Yoo et al. BMC Medical Informatics and Decision Making (2018) 18:80 https://doi.org/10.1186/s12911-018-0656-0 RESEARCH ARTICLE Open Access Real-time location system-based asset tracking in the healthcare field: lessons learned from a feasibility study Sooyoung Yoo1†, Seok Kim1†, Eunhye Kim1, Eunja Jung2, Kee-Hyuck Lee1 and Hee Hwang1* Abstract Background: Numerous hospitals and organizations have recently endeavored to study the effects of real-time location systems. However, their experiences of system adoption or pilot testing via implementation were not shared with others or evaluated in a real environment. Therefore, we aimed to share our experiences and insight regarding a real-time location system, obtained via the implementation and operation of a real-time asset tracking system based on Bluetooth Low Energy/WiFi in a tertiary care hospital, which can be used to improve hospital efficiency and nursing workflow. Methods: We developed tags that were attached to relevant assets paired with Bluetooth Low Energy sensor beacons, which served as the basis of the asset tracking system. Problems with the system were identified during implementation and operation, and the feasibility of introducing the system was evaluated via a satisfaction survey completed by end users after 3 months of use. Results: The results showed that 117 nurses who had used the asset tracking system for 3 months were moderately satisfied (2.7 to 3.4 out of 5) with the system, rated it as helpful, and were willing to continue using it. In addition, we identified 4 factors (end users, target assets, tracking area, and type of sensor) that should be considered in the development of asset tracking systems, and 4 issues pertaining to usability (the active tag design, technical limitations, solution functions, and operational support). Conclusions: The successful introduction of asset tracking systems based on real-time location in hospitals requires the selection of clear targets (e.g., users and assets) via analysis of the user environment and implementation of appropriate technical improvements in the system as required (e.g., miniaturization of the tag size and improvement of the sensing accuracy). Keywords: Asset tracking, Efficiency, Healthcare, Real-time locating system, System implementation Background commodities in medical sites, and when their shifts end, The appropriate placement and supply of commodities they transfer responsibility for the equipment in their de- in hospitals not only improves the quality of patient partments and wards to nurses on the next shift. There- treatment but also influences the outcomes of treatment fore, the effective management of commodities and a in emergency situations. Therefore, commodity man- reduction in the time required to transfer them between agement could be considered an exceedingly import- nurses would not only increase the time available to ant task that should not be neglected by hospitals [1–4]. nurses for the provision of patient care but also improve Nurses are generally tasked with the management of care quality [5–9]. One method of improving commodity management * Correspondence: [email protected]; [email protected] involves real-time location systems (RTLSs), which are † Sooyoung Yoo and Seok Kim contributed equally to this work. used to manage assets efficiently in other industries. 1Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si 436-707, South Interest in the introduction of these systems to the Korea healthcare field is increasing, [10] albeit gradually [5, 11]. Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Yoo et al. BMC Medical Informatics and Decision Making (2018) 18:80 Page 2 of 10 In healthcare, RTLS solutions are used mainly to track active tags, and web-based asset management application medical staff, patients, and assets. The introduction of during the 13-month period. these solutions has been shown to provide hospitals with The asset tracking system tracked the locations of as- certain benefits [5, 7, 10, 12–16] including cost reduction, sets throughout every ward in the hospital using the improvements in medical care quality and work processes, existing WiFi infrastructure; however, we used separate and increased patient satisfaction. BLE beacons to provide location measurements with Recently, the healthcare sector has adopted the bar- greater accuracy in the emergency room and the storage code, radio-frequency identification (RFID), WiFi, and areas of the wards. The location of each asset and the Bluetooth sensing technology in the development of status of the active tag battery could be checked using tracking systems. Barcode technology, in particular, has the hospital information system, into which the asset been widely adopted by nurses to reduce medication ad- management system was integrated. Figure 1 shows the ministration errors and the related costs and to improve overall architecture of the BLE/WiFi-based asset track- patient safety [17]. Furthermore, previous studies have ing system. shown that these systems are effective in reducing costs, The asset management application consisted of 2 improving the quality of medical services, enhancing applications: 1 for users (i.e., nurses) and 1 for system work processes, and boosting patient satisfaction, by administrators. In the user application, the types and po- tracking medical professionals and patients [6, 8, 10, sitions of the assets on each floor were depicted as a 12–16, 18, 19]. RTLS technology is based mainly on bird’s eye view of the entire hospital, with the detailed the use of WiFi and RFID, although some research locations marked clearly on a floor plan (see Fig. 2). The has examined whether Bluetooth could be used as the user application also provided detailed location informa- basis of RTLSs [5, 6, 20]. Researchers in the healthcare tion according to the asset status (i.e., onsite, offsite, or field have demonstrated strong interest in localization sys- borrowed) for each department. In contrast, the admin- tems; however, these systems are still in their infancy. istrator application provided information regarding the Given the differences between sensors in terms of track- registration and management of target assets, the assets’ able distance, cost, and accuracy, people should consider most recent locations and location histories, whether as- the pros and cons of sensors to ensure selection of the sets were onsite or offsite, and battery power levels for most appropriate product [21]. In addition, the user inter- the tags. In addition, administrators could check the face, security, and effects of interference need to be con- status of specific assets and all assets in a registered de- sidered [22, 23]. Therefore, system users should share partment using the search filter. their experiences of implementation with others to aid medical institutions that are willing to adopt the technol- Active tags and BLE beacons ogy in developing the most suitable systems [6, 11]. The active tags and BLE beacons were designed in con- Therefore, this study aimed to share considerations sideration of the characteristics of the medical environ- and insights and to provide information regarding the ment and RTLS-based tracking system. Because the adoption of an RTLS in a medical environment, obtained active tags were used to track highly mobile assets, they via the implementation and operation of a real-time were battery operated and able to transmit their own Bluetooth Low Energy (BLE)/WiFi-based asset tracking location information based on data received from the system in a tertiary general university hospital. beacon. Battery capacity was prioritized during the pro- duction stage, with the aim of maximizing the conveni- ence of the tags. We ultimately selected tags that were Methods 66 × 40 × 25 mm in size and required 2 AA batteries Development of the BLE/WiFi-based asset tracking system (3000 mAh, 3.0 V). We attached tags to a total of 400 The development of the asset tracking system initially instruments, including 4 iPads and 21 oxygen holders in involved obtaining the definition of the asset manage- the emergency room, 200 infusion pumps in the emer- ment process by various medical professionals including gency room and 3 intensive care units (ICUs), and 160 a medical doctor, 4 nurses, a medical informatics profes- patient monitors and 15 bladder scanners in all depart- sor, and 2 staff members from the asset management de- ments. The tag locations were selected to minimize partment at the tertiary general university hospital to interference with the equipment and prioritized accord- which the authors are affiliated. Thirty developers ultim- ing to improvements in nursing workflow and relocation ately participated in the development process, which frequency. took place over the course of 13 months, from November The beacons relied on BLE, which is a low-power, 2013 to November 2014. For approximately 2 months low-cost solution that has been used widely in recent thereafter, we stabilized the system and performed tests to years. They operated with replaceable batteries to obvi- improve the software used to develop the BLE beacon, ate the need for separate power supplies. The beacons Yoo et al. BMC Medical Informatics and Decision Making (2018) 18:80 Page 3 of 10 Fig. 1 Overall architecture of the asset tracking system Fig. 2 Interface of the asset tracking system for users (Nurses) Yoo et al.