Identification, a rather common word integrated into daily life, whether while using a credit card at a retail store, calling the bank or even when applying for a loan. Identification is key and vital for everyone in order to ensure safe identification for use of personal information. The same goes for patients in the hospital. How is a patient identified safely? How would an emergency room identify a critical, unconscious patient without physical identification? How could the name, medical history/diagnosis or even allergies become known to the healthcare providers?
In the past several years some say the answer to all these questions could be resolved with implantable radio frequency identification or RFID. According to the Department of Homeland Security, "Radio Frequency Identification (RFID) technology uses radio waves to identify people or objects. There is a device that reads the information contained in a wireless device or "tag" from a distance without making any physical contact or requiring a line of sight" (Department of Homeland Security, 2015). This report will cover the pros and cons of RFID technology, identify legal, ethical and social implications, policies and logistics, and finally the author's recommendation regarding the use of implanted RFIDs in healthcare facilities.
Advantages of RFID
According to Vanguard ID, an industry leader in RFID technology, RFID "allows a doctor or nurse to pull up a patient's medical history [and] using the RFID helps the doctor access patient history faster" (Vanguard ID, 2016). The advantages related to the RFID identification can help reduce medication errors from the nurse being able to scan the implanted RFID, viewing patient name, date of birth, allergies, etc. This helps ensure proper and safe medication administration to the patient. In addition, while the patient is in the hospital, their location, and vital signs can be wirelessly transmitted to pertinent staff as well as save on the RFID for future use by additional practitioners. When the patient is discharged, the information from the current visit is saved to the RFID for later use. If a new diagnosis is made during that visit, it is added to the history, and duplicate information is omitted.
Recently, Medtronic introduced a pacemaker that can be monitored remotely through a smartphone application through iOS and/or Android smartphones. Medtronic, a company with a goal of increasing human well-being through biomedical technology has created an application called MyCareLink that helps transmit data from the implanted RFID device to the phone (through a smartphone application) and then relays the information to the physician. The use of the RFID also allows the patient to monitor their health through the smartphone application. "The system reduces the time to receive treatment if the physician detects a problem with the pacemaker based on transmitted data, less time spent at a doctor's office or clinic for regular checkup" (Healthcare IT News, 2015).
RFID not only has medical benefits but also safety and welfare benefits for children. ABC News published a report in February of 2016 about implantable RFID with multiple benefits. These benefits include GPS location of the child and medical information that can be scanned immediately if the child requires medical help through EMS or the emergency room. In addition, when the child reaches the hospital, the implanted chip will also have the child's healthcare policy information, allergies, and the complete medical history. Besides the above-mentioned benefits, how is this beneficial to a parent? The GPS enabling of the RFID would allow the child to be tracked if the inevitable kidnapping were to take place. This would allow the child to be located faster and to be rescued promptly, as well as being immediately identified by authorities with the help of the implanted RFID (Eng, 2016)
Disadvantages to RFID
One of the biggest disadvantages seen with RFID technology is privacy. "RFID chips contain a unique identifying number for use with a corresponding database, but a third-party scanner could pick up that number and allow someone else to use it for tracking purposes" (Kazmeyer, 2016). Much like the scanners thieves are using to duplicate credit cards, the person with the RFID needs only be feet away for the intruding thief to obtain information on the RFID such as social security number, medical diagnosis, as well as being able to track your whereabouts with mobile tracking software that alerts of location when passing an RFID scanning station.
To some, the whole idea of obtaining an implantable RFID is to aid in healthcare safety and identification, but unfortunately, there are health risks associated with implantable devices. According to Kazmeyer, because the RFID would be considered a foreign object in the human body, the site "may become infected, and the chips may also work their way to the surface of the skin over time. In addition, a powerful enough RFID pulse could damage the chip, possibly causing irritation or trauma to the surrounding tissue" (Kazmeyer, 2016). In addition to infection, the device can migrate in the skin unknowingly causing adverse reactions. It should be noted that the FDA "approved the VeriChip implant as a medical device in October of 2004" (AntiChips, n.d.).
Ethical, Legal and Societal Implications
One of the biggest ethical dilemmas plaguing implanted RFID's is privacy. Many consumers feel as though their information and whereabouts are being watched by corporations, such as department stores knowing the areas customers shop, and even fear or government involvement. Many feared their private lives would be on display, their every move would be analyzed or their information could be hacked by intruding thieves (Boeck, 2014). An important key factor to the implanted RFID's is that all information is encoded and even if the implanted RFID is scanned it is not easily decoded by common means or applications.
Computer Weekly posted an article stating:
Quote
"If an application involves the processing of personal data, which can be used directly or indirectly to identify an individual, that application will be subject to certain core data protection principles contained in the Data Protection Directive (95/46).These principles include requirements of fair and lawful processing, retention of personal data for only as long as necessary and collection of data which is relevant and not excessive for the purposes it has been collected" (Computer Weekly, 2012).
Additionally, many consumers fear RFIDs will be implanted unknowingly while at a physician's office or during a hospital stay. Like any medical/surgical procedure, the implantation of a RFID would require informed consent. "Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment" and includes the nature of the procedure, alternatives, risks, patient understanding, etc. (Ethics in Medicine, 2014). If a procedure is done without the consent of the patient not only is it ethically wrong but also illegal and punishable by law.
Policies and Logistics
In order for a healthcare provider to access the information on the implanted device, and RFID handheld scanner is required. By using this proprietary scanner, the patient name, date of birth, medical history and allergies would display on the handheld device and then relay to the hospital's computer system. These handheld devices range from $1,000 and up depending on the additional technology required (built-in printing, etc.). According to NBC News, the actual cost of RFID implantation "costs between $150-$200" (NBC News).
In this author's current practice, RFIDs are used in a variety of ways from patient care to hospital security. Upon arriving at the facility, all employees must use their RFID tag to gain access to the parking garage. This alerts security that employee is on campus. Upon arrival to the telemetry unit, scanning in on the time clock with the RFID badge indicates the arrival time of the nurse. Upon receiving the report on patients, nurses log into their portable workstations with the same RFID badge, allowing only them to access patient records.
Within the author's hospital system, RFID is also used in patient care. Upon retrieving a patient medication from the medication room, the nurse then enters the patient's room, scans their RFID identification tag near the barcode, allowing the nurse to correctly identify the patient, diagnosis, admission diagnosis and admission date. Upon this, the nurse then is able to use the barcode scanner attached to the computer to scan the medications to crosscheck them in order to correctly administer them to the patient.
Personal Usage
In society, RFID technology has been integrated several years. In today's society, RFID has made it possible to purchase products with a credit card and even a smartphone with touchless pay options by simply waving the card or phone by the RFID reader. The RFID scanner then takes the information stored on the card and transmits it to the retailer, therefore debiting the consumers' account. Other technologies where these are used are in microchipping pets. This allows a veterinarian's office to scan the animal and identify the owner so they may be contacted about their lost beloved family pet.
For the patient, when they're discharged, as stated above, the information is stored for safe keeping. In order for the patient to view their medication history, miscellaneous documents, including hospital stays, many hospitals have integrated patient portals so that information can be accessed by the patient. Upon discharge, the patient is offered an ID and personal identification number (PIN). All the patient's medications, labs, procedures, and charges are available for the patient to view. There is also an option to request an edit/audit of the information that can be sent to the healthcare facility for review.
Conclusion and Recommendation
The above report has covered many of the advantages, disadvantages, legal, ethical and societal implications, policies and logistics. RFIDs have made an incremental impact on today's society, not only on their use in the public such as touchless credit card terminals but also in the healthcare setting with patient identification, safety, as well as obtaining health records and patient history in emergent and non-emergency situations.
It is this author's recommendation that implantable RFID's are vital in society as their benefits drastically outweigh their disadvantages. In order to properly ensure patient safety, including proper identification, medical history (including disease processes), hospital stays, procedures, medications and allergies, RFID technology is a necessity. The disadvantages are minimal and carry a nominal risk for the patient's health, security and privacy as the data are highly encrypted and requires costly, close-proximity electronics to obtain the information on implanted devices. Society would greatly benefit from the implantation of RFID's, as will the safety of patients and practitioners alike.
References
Boeck, H. (2014, December 2). An Overview of Ethical Considerations When Using RFID With Consumers. International Journal of Cyber Society and Education, 157-164. Retrieved from International Journal of Cyber Society and Education.
Computer Weekly. (2012). RFID: A Threat to Privacy. Retrieved from RFID: a threat to privacy?
Department of Homeland Security. (2015, August 20). Retrieved from Radio Frequency Identification (RFID): What is it?: Radio Frequency Identification (RFID): What is it? | Homeland Security
Eng, P. (2016, February 25). Implant Chip, Track People. Retrieved from ABC News: Implant Chip, Track People - ABC News
Ethics in Medicine. (2014, March 7). Informed Consent. Retrieved from Informed Consent: Ethical Topic in Medicine
Healthcare IT News. (2015, November 20). Medtronic enables pacemaker monitoring by smartphone. Retrieved from Medtronic enables pacemaker monitoring by smartphone | Healthcare IT News
Kazmeyer, M. (2016). The Advantages & Disadvantages of Implantable RFID Tags. Retrieved from Tech In.
NBC News. (2004). Health. Retrieved from FDA Approves Computer Chip for Humans: FDA approves computer chip for humans - Health - Health care | NBC News
Vanguard ID. (2016). Healthcare | Products that Streamline Patient Data. Retrieved from Healthcare Products | Innovation in the Medical Industry
