April 22, 2004
A proposal that would require accredited hospitals and other health care providers to have bar code scanning systems in place by 2007 has drawn praise from some in the health care community, who say the move is a bold step for patient care, but worry that the deadline could be too ambitious for providers to meet.
Under the Joint Commission on Accreditation of Health Care Organizations' potential 2005 National Patient Safety Goals and Requirements, accredited organizations, which include hospitals, physicians' offices, long-term care facilities and other health care providers, would be required to implement bar code technology to help identify patients and match them to their medications or other treatments by January 2007. Hospitals must meet JCAHO's patient safety goals to be accredited by the organization. The proposal is up for comment until April 30. JCAHO's Board of Commissioners is expected to adopt some of the measures this summer based on the feedback it receives.
Hospitals have been slow to adopt bar code scanning systems partly because most drugs did not come with bar codes on them. The FDA recently mandated that bar codes be placed on all medications dispensed in hospitals within two years. But the agency didn't have the authority to make hospitals install bar code readers to scan the drugs. If approved, the JCAHO's move could go a long way toward spurring bar code technology adoption in health care.
"This was a courageous move that took true leadership," said Scott Wallace, president of the National Alliance for Health Information Technology.
Mark Neuenschwander, a pharmacy automation consultant, said JCAHO's move caught many off guard.
"None of us expected that it would happen so quickly, if it ever happened," he said.
Neuenschwander recently published a report that predicted 80% of hospitals would be using bedside bar coding by 2010. Currently, about 5% have the technology, he estimates. Bar coding vendors are "elated" about the proposal, he said, but that not all would be capable of providing the technology in time to meet the deadline.
Hospitals also might not have the finances to install the technology on such an ambitious time schedule, he said. NAHIT's Wallace echoed those sentiments, saying 2007 could be too soon for hospitals to adopt bar coding. "The issue is not desire. The issue is means," Wallace said. He also questioned whether the goal would apply to all hospitals, especially rural or safety-net hospitals where budgets are especially thin.
Michael Cohen, president of the Institute for Safe Medication Practices and a member of JCAHO's Sentinel Event Advisory Group that helped craft the proposal, said the deadline for implementation is not as important as the intent behind the goal. Cohen, who said his group did not specifically recommend the 2007 deadline, predicted that there would be push-back from hospitals on the date. But he said the proposal could act as a catalyst that would get hospitals to take a serious look at bar coding.
"We have to be addressing medication errors and other types of errors in hospitals," he said. "This is a technology that can work."
Will Bar Coding Equal Safety?
While many hospitals have been working to improve medication safety and are interested in adopting bar code scanning technology, not all agree that bar coding is the best way to improve safety, said Nancy Foster, senior association director of policy at the American Hospital Association. She said the AHA is in the process of gathering comments from its members, but would probably recommend that JCAHO craft a proposal that encourages medication safety without mandating bar code scanning technology.
However, some in the industry maintain that bar coding is a necessary step to reduce medication errors. The Central Arkansas Veterans Healthcare System recently announced that it had cut drug errors by 40% since 1999 with a bar coded medication system. Oftentimes, bedside bar coding provides one of the last opportunities to catch mistakes, said Denean Rivera, president of bar code system vendor Bridge Medical, who called JCAHO's plan "aggressive but doable."
Bar coding also could be easier to implement than another technology with the potential to reduce errors — computerized order entry. "The tide is shifting from all the focus on CPOE to a lot of focus on the bedside," Neuenschwander said. "We're starting to hear statements like, 'CPOE is too difficult, but bar coding is easy.'" He questioned whether JCAHO's move might cause the Leapfrog Group, which mandates CPOE in hospitals as part of its patient safety standards, to include bar coding as one of its standards and potentially drop CPOE as a requirement.
That, however, seems unlikely. Leapfrog Group Executive Director Suzanne Delbanco said that while bar coding is an important part of automating the medication process, research suggests that most medication errors are made at the time they are ordered. In theory, CPOE would catch mistakes in the ordering process — before a clinician administers a drug.
"We welcome initiatives that help improve the quality and safety of hospitals. But CPOE will remain a fundamental part of Leapfrog recommended quality practices as it is proven to prevent medication errors and save lives," Delbanco said.
