Some More Input - How to Integrate Scanner Systems Into Your Sim Program

03/09/2016

Blog post by SimGHOSTS President Scott Crawford.

“Human Factors” is a term cited frequently in relation to simulation and technology integration.  Most simply, this refers to any interaction a human has with a piece of technology. It can be thought of in many ways as ergonomics.  The ideal product would work seamlessly and intuitively to serve its purpose, so that interaction with it feels like an extension of one’s own body.

For most people born in the 1980s, the mouse fits these requirements, as does the “pinch and zoom” to control a tablet or phone  for people raised in the early 2000s. Prior to these two defining eras, the keyboard – still essentially unchanged from the 1890s (Stamp, 2013) – is the primary interface for text and data entry. I hope to describe some of the newer tools and products available in this realm and how they may present in the world of healthcare and simulation.

The bar code scanner, first used in 1974 to ring up a pack of gum in a Chicago supermarket (Hirst, 2014) ,allows the automated entry of alphanumeric characters in a similar manner to a keyboard. Instead of individually typing the characters, an infrared emitting “gun” copies a sequence of vertical bars that corresponds to individual characters, and transcribes them as text on a computer. The bars vary in width and spacing to represent different characters. This system is most commonly encountered now for inventory and tracking or copying a single unique identifier such as serial number or medical record number into a database for verification. The limitation of this system is that it only reproduces previously defined character codes. Twenty-six individual such character bar codes, one for each letter of the alphabet, could be arranged to allow free-text data entry, but this would be inefficient given other methods for character input.

 

An extension of these one-dimensional barcode systems into a more complex two-dimensional barcode system began in 1987. Many types of 2-D barcodes are now present, but the most well-known by smart-phone users is called a quick response (QR) code. This code uses a characteristic pattern of boxes in a grid with three corners different from the fourth to allow orientation of the image by the scanner. The number of squares and the size of the grid can vary and determine the number of characters that can be enumerated within the code. 2-D barcode scanners are now present in many hospital identification systems and are used to track medication administration to ensure safety of dispensing.

Two more systems with very similar outcomes are magnetic card readers and radio-frequency (RF) identification readers. Both of these systems, much like the aforementioned barcode scanner, provide a way to quickly reproduce a stored string of characters. Still, no free-form typing is allowed, but problems like scuffed labels or stray pen marks will not obscure the data like in a barcode. Magnetic strips on the back of credit cards or identification cards contain one or more lines of text, with specific character codes to delineate the stored data. For example, a name like Scott Crawford might appear as <<Scott Crawford>>. The “<<” and “>>” allow computer programs to parse the text field even if many pieces of data are contained in the same string of text.

RF code readers and the associated paired data-containing card or fob (no, it is actually not an acronym), rely on a coil of wire wrapped in such a way as to vibrate in response a radio frequency applied to it.  The corresponding induced vibration is then detected as a unique pattern that is identified again as a stored string of alpha-numeric codes. This allows these tags to work without line of sight, direct contact or the need for a contained battery. The benefit of this type of system in the healthcare field is still growing; think about your pet with a microchip implanted in its neck. RF-ID technology makes inventory tracking and product locating much easier, since multiple items can be scanned at one time, even while still in the box or body.

Barcode scanners, RF readers and magnetic card readers are all available to consumers for $50-$200 and are a great way to ensure consistent entry or product information, login credentials or patient identification. Understanding how these systems work will allow you to better utilize and implement the technology to suit the needs of your center and your learners. All of these systems can be integrated, often without the need for additional software, using a standard universal serial bus (USB) interface and therefore will work with Macintosh, Windows or Linux devices.

Here is an example of how this technology might work in the simulation or hospital setting:

A prescription drug dispensing system like a Pyxis or MedDispense unit may use an RF login device or magnetic card reader to speed entry of an identification code. The label on the medication can then be entered using a barcode scanning gun and the patient who is to be the recipient will have a medical record bracelet that is also scanned using a barcode scanner by a laptop at bedside. This combination of entry devices helps to limit mistyping by only using pre-recorded information and an error will be present if any information does not match, further ensuring the delivery of safe patient care. Beginning the practice of using these devices during training will make them second nature in the hospital environment.

Advances in touch-sensitive detectors have allowed tablet and phone screens, now ubiquitous in the consumer electronics world, to have more than one touch location identified at a single time. This type of interface has allowed track-pads on laptops to mimic the interface on phones and touch-screen monitors to blur the lines between tablet and computer. Patient monitors now in the hospital and the simulation environment allow users to work on the display rather than a surrogate interface device. Given the push from major operating system manufactures and existing medical equipment suppliers, I feel touch screen devices, at least within reach of the learner, should be moved into the simulated environment.

Patient care does not occur with a mouse and keyboard, but data input is an integral part of safe patient care.

 

Bibliography
Hirst, E. J. (2014, June 24th). 40 years ago today: Wrigley gum the first product to have its bar code scanned. Chicago Tribune.
Stamp, J. (2013, May 3). Fact of Fiction? The Legend of the QWERTY Keyboard. Smithsonian Magazine.