Deploying and Adapting an Indoor Positioning System in the Clinical Setting

Introduction

The United States healthcare system has reached a critical point. The demand for healthcare services is rising, driving up costs and expenditures. The US currently spends more per capita on healthcare than any other industrialized nation(1) yet at the same time healthcare resources – including the supply of physicians– are getting scarcer and more difficult to access.

Policymakers, healthcare providers and researchers have long struggled to improve the cost, quality and efficiency of our healthcare system. However, the lack of key quantifiable data has often inhibited or distorted effective decision-making. Decision makers are constrained to work with what information is available, for example, from easily measured areas such as in the procedural or imaging specialties. Key information related to time, resource utilization system behavior and organization and face-to-face time between patient and physician is often missing.

In order to effectively address this policy-information gap we need to develop better methods for quantifying, measuring and collecting data in healthcare beyond the simple counts of surgeries done, images taken or vaccines given that currently characterize our healthcare system for decision-makers. In medicine, time is perhaps the most important resource – yet measuring time spent on core clinical activities, such as the time patients and clinicians spend face-to-face, has been difficult. This has resulted in inadequate weighting and reimbursement of primary care activities (informed decision making, problem solving, resource coordination, counseling) which are typically time intensive but otherwise difficult to characterize. Without comprehensive data quantifying these activities understanding and planning optimal use of our resources is difficult if not impossible.

At Massachusetts General Hospital, an innovative project weaves together industrial design, operations research, outcomes research with emerging technologies to provide a means for objectively and reliably measuring time in the primary care setting. The RFID in Clinical Workflow Project aims to provide a tool with which to understand resource allocation and to shape appropriate and effective policy. Using such information in conjunction with other clinical data and simulation models will allow policy makers to identify optimal current and future configurations of our healthcare resources. In order to successfully incorporate the use of an emerging technology that enables accurate and reliable measurement into the demanding and critical clinical setting, the multidisciplinary team used a hybrid of design techniques sourced from the different disciplines represented on the team.