network design 4 courseworkhero.co.uk

last part from network design project

Future Needs and Recommendations

due date 11:00 Am CST  5/13/2013

Task Type: Individual Project Deliverable Length: 3–4 pages new material; 15–20 pages total
Points Possible: 250 Due Date:

Weekly tasks or assignments (Individual or Group Projects) will be due by Monday and late submissions will be assigned a late penalty in accordance with the late penalty policy found in the syllabus. NOTE: All submission posting times are based on midnight Central Time.

Key Assignment

The final step in developing the network design and architecture proposal is to examine the future distributed-networking needs of the organization. Networking technologies are changing rapidly, and organizations participating in distributed networking will need to stay abreast of the changes and incorporate new software and hardware to support these needs. For this assignment, you will examine the trends in distributed networking and provide an analysis and recommendation to the organization for their future distributed-networking needs. You will also further refine the network design and architecture proposal to produce the final draft version. Updates may be based on peer and instructor feedback.

The project deliverables are the following:

· Update the network design and architecture proposal title page with new date and project name.

· Update the previously completed sections based on instructor feedback.

· The Future Needs Analysis and Recommendations section should include the following:

· Research current and future trends in distributed networking.

· Summarize at least three potential changes in distributed networking that might affect your company.

· Provide a modified design and architecture, and discuss the changes from the original design proposal that would be required to support the new requirements.

· Network design and architecture proposal

· Review the entire document for any changes and improvements you would like to make.

· Ensure this final version of the plan is sufficiently detailed to allow the organization to confidently move forward with a distributed network implementation that is based on your recommendations.

· Any previous instructor feedback should be addressed with appropriate changes.

· Update your table of contents before submission.

· Name the document “yourname_CS635_IP5 .”

· Submit the document for grading.

Building a Smart Hospital using RFID technologies

Patrik Fuhrer Dominique Guinard
University of Fribourg University of Fribourg

Department of Informatics Department of Informatics
Bd de Ṕerolles 90 Bd de Ṕerolles 90
CH-1700 Fribourg CH-1700 Fribourg

patrik.fuhrer@unifr.ch dominique.guinard@unifr.ch

c©GI – Gesellschaft f̈ur Informatik e.V.
http://www.gi-ev.de/service/publikationen/lni/

Abstract: Technologies of identification by radio frequencies (RFID) experience a
fast development and healthcare is predicted to be one of its major growth areas. After
briefly introducing the common terminology of the RFID field and its current stan-
dards, this paper describes how this emerging technology can be used to build asmart
hospital. Indeed, used in combination with mobile devices in eHealth applications,
RFID helps optimizing business processes in healthcare and improve patient safety.

The second part of this article shows how to use an assets tracking application,
called the RFIDLocator, to improve the quality of the hospital services. We developed
the RFIDLocator to support the high requirements for scalability and reliability one
can expect for such an application. An overview of its distributed software architecture
is given. A short cookbook presents the required steps for its configuration to the
concrete case of the hospital.

Some critical remarks about RFID technology, the important questions it raises and
the barriers it has to overcome to be fully integrated in eHealth applications conclude
this paper.

K EYWORDS: eHealth, RFID, EPC Network Standards, smart hospital, workflow
optimization in healthcare

1 Introduction

An alarming statistic from an American healthcare organization [Hea] is that an average
of 195’000 people in the USA died in hospitals in each of the years 2000, 2001 and 2002
as a result of potentially preventable, in-hospital medical errors [Hos04].

[Lin00] asserts that “the problem is not bad people in health care–it is that good people are
working in bad systems that need to be made safer”.

The goal of this paper is to show how technologies of identification by radio frequency
(RFID) can contribute to build asmart hospitalby optimizing business processes, reducing
errors and improving patient safety.

This section starts by a short introduction to the RFID technology and define some of

its main concepts and standards. Then a rough description of the settings and equipment
needed to “RFID-enable” an existing hospital is provided.

The second section describes some interesting hospital use cases that could benefit from
RFID. This section further illustrates that there are already many pilot projects successfully
testing this emerging technology.

Section 3 presents the RFIDLocator application and shows how it can be configured to be
used in a hospital illustrated by a concrete tracking example use case.

The conclusion summarizes the main achievements of this paper and enumerates some
open problems that still have to be solved before RFID is fully adopted by the healthcare
community.

1.1 Terminology and Standards

Radio Frequency IDentification (RFID) is a method for remotely storing and retrieving
data using devices called RFIDtagsor transponders. An RFID tag is a small object, such
as an adhesive sticker, that can be attached to or incorporated into a product. RFID tags
are composed of an antenna connected to an electronic chip. These chips transform the en-
ergy of radio-frequency queries from an RFIDreaderor transceiver to respond by sending
back information they enclose1. Finally, a computer hosting a specific RFID application
or middleware pilots the reader and processes the data it sends. RFID has great character-
istics: 1. it is possible to scan tags in motion; and 2. since radio waves can pass through
most solid objects, the tags don’t need to be in direct line of sight of the RFID reader.

Having labeled or tagged objects being identifiable in an ubiquitous and flexible manner is
already a good start. Building a network out of these objects, so that with a unique number
one can easily retrieve information about them, would enable much more interesting use
cases. In order to make the dream of aseamless global network of physical objectscome
true, an open standard architecture has been defined: the EPC Network (aka “The Internet
of Things”).

The Electronic Product Code(EPC) uniquely identifies objects and facilitates tracking
throughout the product’s life cycle. The EPC is the fundamental identifier of assets in the
so called EPC Network. It basically contains information about: 1. the manufacturer of the
tagged object; 2. the product class or the nature of the tagged object; 3. the actual unique
item. EPCs are often represented as Uniform Resource Identifiers (URI) in order to be used
on large networks and to be easily manipulated and exchanged by software applications.
An example of pure entity representation of an EPC is:urn:epc:id:gid:25.1.12 .

The Physical Markup Language(PML) defines a standardized generic markup language
for information interchange modelling and encapsulating the data captured by the RFID
readers.

The Object Name Service(ONS) provides URLs to authoritative information relevant to

1In fact this is only true for passive tags. There are also active tags, which have batteries and initiate the
communication to actively emit radio signals in order to send information to readers.

an object, as for instance the web site of the object’s manufacturer.

1.2 Towards Smart Hospital

As mentioned before, we aim to describe how the RFID technology can help in medical
facilities and hospitals. Thus, this subsection describes an example RFID enhanced hos-
pital, a smart hospital. To start with, many assets and actors of the facilities have to be
“tagged”:

• The medical equipment must embed RFID tags. In the best case the tags should
be placedinto the devicesby the manufacturer and should contain a standardized
world-wide unique identifier.

• The doctors, nurses, caregivers and other staff members wear a “smart badge”2 stor-
ing their employee ID number.

• On arrival, each patient receives a wristband with an embedded RFID tag storing a
unique identifier, and some information about him (e.g. a digital picture, a unique
patient code, etc.)

• All the patients’ medical histories (aka paper medical files) and other important
documents are tagged with self-adhesive RFID labels containing a unique number.

• The blister packs and other drugs’ packages all contain RFID labels. These transpon-
ders should preferably be EPC compliant.

• The bags of blood are attached with a self-adhesive RFID label holding a unique
identifier, the hospital tracking number and some important information about the
contained type of blood.

Furthermore, RFID readers are placed at strategic places within the hospital:

• RFID gates are disposed at entrances and exits of the hospital.
• Each operating theater contains a least one RFID reader.
• RFID sensors are placed in strategic galleries and important offices. In the best case,

every office should contain an RFID reader: either placed next to the door or under
the desks.

• The staff members (doctors, nurses, caregivers and other employees) each have a
handheld (PDA, mobile phone, etc.) equipped with an RFID reader and possibly
with a wireless (e.g. WiFi) connection to the web.

2Another project developed at the DIUF (Department of Informatics, University of Fribourg, Switzerland)
explores the possibilities of so called “smart badges” focusing on providing location-contextual services to the
members of an institution (e.g an hospital) or to the visitors of an event. See [AG06] for more information.

Eventually, while not mandatory for most use cases, EPC Network standards should be
used as much as possible. This is especially true for the unique identifiers (EPC stan-
dard), the readers (Gen2 EPCGlobal standards) as well as for the application queries for
authoritative information (PML and ONS standard).

2 Use Cases in a Smart Hospital

This section emphasizes how the use of the RFID (and its related standards) can contribute
to create the hospital of the future. It offers a “state of the art” of the RFID technologies
enrolled in healthcare applications.

We envision hospitals and medical facilities where using the identification technologies
can improve the patients’ care, optimize the workflows, reduce the operating costs, help
avoiding severe mistakes (such as patients’ misidentification) and reduce costly thefts.
This section demonstrates not only that several researches goes towards this direction but
also that some sophisticated RFID systems are already being successfully tested (or de-
ployed) in a number of hospitals.

2.1 Patient Identification

Many health professionals are concerned about the growing number of patients who are
misidentified before, during or after medical treatment. Indeed, patient identification error
may lead to improper dosage of medication to patient, as well as having invasive procedure
done. Other related patient identification errors could lead to inaccurate lab work and
results reported for the wrong person, having effects such as misdiagnoses and serious
medication errors [Sir03].

In order to cut these clinical errors, to improve patient care and security and also to improve
administration and productivity, several RFID-based patient identification and tracking
pilot projects have been launched during the last two years. For instance, in New York’s
Jacobi Medical Center [Wes05], in the Birmingham Heartlands Hospital [Bir05] or in the
German Saarbrücken Clinic Winterberg [Bes05].

Concretely, as mentioned in Subsection 1.2, all patients admitted to the hospital are given
an RFID-based wristband resembling a watch with a passive RFID chip in it3. This chip
stores a unique patient ID number and some relevant medical information such as the
patient’s blood type, in order to speed treatment. To ensure patient privacy and to avoid
that medical records are improperly disclosed, further medical data are not stored on the
devices but are rather stored in a secure database that links the unique patient’s ID with its
data.

The caregiver uses a handheld computer with an RFID interrogator (an RFID-enabled

3In other projects [Pat05] the computer chips, which are about the size of a grain of rice, are designed to be
injected into the fatty tissue of the arm.

PDA) to read the data encoded on the patients ID bracelets. Over a wireless LAN connec-
tion, the hospital staff can access the patient’s encrypted confidential medical history as
well as treatment record and can obtain information on which drugs and what dosages the
patients will require.

Patients will also be able to check their own records by scanning their wristbands using
information terminals.

2.2 Blood Tracking

A recent report [Dzi03] points out that mis-transfusion errors (i.e. blood transfusion of
the incorrect type or blood given to the wrong patient) are unacceptably frequent and
serious. As quoted in [All02], “in the transfusion environment, misidentification is the
most prevalent cause of transfusion errors that result in death”.

According to [Sun05], mis-transfusions typically result from an error made during the
bedside check just prior to transfusion. Studies have documented [Saz90] that such er-
rors are most likely to occur among surgical patients. Currently the bedside check is done
by humans using eye-readable information, and in operating rooms this task is particu-
larly difficult. Indeed, blood is often given under circumstances of extreme urgency and
distraction. Patients are unconscious during the transfusion and cannot state their name,
and caregivers in the operating rooms may not “know” the patient as well as nurses on
non-surgical floors.

To address the issue of the bedside transfusion check one should take advantage of new
technology. Two machine-readable technologies are candidates for the automation of these
checks: bar code technology and RFID. Barcodes are unsuitable for bedside checks be-
cause they require line-of-sight so that a handheld laser can read a flat surface with the
code. This constraint represents an important practical obstacle, especially in operating
rooms where the patient is covered with surgical drapes.

RFID technology does not have the practical problems of bar codes, and recently several
hospitals4 have deployed pilot programs using this technology to track bags of blood to
record transfusions and ensure that correct blood is given to each patient.

In our smart hospital as described in [Wes], each bag of blood arriving at the hospital
gets a self-adhesive RFID label. This chip has memory for storing a unique identification
number and information on the contained blood type. These numbers are also saved in
a secure database containing details about the blood’s origin, its designated purpose and,
once dispended, its recipient. When a nurse wants to prepare a blood transfusion, she uses
an reader-equipped PDA to read the data encoded on the blood bag’s RFID chip and on
the patient ID bracelet. The data from the patient and the bag must match before the blood
can be used. With this solution the overall process of managing blood bags is eased and
less time-consuming. Moreover the risk of patients receiving the wrong type of blood is
minimized.

4Examples are the Saarbrücken Clinic Winterberg in Germany [Bes06] or the Massachusetts General Hospital
and its START (Safer Transfusion with Advanced Radiofrequency Technology) project [Dzi].

2.3 Smart Operating Theatres

As mentioned in [Hen04], surgical identification can raise significant problems, according
to recent federal reports. The Joint Commission on Accreditation of Healthcare Organiza-
tions (JCAHO) declared that the most commonly reported surgical errors involved surgery
on the wrong body part or site, the wrong patient or the wrong surgical procedure [Sen01].

The Birmingham Heartlands Hospital [Bir05] is currently running a pilot5 of the RFID
technology on patient undergoing ear, nose and throat surgery [McC06]. The aim of the
system is to ensure the correct operations are carried out on the right patients.

In the smart hospital the patients get a RFID-tagged wristband containing relevant infor-
mation and a digital picture of them. The photograph allows the clinical team to easily
confirm they have the right patient, and the electronic record ensures they perform the
correct procedure. If the wrong patients enter the operating room, the medical staff is
automatically and instantly warned of the mismatch.

Thus radio tagging makes the operating theatre safer and more efficient. Moreover the
risk of litigation resulting from surgery mistakes and the costs they generate should be
significantly reduced.

2.4 Anti-Counterfeiting

Drug counterfeiting is an increasing problem: 1. counterfeit drugs reduce patient safety,
as they can contain dangerous substances; and 2. pharmaceutical companies lose tens of
millions of euros to the counterfeit drug trade each year.

This problem is being taken seriously and in February 2004 the U.S. Food and Drug Ad-
ministration (FDA) published a report [oHFA04] encouraging the use of RFID to combat
it and urging the drug industry to adopt the technology. Coinciding with the FDA’s an-
nouncement, several major pharmaceutical manufacturers announced pilots to incorporate
RFID into packaging of prescription drugs. For example Pfizer, the producer of Viagra6,
plans to spend aboute 4 million on a project for supplying RFID tags for bottles, cases
and pallets.

The goal is to assign a unique number (the Electronic Product Code or EPC) to each
pallet, case and package of drugs and to use this number to record information about all
transactions involving the product. This provides an electronic pedigree through the whole
drug supply chain, from the point of manufacture to the point of dispensing [Rob06].

According to [oHFA04], by December 2007 all manufacturers, all wholesalers, all chain
drug stores, all hospitals, and most small retailers should have acquired and be using RFID
technology (i.e. antennas, tag readers, and appropriate information systems). Thus they
will be able to retrieve the product codes and verify their authenticity by checking the

5This project follows a smaller “pre-pilot” of the RFID tracking system that began in November 2004.
6Viagra is one of the major target for counterfeiting. Five millions of counterfeit pills were seized by author-

ities in year 2005 [Gil06].

manufacturer’s database via the web.

All these measures should make sure that the drugs patients take are safe and effective.

2.5 Tracking Equipment, Patients, Staff and Documents

Amongst all the imaginable use cases, RFID is certainly best suited fortracking applica-
tions. The technology enables an automated and fast tracking of assets, animals or people.
Efficient tracking in a hospital offers plenty of interesting perspectives.

First of all, remember that our smart hospital is equipped with RFID readers at strategic
places: e.g. main doors, entrances of operating theaters, recovery rooms, exits of the
medical histories library, important galleries, etc. Together with the fact that all the medical
histories (and other important documents) are tagged, it enables us to locate them through
the use of an assets tracking application like the RFIDLocator (see Section 3). This fact
can already helpreducing the medical files’ losses. It is worth noting that, according to
a small survey we conducted (see [Gui05]) such losses are not so infrequent and may
sometimes have bad consequences, both in terms of costs and patients safety. Several
documents tracking applications have already been successfully deployed. Most of them
lead to a positive ROI (Return On Investment) such as saving 2500 man-hours a year for
the district attorney for Marin County (USA) [Swe05].

Furthermore, using an assets tracking application within the infrastructure deployed for
our smart hospital gives us the possibility to locate and trace staff members as well as
patients efficiently. This can helpimproving the workflowof doctors, nurses and other
caregivers [Hen04]. It can also help tolocatethem in real-time which is especially worthy
for huge buildings such as hospitals.

Additionally, being able to trace all the tagged equipment introduces anefficient and ac-
curate inventory system. Again, a number of corporates have already successfully intro-
duced RFID systems for real-time inventories. The most often cited positive effects are the
reduction of assets loss. As an example Metro Group, the world’s third-largest retailer, re-
ported a improvement of about 18% in goods loss thanks to the RFID technology. Besides,
tagging and tracking equipments offers many other use cases such as finer maintenance
scheduling, usage statistics of equipment, placement optimization and fast localization of
important material.

Eventually, RFIDtracking also helps avoiding thefts. This latter fact is the subject of the
next subsection.

2.6 Avoiding Theft of Medical Equipment

It is well-known that hospitals own a great number of expensive medical equipments.
What is less known about it is that part of this equipment is stolen on a regular basis7.
As an example, according to a survey [Ran06], more thane 155’000 of material were
stolen in 2005 in eleven hospitals of the United Kingdom. Another survey completed by
Harvard Medical School reported that the Beth Israel Deaconess Medical Center (USA)
was loosing aboute 333’000 a year because of stolen and misplaced equipment [Sun05].
Yet, these surveys do not take into account the sidecosts of thefts. Firstly, before being
identified as stolen, a piece of equipment would have been searched for hours by hospi-
tal’s employees. Secondly, the missing material has to be re-ordered by some employees,
diverting them from patient care or management tasks. Waisted money is not the only
effect of these thefts. The stolen equipment is sometimes vital and its lack may have sever
consequences. According to [Ran06], these facts lead the U.K.’s National Health Service
to explore new ways of protecting high value material.

Once again, the Radio Frequency IDentification can help towards the finding of a solution
to this serious problem. Indeed, as RFID tags are embedded into the medical equipment of
our smart hospital, we are able totrack and traceit (see Subsection 2.5 for more consid-
erations about assets tracking within the smart hospital). This fact already reduces risks of
the thefts as the hospital’s technical staff is alwaysaware of material’s whereaboutswithin
the buildings. Furthermore, as foranti-counterfeiting(see Subsection 2.4), electronic tag-
ging has a preventative effect and can help identifying stolen material. Additionally, RFID
gates at the hospital’s exits can help notifying the security services that medical equipment
is taken out of the building. Nevertheless,access controlmethods (a very common use of
RFID) can also help by introducing identification procedures for accessing the equipment
or running it.

However, it is important to note that similarly to anti-counterfeiting (see Subsection 2.4)
the most embedded in the material the tags are, the most efficient the RFID infrastructure
will be at preventing thefts. Indeed, if the tags can be removed easily (and without conse-
quences) by the thief the presented methods loose part of their value. As a consequence,
the producers of medical equipment should embed the tags at the factory (on demand or
as a standard), or the hospital should have the ability to tag its assets with hard-to-remove
electronic identifiers.

3 Implementing the Tracking

As mentioned in Subsection 2.5, efficient tracking in a hospital offers plenty of interesting
perspectives. Thus, this section is a so called “cookbook” intended to give an overview
of the configuration required in order to enable assets and people tracking in an hospital
using the RFIDLocator.

7Items such as wheel chairs and intravascular pumps often disappear from emergency rooms or intensive care
units [Hen04].

The RFIDLocator is a web-based application we developed at the Software Engineering
Group of the University of Fribourg (CH) in collaboration with Sun Microsystems. It is
an enterprise application allowing the tracking of assets within a predefined area, such as
a building. Special care has been given to use the EPC Network Standards introduced in
Subsection 1.1). As a result, the RFIDLocator is a scalable and robust distributed applica-
tion whose different components8 are depicted on Figure 1.

Medio
L100
Reader

Philips
Rafsec
(EPC Tag)

Radiowaves

L100
Antenna

Coaxial cable

Moxa

RS-232 cable TCP/IP

Sun UltraSparc 450
(Event Manager)

JMS

Transtec Intel Pentium
(Application Server)

Net.

Net.

JMS Bridge

RFIDLocator

IBM Think Pad R40
(Thin Client)

Net.

Figure 1: Components of the RFIDLocator infrastructure

3.1 Placing the Readers

We start by defining a plan describing the readers’ placement. Indeed, as the RFIDLocator
is able to track and trace an object within a predefined area equipped with RFID readers,
one first need to specify and parse a plan of the readers’ placement into the application.

Let us imagine we want to setup the application for an hospital specialized in brain and
heart surgery. In order for the application to work efficiently, we shouldinclude all the
RFID enabled rooms and galleriesof the building in the plan. However, for the sake of
simplicity this cookbook contains the definition of the following places only:

• An operating theater (for brain surgery) corresponding to the room number:
SH_A1_OPERATING_01. Within the RFIDLocator such internal location identi-
fiers are calledBusinessLocationNumber .

• A main gallery at the department for heart surgery corresponding to the number:
SH_A1_GALLERY_06.

Next, we place the antennae connected to the two RFID readers in “strategic” places as
shown on Table 1.

8The global software architecture is presented in [FGL06] and more details as well as a detailed manual can
be found in [Gui05].

Antenna’s ID Reader Location Aim

25.1.10
Medio L100

At the door of the
operating theater for
brain surgery.

Detecting objects
entering and going out
of the operating theater.25.1.11

25.1.12 Medio L200

In the middle of the
gallery heading to the
department for heart
surgery.

Detecting passing by the
gallery.

Table 1: Placing the antennae

This is now translated into a formalism the RFIDLocator understands, namely theReader’s
Configuration Formalism. This XML formalism defines a syntax and a semantics that
models the placement of RFID readers within the environment. An extract of the resulting
XML document is shown on Table 29.

Figure 2: XML extract of the Reader’s Configuration Formalism

.
9A LogicalAntenna can be composed of severalPhysicalAntenna to be able to capture the direction

of the motion.

3.2 Define the Users of the System

Now that the application is aware of the readers’ whereabouts, we can go on with the
definition of our environment. The step is to define the “objects” to be traced. These
are calledTraceableObjects within the RFIDLocator. ATraceableObject is
virtually “anything” that can be tagged with an RFID transponder, ranging from equipment
or medical histories to patients and employees.

For this cookbook, we “tag” the patient Irene Blue with a wristband containing an EPC
compliant (see Subsection 1.1) unique identifier:urn:epc:id:gid:35.5.18 . This
number has to be attached with theBusinessNumber of the patient, i.e. its hospital-
wide unique identifier:SH_06_IRENE_BLUE. This matching is achieved using the web
frontend of the RFIDLocator and it creates a newTraceableObject . Additionally, we
“tag” the patient Josh Green in the same manner.

It is worth noting at this point that the web interface of the RFIDLocator is decoupled from
the core of the application. Thus, the RFIDLocator core could be integrated with a legacy
medical system, enabling the patients’ registrations and tracking asTraceableObjects
(i.e. objects we can locate) directly through the existing system.

3.3 Using the Application

As the readers’ configuration has been parsed and EPC identifiers have been bound to
BusinessNumbers we are ready to use the application:

Let us imagine Josh Green is driven by a nurse to the operating theater for brain surgery.
When entering the smart theater Mr. Green is identified by the EPC number sent to the
reader by his RFID wristband. The system of the Smart Theater (see Subsection 2.3)
detects a mistake: Mrs. Blue was scheduled for operation, not Mr. Green! Immediately,
the nurse notifies the Doctor of the mistake andqueries the RFIDLocator, as shown on
Figure 3,to find Mrs. Blue. The application informs her that Mrs. Blue was last seen in
the gallery on the way to the operating theater for heart surgery (i.e. on the way to the
wrong operating theater). She can now contact the heart surgery department to inform that
the patients where switched.

This simple example already shows the RFIDLocator can serve for patients tracking and
locating. However, it is not limited to this particular use case. For instance, using the
application we may as well: 1. Track the medical equipment in order to locate it quickly,
to prevent theft or to optimize its usage and maintenance. 2. Trace the medical staff to
optimize their workflows. 3. Track medical histories to be able to locate them as quickly
as possible and optimize their management.

Figure 3: Locating a tagged object

4 Conclusion

Healthcare is predicted to be one the major growth areas for RFID. A recent analysis
[Ser05] reveals that the RFID in healthcare and pharmaceutical applications markets earned
revenue ofe 306 million in 2004 and estimates to reache 1’916.6 million in 2011.

This paper describes some interesting applications with promising perspectives. It also
presents an open-source application and shows how it could be used to directly implement
some of the use cases.

However, it is worth noting that there are still some open problems to be solved before the
healthcare community fully embraces the RFID technology.

One must be sure that the deployment of radio frequency devices does not interfere with
pacemakers, heart monitors or other electrical devices that are common in an hosptial.
Furthermore, the consequences and side-effects of radio waves on the exposed humans
have to be clarified. When talking about pasting radio frequency tags on drug packages,
there are concerns that exposure to electromagnetic energy could affect product quality.

Furthermore, any technology implementation in healthcare must deal with privacy and se-
curity issues. But RFID presents unique concerns because of the possibility of unintended
wireless transmission of healthcare-related information. Unethical individuals could snoop
on people and surreptitiously collect data on them without their approval or even without
their knowledge. This could occur even after completion of healthcare services if RFID

tags remain active. Hospital staff has to feel comfortable with the fact that they can be
tracked and located everytime. Maybe some “RFID free zones” should be delimited in or-
der to fight the “big brother” effect and to preserve the freedom of individuals. From these
concerns, it should be clear that challenging cryptographic issues are raised in relation
with wireless transmission and that there is a need for clear laws and recommandations
about the tracking of goods and people.

References

[AG06] Pedro De Almeida and Dominique Guinard. Smart Badge: A project in Ubiqui-
tous Computing. Technical report, DIUF, University of Fribourg, February 2006.
[Retrieved March 28, 2006, fromhttp://www.gmipsoft.com/unifr/docs/
smartbadge_report ].

[All02] Raymond Aller. Patient ID Missing in Action? -A discussion on how accurate specimen
and transfusion identification can avert disaster., September 2002. [Retrieved March 26,
2006, fromhttp://www.bridgemedical.com/09_01_02_a.shtml ].

[Bes05] Jo Best. RFID comes to European hospitals, 2005. [Retrieved March 26, 2006,
from http://networks.silicon.com/lans/0,39024663,39129743,00.
htm ].

[Bes06] Jo Best. Healthcare RFID to track blood, 2006. [Retrieved March 26, 2006, fromhttp:
//networks.silicon.com/lans/0,39024663,39156599,00.htm ].

[Bir05] Birmingham Heartlands RFID-tags patients to avoid litigation, February 2005. [Retrieved
March 26, 2006, fromhttp://www.bjhc.co.uk/news/1/2005/n502016.
htm ].

[Dzi] Sunny Dzik. RFID and Smart Packaging in healthcare. [Retrieved March 25, 2006, from
http://www.idtechex.com/smarthealthcareusa/3.asp ].

[Dzi03] Walter H. Dzik. Emily Cooley Lecture 2002: Transfusion Safety in the Hospital.Transfu-
sion, 43(9):1190–1199, September 2003.

[FGL06] Patrik Fuhrer, Dominique Guinard, and Olivier Liechti. RFID: From Concepts to Concrete
Implementation. InProceedings of the International Conference on Advances in the In-
ternet, Processing, Systems and Interdisciplinary Research, IPSI – 2006 Marbella, Febru-
ary 10-13, 2006, Marbella, Spain. IPSI Belgrade, Serbia, Serbia and Montenegro, Febru-
ary 2006. [Retrieved March 25, 2006, fromhttp://www.gmipsoft.com/unifr/
docs/RFIDIPSI ].

[Gil06] Alorie Gilbert. RFID coming to Viagra, says Pfizer, January 2006. [Retrieved
March 26, 2006, fromhttp://networks.silicon.com/lans/0,39024663,
39155440,00.htm ].

[Gui05] Dominique Guinard. Radio Frequency Identification: Evaluation of the Technology
Supporting the Development fo an Assets Tracking Application. Bachelor thesis,
Department of Informatics of the University of Fribourg, Switzerland, September
2005. [Retrieved December 22, 2005, fromhttp://diuf.unifr.ch/softeng/
student-projects/completed/guinard/download/report_rfid_
guinard_unifr ].

[Hea] HealthGrades.http://www.healthgrades.com/ (accessed March 27, 2006).

[Hen04] Dyke Hendrickson. Study: RFID in hospitals shows ROI promise.Mass High
Tech: The Journal of New England Technology, December 2004. [Retrieved March
25, 2006, fromhttp://masshightech.bizjournals.com/masshightech/
stories/2004/12/06/story9.html ].

[Hos04] In Hospital Deaths from Medical Errors at 195,000 per Year USA, August 2004. [Retrieved
March 27, 2006, fromhttp://www.medicalnewstoday.com/medicalnews.
php?newsid=11856 ].

[Lin00] Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, editor.To Err Is Human:
Building a Safer Health System. National Academy Press, Washington, D.C., 2000. Com-
mittee on Quality of Health Care in America, Institute of Medicine, [Retrieved March 28,
2006, fromhttp://www.nap.edu/books/0309068371/html/l ].

[McC06] Andy McCue. Hospital aims to cut operating errors with RFID tags, February 2006.
[Retrieved March 26, 2006, fromhttp://www.silicon.com/publicsector/
0,3800010403,39156618,00.htm ].

[oHFA04] U. S. Department of Health, Human Services Food, and Drug Administration. Combat-
ing Counterfeit Drugs – A Report of the Food and Drug Administration, February 2004.
[Retrieved March 26, 2006, fromhttp://www.fda.gov/oc/initiatives/
counterfeit/report02_04.html ].

[Pat05] RFID chips in humans get green light, 2005. [Retrieved March 26, 2006, from
http://www.silicon.com/research/specialreports/protectingid/
0,3800002220,39124983,00.htm ].

[Ran06] Steve Ranger. RFID to cure NHS hardware thefts, 2006. [Retrieved March
23, 2006, fromhttp://www.silicon.com/publicsector/0,3800010403,
39156833,00.htm ].

[Rob06] Mark Roberti. Congress Weighs Drug Anticounterfeiting Bill, March 2006.
[Retrieved March 27, 2006, fromhttp://www.rfidjournal.com/article/
articleview/2180/1/1/ ].

[Saz90] Kathleen K. Sazama. Reports of 355 transfusion-associated deaths: 1976 through 1985.
Transfusion, 30(7):583–590, September 1990.

[Sen01] A follow-up review of wrong site surgery, December 2001. [Retrieved March
26, 2006, from http://www.jointcommission.org/SentinelEvents/
SentinelEventAlert/sea_24.htm ].

[Ser05] Frost & Sullivan Research Service. World RFID in Healthcare and Pharmaceutical Mar-
kets, September 2005. [Retrieved March 30, 2006, fromhttp://www.frost.com/
prod/servlet/report-brochure.pag?id=F548-01-00-00-00 ].

[Sir03] Phanoumath Sirivattha. Issues on Patient Identification Related Error. Technical report,
University of Hawaii at Manoa, Information and Computer Sciences Department, 2003.

[Sun05] Sun Microsystems Healthcare Division. Surveys Say RFID Technology Saves Money,
Help Patients, 2005. [Retrieved March 23, 2006, fromhttp://www.sun.com/br/
0205_ezine/hc_rfid.html ].

[Swe05] Claire Swedberg. RFID in Healthcare.RFID Journal, 2005. [Retrieved March 24,
2006, fromhttp://www.rfidjournal.com/article/articleview/1486/
1/138/ ].

[Wes] Rhea Wessel. German Clinic Uses RFID to Track Blood. [Retrieved March 25, 2006, from
http://www.rfidjournal.com/article/articleview/2169/1/1/ ].

[Wes05] Rhea Wessel. RFID bands at the Jacobi Medical Center, 2005. [Retrieved March 26, 2006,
from http://www.rfidgazette.org/2005/12/rfid_bands_at_t.html ].