A vision of the future Will Mobile Indoor Location Become a Commodity? Will RFID Technologies Start to Integrate with Mobile Location? Will RTLS Tags Become Integrated into Devices? Scott Phillips Principal, RFID Portfolio Manager Kaiser Permanente HIMSS 2014 IEEE and RHCC/Intelligent Hospital February 23, 2014

Scott Phillips has no real or apparent conflicts of interest to report Conflict of Interest Disclosure

Learning Objectives Assuming ubiquitous adoption in Healthcare for RTLS, Passive RFID and mobile indoor location, understand the future financial requirements. Increase understanding of the feasibility and benefits of an enterprise location infrastructure designed for many use cases. Increase understanding of the feasibility and benefits of embedded tags and the importance of infrastructure standardization.

Kaiser Permanente 7 regions serving 8 states and the District of Columbia 9.1 million members 17,000 physicians; 175,000 employees (including 48,000+ nurses) 38 hospitals (co-located with medical offices) 600+ medical offices $53 billion annual revenue $1.8 billion invested in our community 68 years of providing care Decision: Work with suppliers to embed RTLS tags into medical equipment.

Types of RFIDExamplesVisual Passive Supplies Specimens Pharmacy Active / Real-time Location Systems (RTLS) Assets Patients Mobile Indoor Location SmartPhones Tablets GPS Specimen Temperature In-Transit Tracking What is RFID? Radio Frequency IDentification is technology that uses communication through the use of radio waves to transfer data between a reader and an electronic tag attached to an object.

Active RFID Tag Adoption Production Implementing Total Asset Tags~147,000 Temperature Sensors:~6,000 Wireless Location Coverage:~32,000,000 Sq Ft Current RFID Use Cases at Kaiser Permanente Active RFID Geographical Activity 37 of 38 Hospitals & 337 of 600+ MOBs 1. Active RFID (RTLS) Asset Tracking Equipment Maintenance Rentals Temperature Monitoring Infant Safety Patient Activity (Pre-Pilot) 2. Passive RFID Retained Foreign Objects Medication (Pilot) Lab Specimens (Pre-Pilot) 3. Mobile Location Wayfinding (Pre-Pilot)

Future Examples - More Infrastructure x3 Members can find the facility using GPS, and then once indoors navigate using indoor location to their doctors appointment. Mobile Indoor Wayfinding Asset Tracking – Enhanced Location Accuracy Nursing and Clinical Technology can quickly find needed equipment by knowing the exact room the equipment is in. Accuracy enables advanced equipment/patient workflows as well (e.g. par levels). Nurses can track the location of on demand medications in transit; plus know when and where they are delivered to. Medication Tracking Today Exploratory

Use Case Todays Infrastructure Requirement Tomorrows Infrastructure Requirement Sensors Type(s) Asset Tracking2-3 meters Room, bay, alcove, more exact coordinates and interactions RTLS Infant SafetyUnit exit pointsUnit exits and beyondRTLS Retained Foreign Objects (RFO) Proximity/Wand OR bed level, OR room level, supply room, supply chain Passive MedicationTray counts Pharmacy, medication rooms, patient rooms, en route Passive Mobile Indoor WayfindingN/A Enterprise with points of interest and area triggers Mobile (Consumer Wi-Fi, BLE?) Patient ActivityN/A Highly accurate distance for very short walks (e.g. <20 ) All Summary – More Infrastructure x3 Could the Future be Room Level or Better for 3 separate location networks? If not, what rooms would be excluded?

Room Level or Better RFID Infrastructure x3 Room with multiple sensors and RFID tags Future hospital floor with room level coverage x3

Location NetworkActive RFID / RTLSPassive RFIDMobile Location Coarse LocationYesNoYes Room Level Location (All)Yes Unit and Building Perimeter (All)Yes Temperature Monitoring (All)Yes No Financial Approximations Average Hospital Per Year Room Level or Better Hardware Installation and Support Costs Full Network Infrastructure Ubiquitous Tags (except Mobile) RFID Technology Refresh ~$500K~$340K~$150K Average Medical Office Per Year (same as above) ~$23K$23K~$20K Option 1: Large Provider Potential Annual Investment for 3 Location Networks (e.g. 38 hospitals, 600 MOBs) ~$75M+ Option 2: Same Large Provider Annual Investment with Network consolidation and embedded RTLS Tags. ~$37M Note: These are not actuals. This is merely an illustration with rough approximations which includes several assumptions around widespread use case adoption, coverage requirements, location accuracy and future support costs for all three infrastructures. Room Level Location Networks x3 - Estimated

Sensor Consolidation Feasibility and Benefits Traditional Implementations 1.Consumables Passive RFID 2.Assets RTLS proprietary networks 3.Mobile Absent of Indoor Location Future Opportunities 1.Passive Remains + assist RTLS? 2.RTLS – Standardized? 3.Will Mobile Dominate? -> Consumer Wi-Fi + BLE? Bluetooth Low Energy (BLE) looks promising for mobile and retail applications. iPhones are sensors too. Could it be used for more? Feasibility Which technology(ies)? Benefits One Infrastructure = Cost savings. Industry growth through greater use and adoption. Increases attractiveness for suppliers to design in.

Embedded Location Feasibility and Benefits Progress - Examples Kaiser Permanente is deploying select gauze with passive RF tags built in by the suppliers. 6+ Years Ago, Kaiser Permanente Clinical Technology Identified this as a future requirement for RTLS tags. Today Kaiser Permanente is starting to address this issue with its strategic medical device manufacturers. Intel announced an initial step Mobile indoor location applications are emerging – using mobile embedded location already. Feasibility Lacking a comprehensive RTLS standard for sensors and tags. Note: It is expected active tags will always be required for medical equipment that doesnt have a battery (e.g. standard wheelchairs) Benefits Reduces initial and ongoing costs for tags. Doesnt fall off. Small/Zero form factor.

Future Recommendations Be Prepared and Contribute: Encourage the advancement of standards for embedded RTLS, making it possible for standards to emerge more quickly enabling industry-wide embedded RTLS. Where possible, encourage blending RTLS with passive and mobile, which can increase the value of the infrastructure/sensors through reuse. Learn from mobile; plan for mobile users and encourage greater use of additional onboard sensors for enhanced location accuracy (e.g. accelerometers, pedometers). Help encourage integrated GPS location with indoor mobile location for use cases such as seamless door to door wayfinding (e.g. home to parking lot to doctors appointment).

Driving Value in the Present In the meantime, we will continue to use the technology to create the most value: – Make it easier for clinicians to do their jobs – Service more patients – Reduce the cost of equipment and supplies – Optimize asset utilization – Drive positive patient and family experiences Things to Consider – What is the return on investment, given the facilitys current state? – What technology best addresses the know use cases and the future use cases? Passive Active Mobile

Summary / Lessons Learned If ubiquitous location infrastructures are adopted (x3), the financial benefits from consolidation are operationally significant. A technology approach that results in a single RFID / Location infrastructure for all use cases which maximizes sensor reuse is likely to lead to the lowest long term cost. Location is embedded in mobile devices already for GPS, and is an emerging reality for indoor location. RTLS could accomplish the same providing standards are available. Single Network + Embedded Tags = Increased Value and Faster Industry Adoption.