2-D, 3-D or RFID:
That is the question

Can advanced bar coding do what active, passive tags cannot?
(First of two parts)

by Rick Dana Barlow　

An ongoing debate continues to simmer between multidimensional bar coding options and radiofrequency identification tags.

One of the key arguments centers on costs. On the surface at least, bar coding seems to be cheaper than RFID.

Of course, that depends on how you define cost: Contractual or retail purchase price vs. total lifecycle costs, including usage. The cost conundrum actually rankled Mark Roberti, founder and editor of RFID Journal, who wrote in a magazine column three years ago: "Saying bar codes are cheaper than RFID tags is like saying a wood-handled hammer is cheaper than a nail gun. Well, yeah. But it takes a mere fraction of the time to finish a job with a nail gun than it would with an old-fashioned hammer."

Another key argument centers on operational capability and user-friendliness.

It’s no secret that you can point and sweep an RFID wand in a room, scanning all of the tags inside with a high degree of accuracy. Meanwhile, any bar code requires line-of-sight contact for the scanner to read the affixed data.

Technically, then, bar codes may be cheaper in price but more costly when it comes to data collection as you’d have to factor human resources and time into the equation. Or are they more evenly matched?

Granted, two- and three-dimensional bar codes can pack a lot more data into a small space than their first-generation one-dimensional ancestors. But do they offer enough capability to satisfy healthcare organizations that may not want to invest in RFID or real-time location systems (RTLS), which can be powered by such modalities as radiofrequency, infrared and ultraviolet beams?

Healthcare Purchasing News reached out to more than two dozen companies that offer asset tracking products and technologies to engage their executives in a virtual discussion about the current and future applications of bar coding and RFID and RTLS systems. Of the 17 executives who responded to HPN’s virtual roundtable, most were mixed on what bar codes versus RFID tags should be affixed. If someone made a cogent case for limiting 2-D or 3-D bar codes to disposable medical supplies, for example, others countered with their own insights. The same for cost-effective applications of RFID tags on equipment and people.

If they all agreed on anything it was this: Both bar coding and RFID and RTLS will remain in play for a long time as the latter will not replace the former. But expect more targeted use as companies improve the technologies, they added.

To read about their cost-justification arguments for implementing advanced bar coding or RFID/RTLS, as well as their forecasts for adoption and implementation through 2020, go to HPN Online at www.hpnonline.com. Be sure to search HPN’s historical extensive coverage of bar coding and RFID/RTLS, too.

Next month, look for their thoughts on RFID and RTLS.

Matt Perkins, Chief Technology Officer and Senior Vice President, Engineering, Awarepoint Corp., San Diego

"2-D and 3-D bar coding requires the person doing the scan to locate and bring a scanner within inches of the tagged item — a medication, patient, staff member, etc. As such, this technology is most useful when the location of what’s being tracked is already known and the item is nearby. If not, whoever needs to scan the bar code must interrupt their normal workflow and carry the device to the item they need to scan — and that’s if they know where the item is.

"Tracking assets, patients and people is by nature a fluid process — all are in motion all the time. RTLS helps locate the item in the first place, then real time data associated with location and status can be used to understand, improve, and automate workflows. RTLS can identify whether a device has been sterilized/cleaned, if it has been properly serviced, or pulled off the floor per a recall. Accurate information about interactions between hand hygiene stations and caregivers help ensure best practices are followed. Understanding if the anesthesiologist has visited the pre-op patient yet helps streamline the OR workflow.

"Examples of effective use of bar coding include inventory counts at a central location, matching medication and blood products to the correct patient and matching mothers and infants, or infants to their mother’s milk.

"2-D and 3-D bar coding does what it’s good at very well, but it’s not designed to address the growing need for real-time, dynamic tracking, monitoring, documenting and reporting. However, for those hospitals that want to continue using bar coding, it can work in conjunction with RTLS to help hospitals improve workflow."

Jonathan Karl, Director, Sales, CDW Healthcare Solutions, Vernon Hills, IL

"Any discussion around bar codes requires a quick level set on the symbologies currently in use. The scale and areas of adoption of bar coding since the first retail use in 1974 have become as diverse as the bar-code technologies available today. The primary symbologies I see in use today are 1-D and 2-D.

"A 1-D bar code contains readable data on one axis (linear bar code), and a 2-D bar code has readable data on both the X and Y axis, providing two dimensions of data — horizontal and vertical. 2-D bar codes are able to contain more information while taking up less space due to the density of the image. 3-D symbology adds a third dimension by introducing depth through engraving or embossing the bar code, and is generally used when you need something more permanent than a label or sticker.

"Applications to consider:

• 1-D bar codes are still used primarily in equipment and product tracking, as well as labs and phlebotomy.

• 2-D bar codes are used primarily for patient data/wristbands.

• Healthcare environments are starting to see broader 2-D integration into pharmaceutical application and labs due to the volume of information systems capture, such as NDC number, lot number, expiration date, etc.

• When it comes to adapting to a range of temperature and humidity conditions, the bar code symbology does not matter as much as the construction of the label. For higher temperatures, we recommend thermal transfer labels over a direct thermal label, as direct thermal labels react to heat. This is where you will see the integration of RFID with bar code systems — to track environmental conditions and provide alerts/reports accordingly.

"Asset tracking has historically been via 1-D bar codes. Because the information on the tag is quite basic, you typically associate the asset number on the label to the bar code and then to the asset. For more proactive asset management — versus simple tracking — organizations use RTLS (real time location system) to track important assets, such as surgical instruments or mobile inventory, reporting back those locations’ on-demand use.

"2-D bar codes are quickly becoming the standard in supply chain management as they enable the capture of more detailed information. Rather than having a vial of a drug, the system can tell me that I have a vial of a drug, ordered by Dr. X, lot number Y, expiring in one month.

"This is also an emergence area for RFID and one of the strongest use cases due to the speed at which you can track and monitor inventory levels over wireless, instead of the labor- and cost-intensive process of manually scanning inventory levels."

Shlomi Avigdor, Director, Sales & Marketing, LogiTag Systems Ltd., Mamaroneck, NY

"Be it 2-D or 3-D, bar code technology lacks the ability for automated reading in the hospital environment, and delivers a single advantage over RFID — lower cost. Moreover, the longer time a bar-code label is placed on an asset, the lower the chances it can be read by a scanner, simply because time has its way and labels can become unreadable, even if for the simple reason of another label being applied on top of it.

"With these considerations in mind, it seems that bar codes can be the choice of technology for patient tracking in extremely low-budget implementations, mainly because it is better than not having patient tracking at all. It is inferior to RFID because it requires patients to voluntarily scan their bar code, and therefore does not allow for the many features that are based on wireless identification — wander prevention, for example — but can provide hospitals with the basic ability of quick patient identification as specific points." 

Fran Dirksmeier, General Manager, Asset Management, GE Global Services, GE Healthcare, Waukesha, WI

"Bar coding technologies are typically appropriate for items that follow a well-defined workflow process. This process requires an item to be handled in a transactional manner, one item at a time. By design, bar coding is a line-of-sight technology that requires item identification to be performed by a close proximity scan so both the item and the bar-code reader need to be accessible at the point of use. The low cost nature of a printed label makes this technology conducive to cataloging a large number of items that may be durable or disposable. 2-D applications are appropriate when there is space on the asset for a larger label, and a simple ID number is sufficient. 3-D bar codes allow for more information to be placed on the label in a smaller space. Bar coding makes sense when used as a lookup mechanism to prevent data entry errors or a centrally controlled, unique identifier is needed."

Arnold Chazal, CEO, VUEMED Inc., Seattle

"I have not seen any 3-D bar codes used in disposable or permanent asset tracking. I have seen 2-D (DataMatrix) bar codes being implemented in some areas of healthcare — specifically when space on a label is limited, such as with drugs, sutures and instruments. It requires a 2-D bar-code scanner to read the information, as well as a system that can receive the data from the DataMatrix.

"For tracking most disposable medical devices, a linear or 1-D bar code makes the most sense. It’s readily available, free to print and can be read by most standard scanners. If a healthcare organization uses bar coding technology, it is typically using the standard 1-D bar-code readers since device manufacturers already print them on their products. The proposed UDI legislation also includes the requirement that a linear bar code be included as one of the identifiers even if RFID is used."

Marcus Ruark, Vice President, Intelligent InSites Inc., Fargo, ND

"Bar coding is the least expensive tracking technology and is typically used for high-volume tracking applications where the bar-code scanner will have line-of-sight and close proximity with the bar-coded items. Unfortunately, the process of reading bar codes in the healthcare environment almost always requires some form of manual activity, such as a nurse scanning a bar code with a hand-held bar-code reader. The many benefits of automating manual processes, combined with the continuing decrease in RFID and RTLS tag prices, is causing a shift from bar coding to RFID and RTLS tagging."

Kurt Mensch, Principal Product Manager, RFID, Intermec Inc., Everett, WA

"For patient tracking, bar-code wristbands are the leading methodology for positive patient ID. Line-of-sight scanning ensures that patients in close proximity are not mistaken for one another. Additionally, passive RFID wristband tags using either shorter range HF technology or UHF frequency at lower reader power also ensures that the correct patient is being scanned and has the added benefit of being less intrusive on the patient. RFID wristbands can be scanned without turning the patient’s wrist or arm and can help identify the patient while they sleep without touching them or orienting the wristband to read it. 

"Another area where RFID is being adopted is tagging infants with passive or active RFID so that a ward can be locked down in the event an infant is moved without authorization through an RFID-enabled passageway. Passive RFID wristbands can also be used to track psychiatric, dementia, and mental disorder patients to ensure they do not leave their area of care.

"For surgical instruments, conventional bar codes are compatible with a wide range of items, including small 2-D symbols for items with little labeling real estate. Common media solutions readily survive common sterilization protocols, such as autoclave." 

Richard Philippe, president, Logi-D, New York, and Laval, Quebec, Canada

"The main advantage of bar codes over RFID is of course the purchase price. Another is the relative ease of applying the technology, as bar codes can be printed directly onto packages, tags, bracelets, etc., using a standard ink jet or laser printer.

"2-D and 3-D bar codes expand the areas where bar code technology can be used, primarily by providing the ability to carry more data. This added feature opens up new avenues, notably pertaining to supply chain integration applications where data is exchanged between trading partners.

"Although there is room for both technologies to cohabitate, bar-code technology has many more limitations than RFID but continues to be a preferred technology choice, for the most part due to its lower purchase price. However, one of the main recognized drawbacks of bar-code technology is that it requires a direct line of sight to be read. It is also neither designed for nor well suited to long-distance or motion readings."

John D’Ambrosio, Senior Manager, Core Team Lead — Supply Automation, Omnicell Inc., Mountain View, CA

"3-D bar codes are well suited for identifying portable patient-use products such as IV poles and SCD pumps. Because these products move through the decontamination process hundreds of times during their life cycle, printed labels with identifying values lose their readability as the cleaning solvents dissolve the inks or thermal print over time. Using an engraved or affixed raised bar code would work well on these types of items. One challenge a 3-D bar code might present to a healthcare facility is related to cleaning the bar coded products, since it is necessary to clean between the bars of different heights. Cleaning protocols need to be established to address this issue.

"A 2-D bar code has an advantage due to its size. Many products used in healthcare are not large enough to allow a linear bar code to be applied. The GTIN, lot and serial numbers and expiration date demand substantial real estate in a linear format. Individual packs of sutures are a good example of where a 2-D bar code serves the industry well."

Adam Peck, Director, Marketing, CenTrak Inc. Newtown, PA

"In healthcare, 2-D and 3-D bar codes are appropriate for tracking small consumable products and instruments for the purposes of supply chain management."

Tuomo Rutanen, Senior Vice President, Marketing and Business Development, Ekahau Inc., Reston, VA

"Products and equipment would be the logical ones, as bar codes are pervasively used today on these items. Patients are another category where a bar code on a patient wristband makes sense when the patient needs to be scanned, or where the item is so small or inexpensive that it would not justify the cost of the tags and software in order to track it in real time."

Dave Stewart, Director, Healthcare, Honeywell Scanning & Mobility, Fort Mill, SC

"Patient safety is the ultimate goal in hospitals. By using 2-D bar codes on medications and patient wristbands, the level of automation can drastically decrease human error. Adverse drug dispensing has also been greatly reduced due to the heightened level of automation offered by using bar codes to track and manage patient safety."

Joel Cook, Director, Healthcare Solutions, Stanley Healthcare Solutions/AeroScout, Framingham, MA

"2-D and 3-D bar coding makes the most sense to apply to low-cost, high-volume items in the supply chain. This often applies to items that have a direct line of sight to a bar code, such as pharmaceutical drugs, when the point of administering, acceptance or consumption involves or permits direct physical contact. Bar coding is especially useful in ensuring the ‘five rights’ of patients (right patient, right medication, right dose, right method of administration and right time). Additionally, bar coding can facilitate reading medication labels and details as well as patient wristbands with higher accuracy, reducing cases of human error.

 "From a compliance perspective, 2-D and 3-D bar coding is useful for tracking inventory. By simply waving an item under a bar-code reader, it can register that the item has been removed from its location."

Jon Poshywak, Managing Director, RTLS Workflow Services, TeleTracking, Pittsburgh

"As people — patients and staff, products, equipment, temperature and humidity are dynamic, 2-D and 3-D bar coding does not make sense as you would only recognize a point in time snapshot for location and status. Bar coding and the manual process of capturing relative information is an acceptable method for inventorying supplies."

Henry Tenarvitz, Chief [Intellectual Property] IP Officer, Versus Technology Inc., Traverse City, MI

"Lower-cost items or products that hospitals use in large volumes are ideal candidates to track with bar coding. Take medication, for example. The sheer volume of meds individually prepared by the hospital pharmacy that need to be tracked in a hospital makes RFID impractical from a financial standpoint. Even though the cost of RFID labels has dramatically decreased in recent years, they cannot compete with the fractions of a penny that bar code labels cost, translating into millions of dollars difference in a yearly budget."

Tom Stewart, Principal, PHG Technologies, Brentwood, TN

"We stepped away from developing asset tracking systems seven or eight years ago to focus on patient ID/forms automation solutions. With regard specifically to patient bar code and RFID solutions, 2-D bar codes certainly offset some of the anticipated benefits of RFID for providing more information. I believe the data capacity of the 2-D/3-D bar code is sufficient for patient ID, so RFID is overkill in that application."

Alicia Torres, Global Practice Leader, Healthcare, Zebra Technologies Corp., Lincolnshire, IL

"When tracing patients or staff, 2-D bar coding is best. For products, equipment, and temperature, either 2-D or 3-D can be used. This is because from a workflow perspective, 2-D bar codes are efficient and reliable. In today’s reality, hospitals don’t need the added benefit of a 3-D bar code. 2-D bar codes allow for the same efficiencies and streamlined processes.

"In some cases, the media (label) is more important than the type of bar code. For example, temperature and humidity monitoring need to have the highest quality label possible to ensure the label can be clearly read. This helps ensure products and medications are safe for patient care and admission. The label is also critical for correct patient identification and reduces errors due to illegible bar-code wristbands."

Editor’s Note: Next month, HPN spotlights insights on RFID and RTLS.

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