Most tracking systems on the market are active systems: somebody has to enter every single piece of data the system displays. Some data (e.g., patient demographics or lab/imaging results) can flow in from other computer systems via interfaces, but the vast majority of information used to track patients and department resources is manually entered by a person sitting in front of a computer screen. Ironically, a system that’s supposed to simplify a department’s operations and improve patient flow actually ends up doing the opposite because people have to constantly stop caring for patients to enter data. And to compound the problem, when the department is busy, people stop making entries to the system and the data becomes stale. Yet it is when the department is busy that the data is most needed.

Automatic Tracking Technology

All patients and staff wear small badges, which emit an infrared (similar to that of a TV remote control), active RFID or ultra-wideband signal roughly every three seconds. The badge signal uniquely identifies the badge. The locating signals that badges emit are received by sensors located in the ceilings throughout the department and ancillary areas (i.e. for an emergency department this would include radiology, ultrasound, nuclear medicine, etc.) that patients frequently visit. These sensors collect the infrared light or radio frequency signal from the badges, translate it into electrical impulses, and forward those impulses to hardware devices that filter the signals to find the location signatures they contain. These devices—known as collectors and concentrators—then convert the location signatures into badge location data that software can understand. Through Amelior automatic tracking systems, users associate badge numbers with individual patients, staff, or equipment. Likewise, the system links individual sensors to specific locations. For example, during a particular shift, badge 12345 might be associated with John Doe. Similarly, sensor ABC is associated with ED exam room 14. Thus, if sensor ABC receives a signal from badge 12345, Amelior can check the associations and determine that John Doe entered exam room 14.

As a result, personnel can use the system’s capabilities to find the current location of patients, charts, equipment, and even staff (if desired).

Although valuable, simple locating is just the most basic application of automated tracking. By applying business rules to location, movement, and interaction data, we can track the progression of visits and determine both what has been done and what still needs to be done. For example in an emergency department,

• When a patient’s badge is first tracked at any sensor back in the main department (i.e., not in the waiting room), we can assume that the patient has entered the ED—one of the primary “milestones” in the visit.
  
• If a patient’s badge is tracked at a sensor representing a treatment room and the system shows that room as available, we can automatically assign the patient to the room.
  
• If a patient badge and a nurse badge show up together at a sensor representing the patient’s assigned room, we can mark the “Nurse at Bed” milestone. (Essentially, the same logic applies to doctor assignment and registration as well.)
  
• If a patient badge is tracked at a sensor representing a CT room, we can indicate that a CT is in progress. When the patient is tracked in the department again, we can indicate that the CT is complete.
  
• If a badge attached to a portable X-ray or EKG machine shows up at a sensor representing a treatment room while a patient is also there, we can indicate that a portable X-ray or EKG is in progress. When the machine leaves the room, we can show it as complete.

These are just a few and somewhat simplified ample rules for translating location, movement, and interaction data into useful information about the visit.

A log of all interactions between patients and staff member is automatically captured. As a result, department managers can accurately measure time spent with patients, identify potential bottlenecks, and assess how efficiently patients flow through the department. In addition, if a patient complains that nobody checked on him even though he pressed the nurse call button for more than an hour, with the infrared or ultra-wideband interaction log, it’s easy to counter such claims.

Put simply, with the automatic tracking technology—which can keep an eye on everyone in the whole department at once—we can gather the kind of comprehensive data people are hard-pressed to keep track of themselves. But more importantly, we can do so with very little human-computer interaction.

Commenting on the National Report Card on the State of Emergency Medicine