Big Brother or Better Care? Sensors Track ER Patients and Docs

Mayo Clinic's digital dashboard shows where everyone in the Emergency Department is at any given time by relying on radio frequency identification.  (Mayo Clinic)

Monitoring a person's every move may sound like something out of Dave Eggers' dystopian novel, "The Circle."

But, in fact, wireless RFID (radio frequency identification) technology, which uses radio waves to transmit information to nearby devices, is already being used to track everything from jeans to cattle to Disney World visitors.

And now, hospital patients. More than 10 health care providers, including Johns Hokpins University School of Medicine and Massachusetts General Hospital are using the technology to track patients.

One of the most recent adopters is Mayo Clinic in Rochester, Minnesota.

From his office in Rochester, Dr. Tom Hellmich, knows exactly what's going on in Mayo Clinic's Emergency Department, half a mile away.

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"There is a medical emergency that came in by ambulance, and I can tell you that a physician has been in that room for 38 minutes and there are 11 people in there right now," he tells me over the phone.

Hellmich is looking at a digital dashboard on his computer screen, called the YES Board. It displays—in real time—the location of every staff member and patient, as well as what the patient's chief complaint is.

The system relies on 750 sensors installed in the emergency department's walls and ceilings. The sensors receive location data from RFID tags embedded in patients' wristbands and staff members' badges.

The information is displayed on Hellmich's dashboard and multiple screens throughout the emergency department. It's also accessible from any intranet-enabled device after user-authentication. The system tracks how much time a patient has spent alone, when he or she came in and whether the patient leaves his or her room—say, to go get an X-ray.

By recording the movements of every person in the emergency department, Mayo hopes to reduce wait-time for patients, and improve care by helping staff, patients and families find each other more easily.

"We are already living in this age of big data where clinical information is being used for a patient’s journey as they go through the system," says Kalyan Pasupathy, scientific director of Mayo Clinic's Clinical Engineering Learning Laboratory.

Pasupathy and Hellmich led a team of multi-disciplinary professionals to develop the system.

"One thing we were missing in that picture is physical location information."

When Mayo rolled out the system last year, patients barely noticed, Hellmich says. Many assumed the clinic already had something like it in place.

But Mayo Clinic staff were less enthusiastic at first.

"Physicians, nurses, lab techs were all worried about this being Big Brother," says Hellmech. "So that was our biggest concern and our biggest hurdle."

The team that developed the system says they assuaged fears by establishing an ethics committee to review how the technology would be used. No individual Mayo employee would have his or her location information analyzed without prior consent, the committee decided. This means, for example, the hospital wouldn't evaluate the duration of someone's lunch break or track whether two staff members spent time together.

When staff are on a break, outside the ED, or in the restroom, they are listed as "out of department." The committee also agreed that the information wouldn't be used in performance reviews.

But Michelle de Mooy from the Center for Democracy & Technology, which works on Internet privacy issues, points to concerns about who might be able to see the data.

"I would really want to be sure that there were restrictions on who could access the information, how much they could access. And that doesn't just include performance evaluations, but also insurance companies," she says. "The government is another really big question. There's a lot of people who get their health care through the government, so there are questions about how much they can see."

The information in patients' RFID wristbands doesn't contain personal medical data or names. Rather, a string of numbers is assigned to each patient and only shows up as a person's name once a staff member is logged in and looking at the YES Board.

If accessed in isolation, information on the wristband has no personal identifying details. So if a hacker got a hold of a patient's RFID wristband, they'd see just a string of numbers. The numbers only becoming meaningful in the YES Board where they are matched up with patient names.

By the end of this year, Mayo Clinic plans to report quality control metrics to the government—things like average patient wait-time and the duration of stay. Eventually this reporting could be automated, says Hellmich.

De Mooy says hospitals need to thoughtful about data sharing with the government.

“What I’ve seen in health data is the government will say they need the information in the name of public health, and that will always override privacy or civil liberties concerns.”

While this may be true, the hospital isn't scaling back; in fact, it's adding new tracking locations. Previously, patients weren't monitored while they were in bathrooms, but that changed when staff decided patients might fall or otherwise need help while there.

Eventually, the hospital aims to use the technology to track the spread of infectious disease. If someone leaves the emergency room and is later diagnosed with tuberculosis, for example, RFID would enable staff to see whom that person came into contact with in the ER, and when.

The clinic is now considering whether the entire hospital network, not just the emergency department, should be wired for RFID.

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"We really need to think about what the unintended consequences could be," De Mooy says. "Thinking about it now, not just if or when the data gets into the wrong hands or there's a data breach."

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