Athough moving at a glacial pace, widespread implementation of bedside bar-code medication administration is inevitable, according to industry analysts. They base that prediction on three factors:

• Powerful players, such as the Food & Drug Administration and the Joint Commission on Accreditation of Healthcare Organizations, are demanding it.
• The technology costs much less than computerized physician order entry (CPOE) systems, and its effectiveness as a patient safety device is well established.
• The technology is increasingly sophisticated and readily integrated with medical administration records (MARs) and electronic medical records.

"Virtually everyone is gearing up for it," said Mark Neuenschwander, president of The Neuenschwander Co., technology consultants in Bellevue, Wash. "By most accounts, the best-of-breed vendors are reporting a significant increase in orders for bedside scanning [technology]."

The number of hospitals implementing what the Healthcare Information and Management Systems Society (HIMSS) calls "bar-code-enabled point of care" (BPOC) remains small, however. Neuenschwander estimates that only about 5% of the nation's approximately 4,900 community hospitals have implemented the technology. One reason is that the drug manufacturers are only now beginning to mark their products with bar codes. Another is cost: Bar-coding might cost less than CPOE, but it isn't inexpensive.

That's all changing, however, as the FDA and JCAHO push for and companies develop BPOC products that can be integrated with other patient-safety and administrative services. The cost of BPOC implementation varies widely, but most estimates place it between $500,000 (for a very small hospital) and $3 million. That includes scanning devices and the computer technology necessary to integrate a pharmacy's MARs, blister packs, patient information, and administering nurse data, according to Neuenschwander and others. The investment is mitigated by three factors:

• Some of the computer technology used in bar-code scanning systems may already be owned by a hospital as part of its medication distribution system.
• Implementation takes a matter of months, not years, as it does for CPOE.
• Bar-code technology does not readily become obsolete.

"Bar-code technology complements other valuable technology, such as electronic medical records," said Michael Wisz, VP of product management for Bridge Medical, a best-of-breed manufacturer. In June, Bridge signed an agreement to be purchased by Cerner Corp., another manufacturer of integrated patient-safety products. "And many of the incremental purchases in this technology are usable by other applications, such as wristbands, for a range of services," he said.

In addition to the fact that new FDA and JCAHO requirements make BPOC a good idea, it's a solid business decision, say analysts. According to an HIMSS report titled "Implementation Guide for the Use of Bar-Code Technology in Healthcare," bar-coding helps avert costs associated with medication, blood transfusion, and laboratory specimen collection errors.

The average cost of a harmful medication error is $4,600, according to HIMSS, and the average amount of a medication error malpractice award is between $363,000 and $668,000. When the FDA proposed the bar-code rule in 2003, the agency estimated the average direct cost of an adverse drug event at $2,257 and ADEs at 28.4 a year, on average, for each hospital. "If each harmful medication error costs $4,600, bar-coding at the bedside may avert millions of dollars in losses each year," according to HIMSS.

"Many elements are coming together to make this technology a powerful force in patient safety," said Mary Beth Navarra, R.N., VP and patient safety officer for McKesson Provider Technologies, another leading manufacturer of integrated bar-code technology. "The ability to verify in real time the appropriateness of a medication at bedside is now seen as a potentially invaluable technology."

In fact, BPOC is just one element of the possible value of bar-coding, said Keith Scheckelhoff, McKesson's VP for medication safety solutions. "The FDA mandate helps in many ways, but it affects only unit doses," he said. "The value of bar-code technology lies also in its ability to help manage inventory and help pharmacists accurately fill prescriptions."

Vendors such as McKesson and Bridge sell an entire suite of bar-code related products. McKesson's integrated bedside bar-coding product is named Medication Safety Advantage and is typical of best-of-breed offerings, according to Neuenschwander. It integrates with the company dispensing system, which features a robotic element capable of reading bar codes.

"For many of the major companies, bar-code technology is an extension of their other product lines," said Neuenschwander, whose report, titled "To the Bedside," takes a detailed look at bedside bar-code technology. "Cerner, for example, added Bridge because it provided a bedside bar-code component to its product offerings. I don't anticipate a lot of consolidations of this type, however, because most of the major players have or are in the process of developing integrated systems."

According to Michael R. Cohen, R.Ph., president, Institute for Safe Medication Practices, Huntingdon Valley, Pa., if a hospital hasn't yet begun adopting bar-coding technology, or at least developed an adoption strategy, now is the time. "It should quickly become educated about available technology and the benefits it brings," he said.

Bar-coding technology has advantages related to inventory control as well as to safety. In addition to the National Drug Code number, manufacturers could also include lot numbers and product expiration dates. The FDA estimated it would cost manufacturers $50 million to add bar codes to packaging and would cost the hospital industry $7.2 billion to install bar-code scanners and other technology. That's obviously a lot of money, said Kenneth Kizer, who introduced the bar-code system to the Veterans Health Administration, which he ran during the Clinton Administration; he now runs the National Quality Forum. "The rule is long overdue," he said. "It is unfortunate that health care has been so far behind in terms of using new technologies. Bar-coding has a proven track record for saving lives."