Let's play tag

Much has been written about Radio Frequency Identification (RFID) chips, the most public debate being that between privacy organisations and trade bodies. RFID chips are the size of a grain of sand or smaller. They can be embedded in labels for consumer products. Any suitably equipped scanner can read the chips from a distance. Businesses value the ability to achieve more accurate stock control by knowing where a particular product is at every stage from manufacture to the display shelf. Privacy advocates have become exercised because of concerns that tracking of consumers might not stop once they leave the shop. In addition, concerns have been expressed that too much information about personal consumer preferences might find its way into the hands of retailers.

Tackling clinical negligence

Whilst all of the above is a proper debate, a more interesting new possible use of RFID technology has emerged which could reduce significantly the numbers of clinical negligence claims arising from inability to locate surgical equipment. In addition, fundamental decisions are currently being made about the future management of medical devices under the Supercentre Investment Programme. This programme will transform the way medical devices are managed in the NHS, with some trusts collaborating to create Supercentre facilities to decontaminate large volumes of medical devices off-site. Not all trusts will embark on Supercentres, leaving a mixed provision of decontamination facilities.

A major report into the tracking of medical devices and associated implications for patient safety was prepared in March 2005. Its author, The Patients Association,1 works in conjunction with GS1 UK2 (formerly eCentre, an organisation with considerable experience in supply chain management and bar coding), together with the Institute of Decontamination Sciences,3 Infection Control Nurses Association,4 and National Association of Theatre Nurses.5 The report draws together the views of frontline healthcare staff in relation to NHS tracking procedures.

Headaches of current practices

Theatre staff often use paper-based systems which rely on bar codes being placed onto paperwork based upon staff observation. There are virtually no systems where each individual item of surgical equipment is permanently marked with a code that can be captured each time the item moves from one point to the next. This can be particularly important for keyhole surgery and diagnostic investigation through use of endoscopes, comprising multiple tubes within tubes. These are expensive, delicate and hard to clean and, should concerns arise, are important to keep track of for both stock control and patient safety.

The Patients Association report asks respondents about awareness levels when devices go missing. Fifty nine per cent of respondents reported that they “sometimes” knew when a device went missing. Only 37% claimed “always” to know when a device went missing. In addition, 39% of respondents reported that it was impossible to track back and locate a single individual surgical instrument after use.

Extensive applications

The foregoing points are of course not promising news for those concerned with patient safety, or with litigation risk management, within the NHS. The Patients Association report found overwhelming agreement about the need to have tracking and trace systems in place when the new sterile service Supercentres were built. Ninety seven per cent of respondents agreed or strongly agreed that off site Supercentres would need more detailed tracking systems and that tracking would need to be at the level of individual surgical instruments to guarantee patient safety. RFID technology would appear to provide an obvious answer to these concerns.

In addition to the use of RFID technology to keep track of surgical instruments, a German hospital is proposing to tag patients. The Klinikum Saarbrucken6 in Germany intends to tag 1,000 patients. They will wear tagged wristbands which will be scanned by hospital staff using handheld PDAs or tablet PCs connecting to a patient database using a wireless local area network. The wristband will carry a unique patient code, which will tally with the encrypted patient records in the database. The clinical staff will be able to read information on what drugs and what dosages the patients require. Patients will also be able to check their own records by scanning their wristbands using patient information terminals.

None of the above should come as a surprise. Pharmacists across the UK have been trialling RFID technology for several months in an effort to reduce dispensing errors. Currently 56 out of every 10,000 prescriptions are being wrongly dispensed. Further, many drugs are counterfeited. The National Pharmaceutical Association’s IT Director Nigel Cox said: “manufacturers recognise counterfeiting and diversions are costing them a lot of money, and they are always keen to associate themselves with patient safety issues. The system being trialled by the UK pharmacists involves dual bar code and RFID readers placed in a variety of locations across the UK. Thirty seven were placed in community pharmacists, nine were located in hospitals, and four were used by dispensing doctors. The scanners were able to recognise eight drugs from six different manufacturers. The RFID-tagged bottles enable pharmacists to check the drugs given to the patients against the drugs prescribed, to check that medicines have not expired and also to take appropriate action if the batch the drugs came from had been the subject of a recall notice or counterfeit warning.

The private sphere

The EU is currently consulting on the rights and wrongs of RFID. The Article 29 Working Party is due to report shortly. In the consultation document already published, the Working Party stated: “while the advantages related to the use of RFID technology seem obvious... concerns arise about the possibility of businesses and governments using RFID to pry into the privacy sphere of individuals”. And even in America it appears that there are limits. In January 2005 the Brittan Elementary Primary School in Sutter, California7 introduced a rule requiring all pupils to wear badges implanted with RFID tracking chips. The school was however forced to drop the scheme only one month later following an outcry from the American Civil Liberties Union and the parents of the children.

The ability to identify and track any item of property electronically would, one might hope, find a practical location in both the civil and criminal limbs of the legal profession. For example, documentary evidence and physical productions could be RFID-tagged, enabling instant or near-instant location of particular items from storage at court or in the office.

Paul Motion is a partner with Ledingham Chalmers, is Convener of the Law Society of Scotland’s E-commerce Committee, and Chairman of the Scottish Society for Computers and Law.

1. www.patients-association.com/publications_detail.cfm?type=Booklet&ID=149
2. GS1 UK is a not-for-profit, membership-based business organisation and the UK authority on best practice in standards development for multi-sector supply chains. GS1 supports the adoption of cross-sector global supply chain standards through bar coding, electronic business messaging, data synchronisation, and through the EPC global network RFID technology members can learn how to enhance product visibility, reduce costs, increase stock availability and improve customer safety. GS1 standards are based on the EAN.UCC system, the global multi-industry open standard for identification most commonly portrayed in bar codes. www.gs1.uk.org.
3. Institute of Decontamination Sciences is committed to initiating educational programmes for its members with the objects of achieving standards of excellence amongst staff operating in the field of medical device decontamination management. www.idsc-uk.org.
4. Infection Control Nurses Association works in collaboration with the medical and nursing professions, professions allied to medicine (PAMS) and strives to achieve a multi-disciplinary, multi-agency and multinational approach to infection control. www.icna.co.uk.
5. National Association of Theatre Nurses states that its vision is to ensure an enhanced patient pre-operative experience by promoting best practice. This is said to include the improvement of patient care by determining standards, facilitating education and providing a forum for partnerships with industry. www.natn.org.uk.
6. www.klinikum-saarbruecken.de
7. www.publicschool review.com/school_ov/school_id/5857