INSIDE THE CURRENT ISSUE

August 2008

Having My Say

Bar coding to endure in a chip- and sensor-driven world

Stripes will continue as automation stars for a variety of applications

by Rick Dana Barlow

Economics aside, how does a mature technology like bar coding remain a viable player in a world increasingly enamored with newer options, such as chips, tags and sensors, to track and trace equipment, people and products?

Certainly, the higher upfront investment for radiofrequency identification (RFID) and real-time location systems (RTLS) may make bar coding more fiscally attractive in the short-term but whether it can weather falling prices long-term for RFID and RTLS components represents another debate.

In a chip- and sensor-driven world, bar coding’s sustainability remains in question even as interest simmers for bedside point-of-care bar coding applications. As a result, Healthcare Purchasing News Senior Editor Rick Dana Barlow reached out to three key executives immersed in the bar-coding world to briefly share their insights on the distinguishing characteristics, applications and endurance of their products as options for healthcare supply chain management.

Not surprisingly, Gale White, vice president, infusion systems, B. Braun Medical Inc.; Rick Ellis, vice president, business development, Precision Dynamics Corp. (PDC); and Cristina De Martini, global practice leader, healthcare, Zebra Technologies, all foresee a promising future for bar-coding technologies, even as the industry enjoys a turbulent relationship with RFID and RTLS applications.

HPN: Where does bar coding fit in an RFID- and RTLS-minded world?

WHITE: By implementing bar-coding systems, health facilities can not only improve care delivery, but enhance communication between pharmacists and nurses, making medication administration safer – from filling the prescriptions to administering the medication.

In B. Braun’s view, bar coding fits extremely well in the bedside medication safety arena for several reasons, beginning with simplicity and ease-of-use. The printing of bar-code labels and the act of scanning are common practice in today’s healthcare facilities. Information technology (IT) professionals and healthcare providers alike are familiar with the various components utilized in bar-code systems.

Reliability is also a significant consideration, particularly when bar coding is employed in a medication safety program. For example, B. Braun’s Outlook Safety Infusion System’s bar coding capabilities are designed to ensure the right patient is receiving the right drug and the right dose by an authorized clinician. A torn, wrinkled or smudged bar-code label can be observed visually and identified as the potential cause for a reading error. On the other hand, RFID reading errors can be associated with several causes not readily observable, such as interference, proximity or circuit failure.

Another important consideration for medication safety systems is that bar-coding, RFID and RTLS systems are merely tools utilized to perform data entry functions. Effective medication safety programs focus first on the standardization and improvement of the medication administration work-flow. As bar-code labels are virtually ubiquitous in a healthcare setting and readers are available with most bedside IT solutions, choosing a bar-code data entry protocol allows the institution to remain focused on the clinical workflows rather than the implementation of new technology.

ELLIS: I don’t know that this is really an ‘RFID minded world.’ We need to be careful to differentiate between Passive/HF RFID for Positive Patient ID and Active RFID for Real Time Location Systems. The primary differences from a patient ID perspective are that RFID information can be updated as the patient’s condition changes, and RFID does not require line of site to read. I expect bar codes to remain the predominant ID mechanism for patients, supplies, medications, test specimen, blood, etc., for the foreseeable future.

DE MARTINI: One major growth area for bar coding is clinical patient safety applications. Historically, the primary uses for bar codes have been in the materials management and medical records departments, but this is quickly changing as the technology expands its reach to clinical areas such as the pharmacy, laboratory and patient bedside. As hospitals continue to search for ways to minimize errors and improve the overall quality of care, bar coding presents a proven, cost-effective option for achieving these goals.

Give me a specific application/scenario where bar coding works better, such as more appropriately, cost effectively or efficiently, than RFID and RTLS and why?

WHITE: First, bar coding is a proven tool in the pharmacy, retail and in inventory management as a robust, relatively easy-to-implement and established technology. It is a straightforward method to deploy at the bedside to verify that a medication is being administered to the correct patient as it was ordered for that patient. It is also, in the current marketplace, less expensive to implement than RFID. In the sense that bar coding is a proximity-based tool – meaning that it works in close proximity to the medication and to the patient wristband – it makes sense to deploy a bar-coding system to improve the safety of bedside medication administration.

In the current market, RFID has been adopted by institutions largely for asset tracking and management with a good degree of success. In the developing market, the cost of radio frequency identification tags is decreasing, and battery life is improving as well. The issue is that RFID is not a proximity-based technique, and much of the issues with deployment relate to that factor.

The main roadblocks with RFID are cost, infrastructure and wireless dead spots. In the current state of development, RFID is seen as too costly to deploy in small to medium hospitals, and a lower cost/lower scale product offering has not come to the marketplace yet. In addition, older institutions face challenges in providing enough access points to gain adequate coverage opposed to facilities that are newly designed for broad wireless networks based on their infrastructure. For example, facilities that have been built by annexation do not have simple building design to add wireless access.

Finally, almost all facilities struggle with some areas that are unable to be served wirelessly due to dead spots. Examples include metal drawers on nursing stations that hold tagged devices, elevators and fire escapes. All of the above issues have led to much slower RFID uptake by the healthcare industry.

ELLIS: Again, bar coding and RTLS are solving entirely different problems – there is no comparison. For bar coding versus HF RFID, I think the bar code will have an advantage in cost, and RFID will have a slight advantage in first-time read rate for the near future.

DE MARTINI: Patient identification for medication administration or specimen collection is one area where bar coding offers a clear advantage over RFID. Bar-coded wristbands not only offer a lower cost of ownership, but they also provide users with a high degree of accuracy and efficiency.

With RFID wristbands, clinicians may be able to confirm that two patients are in the room, but they will not be able to discern which patient is on the right and which one is on the left unless they interact with each individual patient or have cost-prohibitive, process-inefficient antennas to distinguish the two. Since a line-of-site check is essentially required for both technologies, bar coding is a more cost-effective option for hospitals looking to verify patient ID before collecting specimens, administering medications or transfusing blood at the bedside.

In addition, the growing use of 2-D bar codes enables clinicians to read bar codes on patient wristbands just as efficiently as they can read RFID tags. With Aztec Code, for example, there is no need for a quiet zone between symbols, so bar codes can be repeated around the length of the wristband. As a result, nurses simply apply the bar code reader to any point on the band without having to reposition it. Much like RFID, these codes store large amounts of data and can serve as portable records. They can even allow a digital photograph of the patient to be encoded on a wristband and viewed on a PC or portable computer whenever the bar code is scanned.

What specific advancements in bar coding technology keep it relevant for healthcare facilities today versus being rendered prematurely obsolete?

WHITE: The inclusion of bar-code scanning in a larger number of bedside devices has been apparent in recent years. Almost all vendors of bedside glucose testing and infusion pump technology have incorporated bar-code scanning options directly into the device to facilitate bar coding at a modest cost. In addition, the development of more robust and portable scanners along with improved labeling technologies that prevent moisture, smearing and reduce the inability to read bar codes have certainly kept bar coding relevant in healthcare.

Bar-code label printing as an ancillary capability is included in nearly all pharmacy management systems. In this way, printing bar codes for medication are now more integral to the applications than they were in the past. Lastly, the development of 2-D opposed to linear bar coding has kept bar coding relevant as 2-D increases the data density of the bar code over older linear bar codes.

ELLIS: The increased use of 2-D bar codes and imaging scanners have made a big difference. The 2-D bar code allows for a significant amount of information to be written to the label or wristband and the redundancy improves first time read rates. Beyond these existing technologies, continued improvement to the scanners to improve first-time read rate will be important.

DE MARTINI: There are several key trends at work. First, the growing availability of wireless networks means that hospital infrastructures can more easily accommodate mobile computing and mobile peripherals, including portable bar code printers and scanners. These devices are allowing hospital staff members to access actionable, real-time information and generate bar codes at the point they are needed. For example, materials management staff can utilize handheld mobile printers to produce shelf and item labels from any location, including receiving areas, so that the facility can better manage its inventory. Likewise, clinical staff may use the same devices to generate specimen labels at the point of care.

At the same time, enhanced, two-dimensional symbologies are minimizing the need for manual intervention and are enabling hospitals to store greater amounts of information in each bar code. The cost of 2-D imagers is also coming down, which make 2-D codes a more attractive option.

From a clinical perspective, the next frontier for bar coding will be integration with medical devices such as smart pumps, which read bar codes on IV bags to ensure the proper medication and dose. This level of integration further enhances the benefits of a closed-loop medication administration process and enables providers to analyze metrics regarding system effectiveness.

Editor’s Note: Be sure to check out Healthcare Purchasing News’ Capital Equipment Guide in September, which will include an editorial feature delineating and distinguishing RFID from real-time location systems (RTLS).