Use cases and capabilities

This section will explain what RTLS is and the typical use cases relevant to the healthcare environment. Certain vendors will be highlighted that offer solutions for all, or some, of the use cases being discussed, whether in whole or as part of a third-party integration.

Suppliers that offer RTLS solutions for these use cases  are listed in Appendix A of the full report at RTLS Guidance on the FutureNHS Collaboration Platform.

Asset tracking as a capability covers the ability to locate healthcare assets when required. The solutions and technologies involved can be split into several sub-categories, as related to different healthcare tracking scenarios.

In general, the information provided by asset tracking answers the following questions about an asset:

• is it in the right place?
• where is it now?
• where was it at a certain time?
• has it moved to an unwanted location?
• where was it last?

Asset tracking solutions usually consist of 4 elements: tags, detection infrastructure, management or visualisation application and integration with third-party asset management database.

The asset can be tracked with the attachment of a tag. This tag is tracked through wireless technology.

The tag should be:

• small
• suitable in size and shape for the asset to be attached to
• lockable or hidden to prevent tampering or removal
• able to be detected by a wireless infrastructure nearby
• powered, usually by battery or some alternative power source
• some tags can be configurable allowing for 'ping time' to be adjusted to balance battery life and accuracy

This represents the most common and feature rich implementation of asset tracking.

Benefits:

• track valuable assets in real-time
• check position of nearest asset of a type (for example infusion pump, bed)
• asset motion history through the environment
• trail map to the assets location
• supports other applications such as geofencing and workflow
• can use underlying wireless infrastructure
• medical device maintenance and calibration scheduling

Mobile asset tracking revolves around pinpointing active tags attached to assets through an area covered by sensors. These are either represented on a floor plan map, or with those sensors defining geographical zones fed back to an asset register. The extent of the area usually encompasses internal buildings only but can be extended outdoors. Sensors tend to be Wi-Fi access points or dedicated gateways linked to the main network.

One key application of mobile asset tracking is the ability to schedule maintenance and calibration of medical devices where the medical device can be located and either retrieved or serviced in situ without extended searches. If this service is outsourced, visiting engineers could be given access to the tracking system to locate relevant devices without staff intervention.

This feature is a subset of mobile asset tracking and is often available within those solutions. It can also be provided as a standalone capability for asset security reasons only, for example creating admin alerts in software if a tagged asset is detected passing a sensor or into an undesired zone.

Benefits:

• securing assets via alerts on location change
• securing assets via alerts on perimeter crossing

Though it can be deployed as a standalone capability  in the healthcare sector workflow management tends to be a subset of mobile asset tracking. The key difference is what is tracked, and for what reason. The aim of workflow management is for personnel and equipment to be tracked in real-time to provide data allowing for time and motion studies, identifying bottlenecks and if there are congregation areas causing congestion or inefficient work practices.

Benefits:

• personnel efficiency
• time and motion studies
• social distancing

Workflow management requires a tracking solution in place to track tagged personnel. These tags could range from a mobile phone using Wi-Fi, or a device providing more accurate tagging technology for increased accuracy. Most of the solution is back-end software analysis of movement represented to management teams to be able to show bottlenecks, dwell areas and focus and group dynamics.

For certain IT equipment, laptops, computers-on-wheels or other devices that are computerised, these can be tracked using the assets own wireless presence. This means that tags may not be required to track this equipment, and simpler location solutions could be employed using the built in wireless management solution to track wireless clients.

Typically, this technology is used for wireless network troubleshooting but can be re-tasked. If tracking of other non-IT assets is required, then mobile asset tracking is preferred.

Hospitals, clinics and office spaces contain valuable items which are not generally mobile but are important to the provision of healthcare in situ and it is critical that they are regularly checked as being in their correct location for servicing and accurate asset management. Such items may be very high value such as X-ray machines, high definition screens or scanning equipment that would be difficult, but not impossible, to remove.  

Benefits:

• ability to create census of expensive assets
• combines with physical 'eyes on' of assets themselves for assurance
• integration with asset management databases
• low cost
• requires no wireless infrastructure
• no battery technology or replacement regimen necessary

Fixed asset tracking solutions tend to be standalone solutions and are not generally complementary to a wireless infrastructure. They represent a low cost and comparatively easy to implement tracking solution for high value stationary items.

One technology commonly used for this is passive Radio Frequency Identification (RFID). This consists of 2 elements: unpowered tags and handheld readers. Assets are tracked by an operator moving to where the asset, with its tag, should be located using the scanner to activate the tag. The scanner can then record the confirmed location of the asset into a database or asset management solution.

A fixed asset tracking solution can also be used for inventory management.

As more accuracy or automation are required this solution is usually superseded by mobile asset tracking solutions that can locate in actual real-time. Combinations of both are possible and generally require both to integrate with asset management solutions to create a combined asset record.

Inventory is similar to fixed asset tracking, with the key differences being an emphasis on point locations and a larger scale of similar assets. This approach is generally used in medium or long term storage and passive RFID tends to be the technology of choice. Assets tracked with this technology are generally kept in bulk, in designated and secure areas such as pharmacies. A method of signing-in and signing-out of assets will use RFID readers to keep track of inventory. Any other asset tracking technology could also provide this service, but may be more expensive than RFID.

Wayfinding creates a virtual mapping and navigation environment, similar to widely used map services like Google or Apple maps, with a blue dot representing the user who is shown, in real time, a valid route to a destination.

In the healthcare environment, wayfinding is generally used for outpatient or visitor guidance or for new or temporary staff to find their way around the trust buildings, as these environments can be large and difficult to navigate.

Wayfinding RTLS solutions only provide the underlying capability for this application. At its centre is a bespoke mobile application which will either be programmed as an external project or created internally by IT teams. This application will link into the RTLS solution via Wi-Fi for the positioning information, but the mobile device itself will measure its position using known Radio Frequency (RF) sensors (such as access points, gateways and beacons).

As the device itself is doing the measurement, the sensors are just providing reference points on the 'map' for the device’s calculation. Thus, independent devices such as Bluetooth Low Energy (BLE) beacons can be employed that only periodically send out their IDs or 'chirp'.  These can be battery powered in the same way as tags although they do not move and are positioned on the 'map' within the RTLS solution to form reference points. As they are battery powered consideration will need to be given to battery life and recharging or replacing beacons.

Almost exclusively, wayfinding solutions tend to be based on BLE technology and extensive use of beacons to provide reference points, with the exception of Virtual Bluetooth (vBLE). This reduces the need for increased deployment of Wi-Fi access points for accurate asset tracking. Additionally, modern mobile phones have built in Bluetooth radios which support the application to do the measurements necessary.

In general, common wayfinding solutions consist of:

• access points supporting BLE radios
• BLE battery beacons
• custom mobile application
• application integration programming
• custom local maps

An important consideration is the user experience of the published mobile app so that users will download the app and use it rather than using existing signage only. Other initiatives such as marketing, useful information and advertising can be included in the app. It is important for the map routes to be clear and easy to read. Most RTLS vendors do have services to 'clean up' typical floor plans but there are dedicated mapping companies that can provide a dedicated service to support improved user experience. It is important to obtain maps in the file format supported by the RTLS application.

Within the map will be established 'points of interest', usually entrances or exits, stairs or lifts, toilets departments or numbered rooms, receptions and amenities. Guidance paths can then be provided to the user from their current position to the point of interest. This can be done between floors and across multiple buildings if necessary.

Most wayfinding apps can integrate innate GPS input from the mobile phone to guide the user across outdoor spaces but using external access points or beacons is possible as well.

A new alternative to maps is augmented reality where the phone camera is used to produce a real time 'see-through' with the route or points of interest superimposed on the screen to augment the view with additional information.

Proximity solutions tend to be a subset of wayfinding solutions. An example of this would be a hospital information point that can supply information to a visitor app. This may be information about a geographical location such as a static map of toilets or infection controls or even menu details for a nearby cafeteria.

Proximity is about triggering a software reaction in an application when located in a device close to a configured RTLS sensor, typically a BLE beacon. The trigger causes a response on the wayfinding application on the device, such as an admin alert like geofencing or a supply of information for an information point in a similar manner as an info QR-code.

The triggers can be quite sophisticated as most of the solution is software based. Bespoke solutions are possible and supporting programming services are required to get full use of the technology.