What the NHS procurement strategy can learn from the retail industry
Date: November 27, 2014
Category: Guest opinion piece
The use of modern barcodes on drugs and supplies will ensure patients are safe and drive efficiency, writes Tony Walsh.
The eProcurement strategy that is now being adopted by the NHS is the culmination of a process Blue Sphere Health have followed with great interest, having worked on groups developing the GS1 standards and system in healthcare in the UK and globally.
For more than 10 years, these standards groups have been developing tools for better supply chain systems. In particular, there has been a focus on the use of bar codes to ensure that items can be scanned and checked anywhere in the world. The initial work was driven by the retail sector, which wanted to get products to customers in a faster, more accurate and efficient way.
Coding is widely used in the food and fast moving consumer goods (FMCG) sectors, which adopted a single global standard provided by GS1. This is a system we all use every day on items such as packets of crisps, cereal boxes, clothes, tickets and just about every other product we receive in a commercial transaction.
Standardised code systems are now the bedrock of the world’s secure, efficient supply chains. Data carriers such as bar codes, RFID tags and magnetic strips can carry a wide range of different data and information, but the key is the standardised structure of that data. Codes can automatically identify a range of properties concerning the product when linked via a scanner (or now even a smartphone) to a database.
The retail and manufacturing sectors have combined to build supply chain systems that everyone can use, trust and develop. We have codes for small items, for multiple packs, for cases, for pallets for containers and we can track and trace these anywhere in the whole system. Healthcare is now catching up and will reap those same benefits.
The simplest way to understand the power of coding systems is to think about a supermarket checkout. When a product is scanned, the point-of-sale system identifies the product, manufacturer, price, size and weight instantly by accessing a linked database. With no manual data input, the system is capable of immediately printing a detailed receipt, as well as automatically re-ordering replacement products to inventory via the stock control system.
When the bar code is absent or cannot be scanned the assistant has to manually input the product information, which takes time and therefore costs money. It might also lead to errors. These human data entry errors are not physically harmful at the supermarket, but they sometimes are at the patient bedside. Automatic rather than manual data entry is an effective way to reduce medication errors. The insistence in the eProcurement policy on every product having machine readable code will probably save some lives.
Traceability through code scanning will also make drugs safer. In 2006, after more than 70 people died following an incident when a contaminated batch of blood derivative was dispensed in Ireland, the government took action. The contaminated blood derivative was not coded and could not be traced. Nobody knew where the product had been delivered and which of the product was faulty and which was safe.
A small team of specialists developed and implemented a secure system based on GS1 principles and using modern technology to track and trace product from the manufacturer, through distributors into hospitals and right into patients’ own homes. The system was implemented and has been running successfully ever since.
The Irish blood trial was the first to use a new data structure inside a 2D bar code called a data matrix (four pieces of information – item, expiry date, batch/lot number and a unique code – this code structure is now used by the healthcare market globally). The codes were linked to a central database so that the system could check stock, know exactly where product was (including in patients’ refrigerators in their homes) and at what temperature it was being stored and when it expired.
Patients and distributors were issued with mobile phones both for verbal contact and advice, as well as having the ability via the camera on the phone to read each bar code. This could then give accurate information about location, who was scanning the item and where they were located. When the product was used, the system would automatically order a replacement from stock to ensure patients never ran out.
In the case of a problem, patients could be contacted personally within minutes by both voice and text message, should updated advice be needed or if a recall was required. If a patient tried to use a blood derivative that was out of date or faulty they could receive an immediate warning not to take the product.
Understand the benefits
The Irish blood trial was the first real application of GS1 standards and proven modern technology to meet healthcare needs. Since that time, major tests and trials based on GS1 standards have been completed across Europe, including a retail pharmacy study in Sweden by the drug industry federation EFPIA.
The US now has a planned rollout of GS1-compatible coding systems for both drugs and medical devices over the next 10 years. As part of the detailed implementation of the falsified medicines directive, the EU is expected to announce later this year its own drug traceability strategy for the whole of Europe, including the UK. GS1 standards are at the core of all these systems, as the acknowledged best framework for convergence towards a true global, interoperable system.
How can a humble code that carries a few strings of data lead to an eProcurement and patient safety revolution? The system sounds simple and at one level it is. Don’t be complacent about the challenges, though. As with all such changes, the difficulty is in the detail.
The NHS is institutionally resistant to change. The people who work within the NHS, and also importantly the organisations that supply it, need to understand how the GS1 system works, how they can apply it and use it, and how it will improve the efficiency of the service and the delivery of care to patients. This will need a substantial investment in training and awareness raising. Helping all parts of the NHS to understand the new eProcurement requirements will ensure that we all reap the benefits.
Tony Walsh is a senior consultant at Blue Sphere Health
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