Red Cross to Upgrade Blood Tracking, But Still UnsatisfiedBy Larry Dignan | Posted 2005-08-04 Print
The American Red Cross is still tracking its blood supply with dated bar codes. New codes are coming, but they may just be a stepping-stone to radio technology.
In the last 20 years, the American Red Cross has responded to a tsunami, terrorist attacks and numerous hurricanes. One constant: A 1980s-era bar code dubbed the "code-a-bar" on its bags of donated blood.
By August 2006, the Red Cross hopes the code-a-bar will be history. It plans to install a new bar code with a 13-digit label to compile blood-donor data, blood type, expiration date, collection facility location and lab results.
With the new bar code, which will track individual units of platelets, plasma and red blood cells, each blood donation will have a unique international identifier. Since the seven-digit code-a-bar can't hold as much information, the Red Cross uses as many as four bar codes with data such as blood type, expiration date and donor facility. Additional information, say, a C-reactive protein test, is added via a typed label.
"We need to update the bar code and system to handle more information," says Red Cross CIO Steven Cooper. "There's no room for error." Giving type A blood to a type B patient could be fatal.
Indeed, the bar-code update comes as the Red Cross' blood business is operating under an order from the Food and Drug Administration that includes financial penalties for preventable incidents such as mislabeled bags and testing failures between April 15, 2003, and April 15, 2005. According to the April 2003 decree, updated from 1993, the Red Cross failed to include a system that could track each unit of blood distributed. In a May 16 letter, the FDA notified the Red Cross it would be fined $3.4 million for 136 recalls of blood products.
So why is the Red Cross operating with 1980s-era bar codes? Regulators didn't require updated codes. A standard for a new bar code, dubbed ISBT 128, was endorsed by the American Association of Blood Banks (AABB) in July 1994, but the FDA never required adoption.
Dr. S. Gerald Sandler, director of transfusion safety at Georgetown University Hospital and vice president and chief medical officer of the Red Cross' blood services unit from 1984 to 1991, says the new bar code wasn't a major priority because the Red Cross had to revamp its manufacturing procedures to comply with the FDA decree.
Nevertheless, the new bar code is critical for what Jean Otter, director of standards and accreditation at the AABB, calls "vein to vein tracking." Since the new bar code can store more data, medical professionals will be able to reduce errors, she says.
The new bar code, however, could be just an interim step to using radio frequency tags. But the FDA hasn't approved the tags for blood products.
Stanley Roberts, vice president of business strategy for biomedical services at the Red Cross, says the new bar code will get his organization closer to the vein-to-vein vision, but RFID holds more promise. While the FDA has encouraged the use of radio technology for tracking drugs for companies such as Pfizer and Cardinal Health, the agency may not rush to use radio tags on blood bags.
"Drugs are not living tissue," Roberts says. "Do we know if radio frequency will have any effect on living cells?"
CIO Cooper's challenge is to build a system that can expand easily from bar codes to radio tags. He reckons that the Red Cross' Oracle databases will have to be rebuilt to accommodate new data, including geographic coordinates such as street address, state and nearest blood bank so supplies can be diverted in an emergency.
Another big question is how new tracking technology—whether based on bar codes or radio tags—will work once blood products are handed off to hospitals, which track bags with everything from spreadsheets to handwritten tags to bar codes.
Sandler is running two pilots with RFID vendor Precision Dynamics. One minimizes the chance that a patient will get the wrong blood in the operating room; the other tracks blood as it moves from the Red Cross to his hospital.
But for now, Sandler will live with the Red Cross' bar-code update: "It's a major advance, but it's not easy. I'll have to see what they hand to us."
Tracking Supplies 'Vein to Vein' in a Nutshell
Make do: The Red Cross relied on 1980s-era bar codes as it focused on other areas.
Get Up to Speed: A new bar code will allow the Red Cross to store more information about its blood products.
But Plan Ahead: Systems will have to be able to handle new bar codes' data and, potentially, RFID tags.
Be Patient: Implementing RFID tags for blood products will require FDA approval.
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