Recommendations on the use of GLNs in NHS Trusts

Transcription

1 Recommendations on the use of GLNs in NHS Trusts 1. Background This report is the final deliverable of the Use of GLNs in NHS Trusts project as described in the GS1 UK Technical Services for DH ID proposal. It is based on the results of a survey of NHS Trusts and suppliers as summarised in the report Locations in NHS Hospitals dated 11 December Executive Summary Location information is required by many separate functions within a Trust. Currently each function tends to develop its own approach to location information geared to its own specific requirements; this has led to separate, uncoordinated approaches to identifying locations within Trusts which do not always make a clear distinction between physical locations and organisation entities. As Trusts develop integrated applications and technologies which cross departmental and functional boundaries this silo approach will cause problems. For example bar codes or RFID tags on physical locations could be used by a wide variety of applications including medical physics, bed management, materials management and estates management. A common location identifier usable by all applications will become increasingly important. GS1 GLNs provide the best option for a common location identifier which is suitable for all existing Trust applications. GLNs are supported by the ISB, are low cost and are flexible enough to support all relevant Trust applications. (See section 6.1 GS1 GLNs) In addition because GLNs are globally unique they can also be used directly by suppliers to NHS Trusts with consequent savings in administration and reduction in errors. Other location identifiers currently in use in Trusts have been designed for specific applications and cannot support the wide variety of applications found in a Trust. It is recommended that Trusts adopt GLNs for both physical locations and organisation entities and should provide information about the GLNs to their suppliers in electronic form, ideally through an online GLN registry. In the short term any Trust planning to bar code or tag physical locations should use a GS1 GLN in a GS1 compliant bar code or RFID tag. A draft road map for how GS1 GLNs could be introduced is provided in section 9 The Road Map. A key element of the road map is to create a steering group of Trusts and suppliers to provide advice and support. 3. The need for location identification Unambiguous identification of physical location within a hospital is required for the following reasons: Infection control Adverse events Rapid Response Procurement Emergency Medical equipment Asset Register information about where patients have been. This information needs to be accurate even when wards and clinics move physical location. information of where patients have been treated (and by whom). This information needs to be accurate even when wards and clinics move physical location. crash teams need accurate clear information of where the patient is located. procurement need to have clear information of the physical location to which incoming supplies should be delivered as well as the budget code to which they should be allocated. fire departments and other emergency services need clear information about where the emergency is located and linking that to information about potential hazards such as gas canisters. medical engineering need to know where equipment is located so they can carry out maintenance. Clinical staff needs to know where to find equipment for patient care. finance needs to know where assets are located as well as to which budget code they are allocated.

2 Maintenance Contracts general staff need to include location information when reporting faults, equally maintenance staff need to record the location of work planned and carried out. Need to clearly identify buildings and land referred to in contracts related to leases, rents, covenants etc. 3.1 Types of location identifier The application areas listed above may need to identify a. the organisation or department, for example for allocating costs. b. the physical location in which the organisation or department is located, for example for recording maintenance activity. For example in procurement a porter may be asked to Please take this delivery to Ward 10 regardless of where it happens to be physically located in the hospital at present. While a maintenance engineer might be asked to Please go to room 25 regardless of what it is currently used for and carry out a check on the air conditioning. These two different requirements are often conflated in a single identifier such as an NHS requisition point or a ward name or code. This leads to problems when departments move their physical location from one room to another. For example it may be difficult to know exactly in which physical locations a patient was treated which may be important in negligence cases or for infection control. Alternatively it may be unclear as to exactly which room is being used for Ward 10 stores. In procurement it is necessary to clearly identify which entity performs the following roles the dept or function which placed the order the Order-by identifier the location that the supplier should deliver to the Ship-to identifier the final destination of the product within the Trust - the Deliver-to identifier the dept or function to which invoices should be sent the Bill-to identifier the organisation making actual payments the Paid-by identifier Clearly an entity may perform more than one role. Each entity will have master data associated with it such as a room or physical location identifier, postal address, fax number, , phone number, personal contact etc. 4. Identifiers currently in use Internal Code There are many internal location identifiers in use in Trusts. Estates, finance, medical physics, sterile services and pharmacy may all have created their own location identifiers suited for their specific applications. CAD systems typically have codes which identify every physical room and major storage and electrical cupboards within a hospital. Space planners may have separate codes which are linked to descriptions to make them intelligible to patients and staff. Some estates departments are already bar coding all physical locations within their Trust. NHS Supply Chain Requisition Point NHS SC provides a web site where Trusts can create requisition points which are used for invoicing and cost allocation. The requisition point is identified by a 6 character code, the first two of which are alpha and the last four are numeric, e.g. AB3421. The NHS SC requisition point is widely used to identify the internal physical location to which goods should be delivered in addition to the cost centre to which invoices should be allocated. This can lead to complications where physical locations are shared between departments, for example clinics, where departments have multiple ship to locations and also where departments move physically between hospitals. 2

3 Organisation Data Service (ODS) Code The Organisation Data Service is provided by NHS Connecting for Health. It is responsible for the publication of all ORGANISATION and practitioner codes and for the national policy and standards with regard to the majority of ORGANISATION CODES. These code standards form part of the NHS data standards. ODS codes are designed to identify organisations and do not go down to the level of detail required for many Trust applications. GS1 Global Location Number (GLN) A small number of Trusts and suppliers are using GLNs in specific application areas. Of the hospitals we contacted only Leeds and Plymouth were using GS1 GLNs, none of the others were planning to use GLNs and many had not even heard of GLNs. GLN is already one of the optional attributes available when creating an NHS Supply Chain Requisition point. 4.1 Importance of maintenance Location information for a Trust is in constant change and keeping up to date is a key activity. This involves adding, changing and deleting (or making inactive) the codes and/or the information associated with them. Without clear controls there will be duplications leading to confusion over which code to be used and the associated difficulty in consolidating management information. The code maintenance process is made more difficult and subject to error when it involves maintaining cross reference tables between different coding systems in use in a single Trust. 5. The Case for a Common Location Identifier 5.1 Physical Locations Maintaining different location identifiers for different applications within a Trust will become increasingly difficult as Trusts move to more patient centric, cross functional information and operational systems. Rooms and other physical locations will carry bar codes and/or RFID tags to enable the use of automated data capture technology to identify the location of patients, inventory, assets and maintenance and security activity. It is clearly impractical for locations to have different bar codes or RFID tags, depending on application, and to ask users to decide which bar code or tag they should scan. A single location identifier, embedded in a single bar code or tag per location is clearly necessary. 5.2 Organisation Locations Trusts need internal systems to manage their specific coding structures for departments, products, budgets and expense controls. Suppliers need this information to enable them to manage deliveries and invoices. Because the coding structures of different Trusts are likely to clash and be incompatible suppliers map each Trusts structures onto a coding system that works across all Trusts. Of course the way each supplier does this will be different and each system will need to be updated manually as changes occur. Most Trusts manually rekey their structural information into the online NHS Supply Chain Requisition Point system. For other suppliers this information is typically rekeyed into their systems by the supplier themselves. This rekeying of information involves additional administrative effort plus the potential for inconsistencies due to keying errors or update delays. An alternative approach is for Trusts to send their coding structure to suppliers electronically using location and organisation codes which are unique across all Trusts, thus allowing suppliers to incorporate the information directly into their systems without any rekeying. This approach reduces the administrative effort on Trusts and suppliers while at the same time minimising errors. 5.3 Cost and error reduction Having unique location identifiers across all NHS Trusts, to a common standard, will enable Trust suppliers to use these identifiers instead of having to maintain their own internal cross reference tables, again with associated admin cost and errors. 3

4 6. Alternatives for the Common Location Identifier 6.1 GS1 GLNs This section outline the reasons why GS1 GLNs are well suited to providing location identifiers which can be used by all applications within a Trust as well as in the broader industry since they are unique across all Trusts. For more detailed information about GLNs see ISB standard The Department of Health Information Standards Board has adopted GS1 identifiers and bar codes as the chosen standard to be used within NHS Trusts in England. (See ) Flexible GLNs do not have any significant internal structure; they are merely neutral numbers which can be used as keys to look up information in a database. This lack of internal structure means that GLNs can be used to identify physical locations at any level of granularity from whole building sites down to individual shelf locations or cabinets. GLNs can also be used to identify organisations and functions from legal entities, such as Trusts and companies, down to the smallest sub departmental role. The lack of internal structure also means that the GLN will remain effective regardless of any organisational and physical structural changes. It is recognised that the GLN is designed for computer use rather than for direct interpretation by humans. If human interpretable codes are required then these can be linked to the GLN. However the expectation is that over time the use of bar codes or RFID tags together with hand held readers will reduce the need for human interpretable codes. Unique and self managed GLNs, and their associated information, can be created and managed as required by a Trust, hospital or department while still being globally unique. GS1 achieves this by ensuring that all GLNs start with a unique sequence of numbers, known as a GS1 Company Prefix which GS1 UK allocates to each Trust. The use of this prefix ensures that GLNs can created by a Trust as required safe in the knowledge that the GLNs will not conflict with other Trusts or organisations worldwide. Standardised and secure GLNs are all 13 numeric digits which makes them simple to process and reduces the likelihood of users misreading them; for example confusing the number 8 with the letter B, or number 0 with the letter o. In addition the 13 th digit is a check digit which protects against users entering wrong information into computer systems. Bar codes, RFID, messaging GS1 has widely adopted standards for how to embed GLNs in bar codes, RFID tags and electronic messages. These standards ensure that applications using these technologies can be developed easily and securely. They also ensure that different applications can confidently share the use of bar codes or RFID tags. Low Cost The only charge for using GLNs is an annual charge for leasing the GS1 Company Prefix. There is no charge for creating individual GLNs. The annual charge for the GS1 Company Prefix for NHS Trusts in England is met centrally by the Department Of Health Informatics Directorate. Global and cross sectoral GLNs are used around the world in healthcare and in other industries. For example the retail supply chain makes heavy use of GLNs when communicating order and delivery information. GLNs are also a key element of the GS1 standard data pools for communicating product data from manufacturer to distributors and customers through the Global Data Synchronisation Network (GDSN). 4

5 6.2 Internal Code An internal code could be created and used as the common code for a Trust. However this would have the following disadvantages Internal location codes could not be used directly by suppliers since these codes could clash between Trusts Trusts do not have a code that is suitable for all the Trust s requirements and would therefore have to allocate resources to developing and documenting a new code. This would include defining how the new code should be encoded in bar codes, RFID tags and electronic messages. There is a risk that any new code created by the Trust might prove to be unsatisfactory for some applications. 6.3 NHS Requisition Points The following points make NHS Requisition Point codes unsuitable for the common location identifier for Trusts. NHS Requisition Points, and the information associated with them, are controlled and managed by NHS Supply Chain which is a commercial organisation independent of the NHS and in direct competition with a number of other suppliers. NHS Requisition Points do not identify physical locations. A physical location can be linked to a requisition point, however if a department relocates the requisition point code typically does not change even though its physical location has. For this reason requisition point bar codes cannot be used to bar code actual physical rooms. NHS Requisition Points are only targeted at locations associated with procurement and not the much larger requirement to identify all locations within a Trust. 6.4 ODS Codes ODS codes are designed to identify organisations. They are centrally managed, are not designed for physical locations and are not granular enough to meet the variety of location identification requirements listed in section 3 above. 7. Draft Best Practice 1. All physical locations in a Trust that need to be separately identified should be identified with a GS1 GLN. 2. All departments and sub departments that need to be separately identified should be identified with a GS1 GLN. 3. Any machine readable labelling of physical locations such as rooms, cupboards, shelves or cabinets should be implemented using a GLN in a GS1 bar code or RFID tag. 4. All Trust applications requiring location information should be capable of handling GLNs and GLNs should be used for any interface of location information between applications. 5. Orders should include one or more GLNs to identify a. the department or function which placed the order the Order-by identifier b. the location that the supplier should deliver to the Ship-to identifier c. the final destination of the product within the Trust - the Deliver-to identifier d. the dept or function to which invoices should be sent the Bill-to identifier e. the organisation making actual payments the Paid-by identifier 6. NHS Trusts should provide their suppliers and other business partners with computer readable files of the necessary master data detail associated with relevant GLNs. Ideally this will be done through a GLN registry. 7. In the short term NHS Trusts should maintain a cross reference of GLNs to existing location codes. In the longer term Trusts should migrate away from these codes. 5

6 8. Recommendations The NHS should adopt GLNs for both the identification of physical locations and for the identification of functional and departmental entities within Trusts and other healthcare organisations. A steering group of Trusts and their suppliers should be set up to provide advice and support for the implementation road map described in section 9 below. GS1 should work with the steering group to develop informational material for the implementation of GLNs in NHS Trusts including business case, awareness and performance metrics. In the short term any Trust planning to bar code or tag physical locations should use a GS1 GLN in a GS1 compliant bar code or RFID tag. 9. The Road Map A phased approach should be taken. The experience and insights gained in the first phase will be used to clarify the phased road map. In the meantime the following phases are recommended. 9.1 Preparation The following needs to be developed before GLNs can be effectively promoted to the wider health community. The generic business case for the use of GLNs in the NHS and its suppliers. The way that information about GLNs will be communicated, possibly through a GLN registry. Prioritised actions that should be taken by Trusts, manufacturers, distributors and other supply chain partners. Awareness collateral and training. Implementation guides and tool kits for Trusts, manufacturers, distributors and other supply chain partners. The KPIs and metrics to gauge progress of GLN adoption. It is recommended that these elements should be developed by GS1 and DHID and advised by a steering group of Trusts and their suppliers. This preparation phase will merge into the awareness and subsequent phases. The following sections are written from a Trust perspective however other supply chain partners can begin to prepare for GLN implementation independently of Trusts. 9.2 Awareness This will be a program of activity to ensure that supply chain and other staff in Trusts and major suppliers understand the benefits that GLNs can provide and are committed to implement them. While at this stage they will be no firm implementation plans they will have informed their own organisation and their business partners of this commitment. 9.3 Allocate In this phase an internal project will be set be up with the necessary senior sponsorship. This will be followed by the prioritised allocation of GLNs and the details will vary significantly from Trust to Trust. GLNs will be allocated on a hierarchical basis reflecting the organisational and physical structure of the Trust and will typically include: Level One Level Two A GLN identifying the Trust. This will also have a corresponding ODS code Any entity reporting directly to the Trust. This will include individual hospitals. This may also have a corresponding ODS code 6

7 Level Three Level Four and subsequent levels Other buildings and/or subordinate departments of Level 2. This could be A&E, Pharmacy or Outpatients etc. Locations at this level will typically need to align with the systems of supply chain partners. Level four and below can be used for detailed locations such as a specific internal delivery points or work teams. Locations at these levels may not need to be aligned with supply chain partners. It is expected that in general the first priority will be to allocate GLNs as required by suppliers and other business partners; this will be at levels 1 to 3 in the diagram below. The diagram below shows an example of a hypothetical GLN hierarchy. 9.4 Align In this phase the GLNs that have been created will be cross referenced with existing internal or external identifiers used by other departments such as estates, CAD, procurement, finance, pharmacy, medical physics and sterile services. In addition business partners work together to align their GLNs with the information in each others internal systems. During this phase a cross reference database of GLN information will be created for each GLN containing information such as Cost centre code ODS Code NHS SC requisition/delivery point Long description Short description Pharmacy code Sterile services code Contact details such as phone, , address etc 7

8 Physical location information such as site, building, floor, room or alternatively the GLN of the physical location CAD code, if applicable Space planner code, if applicable 9.5 Transact Begin to use GLNs in EDI transactions such as orders and invoices according to internal priorities. This phase could include adding bar codes or RFID tags to identify physical locations within a Trust, although depending on priorities this may occur in earlier or later phases. 9.6 Maintain Each Trust updates its GLNs and GLN hierarchy as required and communicates these changes to its business partners. A log should be kept of these changes to ensure that it is possible to maintain a clear record of the physical locations in which patients were treated 8

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