5 Questions Every Hospital CIO Should Ask Before Buying RTLS

By Mike Maurer, President, MGM Solutions | 35+ Years in RTLS

If you’re a hospital CIO evaluating real-time locating systems, you’ve probably sat through a dozen vendor presentations that all sound remarkably similar. Every vendor claims sub-meter accuracy. Every vendor claims seamless integration with your EHR. Every vendor shows a polished demo on a tablet that makes the whole thing look effortless.

Then you deploy the system, and reality sets in: accuracy is 3-5 meters instead of sub-meter, the EHR integration requires six months of custom development, and your IT team is fielding complaints about Wi-Fi interference from every department on the floor where the RTLS tags are active.

After 35+ years in the RTLS industry — deploying systems in hospitals, VA medical centers, corrections facilities, and government buildings — we’ve seen every failure mode. The following five questions are the ones that separate a successful RTLS deployment from an expensive lesson. Ask them early, and demand honest answers.

Question 1: Does This System Share Spectrum with My Existing Infrastructure?

This is the question that most hospital CIOs don’t ask until it’s too late — and it’s arguably the most important one.

The majority of RTLS systems on the market today use either Wi-Fi (2.4/5 GHz) or Bluetooth Low Energy (2.4 GHz) as their radio transport. These systems share the exact same radio spectrum as your hospital’s Wi-Fi network, biomedical telemetry, and the hundreds of personal devices that staff, patients, and visitors bring into the building every day.

The result is spectrum congestion. Adding 2,000 BLE tags broadcasting every few seconds on the same 2.4 GHz band as your enterprise Wi-Fi doesn’t just affect the RTLS — it degrades your existing network performance. Clinical applications slow down. Nurse call systems experience latency. Biomedical device connectivity becomes unreliable.

433 MHz RF systems operate on a completely separate frequency band. They don’t compete with Wi-Fi, BLE, or any other hospital wireless system. Your RTLS deployment shouldn’t force your IT team to re-engineer the wireless network that the rest of the hospital depends on. For a detailed analysis of why this matters, read our technical comparison of RTLS radio technologies.

Question 2: What Is the Total Cost of Ownership Over 7 Years?

RTLS vendors love to quote initial deployment costs. What they’re less eager to discuss is the seven-year total cost of ownership (TCO) — which is where the real financial picture emerges.

Here’s what to include in a true TCO comparison:

The systems that look cheapest at deployment often have the highest TCO at year seven. Short battery life means replacing thousands of tags every 12-18 months. Wi-Fi network impact means your IT team spends hundreds of hours managing spectrum conflicts. Per-tag software licensing means costs scale linearly with every new use case.

Ask vendors for a complete 7-year TCO projection with all costs itemized. If they can’t provide one, that tells you something.

Question 3: What Happens When the Network Goes Down?

This is the question that separates life-safety RTLS from asset-tracking RTLS — and it’s critical for hospital CIOs to understand the distinction.

If your RTLS is used for asset tracking — finding wheelchairs, IV pumps, and portable monitors — a 30-minute outage during a network maintenance window is annoying but not dangerous.

If your RTLS is used for patient wander management, infant security, or staff duress, a 30-minute outage means your most vulnerable patients and staff are unprotected. A dementia patient can reach the parking lot in under 5 minutes. An infant abduction can occur in under 60 seconds.

Wi-Fi-dependent RTLS systems fail when the Wi-Fi network fails — during firmware updates, controller failovers, power events, or cyberattacks. BLE systems that use Wi-Fi backhaul for their gateways have the same vulnerability.

A 433 MHz RF system operates on its own dedicated infrastructure. It doesn’t care whether your Wi-Fi network is up, down, or being attacked by ransomware. The receivers have their own wired connections to the central server, independent of the hospital IT network. For life-safety applications, network independence isn’t a luxury — it’s a requirement.

Question 4: How Does Accuracy Degrade in Real Clinical Environments?

Every RTLS vendor will quote you an accuracy number: “sub-meter accuracy,” “1-2 meter accuracy,” “room-level accuracy.” These numbers are typically measured in ideal conditions — an empty building, no interference, controlled environment.

Real hospitals are the opposite of ideal conditions:

• Water: Human bodies are 60% water and absorb 2.4 GHz signals (BLE and Wi-Fi). A hallway full of patients on gurneys creates a wall of signal absorption that doesn’t exist in a demo room.
• Metal: IV poles, bed frames, medication carts, and equipment racks reflect and scatter high-frequency signals unpredictably.
• Interference: A typical hospital floor has 50-200 Wi-Fi devices, dozens of BLE-enabled medical devices, and staff smartphones all competing on the same spectrum.
• Building construction: Lead-lined radiology rooms, copper-mesh shielded MRI suites, and concrete stairwells create areas where 2.4 GHz signals simply cannot reach.

Ask every vendor this: “What is your demonstrated accuracy in a 400-bed hospital with full patient census, on a floor with an MRI suite and 15-year-old concrete construction?” If the answer is the same as the spec-sheet number, they haven’t tested it in a real hospital.

433 MHz signals are less affected by these environmental factors because of their longer wavelength and superior material penetration. The accuracy may not be “sub-meter” in every scenario, but it’s consistent — and consistency matters more than peak accuracy for life-safety applications.

Question 5: Can This Platform Scale Beyond the Initial Use Case?

Most hospital RTLS deployments start with a single use case: asset tracking, patient flow, or wander management. But the real value of RTLS emerges when you expand to multiple applications on a single platform.

A unified RTLS platform should support:

• Asset tracking — locate wheelchairs, pumps, monitors, and mobile equipment
• Patient wander and elopement management — protect dementia and behavioral health patients
• Infant security — protect newborns with tamper-detecting tags
• Staff duress / panic buttons — instant location-identified alerts when staff are in danger
• Environmental monitoring — temperature and humidity monitoring for pharmacies, blood banks, and labs
• Patient flow analytics — measure wait times, throughput, and bottlenecks

The key question is whether these applications run on the same infrastructure — same tags, same receivers, same software platform — or whether each one requires a separate investment. Vendors who sell single-purpose systems will have a compelling pitch for that one use case, but you’ll end up with three or four separate systems, each with its own infrastructure, maintenance contracts, and staff training requirements.

MGM Solutions’ SecurTRAK platform runs all of these applications on a single 433 MHz RF infrastructure. One deployment. One maintenance contract. One training program. That’s how we’re different from vendors who sell point solutions.

Bonus Question: Who Installs and Supports the System?

This doesn’t make the “five questions” list because it should be obvious — but we see it overlooked constantly. Ask who physically installs the system: Is it the vendor’s own team, or a subcontracted integrator who may have never deployed RTLS before? Ask who provides ongoing support: Is it a local team that can be on-site in hours, or a call center that routes tickets to a queue?

The best technology in the world fails if the installation is sloppy or the support is nonexistent. MGM Solutions handles installation with our own team and provides direct engineering support — no ticket queue, no call center middleman.

FAQ

Related Reading

• Why Wi-Fi and BLE Fail for Life-Safety RTLS
• How MGM Solutions Is Different
• Infant Security Solutions
• Corrections Facility RTLS Solutions