1. Diamonds In The Rough? The Use of RFID Tags in Global Health Created by: Angel V. Shannon, RN Created by: Angel V. Shannon, RN

2. Objectives Define Global Health Describe the use of RFID tags for disease surveillance in global health Describe the hardware used with RFID tag disease surveillance Describe the software used with RFID disease surveillance Evaluate usability of the software Describe and evaluate the Information System used for RFID tags Define Global Health Describe the use of RFID tags for disease surveillance in global health Describe the hardware used with RFID tag disease surveillance Describe the software used with RFID disease surveillance Evaluate usability of the software Describe and evaluate the Information System used for RFID tags

3. Objectives List the advantages and disadvantages of RFID tags in global health Describe the current ethical and legal issues of RFID tags in global health Discuss the informatics competencies required of a professional nurse working with RFID tags Discuss the functions and responsibilities of an informatics nurse specialist (INS) working with RFID tags

4. What is Global Health? “Global health is an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide.” (Koplan, 2009, pg 1994)

5. Disease Prevention Global Health focuses on: Health Promotion Global Health focuses on: Health Promotion

6. A Major Trend to Achieve These Goals is the use of Radio Frequency Identification tags (RFID) for disease surveillance RFID tags are currently being used in developing countries to identify people with certain communicable diseases is the use of Radio Frequency Identification tags (RFID) for disease surveillance RFID tags are currently being used in developing countries to identify people with certain communicable diseases

7. How Do RFID tags work? RFID hardware includes three main components: RFID tag RFID reader Antenna RFID hardware includes three main components: RFID tag RFID reader Antenna

8. RFID Building Blocks: RFID tags: vary in size, shape, and format depending upon the intended application are either active or passive active tags: have embedded battery power passive tags: rely on antenna to collect power RFID tags: vary in size, shape, and format depending upon the intended application are either active or passive active tags: have embedded battery power passive tags: rely on antenna to collect power

9. RFID Building Blocks The RFID reader: is known as the “interrogater” receives data from the tags and passes it along to the associated software captures the tag’s unique identifier The RFID reader: is known as the “interrogater” receives data from the tags and passes it along to the associated software captures the tag’s unique identifier

10. RFID Building Blocks RFID antenna: receives and transmits data to the reader collects power for tag functioning (passive tags) RFID antenna: receives and transmits data to the reader collects power for tag functioning (passive tags)

11. RFID Building Blocks Once they are placed, RFIDs can be monitored with handheld devices such as: Smartphones - iPhone, Blackberry Palm PDAs Pocket PCs Once they are placed, RFIDs can be monitored with handheld devices such as: Smartphones - iPhone, Blackberry Palm PDAs Pocket PCs

12. RFID Building Blocks The Critical Link Software

13. RFID Building Blocks RFID software is used for: creating barcodes and readable text codes processing unique identifier data managing distribution of vaccines and medicines remotely monitoring patients via implant using nano-sensor technology RFID software is used for: creating barcodes and readable text codes processing unique identifier data managing distribution of vaccines and medicines remotely monitoring patients via implant using nano-sensor technology

14. RFID Building Blocks Current Operating Systems include: Windows Server 2003 Windows Mobile Solaris 9 or 10 Linux Mac OS Pocket PC Palm OS Current Operating Systems include: Windows Server 2003 Windows Mobile Solaris 9 or 10 Linux Mac OS Pocket PC Palm OS

15. Software Solutions: Palm OS A leading application used in RFID disease surveillance Advantages:  Mobility: used on handheld Palm PDAs  Integration: bundled with office suite applications such as Excel, Word, and Powerpoint integrates with MS Outlook for email integrated digital imaging

16. Software Solutions: Palm OS Advantages: Simplicity: Intuitive interface. Known as the ‘little cousin’ to Windows Short learning curve due to Windows format  Usability: Equipped with handwriting recognition and on-screen keyboard Automatic back up with every sync

17. RFID Information Systems To be effective and efficient, RFID systems employ a variety of computer-based information systems (CBISs). A CBIS is: “a combination of hardware, software, and telecommunications networks that people build and use to collect, create, and distribute useful data, typically in organizational settings.” (Jessup and Valacich, 2008, p10) To be effective and efficient, RFID systems employ a variety of computer-based information systems (CBISs). A CBIS is: “a combination of hardware, software, and telecommunications networks that people build and use to collect, create, and distribute useful data, typically in organizational settings.” (Jessup and Valacich, 2008, p10)

18. RFID Information Systems Information systems most often used in global health include: Clinical Information Systems (CISs) Example: Vesalius–CIS™ Resource Management Information Systems Example: MASCAL

19. RFID Information Systems MASCAL developed for the U.S. Navy in 2005 Is an integrated software-hardware system designed to enhance management of resources during a mass casualty incident (MCI) uses active 802.11b asset tags to track patients, equipment and staff during the response to a disaster

20. RFID Information Systems utilizes wireless Internet and geo-positioning technologies also uses an Oracle 9i database, a Lightweight Directory Access Protocol (LDAP) server and an Oracle 9i application server improves communications between care providers and helps to coordinate overall disaster response and emergency medical care (Fry and Lenert, 2005, p261)

21. RFID Information Systems includes interfaces for a hospital command center, local area managers (ERs, ORs, radiology, etc.)

22. Advantages of RFID Tags Effective: enables reliable collection, storage, and categorization of large volumes of vital clinical information Efficient: minimal hardware and software makes it a cost-efficient means of tracking and containing diseases and outbreaks in developing countries Sustainable: uses web-based technology for real- time communication, disease management and outcome evaluation across geographically disparate locations

23. Disadvantages of RFID Tags high risk of tag migration and subsequent adverse tissue reaction when implanted in humans can only be read within a specified range and are subject to interference from other radio wave transmissions data can be read erroneously if the tag becomes damaged or subjected to harsh environments, metals or liquids

24. Legal/Ethical Issues of RFID Tags Most significant concerns relate to: invasion of privacy: how much data is truly being collected? Could there be any data being collected that is not disclosed to the consumer? ownership: who retains the ‘rights’ to the data that is collected from citizens, patients, study-subjects, etc? is data being stored for future use? confidentiality: how does HIPAA apply to global health?

25. Informatics Competencies Nurses working with RFID tags must: understand and identify essential components of computer systems including software and hardware have basic data entry, computer technology and information management skills demonstrate ability to access and use the internet for information transmission and retrieval

26. Role of the Informatics Nurse The Informatics Nurse Specialist working with RFID technology must: demonstrate competence and fluency in clinical nursing, continuous quality improvement, and health information technology demonstrate ability to “implement, evaluate, and troubleshoot user-centered design principles and methods for clients and users” (Senseimer, 2010, pg 64)

27. Diamonds In the Rough? RFID tags: have a wide range of applications use minimal hardware and software are cost-effective and sustainable But in humans, are they diamonds in the rough or an invasion of privacy? While human usage of RFID tags remains controversial, nurses and Informatics Nurse Specialists will play a key role in shaping public opinion by ensuring patient safety and adhering to evidence-based standards of care

28. References Fry EA and Lenert LA. (2005) MASCAL: RFID tracking of patients, staff and equipment to enhance hospital response to mass casualty events. AMIA Annual Symposium Proceedings, 261–265. Jessup, L., and Valacich, J. (2008). Information systems today (3rd ed). Upper Saddle River, NJ: Pearson Prentice Hall. Koplan, JP., Bond, TC., Merson, MH., & Reddy, KS. (2009). Towards a common definition of global health. The Lancet, 373(9679), 1993-1995.

29. References Sensmeier, J. (2010). Statement to the Robert Wood Johnson foundation initiative future of nursing: acute care, focusing on the area of technology, october 19, 2009. Computer Informatics Nursing, 28(1), Retrieved April 15, 2010 from http://journals.lww.com/cinjournal/Citation/2010/0100 0/Alliance_for_Nursing_Informatics_Statement_to_th e.13.aspx doi: 10.1097/NCN.0b013e3181c9017a