For more than 45 years the retail market has relied on bar coding as a staple — and commercially stable — supply chain tracking mechanism with tentacles extended to food service and healthcare operations.
As more advanced techniques and technologies emerged, however, bar coding retained its popularity and solid base in healthcare — some contend for cost purposes, others for familiarity and reliability.
So what is it about bar coding — arguably and metaphorically considered “analog” to the more “digital” offerings of radiofrequency identification (RFID) and others — that cements its stature as the workhorse of people and product tracking?
(Editor’s Note: GS1 US offers a history of bar coding that hearkens back to its debut in 1974. Read about it by visiting: www.gs1us.org/45thanniversary. For Healthcare Purchasing News’ report on RFID, Visit https://hpnonline.com/21092222.)
Against the backdrop of higher-technology RFID and real-time location systems (RTLS), HPN asked eight bar-coding experts — including one retired hospital supply chain executive who is widely regarded as a pioneer in applying bar codes to healthcare provider applications and functions — what motivates the faithful to support it.
Supply chain and beyond
When RFID and other track-and-trace technologies emerged in healthcare roughly 15 years ago, enthusiasts and futurists as well as many curious, foresaw the logical successor to and replacement of bar coding, which at that time had been used for roughly three decades in retail and about two decades in healthcare.
That was then; this is now.
Many bar-code backers and promoters report the “death” of the technology as greatly exaggerated or woefully premature.
“We believe bar coding will become more critical in the healthcare industry as bar-code technology remains the most cost-efficient method used for tracing and tracking,” she told HPN. Lee cites higher demand for patient safety and supply chain efficiency as justifications, buttressed by a variety of federal regulations to protect patient confidentiality and increase visibility and traceability of pharmaceutical products and medical devices, including the Drug Supply Chain Security Act, Unique Device Identification (UDI) and HIPAA (Health Insurance Portability and Accountability Act), with GS1 US at the forefront of supply data standards in multiple industries.
Bar-code labels to identify pharmaceutical products and medical devices and enable tracking of the goods from manufacturing and distribution to use in provider settings, according to Lee. “From safety identification and traceability standpoints, bar codes can minimize counterfeits and fraud while expediting recalls,” she added. “It enables visibility and control of the product throughout the supply chain.”
“As technology and computing power continue to advance, bar codes and other data carriers will also continue to evolve,” O’Bara indicated. “For some applications, the linear bar code is already giving way in the healthcare setting to 2-dimensional, or GS1 DataMatrix, bar codes that can carry more information beyond the product identification number. This transition is now taking place in the pharmaceutical supply chain as trading partners adopt new technologies to meet the requirements of the U.S. FDA’s Drug Supply Chain Security Act (DSCSA). And in the medical device sector, there is movement toward the use of GS1-128 and GS1 DataMatrix bar codes for meeting requirements of the U.S. FDA’s Unique Device Identification (UDI) Rule.” O’Bara noted that some large corporations favor using “the same bar code across their full product portfolio, regardless of packaging size or manufacturing location.”
The variety of available bar code types can apply to whatever information needs to be carried, according to O’Bara.
“Bar codes and the information encoded within are key to patient safety and supply chain traceability,” she continued. “The bar code unlocks detailed product information needed by different stakeholders, including but not limited to the unique product identifier, expiration date, production date, batch/lot number and serial number. Unique identification is fundamental to that data, and because the bar code provides a shareable, standardized gateway to the identifier and associated information, its usefulness will not change.
“At GS1 US, we believe the world is moving toward a future where everything that can be connected will be connected,” she added. “Unique product and location identification are integral in that evolution.”
For example, a 2016 Johns Hopkins study posits that preventable medical errors in a healthcare setting rank as the third leading cause of death in the U.S. so managing and minimizing human errors is critical not only to patient safety, but to the organization’s reputation and credibility. Sullivan emphasizes that bar coding works to solve preventable medical errors.
A 2017 Zebra Technologies video, “Unlocking the Benefits of UDI,” shows that “manually taking down information by hand results in a preventable mistake once every four days in a patient environment,” according to Sullivan. “Bar-coded digitized workflow, on the other hand, has an error rate of about 1 in 10 million, virtually eliminating the threat of human error in recording information. This has created a tremendous difference in the accuracy of the work, from patient admittance to discharge.”
Using bar codes has significantly improved the accuracy, workflow and supply chain management of blood collection, which is a major pain point in healthcare today, Sullivan continued. “Data mistakes in the blood collection process account for a large percentage of errors. Bar-code technology offers a seamless, error-free way to ensure blood is being collected and handled with care,” he added.
Finally, Sullivan posits that supply chain mismanagement leads to millions of dollars lost annually, and that a 2018 Navigant study (https://www.navigant.com/news/corporate-news/2018/supply-chain-analysis-2018) suggests as much as 17 percent of healthcare expenditures are being wasted. “This could be due to expired inventory, products in recall that are still being used, or overages in stock ordering,” he said. “By proactively implementing barcode technology inventory management systems, hospitals are able to more easily optimize the use of their supplies.”
Bar coding represents convenience that generates cost reductions for at least double the philosophical return on investment, according to Kristen Merrell, Vice President, Marketing, Kem Medical Products Corp.
“Rather than the time consuming and laborious tasks of tracking data by hand or by using spreadsheets, as was common practice prior to bar coding, it is easy to scan an item and set in motion a data-rich process that is capable of providing information regarding arrival and delivery confirmations, location tracking, usage history, productivity and quality assurance as well as regulatory compliance,” Merrell noted. “All of this information further assists as a tool for trend predictions and maintenance and staff scheduling.
“Bar coding is an attractive and reliable technology because of its simplicity and adaptability,” she continued. “It is relatively inexpensive to implement, as well as easy to maintain. It also provides a platform that can be adapted for expansion and/or integration into other applications. It is an incredibly flexible technology that allows for near limitless growth.”
“It is unlikely that in healthcare the need for accuracy, efficiency, security, patient safety, cost control, etc., will ever go away,” Kilzer told HPN. “The benefits to using bar codes are well documented and will always drive a need for ongoing use of this technology. Kilzer should know. He spent his entire 43-year healthcare supply chain career at St. Alexius, where he is regarded as one of the first hospital supply chain executives to adopt and implement bar coding at his facility in 1985. He was inducted into Bellwether League’s Hall of Fame for Healthcare Supply Chain Leadership in 2010. (Editor’s Note: For more on Kilzer’s experience with bar coding, read his sidebar below.)
Never say never
“While we can’t say bar coding will never be replaced, there’s really nothing on the horizon that has the potential to replace it,” assured John Freund, President and CEO, Jump Technologies Inc. “I believe bar coding will remain strong because other options are cost prohibitive. Reimbursement rates on med/surg products are low, which makes the cost to invest in alternative technologies like RFID or scales difficult to justify. The lowest cost way to work with med/surg supplies is to use bar codes, whether you’re doing so in a perpetual inventory or KanBan system.”
Jeff Lawrence, Vice President, Business Development, Inventory Optimization Solutions, agrees with that assessment.
For one, bar coding will help organizations manage through regulations, according to Lawrence.
“We’ll always have regulations to comply with and as we need to proactively manage lot number, serial number and/or expiration date, bar-code labels will greatly simplify adherence to these requirements,” he added.
Lawrence hitches a “psychological component” to bar coding’s popularity, too.
“People have come to believe in bar codes and believe bar coding is helping them be more efficient,” he noted. “So do I, by the way. I talk to people in provider organizations every day who say they have a goal to use bar codes toward greater supply chain efficiency, but they don’t yet know exactly how. Tying together that goal with current technology and the data that’s available by capturing bar codes is the grail. The more sophisticated the bar-code data set becomes, and the more efficiently we can capture it, the better the results we’ll see in supply chain and beyond.”
Global endorsements abound
The patient safety promise and labor efficiencies that bar coding brings to hospitals amounts to a tacit endorsement of its utility, emphasizes Zebra’s Sullivan, who uses the retail experience as proof of concept.
“When envisioning the adoption of bar codes in hospitals, an easy comparison is their ubiquity in retail,” he said. “At this point, bar codes and scanners are a staple of the consumer experience and hard to imagine not being present today. To eliminate their use would be a huge step backwards, eroding significant advancements in technology as well as productivity.”
Another endorsement of bar coding comes from governments, global healthcare organizations and standard-setting groups that are all establishing industry guidelines that promote the utilization of bar code and bar code-like technologies in patient care delivery settings, Sullivan maintained. He also cites two cases in point: The United Kingdom’s National Health Service (NHS) has implemented a bar-code scan for patient safety initiative and the U.S. Centers for Medicare & Medicaid Services (CMS) electronic health record meaningful use requirements include bar coding as a core stage two measure.
Bar codes are also being used to help combat major societal epidemics, Sullivan continued. “The Drug Supply Chain Security Act is a federal law designed to help with the safety and management of drugs and helps prevent the use of falsified medicine and opioid abuse by enhancing the identification and traceability of compounded drugs throughout the entire supply chain,” he said. “In addition to drugs, medical device laws have also been implemented to ensure the use of unique identification markers to be able to identify the device through distribution and use and to help prevent patient safety challenges. With the combination of regulations and best practice recommendations, those in the healthcare space can be confident in the future and benefits derived from bar codes.”
No turning back
Jump Tech’s Freund labels bar-code scanning a very simple and mature technology — one that “everyone knows how to use in any industry, as evidenced by the self-checkout lines in most major retailers,” he added.
“In the healthcare industry, bar-code scanning has support from all the major touchpoints in the supply chain, from the supplier to the hospital,” Freund asserted. “It requires a nominal amount of work to maintain and with the right point-of-use system, it is very easy to use with great compliance from staff. Bar-code scanning supports KanBan, perpetual inventory, cycle counting and all other deployed inventory workflows. The hardware costs for bar-code scanning have dropped significantly, and recently we deployed scanners in our customer sites starting at $105.
“With the advent of iOS and Android-based devices, very sophisticated barcode scanning solutions can be deployed at very low costs,” he said. “For example, tracking trunk stock in the OR can be done by manufacturer’s reps scanning GS1 codes on mobile devices during a procedure. Supply chain software can then verify that the item is on contract with the hospital and submit the materials to a circulating nurse for approval. All of this points to bar-code scanning being a solution that has staying power and the ability to provide great benefits to the healthcare industry.”
Bar coding offers a familiar user-friendliness that can be comforting against the backdrop of increasingly complex technology, according to IOS’ Lawrence.
“Bar-code technology is very cost efficient [in that] the equipment isn’t expensive and we’re seeing more organizations using their smartphones to basically create a mobile Materials Management Information System (MMIS),” he observed. “Between the low cost and high efficiency, we’re seeing high growth, especially in non-acute care settings.”
The combination of surgical centers, clinic locations, urgent care centers and other classes of trade that comprise selected organizations are driving fast growth, too, according to Lawrence.
“It’s exciting to see care providers and managers becoming more mobile, moving and managing among locations,” he noted. “The benefit of carrying your ‘MMIS in your pocket’ becomes very powerful. Users can create orders, approve orders, track product consumption, perform physical counts, and more. Within these diverse environments, bar-code scanning drives consistency with processes and tools.”
Even as technology advances, bar coding maintains a way of keeping everyone in the game, Lawrence emphasized.
“Depending on the level of sophistication that a provider has or needs, simply printing internal bar codes that align with the MMIS numbering schema can greatly simplify bar-code scanning processes,” he said. “Overall, because bar coding is so simple, efficient and accurate, as product information tracking becomes more complicated, bar coding is how we’ll keep pace and get more efficient, even while requirements expand.”
Bar coding remains ubiquitous with information technology, GS1 US’ O’Bara noted.
“Behind the bar code is a world of information that will always be necessary — complete, accurate and interoperable information that can be captured and shared electronically — to provide the insights needed to support quality care outcomes and the ultimate goal of patient safety,” O’Bara said. “As a fundamental tool for accessing that data, the bar code has evolved to meet the changing needs of industry, as evidenced by the progression from linear to 2-D bar codes to accommodate the need for more data in smaller spaces.
“Its continued usefulness is driven by industry members’ collaborative efforts through participation in the “GS1 Healthcare US Initiative” (https://www.gs1us.org/industries/healthcare/initiative) to build upon the investment they have already made in utilizing standards for generating and sharing that essential data,” she continued. “The ability to embed critical information within a product’s unique identifier — which can be scanned at each point in the supply chain, including at point of care — is essential to the transformation taking place in healthcare. And the healthcare industry’s ongoing commitment and collaboration with GS1 US helps ensure that the data is optimized to provide the value that is needed.
