Real-time location systems capture work flow behavior

Real-time location systems (RTLSs) can be successfully installed in healthcare settings and can capture work flow behavior such as face time, wait times, and flow times, according to a study published online Nov. 25 by the American Journal of Managed Care.

As time between patients and clinicians becomes increasingly limited, the number of patient complaints that can be addressed during a visit decreases too. While solutions exist for these issues, many have limitations in themselves. RTLSs, which are often used outside of healthcare, offer a new way of solving these problems.

“These systems can be based on a wide variety of signaling modalities including radiofrequency (RF), infrared (IR), and ultrasound, and use a variety of methods to resolve the location of an object or person in time and space,” wrote the study’s lead author, James E. Stahl, MD, CM, MPH, of the Massachusetts General Hospital in Boston, and colleagues. “All systems have varying degrees of granularity, signal resolution, noise, and latency with regard to location and time. To date, the most common use of RTLSs both in and out of healthcare has been for inventory tracking.”

Stahl and colleagues thus designed part of the Massachusetts General Hospital/Massachusetts General Physician Organization (MGH/MGPO) outpatient radio frequency identification (RFID) project to evaluate the feasibility of adapting these systems for use in busy clinical settings and to monitor clinic system behavior.

During the RFID project, participating primary care, urgent care, and specialty clinics installed RFID-based RTLSs. Flow data were then derived from the RTLSs. Radiology testing was utilized as a proxy for medical resource use. The tests’ appropriateness were estimated using MGH radiology order entry (ROE) system.

Data analysis revealed that from July 2008 to October 2010, 2,086 clinical encounter records and measured face times were associated. Of those encounters, 792 patients underwent associated radiology tests, 471 met study criteria, 368 had tests ordered through ROE, and 72 were given ROE scores of one or higher. Nine percent of primary care visits resulted in radiology testing, while 55 percent of urgent care encounters resulted in some form of radiology testing. Tests happened more frequently in the first half of the calendar year and during the second half of the workday.

Seventy-two of the encounters were associated with the electronic health record (EHR), the RTLS database, the ROE database, and had scores of one or higher. Overall, face time was weakly correlated with ROE score. When stratified by subgroups however, primary and urgent care providers acted differently. When time increased for patients visiting urgent care providers, so did appropriateness. The opposite was true for primary care providers.

There are several challenges that must be considered when implementing these systems in the clinical and managerial realms, wrote the authors. Such difficulties include temporal/spatial granularity, latency, and signal-to-noise ratio limitations. Information generated by the systems can also be complicated to analyze, interpret, and present. These systems also have inventory and privacy concerns.

“As we learn more about how time influences resource use, we should be better able to determine whether or not these trade-offs are desirable for patients, clinicians, and the healthcare system as a whole and to design clinical delivery systems that optimally deliver continuity, access, and resources while preserving the essential time between clinicians and their patients,” concluded Stahl and colleagues.