• September 2008 FEATURE ARTICLES •
Thought Leaders
Brothers in Arms
By Cristina De Martini
Scanning recent headlines, it is difficult to
ignore the fact that radio-frequency identification (RFID) is
receiving substantially more ink than bar coding. Even in
healthcare, the consensus seems to be that bar coding is no
longer cutting-edge and that RFID is the newer, more advanced
auto-identification solution that healthcare IT leaders have
been searching for. However, the origins of the two technologies
reveal that they have peacefully coexisted for several decades.
In fact, the first bar code patents were issued in 1952 just a
few years after the British used radar-activated transmitters, a
system similar to modern RFID, to identify friendly planes from
German aircraft during
WW II. And, while bar coding was finally gaining commercial
traction in the 1980s, RFID scientists were busy developing
automated highway toll collection systems.
On closer examination, it becomes clear that
bar coding and RFID are not so much cross-generational rivals as
brothers in arms helping to manage the increasingly complex
information tracking demands of today’s healthcare environment.
It’s true that bar coding’s lower cost and straightforward
implementation makes it ideally suited for a variety of
healthcare auto-identification applications, however, RFID’s
flexibility when implemented at the correct frequency and
wattage to coexist with medical devices makes it a reliable
option for processes such as asset and patient tracking.
Therefore, before pursuing auto-identification projects,
healthcare organizations should evaluate the benefits of
employing a combination of both.
The Bar Coding Value Proposition
Bar coding systems tend to cost less to
implement and maintain than RFID systems. And in the case of
applications such as medication administration and
specimen collection, RFID improves very little on bar coding
systems’ capabilities.
Let’s consider medication administration at
the point of care. The clinician must confirm "the five rights:"
patient, drug, dose, route and time. This typically involves
scanning the caregiver’s ID badge, the patient’s wristband and
then the medication. Whether the clinician uses a bar code
system or RFID, he or she must walk through the identical
sequence of steps.
In fact, RFID may offer limited efficiency
gains in this scenario. RFID’s ability to generate simultaneous
tag counts of multiple items in a particular area is generally
an advantage. However, in close quarters, when identifying
unit-dose medications at the point of care, an RFID reader will
be able to confirm the number of medications that are in the
room, but it will not be able to verify the specific location of
each medication without being very close to the reader or being
surrounded by an antenna that would not fit into a standard
medication administration process. As a result, a line-of-sight
check is essentially still required.
Also, while the price of RFID chips is
rapidly declining, the economics of auto-identification dictate
that bar codes are likely to remain the technology of choice for
applications involving high volumes, such as patient
identification and medication labeling.
In hospital pharmacies, for example, many
medications still arrive without a bar code, and repackaging and
labeling is a large-scale undertaking. For this and related
pharmacy processes, bar coding and automated dispensing
equipment work together to produce on-demand, unit-dose bar
codes that are legible, secure and cost-effective.
When it comes to patient safety, bar coding
systems remain difficult to beat in terms of cost-to-results
ratio. In fact, a study conducted by the U.S. Department of
Veterans Affairs concluded that bar code medication
administration reduced the incidence of medication errors by
86.2 percent. For the foreseeable future, bar codes will remain
a strong option for medication safety and may be just as
suitable for laboratory specimen tracking, medical record
indexing and radiology film tracking and employee
identification.
The Potential of RFID
On the one hand, RFID systems are relatively
expensive. In addition to the cost of RFID tags and readers,
organizations may also need to budget for upgrading wireless
infrastructures and purchasing the right middleware, as well as
for the costs associated with re-engineering business processes.
On the other hand, the potential upside of
RFID is huge. Because of its ability to read information at long
distances, active RFID has proven very useful as a way of
tracking high-value objects such as IV pumps, wheelchairs, heart
monitors, defibrillators and other mobile medical equipment.
RFID is also carving out a niche as a method of tracking
patients. This includes monitoring elderly patients, protecting
mothers and babies in maternity wards, and tagging surgical
patients to ensure the right procedure is performed on the right
person at the right time.
Although bar codes make more sense for
bedside medication administration, RFID is emerging as a method
for protecting pharmaceutical supply chains. The FDA
Anti-Counterfeiting Task Force has strongly suggested the use of
RFID to safeguard against pharmaceutical counterfeiting. RFID’s
utility for track and trace
"e-pedigree" measures is enhanced by its ability to serialize
individual delivery units and to read sealed totes full of mixed
objects.
The complexity of RFID systems presents a
challenge to many healthcare organizations as few hospital IT
departments are experienced in deploying, testing and optimizing
RFID. This is changing as the associated costs continue to fall
and organizations realize the potential gains, but recent
studies have raised some important considerations that hospitals
should keep in mind. One study published in the Journal of
the American Medical
Association demonstrated that some RFID readers can, in
certain situations, interfere with medical equipment typically
used in critical care settings. By understanding the environment
in which RFID equipment will be deployed, and properly
integrating equipment according to established regulations and
standards, healthcare facilities can make great strides toward
realizing the efficiency and safety gains that result from the
use of RFID.
Looking Ahead
An increasing number of healthcare providers
are using RFID to complement their existing bar coding systems.
For example, medication may be dispensed from an RFID-enabled
cabinet where an RFID chip reads what was taken and then updates
the inventory, while the bar-coded medication label is scanned
by the nurse to ensure safe medication administration at the
bedside.
One example of an organization that’s using
both technologies is St. Vincent’s Hospital in Birmingham, Ala.
They use bar coding for their "closed-loop" medication
management integration initiative and RFID technology to monitor
the locations of surgical instruments, as well as
sterilizations, maintenance records and other variables, such as
purchase dates, descriptions, and costs and utilization data for
individual items.
It is likely that the two technologies will
peacefully coexist for some time. While bar coding is entrenched
and growing, RFID will undoubtedly gain momentum in certain
targeted areas, as evidenced in the results of the 19th Annual
HIMSS Leadership Survey.
When respondents were asked to identify the
healthcare application areas they considered most important over
the next two years, 30 percent selected closed-loop medication
management utilizing either bar coding or RFID technology. When
asked to identify the areas in which they anticipated their
organizations would implement technology in the next two years,
43 percent indicated RFID technology and 35 percent specified
bar code technology. It appears that these "peer" technologies
are going to be around for a while, continuing to help hospitals
maximize their benefits in terms of time savings, accuracy and
patient safety.
Cristina De Martini is global practice
leader, healthcare, at Zebra Technologies and a member of the
HIMSS Auto-ID Task Force. Contact her at
cdemartini@zebra.com.
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