A comprehensive RFID solution to enhance inpatient medication safety

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Errors involving medication administration can be costly, both in financial and in human terms. Indeed, there is much potential for errors due to the complexity of the medication administration process. Nurses are often singled out as the only responsible of these errors because they are in charge of drug administration. Nevertheless, the interventions of every actor involved in the process and the system design itself contribute to errors (Wakefield et al. (1998) [23]). Proper inpatient medication safety systems can help to reduce such errors in hospitals. In this paper, we review in depth two recent proposals (Chien et al. (2010) [7]; Huang and Ku (2009) [12]) that pursue the aforementioned objective. Unfortunately, they fail in their attempt mainly due to their security faults but interesting ideas can be drawn from both. These security faults refer to impersonation and replay attacks that could produce the generation of a forged proof stating that certain medication was administered to an inpatient when it was not. We propose a leading-edge solution to enhance inpatient medication safety based on RFID technology that overcomes these weaknesses. Our solution, named Inpatient Safety RFID system (IS-RFID), takes into account the Information Technology (IT) infrastructure of a hospital and covers every phase of the drug administration process. From a practical perspective, our system can be easily integrated within hospital IT infrastructures, has a moderate cost, is very ease to use and deals with security aspects as a key point.
Elsevier
International journal of medical informatics, Vol. 80, issue 1, Jan. 2010, pp. 13-24
This work was partially supported by the Netherlands Organization for Scientific Research (NWO) under the RUBICON grant "Intrusion Detection in Ubiquitous Computing Technologies" awarded to Aikaterini Mitrokotsa.
International journal of medical informatics

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Published 01 January 2010
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AcomprehensiveRFIDsolutiontoenhanceinpatientmedicationsafetyPedroPeris-Lopez,1,AgustinOrfila1,2,AikateriniMitrokotsa1,andJanC.A.vanderLubbe11DelftUniversityofTechnology(TU-Delft),FacultyofElectricalEngineering,Mathematics,andComputerScience(EEMCS),P.O.Box50312600GA,Delft,TheNetherlands2DepartmentofComputerScience,CarlosIIIUniversityofMadrid,Leganes,Madrid,28911,SpainAbstractErrorsinvolvingmedicationadministrationcanbecostly,bothinfi-nancialandinhumanterms.Indeed,thereismuchpotentialforerrorsduetothecomplexityofthemedicationadministrationprocess.Nursesareoftensingledoutastheonlyresponsibleoftheseerrorsbecausetheyareinchargeofdrugadministration.Nevertheless,theinterventionsofeveryactorinvolvedintheprocessandthesystemdesignitselfcontributetoerrors[23].Properinpatientmedicationsafetysystemscanhelptoreducesucherrorsinhospitals.Inthispaper,wereviewindepthtworecentproposals[7,12]thatpursuetheaforementionedobjective.Un-fortunately,theyfailintheirattemptmainlyduetotheirsecurityfaultsbutinterestingideascanbedrawnfromboth.Thesesecurityfaultsrefertoimpersonationandreplayattacksthatcouldproducethegenerationofaforgedproofstatingthatcertainmedicationwasadministeredtoaninpatientwhenitwasnot.Weproposealeading-edgesolutiontoenhanceinpatientmedicationsafetybasedonRFIDtechnologythatovercomestheseweaknesses.Oursolution,namedInpatientSafetyRFIDsystem(IS-RFID),takesintoaccounttheInformationTechnology(IT)infras-tructureofahospitalandcoverseveryphaseofthedrugadministrationprocess.Fromapracticalperspective,oursystemcanbeeasilyintegratedwithinhospitalITinfrastructures,hasamoderatecost,isveryeasetouseanddealswithsecurityaspectsasakeypoint.Keywords:Inpatientsafety,medicationerror,nursinginformatics,informationtechnology,RFIDsecurity,grouping-proofprotocolsCorrespondingAuthor:P.PerisLopez@tudelft.nl1
1IntroductionAmedicationerrorisafailureinthetreatmentprocessthatmayharmapa-tient[2].Itcanbeproducedduringdifferentphases:prescribing,manufacturingordispensingtheformulation,administeringthetreatmentandmonitoringthetherapy.Althoughmedicationerrorsarealmostinevitable,patientsafetycanbeimprovedbymeansofproperInformationTechnology(IT)systems.Forin-stance,failureduetoamisinterpretationofahand-writtenprescriptioncanbeeasilyavoidedwithITtools.Drugandpatientidentificationsystemscanauto-matecertainprocessestoguaranteethattheappropriateprescriptionisgiventoeachpatient.Accordingto[2],therearetwopossiblekindsoferrorswhencarryingoutacorrectplan:actionbasederrors(slips)andmemorybasederrors(lapses).Anexampleofaslipispickingupabottlecontaining“diazepam”fromthepharmacyshelfwhenintendingtopickup“dilitiazem”instead.Asimpleexampleofalapseistheadministrationofpenicillintoapatientwhoisactuallyknowntobeallergic.Possibleknownpreventivemechanismsfortheseerrorsarecross-checking,avoidingdistractionsandlabelingmedicinesclearly.Accordingtointernationalstudies,medicationerrorsoccurpredominantlywithmedicationorders(49%-56%)oradministeringmedication(26%-34%)[13].Aresearch,madebyPeijasHospital(Finland)[15],supportstheseinter-nationalreports:33.6%ofallmedicationerrorswererelatedtodocumentation,31.1%wererelatedtomedicationadministration,and19.5%werelinkedtomed-icationprescription.Effectivenursingisdefinedasa“five-right”method[3]:treatingtherightpatient,withtherightdrug,intherightdose,inthecorrectwayandattherighttime.However,nursesareworkingunderalotofpres-sureandthenursingshortagenowadaysisamajorconcernforthehealthcareproviders[8,18].RadioFrequencyIdentification(RFID)technologymayhelptoreducenurses’workloadanddecreasetheirslipsandlapses.TheJointCommis-siononAccreditationofHealthcareOrganizations(JCAHO)placed“Improvetheaccuracyofpatientidentification”atthetopofitslistofNationalPatientSafetyGoals(NPSG)againfor2010[19],apositionithasheldforyears.1.1BackgroundThispaperusesRFIDtechnologytoenhancethemedicationsafetyofinpatients.RFIDisatechnologyforidentificationusingradiowaves.Itsmaincomponentsareatag,areaderandadatasystemforhandlingtheinformation.AnRFIDtagincludesanantennaandachipforcomputationandinformationstoragepurposes.ThecontentofthechipcanbereadandwrittenwithanRFIDreader.Thetechnologymaybecomparabletothebarcodeidentificationsystem,whereabarcodescannerreadstheinformationfromaprintedbarcode.OneofthemaindifferencesisthatRFIDidentificationsystemsdonotneedalineofsighttoreadorwritetags.TheinformationofRFIDtagscanberewrittenandanRFIDreadercanreadhundredsoftagspersecond.Inaddition,RFIDtagshavecomputationalpower,morestoragecapacityandaremoreresistanttoharshenvironmentalconditionscomparedtobarcodes.Securitymechanismscanalso2