Jan. 28, 2013—The Fortis Escorts Heart Institute (FEHI), in South Delhi, India, manages more than 14,000 admissions and 7,000 emergency cases annually, with roughly 300 outpatients visiting the hospital daily for tests. Managing the movements of outpatients from one area to the next within the hospital has been inherently challenging, because wait times within one department, such as ultrasound, might be much longer than in others, says Gunjan Verma, the senior manager and head of FEHI's Patient Care Services section.

This, Verma says, was unacceptable for a hospital recognized worldwide as a center of excellence providing the latest technology in cardiac bypass surgery, minimally invasive surgery (robotics), interventional cardiology, non-invasive cardiology, pediatric cardiology and pediatric cardiac surgery. Its advanced laboratories perform a range of investigative tests in the fields of nuclear medicine, radiology, biochemistry, hematology, transfusion medicine and microbiology. The use of cutting-edge technology, she adds, is a big part of FEHI's culture, extending beyond medical technology.

Several years ago, FEHI set out to automate processes to reduce outpatients' wait times. After researching and evaluating a number of solutions, the hospital recently deployed an RFID-based real-time location system (RTLS) solution that has enabled the organization to realize its objectives.

Getting Started

FEHI's managers determined that automating the process of monitoring outpatient location within the hospital would resolve existing bottlenecks, increase efficiencies and ultimately improve care, by ensuring that patients would not have to stay in any particular department longer than necessary. Initially, the organization tried a bar-code system, but the technology "failed miserably," Verma says, because it required too much additional manpower. It was "very difficult to handle as it [needs] line of sight," she explains. "That was very time-consuming."

Verma says she had been conducting a great deal of research about RFID systems, and had evaluated a number of company case studies involving the technology. "We then set up an evaluation committee comprising all experienced professionals from various departments," she says, "and [met] every month to discuss" various RFID technologies. In addition to Verma, the group included the hospital's head of operations, the medical director, a biomedical officer, technology officers, an innovation officer, the head of the medical checkup department and a finance director.

FEHI also brought in consultants able to help the organization determine how it could achieve its goals via RFID. Two years after the evaluation period began in 2010, the organization opted to implement an RTLS solution known as Patient Mantra, from India-based ICEGEN (Information, Communication and Entertainment Generation Computing). The process took as long as it did, Verma notes, because approvals were required from various committee heads and funding for the system had to be approved.

The system includes battery-powered 301B Wi-Fi tags, supplied by hardware vendor Ekahau, that outpatients wear around their neck. Ekahau's RTLS Controller (ERC), the heart of the system, tracks the locations of all tags in use throughout the facility. ERC is entirely Web-based, offering monitoring and tag-management capabilities. ICEGEN developed PC-based software called Patient Mantra Vision that allows managers to track patients' locations through the use of graphics. The application also generates alerts and reports via the Internet. The Patient Mantra solution works off a Wi-Fi network provided by Aruba Networks, located in Sunnyvale, Calif. The hospital installed the Wi-Fi system as part of the Patient Mantra implementation.

In summer 2012, FEHI deployed the Patient Mantra system with help from ICEGEN. It took two months to deploy the solution, Verma says, adding that training staff members to use the new system lasted for four days.

Managing Outpatient Mobility

Now, upon registering for services at the hospital, an outpatient is provided with an RFID tag containing a unique identification number. As soon as the patient completes the registration process, Patient Mantra sets up a dynamic queuing system, so he or she can proceed to the first scheduled test.

When the patient enters the first test room, a technician presses a blue button on that person's tag, alerting the Patient Mantra system that the test is about to begin. Once the testing has been completed, the worker presses a red button on the tag, thereby notifying the system of this updated status. If the patient is scheduled for another test, that information is automatically displayed on the tag, and the same process continues until the patient completes all necessary testing.

With the RFID technology in place, hospital personnel can determine a particular patient's location at any given time, as the person moves into or out of particular Wi-Fi zones. Patients' movements are automatically captured in the hospital's back-end database, without the need for any manual supervision, and the back-end systems are immediately updated upon each test's completion.

At any point during the process, an administrator can review a particular patient's status, such as whether a test has finished, as well as the zone in which he or she is currently located. Administrators can also calculate each zone's "concentration level," Verma says. "If the patient is sitting in one zone [for a longer than usual duration], the Patient Mantra system indicates the same to the administrator," she states. "Also, the system gives the patient waiting time at each of these [departments], which is very important for us" in monitoring patient flow.

Digital screens installed within each department display every patient's name, along with the department each individual needs to visit next, and the package selected by that person. If a patient disregards the tag message and goes to the wrong department (for example, to the x-ray area rather than to ultrasound), or to the right department at the incorrect time, the Patient Mantra system issues an alert to the floor manager regarding that individual. The manager can then direct him or her to the proper location. What's more, if a patient moves out of a particular zone or attempts to leave the hospital wearing a wrist tag, the system sends an alert message via e-mail to security personnel stationed at all three of the facility's exit gates.

At the end of each day, the system generates reports providing statistics, such as average patient waiting times before each process, the number of patients who completed all of their tests in a given health-check package, and each patient's current status (for example, if he or she needs to return for additional testing).

Prior to the RFID solution's implementation, Verma recalls, it was difficult for FEHI to identify those areas within its facility that were overly crowded with patients, as well as those much less crowded and able to accommodate additional patients. The average time patients must wait between tests has been reduced by a "good number of minutes," she reports. "Our patients feel delighted, as we are using technology to improve the quality of service, and they see a 'wow' factor with this technology."

Before the Patient Mantra solution was in place, FEHI used an announcement system to page patients late for testing, either due to being lost within the hospital or to waiting in the wrong area. Previously, patients would often leave the hospital without completing all necessary tests or receiving information about follow-up tests required by doctors.

The RTLS solution has made life easier for outpatients visiting the facility for testing, Verma says, by guiding them to where they need to go for tests. While hospital personnel are available to guide patients to various locations for testing, "patients feel very uncomfortable to go ask the staff time and time again," she states, "and the [staff person] would look at the chart in their hands and guide [the patient] as per their understanding, not knowing the current status of that department or the number of patients it would be holding at that given time. Patient Mantra is a boon."

FEHI provides an Online RTLS Web page enabling family members to track a patient's real-time status within the hospital, by entering that individual's "episode number" into the online application. So, for example, they could learn whether a patient had completed a certain test.

The success FEHI has enjoyed with the Patient Mantra RTLS solution has led the organization to consider other ways in which it can employ RFID technology. "We will soon be starting OPD [outpatient department and emergency room] for the patients and the ICU [intensive care unit] area for patient attendant tracking and sharing information to them using RFID tags," Verma says.

For FEHI, continued investment in systems that can help deliver improved service to customers is a priority, Verma reports, as the institution aims to maintain its stellar reputation as a health-care provider."We are best in the industry, and are known for patient care," she says. "We go out of the way to bring in the best technology and practices to serve our patients. [We're] glad that RFID is one such technology [that] helps us realize our dreams."