Introduction

Digitalizing human processes
in the healthcare environment

Today modern hospitals face a wide variety of challenges ranging from rising workforce cost to data management. Digital tools like the CC1 are developed to reduce administrative and repetitive work, to improve safety and help healthcare staff to focus on patient care and communication.

Integrators, technology partners and 3rd party applications

Infrafon aims to build a platform where independent software vendors and IT integrators can work together to deliver a product system, that fits the needs of individual organizations and helps them to overcome the modern healthcare challenges. The product ecosystem is constantly evolving and growing together with a network of partners all over the world.

Security and accessibility

In a healthcare setting there are two important concerns. The first one regarding privacy and data security. The solution by Infrafon makes the case for a closed of system, where sensible information stays on the facility/organization backend, while mobile devices and data transfer are seen as a potential security risk. The CC1 meets those challenges by being an organization operated device, applications and application data is stored on the backend server infrastructure, only data views are sent to mobile devices. End-user control is limited and communication between the device and the backend system is restricted to a structured REST-API dialog. This dialog uses chip level encryption with the NXP secure element 050 edge lock (EAL6+ certified), CL/MIFARE/Wi-Fi credentials and key storage secured by blockchain.

The other important concern is accessibility: With the CC1, Infrafon aims to deliver a slimmed down device using style congruent and simplified data view tasks to make dialog interaction simple and effective. These simplified data views can easily be transformed into audio messages for vision impaired staff.

Staff Workflow

Check-In and Time Tracking

The check-in process automation and the indoor localization feature,open up a whole new perspective on work time evaluation and shift data recording.

Applications enabled by:

Case Example

Nurse Wilson arrives for her early shift, starting in 5 minutes. She checks in with her Staff ID, enters her confirmation key on the number pad and takes her CC1 device, giving her all the access tokens, she needs for the elevator, security doors and medicine storage. 

While she is working her shift, her movement profile is logged and can be used for payroll confirmation. To protect her privacy, while she uses the bathroom or stays in the recreational areas, geofencing prohibits movement tracking. When her shifts ends, she checks out, leaving her CC1 device at the check-in.

Case Example

Nurse Wilson arrives for her early shift, starting in 5 minutes. She checks in with her Staff ID, enters her confirmation key on the number pad and takes her CC1 device, giving her all the access tokens, she needs for the elevator, security doors and medicine storage. 

While she is working her shift, her movement profile is logged and can be used for payroll confirmation. To protect her privacy, while she uses the bathroom or stays in the recreational areas, geofencing prohibits movement tracking. When her shifts ends, she checks out, leaving her CC1 device at the check-in.

Technical Background

Staff check in requires a form of authentication; the scanned information of the ID card is checked with the hospital’s active directory staff data. The entered pin number confirms the claimed identity. While the CC1 device is initialized with the required RFID tokens, the kiosk loges the arrival time into the hospital staff time database. During the use of the device, it sends out a BLE signal which is detected by the multiple BLE sensors inside the building, sent via the Wi-Fi Network to the backend Infrafon server, where this data is used with the WT-Consulting SAS localization algorithm to locate the device and log the movement profile. Geofencing is used to block certain areas to comply with user privacy. When the device is brought back to the kiosk, the staff member is checked out and a full shift documentation is ready to be used to create the payroll document.   

Staff Workflow

Smart Paging

Many hospitals are still operating on analog paging systems, with minimal functionality: Via a stationary Interface a pager number is called, the respective pager beeps and displays the caller’s number.Alarm fatigue is a serious issue, whereby staff is overloaded by alarm signals and becomes desensitized to important calls.  With the CC1 used as a digital pager communication becomes interactive and intelligently selective.

Application powered by:

Case Example

Nurse Wilson needs an orthopedic surgeon asap in the operation room on the second floor in her wing. She logs into the web interface, filters for orthopedic Surgeons and sets the location.  

Surgeon Davies on the right floor receives the message on his device, he has an upcoming operation in a few minutes, so he chooses the decline option on the touch display. The message is routed further to surgeon Brown on the other side of the building, he accepts the request and nurse Wilson is informed about the result.

Technical Background

The basic beeping via a stationary interface (e.g., Cisco connection) is emulated in the Infrafon system. Additional there is a web interface, where you can log in on desktop or mobile and message either the desired CC1 pager directly with the pager number/name or you can filter by location and/or by roll. Through geolocation via BLE (indoor) or GNSS (outdoor) and the connection to the hospital’s active directory every desired staff member in service can be localized and messaged. Receiving the message on the CC1 works in multiple steps: First, a webhook routes the message data to the Infrafon entity server, there it gets converted into a CC1 readable JSON file. The CC1 is subscribed to the respective channel and in a set time interval the CC1 does a lookup for pending messages via the hospitals LoRa network. (LoRa is a low power, long range wireless network built for IoT applications) If there is a message, the device logs into the Wi-Fi and downloads it. The user is then notified by a blinking LED / message sound and the message is displayed on the screen with a set of pre-defined replies. Which are sent back using MQTT protocol again.  

Staff Workflow

Payments

Many hospitals use a variety of payment methods for a variety of vending machine options. Digital tools can help to simplify these processes.

Application enabled by:

Case Example

Dr. Evans and his colleague Dr. Phillips are going for a coffee in the cafeteria, they both simply pay contactless with their CC1 device.

Technical Background

With the passive RFID chip (NXP NTP5210, certification ID 58626), payment with the device, works like contactless card payment. Hospital equipment like electronic wheelchairs can be borrowed and brought back, using the same technology.

Staff Workflow

Medication Description and Sample Collection

The prescription of medication and other forms of treatments is an important workflow, requiring authorization and documentation by doctors and nurses. 

Technology enabled by:

Case Example

Mr. Richard is in examination process with Dr. Brito. Bevor they started Dr. Brito scanned Mr. Richards device to confirm the start of the appointment. First a blood sample is required, so Dr. Brito takes an empty container and scans the NFC label with his CC1. The container is filled and is ready for the laboratory. Next there is a MRT examination planned, for which a contrast medium is required. Since Dr. Brito is the Mr. Richards attending physician, there is no real time authorization by another doctor required. Dr. Brito scans the label and awaits a quick confirmation by the system, while it is checking for any known allergies and cross interactions with Mr. Richards medication plan. The treatment is authorized and Dr. Brito continues.

Technical Background

The CC1 is equipped with the NFC NXP NTP5210 and NFC NXP PN7150 and can be used as an active and passive NFC reader/writer (using Mifare Desfire EV2). 1D and 2D codes can be read with the help of a scanner module. By scanning the patient’s device via NFC, the operating doctor or nurse starts the prescription or sample collecting, the request is, securely encrypted, sent to the backend (via the internal Wi-Fi) and checked for permission. If allowed, the operating doctor or nurse is now able to scan labels of medication with input of the dose via the touch screen, to request a prescription and allocating them to the patients record. This information is then sent and processed by the hospital’s backend, e.g., checked for allergies or cross interactions. Sample collection works similarly: The staff member scans an “empty” label of a sample container and thereby allocates it to the patient data record, without further labeling the sample can be sent to the laboratory, where the results are being automatically written in the database and able to be accessed by the attending doctor.

Staff Workflow

Workplace Safety

Workplace safety is one of many concerns in a high stress environment like a hospital. A digital companion like the CC1 can help staff members to feel safer.

Application powered by:

Case Example

Dr. Audrey is a psychiatrist at the mental health department, she is visiting one of her patients. Bevor entering the conversation, she enables voice streaming on the audio module equipped CC1. She knows if there is a heightened aggression potential in the patient’s voice, she will receive a warning and backup personal assistance.

Technical Background

With the audio module the CC1 is able to record and stream vocal audio to the backend, where this data then can be processed by a neural network to find patterns and in the case of danger to automatically alert staff. The audio module is powered by the CC1’s battery, it records sound and transmits it to the CC1 using a BLE connection. The CC1 encrypts the files and sends it via MQTT protocol to the Infrafon entity server.  

Staff Workflow

Messaging

Application enabled by:

Case Example

Dr. Andrews would like to go to lunch with his colleague Dr. Evans, he knows Evans is in an operation procedure and will not be available until noon. From his desktop or phone, he can use a web interface or application from his preferred messenger and choose to send the message to the Infrafon of Dr. Evans. With the message he has the options to give pre-defined answers. So e.g., he asks “Do you wanna go for lunch?” *Yes/No* and “Where do you want to go” *cafeteria/restaurant1/restaurant2*. This way it will be very easy for Dr. Evans to answer, even in between of medical procedures.

Technical Background

Messaging works very similar to paging. The preferred messaging service, like Netsfere or Trustner messenger, will be extended with a plugin, so CC1 devices can be selected. If a device is selected, a CC1 specific mask will be applied. The message data is transmitted to the Infrafon entity server(using webhook), where a data view(JSON file) is created. The MQTT Server announces a message to the CC1, which performs an interval LoRa lookup and switch to Wi-Fi if to download the JSON file. The device then, via audio or haptic feedback, informs the user about the message. As soon as the messenger data view is opened it displays the message on the touch screen, with the answer options beneath. The device sends back a reading confirmation, which is then displayed as a double mark on the message author side. Like the selected answer, this can also be rerouted to the authors CC1 device.   

Staff Workflow

Access to Medication and equipment

Access to medication storage and medial equipment should be restricted, and often it is required that only certain staff members e.g. only those who are in service at the respective station, have access to the medication storage and equipment.   

Application powered by:

Case Example

Nurse Cooper is the night nurse, after check-in she uses her device to open doors, to get to station 4 where her shift starts. To get the pain medication for Ms. Wallace, she taps her device on the lock panel to open the medication storage. 

Technical Background

When the user checks in, he/she is automatically registered and verified for the respective shift using the active directory data API. The temporary access tokens for the respective station are downloaded on her CC1 and can be updated OTA, using internal, encrypted connection via LoRa / Wi-Fi. When using the device to open the NFC lock, the device automatically sends a notification with information about who and which lock was opened to the backend via LoRa, where it can be stored in a database.

Staff Workflow

Infection Chain Tracking

The global covid pandemic has shown, that one of the most effective tools, to keep infection rate low is to keep track of personal contacts. In a hospital environment, it is even more important to have tools available to document infection chains.

Applications enabled by:

Case Example

There has been a case of covid at the hospital, Ms. Taylor, working in administration, just needs to allocate the case to the CC1 user and authorize the message sending to all physical contacts of said user.

Technical Background

Using BLE beacon signals, every CC1 can detect another signal, given it falls under a certain distance, it processes this information internally and sends it via LoRa or LTE to the backend MQTT where it is further routed to the hospitals server and logged into the respective data base, where this log than can be used to track infection chains. 

Staff Workflow

Survey Design

A solid base of data is the foundation for any management. Digital tools are designed to collect information to help make better decisions.

Case Example

Mr. Smith working in management wants to find a way to improve customer experience, he uses the survey tool, where he can design an individual survey as a data view. He chooses a template, edits the text and selects answer options. He would like to survey older patients a few minutes before leaving. Now he can deploy the survey by selecting age 60+ and a location near the exit.

Technical Background

Surveys can be designed like any other data view. As soon as the user is detected via indoor geo localization using BLE. Data from the active directory using the device ID, parameters like age, gender, staff/patient are checked for a suitable user. The survey data view is then send using the same methods as messaging via the hospitals Wi-Fi infrastructure. The survey answer is then securely transmitted to the backend.

Patients and Visitors

Check-In and Patient journey

Digital solutions for patients and visitors should aim to improve customer experience, to give more individualized treatment, to ensure safety, to save time and to help make communication between staff and patients more effective.

One of the more obvious solutions in the digital age is the reduction of check-in personal, these tasks can be easily managed by terminals with or without human assistance, in fact most people prefer human less interaction for simple tasks, it saves time for the customer and personal cost for the business. Some hospitals are already implementing check-in kiosks, where patients and visitors get a printed ticket or a temporary ID card. This is a great solution for the check-in / identification process, but there is much more unused potential here. The Infrafon system with the CC1 as a mobile smart badge aims to revolutionize check-in and patient journey.

Case Example

Mr. Richard is a recovering cancer patient; he arrives at the hospital for his half yearly check-up and screening. At the entrance he checks in at the self-service dispenser with his health insurance card and confirms with a verification code on the keypad. A few seconds later he is offered his personalized CC1 device. On the e-paper display Mr. Richards sees his home screen, showing his identification and his upcoming appointment with Dr. Phillips. Today Mr. Richard is 30 minutes early for his check-up, as he waits in the cafeteria his CC1 vibrates and a notification pops up: Mr. Richards operational doctor is free and offers to reschedule the appointment, so Mr. Richards doesn’t have to wait any longer. He accepts the invitation, the appointment reminder pops up and he confirms with the “accept” option and leaves for the third floor, where Dr. Phillips awaits him. Because he is very familiar with the hospital, he does not need the provided guiding system, that uses localization and wide LCD screens mounted to the walls and ceilings in every corridor. As he arrives at the elevator, he taps his CC1 against the panel. The doors open and the third floor is already preselected. As he arrives at the checkup room, he sees the big e-paper sign Dr. Phillips name and the new appointment time, he taps the CC1 against the lock panel and the door opens.

Technical Background

At the core of the Check-In process stands the Infrafon kiosk. Check-In requires a form of identification, this could be a pre-sent QR-code, a health insurance card, a passport or just a personal PIN. While checking-in, the provided ID is verified using a REST-API of the hospitals active directory combined with an infrared face identification camera. Using the provided data, the Infrafon Kiosk personalizes a charged CC1 device by initializing it (via Wi-Fi) with a data view ID card (a JSON file converted through the CC1 firmware to a displayable screen) and the other data views respective of the AD’s instruction. Access tokens, according to the user’s permission level, are loaded on to the device and can be updated OTA using wireless communication like LoRa or Wi-Fi, encrypted by the NXP SE050. The CC1 is easily integrated to an already existing appointment application, which is running on the hospitals server and manages, schedules and reschedules appointments. The staff interaction happens via the familiar desktop interface or smartphone application using the internal APIs. The application interface may be extended to mask certain events and adapt it to the displayable options. A webhook then routes the required data to the Infrafon entity server, there the data view JSON file is created. The required device, which is subscribed to a specific MQTT channel does a LoRa lookup every minute. As soon as there is a message, it connects to the Wi-Fi, downloads the JSON file and displays the message. The touch interaction feedback is sent back the same way. All communication between the device and the backend server is end-to-end encrypted.  

Patients and Visitors

Patient Guiding System

Hospital buildings are often hard to navigate through for patients and visitors who are not familiar with the architecture. A patient guiding system prevents long queues at the reception and patients getting lost.

Case Example

The seven-year-old Paul is a patient at the children’s hospital building, he is relatively new and has an x-ray appointment in 15 min, he gets the notification on his CC1 and sees his avatar on the device: an elephant. Now he just has to follow the large wall displays, mounted to every significant way point in the hospital. As soon as Paul comes near the displays his elephant combined with a directional arrow is shown. Arriving at the x-ray section he sees a panel with the elephant and his room number 4, also on the door, his appointment with the doctor’s name and the elephant avatar are shown on the e-paper display. The door opens and Dr. Jones welcomes him.

Technical Background

CC1 devices can be indoor localized using BLE. The device sends a BLE signal, that is read by the BLE receivers nearby. The signal is then routed to the backend server, where it is used to calculate the position. If the user is outside GNSS is used. As soon as the device is detected near a wall display, (which is also connected to the Wi-Fi) it shows the updated directions. If the backend application recognizes that the user is taking a false direction, a notification is sent warning the user. Big e-paper displays (Wi-Fi updated) on the examination rooms, show the appointment data.      

Patients and Visitors

Communication and Feedback

Communication between staff and between staff and patients is one of the main topics of digitalization in the medical environment. With the Infrafon system, the focus is mostly on providing tools for simple and structured dialog, not to replace face to face interaction, but to allow care workers to focus on the essential topics of their communication.

Case Example

Ms. Wallace is a stationary patient, mostly bound to the hospital bed, if she needs something she can just use her CC1, select either the “bathroom assistance” or the . Now nurse Ellen who is assigned to Ms. Wallace station, gets a notification on her device, she opens the message and confirms it. Ms. Wallace gets the feedback on her device and knows her request is taken care of. Later in the morning she gets a notification for ordering lunch, she opens the message and there is the are the three lunch options displayed, normally there would be another one but since Ms. Wallace has a lactose intolerance, the fourth option is already filtered out by the system. She chooses option two and an hour later it is served.

Technical Background

Patient to staff communication through the mobile device is designed to be limited and structured. Most messages will be based on a displayed text with 2-3 selectable options. The process takes place in so called “data views” which are send to the device (via Wi-Fi in JSON format) and then displayed for the user to select option on the touch fields. The selected options are then sent back to the backend, where they are processed and either logged into a database or used build a new CC1 readable JSON file, for another user to give feedback.

Patients and Visitors

Data Collection and Home Care

To provide patients with a more personalized treatment is one of the chances, modern medicine has to offer, to do that, it is important to find ways to collect patient data in a secure and privacy compliant way. These tools can then also be extended outside of the healthcare facility, to pave the way for a comfortable and safe transition from the hospital to the patient’s home.

Case Example

After his cancer treatment a few years ago, it took Mr. Richard multiple weeks to get back to his physically old self. What helped him and his physiotherapist, was the access to his movement and exercise data as well as an overview about his food and drink intake. It especially helped Mr. Richard to stay motivated, because he felt accountable to meet the targeted lifestyle goals. He also decided together with his physician Dr. Phillips and physiotherapist to take the early leave option, where he would take home his mobile CC1 together with a wearable blood pressure and heartrate sensor. Every hour his health parameters and together with his exercise data, is then sent securely encrypted to the hospital, where his operating doctors have access to it. The ability of the device to detect a medical emergency, like a fall, helped him to be more comfortable in his daily life. 

Technical Background

To collect temporary data about the health parameters, the hospitals backend server uses a combination of data from the Bosch accelerometer built into the CC1, as well as the localization methods. If there are digital enabled fitness machines the CC1 is used as identification via the passive NTP5210 NFC or BLE and the data is encrypted and transmitted to the backend MQTT server. Food and drink choices can be logged in combination with the purchases made via the CC1. Health parameter measurements like heartrate or blood pressure can be taken at the patient’s home, using mobile equipment, the CC1s acts as a BLE gateway connection to the equipment and uses the LoRa or LTE secure EAL6+ encrypted connection to the hospital’s backend for transmission.