BLOG: Crossing the Chasm – Marketing to Pragmatists

25 July 2011

It’s been a while since my last BLOG post… it has been a busy few months, not only for me but for UK Healthcare: The Coalition Government’s listening exercise on the NHS White Paper, The Future Forums report, the Government’s response and now the revised (debatable!) draft bill will make its way through parliament in September…

Has this helped the drive to adopt digital and automatic identification and data capture (AIDC) (e.g. barcode) technologies (“disruptive products”) in the NHS to improve patient safety (the subject of my earlier BLOG post)?  I don’t think so; my sense of the situation is that the English NHS is not only in “The Chasm” in terms of technology adoption but also in ‘no (wo)mans land’ between the pre-coalition Government structures and organisations and the radical transformational restructure of the revised White Paper! And looking at meeting saving targets!

But some progress has been made, pilots have been undertaken and now we have a GoogleMap showing us all those NHS organisations who ARE adopting AIDC technologies based on GS1 Standards.  Developed by Neil Lawrence, Connect for Health,  it can be accessed here and shows many organisations who have adopted Asset Tracking, Patient ID, Pharmacy (I assume inventory management), Loan Kits (I assume recording what’s used), Surgical Instrument tracking, Blood Spot card, a few tracking Samples and even a few moving beyond item identification to location identification (GLNs).

The map looks full of the little flags, but even so this still represents a discrete application of AIDC/barcoding in each of the organisations.  I’d equate it to only having the tinned products in a supermarket barcoded with the rest of the wide range of food and non-food products still without barcodes!  So, still a long way to go and I’d still argue that these organisations are “…the early adopters and insiders who are quick to appreciate the nature and benefits of the new development…”

We still need to get onboard “…the second mainstream market representing “the rest of us”, people who want the benefits of new technology but who do not want to “experience” it in all its gory details… the Early Majority” – the pragmatists.

Come on guys (you Early Majority, you pragmatists), we know you “…want to see well-established references before investing substantially… [and the] whole product”.  But, as you can see from the GoogleMap, the references exist, the standards are in place; go for it: improve your organisations efficiency, cut costs and IMPROVE PATIENT SAFETY! Don’t wait for a catastrophic event!

Before ending this post, a request: I’d like to hear the implementation experiences of those organisations shown on the GoogleMap and so would your fellow-pragmatists! 

Contact me and in the meantime visit my website, connect with me on LinkedIn, fan me on Facebook and/or follow me on Twitter.

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BLOG: Crossing the Chasm – Embedding GS1 Barcodes [disruptive technologies] in NHS

14 March 2011

Before beginning This BLOG! I researched and used a number of sources to assist me in generating ideas.  One of the sources was the book “Crossing the Chasm” by Geoffrey A. Moore.  This book was published in 2002, but what drew me to it was the sub-title “Marketing and Selling Disruptive Products to Mainstream Customers”… Why?

For those of us in healthcare, from around the world, who believe in, advocate and are endeavouring to drive adoption of digital and automatic identification and data capture (AIDC) (e.g. barcode) technologies (“disruptive products”) to improve patient safety, this is the situation we face.  We are on the brink of the gap in the “Technology Adoption Lifecycle” (Figure 1) between the “Early Adopters” and the “Early Majority” i.e. “The Chasm”.

 Figure 1

Crossing the Chasm” is actually focussed on marketing in the “Hi-Tech” industry and the underlying thesis of the Technology Adoption Lifecycle “…is that technology is absorbed into any given community in stages corresponding to the psychological and social profiles of various segments within that community.  This process can be thought of as a continuum with definable stages, each associated with a definable group, and each group making up a predictable portion of the whole.” (p13)  In the Foreword Regis McKenna (xiv) writes “The Chasm represents the gulf between two distinct market places for technology products – the first, an early market dominated by early adopters and insiders who are quick to appreciate the nature and benefits of the new development, and the second mainstream market representing “the rest of us”, people who want the benefits of new technology but who do not want to “experience” it in all its gory details.”  The “Early Majority” that makes up “roughly one-third of the whole adoption lifecycle” and are key to growth.

I can hear the cries “Barcodes are not a ‘new development’ they’ve been around for more than 30 years!” True! Well, actually closer 60 years since the first patent [see box below], in retail/consumer products / fast-moving-consumer-goods (FMCG) (whichever term you prefer!).  They are ubiquitous! Indeed, we (as consumers) are even doing our own scanning and check-out in an increasing number of retail outlets and I now have an APP. (RedLaser) on my iPhone to scan barcodes and order on the move!

However, barcodes are NOT ubiquitous in healthcare… that why I see them as a “disruptive technology” in the healthcare sector!

True, there were ‘early adopters’ in healthcare in the decade of the 20th century.  For example, large manufacturers, who realised the benefits of AIDC when their products went through the retail channel, extended AIDC to their healthcare channel (hospitals, pharmacies, care homes etc.) to realise the same benefits – a more efficient and secure supply chain.  But even they face/d challenges in implementation, such as non-standard, local or national identification systems, particularly as their supply chains expand/ed beyond their national borders and become increasingly global.

Of course, some might argue that the same large, international organisations are the ‘late majority’ even ‘laggards’ in regards to adoption of technological innovations such as Radio Frequency Identification (RFID)!  See my earlier posts on review of my MBA dissertation

But over the same period there were few ‘early adopters’ of barcodes from the healthcare provider community (hospitals, pharmacies, care homes etc.)!  Enter the 21st Century and  examples of early adopters around the world have and continue to emerged (e.g. UK: Wythenshawe Hospital, Australia: ResMed, US: BPOC/eMAR) but this still represents only a very few ‘early adopters’ globally and they are broadly focussed on internal materials / inventory / supply chain improvement rather than error detection / prevention / patient safety applications.  STOP PRESS: Another “early adopter”: In the UK Patient Safety awards 2011(9th March) Kettering General Hospital NHS Foundation was “Highly Commended” in the Technology & IT to Improve Patient Safety section, “The Trust Implemented GS1 1D and 2D barcodes on its wristbands and blood spot screening labels to improve safety and efficiency”.

To fight the increasing number of counterfeit medical products and to make the supply chain more secure, numerous governments have consulted on making source-marking (bar coding) of products (i.e. by the manufacturer (i.e. the source)) mandatory.  But the manufacturer’s argument against such legislation (rightly) has been ‘we are already source-marking products (see paragraph 6 above) but their use stops once we’ve delivered the products to the provider, e.g. they don’t use the barcode/scan on receipt.’  But some and an increasing number of governments have mandated use of AIDC, predominantly for pharmaceuticals (e.g. Turkey, India, Serbia, Denmark, France…) but increasingly for medical devices (e.g. Turkey, Spain, Japan, Cyprus…) and the US FDA Medical Device Unique Device Identification rule is due by June this year.

From the supplier side it is arguable that it is the “Laggards”, generally the small/medium enterprises (SMEs) or niche manufacturers / suppliers, not using any form of AIDC technology or using proprietary or other bar codes (e.g. HIBCC), who have yet to start implementing the dominant system of AIDC standards: GS1.  You don’t have to take my word for it, the most recent study (Dec 2010) by US Health Industry Group Purchasing Association (HIGPA) reported that “Sixty-eight percent of the survey’s respondents said they were moving toward adoption of a global data standards system in the next five years, and 90 percent of those moving toward such a system reported moving toward GS1 standards.

On the buyer / provider side adoption remains with the “Early Adopters”:

More than a decade ago the US Institute of Medicine published “To Err is Human: Building a Safer Health System” which “…estimate[d] that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That’s more than die from motor vehicle accidents, breast cancer, or AIDS…”  In 2004 the English National Patient Safety Agency ((NPSA) a victim of the UK Coalition governments Arms Length Bodies cull) published Right Patient, Right Carewhich mentioned similar figures and stated that “…on the basis of the work reported… there is considerable scope in the NHS for improving patient safety… through applying technologies such as barcodes, radio frequency identification, and biometrics”.  And there have been numerous other studies over this period from around the world.

The business case is there isn’t it? So WHY are we stuck at the “Early Adopters” stage?

What will be the game changer? What will see adoption of AIDC/barcodes by the “Early Majority”, i.e. what will move providers across the chasm?

I greatly fear that it will be a catastrophic event.  Of course, any adverse medical event can be a catastrophic event for the individual involved and their family / friends, but in this context I mean a catastrophic event that affects numerous individuals in the healthcare system of one or more countries. 

Why do I fear this? Because:

1. We’ve known for years that adverse events, errors occur in our healthcare systems (see To Err is Human above) but that hasn’t driven adoption and

2. There are examples of catastrophic events changing the game.  For example, from Ireland, The Lindsay Tribunal Report (2001) resulting from investigation into haemophilia patients being infected with Hepatitis C and HIV due to contaminated blood products. Infected products remained in the supply chain after the recall, leading to subsequent infection.  One of the results of this catastrophic event is presented in the St James’ Hospital Case Study.  An impressive result that continues to expand and develop taking GS1 standards and mobile technology into the hands of the haemophilia patients resulting in improve compliance and cost savings.  But it was a catastrophic event that was the catalyst!

I’m an optimist, so I hope I’m wrong!

So, let’s return to the quotation from the foreword of “Crossing the Chasm” “The Chasm represents the gulf between two distinct market places for [AIDC] technology[ies]– the first, an early market dominated by early adopters and insiders who are quick to appreciate the nature and benefits of the new development…”

There is a raft of case studies scattered throughout this BLOG and herethat reflects this state and it’s where adoption is today! “Early Adopters”

“…and the second mainstream market representing “the rest of us”, people who want the benefits of new technology but who do not want to “experience” it in all its gory details.”

That’s the “Early Majority” (ultimately through to The Laggards).  The Early Majority is at least where adoption of these GS1 Standards based systems in healthcare needs to move to, to realise improved supply chain efficiency and, more importantly, Patient Safety!  Use of AIDC technologies (e.g. barcodes) needs to be as ubiquitous as they are in retail: why wouldn’t we as patients be scanning our prescription medications to check, for example, that they are not counterfeit, or out of date, even order a repeat prescription!?

Crossing the Chasm
The book suggests that the “…psychological and social profile…” of the “Early Majority” community is that of the pragmatist.  “They share some of the early adopters’ ability to relate to technology [that’s good!], but ultimately they are driven by a strong sense of practicality… They want to see well-established references before investing substantially.” And they want the “whole product”.  They references exist and are increasing (e.g. here) therefore the “whole product” is available, isn’t it?

If the “whole product” is available, are we as believers in and advocates for digital and AIDC technologies are we not communicating effectively? Do we need to explain the “whole product”, the benefits and references in terms that appeal to the pragmatists? I think this could be it!  That begs the question “what are the terms, the messages that will appeal to pragmatists”?

That is the subject of a future post! But what do you think, how could we communicate the message to the pragmatists? I welcome your comments and feedback – particularly if you are from the provider side!!

In the meantime visit my website, connect with me on LinkedIn, fan me on Facebook and/or follow me on Twitter.


MBA Dissertation Revisited 5/FINAL: Hypothesis proved?

7 January 2011

Last September I began a review of my MBA Dissertation; four BLOG posts since then have focussed on Chapter 6.1 Discussion.  These posts can be found here:

  1. Revisiting. Why?
  2. RFID has benefits?
  3. Applied or Embedded RFID?
  4. Progress? Baby steps

 In this final “MBA Dissertation Revisited” post attention turns to chapters 6.2. Conclusions and 6.3 Recommendations

NOTE: Original text from dissertation shown in italics.

”6.2 Conclusions:

a. Patient Safety is the KEY driver for using RFID with MD (e.g. Ranger & Cousins (NPSA), 2006 (2.3.3); Interviews (5.2.2); Questionnaire (5.3.2), 6.1.1.

b. There have been insufficient pilots and resulting case studies to definitively prove that applying or embedding RFID to MDs will deliver greater patient safety. The theory is largely still based on assumption (Ranger & Cousins (NPSA), 2006, (2.3.3); Vincent (2006), Talon (2006) (5.2.4); Questionnaire (5.3.4); 6.3.1.).

c. Whilst RFID has benefits over other AIDC technologies, they are not universally realisable or applicable to all MDs (Arcarese, 2005 (2.3.3), Interviews (5.2.3), 6.1.3.).

d. There are barriers to be overcome with RFID technology (UsingRFID.Com, Anon, 2005 (2.3.2.4.b); Interviewee, Jensen, R (5.2.4); Questionnaire (5.3.3.2); 6.1.3.).

e. There is potential, in healthcare facilities, to derive benefits through a more tactical, widespread and efficient use of other AIDC technologies that are already used by MD manufacturers (78% of Advamed members are bar coding products (Longe, 2004, (2.3.2.4); 6.1.3.).

The hypothesis has not been proved or disproved, but it can be reworded into a statement based on the research and findings of this dissertation, as follows:

Medical Device Manufacturer applied or embedded RFID should be voluntary. RFID has benefits over existing AIDC technologies, e.g. Bar Codes and has the potential to deliver greater patient safety in the clinical environment. But it should not be seen as a panacea; all

AIDC technologies should be considered and piloted, and the most appropriate selected, when attempting to address reported adverse incidents in the most severe “degree of harm” categories (NPSA).”

Just over 4 years on from publication of the original MBA Dissertation the review undertaken in previous posts shows that some, but little, progress has been made of the utilisation of RFID, in fact any AIDC technologies, in healthcare to improve patient safety.  Taking each of the conclusions in turn, I would update them as follows:

a. Patient Safety remains the KEY driver for using AIDC technologies with Medical Products. The priority for adoption has been pharmaceuticals, driven by the increase in counterfeit products in the global supply chain, with medical devices (MDs) lagging behind. Where there has been adoption it has been adoption of barcodes rather than RFID.

b. There has been a growth in the number of pilots and resulting case studies (see previous posts).  But very few have been focussed on RFID with MDs, the majority have been focussed on use of barcodes predominantly with pharmaceuticals although increasingly on MDs and predominantly they have been manufacturer pilots rather than provider pilots.  Therefore the theory, “…applying or embedding RFID to MDs will deliver greater patient safety…” remains an assumption.

c. It remains true that “…RFID has benefits over other AIDC technologies…” e.g. non-line of sight, multiple reads, but it also remains true that these benefits “…are not universally realisable or applicable to all MDs…”  For example, the use of RFID at the unit level with the low risk (in terms of potential to cause harm) MDs, e.g. gloves, swabs, is not seen as applicable due to cost.  The trend seems to be the use of RFID at the logistics unit / pallet level rather than unit level.

d. Whilst some progress has been made there still remains “…barriers to be overcome with RFID technology, e.g. issues with readability through liquids and on metal or robustness due to repeated reprocessing.  The progress made remain insufficient to warrant widespread deployment. 

Therefore, this final conclusion still holds true:

e. There still remains significant potential, in healthcare facilities across the world, to derive benefits through a tactical, widespread and efficient use of barcodes that are already printed by manufacturers on both pharmaceutical and MDs. And numerous regulators have recognised this and have or are planning regulations on identification of medical products.

This was the original, ultimate CONCLUSION

Medical Device Manufacturer applied or embedded RFID should be voluntary.

RFID has benefits over existing AIDC technologies, e.g. Bar Codes and has the potential to deliver greater patient safety in the clinical environment. But it should not be seen as a panacea; all AIDC technologies should be considered and piloted, and the most appropriate selected, when attempting to address reported adverse incidents in the most severe “degree of harm” categories (NPSA).

Apart from replacing “Device” with “Product” to include pharmaceuticals, I would suggest that the tag line of the conclusion remain unchanged:

Medical Product Manufacturer applied or embedded RFID should be voluntary.

However, the subsequent paragraph requires updating to be more pragmatic, as follows:

RFID has limited benefits over existing AIDC technologies, e.g. Bar Codes and has limited potential to deliver greater patient safety in the clinical environment.  But it should not be seen as a panacea; all AIDC technologies should be considered and piloted in the clinical environment and the most appropriate should be implemented, i.e. the one that shows improvement to patient safety.

You can download the original MBA Dissertation from my website.

My final comment to conclude this review is based on my experience over the intervening 4+ years working in AIDC in Healthcare:

The majority of global pharmaceutical and medical device manufacturers have adopted AIDC technologies and have realised efficiency improvements in doing so.  Therefore, the packaging of their products carry, predominantly, barcodes, a few carry RFID tags. 

The supply chain processes of downstream trading partners, e.g. distributors and wholesalers, have also benefitted from incoming product being identified.

But it is still the case that utilisation by healthcare providers (e.g. hospitals) of barcodes on incoming product is limited.  Therefore, as a minimum, opportunities to realise internal supply chain benefits are being missed; but more importantly opportunities to improve patient safety are also being missed, e.g. ensuring the 5 patient rights, e.g. drug to the right patient.

Implementation/adoption of AIDC technology by healthcare providers has to be the priority going forward… It won’t be easy, but it shouldn’t take the 30+ years taken by the retail sector as healthcare can build on that vast experience.  Potentially we are talking about saving lives, which has to be worth it, doesn’t it?


MBA Dissertation Revisited 4: Hypothesis proved?

2 December 2010

In my previous MBA Dissertation revisited post I concluded with the statement: “few healthcare facilities are capable in terms of “…technical infrastructure (1.3), processes and trained resource…” to benefit from other AIDC technologies, e.g. Bar Codes.”  In this post I consider chapter 6.1.3 “…RFID has benefits… over existing AIDC technologies, e.g. Bar Codes.”

NOTE: Original text from dissertation shown in italics.

 “6.1.3 “…RFID has benefits… over existing AIDC technologies, e.g. Bar Codes.”

The author would suggest that RFID has some benefits over existing AIDC technologies, e.g. Bar Codes, but they are limited. The benefits are discussed in the literature review and subsequently summarised in Table 3 (2.3.2.4.) [page 29].

But it is generally believed that these benefits are not universal, i.e. not realisable for all classes of [Medical Devices] or for all products within the classes. In addition to the infrastructure requirements (1.3) and related financial costs (Roark & Miguel (2006), 2.3.2.4.) that could be barriers to adoption

• It may not be economically viable to undertake item-level tagging for “disposables” (bandages, syringes, consumables (Interviews, 5.2.3.)) because the cost of a tag may be the same or more than the cost of the item.

• There are known issues with RFID technology, e.g. read rate of tags (Interviews, 5.2.4.) and, particularly for MDs, physics issues (e.g. metal, liquid, sterilisation (UsingRFID.Com (Anon, 2005), 2.3.2.4.)

• Radio Frequency standards are not global (Wyld, 2005 (2.3.2.4.b.))

The author would also argue that there are unrealised opportunities in healthcare with Bar Codes or other AIDC technologies that may lead to greater patient safety. As previously mentioned Bar Codes are not ubiquitous in healthcare facilities, and in some cases they have their own type of bar code and over-label that of the manufacturer. Flynn’s comment (2.3.2.4) sums up the situation: “What makes healthcare facilities think they can be successful with RFID when they haven’t fully adopted bar coding into their operations?”

Broadly, the above still holds true: RFID does have benefits over exiting AIDC technologies, e.g. Bar Codes and, although the benefits are limited, I think they have increased during the period between publication of my original MBA dissertation and this review. The benefits remain particular to, for example:

  • Classes of medical devices, e.g. returnable or reusable assets.  A recent case study example is from ThingMagic: “Greenville Hospital Deploys Integrated RFID Solution for Operating Room Asset Tracking1 the reported results included labour savings, loss prevention, physician satisfaction, improved productivity and an expected return on investment within one year. The hospital also expects “…to be able to reduce [their] equipment purchases through a combination of reduced loss and our utilisation history reporting…” and have plans to “…expand the solution, e.g. to track additional critical care devices.
  • Levels of packaging, e.g. pallet.  A relevant pharmaceutical case study is the Building Radio-frequency Identification solutions for the Global Environment (BRIDGE)) Work Package 6 (WP6, pharmaceutical traceability pilot).  The WP6 evaluation report (p32) states that “…the use of RFID (as opposed to bar codes) could offer advantages for tracking the cross docking movements of pallets and the auto recognition of the delivery vehicles used for the process…”
  • Geographies where frequency standards are harmonised.  The frequency landscape is constantly changing but has become more closely aligned.  Probably the best source for the most up to date information is the EPCglobal Inc website; their latest (August 2010) Regulatory status report is available here.

But, some barriers persist… Although the price of RFID tags has reduced, cost remains a barrier to wider implementation both in terms of the infrastructure requirements and the economic viability for some types of medical products.

In terms of the issues with metals, liquids and sterilisation there has been some progress:

  • In September 2008 EPCglobal Inc. (www.epcglobalinc.org) formed the Liquids and Metals Interest Group (L&M IG) “to address this problem head-on” and
  • There are examples of RFID tag manufacturers working to address these issues, such as Odin Technologies, in a blog post Hot in here1 they says they have “run these tags through hundreds of cycles of autoclave simulations at temperatures up to 300° F… to stringent FDA standards for autoclave and chemical bath sterilization processes with no discernable performance degradation.” or the University of Kansas’ Information and Telecommunication Technology Center (ITTC) Tag for Metal, Liquids1 offers superior performance when applied directly to objects containing metal or liquid.

So, although progress has been made, I would still “…argue that there are unrealised opportunities in healthcare with Bar Codes or other AIDC technologies that may lead to greater patient safety”, in particular in healthcare facilities,  and I’m not the only one who thinks this way:

An eHealth Europe article (July 2009) reports on a RAND research report commissioned by the European Commission “…which focuses on Radio Frequency Identification (RFID) [and] says that despite being a useful tool in logistics and operational management it is so far “less successful in patient care and quality of care improvement.””  And:

In July this year (2010) there was a Mobile Aspects blog post on the “Recently HIMSS2 released… results of a survey of healthcare professionals around the use of RFID technology within healthcare…”  Their review of the survey draws similar conclusions to those I’ve outlined above!

Progress has therefore been in baby steps… In my next MBA Revisited post I’ll reviewing chapter 6.2 Conclusions.

 Notes:

  1. It should be remembered that these are publications from commercial organisations.
  2. HIMSS (Healthcare Information and Management Systems Society): US not-for-profit organization dedicated to promoting a better understanding of health care information and management systems.

BLOG: DH Coding for Success Review

4 November 2010

In my August 6th post Coding for Success Future? I mentioned my planned review of that Department of Health (DH) publication.  In the intervening period the DH has published its own “Review of Coding for Success Implementation“, undertaken by the Auto-ID and Patient Safety National Oversight Group (APSNOG) .  This post therefore reviews that review!

A recap: ““Coding for Success simple technology for safer patient care” was published by the Department of Health in February 2007. It described …bar-coding and similar coding technologies, and the positive impact they could have on healthcare, particularly patient safety… [and] …that the GS1 Standards for coding should be adopted throughout the healthcare system in England, both for manufactured products and for coding systems used within healthcare settings, such as patient identification codes on wristbands…”

A key role was given to Connecting for Health (CfH) (now strengthed by Information Standards Board for Health and Social Care (ISB) various standards for coding); CfH has the contract with GS1 UK and the review acknowledges the progress made with 300 trusts now registered with GS1 UK and that numerous “demonstrator” projects have been undertaken (eight interesting examples are included in the document)… where “Benefits have tended to be broadly similar across all projects…includ[ing]reduction in errors… increased traceability… quicker, easier and more accurate process of identif[ication]…. Patient safety… cost and timesavings, effort reduction and have led to services becoming more patient-centric… [and] improvements to staff wellbeing and patient satisfaction….”  In addition “Connecting for Health has taken on the task of undertaking work to determine the current use of auto-identification technologies in the NHS, particularly evaluating the benefits. Work has just started and will form part of Connecting for Health’s business continuity work.

The benefits shown from the demonstrator projects will be of no surprise to those familiar with the benefits that implementation of AIDC technologies can bring to organisations.  However, as highlighted in my prior post, the E-Health Insider article “Judgement day arrives for CfH and NPfIT” states “…CfH will disappear as a brand and the already much reduced agency will be dramatically scaled back…  Many of the responsibilities of CfH are expected to be taken on by the Department of Health Informatics Directorate…”. 

Is there a disconnect between the earlier article and the review? Perhaps.  More likely getting the review approved for publication was less of a priority than getting the White paper (Equity and Excellence: Liberating the NHS) and related documents (e.g. the Arms Length Bodies Reform (probable source of the eHealth article)) published…

But as CfH has (had) such a key role, how will that affect continued progress and continued, wider implementation across the English NHS? Additionally, it is not clear if the “…work to determine the current use of auto-identification technologies in the NHS…” will happen either!

As well as CfH, the NPSA was a victim of the Arms Length Bodies Reform too. They have had a pivotal role in improving patient safety.  The Coding for Success review acknowledges this: “The [NPSA] has played, and continues to play, a key role in the development and promotion of technologies that can lead to safer services…”.  I continue to be concerned about how, beyond the NHS Board, the vital patient safety work of the NPSA (an organisation envied across the world)  “…will be supported…“.  Particularly as there is a long way to go to ensure that English NHS organisations have implemented NPSA Patient Safety Alerts (see: 13th August post: AvMA Report: Implementation of NPSA Patient Safety Alerts).

Before considering the supplier community, the review acknowledges that “…considerable progress has been made to introduce a coding culture to the NHS…” BUT “…there is still more work to do…”

On the supplier side the review accurately reflects that identification of pharmaceuticals leads the identification of medical devices; which reflects a global trend.  Largely because of the number of adverse events related to and counterfeiting of [particular types of] pharmaceuticals has, and continues to be, more prevalent than that of medical devices.  In addition the diversity and packaging of medical devices presents identification challenges (e.g. how to identify a product that is regularly re-processed so that the identification is maintained).

In addition to local tender requirements (e.g. of NHS Supply Chain) to adopt GS1 Global Trade Item Number (GTIN) mention is made of a few of the numerous regulations for product identification (e.g. EU Pharma. Package, EU Recast of Medical Device Directives (MDD), US FDA Serial Number Identifier (SNI), US FDA Unique Device Identifier).  There are others, e.g. India, Brazil, Canada, Australia…) that are driving the increased adoption of GS1 standards globally.

One item that I can provide an update on is that the work between ICBBA (for the ISBT 128 standard) and GS1 has successfully concluded, see GS1 Healthcare press release of 15 Sep 2010: “New guideline enables safer delivery control process for plasma derivatives

The Gs1 Healthcare User Group (GS1 HUG UK), the group established to provide the link between the NHS (providers, CfH, NPSA etc.) and Suppliers is hosted by GS1 UK  and, as there is nothing in the review to indicate its demise, one can assume that it will continue. 

As one of the first two Co-Chairs (along with Rachel Hodson-Gibbons, ex-Head of eProcurement at NHS PaSA), I hope that assumption is correct as the review confirms it is fulfilling its original brief, i.e. “…to be a single source of knowledge, best practice and implementation support for data standards to all UK healthcare providers, trade organisations (manufacturers, wholesalers, distributors) and regulatory agencies. It also provides input and direction to the development of global standards in the healthcare industry supply chain.”!

The review’s conclusion is reasonable and the final paragraph states “We need to ensure that unique coding standards drive the application of codes across the NHS, and the Department of Health has this as part of its ongoing work programme to continue to push the requirement for GTINs and encourage NHS to utilise technologies in the procurement process.” 

There’s the rub!

Unfortunately, due publication of the White Paper (Equity and Excellence: Liberating the NHS) and the Arms Length Bodies reform, in particular the changes affecting CfH and NPSA, it is not clear how the progress made will continue… 

Like every aspect of the NHS, I guess it is watch this space!  I will be!


MBA Dissertation Revisited 3: Hypothesis proved?

27 October 2010

In my previous MBA Dissertation revisited post I concluded the statement “RFID has benefits to patient safety still remains an assumption; indeed a more efficient supply chain employing, both bar codes and RFID, is also an assumption.  But, it is certain that the interest, and potential for growth in use of RFID in healthcare, will continue…” but will that be voluntary or regulated?

NOTE: Original text from dissertation will be shown in italics.

Discussion

6.1.2 “…manufacturer applied or embedded RFID…

…would… manufacturers be requested to voluntarily tag [medical products] or would they be required (mandated) to do so through regulation?

Based on the experience with bar codes in healthcare highlighted by Flynn, quoted in Healthcare Purchasing News (Reiner & Sullivan (2005), 2.3.2.2.), the author would suggest that it should be voluntary.

Whilst… manufacturers may make a commercial decision to invest in and adopt RFID to increase the efficiency of their supply chain (5.3.2.), their control or influence over the supply chain ends at the point of delivery, e.g. at the healthcare facility. For a healthcare facility to reap the benefits of manufacturer applied or embedded RFID, they would require a technical infrastructure (1.3), processes and trained resource to be in place and working efficiently, i.e. fully adopted into their operations – this would require a significant financial and operational investment in each facility (Roark & Miguel (2006), 2.3.2.4.).

To mandate… manufacturers to tag would require a deliverable guarantee that the… supply chain would be fully extended downstream into each healthcare facility, to the point of care/the patient. But a comment taken from the summary of the Harrop report (in Anon, UsingRFID.Com (2006)) indicates that the “…primary impediments to rollout of RFID in healthcare are limited budgets, inertia, lack of education, high cost of many RFID systems…”; the author would argue that such a guarantee to… manufacturers is, therefore unlikely to be deliverable.

Whether voluntary or mandatory, without the technical infrastructure, processes and trained resource operational in the healthcare facility… manufacturer applied or embedded RFID, or any AIDC, will deliver little, if any, improvements to either the healthcare facility’s internal supply chain or to patient safety. The experience with Bar Codes is a case in point (Furness, 2005 (2.3.2.4.)).”

Broadly, I think the foregoing text still holds true. 

Over the intervening few years, since publication of my MBA, I think the hype around RFID has dissipated and the approach to the technology is now more pragmatic, driven in part by various pilots (e.g. BRIDGE) and lobbying by supplier organisations.  Moves by regulators to mandate manufacturers to apply or embed RFID tags to their products are rare, but can occur, e.g. Securing Pharma article “South Korea gets behind RFID tagging” (April 2010).

As predicted “manufacturers [have made] commercial decision[s] to invest in and adopt RFID to increase the efficiency of their supply chain (5.3.2.) as reflected in Alien’s White Paper “Pharmaceutical Shifts

Towards UHF RFID for Savings” (Dec 2008), but at least one pundit believes “RFID is DEAD… at Unit-Level in Pharma.”

In addition, it is still the case that manufacturers “…control or influence over the supply chain ends at the point of delivery, e.g. at the healthcare facility”, indeed globally few healthcare facilities are capable in terms of “…technical infrastructure (1.3), processes and trained resource…” to benefit from other AIDC technologies, e.g. Bar Codes.

The subject of a future “MBA Review” post:

6.1.3 “…RFID has benefits… over existing AIDC technologies, e.g. Bar Codes.”


Competition Winner

8 October 2010

Congratulations to Baxa Ltd, Berkshire winner of A.I.M. Consulting Ltd’s competition to receive 2 days FREE Consultancy.