RFID in Anatomic

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Nov 27, 2013 (3 years and 8 months ago)

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RFID in Anatomic
Pathology at Mayo Clinic


American Association for Clinical Chemistry

Southeast Local Section Teleconference


Schuyler O. Sanderson, M.D.

September 29
th
2010

Disclosures


No significant relationships


No off
-
label usage

Technology Background


RFID
-

r
adio
f
requency
id
entification


Passive


Small


No energy source


Low range


Least cost


Active technologies


Battery/Energy


Long range


Larger sizes


Real time locators

Mayo Clinic RFID Story


Anatomic Pathology


GI/CRS Endoscopy


3M


Specimen Management

GI/CRS Endoscopy


System details


Practice Area


Three separate units


Gonda 9, Charlton 8, SMH/Alfred Main


Practitioners


Medicine and Surgery


Allied Health Staff


RN and LPN


Patients


Procedures


Databases

Specimen Management

Anatomic Pathology


System details


Practice Area


Single Laboratory


Hilton 10


Practitioners


Pathologists


Allied Health Staff


Accessioning, secretarial, HTs


Cases


Procedures/Stains


Databases

1

3

4


Data entered in the lab as
tissue is processed


Complete a requisition form


Bag Specimen

Accessioning


Enter endoscopic data into GI database

Prior Process: Flow of specimens and patient information

Clinical Procedure

5

2


Dictated procedure note


Report written

EMR

GI Database

Lab Information System

Pathologist

Specimen Management



System complexities


Managing


Highest Quality


Guaranteed safety


High volume


Fast TAT


Numerous professionals


Varied databases


Labeling errors


Impacts


Wrong site surgery/medical
treatment


Delay in treatment


Accessioning/processing delay


Diagnosis/Report delay


Corrective action/termination


Garbage holds

Wrong organ designation with misspelling

RFID Specimen Management


Phase I: Jan ’06


May ‘06


Scope
(Tissue for AP):


RFID tag stickers placed on specimen bottles


3M File Tracker


Data capture and transfer


MERGE
-
3M
-
CoPath


RFID tags as unique identifier


Simultaneous tag reading


8 data fields present

1

3

4


Data entered in the lab as
tissue is processed


Complete a requisition form


Bag Specimen

Accessioning

1

2

3


Enter endoscopic data into GI database

Pilot Process: Flow specimens, patient information, and RFID

Clinical Procedure

5

2


Dictated procedure note


Report written

EMR

GI Database/MERGE

Lab Information System

Pathologist

RFID

Endoscopy
Electronic Data
Entry
-

MERGE

Pathology
Electronic Data
Entry
-

CoPath

Requisition Paper Form Data
Entry
-

Handwriting

RFID System

RFID System

RFID Process


Histology Lab

Accessioning

The electronic

information

associated with

each uniquely

identified RFID chip

is transferred

directly into

Co
-
Path

RFID Specimen Management


Phase I: Jan ’06


May ‘06 Results


Bottles ~3000


Cases ~1800


Paper comparison


9.2 % discrepancy


MERGE, Paper, CoPath


Nursing feedback


Promising


Lab impact


2.2 % Accessioning checks

RFID Specimen Management


Phase II: March ’07


March ‘08


Scope (Tissue for AP):


41 Endoscopy Suites


Gonda 9, Charlton, SMH/Alfred Main


Delivery routes


Tube rooms, Central Processing Lab


AP Laboratory

RFID Specimen Management


SMH Specimen Transport

SMH

Specimen

Transfer

Container

RFID Specimen Management


Central Processing Transfer Pads

Tube Station

In

Central Processing

RFID Pad

Central Processing

Transfer Pad #1

RFID Pad

RFID Specimen Management


Central Processing Transfer Pads

Central Processing

Transfer Pad #2

RFID Pad

Train to Accession

In

Central Processing

RFID Specimen Management


Phase II: Results


Bottles/tags ~30,000 (no failures)


Cases ~20,000


Paper comparison


10.1 % discrepancy


MERGE, Paper, CoPath


Nursing feedback


Progressive buy
-
in


Lab impact


2.0 % Accessioning checks

RFID Specimen Management


Phase II: Milestones


Paperless Requisition


9/10/07


CRS transition to GI


Estimated 1
-
5 min. saved/case


AP Laboratory


12/07


0.5 FTE cost avoidance

1


Data transferred in the lab as
tissue is processed

Bag Specimen

Accessioning

1

2

3


Enter endoscopic data into GI database

Current Process: Flow of specimens and patient information

Clinical Procedure


Automated procedure
note created and signed


Report Entered

EMR

GI Database/

MERGE

Lab Information System

Pathologist

Automated Call
-
back

RFID Specimen Management


Phase II: Practice Improvements


Paper Requisition Elimination


Specimen labeling discrepancies


Letter to letter match


No abbreviations






Q1 ’07


Q1 ‘08


Bottles
-




8231


8539


Defects
-




735


35


Error Rate
-



8.93


0.41


Process sigma
-


2.85


4.14



Q2 and Q3 ’08


~16K bottles with 32 discrepancies/defects (4.68)

RFID Specimen Management


Specimen Labeling Costs
-

Clinical


Discrepancies
-


Minor: $300/instance


Major: $3000/instance


2006 clinical estimate


$36,000 in personnel time


Specimen Labeling Costs
-

Laboratory


Discrepancies
-


Minor: $2
-
3/instance (plus delay)


Major: $225/instance (plus delay)


2006 laboratory estimate


$73,000 in personnel time

RFID Specimen Management


Project financial estimates (2006)


Discrepancy Resolution

$109,000


Lab Efficiency



$ 15,000










$124,000



Non
-
financial gains


Staff satisfaction



Safety?

Hard Stops
Patients Affected
GI/CRS Endoscopy
0
5
10
15
20
25
30
July '07
Sep '07
Nov '07
Jan '08
Mar '08
May '08
Jul '08
Sep '08
Nov '08
Jan '09
Mar '09
May '09
July'09
Sep '09
Nov '09
Jan '10
Mar '10
May '10
RFID Specimen Management

Paperless


Phase II: Practice Improvements


“Rule Out” request expansion


>45 clinical questions


Flexible/tailored by GI/CRS and AP


Practice Integration


Putting the “P” back into...


First Transcription point emphasis


Redirection to endoscopist


Elimination of second nurse


Standardization


RFID Specimen Management

Paperless


Phase II: Practice Integration


The White Book


Details specifications for specimens


CMV, KOH, Sprue, HNPCC


Collaborations across Divisions


Microbiology and AP/Cytopathology


Endoscopy (GI and CRS)


Increased utilization of R/Os


70% to 92% over 12 months

RFID Specimen Management

Paperless


Phase II: Practice Integration


All AP specimens RFID tagged


Unique specimens:


Endoscopic mucosal resections


Pancreas tru
-
cut biopsies


Refractory celiac disease



Safety?

RFID Specimen Management


Specimen Tracking (RFID)


Real time tracking


All points identified


Procedure room


Tube staging (refrigerator)


Central Lab


Accessioning Area


Destination verified


Near immediate resolution

RFID Specimen Management


Specimen Tracking (RFID) Case


Patient with GI bleed


Emergent Endoscopy


Weekend case


Specimen labeled


Tagged,verified


Delivered


Accessioned


No issues during specimen movement

RFID Specimen Management


Specimen Tracking (RFID) Case


Biopsy shows adenocarcinoma


Imperfect fit with Endoscopy


Dx Shared and communicated


Follow
-
up resection


Minute lesion


Secondary dx encountered


Gross specimen/exam questioned

RFID Specimen Management


Specimen Tracking (RFID) Case


Biopsy tracking reviewed







RFID Specimen Management


Specimen Tracking (RFID) Case


Biopsy tracking integrity


Laboratory integrity


gross exam/glass slide


Conclusion


Match*




Safety?


RFID Specimen Management


Bumps in the road






Raised significant concerns


Media inquiries



Safety?


RFID Specimen Management


Road fixed






On site testing


Negligible EMI

RFID Specimen Management


RFID Specimen Benefits


LEAN Laboratory Operation


Specimen delivery data


Paperless Accessioning


Transcription point elimination


Tracking


Practice integration


Launching pad
-

innovations...



Safety?



GI Endoscopy

AP
-
Histology

AP
-
Accessioning
-
Internal

RFID System

SIGN OUT

1. Unique bottle ID

2. Medical Record Number

3. Name

4. Date

5. Organ

6. Site Modifier

7. Performing MD

8. Requesting MD

9. Rule Out Request

D

D

Current RFID State
-

The model

Paper Requisition

CoPath LIS

Innovation


Project Butt Ox


Small team of AP folks


Institutional funding


RFID into the ORs




Why?

Specimen Source Information


CSI efforts


Barcoding


Free text data entry

OR Specimen Labeling Errors
0
2
4
6
8
10
12
14
16
18
6/28/2008
7/12/2008
7/26/2008
8/9/2008
8/23/2008
9/6/2008
9/20/2008
10/4/2008
10/18/2008
11/1/2008
11/15/2008
11/29/2008
12/13/2008
12/27/2008
1/10/2009
1/24/2009
2/7/2009
2/21/2009
3/7/2009
3/21/2009
4/4/2009
4/18/2009
5/2/2009
5/16/2009
5/30/2009
6/13/2009
6/27/2009
Week of
Number of Errors
Mislabeled
Source
Unlabeled
Implemented 1/15/07
Data Loss?

Practice Integration


Safety


Ask the question


“Do you think this is lymphoma”


“Do you see Cryptosporidiosis”


“We are worried about GVHD”


Preserve the information


Data creation


OR Scheduled Procedures


Consent

Practice Integration


Data preservation/fidelity

Practice Integration


Data preservation/fidelity

Pathology Report Creation:


Prostate, radical retropubic prostatectomy:_____


Lymph nodes, right and left pelvic,



lymphadenectomy:_____

Practice Integration


Data preservation/fidelity

Pathology Report Creation:


Colon, right laparoscopic assisted colectomy:_____

No more “Butt Ox”




Specimen directs process

GI Endoscopy

AP
-
Histology

AP
-
Cytology

CP
-
Microbiology

AP
-
Accessioning
-
Internal

Urology

Dermatology

Surgery

Breast Imaging

RFID System

Future State 2
-

Expansion of paperless state

Tracking Only

SIGN OUT

CoPath LIS

Future of Patient Safety
Technologies




Really?


RFID: The Future of Patient Safety
Technologies


Keeping Safe


Data creation/verification


Positive Identification


Primary transcription point


Tracking


Positive Patient ID


Unique to individual patient/physician
encounter

RFID: The Future of Patient Safety
Technologies


Keeping Safe


WIP visibility


Lab management


Error/delay alerts


Compliance


RFID power of multiples


Natural handling


Easy motions

RFID: The Future of Patient Safety
Technologies


Making Safe


Cultural Shift


Putting the “P” back...


Ask the questions


Front
-
end database


Client facing applications


Optimizing data and delivery


Cross the bridge...



Questions