With humble apologies to Charles Dickens, this truly is the best of times, the worst of times…for radiofrequency identification (RFID) and bar coding vendors and users.

No sooner had the Journal of the American Medical Association (JAMA) published a controversial study in late June on how RFID devices may interfere with other wireless medical equipment than the Journal of the American Medical Informatics Association (JAMIA) published a potentially damaging study on bar coding a few weeks later. Curious timing, no doubt, that elicits a number of conspiracy theories we’ll ignore for now.

The RFID study found that crossed signals may affect the proper functionality of certain medical equipment – a clear focus on the technology itself. The bar coding study, on the other hand, explored nurse "workarounds" that led to human error when the technology seemingly didn’t work as it should, so nurses would override the devices to "compensate for difficulties" with the systems – a somewhat split focus on the technology, as well as the human behavior and workflow around it.

Regardless of the methodologies, research, strategies and tactics of both studies, it’s hard to dismiss the notion that both tarnished the respective technologies they investigated. Perception in the marketplace is reality after all.

"Bar-coding is still under development," said the study’s primary researcher Ross Koppel, Ph.D., Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine and the Sociology Department at the University of Pennsylvania. "Administrators and vendors may expect it to be fool-proof, but users know it’s not. It’s a very promising technology that still requires constant refining and careful observation of on-the-floor workflow to get it right."

Honestly, if anyone – whether provider or supplier – expected these tools to solve all of their problems flawlessly they need to audition for a cinematic remake of Pollyanna. Over the years, sources consistently have told me that any kind of automation technology remains a work-in-progress. It’s not a panacea; it’s not a silver bullet. And it’s only as good as its human operators – a convenient loophole that tacitly disqualifies the perception of perfection anyway.

The UPenn study learned that some of the motivations of these workarounds included "unreadable medication-barcodes (crinkled, smudged, torn, missing, covered by another label); malfunctioning scanners; unreadable or missing patient-ID-wristbands (chewed, soaked, missing); non-bar-coded-medications; medications in distant refrigerators, lost wireless connectivity; problems with patients in contact isolation and emergencies."

Koppel was quick to point out, "It’s not that staff are lazy or careless, it’s that the system does not work as well as it should."

Perhaps. But only if you expand the definition of "system" beyond the technology to also include the users’ behavior.

If that’s the case, then indeed, the system didn’t work properly. In fact, there’s no indication that any of the end users told either the information technology or materials management departments about this so that IT could explore any internal programming issues and materials management could contact the vendor.

Instead, these end users developed their own "solutions" that apparently compound the problems. It’s a lot like blaming a gun for killing someone and not the shooter pulling the trigger.

Sure, some of these incidents may have involved so-called "emergency" situations when action had to be taken immediately. However, the study authors indicated that they looked at nearly a half-million bar-coding scans and "shadowed" nurses for years so it’s highly unlikely so many "emergencies" happened so frequently to prevent someone from reaching out to IT or MM. In all fairness and with all due respect, this was as much a workflow problem as it may have been a software problem – and that makes it hard for end users to blame the vendors without accepting some culpability.