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Using RFID Technology for Chronic Care

Management and Improvement in Jordanian
Public Hospitals
Bassam Al-Mahadeen

Abstract— There is no precise statistics of people with chronic illnesses in Jordan. As a result, the current delivery system
of the monthly medications for chronic conditions has many deficiencies in current management of diseases such as
diabetes, heart disease, depression, asthma and others. Lack of active follow-up to ensure the best service for patients with
chronic diseases is the main problem. An RFID model for managing the monthly medications for chronic conditions in
Jordanian public hospitals was proposed. This research, which is based on an observational study of mediations for chronic
conditions given to patients with chronic diseases in four public hospitals located in southern part of Jordan, extended over a
period of 20 months, and is expected to help the decision makers to draw the right policies regarding the request of these
medicines. The statistics yielded from the proposed RFID model is of particular importance to help fulfill this need. The
proposed chronic disease management system is expected to control the health care cost, improve the chronic illness care
quality, and provide a comprehensive strategy for restructuring chronic illness care delivery system.

Index Terms— RFID technology, chronic Conditions, RFID reader, RFID tag.

——————————  ——————————

1 INTRODUCTION

C HRONIC diseases are a global challenge. They ac-

count for about 75 per cent of global healthcare costs
and 85 per cent of all deaths. Managing populations
with chronic diseases is a major challenge for developed
as well as developing countries.
Jordan, a developing country located in the Middle East,
has one of the fastest growing populations in the world.
Between the two censuses in 1979 and 1994, the popula-
tion grew from 2.1 to 5.1 million people, an average in-
crease of 2.7 percent annually. At this rate, the population
of Jordan will double in 25 years. The Government of Jor-
dan (GOJ) has recognized that this will place tremendous
strain on Jordan’s health services. Jordan faces several
issues including less than fully functional public health
systems, a significant unmet demand for high quality
health care services and information, and a significant
increase in the prevalence of chronic diseases.
There are three sectors in the provision of health-care
services in Jordan: the public, the private and the interna-
tional sectors. The public sector is composed of the Minis-
try of Health, the Royal Medical Services, the University
of Jordan and the Social Security Organisation. Most hos-
pitals provide primary and secondary health services
with referrals of some patients to the tertiary hospitals
located in the capital city of Jordan, Amman. Primary
Health Centres provide health-care services that include
maternal and child health services, school health services,
and health education [1].
The percentage of Jordanian people with chronic dis-
————————————————
 Bassam AL-Mahadeen is with the Department of Maths & Information
Technology, Tafila Technical University, Jordan.
eases is high. The most common include chronic fatigue
syndrome, chronic osteoarticular diseases (rheumatoid
arthritis, osteoarthritis), chronic respiratory diseases
(chronic obstructive pulmonary disease, asthma), chronic
renal failure, diabetes mellitus, chronic hepatitis, cardi-
ovascular diseases (heart failure, ischemic cardiopathy,
cerebrovascular disease) and others. These patients re-
ceive the prescriptions of their medications every month
on a regular basis. This process of prescribing or request-
ing such medications is not accurate, as there is no accu-
rate number of patients to estimate their needs of each
medicine. The quantity of drugs is, therefore, less likely to
satisfy the actual needs, causing several patients with
chronic disease conditions not to receive their medica-
tions in time. This process of controlling the distribution
of medications for chronic conditions is usually accom-
plished by fixing a monthly note on the patient’s record
once he/she receives his/her medications as shown in
Figure 1. This note details the date of receiving the avail-
able medicines besides the patient’s currently missing
medicines. The patients have to revisit the pharmacy to
check if their missing medicines are in hand or not. There
are no electronic patient records in the public hospitals, or
computer system to manage the process of requesting and
distributing these medicines.
Improving the health of people with chronic illness
requires transforming the system that is essentially reac-
tive – responding mainly when a person is sick – to the
one that is proactive and focused on keeping a person as
healthy as possible. That requires not only determining
what care is needed, but also spelling out roles and tasks
to guarantee that the patient, using structured and

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planned interactions, receives the necessary care. The
proactive system also requires the existence of follow-up
procedure to ensure the follow-up care, and this means
that patients are not left on their own once in home [2].
Fig. 1. Multiple medical files for the same patient.
Effective chronic illness care would be impossible
without information systems that assure ready access to
key data on individual patients as well as populations of
patients. A comprehensive clinical information system
can enhance the care of individual patients by providing
timely reminders for needed services, with the summa-
rised data helping to track and plan care. At the practice
population level, an information system can identify
groups of patients who are in need of additional care as
well as facilitate performance monitoring and quality im-
provement efforts [3].
Radio Frequency Identification (RFID) technology is an
emerging technology that has been successfully applied
in supply chain management, manufacturing, health, en-
terprise feedback control, food safety warranties etc. [4].
RFID technology in healthcare has been used to enhance
patient safety and improve medicine-inventory manage-
ment capabilities [15]. Many hospitals [5], [6], [7] are us-
ing RFID-enabled wrist bands to identify, locate, and ob-
tain status updates on their patients. RFID is also used for
tagging medical devices and placing readers in doorways
at hospitals to minimise time spent looking for these de-
vices and increase their utilisation as a way to improve
the overall efficiency of the hospital.
This paper proposes a cost effective solution for the
management of chronic disease medicines to increase
patient satisfaction and health-related quality of life, have
better disease control and improve clinical process of
care. The solution is based on using the RFID technology
to build a new model for monitoring the distribution of
the monthly medications for chronic conditions and pro-
vide the policymakers with online statistics about the ac-
tual needs of the medications of chronic conditions. This
solution is of use in that it makes sure that the monthly
medications for chronic conditions will be given to autho-
rised patients only. The system should enable the integra-
77
tion and optimisation of resources while improving accu-
racy and minimising patients’ transition, hence improv-
ing the services presented to patients with chronic diseas-
es.
2 CURRENT SYSTEM
Figure 2 shows the flow chart for the current process of
distributing the monthly medications for chronic condi-
tions. When a doctor realises that a patient suffers from a
chronic disease, he prescribes the necessary monthly me-
dications for chronic conditions. The monthly chronic
medicine prescriptions could be given by more than one
doctor, so the patient may have more than one monthly
prescription from different doctors according to their
fields of specialties. A doctor may write the same course
of medication for each month, as shown in Figure 3, and
only one prescription is dealt with by the pharmacist at
the beginning of each month. This process implies that
patients need not visit doctors every month, and this is
likely to avoid them any difficulties that might arise every
month. In addition, some doctors like to see their patients
every six months. This being the case, this process is high-
ly likely to save doctors and patients time and effort.
When a patient goes to the pharmacy to collect his
monthly medications for chronic conditions, he gets the
available medicines only. As for the missing medicines
from the pharmacy counter, the patient is kindly re-
quested to return to the doctor for a replacement prescrip-
tion of the missing medicines. The patient then presents
it to the pharmacist in order to fix a new date to collect
the currently missing medicines. Re-writing a new pre-
scription for the missing medicines is time-consuming for
both doctors and patients. More importantly, the patient
needs to repeatedly visit the pharmacy to check if the
missing medicines have become available. Repeated visit-
ing could prevent patients from taking their medicines in
a timely manner. Added to this issue is the high cost of
transportation if patients come from distant areas.
Due to the unavailability of precise statistics about the
number of people who suffer from chronic diseases, their
needs of each medicine, and the amount of medicines that
are available at pharmacies in hospitals, many patients
may not receive part of their medications for chronic con-
ditions in time, and this could result in more complica-
tions for patients. The absence of a computerised system
to manage and control the distribution of such medicines,
and the failure to keep the pharmacists informed of the
required amount of each drug – so that they order the
right quantity of each drug in a timely manner – are the
main contributors to this problem, timely access to medi-
cines for people with chronic illnesses.
Due to the absence of electronic medical records in pub-
lic hospitals, some patients may retain more than one pre-
scription for the same month, and keep more than one
personal medical record. Driven by the fear of having no
medicines left in the following months, many patients
may replace more than one prescription in the same
month from the pharmacy. Patient stockpiling of medi-
cines will very likely deprive other patients from having
their medicines at the scheduled time.
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The cost of medicines for chronic conditions covered by
the government is very high and constitutes a high ratio
of Jordan’s national expenditure As well, the delay in the
distribution of such medicines potentially cause compli-
cations for patients with chronic conditions. Thus we
propose a system to manage the distribution of such me-
dicines more effectively and to ensure that medicines are
administered only to those patients requiring them and
avoid stockpiling.
Fig. 2. Current system of the monthly chronic system distribution.
The proposed solution to manage medicines for chronic
conditions is based on the employment of RFID technolo-
gy. The premise is to build a database of patients with
chronic conditions to provide the latest statistical infor-
mation to policymakers and stake holders about the sta-
tus of patients, each type of chronic condition and asso-
ciated medicines. This information would provide evi-
dence for appropriate medicine requirements over time.
In the proposed system, each patient with chronic condi-
tions is given a tag with a unique ID to identify them and
their required medications. The patient’s tag can be used
directly by the pharmacist to access the patient database
and retrieve the patient’s information and medicines
without the need of using any prescription. For any miss-
ing medicine, the patient will be able to come directly to
the pharmacy without returning to the doctor for a new
prescription This process will be of great significance, in
that it saves doctors’ and patient’s time and effort.
78
Fig. 3. Scanned document of multiple monthly prescriptions for the
same patient.
3. RFID TECHNOLOGY
RFID stands for Radio Frequency Identification and it is
a term that describes a system of identification. RFID is
based on storing and remotely retrieving information or
data [8]. A typical RFID system consists of tags, readers,
application software, computer hardware, and middle-
ware [4]. RFID tags store unique identification informa-
tion of objects and communicate the tags so as to allow
remote retrieval of their ID. RFID technology depends on
the communication between the RFID tags and RFID
readers. The range of the reader is dependent upon its
operational frequency [9] [10]. Usually the readers have
their own software running on their ROM, and they also
can communicate with other application software to ma-
nipulate these unique identified tags. Basically, the appli-
cation which manipulates tag deduction information for
the end user communicates with the RFID reader to get
the tag information through antennas [10]. RFID middle-
ware that interprets tag information to communicate it to
the application software, and application software are
integrated in a manner to form an RFID solution [9][11].
The main components of an RFID system are:
3.1 Tags and antennae
RFID tag consists of an integrated circuit with memory,
which is essentially a microprocessor chip capable of
holding stored information [4]. RFID tags can be active
(with batteries) or passive (without batteries). The tag has
an identity (ID) that can be broadcast to a reader that is
operating on the same frequency and under the same tag
protocol. RFID antennae collect data and are used as a
medium for tag reading between the tag and the reader
[12]. As well, RFID antennae have a reading range both
sideways and in front of the antenna. The antennae draw
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energy from the reader’s signal to energise the tag and
send the data that are received from the readers.
3.2 Reader
RFID reader works as a central place for the RFID sys-
tem [12]. RFID reader can read data from and write data
to compatible RFID tags. Upon receipt of the RFID read-
er’s radio signal, a tag sends information stored in its
memory back to the reader. The reader then converts the
data into digital information and forwards it to the ap-
propriate application. Communication between tag and
reader enables the location information of an item to be
recorded and transferred to a server through a computer
network, thus allowing the movement of the item to be
tracked or traced [4].
3.3 Communication infrastructure
Communication infrastructure is a collection of wired
and wireless network communication that carries out a
series of information transfer actions that deliver the data
that are stored in a tag to the reader.
Using RFID in healthcare may have a great potential to
reduce operating costs, and improve medical services and
patient safety. RFID allows the wireless storage and au-
tomatic retrieval of data. Such a system has the potential
to help boost supply chain efficiency, improve security,
reduce theft and counterfeiting, increase asset visibility,
enhance inventory control, and automate stock reple-
nishment processes [12].
Although tagging objects, such as medical equipment,
drugs, etc., is a potential area for RFID in hospitals, the
tagging of patients involves both more value and more
challenges, data collected from tagged patients may help
improve medical processes, decision making, and re-
source management. Equipment tagging may be easier in
that experience from manufacturing and retail is already
available. Tagging people is more challenging because it
involves patients, physicians, medical know-how and
practices, and organisational issues [12].
4 RFID TECHNOLOGY IN HEALTHCARE
RFID technology can provide new capabilities and effi-
cient methods for several applications in healthcare. The
RFID system should enable the integration and optimisa-
tion of resources while improving accuracy and minimi-
sation of patients’ transition time (the time needed for a
patient to get service), and this leads to improvements in
patients’ services. The application of RFID in healthcare
could save important resources that can further contri-
bute to better patient care [14]. Moreover, RFID applica-
tions could reduce the number of errors by tagging medi-
cal objects in healthcare setting such as patients’ files and
medical equipment tracking in a timely manner. Improv-
ing the situation for patients care by integrating medical
objects involved throughout the patients’ care is also an
advantage of RFID.
Adapting RFID technologies in hospitals has progressive-
ly become a trend. Medication errors and adverse drug
79
events could be prevented by building a safer healthcare
system. Such technology could be used to reengineer the
inpatient medication process to improve the efficiency of
hospital management and increase higher quality of pa-
tient care [16].
The RFID technology can facilitate the building of the
u-healthcare (ubiquitous healthcare) environment, pro-
vide strategic services to patient-centered recording, use
medical data for cooperative care, process integrated de-
cision support through current medical knowledge and
comprehensively use patient data for research and
healthcare reporting [11]. The use of RFID technology
together with a wireless networking system allows medi-
cal assets within the hospital to be managed and con-
trolled from a fix location. Medical assets can be tracked
and monitored to control the misplacement of resources
and reduce their loss, achieving an optimal use of re-
source management. It provides direct and continuous
identification, position and tracking of patients, drugs
and assets at the right time all the time. A standardised
RFID software network architecture is used to convert the
data gathered by RFID into information. This information
is then processed by the back-end system into useful
knowledge that could be used in the organisation’s deci-
sion-making process.
5 THE PROPOSED SYSTEM
In the proposed system (refer to Figure 4) each patient
who is diagnosed with a chronic condition requiring
monthly medications is given a RFID tag with a unique
patient ID. All monthly medications for the chronic condi-
tions are documented on the dedicated database of pa-
tients with chronic illnesses, with their patient informa-
tion. When a patient comes to the pharmacy for his
monthly medicine, the system’s database is accessed for
validation using the patient’s tag, and the patient’s record
is retrieved automatically. The available medicines are
given to the patient and a note is placed on the patient’s
record beside each medication. For missing medicines,
the patient comes later directly to the pharmacy without
the need to see the doctor again to write a new prescrip-
tion for the missing medicines.
Travelling from distant areas to check the availability of
the missing medicines is not cost effective and often pa-
tients do not return for the missing medications, thus im-
pacting on their health. A suggested solution is the use of
mobile phones in rural communities as the majority of
patients do use these devices. The system can use short
messaging service (SMS) through mobile phones to com-
municate patients upon the arrival of the missing medi-
cines at the pharmacy counter, as in Figure 5. Therefore
patients would no longer need to make frequent visits to
a pharmacy to get the missing medicines. Patients’ visit to
the pharmacy would be timed by the availability of the
missing medications via the SMS system. The flowchart in
Figure 6 summarizes the new process of the proposed
system.
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Fig. 5. Patient notification via SMS.

Fig. 4. RFID infrastructure of medications for chronic conditions

management.

The proposed RFID system will supersede the current pa-

per-based distribution and management of chronic medica-
tions, and will guarantee an optimal way for the manage-
ment of these medicines. The system will ensure that only
authorised patients are given their chronic medications,
achieving better health quality for patients with chronic
conditions. It is proposed that the system will also provide
on-line and immediate up-to-date statistics for stake hold-
ers and policymakers about patients, chronic illnesses, and
the extent of chronic conditions in the population. As well,
the system will provide more accurate predictions about
medication quantities required for the next coming
months. Thus it is hoped that patients will avoid illness
consequences due to medication shortages.
Fig. 6. Proposed System of the monthly chronic system
distribution.

6 CONCLUSION
This proposal is mainly concerned with demonstrating
the significance of introducing and integrating RFID
technology into Jordanian public hospitals. The author is
calling for the RFID technology to distribute medications
for chronic conditions to patients. To this end, a new
model is proposed to electronically regulate the distribu-
tion (on the part of pharmacies) and collection of medi-
cines (on the part of patients). The employment of this
model in Jordanian hospitals, which centres on replacing
paper-based records with electronic records, would be of
crucial significance, in that it would guarantee that only
eligible people would receive medications for chronic
conditions. Under the absence of dependable electronic
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records, medications for chronic conditions could be dis-
tributed to non-entitled people, and this would be at the
expense of those who are really entitled. Equally impor-
tantly, it would be financially and physically unbearable
for patients with chronic diseases to frequently visit
pharmacies to inquire about the availability of the un-
available medicines, bearing in mind that the recipients of
medications for chronic conditions are assumed to be suf-
fering from never-ending diseases. With this in mind,
going repeatedly hence and forth between home and
pharmacies to inquire about medicines would add insult
to injury on their part. In order to avoid patients with
chronic diseases disappointment and do all we can do for
the sake of their comfort, RFID technology was suggested
to be fruitfully employed in Jordanian hospitals. A tech-
nical explanation of how this model operates was pro-
vided, though I strategically aimed to communicate the
technical details in a non-technical way as a way to guar-
antee the reception, on the part of non-specialists, of the
signal of this piece of research.
[12] W. Shang-Wei, C. Wun-Hwa, O. Chorng-Shyong,L. Li, C. Yun-
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2006.
[13] Y. Meiller, S. Bureau, “Logistics Projects: How to Assess the
Right System? The Case of RFID Solutions in Healthcare,”
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