REAL-TIME RFID-ENABLED HEALTHCARE-ASSOCIATED

MONITORING SYSTEM

Belal Chowdhury, Xiaozhe Wang

School of Management, La Trobe University, Melbourne 3086, Australia

Nasreen Sultana

Emergency Department, Frankston Hospital, Frankston 3199, Australia

Keywords: Radio frequency identification, Infectious diseases, Healthcare-associated infectious diseases.

Abstract: In healthcare context, the use of Radio Frequency Identification (RFID) technology has been employed to

reduce health care costs and to facilitate the automatic streamlining of healthcare-associated infectious

disease outbreak detection. RFID is playing an important role in monitoring processes in health facilities

such as hospitals, nursing homes, special accommodation facilities and rehabilitation hospital. In this paper,

we present a design of healthcare system using a real-time RFID-enabled application, called “Healthcare-

associated Infectious Outbreak Detection and Monitoring System (HIODMS)”.

1 INTRODUCTION

Infectious or communicable diseases have been an

ever-present threat to human society since the great

Plague of Athens in ancient times. The changing

face of healthcare poses new challenges for the

detection, treatment and prevention of infectious

diseases. Historically local public health

organizations, hospitals and clinics have been at the

forefront of infectious disease outbreak detection

and treatment. Healthcare-associated infections

encompass almost all clinically evident infections

that patients acquire during the course of receiving

treatment for other conditions within a healthcare

setting. Most infections after 48 to 72 hours of

hospitalization are considered Healthcare-associated

acquired. Healthcare-associated infections (also

known as hospital-acquired infections) are referred

as nosocomial. Most common healthcare-associated

infections are: i) respiratory infections (pneumonia)

and Catheter-associated urinary tract infections, ii)

surgical wound infections, result from contamination

of the surgical wound, and iii) infections associated

with intravascular cannulas or central venous

catheter.

Healthcare-associated infectious diseases (such

as Tuberculosis, Legionnaires’ disease and

gastroenteritis) can affect any person regardless of

age, gender, or race and common among residents of

long-term care facilities (e.g., nursing homes, special

accommodation facilities and rehabilitation

hospitals). Patients with weakened immune systems

are likely admitted to the healthcare facilities (e.g.,

hospitals) and sometimes do not realize that they are

already incubating the virus while in hospital. Also

visitors, staff, and residents constantly come and go,

bringing in pathogens from both the hospital and the

community (Larry et al., 2003). Tuberculosis (TB)

poses specific risks to health care staffs, which can

be responsible for spreading the disease to patients

in their care. Legionnaires' disease has been reported

from many hospitals since the first outbreak and

water cooling towers are identified to the cases of

the disease, which apparently causing pneumonia. A

new study by the School of Medicine, University of

Pittsburgh has determined that environmental

monitoring of institutional water systems can help to

predict the risk of hospital-acquired Legionnaires'

disease (ScienceDaily, 2007). A viral gastroenteritis

outbreak presents a growing challenge in health care

and long-term care facilities. Influenza Epidemics in

the United States result in an average of 136,000

deaths and 114,000 hospitalizations per annum

(Thompson, 2003).

163

Chowdhury B., Wang X. and Sultana N. (2009).

REAL-TIME RFID-ENABLED HEALTHCARE-ASSOCIATED MONITORING SYSTEM.

In Proceedings of the 11th International Conference on Enterprise Information Systems - Software Agents and Internet Computing, pages 163-166

DOI: 10.5220/0001997601630166

 SciTePress

Figure 1: Main components of RFID-enabled HIODMS

Architecture.

The risk of acquiring an infection while

hospitalized is very real and can be responsible for

spreading the highly contagious disease to other

patients, medical professionals, equipment, air,

water and fomites. The impact of healthcare-

associated infections is enormous: the patient may

need longer hospital treatment, re-admission, or

even further surgery, and use of hospital and

community resources (Jenney et al., 2000).

Healthcare-associated infections are one of the top

ten leading causes of death in the United States,

recent data suggests that the rate of hospital-acquired

infections has increased over the past two decades

(Spelman, 2002). In most countries, healthcare

infectious outbreaks are a notifiable disease where

the patient needs to be accurately identified, isolated

and monitored while infected with the virus. The

Institute of Medicine strongly recommended that

monitoring leads to reduction and prevention of

healthcare associated infections.

Information systems plays a vital role in

developing an effective approach and facilitate

infected or healthcare-associated patient’s

information, (e.g., patient medical history,

diagnosis) and associated equipments or assets to

address this emerging or re-emerging outbreaks

threat (Buehler et al., 2004). Mobile or wireless

technology is expected to provide real-time

information about vital signs and other physiological

indicators of one’s health and fitness. Such

monitoring systems are expected to find greater use

in such applications in long-term health care

facilities. In this paper, we demonstrate an

application of real-time monitoring system can be

facilitated by the use of the wireless technology such

as Radio Frequency Identification (RFID). We

integrate RFID technology with a multi-layer

architecture for a Healthcare-associated Infectious

Outbreak Detection and Monitoring System

(HIODMS) via both wireless and wired network.

Following section demonstrate the RFID-

enabled HIODMS architecture. Section 3 illustrates

the application of the RFID-enabled HIODMS and

the security issues.

2 RFID-ENABLED HIODMS

ARCHITECTURE

The main components of RFID-based HIODMS (as

shown in Figure 1) are: patient tags (RFID encoded

wristband), a reader (fixed and handheld), and health

care provider IT systems (i.e., Real-Time RFID-

Based HIODMS). RFID is one of the emerging

wireless technologies that play an integral role to

halt the spread of such outbreak diseases, prevent

and control further outbreaks by isolating infected

patients and associated medical equipments or assets

in real-time. Each unique patient tag can be passive,

semi-passive or active. Passive patient tags can be

used for both reading and writing capabilities by the

reader and do not need internal power. They get

energized by the reader through radio waves and

have a read range from 10mm to almost 10 meters.

We suggest the use of passive patient tags with the

read range of one meter, and RFID-based PDA

readers (e.g., Motorola MC9090-G) for the real-time

Healthcare-associated Outbreak Management

System application. The reason to select a 13.56

MHz (High Frequency) solution is for the low cost,

better read range, and faster read rate.

The passive patient tag antenna picks up radio

waves or electromagnetic energy beamed at it from a

PDA-based RFID reader device and enables the chip

to transmit healthcare-associated infected patient’s

unique ID, and location to the reader device,

allowing the patient to be remotely identified. The

reader converts the radio waves reflected back from

the patient tag into digital information then pass onto

HIODMS for processing. Patient’s basic infection

information is stored in the backend server for

processing data. The patient database can also be

linked to other health centres databases for retrieving

patients past history using Internet via a wireless

network. In addition to monitoring healthcare-

associated infected patients, the system can also

track associative equipments or assets (e.g.,

wheelchairs), staff member, and surgical equipments

in real-time to isolate them and prevent further

outbreaks. RFID-based HIODMS enables healthcare

ICEIS 2009 - International Conference on Enterprise Information Systems

164

staff to follow an infected patient through the

hospital, from admission to discharge. In case of

isolation, if an infected patient enters an

unauthorized area in the healthcare settings, the

RFID based system issues an alert to the healthcare

staff with information that indicate the identity and

location of the particular patient.

An application of RFID-based HIODMS consists

of five layers, namely: physical device layer,

middleware layer, health IT infrastructure

management layer, data layer, and graphical user

interface layers. The physical device layer consists

of the actual RFID hardware components that

integrate with HIODMS for capturing data

automatically. In this layer we used passive HF

read/write RFID readers and patient tags. The

middleware layer or framework acts as the standard

mechanism to get a quick connectivity between

healthcare-associated outbreaks detection tags and

RFID-based HIODMS as shown in Figure 1. The IT

infrastructure management layer is responsible for

managing and controlling healthcare organization’s

IT components such as computers, back-end servers,

networks, and printers. In addition, this layer enables

data mapping, formatting, business rule execution

and the service interactions with back-end databases.

The data layer composed of a Relational Database

Management System and it interacts with a back-end

database (e.g. SQL server). Finally, the graphical

user interface (GUI) layer is comprised of an

extensible GUI, which helps in detecting,

monitoring and managing hospital-acquired various

infectious outbreaks (i.e., wound infection)

information, generating various reports and analyzes

the health information at various stages in the entire

value chain.

3 RFID-ENABLED HIODMS

APPLICATION AND SECURITY

In this paper, we demonstrate some interfaces of the

RFID-enabled HIODMS application as shown in

Figure 2, which can be integrated with the healthcare

IT System for capturing healthcare associated

infectious diseases (e.g., wound infection,

Gastroenteritis, Tuberculosis) data automatically and

wirelessly. The system is developed in Microsoft

Visual Studio.net 2003 environment using Visual

C++.

The RFID-based HIODMS application registers

a reader and issues a unique wristband (patient ID)

to every patient at registration/admission in

healthcare facilities (e.g., hospitals), and also issues

Figure 2: Two examples of RFID-based HIODMS

application.

RFID tags to hospital equipments/assets (e.g., beds,

and surgical instruments) relating to the particular

patient. The RFID then uses the patient ID as a key

to information and perhaps other information (e.g.

name, DOB, drug allergies, and blood group) stored

in the health providers back-end databases (i.e., SQL

server). The patient tag is used to identify patients

all the way from observation, investigation, and

treatment to discharge while in hospital. In case of

healthcare-associated infectious outbreak (e.g.,

wound infection), this tag is used to identify exact

outbreaks area or location, time, and list of

associated hospital equipments/assets in real-time as

shown in Figure 2. For example, an RFID patient tag

contains a unique tag ID, which a HIODMS

application uses to retrieve an infected patient record

stored in the database. When a patient appears with a

wristband within a reader read range, the application

reads and lists the tagged patient IDs, names and

displays the patient admission information

automatically on a selection of a particular infected

patient. The application then transfers these

healthcare-associated outbreaks data to the SQL

server for permanent storage and further analysis

over the mobile network in real-time.

REAL-TIME RFID-ENABLED HEALTHCARE-ASSOCIATED MONITORING SYSTEM

165

While RFID provides promising benefits such as

healthcare organizations business process

automation, some significant challenges (e.g.,

security concerns, process, and manage RFID-based

infectious data) need to be addressed before these

benefits can be realized. To overcome this challenge,

sophisticated security measures are needed. Without

security, illegal activities can cheat RFID systems

easily for the air interface between infected

patient/equipment tags and RFID readers, and the

interface between RFID readers and the back-end

database system. In addition, healthcare-associated

infected patient’s privacy is also an issue, since

anyone can intercept communication between the

patient tags and readers, or between readers and the

back-end system, and then they can obtain

information about an infected patient. To remove

security vulnerabilities and protect patient’s privacy,

a number of existing RFID security measures can be

considered and adopted as a measure of security.

In our RFID-enabled HIODMS, communication

between patient tags and readers, readers and back-

end database is one-way. Our patient tags are

passive, inexpensive and have a minimum amount of

memory. We require very little information in the

patient tag (e.g., Tag ID only). When the outbreak

infected patient tag comes in to contact with the

reader within a range of one meter. The Pocket PC

(PDA-based RFID reader) reads and processes the

patient/equipment tag identification number. Within

this proximity and with the mobile/wireless

environment, there will be no scope to intercept

communication between patient tags and a reader. In

a worst case situation, if an intruder intercepts and

gets the patient/equipment tag ID, he or she gains

nothing because the tag does not contain any

additional information.

To achieve the secure transfer of integrated

patient/equipment data from Pocket PC to back-end

database server via wireless network, we use a Hash

Function-based Mutual Authentication Scheme (Lee,

2005). This scheme, utilizing a hash function, is

widely used for secure communication between

mobile/wireless devices (such as PDA-based IODM

system) and back-end SQL servers in a RFID-based

healthcare environment.

4 CONCLUSIONS AND FUTURE

WORK

We presented a RFID-enabled monitoring system

(HIODMS) to help healthcare providers to overcome

challenges of hospital-acquired infectious outbreak

diseases by providing accurate, automatic and real-

time information on patients, associative medical

equipments or assets as they move to the value

chain. Using HIODMS, health care organizations

have a chance to track rapidly and accurately of

outbreak patients, their location, and associative

assets identification; to improve patient’s safety by

capturing infected patient data; to prevent or reduce

medical errors, to increase efficiency and

productivity, and to save costs in real-time via

wireless network.

In future research, the application based on

HIODMS can be expanded to include a variety of

tracking or sensor (such as temperature) features

using RFID. RFID patient tag (wristband) can

transmit not only its unique identification number,

but also the ambient temperature, which can help

healthcare facilities IT departments to remotely

monitor the room’s temperature or to receive alerts

via mobile phone or emails. We also plan to extract

the healthcare-associated infectious outbreaks data

provided by this proposed RFID-based HIODMS to

analyze the diseases behaviour and outbreak patterns

using data mining techniques. We then could predict

the next step towards controlling these serious

hospital-acquired diseases, enhancing preparedness,

and providing rapid response health measures.

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