Homogeneity...

1. Homogeneity... ...to identify entities The completion of domain specific message and document definitions by process control mechanisms: Project Idef-IS: Identification as Key for Quality Management Spital Thun-Simmental AG Dr.med. Marc Oertle Head Clinic IT Medinorma LLC Christian Hay Partner

2. Agenda IdefIS • Identifications as a Challenge: Background of Project • Path to a Solution • Standardisation with GS1 • Deployment

3. Background (3) IdefIS • Transfusion (when declared...) Switzerland and U.K. : • near miss every 340 transfusion • Full incompatibel transfusion with morbidity: 1:100‘000 • Hospital Thun 5‘100 transfusions yearly, but : every ~ 18 Month a transfusion error • Thun: März 2005-März 2006 declared events: Laboratory: 26 (wrong blood tested....) • Number of non-declared errors estimated as very important • CIRS (Critical Incident Reporting System) additionnally: 13 Declaration in 3 Months (13/46) concerning wrong Patient, medication given to wrong Patient (Hypnotika, Morphium, …), near wrong site surgery, wrong Patient to Xray examination. It is said that weekly laboratories have to eliminate samples badly identified

4. Objective: the 7 R IdefIS • Right patient • Right time • Right plan (to act): prescription e.g. • Right action • Right resource • Right person • Right place

5. Landscape impacting Idef-IS IdefIS • CIS, PIS, LIS are in place • WLAN access across all the Hospital, medical and nursing documentation electronically accessible; mobility with Laptops • Requirement for efficient, user friendly and safe System • Hospital Group with 4 Sites • No Budget

6. Pre-requisits for Idef-IS IdefIS • Existing Systems to be used • Existing identifications to be used • Standardisation of existing and new identifications to achieve uniqueness • Role based identifications; management of attributes • Generic Architecture, has to be used for all cross-matching • All Resources to be handled similarly (Staff, Patient, Material, Locations)

7. Example of blood transfusion IdefIS Accounting / re-ordering Electronic order entry Feed-Back Blood sample with reference to Patient eID-Check Transfusion Blood analysis Clearance Cross Match with Patient Blood product dispensed

8. Uniqueness: GS1 IdefIS • Standard System with set of components (GSRN, GLN, GTIN...) • Individual : Global Company Prefix • Integration of existing (non-unique) Identifications • Example: Global Service Relationship Number • 18 digits Code (numeric) • Global Company Prefix + 10 digits + check digit • GCP+ (Attribut+existing identification)+C

9. Concept IdefIS IdefIS GS1: uniqueness; attributes for roles

10. Identity Management IdefIS • GS1 • unique • Role Management • Standardisation GCP PATFID p 7601005 200 2258316 6 760100520022583166 • Identification: Who/What is it • Mapping: belongs to ? • Validiation: expiry date? • reading the 3 entities in free sequences Idef-IS Tabels

11. AIDC (Automatic Identification Data Capture) IdefIS GS1 GTIN Medication Proprietary Barcode(migration to GS1 planed) Blood sample RFID ISO 15693 Patient wristband GS1 GTIN Materials RFID ISO 15693 Badge Staff ISBT 128 Bloodproduct

12. Last but not least IdefIS Incompetent people are, at most, 1% of the problem. The other 99% are good people trying to do a good job who make very simple mistakes and it's the processes that set them up to make these mistakes. Dr. Lucian Leape, Harvard School of Public Health

13. Contact IdefIS • Dr.med. Marc Oertlemarc.oertle@spitalstsag.ch • Christian Hayhay@medinorma.ch