Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

1
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
HIBCC meeting, January 19, 2006
2
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Positive ID Agenda

• Partners Healthcare
• Partners Healthcare Signature initiatives
• PosID Goals
• PosID Target
• In the Beginningmedication errors
• PosID Development
• Team Assumptions
• Project Sequence
• Result
• Next steps
• Technical Discussion

3
Partners Healthcare

• Boston, Massachusetts
• Founding members are
• Massachusetts General Hospital
• Brigham and Womens Hospital
• - plus several other area hospitals
• Teaching affiliate of Harvard Medical School

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
4
Partners Healthcare Signature Initiatives

• Focused effort by Partners to lead cultural
  change across the healthcare system.
• Invest in methods to provide integrated care.
• Standardize additional proven best practices
• Promote technology that improves the quality,
  safety, and efficiency of care for patients

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
5
Partners Healthcare Signature Initiatives, cont

• Five System-wide projects with one common goal
• To deliver better care to patients
• Care that is
• Safer
• Better coordinated
• More reliable in delivering proven interventions
• With systems that support providers in
• doing the right thing.

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
6
Our Committees initiative

• Positive Identification for Patient Medication
  Safety
• Enhancing patient safety by reducing medication
  errors system-wide

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
7
Committee Goals

• Collect and leverage work done by others on
  Positive ID around patient safety
• Provide an outline of recommendations and
  guidelines for other entities
• Make guidelines available for vendors that want
  to work with PHS

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
8
Five Applications for Bar Codes

• Employee Badge
• Patient Wristband
• IV Medications
• Non-IV Medications
• Patient Care Devices (monitors, pumps)

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
9
In the beginningmed errors

• Tale of two IV pumps. The start of MGH Pharmacy
  IV bar code programming.
• Evolution to the concept of IV pump library to
  both check and enforce guidelines.
• Then.SmartIV

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
10
Development Definitions

• POSITIVE ID at PHS
• (a) irrefutable, certain identification and
  data transmission system
• (b) Standardized system focused on PHS Medication
  Safety
• 1D / 2D
• 1D requires connected central lookup system
• Data payload 2Dgtgt1D
• 15 characters vs 180 characters
• DATA
• Usable, interpretable

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
11
Team Starting Assumptions

• Not all PHS sites have real time wireless
  connectivity
• Connectivity not always 24/7/365
• PHS entities wont have all back end systems in
  place simultaneously
• Mandates/Benefits are real!

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
12
Team Starting Assumptions (2)

• Only one bar code per drug package !
• Only one handheld scanner per caregiver !
• Scan-ability/patient impact are primary
  concerns
• Ease of use reduced training cost
• Enhancements driven by patient care
  considerations
• Immediate caregiver benefits will speed adoption
• Automated documentation
• Intuitive device connectivity
• Automated drug recognition
• Improved patient safety

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
13
Project Sequence

• UHC Tech Report used as a starting point
• Bar Coded Medication Administration
• Detailed Recommendations
• Prior PHS projects / research used and
  revalidated
• Visits and interviews of all PHS hospitals
• Draft of Standard
• Validation of concepts with participants
• Executive presentation to Chief Nursing Officers
• Use by vendors

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
14
Result

• PHS Positive ID Standard
• Choose data elements that will be in bar code
• identify minimum data
• Standard and economic structure for data in the
  bar code so it can be read easily by various
  applications
• Provide extensibility
• Ensure patient care continuity even when network
  is down
• Permit point-to-point Communication between
  patient care devices
• Foundation for migration
• KEEP IT SIMPLE

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
15
Next .

• At the point of critical mass - strong need has
  been expressed on many fronts
• Recognition of the value of open standards
• Need the help and guidance of HIBCC for next
  steps in definition and adoption of Positive ID.
• Draw on the HIBCC standards expertise

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
16
Introduction to Patient Positive ID

• Presented by the principal architect and author
• Harry Manolopoulos
• - IT Management
• - Consultant to Partners Healthcare Signature
  initiatives
• - Former HIBCC member and Committee Chairperson

Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
17
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Scope

• Employee Badges
• Patient Wristbands
• IV Medications
• Non-IV Medications
• Device License Plates
• Blood Products (Future)

18
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Design Goals

• The interface message structures should be
  extensible to provide additional information
  functions as the capabilities of information
  systems expand.
• The interface should support versioning and be
  backwards compatible with earlier versions where
  possible.

19
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Design Goals

• Message components should be optional and
  combinable to provide a range of protocol
  options.
• The interface should include standard definitions
  for data elements.
• The message structures should be clearly
  discernable from the other information.

20
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Design Goals

• The message structures should provide the ability
  to identify the issuing provider within a
  provider network.
• The message structures should be designed to
  result in a very compact symbol.

21
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Design Goals

• In some cases, the symbol may include information
  for different purposes in concatenated messages
  structures and each message structure and its
  purpose should be clearly discernable.

22
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Message Structure

• Messages are comprised of tags bracketing
  sections (similar to XML and HTML) and three
  letter record identifiers with pipe field
  delimiters (similar to HL7).
• Records are constructed with mandatory data
  occurring first, most likely used data next and
  rarely used data last. This optimizes the record
  size for the shortest length.
• Trailing empty fields and delimiters may
  be omitted from the data. (shorter message more
  compact symbol)

23
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Message Structure

• Line Terminators (Record Separators) are Line
  Feed characters. LF
• Symbol data may contain multiple messages.

24
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Message Structure

• Sample Message
• ltSEIDgtLF
• ltSEIDgt Tag indicates the start of Employee
  Badge Data
• ltEIDgtLF
• ltEIDgt Tag indicates the start of an EID
  message
• VER1.0LF
• VER version record
• EIIMGH3457824445556LF
• EII record, Issuing entity, Badge ID, Employee
  ID
• EI2ManolopoulosHarryQLF
• EI2 record, Employee Last Name, First name,
  M.I.
• lt\EIDgtLF
• lt\EIDgt End Tag completes the EID message
• lt\SEIDgtLF
• ltSEIDgt Tag indicates the end of Employee Badge
  Data

25
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Employee Badges

• Basic Information
• Issuing Entity
• Badge ID
• Employee ID(Issuing Entity) and Badge ID are
  the primary identifiers for systems. Lost badges
  are easily deactivated and replaced without
  affecting HR and other systems using the Employee
  ID
• Secondary Information
• Employee Name

26
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Employee Badges

• Sample Data Message
• ltSEIDgt
• ltEIDgt
• VER1.0
• EIIMGH3457824445556
• EI2ManolopoulosHarryQ
• lt\EIDgt
• lt\SEIDgt
• Version 1.0
• Issued By MGH
• Badge ID 345782
• Employee ID 4445556

27
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Patient Wristbands

• Basic Information
• Issuing Provider
• Patient ID
• Date Of Birth
• Gender
• Visit Number / Band Number
• Admit or Visit Date
• Secondary Information
• Patient Name
• Admitting Physician ID and Name

28
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Patient Wristbands

• Sample Data Message
• ltSPIDgt
• ltPIDgt
• VER1.0
• PII210555919671211FMGH120060119
• PI2TestpatientMargarette
• PHY612GooddoctorLesterJ
• lt\PIDgt
• lt\SPIDgt
• Version 1.0
• Issued By MGH
• Patient ID 2105559 DOB 12/11/1976 Gender F
• Visit 1st on 01/19/2006 Admit Physician 612
  Lester J. Gooddoctor

29
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
IV Medications

• Intended for use with Smart infusion pumps
  containing drug libraries.
• Includes patient information, drug identification
  and order administration (delivery)
• Can Check
• Right patient
• Known drug (in drug library) / Right Drug
• Safe dose (per drug library)
• Right Time (scheduled dose modes)
• Authorized Override of medication limits

30
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
IV Medications

• Basic Information
• Patient Information
• Care Area and Indications
• Drug Identification for Primary Additive
• Primary Additive Final Concentration
• Secondary Information
• Delivery Rate
• Scheduled Dose Modes
• MFGd for another provider xref

31
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
IV Medications

• Secondary Information
• Dose Tracking
• Inventory
• Recipe Style Additives and Diluent Info
• Custom Messaging
• Patient Clinical Advisories
• Administration Information
• Set Care Area
• Alarm Points
• Set Override Codes / Badge IDs
• Library ID for Drug Library check

32
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
IV Medications (SmartIV)

• Sample Message
• ltSmartIVgt
• ltORDERSgt
• VER1.3
• CARICUCARD
• PID210559TestpatientMargaretteF1967121139Y
  R
• DID644345Framicil2mg1ml
• VTI644345300ml
• VDR6443453mlHR
• lt\ORDERSgt
• lt\SmartIVgt

33
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
IV Medications

• Sample Message
• ltSmartIVgt
• ltORDERSgt
• VER1.3
• CARICUCARD Care Area ICU Cardio
• PID210559TestpatientMargaretteF1967121139Y
  R
• Patient ID, Name, Gender, DOB and Age
• DID644345Framicil2mg1ml Drug ID, Name,
  Final Conc.
• For Primary Additive
• VTI644345300ml Total Volume to be Infused
• VDR6443453mlHR Volume Delivery Rate
• lt\ORDERSgt
• lt\SmartIVgt

34
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
IV Medications

• Sample Message
• ltSmartIVgt
• ltORDERSgt
• VER1.3
• CARICUCARD Care Area ICU Cardio
• PID210559TestpatientMargaretteF1967121139Y
  R
• Patient ID, Name, Gender, DOB and Age
• DID644345Framicil2mg1ml Drug ID, Name,
  Final Conc.
• For Primary Additive
• VTI644345300ml Total Volume to be Infused
• DDR6443453mgHR Drug Units Delivery Rate
• lt\ORDERSgt
• lt\SmartIVgt

35
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
IV Medications

• Work In Progress
• VTBI Equivalent for drug units
• PCA
• Best Practices Drug Libraries

36
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Non-IV Medications

• Primarily intended for use when repackaging
  medications in order to provide unit of use or
  ordered dose auto-id labeling.
• Supports a tagged (wrapped) and untagged
  (unwrapped) message structure to minimize symbol
  size.

37
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Non-IV Medications

• Basic Information
• NDC
• Provider Drug Alias
• Lot Number
• Dose Amount and Units Of Measure
• Expiration Date
• Protocol Number for investigational drugs
• Dose Form and Dose Route
• DrugName
• Bottle ID

38
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Non-IV Medications

• Secondary Information
• Patient Identification
• MFGd for another provider xref LotNumber

39
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Non-IV Medications

• Sample Message
• ltSDIDgt
• VER1.2
• DIL368004326230123456784555A3456130mg2007121
  2PillOral
• Pseudoephedrine HCL 30 mg
• lt\SDIDgt
• NDC 3680043262
• DrugAlias 3012345678
• LotNumber 4555A34561
• Amount 30
• AmountUnitsOfMeasure mg
• Expiration Date 2007/12/12 December 12th, 2007
• Protocol Number none
• Dose Form Pill
• Dose Route Oral
• DrugName Pseudoephedrine HCL 30 mg
• BottleID 123

40
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Non-IV Medications

• Work In Progress
• Order Administration like SmartIV
• (give instructions, times, etc.)

41
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Device License Plates

• Primarily intended to identify a device for
  association with another device or patient.
• Basic Information
• Type of Device (IV Pump, Vital Sign Monitor, etc.
• Manufacturer
• Model Number
• Serial Number

42
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Device License Plates

• Sample Data Message
• ltDEVgt
• DEV01SIGMASPECTRUM700188
• lt\DEVgt
• SIGMA IV Pump
• Model SPECTRUM
• Serial Number 700188

43
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Device License Plates

• Work In Progress
• IDs for Bluetooth association
• Communication Protocols information
• Inventory and Asset tracking

44
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications
Current Use of Spec

• DELTEC CADD-PRIZM II pump implements basic
  SmartIV.
• SIGMA Spectrum to implement in 2006
• MEDEX to adopt 06/07
• MISYS Pharmacy utilizes MiSim MLPS on Intermec
  printers to enable SmartIV symbol generation by
  printer middleware.
• ALARIS uses MiSim in clinical trials of their
  interface.
• FDA interested in working with team on Device
  License Plates.
• Codecorp CR3 scanner with display PosID decoder
  under development.
• Public Review

45
Positive Identification for Patient Medication
SafetyAuto-Id Interface Specifications