Positive Identification for Patient Medication Safety AutoId Interface

Positive Identification for Patient Medication Safety Auto-Id Interface Specifications HIBCC meeting, January 19, 2006

Positive ID Agenda • • • Partners Healthcare Signature initiatives Pos. ID Goals Pos. ID Target In the Beginning…medication errors Pos. ID Development Team Assumptions Project Sequence Result Next steps Technical Discussion Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Partner’s Healthcare Boston, Massachusetts Founding members are • Massachusetts General Hospital • Brigham and Women’s Hospital - plus several other area hospitals Teaching affiliate of Harvard Medical School Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

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 Safety Auto-Id Interface Specifications

Partners Healthcare Signature Initiatives, con’t Five System-wide projects with one common goal : To deliver better care to patients • Care that is: üSafer üBetter coordinated üMore reliable in delivering proven interventions • With systems that support providers in “doing the right thing. ” Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Our Committee’s initiative: Positive Identification for Patient Medication Safety Enhancing patient safety by reducing medication errors system-wide Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

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 Safety Auto-Id Interface Specifications

Five Applications for Bar Codes • Employee Badge • Patient Wristband • IV Medications • Non-IV Medications • Patient Care Devices (monitors, pumps) Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

In the beginning…med 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…. Smart. IV Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Development “Definitions” • “POSITIVE ID” at PHS – (a) ‘irrefutable, certain’ identification and data transmission system – (b) Standardized system focused on PHS Medication Safety • 1 D / 2 D – 1 D requires “connected” central lookup system – Data payload 2 D>>1 D • 15 characters vs 180 characters • DATA – Usable, interpretable Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Team Starting Assumptions • Not all PHS sites have ‘real time’ wireless connectivity • Connectivity not always 24/7/365 • PHS entities won’t have all ‘back end systems’ in place simultaneously • Mandates/Benefits are real! Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

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 Safety Auto-Id Interface Specifications

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 Safety Auto-Id Interface Specifications

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 Safety Auto-Id Interface Specifications

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 Safety Auto-Id Interface Specifications

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 Safety Auto-Id Interface Specifications

Scope • • • Employee Badges Patient Wristbands IV Medications Non-IV Medications Device License Plates Blood Products (Future) Positive Identification for Patient Medication Safety Auto-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. Positive Identification for Patient Medication Safety Auto-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. Positive Identification for Patient Medication Safety Auto-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. Positive Identification for Patient Medication Safety Auto-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. Positive Identification for Patient Medication Safety Auto-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 HL 7). • 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) Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Message Structure • Line Terminators (Record Separators) are Line Feed characters. [LF] • Symbol data may contain multiple messages. Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Message Structure Sample Message: <SEID>[LF] <SEID> Tag indicates the start of Employee Badge Data <EID>[LF] <EID> Tag indicates the start of an EID message VER|1. 0[LF] VER version record EII|MGH|345782|4445556|[LF] EII record, Issuing entity, Badge ID, Employee ID EI 2|Manolopoulos|Harry|Q|[LF] EI 2 record, Employee Last Name, First name, M. I. <EID>[LF] <EID> End Tag completes the EID message <SEID>[LF] <SEID> Tag indicates the end of Employee Badge Data Positive Identification for Patient Medication Safety Auto-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 Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Employee Badges • Sample Data Message: <SEID> <EID> VER|1. 0 EII|MGH|345782|4445556| EI 2|Manolopoulos|Harry|Q| <EID> <SEID> Version 1. 0 Issued By: MGH Badge ID: 345782 Employee ID: 4445556 Positive Identification for Patient Medication Safety Auto-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 Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Patient Wristbands • Sample Data Message: <SPID> <PID> VER|1. 0| PII|2105559|19671211|F|MGH|1|20060119| PI 2|Testpatient|Margarette| PHY|612|Gooddoctor|Lester|J| <PID> <SPID> Version 1. 0 Issued By: MGH Patient ID: 2105559 Visit: 1 st on 01/19/2006 DOB: 12/11/1976 Gender: F Admit Physician: 612 Lester J. Gooddoctor Positive Identification for Patient Medication Safety Auto-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 Positive Identification for Patient Medication Safety Auto-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 – MFG’d for another provider xref Positive Identification for Patient Medication Safety Auto-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 ID’s Library ID for Drug Library check Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

IV Medications (Smart. IV) • Sample Message: <Smart. IV> <ORDERS> VER|1. 3| CAR|ICU|CARD| PID|210559|Testpatient|Margarette||F|19671211|39|YR| DID|644345|Framicil|2|mg|1|ml| VTI|644345|300|ml| VDR|644345|3|ml|HR| <ORDERS> <Smart. IV> Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

IV Medications • Sample Message: <Smart. IV> <ORDERS> VER|1. 3| CAR|ICU|CARD| Care Area: ICU Cardio PID|210559|Testpatient|Margarette||F|19671211|39|YR| Patient ID, Name, Gender, DOB and Age DID|644345|Framicil|2|mg|1|ml| Drug ID, Name, Final Conc. For Primary Additive VTI|644345|300|ml| Total Volume to be Infused VDR|644345|3|ml|HR| Volume Delivery Rate <ORDERS> <Smart. IV> Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

IV Medications • Sample Message: <Smart. IV> <ORDERS> VER|1. 3| CAR|ICU|CARD| Care Area: ICU Cardio PID|210559|Testpatient|Margarette||F|19671211|39|YR| Patient ID, Name, Gender, DOB and Age DID|644345|Framicil|2|mg|1|ml| Drug ID, Name, Final Conc. For Primary Additive VTI|644345|300|ml| Total Volume to be Infused DDR|644345|3|mg|HR| Drug Units Delivery Rate <ORDERS> <Smart. IV> Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

IV Medications • Work In Progress: VTBI Equivalent for drug units PCA Best Practices Drug Libraries Positive Identification for Patient Medication Safety Auto-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. Positive Identification for Patient Medication Safety Auto-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 Drug. Name Bottle ID Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Non-IV Medications • Secondary Information: – Patient Identification – MFG’d for another provider xref Lot. Number Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Non-IV Medications • Sample Message: <SDID> VER|1. 2| DIL|3680043262|3012345678|4555 A 34561|30|mg|20071212||Pill|Oral| Pseudoephedrine HCL 30 mg| <SDID> NDC: 3680043262 Drug. Alias: 3012345678 Lot. Number: 4555 A 34561 Amount: 30 Amount. Units. Of. Measure: mg Expiration Date: 2007/12/12 – December 12 th, 2007 Protocol Number: none Dose Form: Pill Dose Route: Oral Drug. Name: Pseudoephedrine HCL 30 mg Bottle. ID: 123 Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Non-IV Medications • Work In Progress: Order Administration like Smart. IV (give instructions, times, etc. ) Positive Identification for Patient Medication Safety Auto-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 Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Device License Plates • Sample Data Message: <DEV> DEV|01|SIGMA|SPECTRUM|700188| <DEV> SIGMA IV Pump Model SPECTRUM Serial Number 700188 Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Device License Plates • Work In Progress ID’s for Bluetooth association Communication Protocols information Inventory and Asset tracking Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Current Use of Spec • DELTEC CADD-PRIZM II pump implements basic Smart. IV. • SIGMA Spectrum to implement in 2006 • MEDEX to adopt 06/07 • MISYS Pharmacy utilizes Mi. Sim MLPS on Intermec printers to enable Smart. IV symbol generation by printer middleware. • ALARIS uses Mi. Sim in clinical trials of their interface. • FDA interested in working with team on Device License Plates. • Codecorp CR 3 scanner with display Pos. ID decoder under development. • Public Review Positive Identification for Patient Medication Safety Auto-Id Interface Specifications

Positive Identification for Patient Medication Safety Auto-Id Interface Specifications