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Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer, NCHCD, St James’s Hospital GS1 GSMP Event 9 th October Dublin

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Page 1: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Using GS1 Barcodes and an ElectronicPatient Record to deliver Patient

Safety

Evelyn Singleton, HaemovigilanceOfficer, NCHCD, St James’s Hospital

GS1 GSMP Event 9th OctoberDublin

Page 2: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Agenda• Background to NCHCD and Haemophilia• Combining an EPR, Cold Chain Delivery service and

GS1 barcodes to improve patient safety and increase efficiency

• Exploiting smartphone technology - allowing patients to scan their medication within the home

• Outcomes/ROI• Conclusion

Page 3: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

What is Haemophilia and why is Medication traceability important?• Haemophilia is a Chronic Disease, it is a bleeding disorder caused

by a deficiency of a clotting factor

• Incidence of 1:5,000 – 1:10,000 live male births

• The treatment of haemophilia involves the replacement of the clotting factor (previously prepared from pooled plasma) using a concentrated preparation “Clotting Factor Concentrate” (CFC)

• Patients required to self treat at home

• Lack of prompt response can lead to prolonged hospitalisation, decreased quality of life and misuse or wastage of expensive plasma and recombinant products

Page 4: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,
Page 5: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

National Centre for Hereditary Coagulation Disorders (NCHCD)

• Located at St James’s Hospital, Dublin, Ireland• Manages patients with inherited and acquired

bleeding disorders• Approximately 2000 patients with Haemophilia• Approximately 200 patients with severe

haemophilia (require intensive care/treatment)• Over 75% Patients with severe Haemophilia

self medicate at home

Page 6: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Business CaseCatastrophic Event

Failure of Supply Chain-Infection of patients with Hepatitis C and HIV

due to contaminated blood products. Infected medication remained in the supply chain after recall - leading to

subsequent infection and over 80 deaths

Page 7: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Issues

Non AvailabilityNon validated delivery

No Product barcode

Incomplete data

Incomplete/retrospective treatment information

Wastage/ ineffective Medication

Increased Risk

Page 8: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Lindsay Report 2001Main Recommendations

– Improve communication between treatment centres

– Accurate product tracing

– Enact a validated product recall

Page 9: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Haemophilia EPR

Validated cold chain delivery

Unique GS1 barcoding

Home/Hospitaltracking

validation

The solutions

Comprehensive integrated care

EncryptedMessaging

Page 10: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Multi location EPR (Electronic Patient Record) deployment

Regional Haemophilia Centres

National Haemophilia

Center

Care providerHome access

Page 11: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Key Features of Haemophilia EPR

• Appointment scheduling• Haemophilia specific information capture and

display• Electronic patient Chart• Patient visit tracking by event• International standards support (ICD 10)• Interface with hospital and laboratory systems• GS1 Number generation embedded in the

software• Referral letter scanning• Link to patient ID card printing system

Page 12: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Medication delivery -Where we were

Page 13: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Redesign the Supply Chain

ManufacturerMedicationCold

Chain Supplier

Hospital

Patient Home Patient

Page 14: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Manufacturer Cold Chain

Supplier

Hospital

Patient Home

Patient

Medication

Page 15: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Piece missing!

Manufacturer

Cold Chain

Supplier

Hospital

Patient Home

Patient

Medication

Page 16: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Manufacturer

Cold Chain

Supplier

Hospital

Patient Home

Patient

Medication

Page 17: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Manufacturer

Cold Chain

Supplier

Hospital

Patient Home

Patient

Medication

Page 18: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

The Final Piece!

Manufacturer

Cold Chain

Supplier

Hospital

Patient Home

GS1 Barcodes

Patient

Medication

Page 19: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Solution – Adopt the Retail Track and Trace Model based on GS1 Standards

• Unique identification (barcode) of patient -PMGSRN

• Unique identification (barcode) of medication -Serialised GTIN (+Lot + Expiry)

• Unique identification (barcode) of locations (Hospital/Home/Pharmacy/Transport) –

GLN

Page 20: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Previous Barcode (2 Linear)

ID Formats

Hospital allocated Datamatrix barcodes

Product Name

(GTIN)

Batch Number

Expiry Date

Serial NumberManufacturer allocated barcode

Page 21: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Solution for tracking and tracing products within the Hospital

Bar coded CFC is delivered to the Hospital

by TCP Stock Fridge (GLN)

Issue Fridges (GLN)

Hospital (GLN)

Prepare product (GTIN)

Check Product V Patient and issue

Patient receives CFC

Page 22: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,
Page 23: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,
Page 24: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,
Page 25: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,
Page 26: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,
Page 27: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Recall Reports

Page 28: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Recall Reports

Page 29: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Patient scans product. Verification received from EPR

Data sent to the EPR and stock management system with product usage information

Delivery to the home and “In home” usage

Cold Chain Supplier verifies Order at dispatch - recording batch and expiry dates -GLNs, GTIN

Cold Chain Supplier verifies delivery of product to Patient - recording batch and expiry details GLN, GTIN

Details of all movements are sent to the stock management system

Cold Chain receives home patient orders with GTIN & delivery location details GLNs

Electronic prescription

Page 30: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Outcomes (ROI) for validated Cold Chain delivery system

• Since Cold Chain delivery started all products verifiably delivered between 20-80 Celsius

• Documentation errors reduced from 12 to zeroin the year post service implementation

• Over € 5 Million worth of medication stock has been removed from the supply chain

• In 2010 € 600,000 worth of stock rotated between Hospitals and NCHCD

• Mock Recall identified location of all (100%) Medication within 10 minutes

Page 31: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Patient usage trends

Original 2004 SJH Patients Factor VIII Average Usage Per Month

696

690

675

652

630

640

650

660

670

680

690

700

2004 2005 2006 2007

Original 2004 SJH Patients Factor IX Usage

476466

418

402

360

380

400

420

440

460

480

500

2004 2005 2006 2007

Page 32: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Linking the Patient

- to the Clinical record (EPR)- to the Supply chain

Through the use of Mobile Technology and GS1 Standards

Page 33: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Smartphones with scanning App

Page 34: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

How it works

The system is designed to be simple to use but comprehensive –designed in consultation with patient focus group

Page 35: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Log-in

Secure Login by Username, Password or Scanning unique GS1 ID on Card Card

Page 36: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Patient Details

Patient detail confirmation includes product of choice

The product of choice will eventually be taken from the EPR

Page 37: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Scan ProductBarcode on Vial box is scanned to confirm •product detail•expiry date•Recall status

Page 38: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Validation – FAIL!

If incorrect product or product out of date or RECALLED, system will display a visible and audible alarm

A re-scan is required or exit is forced.

Page 39: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Validation – OK !

If the Product passes the validation checks then the user is prompted to continue.

Page 40: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Infusion DetailUser records reason for infusionSpecific bleed sites can be used to trigger e-mail alerts to the treatment centre•Head Injury•Ileopsoas Bleed•Haematuria •Haemoptysis•Haematemesis•PR Bleed

Page 41: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Infusion Authorisation

Again, the app prompts the patient to proceed.

Page 42: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Process CompleteProcess concludes, system synchronises data wirelessly to web applicationEventually data will be transmitted to

•Warehouse Management system•EPR

Page 43: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Web Application – log on

Page 44: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Patient infusion logs

Page 45: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Patient self treatment report

Page 46: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Initial Outcomes from smartphones

• Realtime recall alert• Timeliness of infusion • Prescription compliance (2000iu instead of

recommended 1750iu)• Automatic compliance (no manual record

keeping)• Electronic diary• Realtime Alerts for specific bleeds• Patient empowerment

Page 47: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Where we are

Page 48: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

Conclusions

• Healthcare must do more with less• Inefficient practices are no longer

financially or morally acceptable• Linking Supply Chain and Clinical systems

can improve patient safety and reduce cost of healthcare delivery

• The hardware, software and standards exist

• Standards are the key enabler

Page 49: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,
Page 50: Using GS1 Barcodes and an Electronic Patient Record to ......Using GS1 Barcodes and an Electronic Patient Record to deliver Patient Safety Evelyn Singleton, Haemovigilance Officer,

[email protected]@stjames.ie


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