1. A Review of Automatic Patient Identification Options for Public Health Care Centers with Restricted Budgets

2. Abstract A comparative review is presented of suitable automatic identification systems based on graphic codes, both one-(1D) and two- dimensional (2D), printed on labels, as well as those based on radio frequency identification (RFID) tags. The results suggest that affordable automatic patient identification systems can be easily and inexpensively implemented using 2D code printed on low cost bracelet labels, which can then be read and automatically decoded by ordinary mobile smart phones.

3. Automated patient identification system Avoid the error of manual identification A speedy access to clinical information Remote instant access and management of patient medical history (EHR: "Electronic Health Record") Security and confidentiality of the medical data to be handled

4. Assessment of available technology The assessment of available technologies was undertaken in the context of its possible deployment by a municipal public health agency that operates a network of local clinics in restricted budget A very effective alternative to the dedicated ID tag reader for scarcely budgeted public health care centers is offered by the ubiquitous mobile smart phone.

5. One-Dimensional Graphic Codes Graphical encoding uses a combination of black and white parallel and adjacent areas of different thickness Automatically decoded by a special reading devices Codes are not descriptive, but store a reference code associated with a database containing relevant information

6. Structure of 1D codes the code begins with a "start character" ends with an "end character," Two "quiet zones," at least ¼ inch long a control digit, or "checksum,"

7. Types of 1D code UPC (Universal Product Code) EAN (European Article Numbering) Code 39 Code 128 Interleaved 2 of 5 Characteristics of 1D Code Advantage: – Fast data capture. – Reliability due to the very low level of errors in the capture and decoding of data. – Immediate integration of the decoded data into the system or database. – Low cost of printing the codes. Disadvantage: – low storage capacity of approximately 20 to 30 digits

8. Current application of 1D Code Inventory control. Tracking of moving objects such as cars, baggage, mail, packages, medicines, laboratory test samples, etc. Access control to transportation, open-air events, buildings, offices, theaters, etc. PPI in Hospitals.

9. Use in health care To control the hospitalized patients medication process, blood transfusions, and in laboratory tests (blood, urine, etc.) to identify the test/patient pair. Houstons "Methodist Hospital System," one of the largest in the state of Texas (USA), uses a patient data electronic verification system, designated KBMA, based on the reading of bar codes. It is connected online to the medical documentation system "MethOD" (medical records database)

10. Two-Dimensional Graphic Codes Two-dimensional codes are in general capable of storing alphanumeric characters including letters, numbers and punctuation & Non- alphanumeric characters, such as Kanji. The way to store information is to represent it two-dimensionally by means of planar distributed graphic patterns (dots, squares, circles, triangles, hexagons, etc.). The two-dimensionality of these codes allows a greater data storage density than is possible with traditional 1-D bar codes.

11. Historic evolution of graphic code

12. Comparison of relevant characteristics of three 2D code types

13. Illustrative examples of 2D code use in health care Health care centers in Japan, Singapore and Hong Kong, have implemented a system known as UPI (Unique Patient Identification) Addenbrooke's Hospital in Cambridge uses 2D codes as part of its patient safety policy. A bracelet on which a 2D code is printed, in addition to other basic personal data, is attached on each patients wrist. An update of Houstons Methodist Hospital KBMA 1D code-based ID system has been proposed, consisting of migrating its old 1D code-based patient identification to a 2D code-based system

14. Some relevant characteristics of 2D code Special programs to read and decode, that run in camera-equipped mobile smart phones 2D codes can be very easily generated and printed on a variety of paper or plastic labels, or on any other surface, without the use of specialized equipment. 2D code requires close proximity of the reader device to the patients bracelet to capture the code.

15. General applications of 2D code Boarding passes in transportation. Advertising in newspapers, magazines, posters and billboards. Inventory management. Tickets for public events. Personal contact cards. Health services. (patients bracelets, medical equipment, laboratory samples and drugs, administration of medicines, medical procedures, and tracking of internal and external transfer of patients )

16. Radio Frequency Identifiers Radio Frequency Identification (RFID) technology can automatically identify people and objects in the healthcare environment by placing identifier RFID tags on the subjects and then remotely reading them using a specialized reader devices.

17. Four Elements of RFID Label (tag) Reader or coupler Transmitting antenna Database or computer system

18. Some applications of RFID Access control. Inventory Management. Baggage identification and screening. Industrial production chains. Library book input and output. Identification and location of animals. Healthcare.

19. Illustrative examples of RFID use in health care Taichung Hospital in Taiwan implemented an RFID-based system, integrated with the Hospital Information System (HIS), to improve the efficiency of patient safety during the medication process of hospitalized patients. The Orthopaedic Institute of Palm Beach, Florida, put into operation a system known as "SurgiChip" that uses RFID patient identification to help prevent surgical errors

20. Types of RFID tags Active Passive Semi passive

21. Operating Frequencies The operating frequency defines – the speed of data transfer – the range is also affected A large capture range facilitates the unintentional acquisition of signals originating from nearby sources other than the subjects bracelet, leading to possible failed or incorrect identification. Passive tags commonly operate at frequencies such as 128kHz, 13.6MHz, 915MHz and 2.5GHz

22. Some relevant characteristics of RFID RFID tags can store an amount of information in general larger than any graphic code Does not require the existence of a short line of sight link between the tag and the reader, as graphic codes require. The single main disadvantage, with respect to graphic code technology, that persists today for the use of RFID technology in patient identification applications is its relatively higher cost.

23. Near Field communication tags An emerging technology closely related to RFID is Near Field Communication (NFC). NFC is a wireless connectivity technology that uses magnetic field induction to establish a communication link between electronic devices placed in close proximity to each other. The use of NFC tags in conjunction with NFC-enabled mobile phones could be an attractive technology for unambiguous and secure automatic patient identification

24. Comparison of three technologies Features1D Codes2D CodesRFID Encoding Method:Printed variable- width parallel bars. Printed two- dimensional geometric patterns. Radio Frequency tag. Type of decoder:Dedicated optical scanner. Camera- equipped smart phone or PDA, dedicated scanner. Special dedicated RF reader device. Stored data:Reference number.Descriptive (general data, web links, contacts, etc) Unique identification number (UIN) Type of data:Numeric, alphanumeric, ASCII, control Numeric, alphanumeric, binary, Kanji. Numeric, alphanumeric, binary. Data Security / Error Correction Method: Although optional in some types, most use Checksum. Reed-Solomon coding: adds redundancy. Partially corrupted code can be read. No inherent error correction, but frequently include error correction codes

25. Comparison of three technologies Features1D Codes2D CodesRFID Capacity (characters): Up to 30Numeric: 138 to 7089 Alphanumeric: 93 to 4296 Binary: 1556 to 2953 Kanji: 778 to 1817. From 512 bits to 512 kBytes. Active tags have greater capacity than passive ones. Advantages:- High speed data capture. - Reliability. - Integration with database. - Easily printed low-cost labels. - Short range*. - High storage capacity, small size. - Stores diverse kinds of data. - Easily printed low-cost labels. - Inherent error correction. - Smart phone readable. - High-storage capacity. - Read and write allowed. - Can be automatically scanned. - Can act as biosensor. Disadvantages:- Low-storage capacity. - Limitations on the types of data they can store. - Must be manually scanned. - Long range*. - Complex use and set up. -needs special tags and dedicated readers. -Security issues.

26. QR Code QR code-based applications intended for the healthcare sector are constantly increasing. The distinct characteristics of QR code-based technology: – high data storage capacity, – low implementation cost, – technical simplicity, – widespread use, and – the ample availability of free programs for reading and decoding it by camera-equipped smart phones – low budget applications – printing in smaller areas or sizes – fast reading – An error correction ability to recover up to 30% of the "codeword" – A capacity to be read or tracked in any direction, and to tolerate bending distortion.

27. Cost comparison of 2D and RFID technologies

28. Conclusion of this comparative assessment The main conclusion of this comparative assessment is that the use of 2D codes, and QR codes in particular, presently embodies the best choice for setting up automatic patient identification capabilities in low- budget public health care centers. The use of QR code- based tag technology, when combined with mobile smart phones as code reading and decoding devices, seems to be the most practical and cost-effective alternative available today for automatic patient identification, as well as for quick remote health record access, by medical personnel in public health care systems with limited budgets.

29. Use of QR code in healthcare Source: http://www.gs1jp.org/2010/barcodes_identification/1_6.html

30. Use of QR code in healthcare Source: http://www.gs1jp.org/2010/barcodes_identification/1_6.html

31. The Patient Safety Education Program poster Common patient safety issues: Insisting on proper hand hygiene from your caregiver Preventing an infection when youre having surgery Preventing a blood stream infection Preventing medication errors Preventing an infection when you have a urinary catheter Preventing errors during medical care Preventing patient falls Safety when your loved one is on a ventilator Patients Guide to a Clean Healthcare Environment Source: http://healthnewstexas.com/5715/quick-response-code- enabled-patient-safety-education-program-launched/

32. QR code generator

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