VA's Real-Time Location System: A way to improve patient safety, or Big Brother?

The Veterans Affairs Department views a planned $550 million Real-Time Location System as a way to ensure its hospitals properly sterilize medical instruments, improve efficiency and track equipment. VA unions view it as a Big Brother system that could monitor employees.

The department is scheduled to release on Tuesday a draft request for proposals for RTLS, which will use signals from Wi-Fi networks already installed in its hospitals to track equipment -- and potentially employees -- within a meter or better.

VA has referred to plans to track employee Wi-Fi tags with the system in a notice in September and a briefing in November, although the department said Monday it did not have an official plan in place to tag and track employees.

Tracking equipment will help solve one of its most vexing problems -- lack of sterilization of medical equipment, VA Chief Information Officer Roger Baker said in a media call last month.

In June 2009, the department's inspector general reported that VA hospitals in Georgia and Florida failed to properly sterilize endoscopes used for colonoscopies before reuse, potentially exposing thousands of veterans to HIV and other infections. Baker said RTLS tags on medical equipment would ensure they would not be used before they were sterilized.

VA, in a "sources sought" notice released to industry in September, said RTLS equipment will interface with cleaning and sterilization equipment for strict adherence to cleaning standards.

Baker said he viewed RTLS as a technology that could support "at least 15 business cases" in VA, including tracking of equipment such as computers. The September notice to industry said the system could follow veteran case file folders used by examiners in the Veterans Benefits Administration and track the remains of soldiers for the National Cemetery Administration.

VA also said in the September notice it wanted to tap RTLS to "locate staff in real time" through 2-inch wide Wi-Fi tags on their badges in the 152 hospitals run by the Veterans Health Administration.

The department also briefed its staff tracking plans to potential bidders on Nov. 8. Staff tracking information -- as well as all the other information gathered by the system -- would be stored in a National Data Repository accessible at the local, regional or national levels.

VA said staff tracking by RTLS will help improve hospital workflow and efficiency and this will be done with the "explicit knowledge" of employees. The department added that data collected from the system will not be used for employee performance assessment or disciplinary purposes, and "will have the support of VHA labor union partners."

That's news to three of the four unions representing roughly 250,000 VHA employees.

Susan Anderson, president of National Association of Government Employees local at the Martinsburg, W. Va., Veterans Affairs hospital, and a member of the labor-management VA National Partnership Council, said she received a briefing from the department in July about RTLS and was assured it would be used to track equipment only, not employees.

Anderson said VA did not furnish her with the information contained in its industry briefings or procurement documents.

Elaine Gerace, vice president of the Service Employees International local for the VA hospital in Syracuse, N.Y. -- and another member of the National Partnership Council -- said the last RTLS briefing she had from VA was a year ago, and the department said the technology would be used to track equipment only.

Oscar Williams Jr., second executive vice president for the American Federation of Government Employees National VA Council, also had the impression that the department planned to use RTLS to only track equipment, and if VA wants to use it to electronically monitor employees then "we're not going to let it happen." AFGE, Williams said, represents 207,000 VA employees.

Gerace views any plans by VA to use RTLS to track employees as "the beginning of Big Brother . . . an invasion of privacy."

Anderson called the $550 million price tag for RTLS "a staggering amount of money that could be used to care for vets."

She also is concerned about the privacy implications. "I really don't want anyone to track how long I spend in the bathroom," Anderson said.

Josephine Schuda, a VA spokesman, said Monday that as of now there was no official plan for staff tagging with RTLS. She said the new contract will "buy technology that will allow a wide range of capabilities for use over five years." Before VA asks a vendor to develop a particular application, there would be discussions with the unions, Schuda said.