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Int. J. Production Economics 112 (2008) 601–613


www.elsevier.com/locate/ijpe

Evaluating the business value of RFID: Evidence from


five case studies
Shiou-Fen Tzeng, Wun-Hwa Chen, Fan-Yun Pai
Graduate Institute of Business Administration, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, Taiwan, ROC
Received 28 February 2006; accepted 25 February 2007
Available online 9 June 2007

Abstract

This paper presents an in-depth analysis toward understanding the business value components an organization can
derive from adopting radio frequency identification (RFID). Although this subject is currently a hot topic, many
organizations are slow in warming up to the idea of using RFID to conduct more effective and efficient business processes.
We propose a framework for evaluating the business value of RFID technology, hoping that a better understanding of the
business value of RFID will encourage more organizations to implement it. Emphasis is on delivering business value
through refining business processes and expanding the business model. We illustrate these concepts drawing on the
experience of five early adopters from the Taiwan healthcare industry and formulate this framework as a set of
propositions based on relevant literature, cases from pioneers in the field and our intuition. These propositions will need to
be validated through empirical evidence.
r 2007 Elsevier B.V. All rights reserved.

Keywords: Radio frequency identification (RFID); IT business value; Business process reengineering (BPR); U-healthcare

1. Introduction considered to be the next wave of the IT revolution.


An RFID can allow any tagged entity to be mobile,
Information technology (IT) is one of the most intelligent and communicate with an organization’s
important resources in creating organizational value overall information infrastructure (Curtin et al.,
(Kohli and Devaraj, 2004) through its capability to 2007). Its applications are not a new phenomenon.
transform the nature of products, processes, com- The British Royal Air Force (RAF) used RFID-like
panies, industries and even competition itself technology in World War II to distinguish between
(Porter and Millar, 1985). Owing to its ‘‘MOST’’ enemy and friendly aircraft (Asif and Mandviwalla,
(mobility, organizational, systems and techno- 2005). Most recently, it is gaining importance and
logies) characteristics, radio frequency identification popularity in many areas such as marathon races,
(RFID) has received considerable attention and is airline luggage tracking, electronic security keys, toll
collection and asset tracking, etc. (Angeles, 2005;
Ericson, 2004; Karkkainen, 2003; Srivastava, 2004)
Corresponding author. Tel.: +886 2 33661048; and is considered to be the next revolution in
fax: +886 2 23625379. supply-chain management (Srivastava, 2004) and the
E-mail address: d90741004@ntu.edu.tw (S.-F. Tzeng). healthcare industry (Ericson, 2004).

0925-5273/$ - see front matter r 2007 Elsevier B.V. All rights reserved.
doi:10.1016/j.ijpe.2007.05.009
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The RFID is expected to add intelligence and  Present a framework for evaluating the business
capabilities to organizations by its identification, value of RFID applications.
tracking and tracing nature. It can acquire a vast
array of location and property information through The paper is organized as follows: Section 2
entities that can be physically tagged and wirelessly presents an overview of pertinent literature on
scanned (Curtin et al., 2007; Weinstein, 2005). As RFID, IT business value and IT applications in
the various entities associated with business pro- the healthcare industry. Section 3 reports the
cesses become increasingly mobile in the presence of research method. Five healthcare institutions are
RFID, the ability of the organization to monitor the investigated in Section 4. Based upon our findings,
location, history and changing states of these tagged we present seven propositions in Section 5. Finally,
entities increases the level of process freedom (Keen Section 6 presents our conclusions and some
and Mackintosh, 2001). The strategic importance of thoughts for future research.
RFID applications cannot be underestimated. The
rapid pace of adoption and advancement of RFID
creates opportunities for new and innovative 2. Relevant concepts from the literature
services provided through RFID infrastructures.
The emergence of RFID is expected to drastically The preliminary step in this research was to
affect a number of industries and impact their review four existing streams of research to gain an
strategic management (Curtin et al., 2007). understanding of the source of value creation in
Both academics and practitioners are keenly RFID applications. These streams of research are
aware how organizations can extract business value RFID technology, IT business value, business
from RFID (Weinstein, 2005; Curtin et al., 2007). process reengineering (BPR) and IT applications
They include mechanical and electrical engineering in the healthcare industry.
(Glidden et al., 2004), systems and software
engineering (Juels, 2004), health management 2.1. Background on RFID
(Thompson, 2004), marketing and customer rela-
tionship management (Compton, 2004). Among the RFID is an emerging technology intended to
questions being asked are how can our business replace traditional barcodes in many ways (Asif and
integrate RFID into existing lines of business? How Mandviwalla, 2005; Chuang, 2005; DoIT, 2004a–c,
can we use RFID to reduce costs and increase Wang et al., 2005). Its wireless tracking nature
competitiveness? How can RFID impact internal allows a reader to activate a transponder on a radio
and external business processes? What are the new frequency tag attached to, or embedded in, an item
business opportunities enabled by RFID? This allowing the reader to remotely read and/or write
paper aims to develop a framework for evaluating data to the RFID tag (Das, 2002; ITAA, 2004;
the business value of RFID applications. The Want, 2004). It enables organizations to deliver
research question that underlies this study is value-added applications related to the tracking and
‘‘How should one evaluate the business value of intelligent management of any entity tagged with an
RFID applications?’’ We will propose some re- RFID chip. The technology has been around for
search propositions based on our case studies. These more than 50 years; however, it has not been widely
propositions form the basic framework for further used. Since 2003, when Wal-Mart announced its
research into RFID applications. intention to introduce an RFID application, it has
Research to assess the strategic impact of RFID brought new business opportunities to many in-
on organizations is scarce. This paper is a step formation companies (Chuang, 2005). With both
towards filling this gap. It presents the results identification and tracking characteristics, RFID
derived from case studies identifying the value of may dramatically change an organization’s cap-
RFID in five healthcare organizations and shows ability to obtain real-time information about the
how RFID can have a strategic impact and create location and properties of tagged object(s), such as
business value. The research problems are as people or products (Angeles, 2005; Karkkainen,
follows: 2003). Current research and development on RFID
focus on the manufacturing and retail sectors to
 How should enterprises evaluate the strategic improve supply-chain efficiency and to learn more
implications of RFID applications? about consumer behavior. Healthcare is considered
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to be its next home (Chuang, 2005; DoIT, 2004a; Davenport, 1993). In brief, IT is treated as the
Wang et al., 2005). trigger for process innovation. On the other hand,
Although highly praised as the next wave of process innovation is regarded as a catalytic agent
innovative technology, RFID is not yet widely for the business value of IT resulting in higher
accepted in practice. Based on a survey by the productivity. In addition, IT business value and
Advance e-Commerce Institute in Taiwan related to organizational business strategies are closely con-
the RFID applications in Taiwan’s Top 5000 nected. However, IT itself cannot be responsible
enterprises, most enterprises are aware of RFID, for the ultimate success or failure of enterprise
but not ready to use it yet. Those who have a better strategies (Chan and Huff, 1993; Grabowski and
understanding, or have read RFID-related docu- Lee, 1993).
ments, are in the logistics industry (60%) and the BPR can be defined as the fundamental reconsi-
healthcare industry (33.3%). Only 8% of enterprises deration and radical redesign of organizational
are currently using RFID-related applications. processes in order to achieve drastic improvement
Most RFID applications are for warehouse man- of current performance in cost, service and speed
agement (66.7%) and production processes (Hammer and Champy, 1993). It is described as the
(33.3%). The survey shows that most enterprises fundamental rethinking and radical redesign of
do not have innovative RFID applications now in business processes to achieve dramatic improve-
Taiwan (DoIT, 2005). It seems that most Taiwanese ments in critical, contemporary measures of perfor-
enterprises are still waiting for RFID applications. mance, such as cost, quality, service and speed
(Hammer and Stanton, 1999). BPR is not new. It
2.2. IT business value and BPR has been around for some time. IT acquisition plays
an important enabling role in most process reengi-
Tapscott and Caston (1993) argued that IT has neering projects (Davenport, 1993). Many proposed
become the most important enabler to enterprise theories exist about BPR, such as MRP, MRPII,
activities including structure, operation and man- ERP and SCM.
agement. Topics of hot discussion are how IT will Research in electronic data interchange (EDI)
change the business process and if it will bring about usage showed that integrating EDI with process
the expected effects (Barua et al., 1995; Brynjolfsson redesign results is more benefits than EDI alone
and Hitt, 1996; Chan and Chung, 2002; Dewan and (Clark and Stoddard, 1996; Riggins and Mukho-
Kraemer, 1998; Gunasekaran and Nath, 1997; padhyay, 1994). Similarly, RFID will require
Lockamy and Smith, 1997; Melville et al., 2004). considerable process redesign at all stages in the
The relationship is not significant between IT value chain where the technology is applied
investment and performance. Some studies show (Chuang, 2005). The characteristics of RFID can
that more IT investment would yield a better make objects become intelligent and processes
performance, but other studies have opposite results automatic. Thus, RFID can reduce the cost of
(Barua et al., 1995; Bloch et al., 1996; Hitt and collecting data on the front line and improve
Brynjolfsson, 1996; Bharadwaj et al., 1999; Sircar efficiency. As with other information systems,
et al., 2000). RFID is not simply a hardware or software
With regard to productivity of IT or business purchase, but a tool. Unlike barcode systems, it is
performance, most of the studies measure the value necessary to implement BPR with an innovative
by output results of business level, which merely spirit on the fundamental processes before imple-
provides limited understanding in terms of the value menting RFID to achieve greater synergy. Similar
generated by IT (Mooney et al., 1996). Since the to the implementations of ERP, some IT companies
productivity factor cannot totally measure the believe RFID systems will create competitiveness
benefits of IT, the best way to explore the effect of for enterprises after the ERP and SCM systems
IT on the organization gradually transfers from an implementation (Guo, 2005).
output-focus study to a process-oriented approach
(Banker et al., 1990; Banker and Kauffman, 1991; 2.3. IT applications in the healthcare industry
Mooney et al., 1996). The critical factor for IT
investment to achieve business value is the relation- The Internet is one example of how technology
ship between IT and process reengineering (Daven- applications continue to advance healthcare. How
port and Short, 1990; Hammer and Champy, 1993; people give and receive health information, and the
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healthcare and E-commerce solutions that will provide strategic services to patient-centered record-
penetrate all areas of healthcare are changing with ing, use medical data for cooperative care, process-
the Internet. Many surveys indicate more customers integrated decision support through current medical
are surfing the Internet to access healthcare knowledge and comprehensively use patient data
information, services and advice on particular for research and healthcare reporting.
diseases, treatment regimens, or improving their
own health management (HIMSS, 2003). Web-
enabled applications also improve medical practice 3. Research methodology
by monitoring vital signs via devices to strengthen
care delivery, improve communications between This research aims to study the strategic and
physician and patient, and support clinical decision organizational impacts of RFID technology. To
and disease management using Internet solutions. date, most of the research on RFID has been
Successful cases include cancer research, which focused on the description of its real-life applica-
creates a national database for the ease of monitor- tions in various settings; however not much research
ing cancer treatment and the sharing of new on the theoretical framework has been proposed.
discoveries, and diabetic clinics, which create auto- Hence, we adopt the case research approach to
matic diagnosis programmers (Rohm and Rohm, exploit a new theoretical framework. A case study is
2004). Another significant achievement is the exten- an ‘‘empirical inquiry that investigates a contem-
sion and evolution of electronic health records. porary phenomenon within its real-life context,
In recent years, recognized shifts in information especially where the boundaries between the phe-
and communications technologies have taken place nomenon and context are not clearly evidenced’’
from the Internet to mobile computing. The major (Yin, 1994). Case studies are a valuable tool for
transformations, triggered by technological changes examining a contemporary phenomenon, especially
and convergences, introduced a new e-health one that is not clearly understood, asking how and
innovative application—m-healthcare. m-Health- why questions, and capturing the context.
care is defined by a range of mobile technologies In 2003, SARS caused panic across all Asian
applied to healthcare: wireless network infrastruc- countries. Countries as far away as Canada were
ture, mobile computing and handheld devices and also infected. Thirty-seven patients died from SARS
mobile applications (Tessier, 2003). Predictably, and some of the attending doctors and nurses were
m-healthcare has an enormous potential to greatly also infected with SARS in Taiwan. The outbreak of
increase the volume of current e-healthcare applica- this serious disease left the safety of patients,
tions (Smaling, 2003). doctors and nurses as a critical issue. Hence, under
The ubiquitous computing revolution, which is the supervision of the Department of Industrial
considered an IT to fuse real space and cyberspace Technology, Ministry of Economic Affairs in
based on the networks among existing things in the Taiwan (hereafter, DoIT), several hospitals were
real world, has been conducted over the whole granted research funds to support the implementa-
of society (Watson, 2000; Watson et al., 2002). tion of RFID to fight the potential spread of SARS.
U-commerce, also referred to as ‘‘ubiquitous As requested by the advisory committee of the
commerce’’, is a new paradigm that extends the DoIT, each hospital is required to choose different
Internet era by providing ubiquity, universality, healthcare improvement projects so that, as a
uniqueness and unison (Accenture, 2002; Galanxhi- whole, they will represent a complete picture of an
Janaqi and Nash, 2004). RFID and the electronic all-RFID-ready hospital. Since then, the DoIT
product code network (EPCglobal) increase the continued its support on RFID applications in the
ability to compare, identify, track and care for healthcare industry for other healthcare procedures
patients in hospitals. The healthcare industry will so as to provide better and safer medical services to
move from e- to u-healthcare. u-Healthcare is patients. In total, more than ten hospitals have
ubiquitous collecting of data, unique healthcare already participated in this program. In this
planning for every patient, universal caring for research, however, we only choose those hospitals
patients in either hospitals or homes and uniting of that have already finished their projects so that the
protecting patients from disease and doing physical real impacts can be measured. Hence, all of the
rehabilitation. The RFID technology can facilitate hospitals with completed projects are discussed here
the building of the u-healthcare environment, (see Table 1).
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Table 1
Key characteristics of the RFID applications studied

Taipei Medical Taipei Minicipal En Chu Kong Show Chawn Koo Foundation
University Hospital WanFang Hospital Hospital (ECKH) Memorial Hosptial Sun Yat-Sen Cancer
(TMUH) (WFH) (SCH) Center (KCC)

Project Location-based Wireless PDA & RFID intelligent Intelligent digital Specialized
medicare service RFID system for healthcare platform health network healthcare system
emergency room
observation
RFID-based blood Healthcare industry Inpatient
bag and resource RFID application management system
management system system
Goal SARS prevention Patient safety Sickroom safety SARS prevention SARS prevention
Application SARS prevention Emergency system Inpatient SARS Prevention Entry and Exit
and isolation medicine inspection Management Waste and Isolation Control Exhibiting
and audit Management Healthcare Institute SOP Management
Start date 2003/10 2004/01 2004/01 2003/10 2003/10
Sponsor Ministry of Department of MOEA MOEA MOEA
Economic Affairs Health
Implement Corporate with In house Corporate with HP Outsourcing Outsourcing
NTU, III and PK
technology
Establish IT
consulting company
Outcome Success Partial success Partial success Success Success
low usage in wireless technology
emergency room cannot use in surgery
room

As for the in-depth interviews, since one of the implementation team members attending the meet-
authors serves as the chief reviewer for the DoIT ings. From time to time, we also conducted on-site
program, we were able to easily setup in-depth visits to observe the utilization of the RFID system
interviews with those involved in the RFID projects. in real-life settings. The DoIT required all system
The interview procedure was semi-structured to and project-related documents to be kept for each
keep the structure of the interview open to allow meeting. Some other documents including the
interviewees to say what they wanted to share with satisfaction survey of all stakeholders (i.e., patients,
us. During the interview, we recorded or wrote doctors and nurses) were also reviewed there.
down interviewees’ opinions. Each interview took To enhance the rigorousness of the study, we
around 1–2 h and, if deemed necessary, we used followed the principles of data collection proposed
either e-mail or telephone to obtain more informa- by Yin (1994):
tion from the subjects. Managers in the hospital
were the main subjects of the interviews; they  Use multiple sources of evidence. Multiple data
usually held positions as either the vice super- sources can contribute to a high degree of
intendent or the CIO of their hospitals. To increase construct validity. In our case study, we inter-
the data reliability and depth, we also interviewed viewed both nursing staff and project managers,
consultants (most from well-known companies such who were provided with devices to support their
as Hewlett-Packard) who helped implement the activities and to enhance services. We also
RFID project, and the project managers and observed the nursing staff’s use of such devices
assistant managers of the companies in charge of when they were interacting with customers. In
system integration (see Table 2). addition, we used archival records such as annual
As for the field observation, throughout the reports and the company website to provide us
2-year implementation period, we conducted quar- with a more in-depth understanding of the
terly review meetings with each of the hospitals organization, and to substantiate and comple-
studied with most of the major decision makers and ment the results of the study.
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Table 2 he/she was in close contact with infected patients


Interview subjects out of the isolation area. If the system detected any
Case Position Their role Interview
event likely to violate the disease isolation policy, an
(hospital) in RFID date alarm signal would immediately trigger and a
Project related standard operating procedure (SOP) would
be launched.
TMUH Vice Information Project 2005/03/04
The main purpose for TMUH in implementing an
Leader
Superintendent 2005/05/20 RFID system was to monitor physiological signals
and track the paths of infection sources to know
WFH Vice Project 2005/04/20
Superintendent Leader
with whom the infected patients had contact. Also,
Vice Department Project 2005/04/20 this system further combined GSM, GPRS, PHS
Director Manager and CDMA to trigger an alarm that initiated the
SOP to prevent an epidemic spread of the disease
ECKH Department Project 2006/07/19
Director Manager and maintain the safety of healthcare personnel.
The LBMS system was characterized as infrastruc-
SCH Senior Project 2005/06/15
ture like. The hospital expected to develop other
Commissioner Manager
2005/06/22 applications based on this RFID system in addition
to preventing the spread of SARS.
KCC Department Project 2005/07/07
TMUH launched another RFID system in 2006,
Director Manager
an RFID-based blood bag and resource manage-
ment system. This system was based on LBMS to
control blood bag circulation and take care of
patient safety by integrating the hospital informa-
 Creating a case study database. A case study tion system and healthcare industry experiments.
database helps to increase the reliability of the Thus, the hospital constructed an ‘‘intelligent blood
case study (Yin, 1994). In our study, we bag management system’’ and ‘‘secure move health-
maintained case study notes by taking notes care system’’ to meet the operational requirements
during the interviews. We also audio recorded of the Chinese Blood Donation Association. Mean-
the interviews for documentation purposes. Our while, ‘‘RFID-based platform system’’ was estab-
case study documents also included company lished to exchange-related information with other
background information and company annual hospitals.
reports.
4.1.2. Wan Fang Hospital
Wan Fang Hospital (WFH) was the first build-
4. Case discussion and analysis operate-transfer municipal hospital in Taipei. Es-
tablished in 1989, it currently has 740 beds. In 2003,
The implementation of an RFID system for each WFH proposed the ‘‘Wireless PDA &
case is described in this section, including case RFID system for emergency room.’’In past patient
introduction and the process analysis for imple- satisfaction surveys, the emergency room was
menting RFID. This section ends with a summary, always the area that performed the worst and had
comparison and analysis of these cases. the most medical disputes. The RFID system was
therefore first introduced to the emergency room.
4.1. Introduction and discussion of the case studies All patients that enter the emergency room are
given a passive tag that stores the patient’s ID
4.1.1. Taipei Medical University Hospital number. Once a reader has been used to validate the
Established in 1967, Taipei Medical University patient’s identity, it is used to access medical-related
Hospital (TMUH) is a 435-bed retrial medical care information downloaded through a PDA.
institution aimed at patient care, clinical teaching The main goal for WFH in implementing an
and medical research. In 2003, TMUH proposed a RFID system was to improve treatment quality and
framework of ‘‘location-based medical service sys- patient satisfaction at the hospital. By making
tem (LBMS)’’ to track a patient’s identification, patient safety the starting point, the risk to patients
path of motion and location to identify whether posed by incorrect treatment, incorrect diagnosis
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and delays in treatment was reduced. Emergency decisions are based on the ideal of humanitarianism,
room personnel are also able to confirm the identity with the patient’s welfare being paramount. As a
of patients and know at all times their current phase group, cancer patients have depressed immune
of treatment. If improving patient identification can systems making them more vulnerable to infection.
improve patient safety, then a reminder system for KCC has always sought to introduce new technol-
patients’ physiological data can be used to monitor ogies to improve their capability to control in-
the patient’s condition in real time. fectious diseases. During the SARS outbreak, for
In 2006, WFH launched another RFID system— example, the center invested a great deal of man-
Healthcare RFID application system. This drew power and resources in defending patients from the
mainly on the experience of the existing RFID disease. KCC therefore participated in the Ministry
system to develop a prototype system for medical of Economic Affairs’ demonstration development
auditing and the emergency medical system. project in hopes that the introduction of new IT
Through the attempt to connect the intra- and technology would help improve the hospital’s
extra-hospital systems, a full understanding was management capability. At KCC, its RFID applica-
gained of how RFID could be applied to the tions focus on access control and drug dispensing
medical treatment and care industry. SOPs. Hospital workers are equipped with active
tags. In the future, this access control system will be
4.1.3. Show Chwan Hospital expanded to include the entire hospital.
Show Chawn Hospital (SCH) was established in The main goal for KCC in implementing an
1973 and is now a regional hospital with 717 beds. RFID system was to be able to track the spread of
In 2003, the SARS outbreak led to public panic, infection and prevent its outbreak. RFID is there-
causing not only patient deaths, but also medical fore used to provide access control for people at the
worker concerns. Protecting the lives of patients and hospital to ensure a safer medical environment.
medical workers therefore became the most critical Since the cancer patients at KCC use a complex
issue. In response, SCH began looking at the variety of drugs, in the interest of improving patient
possibility of ‘‘long-distance’’ and ‘‘non-contact’’ safety, the drug dispensing process that previously
medical care models. SCH therefore collaborated used manual checks was revamped. The verification
with the Ministry of Economic Affairs’ technology of patient identity and confirmation of the SOP
specialization initiative to establish an RFID reduces the risks from insufficient medical oversight.
project. Their goal was to build the ‘‘Intelligent
digital health network.’’ All RFID tags used at the 4.1.5. En Chu Kong Hospital
SCH are the active type. Patient permission was En Chu Kong Hospital (ECKH) was established
requested in advance when fitted with the RFID tag. in 1973 and is today a regional teaching hospital
The main goals for SCH in implementing an with 501 beds. It follows the concept of ‘‘treating
RFID system was to carry out patient temperature patients as our family members and honored
monitoring for potentially infectious patients who guests’’ to provide high-quality medical service.
carried a fever, access control of workers, patient While promoting a policy for mothers and their
and medical worker tracking as well as tracking the babies to share a room, it was discovered that many
movement of hospital waste in transport. The mothers were worried about the possibility of baby
remote data link feature of RFID was also used at snatching from open hospital rooms. ECKH there-
Changhua Senior Citizen Home. Since the senior fore sought a solution suitable for hospital room
citizen home has a shortage of care personnel at management and patient safety. In 2005, the ‘‘RFID
night, RFID can be used to transmit the physiolo- smart medical platform’’ was applied to inpatient
gical data and movements of bed ridden or surgical safety management, infectious waste man-
handicapped patients to the SCH information agement, outpatient management and newborn
system. The data can then be monitored at SCH management. Active RFID wrist tags were used
and action taken if required. for newborns, while passive wrist-tags were pro-
vided for inpatients.
4.1.4. Koo Foundation Cancer Center The main goal for the ECKH in implementing an
Koo Foundation Cancer Center (KCC) was RFID system was to use technology to help the
established in 1989 as a not-for-profit charity hospital redesign its SOP to provide patients
health organization. All administrative or medical with a more comprehensive set of silent protective
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measures. Through wireless communications and intelligent and automate processes, RFID helps to
automatic scanning functions, the ECKH is now reduce the cost of collecting data and improve
able to monitor and manage incidents without operational efficiency. The implementation of
interfering with existing operations or requiring RFID is not just buying hardware and software;
extra manpower. rather it requires the organization to undergo BPR
with an innovative spirit in order to achieve the
4.2. Synthesis greatest synergy. Though beginning as a tool to
achieve operational efficiency, some practitioners
Analyzing the information from these cases believe that RFID could become the next major
reveals the following common traits: weapon for organizations to gain strategic compe-
titive advantage.
 Adoption of RFID results in a dramatic change The integration of RFID technology and enter-
both in the business processes and personnel of prise processes helps enterprises to develop better
the organizations. The RFID-enabled reengi- business models. It also leads to an effective supply-
neering exercise is intended to optimize and chain system to coordinate upstream, downstream
integrate business processes. Owing to the and to members overseas. Here, we analyze and
allocation change of human resources, estimation summarize to identify strategic and organizational
of the effectiveness of reengineering is not issues. Table 3 proposes the business value created
straightforward and is dependent on the analysis by RFID applications.
of many uncontrollable factors and the psycho- Two major value categories are extracted from
logical climate of the organizations. our case research. One is the refining of operational
 Assessments of RFID applications are from both processes and the other is the extending of business
strategic and operational viewpoints. Strategic boundaries and scope. Next, we propose in
systems aim to improve customer satisfaction sequence several research propositions related to
and new business opportunities. Operational these two categories and provide support illustra-
systems focus on the efficiency and flexibility of tions directly from our case study interviews.
process redesign. The evaluation of strategic
systems has to be based on the perceived
5.1. Research propositions
competitive impact, which is different from a
cost based evaluation. An RFID systems are at
the same time both strategic and operational in Proposition 1. (Effective communications). Through
nature. Therefore, the evaluation has to be made improving data visibility and matching people and
from these two different perspectives. entities automatically, RFID can improve the effec-
 Implementation of RFID systems should con- tiveness of communications among staff members.
sider stakeholders outside the organization’s
boundaries, including customers, suppliers and It is a common practice for a hospital to establish
medical institutions in the value chain. To standard operational procedures for each process to
achieve the full potential of an RFID system, prevent mistakes when conducting medical treat-
especially under collaborative structures such as ments. However, sometimes ineffective communica-
cooperation between medical institutions, the tions and time pressures may cause errors. By the
evaluation should consider the impact of the
RFID system on both internal and external Table 3
stakeholders. Components of the business value of RFID applications

Value created Source


5. An integrative framework of RFID business value
creation Refine Effective communications
Increased asset utilization
Enhanced patient care process
The usage of RFID in hospitals is relatively new
with very little reported empirical research. There- Extend Active patient management
fore, we propose the value creation framework as a Virtual integration of the supply chain
New service strategy
set of research propositions based on our case New business opportunities
studies. With the ability to make objects more
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nature of RFID, relevant data can be read into the After setting the clinical path for the patient’s
RFID system making it unnecessary for staff to key health treatment, our staffs can use the real-time
in data when monitored events occur. It also monitoring system to discover the current utiliza-
integrates current SOP so that it can detect tion status of medical equipment and assets required
abnormal events and promptly notify relevant staff by the patient allowing them to be effectively
(TMUH) assigned, even in emergencies (SCH).
After introducing RFID, information systems The use of RFID positioning, together with a
can match patients with their own data. Thus, our wireless networking system, allows medical assets
staffs can maintain correct data through shift within the hospital to be inventoried from a fixed
changes. It also prevents missing or incorrect data location. This can be extended to include asset use
inherent in using oral communication (KCC). tracking, reducing the loss or misplacement of
An RFID provides identification functions by resources. Since RFID also allows data to be read
radio frequency. This characteristic leads RFID to and written, the use of scheduling algorithms
continuously identify, locate and track patients and enables up to date, optimal use of resource manage-
related medical devises at the right time and all the ment. This improves the management efficiency of
time. We employ RFID to increase the data the medical asset inventory (WFH).
visibility and improve the automation of data Through the complete and instantaneous wireless
checking procedures between patient and entity. transmission of electronic data, our staff at the front
The reduction of double checking in the medical end is freed from having to make repeated checks,
care services decreases the workload and resources writing reports and waiting for information to be
needed in front line operations (WFH). conveyed. This allows them to devote more time to
patient care. Using the wireless networking system
Proposition 2. (Increased asset utilization). Matched to collate electronic patient records for storage, it
with a wireless networking system, RFID can improve also saves on time that would have otherwise been
the utilization of assets through the mobility, spent on paperwork after medical treatment. At the
intelligence and communications capability of any same time, it provides an effective method for
tagged object. confirming patient safety, ensuring timeliness of
emergency medical treatment as well as reducing the
Many hospitals lose equipment worth hundreds
loss of time and medical resources caused by the
of thousands of dollars each year and spend
incomplete transmission of information (KCC).
countless hours searching for patient-care assets.
This includes medical devices (such as infusion Proposition 3. (Enhanced patient-care process).
pumps, portable X-ray machines and patient Through the intelligence built into systems and the
monitoring devices) as well as other mobile assets extended availability of intelligent support systems,
(such as wheelchairs, stretchers and gurneys). Poor RFID technology can optimize the patient-care
utilization and slow device cycle time mean that: process.
RFID systems integrated with HIS systems can
 many high-value assets go underutilized, while be used to record doctor and patient treatment
hospitals continue to overspend on new and times. The workload of medical staffs can be
rented assets, analyzed to optimize manpower allocation
 nurses must sacrifice patient-care time-finding (ECKH).
equipment, When read–write-type tags worn by patients
 maintenance staff loses productive hours search- (containing important medical information such as
ing for specific items that need maintenance. the patient’s basic information, drug allergies and
patient records) are linked to the hospital’s HIS
The ability to find assets instantaneously and system, our staffs have immediate access to key
improve their flow through hospital processes saves patient data, reducing the potential for an incorrect
staff time and lowers capital or lease costs (ECKH). or delayed diagnosis (SCH).
Using RFID tags for staffs, patients, medical Emergency procedures are often very urgent and
instruments and patient records, the precise location chaotic, so a reminder system is needed. By
of individual subjects can be tracked at all times, integrating RFID and HIS, the reminder system
greatly reducing search times (TMUH). can alert our staffs to move on to the next patient as
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soon as possible. This will increase the satisfaction Table 4


of patients and healthcare staff (WFH). Patient care process in En Chu Kong Hospital
Direct and continuous access to identification, Process As–Is RFID application Difference
positioning and tracking functions for patients and
their associated data can be provided through the SOP Manual Auto evidence 100% enforcement
use of RFID. This can be used to supplement compliance with auto time stamp
and proof of action
existing medical care systems to track a patient’s
Data entry Manual RFID auto Avoid mistakes
treatment, update data, provide patient status verification
information and real-time monitoring, speed up Rea-time alert
the treatment and diagnosis process, ensure the Wristband Manual Auto printed with Avoid human
reliability of medical treatment, provide an audit preparation with visible and mistakes and has more
name invisible integrated data
and confirmation mechanism to avoid medical
only information
mistakes and improve medical care quality (KCC). Integration Manual Auto trigger- Simplified and
The recording of medical treatments in patients’ control related necessary integrated operation
records is very important, but also very compli- processes accuracy
cated. Since much of the data is very complicated, Patient Manual Auto status Real-time accuracy
status entry change
mistakes are relatively easy to make. Traditionally,
display
incident reports and an audit of the records have
been used to determine the root cause of the
mistake and define an SOP. RFID can now be
used to actively collect this data. If alerts have Patients can also find out where they are on a
been triggered, then relevant personnel can be testing schedule (for example, how many people to
notified. This allows mistakes to be controlled go before it is their turn) and therefore better
before, or as, they can provide active and timely arrange their free time (TMUH).
patient protection (SCH). When RFID and wireless technology is intro-
To avoid the chance of error during medical duced at a hospital, it removes constraints on the
treatment, an SOP is always defined. These proce- transmission of information and a patient’s physio-
dures, however, may become flawed due to the logical data can be actively uploaded in real time.
urgency of the situation, a breakdown in commu- After being processed through various alert systems,
nication or delays in the transmission of informa- it provides healthcare staffs with a real-time view of
tion. The use of RFID enables data to be collected patient data. Thus, healthcare can improve manage-
immediately without the need for manual input, and ment effectiveness by moving away from the
is used along with the existing SOP to determine the generation of reports and passive management to
current condition of the patient. When an incident rely more on benchmark setting and automatic
occurs, relevant personnel can be automatically alerts (KCC).
notified as well (TMUH).
Proposition 5. (Virtual integration of the supply
Table 4 presents the patient-care process in
chain). An RFID technology can virtually integrate
ECKH.
information/resource sharing across the supply chain
Proposition 4. (Active Patient Management). An by improving the visibility of data during workflow,
RFID can transform the pattern of traditional the capability to collect information and by spanning
healthcare by allowing the patient to participate a variety of organizational environments and business
actively in their treatment process, enabling them to processes.
initiate each medical treatment item and provide a
To increase the effective utilization of resources,
mechanism for them to query their treatment
Taiwan’s medical organizations have gradually
information at any time.
become horizontally integrated or have created
When using RFID to initiate a treatment, the tag regional strategic alliances of medical institutions.
is supplied with key information or process-related Hospitals sharing medical information and data
management data. Patients can use an HIS kiosk could reduce the amount of resources spent on
system located in each section to read their own redundant checks and allow the savings to become
records. This allows patients to know their current hospital profits. RFID applications can provide this
health status and progress (ECKH). capability (SCH).
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Emergency medical services are highly reliant on medical oversight be significantly reduced, but the
inter-hospital cooperation. Using RFID to integrate medical institution’s treatment quality can also
emergency medical logistics (patient) and informa- be effectively improved enhancing the hospital’s
tion flow (patient record), all of the data in the operational efficiency and capability (TMUH).
emergency medical supply chain can be linked The wireless sensor network environment created
together to create an optimized emergency medical by RFID and EPCglobal demonstrated it would
operations model; thus, resolving the problem of improve the level of care received by patients
incompatible patient information and medical data through the verification, identification and tracking
flows that exist between the responsible hospital, fire of objects and people. In the future, medical
department, health bureau and dispatch center. At organizations will move from ‘‘e-healthcare’’ to-
the operational level, RFID can be used to wards ‘‘u-healthcare’’—all aspect collection and
implement categorized pre-arrival treatment so that monitoring (ubiquitous), personalized medical and
health resources and scheduling can be optimized by health promotion planning after identification
the time a patient reaches the hospital’s emergency (unique), complete care at home and at the hospital
room. On the management level, when a major for the entire person (universal) as well as a
disaster occurs this will provide an improved healthcare system that combines prevention, treat-
exchange of information and communication be- ment and rehabilitation (united). The use of RFID
tween the responsible hospital, local fire department will contribute to the creation of this ‘‘u-healthcare’’
and the health bureau reducing the information concept to provide patients with a complete medical
asymmetry between them. At the strategic level, it environment. In the medical industry, RFID can be
enables a region’s patient information and distribu- applied to a hospital’s internal management and
tion to be reported fully, allowing resources to be external supply-chain management to create a total
assigned and organized as necessary (WFH). healthcare environment, significantly changing the
The medical institution currently uses a lot of nature of the entire healthcare industry and bringing
manpower and paperwork to carry out batch about a new approach in healthcare management
management. In such a system, drugs and medical (TMUH).
equipment cannot be tracked individually. In a test
Proposition 7. (New business opportunities). The
trial of RFID applied to the drug and blood supply
implementation of RFID provides sources of value
chain in this project, cooperation across companies
through new business opportunities.
and between units was achieved along with indivi-
dual tracking of product resumes (TMUH). An RFID is expected to replace the currently
widespread use of barcode scanning systems. It has
Proposition 6. (New service strategy). Through
a broad range of applications, from passing through
RFID and the wireless sensor network environment
customs during travel and logistics management in
established by EPCglobal, the meanings and con-
the manufacturing industry, to every step of medical
straints associated with location, space and time can
pharmaceuticals management. Case studies pre-
be changed, so that RFID allows for new services to
sented here indicate that RFID, when applied to
be created or existing services to be customized in
the medical industry, can create a completely new
innovative ways.
operational model. This new model has potential to
Using the RFID system to provide direct and benefit both hospitals and patients while saving
continuous identification, position and tracking of manpower, time and cost. The precision of RFID
patients, drugs and assets at the right time all the data processing will also help to ensure that patient
time, a standardized RFID software network data is properly verified. At the hospitals involved in
architecture was used to convert the data gathered the case studies, continued technological innova-
by RFID into information. This information was tions and operational process improvements were
then processed by the back-end system into useful made during the RFID systems’ introduction.
knowledge that could be used in the organization’s A comprehensive exchange platform and super-
decision-making process. Through the effective use visory mechanism was also provided during the
of RFID and the EPCglobal network in medical execution of the project through the creation of an
institutions, (particularly for manpower intensive incubation center. The experience and knowledge
data operations such as search, input, collation and from these successful implementations can be
confirmation), not only can the risk of human packaged into duplicable modules. Through the
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