1. 0 INTRODUCTION

1.1 INTRODUCTION

Radio Frequency Identification (RFID) is regarded as a state of the art technology that makes use of electromagnetic fields which are attached to a tag for the purposes of identifying objects. The tags are basically used for tracking and identification of products. However, the technology has been applied in several other sectors with key functions of tracking and identifying that are aimed at reaching a designated end. RFID is growing trend in the field of health care and is driven by the greater need to ensure patient safety. The technology can help in ensuring that every patient receives the services that they pay for.

There are two major types of RFID tags, the active and the passive tags. Active tags are expensive but play an exceptional role facilitated by their internal power to allow for a two way flow of information. Information in the active tags flows from the server to the tag and back to the server and they are more applicable in tracking application (Ferrer-Roca 2011). Passive tags, on the other hand, are less expensive but they lack an internal power and hence have to be activated by an outside power source. Compared to the active tags, the passive tags have a shorter range and can only transmit data from RFID to the server.

The increasing trend in the adoption of the RFID technology by healthcare institutions has been facilitated by the immense benefits of the technology. In the medical field, RFID has three major uses, which include tracking staff, tracking equipment, and tracking patients. Tracking expensive medical equipment through the use of RFID technology has tremendous benefits. Medical equipment that has historically been forgotten in storage are now tagged with RFID hence making them easily recoverable on need basis. Hospitals can be able to cut on the number of equipment they hold on hand because such equipment can be easily recovered (MobiHealth 2011 & Nikita 2012). Additionally, the number of staff that may be required to scout for lost items is minimized hence serves as a cost saving strategy.

Further, RFID is useful in tracking and monitoring of patients. The technology has evolved to ensure proper monitoring of patients on matters of their location, to control documentation and administration of medication, and also to monitor the interaction between the staff and the patients. However, improvements can still be made to improve the application of RFID in furthering the improvement of patient safety. The expectation is that future application of the technology will help in preventing falling of patients from hospital beds. More amazingly, the RFID system is likely to take things further through the incorporation of facial recognition software. The software has the capacity of determining whether a patient is experiencing excessive pain or whether a patient has a stroke based on the facial expression (Shor 2015). Furthermore, RFID can be used with dementia patients and can assist in preventing the patients from wandering off the premises.

Billing in hospitals is based on the interaction between the staff and patients as well as the services provided. RFID technology enables a hospital to closely monitor these interactions, which ensure accurate billing. Additionally, RFID has the capacity of tracking admissions into the hospital and consequently facilitate discharge and movement of patients. This tracking allows an opportunity for maximization of bed space at a specified period. By tracking patients, hospitals have an opportunity of maximizing billing and consequently increase the revenue generated. Tracking and monitoring of staff using the RFID system enables the hospital management to control costs incurred by the institution (Shor, 2015). By tracking the staff, the hospital management is in a position to determine how much time a given employee spends with a patient. This is important in determining the quality of services offered by the hospital.

1.2 STATEMENT OF THE PROBLEM

The continuing challenges in the human resource, higher wage bills that leave little resources for delivery of services, stagnation in the provision of public health services, dismal performance in the monitoring of health systems, and the difficulties of achieving behavioural change have worsened the health situation across the globe. The emergence of the RFID technology as a solution to the existing problems in the health care system requires proper actualisation within the various sectors in service delivery (Dolicanin et al. 2009). Having a well-outlined strategy is essential in ensuring that the use of technology in health care services will serve the purpose of quality facility services (Garrety et al. 2014). This paper, therefore, undertakes a critical a critical analysis of e-Health and specifically the RFID technology in solving problems in the health care system. An entry strategy for a startup in the industry presents unprecedented desire by various players in the sector to play a part in the problems facing the society across the globe.

1.3 RESEARCH QUESTIONS

1. What is the effectiveness of e-Health in meeting the needs of the patients?
2. What are the viable strategies for starting a RFID technology system in the health sector?
3. What are the challenges facing the health care sector whose solution is the RFID technology?

1.4 RESEARCH OBJECTIVES

1. To determine the effectiveness of e-Health in meeting the needs of patients
2. To determine the strategies for starting a RFID technology system in the healthcare sector
3. To outline the challenges facing the healthcare sector that the RFID technology seeks to solve

1.5 BACKGROUND INFORMATION

Several hospitals in Europe are facing similar threats and challenges in the provision of health care services. The challenges and threats are in equal measure presented with opportunities for improving the quality of services provided. One of the notable solutions in the provision of these services is the introduction of RFID in most hospitals across the continent and in the world. The core mission of every hospital is to offer quality services to their patients. Devising better measures to address the situation is critical in ensuring meeting of the objectives of every institution.

Over the course of the 21st century, there have been greater efforts to address the critical health problems across the globe. The pursuit has been there for over 40 years due to the deteriorating situation in the health sector. For instance, the declaration of the Alma Ata in 1978 categorised health as a very vital social good across the world (Shor 2015). The declaration brought about the concept of primary health care which has formed the basis of the delivery system in the health services.

More recently, there was the development of the millennium development goals that were aimed at providing macro-level targets alongside the efforts to improve the outcome of health are efforts to reduce the digital divide and the differential access to technology by people of various categories. On the aspect of the digital divide, the world has witnessed an increasing number of internet users (Sedlmayr & Munch 2012). The increasing technological advancement is key to improving the service delivery in the health care system. The introduction of technology in the healthcare system creates the unprecedented opportunity of improving access to efficiency and services in the healthcare system.

In the modern day, the management of data and information plays a very vital role in the provision of health care services. The various providers of the healthcare services such as the doctors and the hospitals often generate and process information while attending to the patients. Similarly, patients create, access, process, and exchange information concerning their health status. Information and communication technologies related to health can play a significant role in the management of the data as well contribute to potential gains in financial savings, efficiency and improved patient safety. The use of technology can play a pivotal role in the shift towards patient-centric care (World Health Organisation & United States 2005). The patient-centric care is an approach that aims at building a treatment regime that is tailored towards an individual patient.

The major objective of e-Health programs is to make use of the information and communication technology to improve service delivery. Professionals in the health sector hope that through e-Health more health care services will be brought to the needy population. The strategic use of technologies like the internet, computers, mobile phones, satellite receivers, and Personal Digital Assistants has been among the key technologies in improving the provision of healthcare across the globe (Sitting & Singh 2011). The increasing presence of free and open source software brings about greater chances of improving the delivery of services in the healthcare sector and seeks to offer solutions to lower income earners on easier accessibility to the healthcare.

E-Health offers a great potential in promoting healthy lifestyles, improving decisions by the various players in the healthcare sector, and enhancing the quality of healthcare through improved access to medical and health information and consequently promoting instantaneous communication in places where this was previously unavailable (Raffaeli et al. 2016). The increased use of information and communication technology in the health care sector can help in reducing the cost of the system by improving efficiency in the provision of health care as well as promoting prevention through behavior change communication (Saunders et al. 2009). The introduction of e-health has the potential of advancing the public health services and clinical care by promoting health professional practice and reducing disparities by introducing new approaches to improving the health of isolated populations.

The initial focus of many e-Health initiatives, concerns the use of the internet in promoting the organisation and access of the health-related information. In the health sector, the main areas to benefit from the e-Health include the development of Health Information System, Electronic Patient Health Records, training and eLearning for professionals in the health care, Knowledge Management, and open access to electronic medical journals. As of the first decade of the 21st century, the overall penetration of internet users across the globe was at approximately 21.2%. The emergence of Internet kiosks and cafes has been of significant influence into the use and access to internet services by population across the globe. There has also been a growing interest in the health sector to capitalise on the uptake of mobile communication technologies in the provision of services (Ferrer-Roca 2011).

The healthcare market is on the move from a paper work world to an electronic world. In an era where there is increased managed care, thin financial margins, specialised medicine, difficult insurance claims, the emergence of confidentiality in health information, and increased government demand for secure health, the competitiveness of the health care providers may depend on the usage of information technology (Phan 2008). The increased computerisation, movement of sensitive information, and reliance on databases there is a need to have strict controls that will safeguard the security and ensure confidentiality of the health care records. There are several concerns that have been raised in the health care system.

With the advancement in electronic usage, protection of data has been a key concern in the healthcare system. This has come in handy with legislation to promote the protection of data. The current health care requires the existence of an efficient and secure access to information without compromising the privacy (Ries 2014). RFID technology represents a unique opportunity that offers health care solutions that combine access to secure information and management with data mobility as well as patient privacy (Perry et al. 2004). Healthcare administrators are the major consumers of ink and paper. Keeping patient records, writing prescriptions, following up claims, and making referrals have always been based on manual operations. The few areas that have been automated tend to operate independently of each other. There has been a strong affinity by physicians and other health professionals on the use of paper-based media in undertaking their roles.

RFID is essential as it serves to reduce the amount of paperwork transactions in the health care sector and consequently serve to protect health data and patient records. RFID can hold patient information that has been encrypted and makes use of a digital signature or biometric signature to reduce the ambiguity on the identity of the card holder (Murray et al. 2013). The technology also has the potentiality of reducing fraud in claiming for insurance cover. There is a high likelihood that many health care providers will choose the technology based solution due to their capacity to ensure patient safety. The technology can also provide clean data to be used for eligibility verification as well as claims processing (MobiHealth 2011 & Nikita 2012). The current process of eligibility verification is often characterised by redundant information collection, lengthy delays, and multiple reinforcement forms.

The use of paper-based manual process has an increased risk of human error which may result in avoidable costs to insurers, health care providers, and national health agencies. These processes often result in significant delays due to the complications involved in the paper-based system. The technology can be a solution to these challenges due to their capacity to provide clean data for eligibility verification (Miller & Sim 2004). The technology has the capacity of preventing administrative errors as well as streamlines the process of payment alongside preventing medical errors from rising when the process involves multiple medical practitioners.

Test results that are conducted by one practitioner can be available to other practitioners and hence an easier way of engaging each on their issue. The technology helps the physician to preview the recent history of the patient regarding medical condition that a given patient may have. The information stored in the system is essential in informing any practitioner of the health trend of a given patient (Michael &Michael 2009). It becomes possible for physicians to track the record of the patients and hence in a position to provide the relevant diagnosis. This reduces the trend of giving wrong medication as the physician is in a position to review a patient’s recent diagnosis. As such, there is a high possibility that health care technology can have a greater impact in saving lives.

The ability of RFID to disaggregate data and undertake information encryption can protect the right to privacy of an individual while at the same time allowing multiple health care facilities to share patient information in enhancing facilitation of proper health care. The technology has the capacity of managing very vital health information, and they are also involved in the billing and collection function of information systems. The technology is also vital in the areas of clinical research (Karamanlis et al 2012). The perspective arises from the fact that issues of confidentiality and data protection can encourage participation of patients in research studies. Regardless whether the technology stores confidential information or not it acts as a key to open repositories of patient information, it is an idea whose time is ripe. RFID technology presents a practical enabling technology that has the capacity of ensuring and enhancing confidentiality and privacy of patient’s information. This paper analyses the challenges within the health care system and the clear opportunities arising from the use of RFID technology in the health care (Mantas et al. 2009). Of critical analysis is the entry strategy for startups in the e-Health sector in health care provision across the globe.

Information and communication technology offers several opportunities for improving and enhancing the performance of health systems. The availability of affordable systems and ones that are easy to use presents unprecedented benefits in solving problems arising in their health care system. The availability of affordable systems that are easy to use has led to the establishment of several initiatives that are aimed at improving the effectiveness of the providers of health care alongside offering opportunities for consumers of health care. As such, an increase in demand for use of information technology in the health care system has been experienced (Hannan 1996). These new demands shave arisen in part due to the insights concerning the extent to which information communication technology can alter the provision of health care in the society.

The delivery of health care should take advantage of the opportunities presented by the use of information technology is service delivery. These opportunities range from improvements in management and technical processes that lead to an efficient and effective health services in the growing limitation of resources (Ferrer-Roca 2011). The use of RFID technology in health care implies that the providers of health services and the managers of these systems will have a better control of resources and consequently ensure there is the optimal outcome in the health care services.

1.6 LOCAL SITUATION

Just as any other region, Malta is faced with challenges of achieving patient satisfaction through provision of quality services. One of the challenges in Malta is an increasing population that is seeking health services. The increasing demand for health care seems to strain the existing resources and hence need for having a well outlined system to address the situation. The challenge of ensuring quality health care has come along with challenges such increase in operational costs. The acute general hospital in Malta has 928 inpatient beds and about 100 day care beds. The hospital is served by 3,800 staff. There has been an incremental expenditure of the hospital that necessitates better measures be put in place (Department of Health 2011).

1.7 IMPLICATIONS OF THE STUDY

This paper considers that the providers of the health care, as well as the consumers of health care, may need further evidence on e-Health as a convincing way of starting e-service provision in the health industry. The providers of services require a well-outlined strategy for an e-startup that is based on solid research into the use of information technology in the health sector. There is a need to invest more into the research as well as an investment into e-Health startups that will provide more advanced and innovative solutions to the health problems.

The major purpose of the study is to offer detailed evidence on why RFID technology should be adopted in the health sector and the strategies within which this technology can be adopted. There is a need for collaboration between various sectors in the health care system to ensure effective coordination of the various technologies in the health care sector (MobiHealth 2011 & Nikita 2012). Developing a personalized RFID is essential in transferring and maintaining patient’s health records. Each patient has their medical records stored in the electronic technology. Health providers are responsible for updating information on the system so that it becomes available to any other practitioner in the health sector.

1.8 OUTLINE OF THE STUDY

This study will make use of both descriptive and qualitative technique in addressing the research question. Questionnaires and interviews will be used to facilitate data mining and hence better conclusion from the study.

1.9 FRAMEWORK OF THE STUDY

This researcher proposal consists of three chapters. The first chapter is the introduction which offers a brief introduction into the issues of RFID and also provides background information on the study. The second chapter is the literature review which offers an analysis of previously done research and overview of available literature. The third chapter provides the methodology that the study will follow in addressing the research question. Descriptive and qualitative techniques will be considered for this study.

2.0 LITERATURE REVIEW

2.1 INTRODUCTION

This chapter reviews the existing literature on the adoption of a health information technology system that is patient centered. This technology is essential in serving the needs of the patients in a more effective way and also in ensuring efficiency in the health system. A wide range of information is adopted in this sector to outline the various issues surrounding the incorporation of health information technology in the health sector. The information presented is essential in offering an insight into the various challenges that may be encountered while incorporating the system into the health sector. This information will be essential in offering insight into the strategies to be adopted in putting up a start-up in e-Health.

Several studies have undertaken a review concerning the potential use of RFID technology in hospital environments. Quite often research points on the efficiencies that can be realized in the field of patient and equipment tracking.

2.2 ELECTRONIC HEALTH

According to Hamilton (2009) the electronic health technology is system is currently gaining momentum in several parts of the world, especially the developed economies though at a very slow speed. The Electronic Health Records (EHR) system is being implemented in the United States and several other areas across the globe. The RFID technology is designed to offer the patients a virtual assistance that is accessible through card readers the system allows the patients and the health service providers to update information such as health history, demographic information, health information, and any other relevant information pertinent to the patient. The health providers and the patients can access the EHR of a patient through an internet platform that is cloud-based. The information can also be accessed through data readers that are provided in several locations. The RFID technology allows the patients to access their health records with explanations that are easy to understand concerning their conditions and treatment. While the technology has a wide usage in the United States, the country’s health care system may significantly benefit from the health IT to enhance better coordination of patient care.

Grizzlies et al. (2012) argue that the lack of an integrated health system often leads to a redundancy on the part of the part of the patient while the health providers, on the other hand, struggle to control costs and coordinate care. Patients often become frustrated while repeating several sets of tests with multiple providers of health. This information can be successfully stored in an electronic data system that will enable the providers to get the history of a patient just by the click of a button. According to Fischer et al. (2013) cases of emergency often take to time to address especially when the patients have to be subjected to several sets of tests that may have been previously done. Lack of a proper health technology causes a delay in the provision of health care and consequently affects the quality of medication that is offered to the patient. Such a trend may lead to losing of faith by both the patients and the providers of health care.

Al-Khanjari et al. (2014) argue that information that patients convey may not be properly captured in the paper-based system, and hence the electronic health technology can be essential in solving such a technology. Providers need to document the data and consequently share it with the various health providers to ensure patient compliance with the medical care that has been prescribed while at the same time ensure proper management of costs in the health care. There have been proposals by various agencies in the health sector on the need to have IT professionals to assist the health care workers to communicate more effectively in care coordination for better efficiency, cost reduction, and patient safety across the globe.

Today, most patients do not have control over their health records. The introduction of RFID technology can have a great deal in ensuring that issues of privacy and control being at the helm of the issues tackled by the RFID system. Any person making use of the technology need to have a unique personal number also referred to as personal identification pin. This pin is very vital in safeguarding the security and privacy of the health data. RFID also has the benefit of interacting reliable with several other ranges of systems (Menachemi & Singh 2012). RFID technology has the capacity of operating over the Internet to verify information that is saved in the database and can be updated and read offline at the office of the physician. The technology offers a range of benefits in the healthcare sector as shown in figure 2 in the appendix.

The information technology in the health sector also allows an extensive service provision geographic wise, even in low and middle-income countries across the world where there are critical challenges in the shortage of health care providers as outlined by Mantas et al. (2009). To ensure control of costs while at the same time ensuring maintenance of quality, the healthcare sector has adopted systems improvement initiatives like the PDCA (Plan, Do, Check, Act) cycles and the TQM (Total Quality Management). Breakthrough in the technological advances such ads the Electronic Medical Records (EMR) and the Electronic Health Records (ERH) are becoming increasingly used to boost the medical capacity and consequently ensure there is sustainability in the healthcare systems particularly on the information concerning the vast data on the patient. In the United States, the increase in the adoption of EHR arose from the pressure that was exerted by the Obama presidency, which offered $2.5 billion incentives to increase the usage of these systems. Due to this intervention, the number of office-based physicians that made use of the EHR certification through the Office of the National Coordinator (ONC) for Health Information Technology increased to over 100,000 countrywide. A National Ambulatory Medical Care Survey (NAMCS) of physicians found out that 57% across the country make use of some form of the EHR / EMR system. This implies that there is a huge proportion of the population that is yet to adopt the technology. A worse situation is expected in the less developed and developing countries.

Hovenga and Grain (2013) finds that EHR is capable of interoperability between different organisations. However, EMR does not communicate with other EMRs or EHR. The adoption of EHR and EMR has increased redundancy in the updating of manual data. However, the inability of the system to share accurate data remains a barrier in the realisation of return on investment in the use of EMR and EHR. Some of these systems can deliver content that is not modified which may prove difficult for the patient to understand the information that is being communicated. Instead, the RFID technology can be an essential replacement for these systems as it can solve some of the problems experienced in the healthcare sector. The system allows for correction of any wrong information that may be put in the system. This helps in solving the inefficiencies that may be brought about by the use of EMR.

There has been an increase in the use of technology in the health care sector across the globe. The advancement in technology is responsible for the improving condition of health care delivery. A global projection indicates an increasing trend in the revenue generated from the RFID technology across the globe. This is evident due to the increase in revenue which is an indication of an increasing adoption and application of the technology. Graph 1 represented in the appendix shows the global trend in the application and adoption of RFID in terms of the revenue generated with a projection of up to year 2020.

In the context of health care the Radio Frequency Identification (RFID) technology can be employed in many sectors such as bring down the costs of health care and facilitating automation and streamlining the identification process of patients in hospitals. This is possible through the use of mobile devices such as the smart phones (MobiHealth 2011 & Nikita 2012). RFID has several benefits in its application over the traditional bar code system as demonstrated in figure the appendix.

The development of an e-health strategy constitutes certain stages that ensure effective adoption of the strategy. The first stage constitutes a long-term undertaking that is aimed at raising the performance levels of the health sector in every area of service delivery. This stage constitutes a framework that engages the consumers of the health services by ensuring they contribute effectively towards raising the health status of the population across the globe. The technology at large is a tool that is placed in the hands of the health care providers to empower them overcomes the existing barriers insuring quality provision for the health care services. This serves as a means where the managers of the health care can improve the potential of the service in resource mobilisation by having an effective control of resources and demonstrating accountability and efficiency (Gregoire 2006). The second stage involves constant monitoring and evaluation of the effectiveness of the system in meeting the set objectives. Several review reports have shown the need for having the innovation to push for higher performance levels.

2.3 ETHICAL ISSUES

2.3.1 DATA INTEGRITY

Hamilton (2009) argues that the proliferation of the EHR and the data transition across the health information exchanges has opened a loophole for the for data corruption. As these systems become larger and more complex, greater vulnerabilities come in. There is a need to safeguard the information that is found in the electronic system. In several industries such as the health sector, integrity of data is held in high regards, especially in countries that value the privacy of patient’s data. Rectifying the mistakes in the data system can play a greater role in safeguarding the life of patients. One of the basic concerns in maintaining the integrity of the patient information is the maintenance and implementation of a consistent approach to the health information exchanges and proper matching of the patients with their data. Both the patients and the physicians have to trust that the data is up to date and accurate and hence can be relied upon to make a diagnosis.

The escalating complexity in sharing of data and the increasing provision of information across several platforms necessitates the existence of common standards across the world. This requires a concerted effort between the various players in the execution of the technology. Archer et al. (2011) posit that the ultimate solution for ensuring data integrity from end-to-end does not emanate from one company, but requires the involvement of every player in the sector. The information put into the system by one physician needs careful consideration before it is corrupted or edited by another physician. Giv