Scan4safety: track and trace
Barcodes are so common that they tend to go unnoticed. But step into some hospitals in England and you might see a piece of laminated paper with a barcode stuck to a wall, MRI scanner or tray of surgical instruments.
Staff IDs, and even patients’ wristbands, may include a barcode. Originally conceived as a procurement project that would help track supplies – and when they should be reordered – the introduction of simple barcodes promises to deliver much more for the NHS. It could prove to be a rich vein of information about all that happens in a hospital.
Since 2016, this programme – Scan4Safety (S4S) – has enabled six demonstrator trusts to aim for benefits ranging from reduced procurement costs to increased patient safety.
Heart of the system
At its heart is a relatively simple, procurement-only system. A clinician will read the barcode on a product using a hand-held scanner, automatically informing the trust’s inventory management system, which records the product’s use and checks stock levels. If stock is below a set threshold, the item can be automatically reordered. Mandated e-procurement standards, based on the GS1 barcode system and PEPPOL messaging standards, will mean ordering will be online, reducing transaction costs.
Automating the whole purchase-to-pay process would further reduce costs. But greater potential benefits have been explored by the demonstrator sites. If the clinician also scanned the barcode on their name tag, the one on the patient’s wristband and the GLN (global location number) on the wall, the trust would know the clinician, patient and location of the treatment, and the products used.
Some of the demonstrator sites have also introduced barcodes linked to OPCS codes, recording the procedure that has taken place. This data can, in turn, flow through to informatics and finance systems as the basis for patient-level costing.
Given these benefits, health and social care secretary Matt Hancock believes S4S is a key element in expanding the use of technology to deliver a more efficient health service.
In February, Mr Hancock backed S4S in a speech to the Royal Society of Medicine. ‘I want to see this taken up by the entire acute sector. We can have the most advanced tech, but we won’t see the benefits unless we have real interoperability.
‘So, staff have to make scanning a routine part of their working day. It takes seconds, but saves hours. If adopted across the NHS, the time saved would equate to almost 400 extra nurses.’
NHSX, the Department of Health and Social Care’s new unit overseeing the health secretary’s tech vision – setting common standards, reforming the procurement of technology and developing best practice – takes responsibility for S4S from 1 May.
The S4S demonstrator programme formally ended last summer, but the Department says the six demonstrator sites have continued to build on their work. Examples of this include:
- The development of an app that uses barcode location identifiers to navigate around a hospital
- Blood transfusion tracking
- RFID tracking of medical records and mobile medical equipment
- Safety alerts from ophthalmology systems
- Standardised and automated data fed into registries such as the National Joint Registry.
Much of the safety focus to date has been on giving the NHS the means to trace a prosthesis, for example, that has been found faulty.
There is a drive to use barcode scanned data to prevent never events. Last year, a Healthcare Safety Investigation Branch report on the use of an incorrect prosthesis recommended barcode scanning as a way of reducing risk. The Department has accepted this.
Glen Hodgson, GS1 UK’s head of healthcare, says barcodes can contribute to removing unwarranted variations, improving patient safety and generating efficiencies. ‘We now have senior level support that gives cover to directors of finance to get on and do this. Two or three years ago everyone thought it was a good idea, but wanted to see the clinical benefits. Not unreasonably, they wanted evidence. The evidence shows error rates in the dispensing of medicines were reduced.’
In one Dutch study, use of GS1 barcodes and other technologies led to a 76% fall in dispensing errors. Closer to home, some trusts are combining barcode scanning and clinical decision software to reduce the incidence of misplaced gastronasal tubes (where they are accidentally placed in the trachea rather than the oesophagus).
From April, GS1 has a new five-year contract with the NHS, allowing trusts to use the GS1 barcodes and access the global GLN registry. Mr Hodgson adds: ‘GS1 standards support identification of people, products and place – the person includes patients and staff; the products are assets employed, including medical devices, pharmaceuticals and IV pumps; and place records where the care happens,’ he adds. ‘I was shocked by how few trusts have proper inventory management systems. Apart from the reduction in wastage, the savings from reducing stock to 19 or 20 days are phenomenal.’
S4S is expected to generate more than £1bn in efficiency savings in seven years. But how do these savings break down?
A Department spokesperson says the benefits are best understood in three categories: patient safety, clinical productivity and supply chain efficiency. The six demonstrator sites are realising and/or forecasting a number of benefits.
These include: near real-time track, trace and recall of faulty products and affected patients; one-off reductions of inventory levels; and recurring efficiency benefits, including return of time equivalent to 392 nurses to patient care. In addition, accurate analysis of patient level costing is helping to reduce variation.
‘The anticipated financial benefits of Scan4Safety are a mixture of efficiency and cash-releasing benefits,’ the spokesperson says. ‘The bulk of the cash-releasing benefits are due to a reduction of inventory levels in trusts. The savings are a combination of efficiency and cash releasing savings. It is expected that the benefits will be retained within each hospital to support improvement in patient care.’
PEPPOL key to success
The adoption of PEPPOL (pan European public procurement online) standards is key to the success of S4S and the wider ambition to automate core transactional services, such as invoice processing and payment. Essentially, PEPPOL acts as a go-between, ensuring different computer systems can share information – between trusts, a trust and supplier or a national registry, for example.
The Department says: ‘The implementation of PEPPOL was initially mandated by the publication of the NHS e-procurement strategy in 2014. Scan4Safety is the programme of work to implement the standards mandated in the NHS e-procurement strategy, including PEPPOL. So, S4S has played a leading role to date in driving PEPPOL adoption in the NHS.’
The Department’s assessment of the impact of the S4S programme is expected to be published soon. While the Department may use its report to urge trusts to roll out the programme across England, there could be one major barrier – funding.
The Department has told Healthcare Finance that trusts will have to find their own money to fund S4S implementation.
‘The model employed for roll-out of Scan4Safety will be different from the demonstrator phase and trusts will be expected to self-fund this activity. The proven financial and efficiency benefits of Scan4Safety deliver a return on investment for trusts implementing the programme,’ its spokesperson says.
Some trusts are self-funding their implementation (see Alternative approach, below), while others have secured finance through the global digital exemplars scheme and sustainability and transformation partnership-wide IT funding from NHS England.
Mr Hodgson believes trusts will take the lead in paying for systems. ‘It will be a pull rather than a push,’ he says. ‘We have the mandate written into the standard contract for providers and suppliers to be GS1-compliant by 2020/21.
‘It’s fair to say that many trusts will be waiting to see what happens, but if I were a senior trust manager, I’d introduce wristband identification for patients. It’s a minimal cost.’
Trusts are mandated to implement e-procurement. In most cases it will not be subsidised, but the Department believes the potential benefits not only in efficient procurement but also from wider uses of the data – including safety, quality and a richer picture of the patient journey – outweigh the costs to individual trusts.
Alternative approach
Inspired by the use of GS1 technology at pioneers such as the Royal Derby Hospital and the level of automation at the Jaguar Land Rover factory in Solihull, Hull University Teaching Hospitals NHS Trust chief financial officer Lee Bond (pictured) has championed implementation at his trust.
‘Whenever I go into a supermarket or factory, I see automation that far surpasses anything in the NHS. The technology underpinning this is heavily based on the use of barcodes and therefore GS1,’ he says.
With no central funding available for non-demonstrator sites, Hull decided to fund its own GS1-based programme, spending £300,000 a year on a programme and full-time programme director.
‘We put in a small amount of money and bought the Genesis inventory management system. We’re doing it on a bit of a shoestring, but progressing well,’ he says.
The trust approached implementation in a different way to other pioneers. Instead of placing the initial focus on theatres, in the first instance it introduced barcodes into a single patient pathway – cardiothoracic care. ‘We’ve implemented not just in theatres, but in everything, including intensive care, central sterile services, anaesthetics, perfusion, even the mortuary,’ Mr Bond says.
The implementation has included the roll-out of patient wristbands, staff barcodes, procedural barcodes (which incorporates the OPCS national coding) and GLNs, giving the trust information on location and total resources involved in that patient’s episode of care.
‘It gives us such a rich mine of information. We can follow the patient pathway through the hospital. It’s early days, but people are asking what we can use it for beyond giving us information that’s credible.
‘As well as the potential quality and safety improvements, there could be significant financial implications in terms of efficiency as it’s enabling me to have a conversation with clinicians that I’ve never had before concerning variation.’
He has a ‘long shopping list’ of ideas – nurses are asking if it could be used to measure activity, with the information then being used to redesign the skill mix on a ward.
The trust has an 18-month road map to implement the barcode technology beyond cardiothoracic services, starting with cardiology. Central funding would allow Mr Bond to roll out the programme further and more quickly.
‘My only regret is that I can’t do it quicker. The centre keeps saying there are huge benefits from the introduction of this technology – and intuitively I feel that this will be the case. However, it is frustrating that no central funding has been made available other than that which went to the original demonstrator trusts.’Cornwall’s journey
The Royal Cornwall Hospitals NHS Trust is starting to see the benefits of its Scan4Safety (S4S) programme. The trust is one of the six demonstrator sites chosen in 2016 and has introduced the programme in a number of clinical areas across the trust.
Its procurement inventory manager, Stavros Ballas (pictured), says the first step after
being chosen for S4S was to get control of its inventory. ‘We found we were over-stocked and not really looking at waste. Everything was hand-written, so accessing records was time-consuming and it was difficult to know what we had. Clinicians, ward and theatre managers were spending time managing and ordering stock.’
The trust invested in a catalogue management system and PEPPOL exchange from GHX, together with the Ingenica inventory management system, which introduced GS1 barcodes for supplies.
‘We can now track our stock from the point of ordering to the point of use,’ says Mr Ballas.
Trust chief procurement officer James Leaver says good inventory management is key. ‘You couldn’t do Scan4Safety without knowing your inventory. People in the NHS didn’t understand the benefits of having a good inventory management system. However, Scan4Safety is the lever that’s enabled us to show inventory management is a strategic programme of work.’
Mr Ballas says the trust has seen a 15% reduction in expenditure for the areas using the system and is aiming to reduce waste by 50% over three years.
The project is also freeing up clinical time and can trace a recalled implant in seconds. The system has other safety features, including alerting a clinician that a product has expired.
Future developments could include steps to prevent never events.
Patient-level costing is more accurate – clinicians can scan the patient, the location and 80% of the products used (a value is assigned to the other 20%, which are mostly commonly used, lower value items).
Barcodes for the OPCS code and consultant are also logged, giving a fuller picture.
Mr Leaver adds that S4S began as a safety initiative, but has produced many beneficial spin-offs. And while it is tempting to push on to gain these additional benefits, he says it is important to get the basics in place first.
For example, the trust is beginning to see the benefits of end-to-end automated procurement. But first it had to agree stock levels and establish clear schemes of delegation. Agreed stock levels allow automatic reordering, while new schemes of delegation ensure a relatively seamless procurement process with little human intervention.
Previously, an order would have gone through a cumbersome approval process before being sent to the supplier. Mr Leaver says: ‘It is now a full, end-to-end e-procurement system and it frees up my staff to perform more value-added work, such as negotiating with suppliers.
‘We are seeing some of the benefits of S4S, though we won’t see it fully until the system is implemented in full. We are still on that journey, but we can see the benefits it will bring.’
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