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Two Dimensions Are Better Than One

March 1, 2006
by Rob Hussey
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New developments in patient wristbands may help reduce errors in healthcare.

Barcodes are commonly prescribed for improving accuracy and efficiency of data entry. In the hospital setting, barcodes are increasingly being used as part of a system to reduce errors in medical treatment. Unfortunately, the practitioners who have to read the barcodes complain that it's a difficult and arduous task.

Traditional linear barcodes are just not suited for many healthcare applications, including patient wristband reading. The shape of linear codes tends to be a long rectangle that becomes wider as more data characters are added. No matter how hard one tries, these linear barcodes cannot be positioned, rotated, or shrunk in a way that addresses all of the patient-wristband reading challenges.

These challenges have motivated facilities to seek other solutions. However, no other proposal — including radio frequency identification (RFID) — has been successful in removing all of the frustration.

Cracking the barcode

In order to tackle the wristband reading challenges, the industry as a whole must make a fundamental change to the barcode. Two-dimensional (2D) barcodes, such as MicroPDF417 and PDF417, are more space-efficient than linear codes. In a limited amount of space, the use of 2D codes for patient identification will immediately impact reading accuracy, data security, ease of use and patient interaction at the bedside.

Two-dimensional codes employ Reed-Solomon error detection and correction. This is the same technology that has been used for reliable communication to and from satellites in deep space. In fact, you are more likely to win the lottery than you are to experience a misread of these codes.

Today's wristbands are up to 1.25 inches wide in order to accommodate current barcode design; this makes them more expensive, less comfortable for the patient, and too big for children.

If you are using a traditional laser scanner, you may be limited to reading traditional linear barcodes. Fortunately, state-of-the-art image-based readers are now commonly used in applications where greater versatility is required.

With the capability to read every type of barcode, capture digital images and deliver flawless reading at any angle, Area/2D Imagers make wristband reading easy. The nurse simply points and shoots; no more twisting the patient's wrist to align a laser beam with a barcode.

You gotta have standards

The Provider Applications Standard was created to facilitate interoperability in a networked hospital environment. It describes the preferred method for formatting barcodes and, more importantly, how to structure the data that is encoded into the barcode.

Two flags are used to indicate "what" the data is and "where" it was captured from.

Unfortunately, a large number of hospitals fail to conform to the Provider Applications Standard. However, by using any of the two-dimensional barcode solutions, a hospital would be in compliance.

In fact, there is a revision to the standard under way that seeks to add additional data to the patient wristband. It will recommend that a second field be added in order to identify the Health Industry Number (HIN), which will identify the healthcare location where the wristband was affixed. This is a benefit when patients are transferred from location to location, such as a remote clinic or an ambulatory surgical site.

The use of a two-dimensional barcode, with their smaller size, increased data capability and ease of use, is the most sensible way to implement patient wristbands.

Rob Hussey is image technology manager at Hand Held Products, based in Skaneateles Falls, N.Y.