For Florida Hospital System, asset tracking means much more than figuring out where the portable ultrasound is being stashed. It means using location data to generate better outcomes by understanding the time frame between operations and rehabilitation. It means looking at the way nurses are interacting with surgical patients to establish better protocols and a more efficient workflow.

It also means having a stronger grasp on patient satisfaction – which is increasingly important to a provider’s bottom line. But, according to Ashley Simmons, the hospital system’s director of innovation development, for all the benefits these insights bring, there is still plenty of untapped potential when it comes to making these kinds of solutions worth the investment for hospital executives.

HCB News: When people think of RTLS and RFID in health care, they usually think of tracking down a device when it's needed. How did you and your colleagues get started in exposing the analytical insights hidden beneath the surface?

Ashley Simmons: Initially, it was part of a larger plan about six years ago with our Florida Hospital Celebration Health facility. When we looked at building a new tower onto the hospital the leadership at the time said, ‘Let’s do this right. Let’s bring in partners and really think about innovating, creating a care environment for the future.’ We had some visioning sessions with partners and asked, ‘What can we do differently to drive more effective, efficient care and improve outcomes in the care setting?’

One of those partners was AeroScout (acquired by Stanley Healthcare). They felt there was more that we can do with RTLS/RFID in this stage versus just the typical tracking of a pump or a wheelchair. That's when we really started to dive into what this information could tell us. It could give us real-time insight on not just things but, more importantly, people. The more data and information you can gather, the more you can proactively manage the future.

That was our goal. How can that data provide us insightful analytics on how we approach things, processes, workflow and teams, going forward?

HCB News: Can you give an example of one way in which RTLS/RFID analytics have enabled you to improve efficiency?

AS: One of the things we immediately did in the surgical unit was track the nurses and the patients to see what was happening in that transition out of the OR into recovery. We had a specific use case around one of our engaged surgeons who was very efficient in his process with his patients. He knew exactly what their care should look like, how quickly they should be getting up and walking after their surgery and what that means for their recovery, when they should be going home. That gave us a great use case to track whether or not outcomes are different for patients who aren’t doing what he feels they should be doing.

So we began tracking (wearable tracking via ultrasound exciters in the ceiling) those patients and the nurses caring for those patients – what were the interactions, how long was it taking to get from surgery to the unit and once they were on the unit, how long before they were physically getting up and walking as he recommended they do? He thought it should happen within four and six hours. We were able to track if that was really happening.


HCB News: What did you find out?

AS: We actually found some really cool stuff. We found that the surgeon was spot on in terms of length of stay related to patients who got up within four hours of getting to the unit. There was an absolute correlation with their length of stay and how quickly they got up and started walking around post-surgery … and from a clinical outcomes perspective of getting out of the hospital sooner – which most patients want to do.

Overall the outcome quality for the patient was higher. We started to find some predictors of the experience of the patient related to their nurse/clinical time. Through the data we were able to find some very interesting relationships between how often a nurse entered the room on the day shift versus the night shift, how long they spent with the patient … things which, at the end of the day, could predict how happy that patient was with us.

So we found a sweet spot in terms of engagement of the nurse with the patient on different shifts as to how we would create the right experience for that patient to be happy with us on the satisfaction survey. This helped us to do some interesting work around the experience for the patient in terms of what they wanted, how to set expectations, how we educate the nursing team on how to interact with those patients depending on the hour of day so the patient would leave ultimately satisfied and taken care of as best as possible.

HCB News: Has Florida Hospital explored using similar analytics to improve workflow in other departments?

AS: We’re now also using this at one of our new NICU units and scaled it to all of our emergency room facilities across our Orlando system to primarily track staff duress and safety.

HCB News: What advice would you give to a hospital hoping to get started with unlocking deeper meaning from its RTLS/RFID data?

AS: Start with equipment. You learn a lot about your processes (or lack thereof), operational gaps and your infrastructure. It gives you a safe way to figure out if you have the right Wi-Fi, cabling and building infrastructure. That is the killer.

If you don't have the right processes to scale to staff and patient tracking, it will be a complete disaster. Starting with pumps and wheelchairs is a way to find out if you're ready. It's a good readiness assessment. At first we weren't ready. It took us years to be ready. But it was failure from a learning perspective, where we had to rethink things and approach them the right way.

Also, this has not been a very scalable model because it is very costly. Ultrasound exciters and cabling are extremely expensive and to put an ROI behind that is difficult to do. We've been working with Stanley to develop and engineer more efficient ways to deploy this type of technology.

It's hard to prioritize this over something else. Is it clinically critical? It is an additive for process improvement, so it’s sometimes hard to justify over other capital needs.

HCB News: At HIMSS 2016 you gave a presentation on your successes with RTLS/RFID. Have there been any major milestones or achievements since then?

AS: From a scale perspective, what we’ve been doing is figuring out how to maintain and manage things because we’re so large. We scaled to do temperature checks (clinical refrigerators and coolers) and asset tracking across different campuses. That required a lot of manpower and facilitation of monitoring alerts, replacing batteries and making sure medical devices are getting preventive maintenance.

We had a team that all they did was walk around and check the temperatures in the refrigerators, but now we have a monitor that can alert us when a refrigerator gets unplugged so we don't lose $10,000 worth of drugs. Starting in 2012, when we started tracking staff and patients, we’ve been continually trying to standardize processes.

Now, we have a process for teams and departments that want to do staff and patient tracking. They go through an application/approval process – why do you need it, here’s what it’s going to cost, here’s what it will take, here’s the value/cost for doing it.

The last two years we’ve had a major organizational shift. Our IT infrastructure that leads this project got merged with our Central Florida group, so that has slowed our acceleration.

HCB News: What kind of conversations do you expect to hear at HIMSS 2018 regarding RTLS/RFID?

AS: I’ve talked to Stanley about this. I think someone is going to blow this up in some way because it’s not sustainable to go forward where it is. It's too costly and it’s never going to be prioritized over other clinical capital needs. I think someone is going to leapfrog it and figure out a way to allow for efficient tracking and movement of people and items throughout a facility at a lower price.

HCB News: Looking further ahead, is there a level of RTLS/RFID insight that we're not yet tapping into?

AS: People who have never done temperature tracking are still buying it, so the business is still viable. But in terms of innovation and taking it to a different level, it’s stuck. Until it gets leapfrogged and able to return a value that is easily and quickly achievable – not a five-year ROI – that’s when we’ll see movement forward.

I think the engineers get stuck in their minds over how it can really work. They tell me that the size of the tags and the battery life having to be so long explains why it’s so costly. But how can I have an Apple Watch that can track me in a five-mile run, but you can’t track me in a building? I think there’s a need for rethinking the technology for tracking and wayfinding in health care.