Special Advertising Section: Barcoding
Just a Twist of the Wrist(band)
After 40 years, healthcare still struggles with barcode adoption.
By Tom Inglesby
When the Buick plant in Flint, Michigan, demonstrated in 1969 that automatic identification could be done with laser-based barcode readers even on a moving assembly line, many industries took notice. Unfortunately, healthcare wasn’t one of them.
Early arguments against barcoding in the hospital environment were based on concerns that reading errors could endanger patients. It would be much better, detractors argued, to limit patient and medication identification to visual observation by the staff. Decades later, barcodes are found throughout the hospital. Combining visual and automated identification, barcodes, and human-readable text and images improves safety throughout the facility.
Several companies provide products to hospitals, clinics, medical practices, and other facilities; one of them is PDC Healthcare in Valencia, California. The company is the result of the merger of two industry leaders and pioneers in healthcare: Precision Dynamics Corporation (PDC) and The St. John Companies. John Park, vice president of marketing at PDC Healthcare, says, “We focus on identifying people, products, and premises. For every patient admitted to a hospital, you can imagine the number of prescriptions, laboratory samples, and pieces of equipment that are used for them daily. While the wristband is used for the patient, hospital-grade labels are used for other things. In order to have closed-loop medication administration, for example, you need to have barcoded wristbands for the patient as well as barcoded labels on mediations.”
What distinguishes PDC barcoded products from others in the marketplace? Park replies, “From a product perspective, we believe three things are important: First, the product is designed for patient care—what we call ‘hospital grade’ products. For example, wristbands that have been tested to reflect real-life situations that will occur during a patient stay, such as withstanding hand sanitizer or soap and water while being antimicrobial and latex free. Second is that the products are formatted to be seamlessly integrated for use with the myriad of software and hardware used in hospitals. Third is that there is strong support for implementation of these products. More than 90% of U.S. hospitals rely on PDC Healthcare because they know that the media used really matters. Implementing wristbands and labels in hospitals that have specific clinical and IT requirements is no small task—each job is unique. We are committed to making ID solutions that fit and work in their facilities.”
A quick trip through almost any unit in a typical hospital might create the impression that there is universal adoption of barcoding, but that isn’t the case. Park notes, “There are broad areas to look at regarding barcode adoption. The first is on the front lines of patient care, where adoption is well documented by HIMSS. Hospitals in Stage 5 have closed-loop medication administration; they are actually using the patient’s wristband barcode to log the ‘five rights’ of administering a medication. Over 55% of hospitals have achieved this functionality. We anticipate that this will only grow with the continuing implementation of this technology.”
He continues, “The second area is the use of barcoding in tracking things in the hospital. The definition of things could range from wheelchairs to drugs. Barcodes are well used in the lab and pharmacy. The next wave is for things outside those areas. For that, the technology in question is RFID (radio frequency ID) and related tracking technology. RFID still has much less penetration than the wristbands in the front lines of patient care. When the cost of technology begins to become more attractive, we will see early adopters start to pick this up.”
Cost isn’t always the issue; government and regulatory mandates can force adoption regardless of cost. Take the Affordable Care Act (ACA). Park explains, “The ACA has been positive for this market by accelerating the adoption and use of barcoding. Many hospitals had barcode technology prior to ACA but did not use it until they had to implement it. Now they are using it, and those that didn’t adopt it before, have done so. This has been positive for patient safety and for barcoding.”
Barcoding for medication management is becoming a mature practice. “Early on, we often needed to explain the process, but it is now readily accepted and understood by everyone,” comments Robert Chadwick, president of Endur ID, Inc., in Hampton, New Hampshire. Endur ID focuses on the wristband application for patient identification. Chadwick says, “Through material and coating science, we have made the barcodes we print on wristbands very reliable, whether they are the original barcodes or the newer 2-D high-density version. Advancements in wristband materials, laser printers, and scanners have made this technology bulletproof, resulting in very accurate scan rates.”
With universal acceptance, technology is being used more in outpatient settings, for blood products and in behavioral health, where wristbands and barcodes were not considered in the past. Challenges still exist in areas such as unit-dose labelling, maternity and infant care, and the development of processes and infrastructures to utilize the barcodes.
“Maternity is the most difficult area,” admits Chadwick. “We’re combining adult bands with infant and pediatric bands. The trick is to get them all to work very well. The problem with barcodes on infant bands is there’s simply not enough space, so we’ve been using 2-D barcodes in those situations.”
High-density barcodes can be tricky to print and scan accurately. Chadwick says, “Working on the material and coating sciences, we’ve been able to make the bands very reliable. Initially, it was difficult to get great results, but now we can get crisp, high-density barcodes. There have also been advancements in the materials, printers, and scanners. I remember when barcode quality was a topic of discussion. Now, it’s not really brought up, it’s just expected.”
Chadwick notes a program in the U.K. that will eventually have application in the rest of the world. “The National Health Service mandated a new 2D high-density barcode called GS1 that includes everything that’s on a wristband plus more—patient’s name, demographics, address, location, and medical record numbers. You almost don’t need human-readable information on a wristband. I think that may be where we’re going in this country.”
PDC’s Park adds, “We should continue to see barcode products evolve to meet the needs of specific patients. Previously, there was a ‘one size fits all’ approach, where the same wristband would be considered appropriate for a newborn or an oncology patient. We know more and more that clinically specific applications to improve the patient’s care and journey are important for satisfaction as well as patient outcomes.”
Tom Inglesby is an author based in southern California who writes frequently about medical technologies and improvement strategies.