By Gary Wolfe

Using bar code technology and wireless networking, McKesson's Horizon MobileCare Phlebotomy helps laboratories ensure positive patient identification from the time a physician orders a test to the time a specimen is collected at the patient's bedside and then processed in the laboratory.

Misidentification of patients, specimens, and laboratory test results ranks high among the most worrisome procedural errors that have historically plagued the medical community and compromised patient safety. All too often, the news media seem to focus on yet another episode in which an inadvertent mix-up of patient data has led to a medical calamity that, in hindsight, should have been easy to avoid.

Patient identification problems in point-of-care settings typically arise from simple human error when reading, entering, matching, and routing patient-related data by manual methods involving handwritten or printed notes, labels, and paper forms. Staff shortages and heavy workloads in hospital laboratories, common in many health care institutions today, only increase the likelihood of such errors.

Preventing patient misidentification is the driving force behind the creation of the Horizon MobileCare Phlebotomy, an add-on module for the McKesson Information Solutions’ Horizon Lab laboratory information system (LIS). A comprehensive, integrated, enterprise-wide solution currently used in a variety of laboratory settings, Horizon Lab automates laboratory processes and workflow, facilitating such activities as specimen ordering and routing, medical necessity checking, and result reporting and tracking.

According to Jeff Watson, MBA, MT (ASCP), director of marketing for Horizon Lab Products, “The MobileCare Phlebotomy employs a combination of bar code reading, wireless computer networking, and workflow automation technologies to provide hospital laboratories with error-free, pre-analytic tracking and positive matching of patients, specimens, and test results in real time.”

Through its integration with Horizon Lab, says Watson, MobileCare Phlebotomy can help ensure CAP and JCAHO compliance by providing positive patient identification; by following a process for accurate, consistent capture and documentation of collector’s identity, date, and time for all specimens; by providing a definitive audit trail; by enhancing specimen tracking; and by facilitating turnaround studies.”

Advantages for Centralized Collection Applications
When patients are admitted, many health care facilities attach bar-coded wristbands, which remain in place until the patients are discharged. Watson explains that the Horizon MobileCare Phlebotomy uses the bar code to ensure positive patient and specimen identification before laboratory technicians or other health care professionals obtain specimens for tests.

The user employs a wireless handheld device with an integrated bar code reader to scan the bar codes on the patient’s wristband and on a preprinted laboratory label for each test request. The user can also enter special notes (using canned routines or freehand entries) to denote such factors as problems getting a sample, the unavailability of a patient at the scheduled test time, a patient's refusal to allow a sample collection, cancellation of a test by the attending physician, and so on.

Once the data is acquired and updated on the wireless device, the user simply presses a button to transmit it back automatically to the Horizon Lab LIS server via the hospital’s 802.11B secure wireless network, and the data management loop is closed. The date and time on the handheld device always default automatically to the current date and time of the Horizon Lab server, ensuring temporal consistency throughout the system.

Advantages for Decentralized Collection Applications
In situations where nursing staff or other patient care technicians must perform phlebotomy as well as their other duties, MobileCare Phlebotomy proves advantageous because it frees them from manual specimen recording and automatically transmits information back to the laboratory, according to Watson. After collection, specimens can be sent to the laboratory via a hospital transport system with the confidence that all specimens and patients are correctly matched. Nurses and other clinicians never need to leave their assigned units and therefore have more time to spend on patient care.

Watson notes, “One of the added advantages of MobileCare Phlebotomy is that, when being used by nurses, it can also facilitate the error-free dispensing of medication since the same handheld device can also run Horizon AdminRx, McKesson’s medication administration product.”

How the MobileCare Phlebotomy Is Deployed
The handheld device on which the MobileCare Phlebotomy is deployed is a Symbol Technologies Pocket PC. The number of devices used will vary according to individual hospital and laboratory requirements. Each device runs a modified version of Microsoft Pocket Internet Explorer: the McKesson Web Browser, which was developed as a graphical user interface (GUI) for this application. The bar code reader can scan all popular bar code symbologies now used in hospitals.

The Web browser code is currently supported only on the Symbol Pocket PC. However, Watson says McKesson has plans to roll it out to other bar code reader-equipped, handheld, and mobile products in the future. The current version of MobileCare Phlebotomy is not compatible with Palm or other handheld device operating systems.

Once the user scans the bar codes on the wristband and the label, the patient name and test are matched to an electronic list, which reads out on the handheld device’s display screen and indicates all patients who require specimen collection. “In this manner,” says Watson, “the user instantly achieves a three-way match, correctly associating the patient, the test request, and the collection time.”

A Secure System
The Horizon MobileCare Phlebotomy incorporates a variety of features that ensure patient privacy and maximize data security in accordance with HIPA requirements. “For example,” says Watson, “the product automatically captures and tracks the phlebotomist’s identification from user-specific bar codes that must be scanned before using the device. As long as the proper protocols are followed, multiple authorized personnel may share a single device at various times during their rounds. There is no need to dedicate individual devices to each staff member.”

If the device is not used within a predefined time frame, it automatically logs itself off the network. “Moreover,” says Watson, “information placed into the device’s memory is volatile. So, if someone carries the handheld device outside the range of the hospital’s wireless network for any reason, all stored data is lost and the unit is unusable until it is reinitialized within the boundaries of the wireless network.”

Training, Availability, Pricing
“Using the MobileCare Phlebotomy is very intuitive,” says Watson. “Training takes only about 15 minutes.” Onboard diagnostics automatically alert the user in case of problems with the handheld device, and context-sensitive help is provided to aid troubleshooting.

The initial release of Horizon MobileCare Phlebotomy is compatible only with McKesson’s existing Horizon Lab LIS. Presuming that Horizon Lab is already running, MobileCare Phlebotomy will run on the existing application server and wireless network server equipment, with the addition of an appropriate number of Symbol Technologies handheld wireless devices, which McKesson resells. Pricing varies according to individual institutional requirements for software, hardware, and implementation services. In the future, McKesson plans to offer a similar add-on module to facilitate the administration of blood transfusions.

For more information contact McKesson Information Solutions, Alpharetta, GA; Tel: 1-800-981-8601; http://infosolutions.mckesson.com

Gary Wolfe is a contributing writer for Clinical Lab Products.