Text: Julie Zaugg
Photo: Tang Yau Hoong

A vital accessory for patients

Electronic bracelets help reduce medical error by improving the communication of information about patients. They also signal the arrival of the “Intelligent Hospital”.

Nov 12, 2014

Follow Up

Massachusetts Institute of Technology has developed a scanning device to prevent patients from receiving the wrong medication. Nursing staff use the bedside machine to scan the barcode on the patient’s electronic wristband, then place the medication on the tray and insert it into the device. In a few seconds, the scanner identifies the size, shape, colour and any markings on the pills to check whether they correspond to the patient’s records.

In November 2012 two men visited a hospital in Isère in France for a medical examination. One of them had an aneurism that needed to be operated on straightaway. But he was sent home and the other man was operated on for an inexistent aneurism. Fortunately, there were no serious consequences for the two patients. But the case of mistaken identity could have ended tragically. To avoid this kind of error, some hospitals have started to fit their patients with electronic bracelets equipped with barcodes for 100%-sure identification.

Information is sent from the patient’s wrist to the caregiver’s smartphone via a chip in a key ring. The telephone is connected to the hospital’s IT system.

But the computerisation of the system is still in its infancy. Geneva University Hospitals (HUG) began a pilot project in 2006 to test electronic bracelets in some oncology departments. “Caregivers now systematically scan the barcode on the patient’s bracelet to check that it matches the barcode printed on the pack or syringe to be administered to the patient. The idea being to not give them the wrong medication,” explains Pascal Bonnabry, head pharmacists at HUG.

A test study with imaginary patients showed that using a scanner identified 100% of potential mistakes, compared with 98% for a checklist on paper and 85% with neither of these tools. The project is to be extended to the rest of the establishment by 2014 or 2015. “As well as preventing medication mistakes, electronic bracelets could be used to avoid errors in administering blood packs and fitting equipment such as prosthetics and pacemakers,” adds Pascal Bonnabry.

But what happens if the patient gets the wrong bracelet? Dartmouth University researcher Cory Cornelius has solved this problem by developing a bracelet that “recognises” the person to whose arm it is attached. “When a slight electric charge is applied to the wrist, it reacts according to tissue and bone density,” he explains. This is what is known as bioelectrical impedance analysis, or BIA. “The impedance, or resistance, establishes a ‘print’ that is unique to each human being and informs the bracelet of the identity of the patient in question.”

Since the mid-2000s, most Swiss hospitals have fitted patients with paper bracelets, marked with their name.

Olivier Hugli, head physician at the emergency service at the Lausanne University Hospital (CHUV), is looking even further into the healthcare future, one in which electronic bracelets are just the starting point for a huge network of patient data. “Three or four years ago, when the hospital replaced doctors’ beepers with mobile telephones, I began asking myself how we could make better use of handsets in our day-to-day work,” he says. The result of that thinking is the Smart Access to Versatile Emergency Resources (SAVER) project, co-developed with the Haute École d’Ingénierie engineering school in Yverdon.

The aim is to fit patient bracelets with RFID (radio frequency identification) chips. “When caregivers approach a patient’s bed, information on the patient is displayed on their smartphones,” says Olivier Hugli. The information is “intelligently” sorted according to the caregiver’s needs and function (doctor, nurse, etc.). They can then access information on the patient using their phones. “We’ve developed software that makes it easier to enter these data in a smartphone. For example, pain intensity would be indicated by a cursor from one to ten, while blood pressure could be illustrated via a dial.” Away from the patient’s bed, doctors could receive alerts about them on their telephones.

To guard against this information falling into the wrong hands, the device would only work within range of an identification beacon worn at all times by the doctor and activated by Bluetooth. “No information on the patient is stored on the phone,” says Olivier Hugli. SAVER would take on its full meaning with the introduction of the patient’s electronic file, centralising all the data on the patient in electronic format. This is planned for 2017 at Federal level in Switzerland (see p. 34).

At the CHUV, patient data have been entered electronically since 2010 as part of the “Dophin” project (“Dophin” being short for institutional and electronic hospital patient file in French). “Between now and 2015, caregivers will also start entering instructions for patient treatment, including orders for medication and x-rays,” says Pierre-François Regamey, head of IT systems at the CHUV. A pilot project on accessing patient files via electronic tablets will be rolled out by the end of the year. In the long term, Dophin could be connected to SAVER, the implementation date for which has yet to be set. “The two projects tie in,” stresses Pierre-François Regamey. “Electronic bracelets generate automatic patient identification, creating an instant and reliable link with their file, saved in electronic format.”


“It is crucial to set clear rules”
Christian Raetz, data and information protection commissioner for the Vaud canton, talked to us about the big issues in medical data security.

IV What are the risks involved in the increased digitalization of patients’ medical records?
CR The advantages of digitalizing patients’ records are undeniable, but, yes, there are dangers involved, too. The main risk stems from the volatility of IT data, which are easy to transport, share and modify. Concerted efforts need to be made to ensure that the data are not meddled with or accessed by unauthorised people. We also need to make sure that the information is used purely for the original aim, that of bringing patients the best possible care.

IV What measures need to be taken to safeguard the security of patients’ records?
CR The first, naturally, is to ensure the physical security of the data, mainly through encryption, in other words, making a document unreadable to all those without a decryption code. Another key issue is access rights. Not all hospital staff should be able to access all the medical data of all the patients.

IV What about information leaks at hospitals?
CR Healthcare personnel are bound by medical confidentiality and well aware of that fact. But unlawful treatment can’t be ruled out, so a set of basic conditions needs to be implemented to limit risks. It is also important to distinguish between two types of records: the computer records drawn up by each healthcare provider (hospital, GP, etc.), which in principle are accessible only in the hospital or doctor’s office where the patient is treated; and the records as envisaged by the federal bill on electronic patient records, containing data that can be potentially accessed by all healthcare providers. In both cases, it is vital to set clear rules on who can communicate what to whom.

Surveillance tool

In the United States, some hospitals are delving deeper into the possibilities of artificial intelligence. El Camion, a 411-bed establishment in Silicon Valley, is one of the most “connected” hospitals in the world. Doctors can check their patients’ electronic files at any time and analyse exam results using one of the terminals located around the facility or via their smartphones. Patients are hooked up to the system via electronic bracelets, which are equipped with a biometric ID (an ultrasound of the vein network of their hand taken on admission) and enable doctors to check where they are in the hospital in real time.

And so an electronic bracelet can also be used as a surveillance tool. “Providing it is equipped with a RFID chip or GPS, we can monitor the patient’s movement, from one service to another and from one caregiver to another,” says Pascal Bonnabry. “This can be useful in a psychiatric environment or for fighting baby theft.” Newborns are fitted with such bracelets in a number of hospitals in
Texas, California and Colorado. An alarm goes off and the hospital doors lock shut automatically if an infant is taken from the nursery by a non-authorised person.

“Electronic bracelets could also be interesting for people with Alzheimers or other forms of dementia,” says Birgitta Martensson, director of Association Alzheimer Suisse. “When they first arrive at hospital, they are often very disoriented, don’t understand why they are there, and try to leave. Bracelets can help to find them. In nursing homes, it gives them a welcome dose of independence, since they can move around freely in a secure perimeter instead of being stuck behind a locked door.” ⁄