The National Academy of Engineering recently released fourteen Grand Challenges for the engineers of the 21st century. These challenges reflect global problems that range from the creation of new energy sources to the advancement of healthcare informatics. With the growth of informatics technology, more patient files are making their way onto hard-drives and servers, which are economical and eco-friendly alternatives to paper. In fact, files can now be stored underneath the skin through the use of an implantable microchip. This device is a milestone for the advancement of healthcare informatics because it facilitates storage of medical information and provides fast access to these files under critical circumstances. Becoming more acquainted with this technology requires knowledge of how it works, current uses of the microchip, current limitations, and future applications.
The implantable microchip is an advanced form of Radio Frequency Identification (RFID) tag or transponder . It contains the ability to communicate with and transfer information to other devices that operate on the same radio frequency. Some of its predecessors can be found on the back of shipment labels, helping shipping companies to accurately track packages from point of departure to destination.
RFID technology was developed in 1935 by Scottish physicist Sir Robert Alexander Watson-Watt to identify approaching airplanes while they were still miles away. Although it was used during World War II by the Germans, Japanese, Americans, and British, the technology could not differentiate the airplanes; it could only detect that they were coming. The technology re-emerged in 1973 when Charles Walton used it to open doors without keys . Thirty years later different companies incorporated RFID technology into a global positioning system (GPS) device, and in 2004 Verichip received approval from the FDA to use the technology to link a chip implanted within the subcutaneous layer of a patient’s skin to an online server containing relevant medical data and records. The company merged with Steel Vault Corporation in 2009 to form Positive ID, which today is the largest national microchip provider serving a variety of industries, including healthcare .
How It Works
RFID tags come in a wide range of shapes and sizes (some about a third of a millimeter) and can be broken down into 3 main parts (see Fig. 1): RFID transponder, Reader, and Server.
The RFID, or transponder, sends out a unique signal that allows the Reader to identify its location and identification. There are two types of transponders: passive and active. Passive transponders are smaller in size, do not require power, and have long-term operation capacity. Since they do not actively broadcast their signal, they require an external radio wave to establish contact and initiate data request. This is the type of transponder used in healthcare informatics. Active transponders require battery power to broadcast signals to the Reader, but transmissions are more reliable.
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The RFID Reader reads and writes information from the transponder. In the healthcare sector, it acts as a wire connecting the transponder to the patient’s data stored on the server. Upon scanning the unique set of numbers from a patient’s transponder, the reader sends the information out onto an online database, which is matched with a corresponding file and opened within seconds onto a monitor screen.
The server stores all patient information and can be accessed by the unique set of digits from the transponder. It is typically encrypted and can be accessed through the Reader’s transmitted signal or the right set of passwords .
Operations and Breakdown
RFID tags operate on different radio wave frequencies. Higher frequencies require more power, but signals are stronger, making long range communication possible (Active Transponders). Lower frequencies require a smaller amount of power, if any, to become operational, but require readers to be within a close vicinity of a few inches from them (Passive Transponders). Currently, tags are available in 3 levels: Low (125-134.2 kHz – 140-148.5 kHz), High (13.56 MHz) and Ultra High (868-928 MHz) .
The microchip introduced for healthcare applications is a passive transponder (see Fig. 2). It is 11 millimeters long and about 1 millimeter in diameter, comparable to the size of grain of rice. It consists of a tissue-bonding cap made from a special plastic that covers a sealed glass capsule containing the RFID circuitry. The cap is designed to bond with human tissue and prevent the capsule from moving around once it has been implanted. The coils of the antenna turn the reader’s varying magnetic field into current that powers the chip. The coil is coupled to a capacitor to form a circuit that resonates at 134 KHz (Low Frequency). The chip modulates the amplitude of the current going through the antenna to produce a 128 bit signal, which translates into 16 decimal digits.
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The translation and recording of the amplitude onto the scanner is a vital part of the process. The RFID tag modulates the amplitude to create waves with higher and lower amplitudes. Thus, the amplitude oscillates between high and low waves. The scanner records highs as ones, and lows as zeros. In binary terms, the sequence of these digits can be translated into decimal numbers, making from a simple oscillation a unique set of numbers (Example: 7 in decimal = 0111 in binary). Thus, by changing the amplitude, the microchip can communicate a string of binary digits that can then be interpreted as digital information .
Biomedical engineers have been tailoring microchip technology to fit a wide range of medical applications. Positive ID has a division specifically for the healthcare sector, known as Health ID (see Fig. 3). Beyond patient identification and medical storage microchips, which are presently available for about $150, the company has two other systems: the Glucose-Sensing Microchip and the Rapid Virus Detection System. The Glucose-Sensing Microchip is an implantable device that measures glucose levels in the body in real time. Phase I studies, which involve tests of the signaling components of the technology, have been completed. In ongoing Phase II studies, researchers are working to enhance the glucose response in the presence of blood to provide more accurate readings. A Rapid Virus Detection System is also under development. The proposed non-invasive device would check a patient’s fluids for viruses within minutes, rather than hours. If viruses are present, it instantly breaks it down into main parts in order to identify and treat it .
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The microchip gained popularity in Florida, where Verichip’s headquarters were once located. Local hospitals considered the idea of using the technology to track the elderly and patients with dementia. However, religious and ethical concerns derailed Verichip’s efforts in this area. Although the implantable microchips are not commonly found today, hospitals have embraced its non-invasive version, similar to the microchips used in shipping and tracking. These non-invasive tags are taped onto the patient’s bracelet during check-in, and scanners throughout the hospital indicate the patient’s exact location at all times .
Microchips are also used in payless toll-booths, smart-cards, shipment labels, search-and-rescue military applications, business transactions, and more.
According to a study conducted by the Institute of Medicine, 98,000 preventable deaths from medical errors and 200,000 from adverse drug reactions occur every year, often due to limited access to patient data . It costs the U.S. more than $29 billion to repair these damages, and a large portion is paid by the general public through yearly healthcare premium adjustments . In order to reduce these costly errors, fast access to medical files would be ideal in order to ensure that patients receive the right treatment, but often these files do not find their way to the right personnel until it is too late. Protocols to digitize patient files were established two decades ago, but it was not until 2007 that Electronic Medical Records, or EMR, gained support and popularity in the health sector .
As defined by the Healthcare Information and Management Systems Society, Electronic Medical Records are individually designed by each doctor’s office and must conform to requirements imposed by health rules and regulations . This allows for medical offices to store documents on computers legally but does now allow them to share with doctors outside of their network. A non-network file request can take days to process. For example, if a California resident were about to receive critical care from doctors in Brazil, with no access to that patient’s files, the Brazilian doctors would not know the patient’s medical history, potentially leading to fatal complications.
As EMR merges with microchips and worldwide databases, globalized access will allow patients to receive proper care in hospitals at any location. However, some changes will have to take place to ensure the functionality of this relationship. First, medical offices will have to conform to worldwide standards. Second, a central implant location will have to be determined so that medical professionals will know where to look for the microchip (Left Hand Outpatient Procedure Shown in Fig. 4).
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Use of this technology has ethical and technological limitations. From an ethical perspective, there are growing concerns over issues stemming from the inability to deactivate the device. Confidential information such as location, bank accounts, medical information and blood monitoring data might be easily transferred to anyone with a reader and the right set of passwords, with or without the user’s consent (see Fig. 5). In the healthcare sector, liability regulations would have to be revisited so that unauthorized access to sensitive patient data would not lead to mistrust and lawsuits against hospitals. As use of the microchip spreads to other industries, such as with parents tagging their children to protect against kidnapping, the question of whether children should have a vote in this process also becomes an ethical dilemma . Within that same realm, some believe we will reach a moment in time when choice will turn into a requirement. They predict that the popularity of the microchip will increase at such an exponential rate that government regulations will force the population to implant these devices in order to receive general healthcare benefits .
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From a technological perspective, there is a growing concern with the security of tags and their radio-wave transmissions. University of North Dakota Professor Yanjun Zuo points out several flaws in the design of the RFID structure . One physical flaw is that attackers can physically remove the device and use it for personal gain. Furthermore, through tag cloning, duplicate microchips can be generated. The attacker may also gain access to communications between reader and transponder. Through tag tracking, the attacker could also keep track of a tag to execute forms of extortion. In the medical world, attacks like these could compromise the lives of many patients. If signals are jammed or misread, patients may receive the wrong treatment. If cloned, attackers could receive treatment instead of the original patient. If tracked, patients may be vulnerable to their attackers, especially if they are confined to a hospital bed or wheelchair. As research has shown, with an implanted microchip, users become beacons of information, ready to be decrypted by any reader using the right frequency and the right set of passwords. Engineers will have to fully address these problems and protect patient confidentiality and security in order for the microchip to be successfully integrated into healthcare systems.
The microchip has the potential to improve healthcare informatics and could reduce unnecessary costs in the healthcare industry. With fewer medical errors, there could be up to a 50% reduction of healthcare premiums . Individuals who suffer from a number of diseases may benefit from its testing abilities and use it to check for new viruses and blood glucose levels. Finally, patients with dementia, the aging population, young children, and their respective families may benefit from its tracking capabilities to ensure their loved ones’ safety.
As with every new technology, the microchip is undergoing some improvements, including added security for the radio wave transmissions, as well as the creation of regulations to resolve ethical issues of its use. Once changes are made and implemented in hospitals worldwide, the microchip will have the potential to improve the future of healthcare informatics, facilitating the exchange of medical information and providing fast, globalized access to patient files so the best specialized treatments can be given. This is one tiny microchip that is ready for one great challenge!
-  S. Granneman. (2003, June)."RFID Chips Are Here." The Register: Sci/Tech News for the World. [On-line]. Available: http://www.theregister.co.uk/2003/06/27/rfid_chips_are_here/ [Oct. 25, 2003].
-  RFID, Journal. (2005, Dec.). "The History of RFID Technology - RFID Journal." RFID Journal - RFID (Radio Frequency Identification) Technology News & Features. [On-line]. Available: http://www.rfidjournal.com/article/view/1338 [Oct. 25, 2010].
-  VeriChip. "HealthID." Internet: http://www.positiveidcorp.com/health-id.html, Aug. 01, 2004 [Oct. 14, 2010].
-  W. Yao et al. "The Use of RFID in Healthcare: Benefits and Barriers," in Proceedings of 2010 IEEE International Conference on RFID-Technology and Applications (RFID-TA), 2010, pp. 128-34.
-  S. Y. Lee et al. (2010, July). "A Low Power RFID Integrated Circuits for Intelligent Healthcare Systems." IEEE Trans Inf Technol Biomed. [On-line]. Vol. 1.1 PubMed. Available: http://www.ncbi.nlm.nih.gov.libproxy.usc.edu/pubmed/20615816 [Oct. 15, 2010].
-  A. Nassim. (2009, Mar.). "What Is a Verichip?" Electrical and Electronics. Electrical and Electronics Portal. [On-line]. 2010. Available: http://electricalandelectronics.org/2008/11/17/what-is-a-verichip/ [Oct. 25, 2010].
-  E. Lutton et al. "PATIENT IDENTIFICATION WITHIN A HEALTHCARE SYSTEM: The Role of Radio Frequency Identification and Bar Code Technologies," in Proceedings of 11th International Conference on Mathematical Methods and Computational Techniques in Electrical Engineering/Applied Computing Conference, 2009, pp. 17-23.
-  P. Chen. "Implementation of an RFID-based Management System for Operation Room," in International Conference on Machine Learning and Cybernetics. Proc. of Proceedings of 2009 International Conference on Machine Learning and Cybernetics., 2009, pp. 2933-2938.
-  HIMSS (Healthcare Information and Management Systems Society). (2006, Apr.). "The Legal Electronic Medical Record. Chicago: Healthcare Information and Management Systems Society (HIMSS)." HIMSS (Healthcare Information and Management Systems Society). [On-line]. Available: http://www.himss.org/ASP/index.asp [Oct. 20, 2010].
-  B. Chowdhury and C. D'Souza. "Challenges and Opportunities Relating to RFID Implementation in the Healthcare System," presented at the Business Information Processing LNBIP 20.3rd International United Information Systems Conference, UNISCON, Germany, 2009.
-  T. Monahan and J. A. Fisher. (2010, Oct.). "Implanting Inequality: Empirical Evidence of Social and Ethical Risks of Implantable Radio-frequency Identification (RFID) Devices." Cambridge University Press. [On-line]. Vol. 1.1. Available: http://journals.cambridge.org.libproxy.usc.edu/action/displayAbstract?fromPage=online&aid=7911612&fulltextType=RA&fileId=S0266462310001133 [Oct. 15, 2010].
-  Y. Zuo. "Survivable RFID Systems: Issues, Challenges, and Techniques." Systems, Man, and Cybernetics, Part C: Applications and Reviews, IEEE Transactions. [On-line]. Vol. 40.4, pp. 406-418, 2010.
-  A. Bahney. (2006, Feb.). "High Tech, Under the Skin." The New York Times. [On-line]. Available: http://www.nytimes.com/2006/02/02/fashion/thursdaystyles/02tags.html? sq=rfid&st=cse&scp=14&pagewanted=all [Oct. 15, 2010].
-  L. L. Chen et al. "Using RFID to Realize Human Computer Interaction." IEEE, vol 978-1-4244-5228-6, 2009.
-  J. Edwards. (2010, Sept.). "Human or Cow, PositiveID Has an Implantable Microchip for You | BNET." BNET. The CBS Interactive Business Network. [On-line]. Available: http://www.bnet.com/blog/drug-business/human-or-cow-positiveid-has-an-implantable-microchip-for-you/5772 [Oct. 14, 2010].
-  S. Gossett. (2004) "Paying for drinks with wave of hand: Club-goers in Spain get implanted chips for ID, payment purposes." WordNetDaily. [On-line].
-  Available: http://www.wordnetdaily.com/news/article.asp?ARTICLE_ID=38038.
-  L. Ho et al. "A Prototype on RFID and Sensor Networks for Elder Healthcare: Progress Report," in Proceedings of the 2005 ACM SIGCOMM Workshop on Experimental Approaches to Wireless Network Design and Analysis Table of Contents, 2005.
-  S. Kirsner. (2010, Jan.). "Imbedded Chips Track Drug Doses, Health Shifts." The Boston Globe. [On-line]. Available: http://www.boston.com/business/technology/articles/2010/01/11/investors_place_165_million_bet_on_microchips_implantable_devices/ [Oct. 15, 2010].
-  L. Kohn et al. (2000, Oct.). "To Err Is Human, Building a Safer Health System." The National Academy Press. Institute of Medicine. [On-line]. Available: http://www.nap.edu/openbook.php?record_id=9728 [Oct. 20, 2010].
-  J. Markoff. (2006, Mar.). "Study Says Chips in ID Tags Are Vulnerable to Viruses." The New York Times. [On-line]. Available: http://www.nytimes.com/2006/03/15/technology/15tag.html?_r=1 [Oct. 14, 2010].
-  S. Morrissey. (2007, Oct.). "Are Microchip Tags Safe? - TIME." Time Magazine. [On-line]. Available: http://www.time.com/time/health/article/0,8599,1672865,00.html [Oct. 14, 2010].
-  National Conference of State Legislatures (NCSL). "Privacy Legislation Related to Radio Frequency Identification (RFID)."
-  Internet: http://www.ncsl.org/programs/lis/privacy/rfid06.htm, 2006.
-  M. I. Songini. (2007) "ND bans forced RFID chipping. Governor wants a balance between technology, privacy, Computerworld." Computer World. [On-line].
-  Available: www.computerworld.com/action/article.do?command=viewArticleBasic&taxonomyId=15&articleId=9016385&intsrc=hm_topic.
-  R. Stein. (2004) "ID chip for humans wins approval by FDA." The Seattle Times. [On-line].
-  Available: http://seattletimes.nwsource.com/html/nationworld/2002062686.chip14.html.
-  R. Want. (2008, Aug.). "RFID--A Key to Automating Everything: Scientific American." Scientific American. [On-line]. Available: http://www.scientificamerican.com/article.cfm?id=rfid-key-automats-everything [Oct. 14, 2010].
-  R. Waters. (2006) "US Group Implants Electronic Tags in Workers." Financial Times. [On-line].
- Available: www.ft.com/cms/s/ec414700-9b4-11da-8baa-0000779e2340.html.