Hospitals start pilot testing RFID to curb drug diversion
DRUGTOPICS© FOR THE HEALTH-SYSTEM PHARMACIST
Hospitals start pilot testing RFID to curb drug diversion
As many hospitals are pondering the problems of implementing bar codes, M. D. Anderson Cancer Center in Houston is tagging drugs with radio chips. The pilot project to track Neupogen (filgrastim, Amgen) and Procrit (epoetin alfa, Ortho Biotech) from the wholesaler through administration may be the nation's first hospital pharmacy-based test of radio frequency identification, or RFID.
Instead of physically scanning a bar code, RFID scanners can spot tagged products in a pocket or mixed in a jumble of other containers. "We're talking about drugs that have tremendous potential for diversion back into the supply chain," said VP of pharmacy Roger Anderson. "We want to know that the drug went into a patient, not into a backpack and out the door."
M. D. Anderson isn't the first hospital to look at RFID. Johns Hopkins Medical Center is already testing RFID to track IV bags. Georgetown University Hospital is preparing a head-to-head trial of RFID versus bar codes to track blood products from donor to patient.
Retail giant Wal-Mart is requiring 18 pharmaceutical suppliers to implement RFID by the end of June for inventory tracking. The Food & Drug Administration expects drugmakers to have RFID tracking in place by 2007 for nearly all pharmaceuticals to control counterfeiting. Anderson isn't waiting.
"We're looking at RFID for inventory control after internal thefts of Procrit and Neupogen," Anderson explained. "But if you can do it for inventory management, you can do it for billing, for security, for matching dose and patient, or any other purpose. Preventing counterfeiting could be the factor that accelerates interest in RFID."
The concept is simple, Anderson continued. RFID tags are attached to pallets, boxes, or individual drug containers. Each tag holds a unique identifying number and a simple radio circuit, but no power source. As the tag passes near an RFID reader, the circuit picks up power from the reader and identifies itself. The tag ID number is linked to a database that is updated every time a tag is read.
A drug bar code is typically linked to an NDC number, explained John Roberts, director of health care for EPC Global, the organization that oversees both bar codes and RFID codes. Scanning the bar code simply identifies a drug by NDC code.
An RFID code is linked to a specific item. Where a bar code could identify Procrit, RFID could identify a specific box or vial of Procrit and where it has been since the tag was first entered in the database. If a vial appears without an RFID code, or carries an incorrect code, or is in the wrong location, there very likely is a problem with the item.
"RFID will dramatically cut inventory shrinkage, especially once you put readers on every exit," Roberts said. "I think hospitals will get the cost back in a year just in inventory savings."
RFID is already used to collect bridge and highway tolls from San Francisco to London to Singapore. Readers at toll gates check RFID tags attached to vehicles and charge credit cards or toll accounts without slowing traffic. The biggest difference between automated toll systems and hospital-based RFID is tag size and reader power, Anderson noted. Cars usually carry tags about the size of a credit card. Readers have an effective range of several feet.
M. D. Anderson's pilot tags are embedded in paper strips one-half inch wide by an inch long. Readers have a range of 12 to 14 inches. Tags will be attached to thousands of drug boxes at the wholesale distribution center.
If the pilot succeeds, RFID tags will be attached to individual vials and expanded to other drugs. Anderson has already identified about 100 high-value products he would like to track with RFID. Controlled substances are also likely candidates for RFID tracking.
"This is proof of principle," he explained. "We're not trying to hide these tags. But in the future, tags could be embedded in packaging and be essentially invisible."
But RFID won't sweep into hospitals overnight. In Boise, Idaho, industrial intelligence consultant firm Provizio predicted that hospitals will take at least six years to move from bar codes to RFID, because of cost and technology questions.
"RFID will eventually replace bar-code technology at the bedside," said Provizio president and healthcare practice leader Tim Rhodes. "But it will take time for RFID vendors to create a lower cost end-to-end solution for hospitals to adopt easily." Early studies, he said, suggest that RFID can cut medical error rates by 50%.
Anderson isn't talking about how much the RFID pilot will cost or who pays. He is testing a proprietary system from a manufacturer that declined to be named.
Wal-Mart isn't disclosing costs, either. A spokesman for the chain said RFID tagging costs are being shared by manufacturers and retailers. Every player in the supply chain, from manufacturer to distributor to retailer, must provide readers linked to databases that can track every package through every move.
"No one has done a detailed study of costs yet," said Gary Dolch, executive VP for quality and regulatory affairs at Cardinal Health. "We are looking at costs ourselves. So are other wholesalers, drug chains, health systems, and drugmakers."
Technology is an even bigger problem than cost, he said. RFID tags need to be more reliable and more rugged. The databases needed to track hundreds of millions of individual drug products do not exist. Radio frequencies used by existing readers can interfere with vital hospital electronics. Patient privacy is also an issue.
"As it stands now, if you have the right equipment, RFID lets you know what meds a patient is on," said Michael Cohen, president of the Institute for Safe Medication Practices. "But RFID can provide safety in so many ways because it can present so much more information than a bar code. You would be able to better assure the distribution channel and deal with counterfeiting. That's only one plus from RFID, but it's a big one."
Fred Gebhart. Hospitals start pilot testing RFID to curb drug diversion. Drug Topics May 17, 2004;148:HSE1.