Real Time Location System (RTLS) Part 2 of 2: Not One-Size Fits All Solution for Healthcare

This is part two of a two blog series blog discussing how BLE has the potential to change the healthcare RTLS landscape. Part one, “The Promise of Bluetooth Low Energy (BLE) to Disrupt Healthcare Real Time Location System (RTLS)”, summarizes the benefits of RTLS, highlights some of the issues that have limited the rate of RTLS adoption, touches upon some of the RTLS technologies available, illustrates the promise of BLE-based RTLS, digs into why BLE-based RTLS is taking off and what benefits it may bring, and introduces how TAGNOS is integrating with systems today and planning for the future. 

In part two of this blog series, we will look at the details of why BLE tracking, or for that matter any other available solution, cannot solve all the tracking needs of a Hospital System. By utilizing a variety of technologies, BLE can be paired with other RTLS systems to assemble a cost-effective solution that will provide optimum coverage for the variety of complicated tracking scenarios hospitals are required to solve. 

Hospital ecosystem challenges 

RTLS data from a variety of equipment and people  

The Hospital Ecosystem has a large variety of equipment and equally diverse group of people that interact with the equipment. Equipment ranges in size and cost and is constantly being utilized throughout the hospital by different staff. In addition to the constant movement of equipment, each item in the hospital inventory has a lifecycle along with varying types of inventory. These problems are compounded with surgical equipment and sterilization requirements.  

Accuracy limitations with some RTLS technologies present additional complexity as they can solves some problems, but not all. Once you include accounting for complications from patients, the challenges get more complicated. 

All of this creates an opportunity for hospitals to utilize RTLS to derive very useful data from the location of equipment and people and from tracing the interactions between the equipment and people to solve the problems of the Hospital Ecosystem.  

Complex Inventory of Hospital Equipment 

Let us start with the equipment hospitals use. Equipment in hospitals can range in size from large c-arm machines to miniature surgical tools. The equipment comes in all sizes and shapes and can range in cost from a few cents to hundreds of thousands of dollars. The wide variety in cost and shape/size presents one with a problem tagging equipment in the Hospital Ecosystem. Bigger tags will not fit on small surgical tools and expensive tags may not be economically feasible for smaller equipment. There is no “one tag fits all”, or even one technology appropriate for all the types and variety of equipment that needs tagging. 

TAGNOS: Ziehm / Stryker Intraoperative C-Arm, Infrared Navigation
“Equipment in hospitals can range in size between large c-arm machine to miniature surgical tools.”

Equipment on the move… all the time! 

Hospital equipment is constantly on the move. Bedside equipment is designed to be mobile as it is constantly moving from one room to another as it is needed to cater to patient needs. The movement of equipment is accelerated by the fact that hospitals are limited by economics to the number of select expensive equipment available. This leads to the relocation of limited expensive equipment, such as mobile EKG, whenever it is needed for a patient.  

The constant movement of equipment of course poses one of the key challenges RTLS offers to solve, the ability to find mobile equipment. 

A plethora of variety in the supply chain 

Consumable supplies in hospitals follow typical supply chain processes. Several hospitals set up a refill system (Kanban) where supply cabinets are filled whenever they fall below a threshold. Supply cabinets can have hundreds of slots and hospitals can have dozens of supply cabinets.  

TAGNOS: Hospitals have all types of inventory to track

The vast number of consumables that need to be tracked make it an unviable candidate to track with technologies such as BLE, as the tags, although going down in price every year, are still prohibitively too expensive. 

Equipment life cycles 

Another challenge hospitals face is managing the various life cycles of different types of equipment. It is necessary to locate equipment that requires periodic maintenance in order to perform the recommended maintenance.

Some of this equipment is larger, more expensive, and conducive to tracking with zonal level accuracy such as BLE with semi-expensive tags while other equipment types are smaller and hard for staff to find even if they know room level location accuracy. 

Zonal tracking for equipment is often fraught with frustration 

Zonal tracking places equipment at a five-to-ten-meter level of accuracy. This in itself is a huge advantage, because the hospital staff roughly knows the location of the equipment. Zonal tracking is an even greater advantage for large hospitals with multiple buildings and floors and significantly reduces the time to locate equipment.  

TAGNOS: Hospital inventory of ventilators

Although this is a definite improvement over not having RTLS and zonal tracking places equipment in a certain zone, it can still be difficult to identify a particular piece of equipment. For example, if a staff member is looking for a small piece of equipment in a room full of small equipment, the staff member will still have to sift through a large amount of inventory. Another example might be if a staff member is searching for a specific IV pump, with a specific serial number, the staff member may need to look through many pumps to find the exact pump they are looking for or for which they are looking.

Surgical equipment has its own flow 

Hospitals that support OR procedures have complex facilities to sterilize and package equipment for surgical procedures.  

These surgical instruments are often bundled into trays or bins and then sealed to prevent further exposure to contaminants. They are then placed on trolleys and wheeled into the OR.  

These trays are sometimes placed in sterile storage for several months before they are used. In some cases, equipment can sit in storage too long and need to be cleaned again, as they pass their sterilization date. 

TAGNOS: Autoclave sterilizing hospital surgical tools tray

To add to the complexity, surgical trays go through autoclaves that are extremely hot. Specialized tags are needed which can withstand the high temperatures.  

These kinds of unique requirements create specialized tagging needs where tags need to be generated as trays come out of the autoclave. This tagging problem is not easily solved with BLE or WIFI tags. 

The human factor 

Hospitals gain a lot of advantages when they can trace patient movement, as that information can be harnessed to create better patient experience and reduce wait times. The flow of patients through a hospital is constant with very short stays, particularly in the ER.  

Nurses are already stressed to the point of burnout. Anything that we can automate or remove from the list of things nurses need to manage helps. If you are limited to one RTLS system that utilizes expensive tags, nurses will be burdened with having to put on and take off expensive RTLS tags to prevent patients from leaving the ER with the tags causing a potential for loss. 

Having alternative tag options can alleviate problems with loss. 

Combined RTLS solutions 

Complex problems in hospitals can be solved by taking advantage of different RTLS technologies. 

Passive tags can help 

Passive tags are low-cost tags designed to be printed on-demand or supplied in bulk at very economical rates. Industries such as retail for example use hundreds of thousands or even millions of inexpensive passive tags.  

The low cost can make it possible for hospitals to utilize passive tags tracking technology where is appropriate, for example to set up a Kanban system or to track smaller consumables.  

Disposable tags 

Passive tags can be truly disposable because of the low cost and that can be a great advantage to track low-cost items as well as patients. 

Economically designed RLTS network 

One of the drawbacks of passive tracking is the expense and trouble of setting up passive readers. Passive readers have been traditionally more expensive to install and set up.  

To deal with the expense of passive readers, they can be strategically placed at certain choke points and in specific locations in a vast area. By utilizing passive readers at the right time and in the right place, they become more feasible. For example, readers can be placed at laundry entry points to prevent equipment from being unknowingly sent into the laundry machines. 

Double Tagging 

Passive tags could solve one of the vexing problems with zonal level tracking. When a specific item or set of items needs to be tracked, if the items are tagged with passive RFID tags in addition to their zonal tags, the RFID locator sleds/guns can then be used to easily pinpoint the exact location of the item or set of items.

Zonal + passive:  A winning combination for hospitals 

Hospital ecosystems present a complex and complicated environment where a single technology such as BLE cannot solve the entire range of problems. There are a variety of RTLS technologies that can be leveraged to trace the movements, location, and interaction of equipment and people in a hospital. In most cases, hospitals are better off mixing and matching zonal tracking with passive RTLS tracking to gain benefits from both systems.  

When hospitals need to use multiple RTLS systems, it is important to have one platform that can aggregate all the data and present a common, consistent, and seamless experience for hospital staff. 

Tagnos integration with Cisco DNA Spaces and Zebra Location Services

TAGNOS is a hardware-agnostic and RTLS-agnostic solution. Our workflow orchestration products integrate with all types of RTLS hardware and systems. Our solutions are integrated and work seamlessly with solutions such as Cisco DNA Spaces and Zebra Location Services and we support RTLS data from multiple hardware vendors such as Cisco, Juniper, Zebra, and This makes implementing and integrating with facility-wide mixed RTLS technologies solution a reality now. 

TAGNOS Connect: Agnostic Interoperability Platform 

Through TAGNOS Connect, our workflow solutions ingest data from both clinical & non-clinical IT applications and from both physical & virtual IT infrastructure.  We perform real-time analytics to interpret all data, we apply artificial intelligence (AI) to develop workflow insights, and finally we connect with user-facing systems such as the EHR and mobile devices to communicate workflow insights to operators and clinicians at the edge.

Asset Orchestration Solution with Asset Map on Desktop and Mobile Device
The ‘Asset Location Map’ provides real time location information of equipment and is accessible via desktop and staff mobile devices. 

Our solutions and tools such as dashboards, automated communications, and predictions, are purpose built to optimize operations in a variety of hospital departments from the operating room to the emergency department to biomed and beyond. Increasingly, we are seeing opportunities for cross-departmental, holistic workflow optimization that requires facility-wide RTLS.  These include use cases such as orchestrating transfers & discharges, integrating asset tracking with other departmental workflows (e.g., integrating sterile supply tracking with OR use cases), and more.  We believe now is the time to double-down on integrating with BLE-enabled solutions. 

About the Author

Jag Padala

Engineering solutions for a better experience

For over five years, Jag has helmed the product development at TAGNOS as its Chief Technology Officer. Beginning with a single customer installation when he first joined, Jag has re-architected TAGNOS to create a cloud-enabled and enterprise-scaled product now deployed at Adventist Health, Providence St Joseph’s, and USC Keck to name a few. Jag brings a wealth of enterprise software and product development experience to TAGNOS, including having worked extensively in the supply chain and compliance areas for companies such as Motorola, GE and, most recently, Oracle. This extensive supply chain experience provides Jag the background to be able to create workflow and process optimization software while leveraging his prior startup experience to create and sustain TAGNOS. When Jag isn’t developing end-to-end product solutions for hospitals, you can find him either hiking with his golden retriever Thor, concocting delicious vegan dishes, or blogging about his many travel experiences around the world.

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