Purpose

The creation of this project closely followed the ANSI withdrawal of the HL7v3 specification in 2022, which was the only available standard for the implementation of a Real Time Location System (RTLS) at the time. Since RTLS and patient location tracking continues to be a growing space, this introduced the need for a more current standard, such as FHIR, that is able to continue supporting all previously existing workflows, as well as support the addition of new functionality to the standard.

Current Project

For this version of the RTLS FHIR Implementation Guide, the primary focus is to implement the subscription notification communication model as the method for sending tag location updates from a RTLS to a subscribing system, such as an electronic health record (EHR) system. This means that initially, the specification defines only the Tag Centric Workflow and does not support the communication of subjects associated with tags. See the Specification page for more technical details.

Tag Centric Workflow

The Tag Centric Workflow is a scenario where the subscriber or non-RTLS system is the source of truth for all information about tag associations. The only roles of the RTLS in this case are to notify the subscriber when a tag has a new/updated location, which tag the update is for, and what the new/updated location is. The following storyboard illustrates this workflow:

1. A patient arrives at the hospital and is assigned a tag. The tag's unique ID is entered into the EHR system, and the "association" is recorded in the EHR system.
2. Since the tag is now associated with a patient, the hospital wants to receive updates on the tag's location so that they know where the patient is throughout their stay. The EHR system communicates this desire to the RTLS by sending an Enroll Tag message containing the tag's unique ID.
3. The RTLS receives the Enroll Tag message with the tag's unique ID, and knows which tag to "enroll," or start sending updates for.
4. The patient is escorted to their room, bringing along their tag with them. The RTLS notes the tag's new location and notifies the EHR system with a Tag Location Update message containing the tag's unique ID and the updated location.
5. The EHR system receives the Tag Location Update message with the tag's unique ID, and recognizes it as the tag associated with the patient. The EHR system records the location sent from the RTLS as the patient's most recent location.
6. The patient finished their treatment and was discharged, returning their assigned tag in the process. This "disassociation" is recorded in the EHR system.
7. Since the tag is no longer associated with a patient, the hospital no longer wants to receive updates on the tag's location. The EHR system communicates this to the RTLS by sending an Unenroll Tag message containing the tag's unique ID.
8. The RTLS receives the Unenroll Tag and knows which tag to "unenroll," or stop sending updates for.

Terminology

• Association - The linkage between a tag and its subject. Literally, an association indicates that a tag is attached to or physically in the same location as the subject.
• Enrolled - The state of a unique tag when the subscriber wants to receive updates related to that specific tag.
• RTLS - The acronym for Real Time Location System, which is a server/software that captures, processes, and stores information about the location of tags.
• Subject - The patient, provider, employee, piece of equipment, asset, etc. that is associated with a tracking tag. The subject is the person/item that there is interest in tracking the location of, through use of tracking tags.
• Subscriber - The system that is "subscribed" to and wants to receive updates from the RTLS about information pertaining to the location/status of tags.
• Tag - A physical tracking device that is assignable to patients, providers, staff, or other assets in the healthcare facility context. This may also interchangeably be referred to as a "beacon" or "tracking tag."
• Unenrolled - The state of a unique tag when the subscriber does not want to receive updates related to that specific tag.