Going electronic with 2D barcodes
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Forms scanning using 2D barcodes |
Without accurate and efficient data entry the benefits of any electronic information system are significantly diminished. In primary care, for example, the fundamental requirement is being able to make laboratory results visible and available back to GPs is knowing who the patient is.
All that is needed for accurate identification is the patient ID, surname and forename – but if any one piece of this information is missing or inaccurate, then it is impossible for technology at the practice or the laboratory to process the 'patient result' without extensive human intervention – whether that be searching for the correct details or creating a new record for the patient.
By automating the production of labels accompanying laboratory requests from general practices, not only is the data more accurate but the labels are generated in less time than hand written equivalents in common use today.
Employing the use of barcode technology in the process can help make further efficiencies – especially at the laboratory, where they make the processing the sample requests simpler and faster. 2D barcodes can store up to 1800 characters of text in a single code, which can be picked up by a barcode reader almost instantly. This can be used to great effect on request data, including relating to the patient, the requesting GP, requesting practice, tests required and so on.
2D barcodes, LabelTrace and forms scanning solves problems for laboratoriesThe Southern Health and Social Services Board in Northern Ireland was one of the first healthcare providers to recognise the benefits of introducing a common, automated labelling approach. They deployed Infocom’s document scanning system combined with a LabelTrace solution that prints a 2D barcode label containing all the demographic data. Now, when requests arrive at the lab, the forms are passed through a document scanner which is able to locate and decode the 2D bar code. This virtually eliminates keyboard data entry.
Infocom’s software not only extracts the data, it validates it and the requested tests against the laboratory’s business rules and then enters the data directly into the laboratory information management system (LIMS).
At SHSB’s Craigavon Labs 1.7 million individual tests are handled every year; up to 1,700 request forms per day. Of these, about 60% are from GPs - around 900 requests. Prior to the introduction of forms scanning, it took more than three staff up to 24 hours from receiving the sample to register the requests on the system. Now, those with 2D bar codes, if received by 4pm, are registered by 5pm; with only the equivalent of 50% of a staff member’s effort.
Craigavon's pathology service manager Brian Magee "is delighted with the system". He says: "There has been a massive improvement in efficiency but even more importantly a massive improvement in data quality. Consequently results are passed back much more quickly to the GP practices that are then able to inform patients and if necessary decide on follow up actions more quickly”. Magee added that he anticipates further improvements as more practices come online.
The GPs and nurses using this system in practices are also delighted with the amount of time and effort saved in completing test requests as this frees up more time to deal appropriately with patients.
As a result of the successful introduction of 2D barcoding for requests at Craigavon Labs, there are moves to introduce the same approach at all laboratories in Northern Ireland.
To help achieve this, a standard label design for a requesting 2D barcode label has been approved for use throughout Northern Ireland. Now the same label design is used irrespective of which lab the request will be sent to, thereby widening the potential for using labelling to those labs, such as Link Labs in Belfast, which potentially handle requests from practices anywhere in Northern Ireland.
There are alternatives to labelling more effectively, including electronic requesting, but many see this as a step too far in the automation process. Richard McEwan of NHS Lanarkshire believes that appropriate labelling of forms and samples is the most effective means of processing test requests from primary care health establishments. McEwan was responsible for the introduction of forms and tube labelling to all NHS Lanarkshire practices three years ago, after which hundreds of thousands of requests have been labelled using the LabelTrace system.
Until recently the labels carried primarily eye-readable data with a single barcode representing the CHI (Community Health Index) number - the unique patient identifier used in Scotland. Even the single barcode and the legible eye-readable information saved time at the labs.
McEwan recently led a project to examine alternative strategies to improve even further efficiency of transmission of test requests from GPs to the NHS Lanarkshire laboratories at Wishaw, Monklands and Hairmyres Hospitals.
A pilot scheme demonstrated that enhancing the existing LabelTrace installations in GP practices to print 2D barcodes and scanning these at the labs could provide most of the benefits of electronic requesting. It also avoids some of the downsides, such as administrative problems if a request is received electronically but the sample fails to appear.
The LabelTrace option was also considered to be a reasonably low-cost system to introduce as the changes at the practice required nothing more than replacing the label templates which are simple text files. This was cost free and required no additional training for GP staff.
At the laboratories, the 2D barcode on the request form would be scanned and the information entered into the Laboratory System via an independently developed front end that utilises existing interfaces.
Richard McEwan considers the next step to be the incorporation of test requests and clinical details in the 2D barcode, to completely automated data entry. The development work for this is ongoing to ensure that the laboratories and GP surgeries alike can reap the benefits offered by these advanced barcode technologies.
LabelTrace in the acute sector
If a hospital laboratory is receiving complete, accurate and legible requests from external GP practices and surgeries, then it should be a cause for concern if they receive poorly completed requests from their own hospital wards or community departments.
Hospital laboratories receiving test requests from GPs and practices as well as from their own wards and departments are under enormous time and resource pressures that are increased by handling multiple styles of request. Like commercial labs, they benefit from all requests having an identical layout in terms of data format and placement on request forms.
In Scotland, such a system was seen to have additional benefits – due to the existence of the Scottish SCI Store system, a large database system holding demographics and aggregated laboratory test requires for patients.
This system is used by the majority of Scottish Health Boards, and is accessible from a large number of the PCs in hospital wards, administration areas and GP practices. With this in mind, Gerry Mellan of NHS Greater Glasgow and Clyde asked QuickTrace, developers of the LabelTrace label printing solution, to examine the feasibility of linking LabelTrace to the Scottish SCI Store system so that the GP test request labels could also be accessed by nurses and doctors on hospital wards.
In conjunction with Atos Origin plc, the company responsible for developing and supporting the SCI Store Interface, a link was produced which enables nurses or doctors in hospital wards to generate request form labels which are very similar to those produced for GP requests. This has also allowed for greater use of CHI (Community Health Index) to be enhanced, to meet a recent directive from the Scottish Executive that all clinical communications must include the CHI Number. In principle, this includes not only test requests but any written communication.
Gerry Mellan, who was instrumental in the adoption of LabelTrace as the solution for GP lab labelling commented: “Having achieved quite rapidly a situation where the GP practices in our Health Board Area were providing a very high percentage of requests with the minimum data set, we have been anxious for some time to add ward based requesting using the same solution.
"Now that this has been implemented, we anticipate achieving the same consistent quality of data being sent to the labs. The fact that LabelTrace operates in conjunction with hospital systems as well as with GP systems gives us confidence in the labelling quality from a range of sources we need to cope with. We also know that staff can be trained in minutes to use it.”
Having produced a link from the SCI Store, developments are underway to provide similar links from other systems including COMPAS and under consideration most recently is a possible link to iSoft’s PatientCentre product. This is used extensively in Northern Ireland hospitals and a link would allow production of requesting labels on the wards identical to those from local GP practices.
Pocket LabelTrace brings the label to the patient
Because not every nurse or doctor spends time at a desk, it is inevitable that there are some situations where there is a need to print labels for test requests and specimens without being in front of a PC.
For example, a GP may need to take a blood sample for a patient confined to their home, or a hospital phlebotomist needs to take a sample at the bedside in a hospital ward.
In order to complete the circle of efficient laboratory testing, many trusts had been looking for a similar facility to LabelTrace that could be wherever the patient may be.
Pocket LabelTrace is a system that runs on Pocket PC devices such as an HP iPAQ or Symbol MC50 rugged mobile computer.
For GPs, this system runs alongside a common GP clinical system, such as Pocket GPASS or Pocket Vision produced by Inchware Ltd, and allows a GP to retrieve a patient’s record at a patient's home. Using the latest portable barcode label printers, labels can be printed to accompany test requests that are identical to those created in the practice.
As with other Pocket PC applications, the software is updated immediately before leaving the practice to ensure that only the most up-to-date information is available, and only the very latest label designs are printed.
There are options on the printing in terms of type of connection and model of printer used. The most common printer utilised with LabelTrace is the Zebra LP2824 small footprint desktop thermal printer. These are sufficiently small to be taken out of the GP practice and used as a mobile printer. A battery pack is available which facilitates this and either a cable connection or Bluetooth connection (using a Bluetooth adaptor) can be used. Alternatively, compact mobile printers such as the Zebra QL320 may be utilised with a cable or Bluetooth connection.
In hospital wards, it is possible to take advantage of WiFi connections where they are present. So, by simply scanning a patient’s barcoded wristband, the patient can be identified by Case Record Number, NHS number, Health and Care Number or CHI Number, with patient records being available from the hospital PAS or other hospital systems such as SCI Store.
In the situation of a sample being taken at the bedside in a hospital, there are two principle ways of operating. Where WiFi is not available, use of the latest 2D barcodes on the wristband will enable the doctor or nurse to obtain all the required demographic information, as well as patient identification. The end result is the same - instant, legible barcoded request and specimen labels.
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