Why did 2005 safety goals omit bar coding?

New autoidentification systems are on the horizon

The finalized 2005 National Patient Safety Goals of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) bore a close resemblance to the proposed goals announced earlier, with one notable exception: The elimination of the bar-coding requirement. This was in large part due to feedback received from health care organizations during the field review for the goals being considered, according to Paul Schyve, MD, senior vice president at the Joint Commission.

The main objection to bar coding: New and emerging technologies likely will be more efficient and effective than bar coding. As a result, the Sentinel Event Advisory Group did not include the bar-code requirement in the 2005 Goals it recommended to the Board of Commissioners.

This year was the first time feedback was solicited before the goals were finalized. The purpose was to get information from the field about specific technical issues and possible barriers to implementation, as well as to get an idea of where the goals fall in organizations’ lists of priorities, Schyve says.

"The information that came back to us told us that bar coding was a good goal and a worthwhile idea, but there were some technical issues around its implementation at this point that led people to suggest that maybe it wasn’t yet ready for that small list of priorities for 2005," he explains.

Bar coding may soon be rendered obsolete

The main concern was the idea that bar coding soon might be replaced by up-and-coming autoidentification technologies, such as radio frequency identification. "The concern was that if this suddenly became a requirement for accredited organizations, they would invest in bar coding, which is not cheap to put into place. Then, a couple of years later, they’ll find out they would be better off with new technology, but they’ll lack the resources to quickly replace the bar-coding technology," says Schyve.

Cost was a significant worry, especially for smaller organizations, Schyve says. "It is not an inexpensive technology to replace, even for a larger organization, but obviously it becomes more of an issue for smaller organizations," he says. "The concern was that this will be a relatively big investment, and it would be a shame to make that investment only to learn a couple of years later that it has been superseded by a different technology."

One organization argued that this would result in health care being a generation behind other industries in terms of use of technology, Schyve says.

After these concerns were shared with the Sentinel Event Advisory Group, a decision was made to get more information on potential problems with implementation of bar-coding systems and to learn more about alternatives for autoidentification.

But since there was a general consensus that autoidentification systems improve safety, why not simply require organizations to implement a system of their choosing instead of specifying bar coding? "If that were to be made a goal, then at the same time, the JCAHO needs to be able to tell the field about the advantages and disadvantages of the different options," says Schyve. "While people would have their own choices, they would need something more from the JCAHO than just go do this autoidentification thing.’"

Many organizations have not yet taken any definite steps toward implementation of autoidentification systems, Schyve says. "It is clear from the feedback we received that there are those who had not really thought about this and did not know what the technology might provide," he says.

To address this, a Sentinel Event Alert will be issued sometime next year to provide information on the benefits of autoidentification and the different options currently available, Schyve says. "There is little doubt in my mind that sooner or later, most health care organizations will be using an autoidentification system of some sort," he says.

There are a number of advantages in addition to the patient safety aspect, says Schyve. "Wal-Mart, for example, uses it because it’s one of the most effective ways for them to track what is going on in their organization and helps with efficiency," he says. "This is a technology that people will be increasingly focused on. It certainly will continue to be a focus of discussion by the Sentinel Event Advisory Group. Within that context, it may or may not become a National Patient Safety Goal in a future year."