Automatic identification technology-application in hospital management information
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1. Application in Brigham and Women’s Hospital
A recent study in the “Journal of Internal Medicine” shows that in the United States, almost one out of every five medicines taken by patients in the hospital will be wrong. As a leading institution in patient safety research, Brigham and Women’s Hospital (BWH) in Boston, USA, hopes to create an automatic safeguard system through the preparation and use of prescription drugs to reduce the possibility of such accidents. BWH concluded that barcode scanning is the best system to improve the safety and accuracy of all operations. An effective system would require a separate bar code label on all prescription drugs, and only about half of the drugs shipped to the hospital are labeled with the unit of use bar code.
When BWH planned its system, the US Food and Drug Administration (FDA) was brewing new rules that would require the use of unit labels on drugs. The hospital did not passively wait for the FDA to propose bar code labeling requirements for individual drugs, nor did it rely on suppliers to provide bar code labels. Instead, the hospital produces individual two-dimensional barcode labels for more than 3.5 million medicines each year.
solution
BWH implemented a system to track and record medicines through barcode scanning. From the beginning of the processing of medicines in the pharmacy until the patients use them, all conditions are recorded. Bar codes are also applied to patient wristbands, employee ID badges, prescription drug orders, and laboratory samples for automatic tracking and accurate information recording. In pharmacies and laboratories, we use various types of labels. Similarly, there are various labels for medicines used by sick patients, said Bill Churchill, Director of BWH Pharmaceutical Services. We rely on bar codes to achieve highly accurate operations. Therefore, we must ensure the reliability and continuous availability of the printer.
The doctor enters drug information in a computerized system that records the time of the order and the time the pharmacy receives and reviews the order. The pharmacist checks the order in the computer, and then prints a barcode prescription sheet for the pharmacy technician to prepare the medicine and execute the order. Before the order is issued, the barcode on the medicine and the order will be scanned to ensure that the medicine is in line with the order.
When orders and stock medicines are sent from the pharmacy for delivery, the barcode is scanned and the record system is automatically updated. Doctors, soil protectors and pharmacists can check the status of orders at any time through computers throughout the hospital. The hospital has a wireless local area network, so information can be updated and obtained in real time. When receiving drugs, you can scan the drug barcode to record the receipt of them. When the drug is taken from the drug store, you must scan the drug barcode again. Employees must scan their own barcode ID badges during each drug transfer process to automatically create a chain of custody record.
When using medicines, the nurse scans the barcode on the patient’s wristband and then scans the barcode label on the medicine, medicine bottle or precision infusion set. Calculator will verify the correctness of the medicine to ensure that the medicine with the correct dosage and composition is provided to the correct patient at the correct time.
We have a fully integrated tracking and control system. Bar codes will maximize the accuracy of our operations. Churchill said. Labeling each medicine, medicine bottle and precision infusion set with bar code is a relatively large project. Approximately 50% of the packages of medicines used by BWH do not have a separate barcode label. Those drugs are usually only compiled with a National Drug Code (NDC), which is not enough to meet BWH’s information needs.
In order to ensure that the barcodes of all medicines contain sufficient information, BWH has set up the first full-featured, completely hospital-based medicine repackaging center. The center labels approximately 3507 products each year. In addition to the National Drug Code (NDC), Brigham and Women’s Hospital has also incorporated the drug batch number and expiration date in the Data Matrix two-dimensional bar code label produced.
We want to ensure that all information is compiled in the barcode to help us complete our work more accurately, Churchill said. Two-dimensional barcodes allow us to collect more detailed information in the smallest available space. Compared with one-dimensional barcodes, two-dimensional barcodes can provide us with more information about each medicine.
The FDA has required pharmaceutical manufacturers to label all drugs dispensed in hospitals with a barcode for the unit of administration before 2007. However, this regulation may not reduce BWH’s need for secondary labeling, because the FDA only requires one-dimensional barcodes to be included in the National Drug Code (NDC) (and drug batch numbers and expiration dates/recommended to be included, but not mandatory ) Without including Data Matrix.
Data Matrix symbols can encode up to 3,116 numbers or 2,335 alphanumeric characters, which is far beyond the reach of traditional one-dimensional barcodes (for example, ordinary UPC symbols can encode 12 numeric characters:). Data Matrix symbols have no fixed size and can be very compact, which is one of the main reasons why hospital planners choose symbols. BWH incorporates data such as the national drug code, drug batch number, and expiration date in a symbol that is not half a square inch.
The high density formed by compiling data in such a small space requires high-quality and accurate printing. BWH uses the Zebra industrial label printer, which can maintain high print quality in high-volume printing. Zebra thermal printers fully support DataMatrix symbols and have an optional 300dpi resolution print head, which is very suitable for making compact, high-quality symbols.
A high-quality printer is needed to encode two-dimensional barcodes. Such two-dimensional barcodes must be small enough to be affixed to a one-ml medicine bottle, Mr. Churchill said.
The Data Matrix barcode can also be used on wristbands to encode information such as the name of the criminal patient, the doctor on duty, the date of admission, and the date of birth. Encoding the wristband information meets HIPAA privacy requirements and meets the National Patient Safety Goals (NPSG) requirements of the Joint Committee for the Accreditation of Medical Institutions of the United States (JCAHO) for identifying patients who are obstructed by medical examinations.
Because hospitals use imagers instead of laser scanners to read barcodes, it is easier to read symbols when the label is attached to a curved surface (such as a medicine bottle or a patient’s wristband). According to BWH, the scan rate is very high.
Effect
Bar code systems have been used to prevent errors in prescription entry, prescription execution and dispensing. Barcode data entry and computerized control also provide accurate and up-to-date records, thus improving the medicine at Brigham and Women’s Hospital: brother tracking and inventory management. Since we implemented the barcode system, we have made tremendous improvements in reducing errors in pharmacies, Mr. Churchill said. For example, the phenomenon of excess in the execution of prescriptions has almost benefited: absolutely. However, the most prominent feature of our system is the ability to reduce errors in the use of medicines. From the content of this document, you can understand that through the use of barcodes, drug use errors are expected to be reduced by 60% to 80%. This is very consistent with what we have observed.
In the future, two-dimensional symbol technology will provide us with more opportunities to innovate. One potential application is to use patient ID, weight, drug concentration and other information to encode infusion pumps, Mr. Churchill said. For such detailed data, we must use two-dimensional barcodes.
2. The application of barcode in the laboratory of hospitals-Zhejiang Run Run Shaw Hospital barcode application case
In the past ten years, laboratory medicine has developed rapidly, and the advent of many new technologies has completely changed the traditional laboratory work mode, and at the same time reduced the labor intensity of the staff. However, the management of hospital information is far from keeping up with the rapid development of information technology in laboratory medicine. Laboratory quality control, intelligent management, standardization and integration have brought crises to the research and management of laboratory medicine.
Modern medicine requires medical institutions to collect, archive, process, supervise and manage a large amount of inspection and treatment information. The records formed by the hospital’s traditional manual copying and thermal paper reports are far behind the development of laboratory medicine. Even if it is a Chinese stand-alone report and the internal network of the laboratory, the computer is only used as the processor of the department or department to receive, store, print or send data, but it does not make full use of the resource advantages of the computer network, so that the computer management only stays in one direction. Net or Ke intranet status.
The Run Run Run Run Hospital affiliated to Zhejiang University School of Medicine was established in 1994. It was donated by the well-known Hong Kong businessman Sir Run Run, supported by the Zhejiang Provincial People’s Government, and assisted by the Loma Linda University Medical Center in the United States. A sex, research-oriented tertiary class A hospital. The hospital is located in the downtown area of Hangzhou. There are 33 clinical departments and a Shaw Clinical Research Institute of Zhejiang University.
A first-class hospital needs a first-class information system to improve the operating efficiency of the entire hospital. Run Run Run Shaw Hospital has applied automatic identification technology to the laboratory department, which has greatly improved the hospital’s information management level. They have introduced an advanced management model, operating laboratory management. The system integrator has designed a reasonable data flow, implemented practical plans, and selected the best equipment through full communication and communication with the hospital’s inspection personnel, making the hospital’s inspection information operation unprecedentedly efficient.
Data flow
The inspection data of the hospital is mainly concentrated between the nurse station and the laboratory (Figure 1). The working process of the nurse station, that is, the process of generating a medical order for inspection includes: medical order application, label printing after verification, sampling, signature (work number, time), and submission for inspection.
The workflow of the laboratory, that is, the flow of an inspection order in the laboratory: sample receipt, confirmation, automatic charging, distribution to groups, task list formation, computer measurement, result review, and regular printing at the corresponding nurses’ station.
Laboratory maintenance and quality control process: maintenance operations (such as cleaning the instrument, scrubbing the workbench, recording temperature, preparing cleaning agents, instrument calibration, etc.)-quality control on the machine to determine the quality control results.
implementation plan
The doctor’s order number and specimen number are commonly used in the daily work of the laboratory. The medical order number is a serial number generated when the LIS is executed when the medical order is issued by the applicant. It corresponds to a record in the medical order execution form. The specimen number is the number compiled by the operator when analyzing the specimen. There is a one-to-one relationship between the medical order number and the specimen number. The medical order number or the specimen number adopts barcode technology, and the analyzer and equipment can be connected to identify the specimen. Combined with the LIS, the degree of mobilization of the experiment is improved. One-dimensional barcodes are commonly used in laboratories, and the barcodes are pasted on the circular test tube to ensure the recognition rate. The bar code label is customized by a specialized manufacturer, using materials that are thin, sticky, and anti-static. The information is dynamic, and barcodes can only be printed on-site with a dedicated barcode printer.
The bar code is printed by Renye bar code printer, which has clear quality, replaces the original application form that needs to be written by hand and replaces the label affixed to the test tube or container after sampling, in order to facilitate the identification of the inspection instrument. Barcodes need to be posted vertically, and the angle should not exceed 15 degrees.
Barcode labels are double or triple, one is affixed to the test tube or container, and the other is left or given to the patient, reducing manual loading. By adopting the method of collecting documents and labels, patients can clearly know the report time and place of collecting documents.
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Figure 1 Hospital data flow chart
The outpatient service desk is equipped with a barcode reader to realize that the patient can automatically print the receipt by scanning the label of the receipt voucher. The bar code enters the analysis instrument directly, and some instruments use two-way communication, that is, the instrument sends a request to the computer system through the RS-232 serial port after identifying and reading the bar code information. Information such as liver function waits until the instrument, the instrument automatically conducts the test, and sends the result to the computer after completion.
The laboratory workstation is equipped with a handheld barcode reader for fast and accurate reading of barcodes. LIS uses barcodes to query specimen information, status on the analyzer, audit results, query reports, specimen logs, and all specimen-related tasks.
In order to facilitate the distinction between specimens in emergency, inpatient and outpatient settings, it can be easily achieved by using different color ribbons. For example, all printers in the emergency room use red ribbons and the bar codes are green. After the specimens are sent to the laboratory, they are easy to distinguish. Handle emergency specimens as soon as possible. However, due to the relatively high price of non-black ribbons (5-10 times that of black), they are currently used less frequently.
Equipment selection
According to the actual situation of the Run Run Run Run Run Run Hospital affiliated to Zhejiang University School of Medicine and the characteristics of the data flow and plan, the system integrator selected the equipment for the project.
The server door operating system selects Windows 2000 Advance Server, UNIX, LINUX, etc.; the database software is mainly Microsoft SQL Server 2000, ORACLE, ACCESS, etc. The workstation operating system uses Windows98, Windows2000/XP, etc. The program development tools are POWERBUILDER, DELPHI, VB, etc.
Servers, workstations, printers, and card hardware equipment indicators are configured according to the scale of the hospital.
The selection of bar code related equipment and consumables is based on the principle of reasonable and effective procurement. Choose Ze b r a TLP2844 for the barcode printer. The machine has the characteristics of fast printing speed, simple operation, expandable memory, suitable for all kinds of one-dimensional bar codes and MaX i C o d e, PDF417, Datamatrix two-dimensional bar codes and so on. Fully consider the scalability of the system. In addition, the machine is optional with LAN/Ethernet via EPL PrintServer and has a unique and simple EPC2 programming language. The barcode readers, ribbons, labels, etc. required for this door have also been selected.
The application of automatic identification technology in the Run Run Run Run Hospital of Zhejiang University School of Medicine has achieved obvious application effects. Realize true fully automatic operation. Bar code technology was successfully transplanted into the process of inspection and analysis, so that the instrument can identify the relevant information of the specimen, and automatically perform various operations according to the bar code information or the information sent by the host, eliminating the need for manual input of various inspection instructions on the instrument, simplifying the process The working procedures have made fully automatic analysis a reality.
Reduce human error. Due to the application of barcodes, the original test tubes from which blood is drawn can be directly placed in the instrument for testing after centrifugation. This avoids possible mistakes in the specimens when separating serum, mutual contamination between different specimens, etc. Errors improve the accuracy of the results.
Increased the flexibility of operation. The real-time two-way communication between the computer and the HOST makes the operation more flexible. When necessary, a certain command can be issued on any of the computers, such as making the instrument review a certain item.
Reduce workload, improve work efficiency and inspection quality. A barcode is attached to the specimen collection, and routine laboratory operations such as specimen classification, data transmission, analyzer two-way communication, audit results, inquiry report, and specimen preservation are completed according to the barcode. The bar code uniquely identifies the specimen in laboratory operations and communicates with the analyzer in two-way, which simplifies the laboratory workflow. The application of bar code technology in the laboratory. Effectively improve work efficiency, result reliability, and degree of automation, which is the direction of laboratory development.
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