinets or
out inventory or for Smart Shelves are a good
transfer of inventory to choice. When it is just dollars
another room. In these that are to be saved by reducing
modes, the reader in set labor and loss, then Entire
to a very short read range Room Inventory Management
to avoid reading systems are much more cost
unwanted items. This ef fective per cubic foot of
mode is used, for storage. All of these systems
example, in a lower the risk of using expired
catheterization procedure inventory on a patient, prevent
to check out inventory to loss, reduce inventory levels by
Example of Wyze-Scan UHF label integrating Real Time Inventory
be charged to a patient
bill. One advantage in Management (R TIM), and
this system is that the reduce labor. Normally the ROI
door on the cabinets can on these systems are easily
be left open for easy access during a surgery. When a justified. ∞
full room inventory is taken, the reader is set to high
power level for long range reading. The handheld About   the   author:   Ronald   Pulvermacher   has   a   BSEE   from   UW-­
antenna or scanner is waved in front of the cabinets Madison   and   is   founder   and   president   of   Matrix   Product  
and the entire room is scanned in minutes. This Development  for  the  last  12   years.     His  Airm  specializes  in  high   tech  
eliminates doing a manual inventory count every 6 electronics   with   a   focus   on   RFID   and   wireless   devices.     He   has  
months, which is a highly laborious task, and experience   in   agricultural   tractor   instrumentation,   automated  
definitively not a fun job. A barcode/RFID tag milking   systems,   hand   wash   veriAication   systems,   and   medical  
combined reader is used for check-in where the UHF equipment   design.    Ron   is   a  member  of  the   Institute   of   Electrical  
tags are applied and assigned to a cabinet. and   Electronics   Engineers,   Inc.;   Madison   Area   Business  
Consignment inventory vendors can receive automatic Consultants;   and   Past   President   of   Product   Development   and  
emails that list all of their products along with the Management   Association   (PDMA).   He   holds   several   patents   and  
product expiration dates. An example of a company that awards   related  to  Alow  meters,   milk   sensing  devices,  pedometers,  
produces this Entire Room Inventory System is Matrix positive   pressure   variable   pulsation   systems,   and   wheel   cleaning  
Product Development’s Wyze-Scan™ System. apparatus  for  wheel  chairs.

RFID   EfPiciency   throughout   Pharmaceutical   threat of counterfeit or compromised quality drug


Manufacturing products entering the supply chain.

by Gary Andrechak and Jeffrey Johnson Most people in the RFID technology space will
readily identify some of the earliest implementation
RFID is a powerful traceability technology, that successes for RFID technology in manufacturing control
when carefully and properly implemented, greatly and automation. RFID tags are instrumental in better
assists in managing healthcare related assets. The need managing and automating complex manufacturing
to track infusion pumps, wheelchairs, consignment processes, from automotive bumper painting booths to
inventories of surgical tools and implants, and even computer hard disc drive assembly. Pharmaceutical
newborn babies has fostered innovative, practical uses manufacturing is similarly process-complex and also is
for RFID. In hospital pharmacies, RFID applications subject to recordkeeping requirements imposed by FDA
have improved patient safety by verifying the correct regulatory compliance. Pharmaceutical and medical
drug is being administered to the correct patient at the device manufacturers are now realizing the same
correct dosing schedule. Pharmaceutical companies benefits that RFID brought to traditional
have elevated visibility and traceability of prescription manufacturing.
drugs with RFID integrated packaging, lessening the

R F W A V E S! ! 8
In phar ma and biophar ma manufacturing the contents, movement from one process to the next,
automation, RFID’s greatest strength is its ability to and other manufacturing data can be recorded onto the
monitor all process equipment involved with a RFID tag traveling with the bag or other vessel. After
particular batch of product from start to finish. When the production process is complete, the tag data is
every process equipment item and raw material downloaded off the tag into a database for permanent
compound that touches a particular production batch storage and retrieval.
bears its own uniquely coded RFID tag, the production
Some industry insiders may comment that the
batch can be near faultlessly documented--
same unique identification process can be implemented
electronically. RFID tags easily attach to components
equally as effectively with barcodes, eliminating the
such as sample and production bags, tanks, storage
added cost of RFID tags. The main benefit of RFID over
vessels, filters, manifolds, container closures, tubing
barcode in the production environment is ease of use,
and hose, and complete single-use systems.
which leads to better user compliance and time
RFID reduces reliance on handwritten logbooks, efficiency. Also, barcode readers must be visually
leading to a reduction in transcription errors and aligned with the barcodes. In some cases, the alignment
illegible records. It delivers a much more precise audit is not always practical or fast. Barcodes have a limited
trail that can be queried in a fraction of the time it takes number of characters compared to some RFID tags
to retrieve data from handwritten logbooks. Those same which hold kilobytes of writable data. Write-ability is
RFID tags perform a second duty by tracking usage and the key to enabling electronic stamping of events into
cleaning cycles of the various production items to the RIFD tagged item during the life of the product. It
ensure timely maintenance and replacement before provides an on-board traveling history for the item.
parts begin to fail, risking product integrity and labor. RFID tags have the ability to secure this data as most
common air protocols such as ISO 15693 have
If a question or concer n about a specific
permanent data lock commands. Today, RFID tags can
production batch should arise, the electronic records for
survive sterilization processes such as autoclaving, EtO,
that batch can quickly generate a list of all materials
VHP, gamma and e-beam, as well as other harsh
and process equipment items that touched the
environmental factors as required.
production batch under review. Production batch data
can be linked to filling and packaging data of the final Although we are at the early stages of RFID
drug product to provide complete traceability in the enabled process control, suppliers to the
event of a recall. pharmaceutical manufacturing community are already
leading the way to establishing basic data structure and
Realizing the power of positive item identification,
core standards for pharma-use RFID tags. IT systems
some suppliers of critical manufacturing components
and software are evolving to manage multiple types of
are providing pre-RFID-tagged versions of their
RFID tag frequencies and protocols. Data interchange
components to the pharma industry. The RFID tag on
between tags and software is becoming more and more
the item arrives at the customer site with relevant item
transparent. No matter what tags are applied to items,
details such as part number, lot number, manufacture
systems can accommodate for their differences and
date, expiration date, as well as key information for the
make sense of the data the tags contain, creating
supplier, should the item be returned to the supplier for
harmonized databases and production records. ∞
any reason. This supplier data typically includes
manufacture plant, assembly operators involved, and About   the   author:   Gary   Andrechak   is   the   Leader   of   Auto-­ID  
the equipment used in the part’s manufacture, Solutions   Business   Development   for   NewAge   Industries/
essentially providing an even deeper layer of vendor AdvantaPure.   Gary   has   been   in   the   RFID   industry   for   10   years  
traceability. The RFID tag permits all parties to gain including   over   5   years   as   RFID   Product   Manager   at   Hitachi  
rapid access to part details such certificates of America,   Ltd.   before   joining   NewAge   Industries.     Gary’s   prior  
compliance, validation documentation, approved prints, positions   in   auto-­ID   include   client   service   and   marketing   with  
etc. Moreover, existing ERP, BES, and MES software can Towne-­Oller/Information   Resources,  Inc.,  a   syndicated  retail   sales  
manage process equipment items by utilizing the pre- tracking   information   service   for   the   consumer   packaged   goods  
attached RFID tag data. industry   built  on  store-­level,  item  UPC  scanner  data  combined  with  
warehouse  shipment  data.
Single use disposable systems, especially those
used in biopharma manufacturing are shipped today
with pre-attached large memory RFID tags that can Jeffrey   Johnson   is   the  Director   of   Software   Solutions   at   NewAge  
store production batch data on the tag for improved Industries/AdvantaPure   where   he   manages   the   development,  
lifecycle analysis. For instance, production facilities can installation   and   support   of   the   company’s   RFID-­based   products.  
optimize system utilization, supply chain and Jeff  is  an  RFID+  certiAied    developer  for  the   Hose  Track™  and   P*E*T  
maintenance with the addition of RFID tags on single Process  Equipment  Tracking™  software.
use disposable vessels. Ingredients added to a
bioreactor bag, tests and measurements conducted on

R F W A V E S! ! 8
Supplementing   Fall  Prevention  Tools   with  a  Falls   corner of the lab). Ten trials each of three positions
Detection  System (standing, sitting in a wheelchair, laying in a bed) by
subject (mannequin/human) were examined and
by Mary Elizabeth (Libbey) Bowen, Ph.D. Receiver Operating Curves were used to analyze the
At the HSR&D/RR&D Center of Excellence (COE) sensitivity and specificity of the tool. Kappa values were
in Tampa, FL, which includes a translational research calculated to determine the inter -rater reliability
center (the Patient-Safety Center of Inquiry), Dr. Bowen between the tool and the observed fall. For example,
is interested in using real-time locating RTLS significantly detected 94% of falls
systems (RTLS) to detect falls in the from a bed and was 88.5% more likely to
Veterans Health Administration (VHA). provide a false positive (detect a fall when
R TLS is a passive unobtrusive radio it did not occur) than a false negative
frequency system that can be used to (miss a fall that occurred). Results were
monitor many patients at once, recording similar across positions and subject. The
their location and movement over time.1 next phase of this research will test the
This is accomplished with sensors (placed ability of RTLS to detect falls in a clinical
throughout the room/facility) and RTLS setting. The author has received funding
tags embedded in wristbands and worn by from the National Center for Patient-Safety
the patient. This article briefly discusses to continue this exploratory research in
the feasibility of RTLS as a fall detection the JAHVH Community Living Center. The
system. Contact the author for additional author is also involved in a falls detection
information on this system. project ongoing in a polytrauma unit of
the JAHVH.
Background
Implications
Falls are the most frequently reported
adverse event in the VHA with an The VHA prioritizes fall prevention;5 fall
estimated 10% of residents in VHA nursing prevention tools (e.g., hip pads) have been
facilities experiencing a fall. It is likely
2 shown to effectively reduce the risk for
that this is an underestimate of the actual injurious falls.6 RTLS would supplement
number of falls; some non-injurious falls these tools. For example, when properly
may go unreported. Non-injurious falls are integrated into an alarm system, RTLS
important because they may indicate a may be used to alert staff, reduce fall
change in the cognitive/functional status response time, and injury severity.
of the patient or an underlying Example wristband Because RTLS also records the time and
vulnerability that should be addressed. In location of a fall, RTLS may be used to
embedded with identify when/where a fall is most likely to
the VHA, long-term care residents are
RTLS tag occur, helping to identify environmental
given a fall risk assessment on admission.
If found to be at risk for a fall, staff use a (e.g. obstacles) and other factors (e.g.
variety of market products including hip periods of low staffing) that increase fall
protectors, fall mats, and fall alarms (on wheelchairs) to risk. RTLS may also be used to track
ensure the safety of the resident and alert staff of an changes in fall rates over time and determine whether
adverse event. Despite these efforts, reducing falls and fall prevention tools and policies are effectively reducing
injuries due to falls continues to be a top priority the rate of falls by facility. ∞
throughout the VHA. Falls are associated with hip
fractures, head injuries, and mortality. Older adults About   the   Author   Mary   Elizabeth   (Libbey)   Bowen,   PhD   is   an  
who fall undetected or have long response times OfAice   of   Academic   Affairs   Patient-­Safety   Research   Fellow   at   the  
experience more severe injury, have higher healthcare HSR&D/RR&D   Center  of   Excellence   in   Tampa,   FL.  Dr.  Bowen   is   a  
costs, and are at an increased risk for death. Older men social  gerontologist  with  interests   in  population  health,  aging  and  
have higher fall-related mortality than older women. the  life   course,   longitudinal  research,   and   innovative   technologies  
This is particularly important here as older men are the in   healthcare.   She   received   her   PhD   from   Virginia   Polytechnic  
majority of residents in nursing facilities in the VHA.3-4 Institute   and   State   University   (Virginia   Tech)   in   2006   and   her  
dissertation   was   funded,   in   part,   by   a   national   award   from   the  
American  Association  for  Retired  Persons.     Dr.  Bowen  came   to  the  
Current Work
VA  after  a  3-­year   (2006-­2009)  NIH  funded  postdoc  at  the  Institute  
In this research, approved by the Internal Review of   Gerontology   at   Wayne   State   University.   There   she   analyzed  
Board at the University of South Florida, Tampa, FL and various   mental   and   physical   health   outcomes   using   nationally  
the VA Research and Development office, the author representative   data.   She   has   published   on   the   relationship  
and COE colleagues fitted RTLS tags embedded in between   depression   and   cognitive   decline   in   later   life,   childhood  
wristbands (Figure 1) to a mannequin and a healthy conditions   and   adult   disease   and   disability,   and   racial/ethnic  
human subject in the lab. The exact location of the fall differences  in  the  use   of  health   care   services.  At  the   VA,   Dr.  Bowen  
was determined by comparing coordinates to a known focuses   largely   on   the   relationship   between   wandering   and  
fixed location (e.g. from the 4 sensors mounted in each changes  in  functional  status  over  time.  

R F W A V E S! ! 9
Integrating   RFID   in   Hospitals   as   Part   of   the  
Healthcare  Chain Technology is advancing quickly

Key   to   reducing   the   risk   of   using   wrong   pharmaceutical   The introduction of microchips in our lives
represents an opportunity and a challenge. It is an
treatment    
opportunity because it allows improving the
by Mikos (Michael) N. Pesmatzoglou effectiveness and efficiency of several daily activities,
Healthcare organizations within the international however, using this technology in order to capitalize its
community are facing various challenges in order to usage is very challenging.
deliver quality care to all its citizens, at an affordable RFID systems belong to the emerging technologies
cost. The ageing society, the relentlessly rising cost of area. Using RFID tags (e.g. active and passive),
medical operations, the demand for better health installing tracking and scanning systems at specific
treatments, the increased pressure to reduce places (antenna and readers), and integrating the
expenditures and cut applicable costs through the appropriate software solution permits to retrieve and
whole chain of operations are some of the factors send several pieces of information that will assist the
influencing the daily operations of healthcare business at all levels. In the health care area, systems
institutions. We must understand that healthcare which will immediately provide details on patients
spending is very significant, standing at an 8.5% level of condition without the need of tedious procedures,
the GDP on a European average, whereas the tendency facilitate the secure monitoring of medical
is to keep on the rising. This is certainly something that transportations (e.g. blood and medicines at specific
must be treated carefully. temperatures, etc), allow a real-time tracking of medical
Further, these factors are driving the financial records, placenta and DNA specimens information for
pharmaceutical environment to find the best possible future usage, patients and clinical staff, as well as
solutions, quality and cost wise, to cope with these monitor the correct treatment and the appropriate
issues. Information and communication technologies usage of pharmaceutical products (per patient and per
(ICT) practices are able to play a key role to tackle these bed), etc. give certainly a positive pace to our lives.
issues since they seem to have the potential to provide
the necessary solutions and improve the existing
situation. However, ef ficient and ef fective ICT RFID technology is certainly a part of the ICT
applications have to combine both sides: the pharma applications in Hospitals
environment and its participants, as well as the
Real time visibility of pharmaceuticals can be
patients. Some of the main target applications in this
achieved by placing suitable and effective (according to
sector will be to improve illness prevention and safety of
the type drug and drug-package) RFID tags on each
care. For instance, by using remote medical care and
individual item. Through GPRS, Internet, and WiFi
remote diagnostic systems to monitor patients not only
connections any information contained in the RFID
inside the hospital, but when the patient is at home as
tag's memory or stored in a database where the ID of
well, it will be possible to boost the effectiveness of the
the tag is being held could be accessed. For instance,
medical treatments and increase their success. Through
the information retrieved can be matched either to
the usage of specific applications at hospitals we can
patients’ historical data, or to doctor's prescriptions. At
reduce the occurrence of medical errors resulting from
the same time, all information can be disseminated to
wrong medical treatments, enhance medical devices
anywhere is required, including hospitals, doctor’s PDA
monitoring management as they are move inside the
or Laptop, pharmaceutical companies, National Health
hospital, or offer patients a quick response and reliable
system, insurance companies, ministry of Health, etc.
service.
In general, the main objectives of integrating ICT Within the context of a hospital, patients could  be
practices to the pharmaceutical chain will be to: furnished with  a RFID tag (e.g. RFID bracelet) as they
enter the hospital. The tag can be updated either by
• Increase patient safety programming its memory or via the server's database.
• Reduce Adverse Drug Events as much as Scanners or readers (fixed or handhelds) will recognized
possible the tags and capture data contained in the tags in order
• Provide continuous and more personalized
to have real time information on medication reactions,
healthcare solutions
• Save lives and resources by focusing on as well as treatment and historical data. This
prevention and prediction rather than on costly i n f o r m a t i o n c a n b e u s e d w o r l d w i d e  f r o m
medical interventions after symptoms and authorized  participants so a patient can be treated
diseases have developed according to his historical data when ever and
• Improve productivity of healthcare systems wherever there is a need.
• Promote leadership of the e-Health and medical
imaging/devices industry It is evident that the correct usage and matching of
• Facilitate international cooperation between information related to prescriptions will assist the
health care authorities, hospitals and environment to avoid the usage of unwanted medicines
pharmaceutical companies. or treatment, while updating statistical and informative

R F W A V E S! ! 8
data. Interoperability to the patient's health benefit will lead us.
be the ultimate target.
The world we live in and where we operate as
RFID technology is being strongly promoted managers or scholars, etc, as well as the tasks and
especially by USA and EU, during the last few years. opportunities that we are called to face, permit us to
Through RFID the costing systems can be improved derive the optimum solutions on a daily basis. Although
dramatically too. If we integrate RFID for in some cases acting deterministically, we are compelled
pharmaceutical products monitoring, then we can to trace a solution based on heuristic patterns,
expedite the time to perform procedures like recalls, understanding that the theory of Chaos is all around us
have a better pharma e-pedigree monitoring, eliminate continually!
counterfeit by combating it continually, monitor
So using in the best possible way the
prescriptions and usage of medical or para-medical
accoutrements, which knowledge, technology and
products within the hospital, manage devices used at
experience offer to all of us, we can improve and
home treatments, etc.
enhance our daily lives. RFID starts to play a
In addition the total supply chain (referred in the significant role in our daily opportunities! ∞
main objectives of many companies in order to reduce
their expenses) will  be greatly assisted in a better and
About  the  author:  Mr.  Pesmatzoglou  holds   a  Mathematics  degree  
more efficient and accurate way of monitoring
from   Athens   State   University   and   a   MSc   degree   in   Industrial  
transactions. Installing RFID applications we will
Mathematics   from  Aston  University  in  Birmingham,  U.K.  For   many  
monitor the product from the suppliers shelves
years   he   worked   at   planning   departments   of   leading   industries  
(warehouses), through transportation, to its delivery to
including   the  refractory   bricks  and   mining  industry,  consumer  and  
the customer.
healthcare  companies,   etc.  Mr.  Pesmatzoglou  was   for  several   years  
the   Supply   Chain   Director   at   Bristol-­Myers   Squibb,   a   leading  
Conclusion pharmaceutical   company   in   Greece   with   exposure   to   several  
European  projects.   During   the   last   few  years,   he   is   been   dealing  
“When electricity was invented, people become
with   supply   chain   technological   applications   and   he   is   closely  
discontent with oil lamps. And so our missionaries
involved  with  RFID  applications   in  Greece.  He  is   also  a   lecturer  on  
employ this sound business principle: Show the people
new  technologies   and   Supply   Chain   at   BCA   College   in   Athens.  He  
something better and they’ll want it” (Horage B.W.
participated  as   speaker  at  several  conferences   and  seminars  and  is  
Donegan). So how do we proceed? Just have vision, and
the  author  of  several  articles  revenant  to  technology.
spot a benchmark opportunity. Technology will then

References
1
Kearns WD, Algase D, Moore DH, Ahmed S. Ultra wideband radio: A novel method for measuring wandering in persons with dementia. Gerontechnology. 2008;7(1):48-57.

2
Stalhandske E, Mills P, Quigley P, Neily J, Bagian J. VHA's National Falls Collaborative and Prevention Programs: AHRQ;2007.

3
Poor G, Atkinson EJ, Lewallen DG, O'Fallon WM, Melton LJ, 3rd. Age-related hip fractures in men: clinical spectrum and short-term outcomes. Osteoporos Int. 1995;5(6):419-426.

4
Quigley PA, Palacios P, Spehar AM. Veterans' fall risk profile: a prevalence study. Clin Interv Aging. 2006;1(2):169-173.

5
Quigley P, Haley JA, Sarduy I. A guide to fall prevention: understanding a Fall Prevention Program. Director. Winter 2005;13(1):38, 40, 42-33.

6
Quigley PA, Bulat T, Hart-Hughes S. Strategies to reduce risk of fall-related injuries in rehabilitation nursing. Rehabil Nurs. May-Jun 2007;32(3):120-125.

R F W A V E S! ! 11
RHCC Management Team
Co‐Founder, Chairman & CEO - Harry P. Pappas Vice President and Chief Technology Officer – Dr. Paul Frisch

President and Chief Medical Officer - Dr. Suraj Kapa Vice President and Assistant Chief Technology Officer – Mayank Trivedi

Co‐Founder, Executive Vice President  – Emily Sopensky Vice President for Conferences, Trade Shows, and Special Events – Debra Braun

Executive Vice President - John C. Shoemaker Vice President of Medical Device Integration & Interoperability – Dr. John Zaleski

Executive Vice President of Finance – TBD Vice President for Medical Devices, Sensors, and Wireless Technologies – Dr. James Fonger

Vice President and Chief Operating Officer – Troy Reiff eNewsletter Editor-in-Chief – Linda R. Castro

The RFID IN Our  Vision  Statement

HEALTHCARE The RFID in Healthcare Important dates:


CONSORTIUM Consortium enables the safe and
Next issue:
effective use of innovative
Submission deadline:
technologies that affect patient safety
and influence the economic well‐ August 30, 2010
being of the healthcare industry.
Author notification:

Our  Mission  Statement September 15, 2010


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The RFID in Healthcare Publishing date:
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Consortium is the healthcare
September 2010
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Send your article to:
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R F W A V E S! ! 13

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