Bar
coding earning its stripes in middle age
Healthcare organizations must read
between the lines for ongoing progress
by Rick Dana Barlow
F
our decades ago
this past summer, a retail clerk at a supermarket checkout line scanned a
pack of chewing gum that sported something called a bar code designed to
record and track its purchase, setting into motion the process of restocking
the shelf with new product.
The monumental feat represented the culmination of a
hard-fought effort to make bar coding the retail rule of the industry,
roughly a year after retailers accepted Global Standard 1’s (now known as
GS1’s) standard as the uniform method for identifying and tracking products.
Since that time, bar coding as an identification and tracking
mechanism migrated to other industries — including healthcare, where the
now-retired hospital supply chain executive Frank Kilzer made bar coding the
cornerstone of his supply chain operations in North Dakota the year
following its official debut in retail.
Back in the mid-1970s, the band of vertical stripes arrayed in
such a way that it carried useful and valuable information for sales and
supply chain, seemed remotely futuristic. These days, however, in the era of
smartphones, tablet computers, real-time location systems, and chips and
tags, those stripes seem downright quaint.
But developers have helped the stripes to innovate, too. During
the last few decades, next-generation variations of bar coding formats have
emerged, including two- and three-dimensional options that are designed to
carry even more information in the Big Data era, as well as the latest
wrinkle with color-coding.
In fact, as the traditional linear or 1-D bar code celebrates
its 40th anniversary this year, the 2-D bar code celebrates its
20th.
So in this era of healthcare reform regulations, reimbursement
and budget cuts as well as enterprise data demands, what could be worked
into the format next to push it forward?
What could suppliers do with the spaces between the stripes?
Could altering the angle or changing the direction of the stripes provide
additional flexibility? With Generation X now entering middle age, how can
this identification and tracking modality appeal to the Generation Y crowd
and beyond? What if the bar code were printed using programmable electronic
ink so that the data and information it carried could be more fluid than
finite and static?
Healthcare Purchasing News asked a group of bar coding
executives their impressions about bar coding’s practicality and progressive
outlook based on its composition and past performance.
Weighing options
As the specter of advanced tracking and tracing technology
looms larger, the applicability of bar coding — no matter the type — likely
won’t diminish, sources told HPN. That’s because the ongoing
utility of 1-D, 2-D, 3-D and now color bar coding among the variety of
industries using them far outweighs their obsolescence.
 |
Alexis Arenas |
The differences between the various bar code symbologies are
straightforward, according to Alexis Arenas, Strategic Accounts Manager,
Barcoding Inc. "The
more complex the code, the more information can be stored," she noted. "1-D
is generally the simplest code and is widely used in inventory management,
warehousing, and retail. 2-D codes are growing across industries and are
widely featured in some of the largest [electronic health record] software,
showing up as the small box code seen on a hospital wristband."
Arenas insisted that bar codes won’t be retired any time soon
or even farther out. "While 2-D and 3-D bar codes are clearly the way of the
future, there will always be a place for 1-D codes," she said. "1-D is the
backbone of slim-margin industries like retailing and foodservice. 1-D codes
are the easiest to use to organize a warehouse or distribution center.
Hardware that works for these solutions tends to be the least expensive,
while the standardization of services, inexpensive-to-maintain hardware, and
easy-to-launch applications make this type of technology attractive to many
industries."
In healthcare, bar codes must be used on packaging and devices
to comply with the Food and Drug Administration’s (FDA’s) Unique Device
Identification (UDI) standards being phased in during the next few years.
"This is only one small facet of one vertical for bar coding — the
applications for each type of bar code are endless," she added.
 |
Ravi Panjwani |
Ravi Panjwani, Vice President, Marketing and Product
Management,
Brother Mobile Solutions, indicated that Code 39, a 1-D linear format,
has been "one of the most commonly used" since the inception of bar codes —
particularly in healthcare for patient wristbands — "because it was easily
supported by legacy hospital information systems." In fact, "it is still
prevalent in hospitals, along with the high density Code 128, because of its
compatibility with laser scanners and its comparatively lower cost. However,
Code 39 bar codes tend to be long, making other more space-efficient
symbology options preferable for wristband use," he said.
Healthcare organizations may be interested in 2-D bar codes
because "they can store substantially more information in a much more
compact space and can even serve as a portable medical record for the
patient," Panjwani continued. He specifically cited the PDF417 symbology’s
popularity among 2-D bar codes because it can be read with a simple linear
scanner that offers more flexibility.
"Other 2-D options, such as Aztec, require a scanning device
that includes an image sensor," he noted. "So clearly there are cost
implications in moving from 1-D to 2-D. But 2-D bar-code features, such as
large data capacity, error detection and correction are valuable in
supporting patient safety initiatives."
Shaping up the data
 |
Arnold Chazal |
What primarily differentiates the 1-D/linear bar codes from
other types of bar-code formats are the amount of space taken on the label
and the amount of information encoded, according to Arnold Chazal, CEO,
VUEMED.
"Linear barcodes are sufficient for most clinical products
packages, with the exception of some packages where space is extremely
limited and the amount of information that needs to be encoded is
significant," Chazal told HPN. "There are relatively few types
of clinical products on the market today that have such space constraints on
their labels that they require a 2-D bar code. Sutures are a good example,
as well as some small surgical instruments. The information encoded in 2-D
bar codes on these products is typically the same as in linear bar codes:
item identification/reference, lot and/or serial number and expiration
date."
 |
Andy Tippet |
Andy Tippet, Senior Marketing Manager, Healthcare,
Zebra
Technologies, categorized 1-D/linear bar codes having the traditional
stripes, but that 2-D bar codes consist of rectangles, dots, hexagons and
other geometric patterns in two dimensions. Further, Aztec and color
represent types of 2-D bar codes beyond the standard 2-D formats. "Aztecs
have the potential to use less space than other matrix bar codes because it
does not require a surrounding blank ‘quiet zone,’" he noted. "Color-coded
bar codes or high-capacity color bar codes are also 2-D and provide the
potential for color."
While 1-D bar codes contain "lower information density and
depend on a database or communications network for interactivity," 2-D bar
codes can contain "high information density, including voice, photos and
need not depend on a database," he added.
 |
Scott Clifford |
Scott Clifford, Clinical Solutions Manager,
Microscan,
highlighted some of the useful capabilities and ongoing challenges of each
type.
For example, 1-D/linear bar codes must be printed on
high-contrast labels where characters are encoded as bar widths and spaces
and decoded via an analog signal. In addition, 1-D bar codes carry a little
amount of data and allow for very limited to no error-checking, he advised.
Meanwhile, 2-D symbols solve a portion of 1-D bar coding’s
challenges because more characters can be encoded on 2-D symbols, offering
greater data density, and they are decoded via a digital signal, he
continued. "Characters are encoded based on the presence or absence of
symbol elements, also called cells," Clifford noted. "Therefore, 2-D symbols
can be decoded even if they are printed in low contrast or directly on parts
(DPM).
2-D symbols offer more error correction capabilities, because
"symbol data can be reconstructed even if 20 percent of the symbol is
damaged or missing," he added.
 |
David Kane |
Because 2-D and 3-D bar codes involve a grid format, compared
to 1-D/linear codes oriented in an array of parallel bars of varying width,
they can "handle significantly larger amounts of information with minimal
impact on the dimensions of the symbol," said David Kane, Product Manager,
TEKLYNX. "Linear bar
codes would have to grow quickly in size as information is added."
Consequently, available real estate — the amount of space on
the product and its packaging — influence the decision on which bar code
symbology to use, Kane added. In effect, label space is the "primary driving
force" because "you can fit significantly more information in a much smaller
amount of space when using 2-D [or] 3-D bar codes."
Paul Czerwinski, Director of Healthcare for North America,
Motorola Solutions, linked bar coding’s progress to the advancements in
scanning technology, including hand-held laser scanners, since the early
1980s. "Over the years [laser scanners] became smaller, better, faster and
less expensive," he noted. "They are fantastic at scanning traditional 1-D
bar codes printed on packaging or label stock. Linear imagers can now do
everything laser scanners can, but offer the additional functionality of
scanning ‘virtual’ 1-D bar codes or bar codes that are not printed but
instead exist only as pixels on a computer or cell phone display."
 |
Paul Czerwinski |
More expensive array or camera-like imagers can scan just about
any bar code format, including virtual, because when the user pulls the
trigger, the scanner takes a picture of an area and then decodes the bar
code from the digital image, Czerwinski said.
"Array imagers also are capable of advanced functionality such
as capturing digital images and scanning optical character recognition
(OCR)," he continued. "Another benefit of array imagers is omni-directional
scanning, which allows the user to scan and decode a bar code from any angle
without the need to orient the scanner, making array imagers inherently more
productive than linear readers. With advancements in complementary
metal–oxide–semiconductor (CMOS) arrays and microprocessors, latency has
been eliminated, and array imagers are now as fast to decode as linear
scanners."
Reviews are mixed about 3-D and color bar-code applications in
healthcare, even as the latter only may be "breaking the surface," Arenas
observed.
"3-D tends to be used in harsher environments, so we have not
seen it adopted in healthcare," Panjwani said. "Nor do we see color bar
coding, which many laser scanners cannot read. However, we are seeing
different color wristband clips strategically used to define patient risks
and clinician alerts."
Arenas indicated that color bar codes generally have gained
prominence in television, video games and other media and are scanned by
personal mobile devices, but warrant further exploration and investigation
in other industries, such as healthcare, where scanners used in traditional
automatic identification and data capture (AIDC) applications may need to
change.
Clifford added that 3-D and color codes can be "more difficult
to print and decode because color cameras are required."
Making choices
When deciding which bar-code symbology to invest in and deploy,
the simplest solution typically can be the right one, Arenas urged. But
something that is relatively inexpensive and easy to implement also must be
future-proofed with hardware and software options down the road.
"The safest path right now is to use digital imagers, as the
ability to scan all types of bar codes eliminates the fear of having the
wrong tool," she advised. "If there is a specific need to read DPM codes,
DPM-capable imagers can be procured for just that use."
 |
Cheryl Flury |
Speed-to-implementation to leverage data should motivate and
drive these decisions, emphasized Cheryl Flury, Vice President, Marketing,
Jump Technologies.
"Getting started quickly may be more important than
considerations about which type of technology to use," Flury advised.
"There’s a large number of inexpensive mobile devices including smartphones
and tablets, along with key-fob sized scanners, which can be given to a
large number of team members while keeping costs low. With scanning apps for
all types of devices and all types of bar codes, wide-spread deployment is
quick and easy. Beginning to capture this data can provide the hospital with
richer information about, for example, supplies being used across the
organization, which in turn could begin the process of building greater
understanding of cost, quality and outcomes."
Flury cited the hectic nature and rapid pace of the emergency
department (ED) where clinicians must concentrate on caring for patients
more than finding, recording and managing products they need to carry out
their mission.
For example, in the ED of a large hospital in Pennsylvania,
nurses expressed dissatisfaction with the high costs of the automated
dispensing cabinet system they were using so they switched to a
"grab-and-go" system for high-velocity products. Flury said, "Managing
inventory using a two-bin system and scanning at a bin level rather than an
‘each’ level resulted in a climb in nursing satisfaction (to 90 percent from
15 percent), as well as a reduction of stock-outs and significant savings in
cabinet leasing fees and inventory costs."
Black to the future?
Still, any technology deployed must match the needs of the
facility, she continued. "A simple, 1-D or 2-D bar code may contain
everything that’s needed to track and manage supplies, and understand the
velocity of inventory leading to cost improvement," Flury added. "For
clinicians, making the use of technology as simple and efficient as possible
is key. In a high-stress environment, and with nursing salaries representing
the highest portion of the hospital labor spend, alleviating staff time
spent away from the patient and reducing time spent managing burdensome
manual tasks will directly relate to nurse satisfaction, and potentially
reduce errors and overtime."
Operating within the confines of cost-conscious accountable and
value-based care, healthcare organizations must balance the substantial
investment required for more advanced scanning equipment with the
efficiency, accuracy and patient safety aims they seek, according to
Panjwani.
"Even state-of-the-art technologies are ineffective if they
aren’t used properly and regularly," he continued. "Simply having the
technology available doesn’t promote patient safety. The key is to
seamlessly integrate it into workflow, enabling clinicians to view it as a
tool that helps them provide safer, more efficient, higher quality care.
"To truly turn the tide on patient safety, hospitals need to
expand the adoption of bar coding technology — even if it’s the most basic
1-D — into all areas of the hospital, from the patient room to the lab to
the pharmacy. That way, anytime providers perform an action on or for a
patient, they can easily scan bar-code labels with accurate drug-, test- and
patient-specific information and then generate a data record entered
directly into the patient’s EHR."
Choosing the right technology to deploy depends on the
facility’s customized workflow processes and systems, which includes
operating software system compatibility, according to Tippet. "If they need
to capture large volumes of information including images, sounds and other
high-density data, then 2-D may be the answer," he added.
Healthcare facilities must determine whether the larger volume
of information captured in a noticeably smaller amount of space provided by
2-D, 3-D and color-coded bar codes outweighs the higher cost of the imaging
technology needed to read the data, according to Kane.
Healthcare organizations should not overcomplicate their
choices and sweat about automated cabinet systems or radiofrequency
technology, according to Chazal.
Against the backdrop of complying with FDA’s UDI rule, and
using any of the supply data standards systems available, hospitals need to
control their costs and manage their clinical inventory all the way to the
point of care, he noted. "There is no need for additional data to manage
products other than the product ID and pedigree, all of which can easily and
reliably fit into the 1-D bar codes currently in use on most clinical
products," he said.
"The prevalence and low cost of 1-D bar code readers, added to
the fact that this technology is deeply embedded in many other healthcare IT
systems (including MMIS, billing, clinical documentation, admission,
scheduling, etc.) means that 1-D bar coding is perfectly appropriate and
effective for managing clinical items, implants, blood products, and so on
from the manufacturer’s facility all the way to the patient’s bedside,"
Chazal added.
Further, Chazal observed that healthcare product manufacturers
are exploring the broader use of inexpensive RFID tags that can contain the
same information found in a 1-D serialized bar code, rather than the
application of more advanced bar-code formats.
Bar coding on the brink
… of further growth?
Bar coding’s
family tree