RFID in action: Improving safety sharing data

The cost to taxpayers of inefficient procurement and duplicated processes in the NHS is a topic which is never far from the headlines. Last month (November), another report, this time from Ernst & Young, highlighted unnecessary spending by some NHS hospitals due to significant purchasing discrepancies.

Of course, this is an important issue that continues to need addressing, but what this report and others often fail to fully recognise is the significant progress already being achieved by some NHS hospitals to improve efficiency and reduce costs.

One of the ways in which Trusts are effecting change is through global standards for bar codes and Radio Frequency Identification (RFID) tags, which help hospitals to identify, capture, and share patient and product information automatically, improving safety and supply chain efficiency. In so doing, they can also make considerable financial savings.

Supply chain benefits
There are multiple ways in which global standards can improve patient safety. Bar codes and RFID tags can help reduce errors by matching the right patient to the right treatment and can also be used to track medication and ensure that patients receive the right dose at the right time. 

Patient safety is also protected by preventing counterfeit medication entering the hospital by identifying and tracing them in the supply chain effectively. Patients can also be protected from harmful medication by accurate identification of products, which can improve the efficiency of recalls and withdrawals. Accurate product data can also reduce data errors on patient and inventory records.

The knock-on benefits in reducing costs by ensuring a fully efficient supply chain are no less impressive. Paperwork and manual processing can be reduced, enabling staff to spend more time caring for patients – which is always a high priority for Trusts. Knowing exactly what you have and where it is sounds straightforward, but in an organisation the size of an NHS Trust or even a hospital when using manual systems, it isn’t. By replenishing stocks automatically, the need for manual ordering and counting is removed, while greater data integrity means new assets are only bought when they are needed, delivering cost savings and improving efficiency. These savings can then be reinvested into further improving patient care – the ultimate ambition of every healthcare manager.

Leeds stocks up
Many NHS hospitals have already successfully implemented GS1 standards. One of these is Leeds Teaching Hospitals NHS Trust – one of the largest Trusts in the UK and including St James’s University Hospital, the largest teaching hospital in Europe. It employs around 14,000 staff across six main hospital sites, treating over a million patients every year with a budget of around £930 million.

The Trust has been at the forefront of implementing GS1 bar coding and RFID technology to improve patient safety and efficiency. It has used GS1 standards to develop an automated stock control and forecasting system that employs bar code scanning at point of use to reduce unnecessary stock holding levels by £570,000 in one department over three years. The Trust has also successfully piloted RFID technology to track and trace its orthopaedic loan kits, containing vital hip and knee joints. The pilot showed the system provided better information to staff and suppliers, reduced administration and improved efficiency. Leeds has also adopted GS1 Global Location Numbers (GLNs) to ensure the correct stock is delivered and invoiced to the right location, cutting wasted stock, improving stock visibility and driving efficiency savings.

When it comes to ordering and delivery of stock, many NHS Trusts face the same problem – there’s no standard way of identifying delivery locations and costs are often allocated to the wrong department or cost code due to poor-quality data. The problem is magnified as Trusts have hundreds of delivery and stocking points across different departments and hospitals. Yet hospital staff need to be able to communicate accurate product and location information with their suppliers, as well as various departments within their own Trust. This is essential to ensure that the supplier knows where the order needs to be delivered within the hospital and the finance department knows which cost code to allocate to the order purchased.

Due to a lack of standards for identifying locations in hospitals, orders are very often delivered to the wrong delivery point or go missing. Poor data quality in the ordering system also affects the Trust’s finance function which requires an accurate cost code to be matched to each order. Staff at Leeds previously manually charged orders to cost codes which was prone to errors and resulted in the wrong departments being charged for the order. Fixing these errors often involves time-consuming and complex investigative processes which costs the hospital vital resources.

Global Location Numbers
At Leeds, GS1 Global Location Numbers (GLNs) are used to identify physical locations such as the supplies department reception, theatre store or ward reception. The GLNs are allocated and maintained by the Trust’s supplies department. The full list of GLNs which includes the unique number, location address and description is sent electronically to distributors together with the corresponding cost codes. Any updates to the list are sent daily via email.

Hospital staff can order stock electronically using the Trust’s inventory stock replenishment system which is linked up to suppliers’ systems. Staff can also top up their stock using handheld bar code scanners which are linked to Leeds’ electronic ordering system. This ensures that only scanned products are ordered, avoiding any potential manual keying-in errors. More than 94 per cent of the Trust’s orders are made electronically, with GLNs ensuring the order location and cost code are identified and recorded automatically by the ordering and finance systems.

By using the GLN and associated information, suppliers receiving the order electronically now know where to deliver the stock and who to invoice. A printed bar code label containing the GLN is also included on the order’s roll cage, tote or box. The Trust’s supplies team is able to keep an accurate and up-to-date record of all the stock ordered and delivered to each department or ward. Using GLNs which are matched to the hospital’s cost codes has also benefitted the Finance team which can now accurately match suppliers’ invoices to the electronic order. As well as ensuring the right department is charged for the right stock, this has improved the Trust’s data quality and reduced the number of costly invoice disputes and investigations. Receipting invoice disputes with one of the Trust’s main suppliers have been reduced from 20 per cent to less than 2 per cent since implementing GLNs, generating significant cost savings.

Tracking medical records
The flow of medical records can be complex as patients move between wards and clinics and several people handle a record. It is compounded by the fact that hospitals may operate multiple permanent storage facilities, on-site and off-site, as well as a large number of temporary storage areas including wards, secretaries’ offices and clinics.

Tracking medical records manually creates several opportunities for them to go missing (defined as the physical location no longer matching the system location), which can cause confusion and wastes staff time.

This is one application of many where RFID can be effective. RFID uses radio waves to transmit a unique identification number into a product or person for identification and tracking purposes. By using Electronic Product Codes in RFID tags, it is possible to identify anything – from an individual item, to a case of products, to a transportation container. This enables organisations to save money through improved efficiency, effective tracking of assets and reducing the amount of inaccurate data being shared.

RFID enabled records management
The Royal Bolton Hospital is one of the busiest hospitals in north-west England for emergency admissions, and its medical records department manages almost 450,000 records in a main library facility with an off-site location for older records. The Hospital has been investigating how RFID can be used to improve the efficiency of the medical records department and the management of files in order to drive cost and operational benefits. At the request of the Department of Health, GS1 UK carried out an independent review in order to identify the areas within the current management system that would benefit from RFID technology and determine what these benefits are.

In common with other large NHS hospitals, the flow of medical records in the Royal Bolton can be complex as patients move between wards and clinics and several people handle a record. The current manual tracking process creates several opportunities for records to ‘go missing’ (the physical location no longer matches the system location).

Review findings
GS1 UK’s review found that: Records are passed between areas and in emergency situations or at times of high pressure on resources, the movement happens without the event being tracked on the system, which creates confusion as to their current location and wastes staff’s time; when files have moved without the event being recorded, knowledge of the workings of the hospital is required to locate files in many cases – a great challenge for new staff; Manual processes create opportunities for files to be placed in the wrong location; With the number of files and their compactness, there is a risk that thin files can be placed in larger files or that they can be missed when looking for the record; Non medical records staff, without the necessary training, have controlled access the files to insert letters etc, which increases the possibility of files being misplaced and not being tracked properly. Finally, when files are outside of the medical records department their management varies considerably – often there is limited or no system for tracking files.

By switching to an RFID enabled medical records management system, major efficiencies can be realised. The process is quite simple and involves attaching a small RFID tag, carrying a document identifier which uniquely and accurately corresponds with a record on the Patient Administration System, to each physical medical record. Fixed RFID readers at key locations in the hospital can then be used to automatically track the movement of files. Additionally, hand held readers can be used to “sweep” an office or an aisle in the library in order to exactly pin down and locate a file.

By replacing manual processing of returned records with an automated system, the departments could save £22,600 per annum and automated location tracking throughout the hospital could save a further £25,000 per annum. Greater visibility of file locations has additional benefits. Clerks can plan their routes around the hospital more efficiently and manual tracking can be removed entirely from certain locations, such as receiving files back into the library. This will save £19,000 per annum.

Reducing consultation risk
RFID also reduces the chances of notes not being available for a patient clinic visit, or not being located in timely fashion for an emergency or unplanned visit while safety risks attached to consultations without compete case notes are also reduced.

The conclusions of the review provide an illustration of the transformative effects that RFID can have. After studying the current process, it is anticipated that switching to an RFID enabled medical records management system will cut time spent looking for misfiles by 80 per cent, saving £38,300 a year. In addition, the average time taken to locate a missing file will be reduced by 92 per cent, saving £20,500 a year. By cutting the time to find misfiles and missing files, lost revenue due to coding time outs will be cut by 64 per cent, saving £230,000 every year.

Conclusion
GS1 standards are already at the heart of Department of Health Guidelines for maintaining complete and accurate medical records, as well as many other individual hospital initiatives, and we will continue to work with the Department on its new bar coding system for clinical products and management of goods and assets across the NHS supply chain.

Further information
www.gs1uk.org