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If your lab seeks to sail smoothly into the future, then consider installing a barcoding system. Industry professionals agree that by implementing such a system, you will be in a better position to keep your lab shipshape.
Bar coding can benefit lab processes in many ways, from the initial drawing of samples, through analysis and finally to storage. Take a moment and envision bar coding at its finest, says Karen Longe, MEd, MA, president, Karen Longe & Associates Inc., Lake Bluff, IL, who advises laboratories on how to use barcode systems. In an ideal world, all inpatients will wear barcoded wristbands, Longe says. When blood is drawn, wristbands would be scanned to verify identity. As soon as the sample is placed in a test tube, it would be labeled with a bar code.
When the test tube arrives in the lab, the tube's bar code would be scanned into the lab's information system and the date and time of its arrival documented, she continues. Therefore, if a physician inquires about a specimen's status, it could immediately be obtained.
When a sample is processed on an analyzer, this machine would read the tube's bar code, Longe says. Ideally, when the tube comes off the analyzer it is placed in a barcoded refrigerator that contains shelves and compartments that also are barcoded. This enables the specimen to be easily located at a later time.
Advantages
Bar coding provides many advantages when used to its full potential, Longe says, as in the above scenario. These include:
trackingidentification of a specimen and documentation of its path throughout the laboratory.
identificationverification that a sample was drawn from the correct patient.
documentationverification of when a procedure occurred.
cost savingsby scanning information, paperwork is reduced and time is saved. Bar codes can be read by a computer three times as fast as keyboard entry, adds Richard Kriozere, BA, president, Digi-Trax Corp., Buffalo Grove, IL.
error reductionscanning in bar codes eliminates data entry errors. While manual key entry has an error rate of one in 300-500 key strokes, bar codes have substitution error ratios of between one in 3 million to 10 million characters scanned, Kriozere notes.
Implementation Challenges
Although the benefits of bar coding are numerous, making a system operational may take some work, depending on the scope of the project, says Niels Wartenberg, field applications engineer, Microscan Systems Inc., Renton, WA, which manufactures barcode scanners for embedding into laboratory equipment.
If the barcode system needs to be tied into the LIS and HIS, group effort is required to be successful. "While this is a common occurrence in today's clinical environment, it often requires involvement of both LIS vendors, analyzer vendors and laboratory and/or hospital information system staff," Wartenberg said.
The ability to consistently print barcode symbols of acceptable quality is also important, he adds. Starting with a high quality bar code goes a long way toward ensuring 100 percent data integrity of the system. If a bar code is generated that does not fully conform to the appropriate standard(s), some laboratory equipment might be unable to read it. "That is why Microscan spends a lot of time educating users on how to create a good bar code. If laboratories follow our five simple guidelines, they will be able to avoid a lot of unnecessary application challenges down the road," Wartenberg said.
One of the most important steps toward achieving a good bar code is selecting the best symbology for the application, Wartenberg says. Fortunately, the NCCLS has saved labs a lot of time by selecting a single barcode symbology for specimens (Code 128).
Only a limited amount of data can be stored in linear bar codes. However, compact two-dimensional (2-D) barcode symbologies (e.g., data matrix) allow more data to fit on a smaller label, says Irwin Thall, manager, Healthcare Market Development, Precision Dynamics Corp., San Fernando, CA.
Labeling Issues
Another challenge of implementing a barcode system may be determining what kind of label to use. Electronic Imaging Materials Inc., Keene, NH, is a manufacturing and consulting firm that specializes in manufacturing specialty labels and assists labs with using barcode systems. "Progress with a barcoding system will not be made unless a proven label material is in place," said Dennis Shanoff, sales and marketing specialist. The core component of a barcoding system is actually the label.
One of Electronic Imaging Materials' areas of expertise is recommending label materials for extreme circumstances. For example, a labeled container may be stored in a freezer at -80ยบ F. In this instance, a regular label couldn't be used. A special barcode label would also have to be specified if the label was exposed to chemicals.
There are different ways to determine which label will work best. First, the environment in which the label must exist is determined as well as the container that it will be on. Then, Electronic Imaging Materials can either send labels to a lab to experiment with or it will conduct the testing after acquiring the container.
Once the correct label is determined, the company can establish a system to supply the lab with pre-printed labels or it can provide a system so the lab can print labels onsite and on demand.
"We also sell barcode scanners, portable data terminals, printers and tracking software," Shanoff said. "We will do anything from delivering individual components to onsite consultations and installations."
A Living Example
At Loyola University Medical Center (LUMC), Maywood, IL, the laboratory uses bar coding for sample, patient and operator identification, reports Kathleen M. McKenna, MBA, BA, MT(ASCP), manager, specialty and point-of-care testing (POCT), Clinical Laboratories. Samples are labeled with bar codes when collected and are placed on the lab automation system for processing or on instrumentation interfaced to the LIS.
The admissions department generates barcoded armbands and labels for each patient. Employee identification badges are also barcoded; the employee bar code is used as the operator identification in POCT. Bedside glucose meters are equipped with a barcode scanner to identify the operator and patient. In addition, bar codes are used in reagent labeling for analyzers.
LUMC opted to use bar codes in 1990 when its LIS vendor made them available. Bar coding was implemented to reduce errors in sample identification and to take advantage of changes in technology. Such changes included lab analyzers with built-in barcode scanners and bi-directional interfaces with the LIS. The lab began using patient and operator bar codes in late 2002 for bedside glucose testing.
McKenna says that when using bar coding in POCT, a hand-held scanner (part of the glucose meter) is used to identify the operator and patient. In sample identification, orders for testing are entered into the LIS either by direct interface or manual entry. Sample labels with bar codes are then printed at point of service to use in sample collection and labeling. Bar codes have replaced collection lists and serve as tube labels and test orders. Laboratory barcode printers have been installed in all nursing units and outpatient clinics.
"We're seeing interest in using small, space efficient, 2-D codes to track reagents" Wartenberg said.
Technically speaking, bar coding uses various schemes or barcode symbologies, Kriozere explains. Scanners translate these bars and spaces to signals recognized by the computer.
Most commonly recognized bar codes are called one-dimensional (1-D) or linear codes, Kriozere says, which represent a license plate of sorts that connects to a complex computer database. Recently, the industry developed new 2-D bar codes. These can contain more data when a volume of alpha-numeric information is on the label for transmission to a computer.
Future Uses
Wartenberg notes that bar coding can be used to further mitigate risks in the area of misidentification between patients and specimens. One approach is to equip phlebotomists with computing devices (e.g., personal digital assistants) outfitted with barcode readers. Prior to leaving the laboratory, information regarding specimens associated with a patient can be downloaded to this computing device. This would allow phlebotomists to read a barcoded patient armband and verify that the barcoded specimen tubes indeed are for a specific patient.
Longe adds that bar coding is an ideal way to keep track of test tubes sent to other labs. Bar coding also presents the opportunity to document vital information, such as a patient's health insurance information and lab test orders that are needed.
Additionally, bar coding has found a place in many other industries, Kriozere says, that seek to prevent errors. Later this year, the FDA is expected to issue a mandate requiring bar codes to be placed on all drug and blood products.
"Many regulatory agencies or certification groups will follow the FDA's lead and require the use of bar codes for laboratory certification," Kriozere added. "Now is the best time to explore the barcode options."
He also says that bar codes can be the basis for lab robotics as an element in a total process control system by combining either 1-D or 2-D codes with radio frequency identification (RF-ID) chips as part of a barcode label. This technology is available today.
RF-ID labels offer better scanability than barcode specimen labels, says Thall, because they do not require line of sight. Instead, specimens simply need to be within the proximity range (typically a few inches) to be read.
Barcode technology is a read-only process (like the license plate of a car), Thall says. The data contained in the bar code cannot be changed or updated. However, RF-ID technology allows new information to be written to the label (e.g., time of blood draw).
Conclusion
A well thought-out barcode system is paramount to maintaining data integrity, Wartenberg says. Although challenges will likely occur when a barcoding system is implemented, the advantages will be well worth it.
Karen Appold is a freelance writer based in suburban Philadelphia. Contact her at kappold@msn.com.
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