1. Barcoding: The solution to “it takes too much time?”
Jan Bloom, MS, Immunization Section, Community and Public Health Division, Wyoming Department of Health
Danielle Reader-Jolley, MHS, Scientific Technologies Corporation
National Immunization Conference
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2. Assessed Issues
Direct data entry into IIS is a real and perceived barrier to private provider participation
Analyze the most labor intensive direct data entry tasks for private providers’ IIS use
What’s real
What’s perceived
Where is the “win win” (no double-data entry)
Use current technology
No additional provider cost

3. Assessed Issues
2. Mass immunization events demand rapid patient management and accurate counts of available inventory
Analyze the mass immunization pathway
Patient
Staff
Program manager

4. Private Providers

5. Private Providers – Issues
Searching for Patients
Requires logging into another application (IIS)
Another UN / Password
Leave provider’s application and open another screen
Search criteria may not be the same as they use in their own system
If patient not found, need to enter new patient into the IIS
Entering immunizations
Duplicate data entry if already entering into an Electronic Health Record (EHR)
Entering vaccination encounter data
Set up inventory in IIS in order to pre-populate vaccine manufacturer, lot number and expiration date.
Enter vaccinator

6. Private Providers – Perceptions
Time demand on already overtaxed staff does not outweigh the benefit of entering data into the IIS
Meaningful use will take “care” of participating in an IIS
Entering data into the IIS is Public Health’s job

7. Mass Immunization Events

8. Mass Immunization Events
Goal: Immunize people who present and are due for vaccinations
Pathway Analysis
Patient Pathway
Registration
Bottleneck
Immunization Assessment Check Point
Waiting Queue
Vaccine Administration
Vaccine Documentation
Patient Discharge / Follow up immunization instructions

9. Mass Immunization Events
Staff Pathway
Sign in patients on arrival
Assess patient’s need for vaccination
Preparation of vaccine for administration
Administer vaccine
Document vaccination in IIS
Typically, vaccinator does not do direct data entry
Data entry frequently not completed prior to patient discharge

10. Mass Immunization Events
Event Manager Pathway
Manage patient flow
Manage staffing levels and placement
Manage vaccine availability
Vaccines on hand are always an estimate
Ensure vaccines are accounted for (lot number, site/route)

11. The Solution

12. Reasons for Bar Coding Minimal time to secure data
Data is stored in both 1D and 2D bar codes
Easy to generate own 1D bar codes from IIS
Inexpensive tool
Tethered
Untethered
Works with most models of computers
Minimal to no training time required
Proven technology in other industries

13. 1D Barcodes 1 Dimensional
Stores a smaller amount of data, usually up to 12 or 20 digits.
Inexpensive software can generate 1D barcodes

14. 2D Barcodes 2 Dimensional
Stores up to 1,800 printable ASCII characters
Used on Driver’s Licenses
First and Last Name
License number (or ID number if non-driver)
License classification code
License restriction code
Date of Birth
Gender
Height and Weight
Eye color
Address
City / State / Zip Code
License Issuance and Expiration date

15. Bar Code Scanners “Reads” data stored in Bar Code formats
Converts bar codes into electrical pulses
Software converts electrical pulses into readable text
Keyboard wedge or USB output does not require collection software
Dumps data into the PC application
Various Models
Tethered directly to PC – Price range $
Remote – Price range $600-1,000

16. Applying the Solution

17. Wyoming Solution Private Provider and Mass Immunization Events
Search the Wyoming Immunization Registry (WyIR) for immunization data using 2D bar code on reverse of driver’s license
Create patient record in WyIR if no record currently exists
Generate 1D bar codes for:
Vaccine Lot number
Vaccine Manufacturer Name
Site
Route

18. Wyoming Solution Mass Immunization Event
Rescan at check points – time stamp
Assign patients to Waiting Room status
Conducted pilot project clinics with three providers in March 2011:
Sheridan County Public Health Nursing (local health department)
Cheyenne Health and Wellness (Federally Qualified Health Center)
Midwest Clinic (private provider)

19. New Wyoming Driver’s License
Contains 1D (driver’s license number only) and 2D barcodes (demographic data).

20. Sheridan County Public Health Nursing, Sheridan, WY
The previous version of the Wyoming driver’s license contained only a 2-D barcode.

21. Sheridan County Public Health Nursing, Sheridan, WY
When an individual arrives at the office to receive an immunization, the driver’s license holder will present her driver’s license to the administrative staff, who will then use a bar code scanner to conduct a search or populate a record for the patient in the Wyoming Immunization Registry (WyIR).

22. Barcode scanner in ACTION!

23. Testimonial:
“I like that the scanners improve my data entry time tremendously. The data entry is done by the time the [patient] sic has read and signed the consent.”
Amanda Brinkman, L.P.N.
Outreach Coordinator
Cheyenne Health and Wellness Center
(Federally Qualified Health Center)

24. Testimonial:
“I see this technology benefitting our office by giving us a jump-start on the inevitable: integration of electronic health records. I also envision this technology reducing the time spent entering vaccines as well as fewer errors in entering vaccines.”
“The bar code scanner for entry is quick and relatively easy to use once you are accustomed to it.”
“The waiting room functionality worked really well for our clinic.”
Amy Wyatt, R.N., B.S.N.
Communicable Disease & Environmental Health Coordinator
Immunization Specialist
Sheridan County Public Health
(local health department)

25. Testimonial:
“As time goes on and the remainder of the system becomes functional, I see it as a being a HUGE time saver. Much of the time spent during mass vaccinations is spent on records. This system has the potential for cutting that time by 50% or more, allowing a small clinic with a limited number of personnel to do mass vaccinations…”
“[Barcode scanning] sic allows for personnel who have limited training to assist, freeing up medical personnel. It allows for fewer personnel to do the job at a faster rate so that a smaller contingent of personnel can do the job. This is always important in smaller communities with limited resources.”
Mike Smith
Clinic Director
Midwest Community Clinic
(private provider)

26. Conclusion
Bar coding technology alternative brings new offering IIS provider recruitment
Bar code scanners are affordable and allows provider to use existing computer
In Mass Immunizations
Track patients
Expedite registration
Expedite vaccination documentation
Supports real-time monitoring of vaccine usage / supply