Bar code technology in healthcare

Bar code technology in health care describes a method of tracking patient care efficiently and safely. Bar codes are typically assigned to a patient upon admission and put on an identification bracelet. Bar codes are also applied to medications and laboratory samples. Scanning the bar codes ensures that patients are correctly identified, so the proper medications are dispensed and patients receive the correct procedures. Scanning also immediately updates patient records, helping medical staff know a patient's care status and eliminating many errors of record keeping, such as illegible handwriting.

Bar codes were initially developed as a way to quickly scan groceries and record sales to simplify the process of keeping shelves stocked. From the grocery industry, use of bar codes spread to other products and industries, making them ubiquitous in many aspects of everyday life by the twenty-first century.

Background

The bar code was invented by graduate student Joe Woodland, who wanted to develop a code that could be printed on groceries to make checkout faster and to help supermarkets track inventory that needed to be restocked. Woodland was eager to solve these problems and quit school in late 1948, to devote all of his time to developing a system.

The first bar code Woodland developed, with fellow grad student Bernard "Bob" Silver, was round. It became known as the bullseye bar code. They chose this shape because it could be read from any angle, and they felt a rectangular code had limitations. They built a prototype scanner that was about the size of a desk. The technology needed to use the bar code—a bright enough light and a minicomputer—did not yet exist, however. Although they received a patent for the idea in 1952, it was not developed at the time.

Many scientists were working on atomic radio light. In 1960, Hughes Aircraft Company announced that research scientist Theodore Maiman had created light amplification by stimulated emission of radiation, which is known by the acronym laser. The scientists involved knew the laser was important, but they did not know how it might be used. Several years later, the Radio Corporation of America (RCA) found an application for laser light. The company decided to develop a system to read scanned items at checkout. As a result, the grocery industry worked to develop a universal code, or Universal Product Code (UPC). Eventually, the industry chose a rectangular bar code of vertical lines created by George Laurer for IBM. The first automated check stands, with lasers to read bar codes, were installed in Kroger stores. Bar codes were placed on groceries, and scanned grocery checkout began in 1974.

Bar codes took another leap forward when mass merchandisers began adding UPCs to products, beginning with Kmart. Use of the code greatly expanded during the 1980s as manufacturers adopted bar codes as well.

In simple terms, a scanner reads a bar code by shining a laser or LED light on it. A photoelectric cell detects reflected light from the bar code and generates a pattern of pulses, on and off, that match the stripes of the bar code. An electronic circuit converts the pulses into zeros and ones, or binary digits, and sends this information to a computer hooked up to the scanner.

Overview

Bar codes entered hospital systems during the late 1970s when National Cash Register developed a hospital order communications system. It consisted of sheets of bar codes for medications, procedures, and tests, as well as bar codes for patients. These code sheets were at the staff computer terminals, where a staff member scanned a patient's bar code and the bar codes for any medicines, procedures, and tests that physicians had ordered for that patient. This and other systems were tried, but ultimately fell short of health industry needs.

The Health Industry Business Communications Council (HIBCC) established standards for bar code labeling in the health care industry during the early 1980s. For the most part, bar codes were used to label specimens. The industry did not see medical errors as a significant problem until a 1999 report by the Institute of Medicine (IOM) cited visual and transcriptive errors—or mistakes made when reading and copying information—as a serious problem. According to the US Food and Drug Administration (FDA), between 44,000 and 98,000 deaths a year might have been caused by hospital medical errors, including more than 7,000 deaths related to medications. The industry began exploring ways to reduce medical errors, and soon focused on better ways to use bar codes. The Healthcare Information and Management Systems Society (HIMSS) eventually established a series of recommendations and standards for using bar codes.

HIMSS advocated bar code use in registering and admitting patients, tracking patient care, tracking products and supply systems, and in accounting and billing for health care. At admission, bar codes are used on forms, wristbands, and patient records. Patient care is tracked using bar codes on medications, medical devices, supplies for medical care and surgery, caregiver identification, order requisitions and test results, and patient charts. Bar codes are used in material and supply management when staff scan them to update inventory and track materials. Bar codes also protect patients by alerting staff to product recalls and allowing hospitals to track medication and devices back to the manufacturers. During the billing and accounting processes, bar codes help facilities track supplies used in patient care and medical care provided to the patient.

Health industry experts say bar codes increase accuracy by eliminating opportunities for human error. This was proven when bar code technology was first introduced in some Veterans Administration hospitals in the late 1990s. After four years of use, in 2002, a study found that medication errors were reduced by 86 percent in those hospitals. In 2004, the FDA put forth a final rule, following years of deliberation, that required bar code labels on certain medications to help ensure hospitalized patients receive the correct medications and accurate dosage at the proper time. The regulation forced all drug manufacturers to place bar codes on all drugs sold to hospitals. The administration predicted that the regulation would prevent approximately 500,000 unintended side effects and medical errors over the subsequent two decades.

Following the FDA ruling, many hospitals in the US began using laptop computers on medication carts and handheld scanners to check the patient's wristband and the medications given. Identification is a primary concern while dispensing medication; scanning patient bands ensures the medication is dispensed to the correct patient. Any conflict between the patient identification bar code and medication brings up a warning on the computerized system. Physicians can update orders at any time, allowing nurses to have the most current orders while dispensing medication or providing other care. Bar code scanning also allows staff to validate that care has been received. In 2007, HIMSS reported that bar code systems were the top priority for reducing medical errors in hospitals, according to its annual survey.

By the 2010s, studies continued to show that bar codes were an effective tool in hospitals, with many reporting a reduction of 50 percent or higher in medication administration errors. However, not all hospitals had yet implemented such technology, particularly smaller facilities with lower budgets. In 2014, around two-thirds of hospitals used a bar code management system in which patients and medications are scanned before the administration of drugs. Many pushed for wider implementation of bar code systems in hospitals, and reports indicated that by the early 2020s nearly all US hospitals had bar code management systems in place. At the same time, some hospitals with bar code systems encountered challenges, such as poorly trained staff, poorly designed systems, and costly equipment.

Bibliography

Dubin, Cindy. "Eliminating Costly Medical Errors with Bar Code Scanning." Health IT Outcomes, 3 June 2013, www.healthitoutcomes.com/doc/eliminating-costly-medical-errors-with-bar-code-scanning-0001. Accessed 4 Dec. 2017.

"Factsheet: Bar Code Medication Administration." Leapfrog Hospital Survey, 1 Apr. 2020, ratings.leapfroggroup.org/sites/default/files/2020-08/2020-BCMA-Fact-Sheet.pdf. Accessed 27 Sept. 2023.

"Implementation Guide for the Use of Bar Code Technology in Healthcare." AutoID Solutions, www.autoidsolutions.com/wp-content/uploads/Implementation‗Guide‗BC‗Healthcare.pdf. Accessed 4 Dec. 2017.

Khammarnia, M., et al. "The Efficacy of Patients' Wristband Bar-code on Prevention of Medical Errors." Applied Clinical Informatics, vol. 6, no. 4, 2015, pp. 716–27.

"Working to Reduce Medication Errors." US Food and Drug Administration, 23 Aug. 2019, www.fda.gov/drugs/resourcesforyou/consumers/ucm143553.htm. Accessed 26 Sept. 2023.

"Use Bar Codes to Identify Medications." Institute for Healthcare Improvement, www.ihi.org/resources/Pages/Changes/UseBarCodestoIdentifyMedications.aspx. Accessed 4 Dec. 2017.

Vecchione, Anthony. "Hospitals Could Do Barcoding Better." Healthcare IT News, 26 June 2014, www.healthcareitnews.com/news/hospitals-could-do-barcoding-better. Accessed 27 Sept. 2023.

Weightman, Gavin. "The History of the Barcode." Smithsonian, 23 Sept. 2015, www.smithsonianmag.com/innovation/history-bar-code-180956704/. Accessed 4 Dec. 2017.

Wohlsen, Marcus. "40 Years On, the Barcode Has Turned Everything into Information." Wired, 26 June 2014, www.wired.com/2014/06/forty-years-on-the-humble-barcode-has-turned-everything-into-information/. Accessed 4 Dec. 2017.