Healthcare organizations are faced with surging costs and a complex technological landscape, which can make justifying expenditures for infrastructure, equipment, and technology resources more challenging than even a few years ago. Yet new tools are evolving that enable healthcare organizations to deliver better patient care with more efficient workflow and better inventory control in a more cost-effective way.One such tool is the emergence of sensor and data distribution networks for automated equipment tracking. However, understanding the nature of different location technologies is essential for harnessing their potential—and for justifying the expense to administrators. This article differentiates between radio frequency identification (RFID) and real time location system (RTLS) technology from both a biomed and an information technology (IT) professional's needs, and demonstrates how these technologies gather hard data to make tough strategic decisions that can result in both hospital-wide capital expense reductions and process improvements.The introduction of location technology in the healthcare environment offers new possibilities for managing hospital resources. In addition to automatically tracking clinical care equipment, RTLS has the potential to transform hospital processes, such as asset temperature monitoring, bed capacity management, patient/provider workflow, patient elopement, security, and other location-dependent applications. As RTLS technology matures, new applications will emerge that leverage the location intelligence derived from these systems. This article focuses primarily on using RTLS for asset tracking since this application offers dollar-quantifiable benefits for biomedical engineers, technicians, and other staff.Prior to the availability of automated asset tracking for mobile medical devices in healthcare organizations, it was often a mystery as to how many devices of any given type (infusion pumps, wheelchairs, etc.,) were really needed, how these devices were being utilized, and where they were being used or stored. The overwhelming perception in a majority of hospitals is that there is a shortage of mobile medical equipment, such as infusion pumps. Biomedical engineers spend an extraordinary amount of time searching for equipment.1 Anecdotal stories abound about how these engineers take 85% of their time to find the final 15% of unaccounted-for equipment when performing preventive maintenance. The biomedical engineer is expected to meet strict maintenance deadlines despite this time burden, and usually is the arbiter in finding devices when all else fails in getting them to the patient's bedside. Additionally, nursing staff spend too much time searching for limited equipment, such as bladder scanners. They also have a tendency to hoard critical care devices since they want to make sure the proper equipment is readily available for patients. This behavior adds to the equipment shortage perception.Hospitals are realizing they may be spending more money than necessary to purchase and maintain excess equipment. The emergence of location tracking technology has now enabled a more accurate assessment of the exact number, location, and functionality of medical devices so hospitals can better focus on improving patient care and reduce capital expenses and inefficient use of human resources.For these reasons and many others, automated asset tracking is a strategic choice for many hospitals. With an RTLS system, biomedical engineers can greatly expand their performance in meeting critical accreditation mandates and improving patient safety by simply being able to efficiently execute their programmed maintenance obligations, and rapidly locate and remove recalled devices from use.Asset tracking is something most healthcare industry experts, including KLAS Research2 and ECRI Institute,3 believe will help biomedical engineering departments do their jobs better and help hospitals run more efficiently. Although this opinion is not shared by everyone, a stronger case is being made as more hospitals are adopting new automated asset tracking methods. With mounting financial pressure and accountability requirements in healthcare, hospital administrators are starting to seriously consider the necessity of tracking technologies.Historically, the first priority for capital expenditures generally has been revenue-generating purchases such as computed tomography (CT) and magnetic resonance imaging (MRI) scanners. Today, priorities are shifting as the value of asset tracking is becoming better defined. More hospitals understand that substantial money can be saved by reducing capital expenditures through better management of assets and by making operational improvement not only within support services, but within the clinical arena as well.Before evaluating location tracking, there are a few concepts to understand in order to fully appreciate how the technology benefits operational efficiency and patient care.One of the fundamental barriers to adoption of automated asset tracking using RTLS is an incomplete understanding of the technology involved. Most people broadly refer to asset tracking technology as RFID and do not understand how this differs from RTLS.The term “RFID” emanates from the underlying functions: radiofrequency (RF) and identification (ID). There are several types of RFID systems, each serving a different set of requirements, and they operate on different radio bands. A series of international standards governs what RFID systems do and how they work. In general, RFID is often a replacement for barcodes, and RFID is deployed in situations where it is not practical or efficient to be within visual range of a bar code in order to read an inventory number, or similar piece of information.RFID technologies are usually broken down into two types: ones employing passive tags and those using active tags.Passive RFID systems use tags that do not have their own power source (a battery) and are powered by a burst of RF energy from a transmitter (reader). The reader and a passive tag need to be in close proximity—typically within a few feet—to work. Passive RFID systems are found in fixed portal-based applications like access control, inventory control (i.e., warehouses, retail stores, central sterile supply), or in the pharmaceutical industry. Implanted passive RFID chips are commonly used to identify pets.Active RFID systems include battery-powered tags, an extended distance between tag and reader, and, in comparison to passive tags, they feature a significantly larger physical tag to house the power cell and the more complex electronics.There are limits to what RFID technology can accomplish. RFID by itself cannot track movement, or actively pinpoint location of tagged items. It is simply an identification system, usually employed to replace a bar code-type label.Because some RTLS technologies resemble RFID in that the system components are architecturally similar, many people confuse the two. While the two terms are commonly interchanged, their differences are actually quite profound. RTLS solutions incorporate communication between tags and readers. However, they also include location calculation, real time data gathering, and (for hospitals) “healthcare intelligence.” By themselves, neither passive nor active RFID can calculate distance, range, time, or direction, and one or more of these attributes are necessary to determine the location of movable objects. Additionally, an RTLS is capable of providing stored data, both real-time and historical, for analysis and reporting. New RTLS technology can also determine the real time and historical status of a device—for example, whether an infusion pump has gone through proper cleaning and decontamination procedures.The distinction between RFID and RTLS needs to be fully understood before evaluating any automated asset tracking system. Generally, an effective asset tracking system must perform three basic functions with speed and precision:While these three functions are essential in managing medical devices, the value of the tracking system is vastly diminished if it cannot also gather and analyze real time and historical data about medical equipment. Location information must be continuously updated for clinical staff to quickly and immediately find equipment in real-time, via any hospital computer. RTLS has this added capability, and this is where it parts company with RFID, enabling a hospital to optimize its mobile assets.Inventory and workflow optimization are areas where simply locating something is not going to solve problems. Locating an asset is ineffective unless the supporting software systems are capable of analyzing and presenting the information. This is how a clearer definition of RTLS becomes apparent:This is the fundamental difference between RFID and RTLS. RTLS provides solid return on investment data by precisely measuring and analyzing device utilization and work process (more return on investment information from RTLS is discussed later in this article). Tagging medical devices just to know their location is not an adequate reason for asset tracking. The greatest power and benefit of RTLS technology lies in its ability to gather and analyze that data. Acting as a continuous, automated monitoring system is one of the most powerful features of RTLS. Another is its ability to provide notifications and preconfigured system alerts, depending on departmental responsibilities—the healthcare intelligence component.Even if all assets are tagged and entered into a system, unless the system is designed to check for the presence of an asset somewhere in the facility on a regular and frequent basis, an accurate inventory is not possible. If a hospital has tagged an asset, but the system does not continuously monitor and only intermittently reports, the hospital cannot be certain it still has the asset.The advantages of RTLS for location tracking are obvious; however, RTLS technology can also be further differentiated. The following discusses several approaches to RTLS technology and why wireless sensor network-based RTLS is optimal.RTLS technologies use different implementation systems, namely wireless sensor networks or data distribution (such as WiFi or 802.11) networks. Wireless sensor networks consist of a number of sensors (readers) that are spread across a geographical area. The sensors monitor physical and environmental conditions such as motion, sound, and temperature. Each sensor has wireless communication capability at compatible frequencies and some level of intelligence for signal processing and networking of the data it collects.RTLS using sensor network technology provides a synchronous, real-time tracking system for the location of tagged medical devices or any capital asset. The tags in a sensor network interact with other system devices and sensor information (status, temperature, etc.) to create greater location visibility. Sensor networks are able to assess location, as a function of the sensor-data gathering activity. Readers are purposefully positioned in areas of interest, clinical zones, or rooms depending on the desired level of location information accuracy. The accuracy in sensor network deployment is limited only by the density of tag readers. The number of readers communicating with tags increases location determination accuracy.With hospital data distribution networks, such as WiFi networks, readers, or wireless access points (AP) are deployed at a level of density to maximize their primary function—to move digital information in a pattern that minimizes interference. Tags attached to medical equipment communicate with APs over the same 2.4 GHz frequency used by wireless computing systems. However, data distribution systems can only estimate the location of the tagged item based on the signal strength and ability to calculate the distance between the AP and the tag. An uninterrupted signal path between tag and at least three WiFi APs is required for location accuracy.Location strategies for WiFi networks depend upon complex probabilistic location algorithms and only provide derived rather than detected location. Derived location is highly dependent on environmental factors such as reflection and absorption of radio waves, resulting in what is known as multipathing. Unfortunately, a 2.4 GHz WiFi signal can be easily deflected by moving objects in hospitals such as carts, beds, equipment, and people. In the complex, rapidly changing hospital clinical environment, this inherent diminished accuracy represents a severe limitation of using a data distribution network to accurately and consistently locate tagged objects.The placement of APs sufficient enough for a typical hospital wireless network is usually not dense enough for optimum location tracking (see Figure 1 and Figure 2). A data network also depends upon complex orderly sequences of identification and authentication of the devices that communicate with it. When there are thousands and maybe even tens of thousands of tagged assets attempting to communicate with the network, its primary function—to transmit essential clinical and financial information—may be threatened.The bottom line is data distribution WiFi networks were not designed for use in meticulous, accurate location tracking. Sensor networks, on the other hand, can yield more reliable data for improving cost effectiveness and human resource efficiency.Excellence in tracking systems is defined by accurate, consistent measurement of the location of objects. Sensors accurately detect rather than derive location in any delineated area. The statistical data generated by the sensor network is highly useful because it allows hospital staff to discern the value of the assets and whether, for example, to buy more or fewer devices based on usage and device-state patterns. Sensor networks also ensure optimal utilization of capital assets because equipment can be put in the right place at the right time and (with certain specialized RTLS tags) identify if equipment is in suitable condition for use.The features of sensor networks in RTLS represent a clear and rapid return on investment for the healthcare industry. Adding efficiency to the delivery of healthcare has both economic and social implications. Hospital staff is better focused on improving patient care and mission-critical services. Costs for the rental, purchase, and maintenance of hospital equipment are greatly reduced and valuable resources can be further stretched.When taking a multidisciplinary approach to evaluating an RTLS, the benefits derived reach much further than only reducing capital outlays for medical equipment. A 2009 report on RFID options and application by Rand Europe included a U.S. RTLS case study and offered the outline seen in Table 1 for determining the total costs vs. the gains achieved from implementing an accurate RTLS for both asset and patient tracking.The critical tool of the IT department is its network and related components. IT systems are designed for the storage and distribution of information—by definition data networks. Data networks have become the life blood of healthcare facilities and the WiFi network represents an invaluable tool for high-speed, high-pressure hospital environments. With this technology, clinicians and support staff have greater freedom to carry out their responsibilities. The drawback is that the network is now a critical utility that hospitals can no longer do without, and they are hamstrung when it fails.Hospital IT departments are frequently relied upon for decisions regarding new digital advances in hospitals due to their understanding of evolving software and complex enterprise-wide systems. However, because of their prominent role and significantly larger budgets than clinical engineering, IT departments often hold sway over the adoption of asset tracking technology and need to be fully informed of the underlying technologies inherent in different RTLS solutions.Initially, using the WiFi network for tracking may seem adequate, but limited, imprecise location capabilities may actually cost a hospital more money over time and will not fulfill the strategic, long-term goals of the institution. A less-than-accurate tracking system will impact the biomed's time and effort in locating and delivering medical devices and the hospital's ability to provide patients the highest quality care. Biomed managers, hospital IT directors, and other stakeholders should work closely in defining not only short-term but long-term objectives of a tracking system, i.e., patient, staff, vendor tracking, etc. Recognizing the system's potential impact on improving other hospital processes for nursing, patient transport, environment services, materials management, etc., is another important consideration. Moreover, senior management advocacy and commitment are essential to the entire technology adoption process.Hospital management must also recognize that the power of an accurate RTLS is its capacity to develop mobile medical device utilization statistics to support informed capital expenditure decision making. Management should fully understand that insufficient location tracking capability will fail to produce the precise room-level location information necessary to support more sophisticated applications like workflow management and patient tracking.IT staff, biomeds, and hospital management must collaborate in order to adopt a system that best serves everyone's needs, increases location accuracy and expanded data availability, and decreases wasted time and resources.RTLS solutions go far beyond basic RFID to track the location of medical equipment and patients. More sophisticated RTLS based upon sensor network technology can augment location with other valuable information such as temperature or the actual status of equipment (whether equipment is in use with a patient, needs cleaning, or is ready to be used). Wireless sensor-network based RTLS provides healthcare institutions with the most sophisticated, precise, and robust location-tracking technology. The valuable data that tracking systems generate enables a comprehensive understanding of how well equipment is utilized and at what cost. Armed with better location visibility, hospitals are better positioned to increase employee efficiency, minimize wasteful spending and time, maximize equipment utilization, and provide exceptional care to their patients.