Radio frequency technology in the lab.

Wireless technology--the field that is revolutionizing telecommunications--may also affect how clinical laboratories communicate with clients and other providers. Two applications have emerged that both use radio waves to transmit data: radio frequency identification (REID), which replaces handwritten requisitions, thereby reducing the time to process large volumes of specimen data; and radio frequency (RF) networks to transmit data within a facility, allowing providers throughout a hospital to access information from the hospital information system (HTS).

Radio frequency identification.

Traditionally, a laboratory client collects a specimen, fills out a test requisition, and sends both to the laboratory, where a technician enters the data into the lab information system (LIS). With REID, the client enters patient and test requisition data into a special reader/writer unit that transfers that data via radio waves to a special "tag" that is attached to the specimen. The tags are attached using special plastic bags or hard plastic test-tube holders. The tagged specimens can then be passed in front of a reader/writer unit at the laboratory to instantly upload the patient and test requisition data into the LIS.

According to Alex Gelbman, cofounder and managing partner of eID Solutions in Mountain Lakes, NJ, which developed REID, the technology, although complex, is easy to understand. "The reader/writer not only reads the tag but also writes information to it, much like combining the qualities of a cellular phone and a computer disk, only on a smaller scale," he says.

The tag is the size of a penny or a pencil eraser, adds Gelbman, and the reader/writer unit has a transmission and reception range measured in inches. This range depends on the size of the reader/writer's built-in antenna, which, for most REID applications, is comparable to that of a credit card.

Gelbman likens eID Solutions' plastic, tag-embedded specimen containers to bar coding, except that the REID containers are capable of storing more information. "With a reader/writer, you can encode as many as 1,000 characters on the tag, which serves as an electronic requisition," says Gelbman. "This includes information about the patient, the physician, specimen data, and billing. You don't have the hassles of optical systems, such as problems with obscured bar codes, and you're not limited to one piece of data."

According to Gelbman, RFID is especially applicable to laboratories that receive hundreds or thousands of samples daily. "High-volume laboratories can save money because the tag-reading eliminates clerical errors made by people processing written requisitions by hand," says Gelbman. "We found that processing a requisition normally takes from 40 seconds to 2 minutes; our system reduces that to 5 seconds."

RF networks. John Toffaletti, PhD, associate professor of pathology, director of the blood gas lab, and associate director of clinical chemistry at Duke University Medical Center, Durham, NC, describes how wireless technology was applied on a larger scale at his hospital. An existing RF network was used to link the blood gas instruments located in the operating rooms to the HIS.

According to Toffaletti, the operating rooms had originally been set up with blood gas instruments for rapid testing during surgery. Because the analyzers were not connected to the HIS, ordering and billing data often were not entered. "In addition, anyone could use the instruments for any reason--curiosity, research, whatever--and no one would know how often they were used," he notes. "As a result, we were billing operating room patients for an average number of tests."

Wiring the operating rooms to support an HIS interface for the blood gas instruments would have been extremely expensive and troublesome. "Rather than spend the money and go through the approval process, we attached an RF antenna to the instruments," says Toffaletti. This allowed the instruments to connect with the HIS through an already existing RF data-transmission network. originally installed for the pharmacy. The RF network consists of an interface with the HIS combined with radio receivers spaced at 20-foot intervals in the ceilings of the hospital.

To meet the needs of their system, Toffaletti chose the Omni blood gas analyzers and Omnilink instrument management software (AVL Scientific, Roswell, GA) because at the time (the mid-1990s), these products offered the necessary security and remote-monitor features that are now standard on similar products of most companies. His laboratory can now monitor the tests being run on each instrument, identify who is doing them, and identify what tests were ordered. The system also ensures that only authorized personnel can use the instruments.

Toffaletti believes that Duke's system has no drawbacks other than those normally associated with any HIS. "You must have an RF network in place, or it is very expensive," he says. "But as point-of-care testing becomes the standard, a system like this one will make ordering, billing, and tracking much easier."