Last Updated 02 Apr 2020

Utilizing Qr Code Technology for Emr.

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Utilizing QR Code Technology In Encoding Patient Summary List 2012 Utilizing QR Code Technology In Encoding Patient Summary List Fatima Alsaleh and Samir Elmasri PhD College of Computer and Information Systems, King Saud University, Saudi Arabia Abstract: In situations like emergency, where the immediately gained, summarized and accurate information may radically make the difference between life and death, the need for a solution that fulfills this requirement arises. Number of solutions was previously proposed including emergency card and smart cards, but each has number of cons and pros.

With the rapid adoption of smartphones, QR codes (Quick Response) is the ideal substitute for the current circumstances. It can be easily read by the paramedics, whether they are medical professionals or bystanders and provide immediate, accurate, reliable information that radically impact an individual's life, in case of emergency. This paper discusses the advantageous utilization of the QR code and smartphone revolutionary technology in the medical field. It also discusses other uses of QR code, in some related fields where it can be beneficial the most.

Page | 1 Utilizing QR Code Technology In Encoding Patient Summary List 2012 Introduction Accidents happen all the time all around the world. A continuous work by the governments and non-profit associations has been accomplished to propose and impose policies and procedures that best decrease the number of accidents and control their tragic consequences. On the other hand, an increasing number of researches and tested methodologies have been conducted in the past few years, specifically in the field of emergency, to best control the damages.

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The main focus was to summaries the most important and critical medical information about an individual in an in a portable means and ensure a quick retrieval of these data in a secure manner. The earliest attempt to compliance with the quick, secure and summarized access to an individual's critical medical information was by using emergency cards. Some Health providers companies provide their patients with an emergency card that has some information extracted from the patient summary List. This card has saved lives as it's the guide that could help the first aiders or emergency staff to act accurately in a timely manner.

The means, however, evolved over years to cope with the technology revolution and benefit the most of it. Encoding the patients EMR in smart card is a methodology that has been rapidly followed by many EMR companies and healthcare providers. A part of the medical record of any patient is a summary known as a Patient Summary List or Problem Summary List. This paper proposes a method that could benefit from the two aforementioned important concepts. The method introduces the use of the Quick Response (QR) technology in the patient’s Emergency card.

Related Work Some health providers provide their patients with an Emergency Card that usually has the vital medical information that could make the difference between life and death, usually known as Patient summary list (part of the Electronic Medical Record). The list should include the patient’s ID, medical history of Arthritis, Hypertension, Cancer, Diabetes, Heart Disease, etc. any operative and invasive procedure, any adverse and allergic drug reaction, present medications [1][2]. The natural medium to record the patient's medical information is the papers.

Even though papers have advantages of being low in cost, available and portable, problems raised due to the decentralized nature of the paper-based medical records, difficulties Page | 2 Utilizing QR Code Technology In Encoding Patient Summary List 2012 in data storage and retrieval, threat of being damaged or lost, etc. Consequently, the concept of Electronic Medical Record has been introduced to overcome these issues. Examples of early electronic systems include Computer-stored Ambulatory Record (COSTAR), Health Evaluation through Logical Processing (HELP), and Multiphase Health Testing System (MHTS) [3].

Smart Card is the perfect media that can be used as a health card due to its small size, secure, capability of digitizing a huge amount of personal and medical data [4]. Some attempts have been done by researchers to develop a personal portable healthcare record smart cards and a corresponding framework to simplify maintenance and transfer of patient records [9]. Researchers in the U. K. have created MyCare, a smart card with a fold-out USB plug that can hold a patient’s medical history. MyCare was developed with open source that enables it to run on different computers and operating systems.

Data is protected through PINs and encryption, with a higher level of encryption planned for further stages in the development process [5][6]. These smart card projects work better in countries with nationalized health care. In the US For example, competition among hospitals is a barrier to a smart card system [5]. Smart card technology was not widely spread due to lack of standards (Dash, 2001); the communications between a smart card and smart card reader. The cards also need to be updated constantly which would be hard to enforce [10].

For smart cards, user mobility is only possible if every machine that the user access has a smart card reader attached. The machine must support the same standard smart card reader interfaces or use the same proprietary smart card reader [11]. Research Statement Due to the barriers of smart cards usage including, the high cost value, the unnecessary imposed security and the need for a special card reader, the smart emergency card solution may not be the best solution. The proposed method is the use of Quick Response (QR) codes to hold the patient's critical medical information.

The solution overcomes the expense, unavailability and communication issues of the smart card, by the fact that QR is inexpensive technology that doesn't need a special reader, it needs software that could be installed freely on any smart phone. This ensures the quick yet accurate and responsive aid provided to unresponsive individual in case of emergency. The solution should also be used as a reporting tool. It can be embedded into a smart phone application developed to be used for reporting accidents. This may overcome the issues of Page | 3

Utilizing QR Code Technology In Encoding Patient Summary List 2012 reporting accidents by using the QR technology as an accurate, unique and prompt reporting tool. Background Quick Response (QR) codes are type of two dimensional barcodes. It's a technique that was first invented by Denso-Wave, a subsidiary of Toyota Group that was firstly designed to track the vehicles' parts manufacturing process, and since then it has grown rapidly. In Recent years it has been utilized to work as a marketing tool to advertise for products, sites, brands, etc.

Fig1: QR codes structure [16] QR Code can store up to 7089 numeric characters, 4296 alphanumeric characters or 2953 bytes (8-bit binary). They are capable of storing different types of data: text, vCards, pictures, URLs, Videos, etc. The stored data is extracted in a readable form through QR readers that are usually smartphone software, or dedicate QR reading devices. Number of QR code scanner applications is available for Apple, BlackBerry and Android smartphones, mostly for free. Once installed, it uses the phone's embedded camera to scan the code and decode it instantly. Page | 4

Utilizing QR Code Technology In Encoding Patient Summary List 2012 Proposed Solution The idea behind this paper is very easy to grasp. The aim is to have a mechanism that provide the first aiders to know what needed to be known, at the right time, with the easiest possible means. For unresponsive person, or in case if an individual was unable to speak and give vital information, it is important to have some sort of easy to get yet authenticated and accurate medical summary that can be available at anytime, anywhere. In some cases, it makes the difference between life and death.

Patient Summary List The more we know the better we act and response. In medicine, to know the patient's historical and current medical condition is as much important as the action to be taken on the case. Delaying a treatment or prescribing a wrong medication or one that conflicts with the patient's medical condition could be dangerous and might end up deadly. From this point, the importance of the Patient Summary List arises. The Patient Summary List is a summarized accessible list of the patient's significant medical information.

The summary should contain as much information as possible to assist medics and other first responders in case of emergency. The information may include the following categories, though, some entries might be optional. Each entry has to be timestamped: 1. 2. 3. 4. 5. Patient's information: age, sex, marital status, weight, height and blood type. Hospital-related information: name, ID, address, phone number, medical record, hospital's name. Emergency contacts. Allergies/Adverse Allergic Drug Reactions.

Significant medical diagnoses and conditions: Cancer, Diabetes, High Blood Pressure, Heart Disease, Angina, Pacemaker, Stroke, Circulation Problem, Arthritis, infectious disease (TB/Hepatitis/MRSA), Osteoporosis / osteopenia, Lung problems, Seizures, Polio / post-polio, Urinary incontinence, Depression, HIV positive, Pregnancy condition, Wearing Contact Lenses, Smoker or not. 6. Significant surgical/invasive procedures. Page | 5 Utilizing QR Code Technology In Encoding Patient Summary List 2012 7. 8. Medication/Vitamins/Supplements names, doses, frequency and rout for each.

Education: Language spoken, Barriers to learning (blind/deaf/etc) [12]. Medical Records are created by the medical institutes for every individual assessed or treated. Consequently, the Patient's Summary List should be derived from the patient's Medical Record. The Summary List must be prepared by the Hospital of which the patient is having his treatment to ensure the legibility, completeness and authentication [13]. It's also important to have the list updated whenever there is a change in medication, diagnose or allergies and also whenever a procedure is performed.

Why QR Codes? Some medical institutes tend to provide their patients with a Summary List printed on a paper (or card) or coded in a smart card. Both ways have number of cons and pros. The usage of printed Summary List in a paper is condition of damage. Especially ICE (In Case of Emergency), it can easily burn, get wet or shredded into pieces and loss it's value. The use of cards might be a safer choice, but it's impossible to have it small enough to fit in someone's wallet and yet have it containing all needed information about the person's medical condition.

The use of smart cards on the other hand, might be the best solution comparing with the other available means since they are safer, have a larger capacity, easily to carry along and can be kept up t date without the need to issue new ones. However, they need special readers to read them that are usually unavailable for the first aiders ICE. Besides, smart cards are costly to issue and maintain. QR code's quickness, availability, widely spread and low cost might lead it to be a very good choice to encode the Patient's Summary List.

It overcomes the issues encountered in other means, and they can be utilized to serve other purposes that will be discussed later in this paper. With the advantages of the QR codes usage has been examined and assessed, we are ready to discuss the proposed procedure and a suggested standard: ? The list should be captured and stored in a standard encoding system to support data sharing, analysis and provide a more practical and accurate way Page | 6 Utilizing QR Code Technology In Encoding Patient Summary List 2012 o retrieve the required information. The standard of the Summary List has to be proposed and admitted by the Ministry of Health. ? Administration and maintenance of the Summary List is important. Healthcare providers are responsible of issuing a Summary List of each patient's EMR. They are also responsible for encoding it in a QR code. ? ? The issued QR codes should be printed on wallet-sized cards and submitted to patients. The QR card should be on the medical card (printed right on the back of the card on printed on a sticker on the same card).

The medical card (with QR code at back of it) has to be kept right next to the driving license in someone’s wallet. This is critical to have the first responders make use of this method. ? The Summary List has to be updated by the issuer upon any significant change in the patient's medications or health condition. Further, if the patient was examined by a hospital other that the one issuing the code, it's the responsibility of the patient to update the QR code with the new medical information according to the hospital's report. People have to be educated by spreading the QR concept and the role it's playing in rescuing individuals ICE. The paramedics (emergency staff) on the other hand have to have the dedicated QR code readers or having the scanning software installed on their smartphones. Having these standards stated out, the QR code usage can be efficiently utilized and beneficial. If individuals were educated and aware about saving someone’s life using the proposed method, the number of errors that might be encountered will decrease rapidly.

In contrary with the other possible means, QR codes do not require a special reader or password authentication or a computer to be read, which make them accessible whenever needed. In addition, bar codes are proven technology that can be used in health care, where little room for error exists. Page | 7 Utilizing QR Code Technology In Encoding Patient Summary List 2012 Possible Scenario The following scenario is summarized in Fig 4 below, a possible QR utilization scenario: 1. 2. 3. 4. 5. An accident happens to an individual carrying a QR code card.

The first responder (emergency professional or bystander) check the infected person's wallet and find the QR code. The code is scanned by the rescuer's Smartphone's QR reader. The summary list with all significant medical information is displayed. The rescuer provides the first aids according to the infected person's medical status, whether he/she has a Diabetes, High Blood Pressure, Heart Disease, etc, and call the emergency. 6. The emergency professionals should take the proper, most accurate action based on the extracted medical status. This can make the difference between life and death.

Other actions can also be taken by the rescuer like for example sending the QR code through a Smartphone's software (detailed in Other Medical-Related QR Uses section below). Fig2: QR code workflow in case of emergency Page | 8 Utilizing QR Code Technology In Encoding Patient Summary List 2012 QR Coded Patient Summary List Update As stated above, the providers should update the patient's summary list whenever there is a change in diagnosis, medications, or allergies to medications and whenever a procedure is performed. The Patient Summary List is derived from the patient’s Electronic Medical/Health Record [17].

The summary list contains specific attributes extracted from the medical record. Having these attributes labeled in the electronic medical record will ease the process of extracting and updating the Patient Summary List attribute’s values. So, the system should trigger an update on the patient’s list whenever a change in the labeled attributes. Fig3: QR code workflow in case of emergency [17] How to Update QR Codes? There are two main types of QR codes; static and dynamic. Static QR codes contents are static, cannot be edited or updated, whereas the dynamic QR code’s content can be easily updated.

Also, unlike the static QR codes, it does not require generating new QR code. The exact printed QR can be used that leads to the updated contents. When the QR codes are used to encode the Patient Summary List, a frequent content update will be needed. Accordingly three main QR forms are proposed: Page | 9 Utilizing QR Code Technology In Encoding Patient Summary List 2012 1. Using a static QR codes with a static summary list that needs to be re-printer upon each record change. In this case, the provider may print the codes on stickers and remove the old ones once the new ones are issued.

This might be more cost effective than re-printing the patient card with the new QR code on the back. 2. Instead of having QR codes printed out, a soft copy of the QR code can be generated and loaded into an individual's mobile. This is also effective in cost-wise, but it might be not so practical in case of an emergency. The rescuer may not be able to locate the QR code image in the mobile of an unconscious person, or the mobile is locked with a pin or it’s out of battery, etc. Though it is easy to maintain and saves the cost of reprinting the code upon a record change. . Using the dynamic QR codes that have a dynamic content with an editable, editable content using the same printed code. Further, some QR code generator companies (like SQUARE) provide a track service and statics of how many devices scanned the code, where, scanner device type, etc. Having this concept applied on the medical health field considered very practical. In view thereof, dynamic QR codes are the best utilization due its cost saving, efficiency and easy to maintain. However, since this kind of codes requires a wireless connection, it might be limited.

Though, it’s not a huge barrier in today’s networked world. Fig4: QR Update trigger scenario. Page | 10 Utilizing QR Code Technology In Encoding Patient Summary List 2012 Updating QR code procedure Each step in the above scenario figure (Fig 4) is described as follows: A patient visits the hospital (1), and a change in one of the stated record attributes (2) (change in diagnosis, medications, or allergies to medications and whenever a procedure is performed. ) has been encountered. So the updated patient record should trigger a generation of an updated summary list (3).

Accordingly, new updated QR code/QR content has to be issued (4), and a notification sent to the patient with this update. ? ? If the static QR code form is adapted by the hospital, then the notification should instruct the patient to pick up the updated QR code card/sticker (4. 1). If the soft copied QR code form is adapted, then the notification should instruct the patient to download the latest QR code (either from the hospital’s site after the patient login or sent for the patient email) (4. 2). ? If the dynamic QR code form is adapted, then the codes destination contents updated upon the new summary list update (4. ). Other Medical-Related QR Uses Aside of utilizing the QR codes as an emergency guide for paramedics that provide a reliable, easy to use, quick access to an individual's Medical Summary List, QR codes can be used in other fields as well, as detailed in this section. The QR codes can be used as a reporting tool. By having an Emergency reporting channel other that the unified number, a software application installed on the smartphones, QR can be used as follows: ? ? Using the smartphone's camera, the QR code of the affected person is scanned through the Emergency software application.

The software should display the encoded information, and a reporting option should also be available (say, a button). Page | 11 Utilizing QR Code Technology In Encoding Patient Summary List 2012 ? ? ? Upon pressing the button, the software should send the patient information to the emergency department along with the reporting location coordinates. The reporter information may also send (the reporter phone number can be easily gained from the user's phone). To capitalize the benefits, the reporting tool can play a complementary role of a clouded EMR system that is made available for the centralized Emergency unit.

If this the case then a link to the QR holder's EMR could be also implicitly embedded and can be easily gain access to be the authorized Emergency staff. Having such system will not only provide a fast, accurate and reliable accident reporting tool, but it'll also help in reducing the redundancy encountered when reporting accidents and emergencies. Another usage of the QR code can be as portable, summarized EHR. Keeping a personal health record encoded in a QR with you when visiting a doctor that is not necessarily a staff member of the hospital where your Medical Record is kept is very helpful.

It'll provide the doctor a sufficient answer when the he asks “what medications are you taking? ” It'll save time, effort and the cost of running lab tests and radio-imaging for checking the accurate medical condition since they are encoded in the QR code, summarized, reliable and up to date. Another use could be on some other direction, by the police department. When someone is kept under custody, it would be helpful to avoid unexpected situations can be experienced with the kept person such as infectious diseases, heart diseases, high blood pressure, etc.

Knowing such medical information is as much needful as keeping the person in prison, since it help in saving the lives inside the prison (life of the prisoners) and out (keeping the offender in custody). Conclusion We may not be able to stop the accidents from happening, but we are able and responsible to cut the losses and control their tragic consequences as much as we can. The practical knowledge of the medical workers coupled with the knowledge and expertise of the technology experts and developers can result technology-utilized solutions to everyday.

In this Page | 12 Utilizing QR Code Technology In Encoding Patient Summary List 2012 respect, solutions were proposed, researches were conducted and regulations were imposed, every day to best achieve this goal. This paper proposes a practical, non-cost affective, timely solution that can best utilize the widely spread technology "QR" to help saving lives. This solution can be utilized even more to be a complementary tool for the currently function, or proposed, emergency systems. References [1] http://westhoustonmedctr. ehc. com/CPM/Patient%20Summary%20List. df [accessed: 9 March 2012] [2] http://www. urology-partners. com/Forms/MEDICAL_HISTORY. pdf [accessed: 9 March 2012] [3] Lowe, H. J, “The Electronic Medical Record”, (2003), Stanford University School of Medicine [4] http://www. smartcardsource. com/health. html [accessed: 11 March 2012] [5]http://www. secureidnews. com/2011/06/15/smart-cards-show-potential-for-medicalrecords [accessed: 12 March 2012] [6]http://www. smartplanet. com/blog/rethinking-healthcare/mycare-your-entire-medicalhistory-on-a-smart-card/5207 [accessed: 12 March 2012] [7] http://www. martcardalliance. org/pages/publications-smart-card-technology-in-healthcare [accessed: 15 March 2012] [8] Smart cards—the key to trustworthy health information systems BMJ 1997; 314 doi: 10. 1136/bmj. 314. 7080. 573(Published 22 February 1997) [9] Changrui Xiao and Arthur Yu: Medical Smart Card System for Patient Record Management. Bears Breaking Boundaries 2009 Science, Technology, and Energy Policy White Paper Competition [10] Dennis Emmett and Reagan Bundy, Marshall University: PROVIDING BETTER PATIENT SERVICES UTILIZING SMART CARD TECHNOLOGY.

Proceedings of the Annual Meeting of the Association of Collegiate Marketing Educators (2005) [11] David Chadwick: Smart CardsAren’t Always the Smart Choice. University of Salford. Decemper 1999 [12]http://www. barnabashealth. org/hospitals/ambulatory_care_center/acrobat/rehab_adult_s ummarylist. pdf [accessed: 12 April 2012] [13] http://www. dental-design. co. uk/2011/11/29/a-guide-to-qr-codes/ [accessed: 2 April 2012] Page | 13 Utilizing QR Code Technology In Encoding Patient Summary List 2012 [14]http://www. medical. siemens. com/webapp/wcs/stores/servlet/PSGenericDisplay~q_catal ogId~e_-1~a_langId~e_-1~a_pageId~e_83438~a_storeId~e_10001. tm 2012] [15]http://jpgraph. net/download/manuals/chunkhtml/ch27. html#id2608334 May 2012] [16] http://www. thisbloglife. com/2012/01/qr-codes-enter-the-matrix/ [accessed: 20 April 2012] [17]http://www. philblock. info/hitkb/s/system_and_DB_architectures_used_in_commercial_EH Rs. html [accessed: 10 May 2012] [18]http://www. csinov. com/wordpress/index. php/solutions/ehr-solutions/electronicmedical-records/ [accessed: 4 May 2012] [19]http://tracertong. co. uk/ttf/2010/10/qr-code-test-for-wallpaper-download-to[accessed: 5 [accessed: 10 May iphone/ [accessed: 4 May 2012] Page | 14

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