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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



October 2013

Products & Services

New Technology

Pain-free microneedle influenza vaccine is effective, long-lasting

Scientists have developed an influenza vaccine delivered via microneedle patch that provided 100 percent protection against a lethal influenza virus in mice more than one year after vaccination. Microneedles are a medium for delivery of influenza vaccine that avoids the pain associated with ordinary hypodermic needles. They are a mere seven tenths of a millimeter in length, and the volume of vaccine—a major contributor to pain—is minuscule.

Instead of a liquid containing whole killed or attenuated virus, this vaccine uses dry virus-like particles (VLPs) which simply coat the needles in the presence of a simple stabilizing agent, reducing the need for refrigeration — a potential boon for use in developing countries. The lower dose required when using microneedles also reduces the potential for side effects, such as lung inflammation.

"This method can induce higher levels of IgG2a antibodies as well as rapid recall immune responses following lethal challenge infection. Our previous study showed that microneedle vaccination induced higher levels of antibody-secreting cells in spleen and bone marrow compared to intramuscular vaccination," says Sang-Moo Kang of Georgia State University, a researcher on the study.

Earlier studies by this group showed that influenza VLP-coated microneedles actually produced higher short-term protection than conventional intramuscular immunization. In this study the researchers tested how effective the long-term protection of the vaccine was. Mice that received the vaccine were 100 percent protected from a lethal challenge with the influenza virus 14 months after vaccination.

Kang says his aim was to develop an easier and pain-free method of vaccine delivery. He also says that patients could probably use this system to vaccinate themselves.They report their findings in the September 2013 issue of the journal Clinical and Vaccine Immunology.

Urine test may show risk
 of mental decline in people with type 2 diabetes

A simple urine test may be able to identify type 2 diabetes patients at increased risk for mental decline, according to a new study. This study of nearly 3,000 type 2 diabetes patients, average age 62, found that those who had persistent protein in their urine over four to five years had greater declines in their brain's information-processing speed than those with no protein in their urine. The decline in patients with persistent protein in the urine was greater than 5 percent.

The findings suggest that protein in the urine — a condition called albuminuria — may be an early warning sign of future mental decline.




Data Matrix Example

Raising the bar on tracking products, people, equipment

First in a multi-part series

by Rick Dana Barlow

From desktop personal computers to laptops, notebooks, tablets and smartphones, healthcare supply chain professionals have a plethora of hardware and software choices to use to keep track of the stuff and people moving throughout their facilities.

Linear Bar Code Example

Since the start of the third millennium they’ve seen their technology selections blossom, too, from bar coding advancements to radiofrequency identification (RFID) and real-time location systems (RTLS) that can employ infrared, ultraviolet and other "modalities" to do the trick.

Pens, pencils, paper and sticky notes are feeling a bit crowded.

With looming healthcare reform regulations, anticipated reimbursement declines and expected annual budget cuts, supply chain pros may be strapped for cash and time as they consider the wealth of possibilities to implement.

Within the last decade, Healthcare Purchasing News has explored the variety of issues surrounding bar coding, RFID and RTLS, from the over-arching vistas to the subtle nuances on the shelf or at the bedside. Editor’s Note: To examine the editorial arsenal, go to HPN Online and search for "bar coding," "RFID" and "RTLS."

In this era of smartphones and near-ubiquitous online wireless access, HPN revisited some of the "back-to-basics" fundamentals for those either new to the game or needing quick updates on the latest developments potentially affecting their business.

We reached out to more than a dozen executive leaders at some of the leading bar-code, RFID and RTLS suppliers for their insights and perspectives on a variety of salient issues. Here’s what they shared with us.

HPN: What are some of the real, practical differences between the various bar-code reading technologies?

"The application and the environment dictate what bar-code reading technology a customer will elect to employ. Purchasing a scalable solution — like an imager –allows for future technological growth and greater scalability of the solution in addition to delivering the best return on investment. For example, if an organization is looking for EMR healthcare-grade scanners today, it may want to look at one of the full-color imagers available on the market as they can be used for taking photographs to attach to the electronic record. This is especially helpful in wound care and for documenting various images at the point of care."

– Merrie Wallace, R.N., MN, Executive Vice
 President & CNO, Product Solutions,
Awarepoint Corp., San Diego

“Many of the technological differences in reading bar codes are driven by the amount of information that you are attempting to transmit through the bar code. For example, if you’re only capturing an item number of a bag of cotton swabs, a linear 1-D bar code works great and can be scanned by a wide variety of equipment. If you are transmitting more information, such as a Lot number, expiration date, serial number from a class II pharmaceutical, this may be better served with a 2-D bar code, which requires a different technology to interpret. In addition, the 2-D label can be created with a smaller ‘footprint’ making it optimal for labeling smaller items. (See examples at top of story)

“Linear readers for 1-D bar code send out a light beam that reads the black and white stripes of the bar code, interpreting the varying widths into numbers. Data matrix readers take a picture of the image and interpret the colored cells in the photo to into information being transmitted.

“Linear 1-D barcodes are still the most efficient bar codes for locations and internal movement labels in our facilities, so we can still leverage older terminal/PC hand scanners and RF handheld devices with linear scanning capabilities. However, we have seen a marked increase in 2-D bar coding (DataMatrix, PDF417, etc) and approximately three-to-five years ago we started replacing all equipment with 2-D imagers. Since the 2-D imager can also read linear 1-D bar codes and price points on those scanners became a non-issue, there is no down side to ordering 2-D equipment. We now use 2-D image scanners for ‘sortation,’ RF handheld units for various functions, including voice directed picking, ‘putaway,’ etc., and to replace hand scanners.

This technology used in our distribution centers enable us to ship 120,000 cartons each day with 99.9 percent order accuracy and a 99 percent order fulfillment rate.”

– Tom Meier, Senior Project Manager, Henry Schein Inc., Melville, NY

"2-D scanners are becoming increasingly popular, and offer several significant benefits. They are the only models that can read 2-D symbols such as DataMatrix or Aztec Code, which are becoming increasingly popular. They also read 1-D symbols, rendering them capable of reading the range of symbols potentially encountered today and in the near future.  They also often offer omni-directional decoding, so users do not have to carefully align the reader with the bar code, increasing speed and simplicity of the scanning activity."

– Alexis Arenas, Strategic Accounts Manager, Barcoding Inc., Baltimore

"With the widespread adoption of smartphones and tablet computing, many users have become acquainted with applications enabling these devices to read bar codes. However, in the healthcare setting, it is essential that the scanning equipment used for key applications (such as positive patient ID/wristbands, bar-code medicine administration and mobile phlebotomy) be extremely robust. Technology cannot frustrate or delay the point-of-care staff or adoption of these bar-code-driven error-proofing methodologies will be undermined or even abandoned. Consumer-grade camera-based scanning applications simply do not offer the speed, reliability, motion tolerance or decoding power to adequately support critical scanning tasks for these point-of-care applications, threatening the quality of care benefits.  However, this can be addressed by wirelessly pairing dedicated scanners to mobile computing devices to provide the performance needed to support these applications.

"1-D scanners have been widely adopted for years, and still offer excellent value when only conventional bar codes will be read. Most potential users will be very familiar with the common form factors of these scanners, and it can lead to quick and intuitive learning curve.

“2-D scanners are becoming increasingly popular, and offer several significant benefits. They are the only models that can read 2-D symbols such as DataMatrix or Aztec Code, which are becoming increasingly popular. They also read 1-D symbols, rendering them capable of reading the range of symbols potentially encountered today and in the near future.  They also often offer omni-directional decoding, so users do not have to carefully align the reader with the bar code, increasing speed and simplicity of the scanning activity.”

– Glenn Aspenns, Senior Media Applications Analyst/Product Manager, Intermec Technologies Corp., Everett, WA

"The cost of bar-coding scanning equipment has decreased, making it a cost-effective technology for inventory management and requisition, especially with regard to commodity type items. The basic differences among bar-code reading technologies lie in how much information the bar code may contain and the distance between the bar code and the scanner trying to scan it."

– John Freund, CEO, Jump Technologies Inc., Eagan, MN



"A hospital, or any company for that matter, looking to track its assets/people, must examine its needs very accurately.

  • What are they tracking (patients, expensive machines, inexpensive supplies, staff, security, medical procedures…etc)?

  • What are the features the hospital must have, and what can they manage without?

  • Do they need the information in real-time and what are the most important pieces of information the organization needs?

  • Should this information be very secured, or under free access?

  • How is the human interaction with the product — can it be seen, touched, accessed by people?

  • After all of this is considered, the hospital must:

  • Find a solution that fits its needs, not the other way around

  • Calculate the total cost of ownership and cost effectiveness of the solution, which typically is reflected in cost savings and fast ROI

  • [Choose technology that is] under very low maintenance with little human interaction/interference

  • [Choose technology that is] flexible to change with the hospital needs

  • [Choose technology that is] reliable and maintenance-free.

"The main difference between the different types of bar-code technologies is the amount of data they can store. QR codes, in comparison with other simpler bar codes, can provide the customer access with much more information.

"Both types can be produced and copied easily, while any simple device can read them — including smartphone applications. They cost very little, if anything, to print, and we normally see them on mass productions, such as food produce, clothing…etc. QR codes can be used for marketing efforts, such as special coupons/discounts or various promotions.  

"Bar codes are widely used today in hospitals to identify patients and their documentation. Their capabilities are fairly simple."

– Shlomo Matityaho, Founder and CEO, LogiTag Ltd., Mamaroneck, NY

"Probably the biggest difference in current bar-code reading technologies is the variances in symbologies and how they are implemented. Choosing a symbology is like choosing a font when you write a document — do you choose to use Times Roman or Arial? Bar-code symbologies like Code 128, Datamatrix, QR Code, etc., each have their place depending on what you are trying to accomplish similar to the message that you convey with a font.

"Symbologies are broken down into categories: 1-D (usually rectangles comprised of vertical lines like you see on a can of soup), 2-D (usually squares comprised of smaller squares in a pattern, like you see in many social media applications), and 3-D, which usually add color (or shades or depth [if engraved] to vary the light returned to the scanner) to 2-D bar codes to add an additional layer of information stored in the bar code. As you progress from 1-D bar codes to 3-D bar codes you are able to store greater amounts of information in the bar code.

"Additionally, organizations like GS1, HIBCC and ISBT have developed data-encoding schemes on top of one or more of these bar-code symbologies that enable organizations to standardize and define the information communicated in the bar code. Obviously, 2-D and 3-D bar codes are able to more efficiently store large amounts of information in a smaller area that makes them more practical for these types of encodings, but we are also seeing schemes where multiple bar codes can be chained together to communicate more information about a particular product."

– James Casavant, Chief Operating Officer and Chief Technology Officer,
LPIT Solutions Inc., Grand Rapids, MI

"Handheld laser scanners have been in use since the early 1980s. Throughout the years, they have become smaller, better, faster and less expensive. They are fantastic at scanning traditional 1-D bar codes printed on packaging or label stock.

"Linear imagers now can do everything a laser scanner can do, but offer the additional functionality of scanning ‘virtual’ 1-D bar codes or bar codes that are not printed at all but instead exist only as pixels on a computer or cell phone display.

"Moving up the price-performance spectrum, the most capable bar-code readers are array imagers. An array imager is essentially a camera. When the user pulls the trigger, the scanner takes a picture of an area and then decodes the bar code from the digital image. Array imagers are able to scan traditional 1-D bar codes, 2-D bar codes and virtual bar codes. Additionally, array imagers are capable of advanced functionality such as capturing digital images and scanning optical character recognition (OCR).

"Another benefit of the array imager is omni-directional scanning; the scanner will scan and decode a bar code from any angle without the need to orient the scanner, making the array imagers more productive than linear readers for certain clients. With the recent advancements in complementary metal–oxide–semiconductor (CMOS) arrays and microprocessors, early-model latency has been eliminated and array imagers now are as fast to decode as linear scanners."

– Randy Briley, Healthcare Director, Motorola Solutions, Schaumburg, IL

“The two predominant barcode symbologies are 1-D and 2-D. It depends on your intended use as to which is more suitable for your needs. 1-D linear bar codes are typically a string of numbers that identify a manufacturer and item. This can be used in an application to retrieve related information, such as quantity, location, description, etc. 2-D bar codes can be encoded with significantly more information in a smaller label footprint than 1-D barcodes. So for inventory management and asset location, 1-D bar codes are typically used due to their low-cost. For sales brochures, tools which drive users to Web sites and other potentially data-intensive applications, 2-D bar codes are the better choice. 3-D bar codes store even more data than 2-D bar codes.”

– Cliff Anderson, Product Marketing Manager,
Wasp Barcode Technologies, Plano, TX

HPN: How do you choose between laser scanners and area imagers (based on capabilities, functionality and where you want to deploy them)?

Aspenns: "Over recent years, area imager technology has made dramatic advances in capability and affordability. Whereas 2-D imaging capability once came with significant trade-offs in terms of reading speed, ease of use or limited compatibility with print types, products are now available that offer excellent decode speed, motion tolerance and even ability to read damaged or poor-quality symbols. Where minimizing initial investment cost is the major deciding factor, 1-D-only scanners (laser or CCD) can still offer a moderately more economical choice. However, the ability to read 2-D symbols can help future-proof an investment in scanning technology."

Arenas: "The starting place for any scanner selection is always with the software being employed. The software development company may require a certain set of requirements that can only be fulfilled by a certain set of hardware parameters. However, it is always important to utilize the most cutting-edge technology and healthcare-grade plastics to provide the most hygienic and streamlined experience for the patient.

"Once the software has been verified and there is a starting place to work from, it is essential to look at the task at hand and the trajectory for both the hardware and the institution. For example, the organization may want to utilize the hardware in one part of the hospital today; but, as needs change and the facility grows, the organization must take into consideration where that same hardware can be used two, five, or seven years down the road. By anticipating future developments, we can make the best choice for that customer and their unique goals."

Meier: “Being a global distributor with 4.4 million square feet of warehouse space, handling more than 96,000 branded products and Henry Schein private-brand products in stock and more than 110,000 additional products available as special-order items, we experience a variety of bar codes and labeling formats. Therefore, the equipment we select for our receiving and returns process needs to be flexible enough to ‘read’ and interpret the most popular bar code versions, which are linear (1-D) and the data matrix (2-D), which is growing in popularity. Internal processes, such as cycle counting and order picking, can be accomplished with portable 1-D scanners.

“The flexibility of our data-capturing equipment also allows us to use any variety of bar-code formats for internal processing.

“Since price is not a concern, we will be purchasing mostly imagers. We do very little long range scanning, but for the few areas where we need to do that, we will still install linear 1-D long-range scanners.

Freund: "The imager scanner takes a picture, scans and interprets the image. Imager scanners have become increasingly more responsive, and today are almost as fast as laser scanners. In situations where bar codes are easily accessed in close proximity to the scanner, an imager scanner is an adequate cost-saving choice. However, if the situation requires scanning bar codes that are farther away, such as in a storeroom with tall shelving, then a laser scanner could be required. Another situation that might merit the additional cost of laser scanner precision is bar codes residing extremely close to each other.

"In today’s world, smartphones and tablets can replace costly scanning terminals. For low-volume scanning, the camera in a smartphone or tablet can work as an effective imager scanner. However, since this is really a camera taking a picture of a bar code, it can be time consuming and frustrating if attempting to scan many bar codes. Some scanner manufacturers are attempting to solve this problem by developing scanners for specific mobile phones that connect directly to the phone. However, as smartphone and tablet designs change, new plug-ins are required, rendering the old scanning hardware obsolete. However, Bluetooth technology solves this issue, creating a $200-to-$300 bar-code scanning solution that is independent of a device’s connecting port and will work with any device as you upgrade over time.

Casavant: "A lot of what we recommend to our customers has to do with cost sensitivity with area scanners being more expensive than linear scanners. However, because of their compactness we see far more 2-D bar codes being implemented on packaging and standard linear scanners can’t read these. Advancements in the optics on area scanners combined with their capabilities to read 1-D and 2-D bar codes (and sometimes 3-D bar codes) as well as do other things in some cases (like take pictures of products) leads us to most often recommend area imagers."

Briley: "There still are areas within a healthcare environment where basic linear imaging or laser scanning is a perfect fit, and purchasing managers need to take into account scanning considerations for the next five to 10 years. Scanners, for the most part, are extremely reliable and should have a service life of more than seven years.

"For basic 1-D applications like specimen tracking, asset management or inventory replenishment, a laser scanner or linear imager is an excellent solution. However, with examples such as supporting Aztec (patient wrist band), Datamatrix (surgical instruments and/or unit dose meds) or PDF417 (driver’s license scanning for patient check-in), the purchasing manager can future proof the investment by selecting an area imager."

Anderson: “Laser scanners are typically used to scan 1-D and 2-D-like symbologies (for example PDF417). They also achieve more scanning distance (range) than area imagers. In addition to 1-D bar codes, area imagers also easily decoded to 2-D images. Most imagers capture images such as in-signature captures or bar codes displayed on a mobile phone screen. Area imagers are also omni-directional, meaning they can scan bar codes in any orientation. So symbology plays a big part in the selection of a laser scanner or area imager.” 

HPN: If you were struggling to determine whether to invest in and deploy traditional 1-D, 2-D and 3-D bar coding, what economic/financial and operational factors would you have to consider (based on capabilities, functionality and where you want to deploy them)?

"Simplicity should be king. The type of bar code (1-D or 2-D) that you should use can be determined by asking two questions: What data are you looking to capture, and how much space will you have on the item to work with for a potential bar code?

"3-D bar codes are a rarity but sometimes a necessity. An example is direct parts marking where the bar code will need to be engraved into the part because of temperature or chemical exposure or for longevity. This is an expensive solution but is a necessity for some applications. The need for 3-D will mean marking the bar code in the manufacturing process utilizing special scanners designed to read the 3-D code."

– Kelly Harris, Director of Program Management, Barcoding Inc., Baltimore

Arenas: "A bar-coding solution starts with the software that the institution is looking to launch on an enterprise level. Once the software is chosen — ask what bar-code symbology does that software support? Most support 1-D and 2-D — or they may only support 1-D at this time but have a plan to support 2-D in the future. The most economical solution is generally the simplest: Look to 1-D bar codes — they are widely used, easy to support and the hardware to read them is widely available. On the other hand, 2-D bar codes are becoming more and more prevalent within the healthcare arena, on everything from admissions wristbands to blood banking. The ability to read 2-D bar codes comes from deploying an imager that will read all the symbologies (1-D, 2-D and 3-D), thereby making this imager the ‘go-to’ hardware for most institutions now and in the future."

Meier: “Here are some key considerations:

  • What information are we collecting/scanning?
  • How often do we scan?
  • How large of an area do we have for the bar code on the packaging?
  • Who is my customer and will they be using my bar code as well?

“The industry appears to be trending to the 2-D bar code. The information that is contained on the 2-D, and the price for equipment, suggests that it will be the staple for the near future. We will always have linear bar codes in play as they are the fastest and least expensive tool for moving and tracking most products.”

Aspenns: "For many applications today, 1-D symbols may satisfy all existing requirements. However, as the number of bar-coded transactions continues to increase, and as more data needs to be communicated to support applications, 2-D symbologies offer compelling solutions to reduce the number of scans required (by encoding multiple fields into a single symbol) or increase the data capacity without increasing the size of the symbol or the label.

"Most common printing hardware can handle either 1-D or 2-D symbols so that equipment generally will not impact consideration.

"While 2-D imagers can read either type of symbol, 1-D-only scanners cannot read matrix-type bar codes. For this reason, before implementing a 2-D symbology, it is essential to check each touch point in the system to ensure that all users have existing hardware capable of reading the symbology selected, or have a plan to replace the hardware.

"Some applications, such as laboratory slide labeling, cryogenic sample tracking or in-pharmacy labeling of medications with unusual form factors, face severe space constraints. These can benefit from the compact encoding of 2-D symbologies, such as DataMatrix or Aztec Code. These symbologies also offer decoding even with partially damaged or degraded labels, increasing the scanning success rate and thus support and adoption rates with point of care workers. This same robust performance can also be used to further enhance existing applications currently satisfied by 1-D symbols (such as patient wristbands)."

Freund: "It all gets back to the basics: what information needs tracking. For commodity products such as tongue depressors, gloves and other commodities, where the vendor and item number is all that may be required, 1-D bar coding does the trick. For tracking details about more sophisticated items such as implantable medical devices, 2-D bar coding is necessary to include more detailed information about the device such as serial number, patient name, date of implant and so on. Other information related to drugs and cell-based material that may entail capturing expiration dates or lot numbers may also require 2-D bar coding. Another factor to keep in mind is the nature of the information being tracked. Generating bar codes containing numbers requires much smaller widths than bar codes containing alpha numeric characters. Simply bar coding a person’s name can generate a very wide 1-D bar code, where putting that in a 2-D bar code keeps the bar code itself small making it easier to place on smaller items or forms."

Matityaho: "Producing 1-D, 2-D and 3-D bar coding is fairly simple. The problem begins with the reading devices. The hospital requires a more expensive reader equipment and application for 3-D bar coding, while 1-/2-D can use any method — including today’s smartphone devices. As the buyer, the hospital must examine its needs in order to make the decision between 1-D, 2-D and 3-D bar coding."

Casavant: "Generally speaking, 3-D bar codes don’t have a lot of traction in traditional product labeling. For the next two to four years I would almost always choose to invest in 2-D bar coding due to the amount of information that a 2-D bar code can communicate and the fact that while area scanners are more expensive than linear scanners, the cost difference isn’t that great over the lifespan of most comparable scanners. The industry is evolving rapidly enough that we simply have to see how cost and logistics will affect those decisions in four years, which under normal use is probably the lifecycle of a suitable scanner anyway."

Briley: "In the grand scheme of things, there is good news for purchasing professionals in the healthcare industry. Motorola Solutions, and the industry as a whole, have been designing array imagers for more than 20 years and now are on the fifth generation platform. Over time, the economic premium between basic 1-D scanners and advanced 2-D imagers has narrowed substantially while performance continues to improve.

"The tougher call for purchasing managers is determining when to spend the extra money for cordless devices and when to stick with traditional corded scanners. There still is a significant economic premium for cordless scanners, mainly because cordless units require two radios, a robust battery, a sophisticated charging mechanism, and they have to be nearly indestructible. Because of environmental design requirements — palladium alloy charge couplings, healthcare-rated polymer housing and smart batteries that last through tens of thousands of scans — a cordless imager typically is about double the cost of a traditional corded scanner.

"Today, most healthcare environments deploy cordless scanners for mission-critical, patient-centric applications like bed-side medication administration, mobile workstations on wheels and operating rooms. For less-than-critical applications, like clinical labs, stockroom and asset management, a traditional cost-effective corded scanner still is appropriate."

Anderson: “End-user application and environment, industry standards, symbology needed, and cost are primary factors in determining which to use.”

Color commentary on bar codes