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Raising the Bar: Using Bar Coding, Automation and Lean to Drive Efficiency.

Bar codes are on almost every product we buy. In fact, it could be challenging to go shopping and find a product for sale sans one. In the clinical laboratory advantages to using bar codes abound as well, and in some instances for similar reasons.

Bar codes in laboratories are an essential component to an automatic identification system that allows patient data to be captured. Bar codes enable labs to easily track, monitor and access real-time patient data electronically.

There are two types of bar codes used in a laboratory. A linear bar code is one dimensional and usually contains less than 15 characters due to the size constraints on specimen carriers. It typically contains simple data and represents a key to a link in a database. A biopsy reference is a good example as it may be just a unique number.

A two dimensional or 2D bar code, on the other hand, can in general store from one to about 2,000 characters (which is 20 times more space efficient than a linear bar code). For a specimen carrier such as a tissue cassette or slide, an average of 24 characters will fit into a 2D bar code. Although it has a small footprint, it contains loads of information and due to its redundancy is tamper resistant. This type of bar code commonly stores a patient's name, date, biopsy reference, identification, etc.

Advantages to the Automation Process

Bar codes offer tremendous improvement opportunities for laboratory identification, particularly when it comes to reducing errors and improving lab technicians' productivity levels. It's estimated that an error is made once every 200 keystrokes. Handwriting and tracking manually have an even higher error rate.

Labs that implement bar coding, however, can significantly reduce those error percentages. In fact, it's estimated that linear bar coding has only one error in three million serial bar code scans and one in 10 million two dimensional bar code scans. "Given these numbers alone, bar coding can greatly improve a lab's specimen data integrity," says Nicole Nelson, MBA, global materials portfolio manager, Brady Corp., Milwaukee, WI.

In addition to error reduction, bar code labels also allow labs to track, secure and manage patient data in an automated process--which alleviates much responsibility and time from lab technicians. Bar codes allow for real time immediate information, keyless data entry, standardization, legibility and chain of custody tracking.

Most, if not all, LIS/HIS systems are already programmed to support bar code data entry. When a laboratory bar code is scanned, the scanner will automatically access the patient's data record and update it accordingly in the LIS and even into the eMAR system when applicable.

"With an automated system, technicians don't have to spend significant time looking or waiting for the right information," Nelson says. "And most importantly, they don't waste time re-doing identification and tracking work."

Benefits of a laboratory bar code labeling system include:

* Increased speed and accuracy

* Improved management and reporting

* Reduced costs

* Clear, legible patient identification labels

* Quick and easy label design and printing

* More patient information fits on the label

Identifying Lab Samples

Sample identification validates the uniqueness of the sample. "Chain of custody is achieved when each sample has a unique identifier, the sample can be tracked throughout the process so at any given moment it can be determined what samples a lab possesses, where samples are in the process and who has touched those samples," Nelson says.

The identifier allows automation systems to error-proof the process, and it enables technicians to easily access the sample's patient data regardless of where the sample is in the process.

Lean's Role in This Process

Throughout the automation and identification process, labs have a number of improvement opportunities to make their processes more efficient, including lean. Lean is one of the most popular improvement methodologies used in today's manufacturing world, and its success is quickly being adopted by other industries including laboratories. Lean is a set of techniques used to manage a work environment by eliminating waste, (i.e., any activity that does not add value), organizing the workplace, streamlining procedures and establishing clear, visual standards.

In the laboratory, lean initiatives focus on improving safety, eliminating wasted motion, space and supplies, reducing errors and automating the specimen handling process.

"Despite the clear differences between the product and processes, lean has been proven to yield tremendous results in laboratories, including inventory reduction, shorter lead times for specimen processing, fewer defects and improved safety, to name a few," Nelson reports.

As lean continues to gain popularity, laboratories nationwide are quickly identifying many necessary improvements within their environment and processes. "Today's labs are faced with reduced budgets and fewer staff members; lean can be a successful solution for managing lab processes in a more cost-effective and safer way," Nelson maintains.

How Lean Makes a Lab More Efficient

Lean tactics create a concise, step-by-step methodology for organizing, cleaning, developing and sustaining a productive lab environment.

They include:

Remove waste: The first lean lab initiatives focus on eliminating the seven types of waste. These wastes specifically are related to transportation, inventory, motion, waiting, over production, over processing and defective product.

5S workplace organization: This Japanese concept was designed to reduce waste and optimize productivity through better workplace organization. The 5S pillars are sort, set in order, shine, standardize and sustain.

Value stream mapping: Create a map or flowchart that outlines the current state of a process in your lab, including the task, duration and deliverable of each stage. Then create a "future state map" that illustrates your ideal process. Begin to implement the improvements by slowly modifying your facility's layout, workspaces and processes as defined in the future state map.

Work cell specimen processing: Lean labs that arrange their environment into work cells can minimize movement, reduce batch sizes, decrease set up time, improve lab safety and standardize work processes to reduce errors.

At Work in the Lab

In the past, due to space constraints and more advanced laboratory equipment, lab equipment was placed wherever space was available. This often led to inefficient routing and waste. With the prevalence of informatics in the lab and bar coding capability, it is an optimal time to re-evaluate the placement and location of equipment and data capture in the process. When a specimen is bar coded with a unique identifier as it enters the lab, the identifier is tied to the specimen record in the software. At each station in the lab, the specimen bar code can be quickly scanned and automatically sent into the software, thus allowing chain of custody (knowing what specimen you have, where it is and who touched it last).

"With the advent of new equipment, along with information system software to track the specimen, a lean implementation and improved work flow can make the histology lab even more efficient; it reduces errors as well as improves technicians' safety, performance and morale," Nelson says.

The Big Picture

In histology, the goal is to present accurate answers as quickly as possible to the patient. To this end, new equipment and processes are being developed in order to process smaller, quicker batches of specimens. Bar coding relates not only to accuracy (in terms of reducing errors and accurate identification of the specimen), but also to the speed of processing. Automated scanning can immediately send the information to the software without requiring a technician's manual or time consuming data entry.

"Bar coding, single specimen handling and lean implementation will work together to complement new processes and equipment so that the entire value chain is optimized," Nelson concludes. "Time is minimized, errors are reduced and technicians' time is efficiently used." In the end, the ultimate goal of providing fast, accurate answers to doctors and patients is better achieved through implementation of automated bar code systems and lean practices.

This article is based on the National Society for Histotechnology course, "Using Automation, Bar coding and Lean to Drive Efficiency" presented by Nicole Nelson, Brady Corp. For more information on this topic, visit www.BradyID. com/lab.

Karen Appold is a medical freelance writer and editor. Visit
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Title Annotation:Article 423: 1 Clock Hour
Author:Appold, Karen
Publication:Journal of Continuing Education Topics & Issues
Date:Aug 1, 2015
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