Stripes, tags can chip away at supply chain inefficiencies, tracking-and-tracing troubles

Aug. 24, 2022

 As the world struggles to emerge from a lingering global pandemic that exposed underlying vulnerabilities in the supply chain, healthcare organization interest in bar coding and radiofrequency identification (RFID) tools for tracking and tracing products and services should be that much more alluring.

But industry experts tell Healthcare Purchasing News that sourcing and evaluating bar coding and RFID products need to be accomplished with the right intentions, motivations and priorities.

Strategies vary somewhat, yet an overarching theme remains: Start with the endgame and work backwards rather than merely salivate and yearn for the latest gadgets, gizmos and technology generating buzz in conversations and in social and traditional media outlets.

“It can be tempting to look at technology first,” cautioned Jody Costa, Vice President, Marketing & Strategic Partnerships, Barcoding Inc., “but resist that temptation and start with the process or challenge you need to solve. We recommend building out a current state workflow and a future state workflow before reviewing technology. It’s vital to talk to users and/or nurses who are handling items and/or caring for patients, as well as the people who access and use the inventory data. That’s where the path toward your best solution will begin to reveal itself.

Costa recommends the following considerations:

  • Always start with the process first. Starting with process flows and user interaction will allow you to determine if bar coding or RFID (or both) is the right path forward. Often these technologies are best working together.
  • The nature of the materials and environment – radio signals, metals, and liquids can interfere with RFID signals, while certain environments or exposure to chemicals (like disinfectants, for example) could damage some barcode labels and/or devices. That’s why it’s vital to have the right partner helping you.
  • Understand the amount and nature of the data you’re handling—RFID tags and labels can carry more information than barcodes, and can be “read” in bulk, but if you’re looking at patient item tracking, for example, barcode labels are a more appropriate solution.
  • Integration – how is the data being used, stored, accessed, analyzed, and reported? What will be needed to integrate the data into your organization’s data management system? What level of visibility do you need to meet business goals? These questions will help with solutioning.
  • When reviewing the process, does a person need to be involved? That’s one of the key differences between bar coding and RFID. Bar coding needs line-of-sight scanning and RFID does not.

To maximize return on investment, Costa encourages keeping an eye out for any opportunities to improve accuracy and efficiency by implementing technology. Examples might include identifying places where cycle counting is taking significant time. “RFID can often speed up the cycle count process from days/weeks to hours,” he said. “Identify any workflows that are currently tracking assets or inventory on paper or Excel – that’s a perfect spot to start to implement a bar code- or RFID-based solution. One particular niche we’ve seen is with patient belongings and valuables. Using a solution like IntelliTrack’s Patient Belongings Tracking application will improve the patient experience immensely.”

Concentrate on labor early

Healthcare organizations should focus on three key areas when evaluating the type of track-and-trace technology sought as well as the brand, according to Rich Leitermann, Director of Engineering, WaveMark Supply Management and Workflow Solutions, Cardinal Health.

Healthcare staff time is one. “How do you value the time of healthcare staff?” Leitermann asked. “Day-to-day use of bar codes requires gaining ‘line-of-sight- access to each bar code, pointing and shooting. Conversely, reading RFID tags does not require line of sight and will read at up to 100 tags per second at a distance. Think about taking away the tedium of using staff time to find the bar code, point and shoot over and over for each product being counted. I’d ask if the healthcare providers really have the time to do this?”

Tracking individual item attributes versus stock-keeping units (SKUs) is another. “Is it important to track individual item attributes versus only SKUs?” he indicated. “Bar codes often do not include information that identifies individual items. Instead, the bar code may represent just manufacturer and manufacturer’s part number. RFID systems usually uniquely identify products down to the ‘each,’ including serialization, lot number, etc. This is possible because RFID tags contain a worldwide unique identifier that can be associated with all relevant information about the product to which it is affixed. The unique identification from RFID enables richer data that can be used for more advanced reporting and analytics.”

Automation and inventory accuracy is a third. “Is automation and inventory accuracy important to you?” he noted. “Using bar codes is predominantly a manual operation. A person has to point the bar-code reader at a bar code. By definition, this makes bar code an error-prone process and will result in lower inventory accuracy. RFID is the path to automating item identification and can provide highly accurate inventory information without taking the time and attention of staff.”

Labor should be a key consideration, acknowledges John Freund, Founder and CEO, Jump Technologies. He points to nursing and supply technician compliance in recording transactions.

“I think most would agree that if nurses found scanning bar codes to be a simple and efficient part of their everyday workflows, they would do so,” Freund said. “However, while bar coding as a technology is less expensive, compliance with scanning is the challenge.”

Nursing compliance represents the first factor in that any system should be user-friendly and integrated with other systems, according to Freund. “For example, the ability to update lot and serial numbers, along with expiration dates in the [electronic health record], would be a valuable feature to look for in a system,” he said. “Other features to look for in a system include: Does the system decrement inventory and create reorders for items? Does the system create requisitions for bill-only, consignment, and trunk stock items? And does the system update the implant log in the EHR?

“You can have an RFID system that makes recording the transaction simple, but if it doesn’t interface with the backend systems properly and nurses have to do dual entry, then clinical issues will arise, which can complicate implementation and reduce the savings potential of an RFID-based system,” he continued. “Therefore, nursing should play a critical role when evaluating these technologies.”

Naturally, economics plays a role. “The monetary value of the items being tracked is also an overriding factor in this decision,” Freund noted. “RFID technology is good, but not inexpensive. Not only are there facility charges associated with physically implementing the technology, there are ongoing costs associated with getting RFID tags on the items you want to track. That’s why RFID doesn’t make sense for inexpensive med/surg materials. However, for more expensive materials like implants, it may make sense.”

Consequently, Freund recommends bar coding as affordable for tracking med/surg items in sub-inventory locations. “For example, the Jump Technologies system supports Kanban as an inventory method using a bar-code scanner costing just $105,” he said. “It’s important to remember that the technology being deployed can’t drive the costs to track them beyond the reimbursement hospitals receive for them.”

Focus on value of labor, products

Any product or service decision designed to improve a process should see roots in a value assessment, according to Jason Rosemurgy, Senior Vice President, Sales and Marketing, Terso Solutions.

Staff efficiency must be obtained and maintained. “If making the most of staff time is important, then it’s important for providers to consider technology that enables their team to perform the jobs they were hired to do,” Rosemurgy said. “Nurses’ core responsibilities revolve around providing patient care. A recent study found that nearly 40% of an average nurse’s shift time is spent on ‘wasteful’ activities — often looking for items like supplies and critical inventory. RFID technology, further enabled with the right integrated software platform, can direct nurses to the right inventory in a department or facility. And if that inventory or item isn’t where it is supposed to be, it can direct staff to who may have handled it most recently, allowing nurses to refocus on patients and urgent procedures.”

Criticality of the inventory needing to be tracked is important, too, and that doesn’t always involve costs, Rosemurgy indicates. “As we learned in the pandemic, while expensive inventory is often critical, critical inventory isn’t always expensive,” he said. “Supplies and items like [personal protective equipment] were often in short supply, sometimes hoarded, or simply not located where they were meant to be stored. Barcode-based systems can be ‘confused’ by users scanning an individual item and inadvertently taking more than one thing, throwing inventory levels out of balance and possibly overstating inventory levels on these critical items.”

Additionally, certain cold chain implants are often best tracked using RFID, specifically RFID enclosures, Rosemurgy recommends. “Knowing for certain that a particular product has been stored at the proper temperature can be a requirement for items like tissue and biologics,” he said. “Some of these items have been donated or are related to a trauma-specific surgical case and could truly be considered priceless. Misplacing them or having to scrap them due to not knowing whether an item was kept outside of specified temperature ranges does tragically happen in the world of healthcare inventory management but can be prevented with the right technology safeguards in place.”

Accurate data in real-time can be an important asset, Rosemurgy insists. “Often, hospital inventories are only as good as the last time somebody completed a physical assessment utilizing bar codes, logbooks or spreadsheets,” he noted. “Within hours they can be considered completely out-of-date. Barcode-based and other manual systems require compliance by team members, and with today’s staffing challenges, these tasks might not be able to be completed as regularly as needed. RFID is automated, requires no line of sight, and connects inventory data to the proper software platforms in real time as inventory and assets are transported or consumed within a facility. The more real time data a provider has, the better decisions their team can make.”

Still, bar coding and RFID are data capture technologies that both have their place in healthcare and should not be considered mutually exclusive, Rosemurgy urges.

“Bar-code technology is a solid performer in applications where item value is often lower, and accuracy of the items tracked doesn’t need to be 100%,” he said. “High-turn, med/surg products often utilize bar codes and workflows like patient charting and tracking applications are also common for barcode-based systems.”

As demand for automation increases and the cost of RFID technology decreases, interest in and application of RFID likely will become more pervasive in healthcare, Rosemurgy predicts. “While often part of a barcode-based tracking system, the lower-cost med/surg products could also be incorporated into an RFID two-bin Kanban system, where RFID tagged bins – not individual items – can create automated demand signals and save materials staff tremendous amounts of time not having to run from PAR location to PAR location checking bins. Similarly, we are seeing the emergence of RFID room-based systems in healthcare [that] focus on tracking a product as it moves throughout a healthcare facility, providing data as products make their way from storage all the way to usage.”

Functional span, history shape interest

In general, bar coding is more widespread because it has become an established technology within the industry for decades, observes Scott Hondros, Vice President, Professional Services, CenTrak, but he sees RFID as more effective for actively locating assets, patients, staff, and visitors.

“Once the appropriate tag and infrastructure are in place, RFID allows healthcare workers to efficiently share data, know real-time locations and conditions of equipment, and avoid human error from manual data entry or human intervention,” he noted.

Bar coding can be more prevalent with bulk consumable type items in high demand, such as with bandages and gauze, Hondros compares, but for medication, surgical instruments and very small items in a group, passive RFID can be more efficient, accurate and effective. “Both active and passive RFID have the potential to read multiple assets simultaneously, whereas bar codes require line-of-sight and must be read one at a time. Additionally, mobile medical equipment (MME), such as wheelchairs, stretchers, infusion pumps, etc., tend to come with a higher price point, so it’s often beneficial to invest in asset locating technology that can provide real-time locations [via active RFID].”

Hondros further highlights RFID benefits in terms of expanding scale for greater capabilities. “When partnered with a Real-Time Location System (RTLS), it enables healthcare organizations to analyze data to find opportunities for improvement, like shortening patient wait time, reducing bottlenecks, and increasing hand-hygiene compliance, as well as automating workflows, like biomed reprocessing and nurse call response. RFID also allows healthcare facilities to keep patients and staff safe, with solutions like duress location detection tied to panic buttons and tags that help prevent infant abduction. Additionally, healthcare facilities can enhance their asset tracking solution to automate biomed workflows such as PAR-level management, preventative maintenance management functions, and equipment distribution. 

Hondros also emphasizes the crucial application of active RFID in dealing with ongoing staff shortages, workplace violence and supply chain challenges to deliver staff satisfaction and retention, peace of mind and availability to critical supply data.

Six degrees of evaluation

James Moore, Vice President, Electronic Healthcare Systems, issued six questions healthcare organizations should ask themselves prior to reaching out to prospective bar-coding and RFID vendors to determine the optimal choice for their facility.
  1. Will tracking cover the supply chain end to end? Receiving through distribution to patient?
  2. Will patient charges be captured and processed to the billing system?
  3. Will compliance or the lack of compliance be an issue with organization’s personnel?
  4. What information needs to be captured?
  5. What information will need to be shared with other systems?
  6. Is it practical to have part of the supply chain using bar coding while other parts are using RFID?
Any automatic identification technology is meant to reduce errors and increase efficiency by providing identification, location, and at times, health/status data, according to McLeod Williamson, Intelligent Edge RFID Solutions Specialist, Zebra Technologies. He cites a basic example of how bar codes add value with meds administration and how RFID amplifies capabilities.

“With bar-coded patient wristbands and meds containers, fast and accurate scanning of these bar codes helps clinicians adhere to ‘The 5 Rights’ without slowing down care,” he said. “RFID extends this functionality with its capability of scanning multiple items at a time, [such as] taking inventory of a supply room where you have perhaps hundreds of items to be scanned. RFID can be utilized to accomplish this in seconds, whereas scanning each barcode individually would take much longer and could be prone to user error.”

Williamson recommends healthcare organizations to consider their own workflows to understand where a lack of data impacts operations and patient care. “Bar codes should be considered table stakes and employed wherever accurate data entry is required,” he said. “From there, consider how inventory and durable assets move, are replenished/serviced, or are audited, and determine where a bar-code scan wouldn’t be feasible but the more automated, one-to-many scanning from RFID can provide visibility at critical points as these assets travel across the organization.”

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