The Limitations of 2D Barcodes for Surgical Documentation

The Limitations of 2D Barcodes for Surgical Documentation
The Limitations of 2D Barcodes for Surgical Documentation


Shlomo Matityaho, Founder and CEO at IDENTI

As the healthcare sector embraces technology to tackle slow, time-consuming workflows, one task targeted for an innovation makeover is surgical supply data collection.

The capturing of every reportable item used in surgery is vital from a patient safety and business perspective.

In this article, we look at the evolution of surgical supply documentation tools – and in particular, assess the current transition from traditional 1D linear barcodes to 2D. 

We investigate whether the barcode upgrade will improve surgical supply chain management, and also compare it to the emerging technology of image recognition and AI.

Product data documentation during surgery

New digital tools are increasingly being used for supply chain management, in particular, to track medical devices, implants and consumables as they move through the supply chain. Asset tracking technology can be an effective way to monitor the movement of supplies, however, there is one particular healthcare setting that is known to challenge current data collection methods, and that is the point of care. 

There is pressure on healthcare providers to capture full, timely and accurate consumption data to achieve regulatory compliance. The FDA UDI regulations require all healthcare supply chain stakeholders to digitally track medical devices and implants throughout their lifecycle. Manufacturers now place encoded barcode labels on product packaging as the means of capturing item data and communicating with hospital technology to identify, track and document these items as they move through the supply chain. 

Existing data collection processes in OR procedure rooms are known to be inefficient, but this is an area that healthcare providers need to get right. Accurate surgical documentation is not just a clinical issue that enhances patient care, it is also a vital driver for efficient healthcare administration, supporting:

  • A ‘right size’ inventory’, with timely restocks and significant cost-savings 
  • Accurate charge capture and optimized medical billing and case revenue.
  • Enhanced patient safety and prompt recall management
  • Vital OR and procedural room data to support healthcare management and planning.

It’s very common to find a barcode scanning system for product usage documentation at the point of care, but there are many reported issues relating to reliability.

So, why is barcode scanning such a challenge in the surgery setting?

Barcode limitations in the surgical setting

Perioperative nurses report several issues with using 1D barcode scanning at the point of care:

  1. Readability issues – failed scans due to faulty scanners, corrupted labels, system issues, etc.
  2. Multiple barcode labels placed on all sides of the packaging confuse and require nurses to methodically scan each barcode looking for the data they require. 
  3. Missing information – when nurses can’t find all the information they need, such as the expiry date or batch number, they end up manually inputting this data into the hospital system, which is time-consuming and prone to errors. 
  4. Item missing from the system. The barcode may scan fine but if there’s no data match with the Item Master then the product cannot be identified, and the automated process breaks down.

The benefits of 2D barcodes in healthcare

2D barcodes are widely used in digital IoT applications. They are easy to identify and store all pertinent information in one place – so no need to scan multiple labels to populate all the required fields in the hospital system. 

2D codes can be scanned at any angle, and any mobile device with a barcode scanning app can be used. 

This ‘next generation’ of 2D barcodes is being heralded as the solution for simpler, more effective supply chain scanning by organizations such as GS1, which are a 2D data carrier and state, 

“… these high-capacity barcodes can also have a product’s batch or lot number, serial number, expiry date and more. With access to that data, business partners up and down the supply chain can boost transparency, improve inventory management, enable traceability and sustainability initiatives, reduce waste, and simplify recall and return processes.”

With all the fanfare over the introduction of 2D barcodes, could this upgraded technology solve the existing point-of-care data collection issues, or is barcode scanning simply the wrong technology for this setting?

The move from 1D barcodes to 2D barcodes in healthcare 

2D barcodes offer a great solution for many areas of healthcare. In terms of supply chain management, the ultimate goal is end-to-end tracking, and a crucial stage is documenting consumption. 

The point of care, however, has specific challenges: 

  1. The items used in surgery are not always stock items.
  2. ‘Bill-only’ and consignment items that aren’t pre-enrolled on the system may be used.
  3. Documentation during surgery is more likely to result in full, timely and accurate patient records, however, the priority for patient care, and the limitations of current systems, make this difficult to achieve.

When the routine recording of surgical utilization fails, organizations resort to post-surgery documentation and internal audit checks.  

The limitations of 2D barcodes at the point of care

We’ve identified the factors that make the surgery setting so problematic for product documentation, so let’s now look at how the roll-out of 2D documentation has worked in practice.

To be successfully recorded in the electronic medical record (EMR), an item needs to go through the following stages: 

Collection: Product data needs to be captured – this is commonly either manually keyed into the system, or collected by hardware, such as barcode scanners. 

Identification: Hospitals rely on their Item Master as the source of truth. Maintaining this catalog is a tough task due to the sheer volume of SKUs stored, and constant updates to item data. A further issue is the number of non-stock items used in surgery, which may not be listed at all. Where Item Master pairing isn’t achieved, a system error will be generated and the process falls. 

Documentation: Successful documentation requires the first two stages to have worked effectively – item capture and identification. Then, for efficient documentation to take place, the hospital system needs to be integrated and compatible with the data capture software. 

Although there are certainly benefits to the greater storage capacity of 2D barcodes, the complexity of managing inventory at the point of care is exposing the limitations of this system. Continuing reliance on the Item Master is the biggest negative of 2D barcodes

The barcode obsession

Every type of technology has its natural environment, the places where it thrives.

Yet barcodes have struggled in the surgery setting, so is investing in yet more 2D the answer?

Even when it was clear that a new approach was needed, the industry stuck to their barcode fixation and created a different version of the same thing. 

This inability to move on to next-generation technology reminds me of that famous Henry Ford quote, “If I had asked people what they wanted, they would have said faster horses.”

Maybe surgical data capture needs a rethink.

If you analyze the challenges experienced by healthcare providers, could other technologies improve surgical documentation? 

We think so!

In fact, we feel the time is right for healthcare providers to:

  • End their obsession with barcodes – and embrace breakthrough technology for the environments where barcode systems are not the best solution.
  • Ditch the reliance that barcode systems have on the Item Master – by using independent identification sources.

The next generation of point-of-care data capture isn’t 2D barcodes, it’s image recognition and AI technology.

A better alternative to 2D barcodes

Breakthrough technology is providing a brand-new approach to surgical data collection, making it quick and easy for nurses to capture every product used in surgery. 

Collection: Computer-vision technology ‘reads’ product packaging (the whole box or label, not just the barcode). Hand-written Implant Sheets can also be ‘read’ and digitized using computer vision sensors. 

Identification: Item identification is automated via a globally populated cloud database. All relevant details are automatically extracted, including SKU, batch number and expiry date.

Documentation: Seamless interoperability ensures 100% item and charge capture in all core systems, such as the ERP, EHR and MMIS.

The triple technology of AI, machine learning and image recognition technology transform surgical data capture into a simple 3-second task.

Image recognition trumps 2D barcodes

The point of use is a challenging environment to capture full and accurate usage data.

Image-to-data technology outperforms 2D barcode systems when it comes to documenting surgical utilization. 

It’s time to let nurses focus on patients, not products.


About Shlomo Matityaho

Shlomo Matityaho is IDENTI’s founder and CEO. He is a veteran entrepreneur in the Israeli health-tech sector, with 30 years of experience in using technology to improve operational and business processes.



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