563.12.1 Automated Identification

Anh Nguyen

University of IllinoisFall 2007

Agenda

• Identification

• Automated Identification– Applications– Technologies

• Patient Identification

• My research project

1. Identification

• “The function of identification is to map a known quantity to an unknown entity so as to make it known. The known quantity is called the identifier (or ID) and the unknown entity is what needs identification...” – Wiki

• No guarantee of provenance or right mapping.

Need and concern

• Why Identification:– In many cases it is a required part of the workflow.– Build up profile (better shopping experience).– In security:

• Authorization = Identification & Authentication + Assigning Privilege(s).(Identity Crisis: How Identification Is Overused and Misunderstood - Jim Harper - debate at Techliberation)

• Security concerns according to CIA model:- Confidentiality: Might not want outside parties to learn your

ID (SSN)- Integrity: of ID transferred.- Availability: the ID is ready when needed.

2. Automated Identification (AID)

• The process is done automatically, less human interventions.

– To save times, increase productivity

– To operate in harsh environment where it is harmful for human

• Either replace traditional identification procedure to provide more seamless workflow, or bring new applications:

– Commercial: Product identification, Supply chain & Logistics, E-Commerce.

– Healthcare: Equipment tracking/ Patient Identification (later)

– Transportation: E-Tickets

– Others: Animal Tracking, Vehicle / People Identification

AID Applications - Domino

Microsoft touch screen computing & domino technology

http://www.news.com/1606-2-6186146.html

AID Technologies - Barcode

• Printing ID in a way which is machine readable. Information can be expressed via different symbologies.

• History: developed in 1948, commercial use 1966,

not commercially successful until the 1980s.• Recent developments: 2D Barcode / stacked barcode,

Semacode.• Characteristics: cheap, short/long operating range, line of

sight, low data rate.• Current uses: Groceries – UPC, Books – ISBN, drugs

Barcode, Semacode, UPC, ISBN – Wikipedia

Magnetic Stripe Card

• Storing data by modifying the magnetism of tiny iron-based magnetic particles on a band of magnetic material, as in video tape.

• Sticking a piece of magnetic tape to a plastic card base. • Characteristics: cheap, higher data rate, near operating range,

inconvenient (operation + reliability), low coercivity card easily damaged.

• Highly standardized.• Current uses: ID cards (UID), Credit & Debit Cards, Subway and

Bus Card.

Smart Card

• Adding processing power: any pocket-sized card with embedded integrated circuits which can process information.

• Contact, contactless. Contactless and RFID.• Characteristics: has processing power, often come

with tamper resistant feature, short operating range (ISO 14443 – 10cm, ISO 15693 – 50cm), more expensive.

• Current uses: Mobile phone SIM, ATM Cards, contactless CC/DC, smart driver licenses.

RFID Vs Contactless Smart cards – An unending debate - Parul Oswal – 2006

Biometrics

• Uniquely recognizing humans based upon one or more intrinsic physical or behavioral traits. (but must be unique)

• Characteristics: convenient / inconvenient, not very reliable (collision, effect of aging), usually more expensive.

• Current uses: Personal laptops, digital IDs, ePassport (US, Brazil, Germany).

• Concerns: once compromised it is compromised for life, danger to owner.

Biometrics: Universality Uniqueness

Face H L

Fingerprint M H

Hand geometry M M

Keystrokes L L

Hand veins M M

Iris H H

Retinal scan H H

Signature L L

Voice M L

Facial thermograph

H H

Odor H H

DNA H H

Gait M L

Ear recognition M M

Biometrics - Wikipedia

RFID

• Using radio frequency to transfer identifier.• Characteristics: very flexible (HF/LF/UHF, active/passive,

implantable..), convenient, does not require line of sight.• Concerns: privacy, cancer (implantable tags).• Emerging market: DoD and Wal-Mart’s mandate, Prescription Drug

Marketing Act (PMDA) - pharmaceutical supply chain (pedigree system by Dec 2006 – FDA), China national ID card, Qatar National Identification Project...

3. Patient Identification

• Current practice– Use text/color wristband– Use barcode wristband (ex: University of Wisconsin

Hospital – 2004)– Use RFID wristband (ex: Bangkok Hospital – 2006,

Birmingham Heartlands Hospital - 2007)

Need to Improve

• Patient misidentification is identified as a root cause of many errors: adverse drugs event, wrong invasive surgical operations...

• Study by FDA shows that adverse drug events (ADEs) range from 2.4 percent to 6.5 percent per facility, with a mean rate of 4.3 percent – about 770,000 adverse events in the U.S. each year, $1.7 billion cost – Zebra white paper.

• Joint Commission – JCAHO - listed “improving patient identification accuracy” as the first of its National Patient Safety Goals introduced in 2003, and this continues to be an accreditation requirement from 2004 to 2008.

• WHO and JCAHO encourage the use of at least two identifiers.(*3)

The Wrong Patient - Mark R. Chassin – 2002, Patient Identification - WHO Press - 2007

Applications

• Combine it with automated medication administration systems. U of Wisconsin Hospital reduced medication administration error by 87%.

• Blood Administration

• Sample / Treatment Management (to prevent unnecessary procedures)

• Automated Billing

• Patient tracking (babies, sleepwalker)

Technology Trade-off

• Regulations (FDA, FCC compliance; EU Directive – CE mark)

• Reliability• Privacy concerns• Convenience.• Cost for hospital. • Cost for patient. (not a big issue)

(*4)

Barcode, Magnetic Stripe, Smart Card

• Barcode:– Advantage: conform to regulation, proven reliability, cheap – Disadvantage: inconvenient, limited applications, low capacity,

not re-writable.

• Magnetic Stripe– Advantage: conform to regulation, acceptable reliability, cheap,

higher capacity.– Disadvantage: inconvenient, limited applications, not easily re-

writable

• Smart card– Advantage: conform to regulation, high reliability, high capacity,

flexible (contact/contactless, rewritable/not), computation & security features.

– Disadvantage: more expensive, limited applications (range).

RFID, Biometrics

• RFID– Advantage: higher capacity, more applications, convenient,

flexible (long/short range, re-writable/not, passive/active)– Disadvantage: regulation conformation, reliability (metal &

liquid), privacy concerns (more engineering researches), more expensive.

• Biometrics– Advantage: conform to regulation, convenient, no extra cost for

patient.– Disadvantage: limited applications, no extra information, most

expensive (for hospital), reliability improvement.

http://www.pdcorp.com/healthcare/case-study-chang-gung-hospital.html

My research

• Working with Ayesha:

• “To design, implement and verify a system that will enable clinicians to gather, verify and store medical device reading in an automated fashion”

Ser-ver

Nurse

Medical Device

Patient

Nurse ID

Patient ID

reading

(Nurse ID, Patient ID, reading)

Nurse info, patient info, human readable reading (*)

Yes/ No

(*)

Yes/N

o

https://agora.cs.uiuc.edu/display/cs598cag/Automated+Medical+Data+Acquisition

Conclusion

• Automated Identification is very useful.• RFID is an emerging technology.• Patient Identification need to be improved. And could be

done using AID.• Each AID technology has its own advantage and

disadvantage.• More researches to prove/improve reliability of RFID and

Biometrics, design so that RFID will conform with EMC requirements.

References

• Identity Crisis: How Identification Is Overused and Misunderstood - Jim Harper - 2006

• www.rfidjournal.com

• www.rfidupdate.com

• Patient Identification - Patient Safety Solutions - volume 1, solution 2, May 2007 - WHO Press

• Patient identification - a crucial aspect of patient safety - patient Safety First

• The Wrong Patient - Mark R. Chassin, MD, MPP, MPH, and Elise C. Becher, MD, MA* - 4 June 2002 | Volume 136 Issue 11 | 826-833

• It's All in the Wrist: Improving Patient Safety with Bar Code Wristbands – Zebra – 2006

• A wearable device for a fully automated in-hospital staff and patient identification - M. Cavalleri, R. Morstabilini, G. Reni – 2004

• Interoperability Issues regarding Patient Identification in Europe - C. Quantin et al - IEEE EMBS - 2007