Study reveals that RFID technology can interfere with medical equipment

Scientists have revealed that radio frequency ID (RFID) can interfere with medical equipment according to a contraversial study published in ‘The Journal of the American Medical Association’ that warned hospitals to conduct urgent safety tests. RFID technology is commonly used in the retail sector as anti-theft devices on goods but is predicted to be used increasingly in health care. The tags are currently used in everything from security to TfL’s Oystercard, of which 17 million cards have been issued. Hospitals are starting to become aware of the potential of the product that could be used to monitor temperature sensitive products such as blood or to track medical items and surgical tools. RFID-tagged wristbands are currently used in some hospitals to ensure the correct procedures are carried out on patients, but the future of healthcare is likely to involve far more RFID-style technology. A recent Ofcom report predicted that in-body and on-body wireless networks could become the norm for monitoring patients over the next decade.

However, the study by six Dutch scientists at Vrije University, in Amsterdam found that RFID tags could interfere with equipment such as respirators, external pacemakers and kidney dialysis machines. The same group published a study last year indicating that mobile phones could also affect critical care equipment in a similar fashion. This shouldn’t come as a surprise to anyone who’s experienced interference from a wireless device of some kind. It is quite absurd that with all the different signals filling the air around us someone hasn’t thought to test this before.

A series of tests conducted at the Academic Medical Centre in Amsterdam made the ominous discovery that electromagnetic interference (EMI) generated by ‘track-and-trace’ chips has not only the potential to cause disruption to medical devices, but also poses a hazard to patients. The research examined the effect of holding both passive (868MHz) and powered (125kHz) RFID systems close to 41 different medical devices found on intensive care wards, including dialysis machines and pacemakers. Three tests were carried out on each piece of medical equipment with passive systems requiring a reader device and powered systems transmitting active information. In a quarter of the 123 tests the signal emitted by the smart cards interfered considerably with a machine. According to a critical-care scale, twenty-two of the incidents were classed as ‘hazardous’ whereas two were ‘significant.’

Alarmingly, fifty percent of the electrical equipment was so unstable patients were at risk when RFID chips were in the vicinity and nearly twenty percent of cases involved serious malfunctions. This included causing breathing machines to shut down; mechanical syringe pumps that stopped delivering medication; and external pacemakers, usually attached to heart attack victims to turn themselves off or to read a patient’s heart rate incorrectly. The Dutch study found that passive RFID systems caused sixty-three percent of incidents compared with twenty percent of errors in active signals when held at an average distance of 30cm. However, some ‘hazardous’ incidents occurred when the RFID card was more than ten inches away.

The Food and Drug Administration (FDA) is testing some medical devices in response to the study with the aim of ‘determining the vulnerability and to what extent such vulnerability may be a public health concern.’ The FDA underlined that while they were aware of the potential problem they have never received reports of injuries directly caused by electronic interference with the devices.

The ‘JAMA’ editorial said hospitals should consider surveillance for interference problems that employees haven't noticed or reported. It was also recommended that regulatory agencies should determine if new safety measures are required. The report abstract stated, “In a controlled, non-clinical setting, RFID induced potentially hazardous incidents in medical devices. Implementation of RFID in the critical-care environment should require on-site EMI tests and updates of international standards.”

Dr. Erik Jan van Lieshout, the study co-author and critical care specialist at the University of Amsterdam's Academic Medical Center urged hospitals and manufacturers to carry out thorough checks on RFID devices. “The results show that it's crucial for hospitals to test their wireless items before using them around equipment essential for keeping patients alive. New and unfamiliar technology has to be carefully managed in wards with complex medical equipment. Attention must be paid to these findings, it is of urgent significance.”

It seems hospitals, manufacturers and regulators have some immediate work to do, not just regarding RFID tags but also to examine whether similar problems are occurring with wireless technology in other critical care units. However, some experts are suggesting the report is an overreaction and are seemingly reluctant to make drastic changes.

NHS computer specialists claim that the microchip-based ‘smart’ systems will eventually improve patient safety. A spokeswoman for NHS Connecting for Health, which manages various IT projects across the health service, said that RFIDs had the potential to reduce mistakes caused by the wrong identification of patients. She said, “Any product such as this which is for use in a healthcare setting has to meet a standard which means it is very unlikely to interfere with medical equipment. This risk is more likely to come from RFID tags from other sources - such as a travel card, a tag on clothing, or on another retail item.”

Already at Heartlands Hospital in Birmingham patients heading for the operating theatre wear an RFID wristband so that even when anaesthetised their full identity including a picture, can be downloaded into a PDA held nearby. A spokesman for the Medicines and Healthcare Products Regulatory Agency said that the vast majority of machines used in hospitals had been thoroughly tested to ensure they could not be affected by electrical signals. He said, “the MHRA has received very few reports of adverse events caused by this problem over the last seven years or so. Of the incidents reported, only a very small number have been proven to be as a direct result of EMI. There are some particularly sensitive pieces of equipment where you might expect there to be interference, but for everything else it would be impossible for RFID cards to cause this problem.”

Some medical microchip manufacturers have dismissed the reports, suggesting the systems can improve patient safety and that for hospitals to reject such technology because of the new study would be short sighted. Of course, it is pretty obvious they have their own agenda to consider. But it’s not just health risks for the medical industry to worry about. Scientists in Germany discovered that the smart cards could be easily breached using a normal computer and a card reading device. This is likely to end any interest that the British government had in ‘tagging’ persistent offenders with RFID implants, which could contain data on their identity and criminal records.

(Smartcard News Ltd, 2008)

Contactless Cards and Payment 2008 – ‘Easier ways to pay’

Rollout and progress of contactless technology

SMi’s sixth annual contactless event gave global players and industry experts an insight into the latest opportunities, challenges and technological development within the card and payment market. The conference, held in London, attracted market leaders such as MasterCard, Visa and NXP. Predictably the progress of NFC was of major interest to all who attended.

Latest figures suggest that the consumer is bracing himself for changes in the way payments are made. Study results revealed exclusively at the conference predicted that by 2010 personal debit card spending would overtake its cash alternative. Currently cash payment still dominates the market with 22.4 billion cash payments made in Britain alone last year. However, Head of APACS Card Payment division Paul Rodford believes customer preference to cash is gradually declining but acknowledged that it could take a long time before contactless technology was widely accepted.

“Of course Contactless is going to take longer to implement than Chip and Pin, it’s a far more competitive market. There is less urgency to promote this in the industry but what we must remember is Chip and Pin was effectively a ten-year project. It’s relatively early days but the signs are definitely promising.”

Rodford predicted that within the next decade the number of card payments in Britain would double. Currently just 15% of all low-value payments (below £10) are made by card but this is set to increase to over 50% by 2017. The signs are promising. The competitive launch of MasterCard’s Paywave and Visa’s Paypass has proven to be very successful in their early trials across Europe. In another breakthrough for the industry the Evening Standard announced that the London Olympics in 2012 will be ‘entirely cashless’. This comes after the newspaper itself vowed to enable vending machines for the newspaper using contactless technology. Fast food chains and coffee shops have also staked their interest in contactless, with the likes of ‘Mcdonalds’, ‘Subway’ and ‘Yo! Sushi’ piloting contactless payment in their restaurants. It is anticipated that hotels, taxis and pubs will also join the scheme.

Despite 340,000 contactless cards issued in London by the end of May, the form of payment has still yet to make the significant impact that the industry had hoped. It seems as if potential issuers are reluctant to take the risk until ‘Tier 1’ merchants such as high-street supermarkets commit to the technology.

Rodford suggested this was due to a lack of awareness of the product. “Admittedly, there has been less progress than we predicted at this event last year. It is a significant behavioural change for a consumer to make the transition from cash to card. There are limited opportunities to communicate and to use the technology regularly so we are looking at ways to change that.”

NFC: Current projects and mobile developments

The subject of NFC was enthusiastically discussed, with a number of projects and innovations presented at the conference. The importance of the mobile phone was recognised by all. This is not surprising considering that developing countries such as China and India are shipping six million new subscriptions every month, a mouth-watering prospect for players looking to tap into a growing market. The number of phones with mapping capabilities outsold satellite navigation systems last year in Britain and Nokia is the biggest seller of cameras in the world! This only serves to emphasise a vastly lucrative industry. Lauri Pesonen, CEO of Venyon described the mobile phone as the most essential personal device ever and suggested NFC could achieve equal success.

“Mobile Phones will become trusted personal devices storing security information and sensitive credentials, which are used to access both proximity and online services. We strongly believe this is a consumer application and there are a multitude of benefits for the user. It is a multi-application environment and one which offers a wide variety of services to the user.”

Recent NFC trials have allowed manufacturers to test partnerships in a highly intensive environment as well as gauging consumer reaction to the product. In London communications leader O2 trialled NFC via smart posters, transport and access control around the capital. Across the Channel, Bouygues Telecom trialled six million contactless cards in thirty-five French cities. They revealed that 95% of customers would recommend the technology after using it, and 57% of consumers were already familiar with NFC. The results also showed that consumers were more inclined to use their card for low-value transactions, possibly due to the elimination of embarrassment and delay of using a card in that situation. Bouygues are now looking to introduce cash withdrawal capabilities into their trials. The Vice President of O2 research Michael Short praised the pilot schemes but warned that changes still needed to be made.

“Our trial ended after six months, and some didn’t want it to end at all. Our trial was shared between eight partners and was highly complex to initiate and to maintain. A large number of partners are not easy to work with and it required a lot of support. The customer demand exists for this convenient, easy-to-use service but trust needs to be built. Trust needs to be built and cost, conveniences and support are all critical considerations for wide scale deployment. We need consumers to recognise the brand and standardisation of NFC on an international scale would be a positive start. Having said that, it’s going to be a mass market. Customers can see the benefits and are ready to pay for it’

It was suggested at the conference that there are four basic ‘golden rules’ for NFC services.

· A recurrant usage at launch time (It can be used every day)
· Obvious functional added value (It is better than what I already have in my pocket)
· Confidence (My money is in good hands)
· Universal and easy to use (I can use it everywhere)

In truth these objectives have yet to be substantially met. The majority of contactless card users may only use their card three or four times a month, such is the scarcity of compatible outlets. There are just six thousand compatible terminals in Britain, with the majority being within London. Laurent Jullien, Director of contactless services at Bouygues Telecom highlighted a number of other concerns for NFC market.

“In hindsight, we would like to have accessed more merchants and more handsets. Our trial results in France showed that some consumers didn’t like the extra reader and were occasionally critical of inappropriate locations. We also don’t want to overload the consumer with applications, which is why we are focussing upon downloadable services dependant on the needs of each individual customer.’

Orange Group also piloted trials across Europe and were particularly successfully in France where ‘Pegasus’ and ‘Ulysses’ targeted the transport and banking sectors. It seems the motive for Orange group is the adoption of one service will trigger the adoption of another until multiple applications are being used. Carl Chandler-Mullins, the head of UK programmes for Orange outlined his objectives for the delivery of slick, impressive products.

“A full set of services should be delivered to the customer, this is absolutely paramount. We are fully aware a card is fit for purpose – so a mobile phone has to do the same and more. We need to be compatible with existing handsets, regardless of what I put my SIM card in. The bottom line is that we have to find new, simple processes that won’t damage existing business.”

It is quite refreshing that Orange is targeting solutions that have a global platform. Look at TfL for instance, how many of the 18 million Oyster cards sold actually went to tourists rather than those working or living in London? I would bet not many at all.

NFC has been a complex project from day one with issues of interoperability and cost providing a headache for the industry. Perhaps however, the collaboration between mobile operators and key suppliers is the most critical factor to get right. Over-the-air (OTA) service providers have to be neutral and support players in all sectors. This requires OTA services to interact with mobile operators and issuing banks, as well as supporting a variety of different payment application standards and NFC specifications. To maintain this relationship, a trusted service manager (TSM) is introduced into the NFC ecosystem. The role of the TSM is to provide a single point of contact for service providers in co-operation with the operators. It is crucial that NFC has a trusted third party present, as the fragmentation of OTA services could seriously hinder the take-off of NFC. The main consensus at the conference was that while NFC was progressing it seemed to need a little push in the right direction. In my view the issue to address is marketing. This may require disruptive tactics and could be painful for existing players, but in the long run is the very same players who will benefit.

MasterCard PayPass solution – A European success story

The MasterCard Paypass project has been trialled globally in 24 countries, and is accepted at 109,000 merchant locations. Since its inception in 2003 over 28 million PayPass cards have been issued and accepted by merchants across a variety of sectors, including ‘Citigroup’, ‘Mcdonalds’ and ‘JPMorgan Chase’. MasterCard also spearheaded a PayPass project at Manchester City Football Club. The device could be used as a season ticket as well as standard chip and pin. It was the first multi-purpose instrument to be trialled at a European football stadium although there are already 25 ‘hugely successful’ pilots in the USA. In addition, all arenas used at Euro 2008 were also equipped with PayPass devices.

Toni Merschen, Head of MasterCard said, “Contactless is not about money. It’s all about changing habits of consumers and how we eliminate cash, particular in low value payment areas. Global interoperability is the result of an approach that crosses technologies and we were instrumental in hitting the milestones to allow consumers and merchants to achieve their business goals.”

Trials of PayPass in Germany showed that cardholders spent twice as much at ‘Carl Mayer’ catering wagons than those with cash. This is clearly an attractive incentive for a potential merchant. MasterCard also launched the first contactless device in Eastern Europe when PayPass was introduced in Warsaw, Poland.

Perhaps most successfully, in Taiwan full rollout commenced last year of ‘Taiwanmoney’ a MasterCard contactless payment and transport card. The device combines ticketing functionality with pre-authorized payment and has already seen 120,000 cards issued.

Regulatory impacts and constraints on contactless cards

With the growing success of the contactless market it is inevitable that criminals will be looking to make a quick buck from an ever-expanding industry. On a positive note, criminals nearly always prefer the anonymity and universal negotiability of physical cash where no ‘footprint’ is left. By contrast, electronic channels provide the consumer with greater security and permit the monitoring of abnormal or suspicious transactions. The role of the Financial Services Authority (FSA) is to regulate and to facilitate payment innovation. Dominic Peachey, Policy Advisor to the FSA explained the responsibilities of his organisation.

“What we are concerned with is payment, e-commerce and the conduct of business. We strive to stay neutral when it comes to technological advancements. It is key to increase public awareness and consumer protection, as well as reducing financial crime. We are aiming towards orderly and efficient financial markets and a fair deal for retail consumers, focussing solely on the outcomes. It has been said that regulation can stifle new products but equally so can lack of regulation too.”

The e-money directive tried and failed to successfully regulate electronic finances when it was enacted in 2002. After struggling to meet its own aspirations, destroying consumer confidence and effectively hampering technological innovation it was decided enough is enough. The e-money directive was also criticised for focussing on anti-terrorism measures at the expense of arguably more important issues such as fraud and identity theft. Instead the Payments Services Directive (PSD) will subsume its e-money counterpart in the near future and has been described by Peachey as ‘a definite improvement.’

Although the PSD will not be implemented before 2009 it applies to all banks and creates a new category of payments institution as well as issuing and acquiring new payment instruments such with contactless expertise. While there is little e-money in bank-focused Western Europe, the ‘new’ Eastern Europe is set to leapfrog the west in developing new payment technologies. Developing countries provide the most fertile grounds for new payments systems with Europe and the U.S languishing behind. Hong Kong is streets ahead regulating their transport ticketing system Octopus using three simple principles.

Manage float prudently
Back with sufficient, liquid, low risk assets
Ensure sufficient cash flow to handle daily operations

In comparison the European alternative runs to 17 pages of rules and guidance. It is evident that the European Union is in stark danger of over regulation.

Developments of contactless in transport – ticketing payments in London

The director of Oyster card Shashi Verma gave an overview of what has been achieved with the technology as well as the constraints and future plans. Currently Oyster accounts for 73% of tube journeys and 93% of bus journeys around London. The main reason that magnetic day travel cards still exist is because national rail doesn’t accept pay-as-you-go Oyster. However, this is set to change next year and it is predicted usage will increase to over 90% of the tube journeys.

In a bid to improve the accessibility of Oyster and to reduce costs around four thousand ticket stops have been created for the consumer. Compare this number with other major cities (New York has just 300 outlets). Verma told the conference that 99% of the London population are within 400m of an Oyster outlet. The next objectives are to increase pay-as-you-go journeys by 50% as well as reaching 300 new stations across London by next year. This is no mean feat. Currently 24 stations in London need an average gate throughput of more than twenty people per minute. Liverpool Street is London’s busiest station with just 2.3 seconds required for each ticket transaction to prevent queues building. Transport for London (TfL) has already funded £40 million towards the gate line relief project at Liverpool Street.

This is understandably an intense operation with the biggest constraints on the system at national rail termini whereby there is a higher proportion of the slower magstripe tickets. Shashi Verma described the challenges that TfL faces.

“The project is challenging, there are tight delivery schedules and very expensive gate line expansions whereby stations need to be shut down. However, if it weren’t for Oyster and quicker transaction periods 24 stations would have closed. Today ticket queues are no longer a problem. In six years since Oyster’s introduction we have only suffered a system failure for three hours. That’s impressive.”

Another concern is ITSO, the British Government’s national smart card standard for transit. There have been around 10 million ITSO cards issued so far, mostly as free travel to the elderly. ITSO has proved a considerable issue for TfL for quite some time. Instead of making Oyster and ITSO compatible with one another systems will be fitted out with readers capable of reading both types of card. This adds complexity to the TfL systems as well as potentially slowing down transaction performance. ITSO needs to evolve from being just a technical specification to becoming a fully functioning ticketing platform, something that is not really within TfL’s control.

Verma said, “Making ITSO and Oyster compatible is not worth the effort. We will make the card reader systems recognise both smart cards instead. This is highly complex and we don’t want to sacrifice time of transaction. ITSO needs to capture technology space before it moves on, a lot of evolution needs to happen before trust can be built with the consumers.”

(Smartcard News Ltd, 2008)