Brothers in arms.

Scanning recent headlines, it is difficult to ignore the fact that radio-frequency identification (RFID) is receiving substantially more ink than bar coding. Even in healthcare, the consensus seems to be that bar coding is no longer cutting-edge and that RFID is the newer, more advanced auto-identification solution that healthcare IT leaders have been searching for. However, the origins of the two technologies reveal that they have peacefully coexisted for several decades. In fact, the first bar code patents were issued in 1952 just a few years after the British used radar-activated transmitters, a system similar to modern RFID, to identify friendly planes from German aircraft during WW II. And, while bar coding was finally gaining commercial traction in the 1980s, RFID scientists were busy developing automated highway toll collection systems.

On closer examination, it becomes clear that bar coding and RFID are not so much cross-generational rivals as brothers in arms helping to manage the increasingly complex information tracking demands of today's healthcare environment. It's true that bar coding's lower cost and straightforward implementation makes it ideally suited for a variety of healthcare auto-identification applications, however, RFID's flexibility when implemented at the correct frequency and wattage to coexist with medical devices makes it a reliable option for processes such as asset and patient tracking. Therefore, before pursuing auto-identification projects, healthcare organizations should evaluate the benefits of employing a combination of both.

The Bar Coding Value Proposition

Bar coding systems tend to cost less to implement and maintain than RFID systems. And in the case of applications such as medication administration and specimen collection, RFID improves very little on bar coding systems' capabilities.

Let's consider medication administration at the point of care. The clinician must confirm "the five rights:" patient, drug, dose, route and time. This typically involves scanning the caregiver's ID badge, the patient's wristband and then the medication. Whether the clinician uses a bar code system or RFID, he or she must walk through the identical sequence of steps.

In fact, RFID may offer limited efficiency gains in this scenario. RFID's ability to generate simultaneous tag counts of multiple items in a particular area is generally an advantage. However, in close quarters, when identifying unit-dose medications at the point of care, an RFID reader will be able to confirm the number of medications that are in the room, but it will not be able to verify the specific location of each medication without being very close to the reader or being surrounded by an antenna that would not fit into a standard medication administration process. As a result, a line-of-sight check is essentially still required.

Also, while the price of RFID chips is rapidly declining, the economics of auto-identification dictate that bar codes are likely to remain the technology of choice for applications involving high volumes, such as patient identification and medication labeling.

In hospital pharmacies, for example, many medications still arrive without a bar code, and repackaging and labeling is a large-scale undertaking. For this and related pharmacy processes, bar coding and automated dispensing equipment work together to produce on-demand, unit-dose bar codes that are legible, secure and cost-effective.

When it comes to patient safety, bar coding systems remain difficult to beat in terms of cost-to-results ratio. In fact, a study conducted by the U.S. Department of Veterans Affairs concluded that bar code medication administration reduced the incidence of medication errors by 86.2 percent. For the foreseeable future, bar codes will remain a strong option for medication safety and may be just as suitable for laboratory specimen tracking, medical record indexing and radiology film tracking and employee identification.

The Potential of RFID

On the one hand, RFID systems are relatively expensive. In addition to the cost of RFID tags and readers, organizations may also need to budget for upgrading wireless infrastructures and purchasing the right middleware, as well as for the costs associated with re-engineering business processes.

On the other hand, the potential upside of RFID is huge. Because of its ability to read information at long distances, active RFID has proven very useful as a way of tracking high-value objects such as IV pumps, wheelchairs, heart monitors, defibrillators and other mobile medical equipment. RFID is also carving out a niche as a method of tracking patients. This includes monitoring elderly patients, protecting mothers and babies in maternity wards, and tagging surgical patients to ensure the right procedure is performed on the right person at the right time.

Although bar codes make more sense for bedside medication administration, RFID is emerging as a method for protecting pharmaceutical supply chains. The FDA Anti-Counterfeiting Task Force has strongly suggested the use of RFID to safeguard against pharmaceutical counterfeiting. RFID's utility for track and trace "e-pedigree" measures is enhanced by its ability to serialize individual delivery units and to read sealed totes full of mixed objects.

The complexity of RFID systems presents a challenge to many healthcare organizations as few hospital IT departments are experienced in deploying, testing and optimizing RFID. This is changing as the associated costs continue to fall and organizations realize the potential gains, but recent studies have raised some important considerations that hospitals should keep in mind. One study published in the Journal of the American Medical Association demonstrated that some RFID readers can, in certain situations, interfere with medical equipment typically used in critical care settings. By understanding the environment in which RFID equipment will be deployed, and properly integrating equipment according to established regulations and standards, healthcare facilities can make great strides toward realizing the efficiency and safety gains that result from the use of RFID.

Looking Ahead

An increasing number of healthcare providers are using RFID to complement their existing bar coding systems. For example, medication may be dispensed from an RFID-enabled cabinet where an RFID chip reads what was taken and then updates the inventory, while the bar-coded medication label is scanned by the nurse to ensure safe medication administration at the bedside.

One example of an organization that's using both technologies is St. Vincent's Hospital in Birmingham, Ala. They use bar coding for their "closed-loop" medication management integration initiative and RFID technology to monitor the locations of surgical instruments, as well as sterilizations, maintenance records and other variables, such as purchase dates, descriptions, and costs and utilization data for individual items.

It is likely that the two technologies will peacefully coexist for some time. While bar coding is entrenched and growing, RFID will undoubtedly gain momentum in certain targeted areas, as evidenced in the results of the 19th Annual HIMS S Leadership Survey.

When respondents were asked to identify the healthcare application areas they considered most important over the next two years, 30 percent selected closed-loop medication management utilizing either bar coding or RFID technology. When asked to identify the areas in which they anticipated their organizations would implement technology in the next two years, 43 percent indicated RFID technology and 35 percent specified bar code technology. It appears that these "peer" technologies are going to be around for a while, continuing to help hospitals maximize their benefits in terms of time savings, accuracy and patient safety.

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Cristina De Martini is global practice leader, heahhcare, at

Zebra Technologies and a member of the HIMSS Auto-ID Task

Force. Contact her at cdemartini@zebra.com.