As is well-known, human is prone to err1). It is a common phenomenon that medication errors take place in hospitals2). However, the results of the medication errors occurring everyday in the world are so harmful and fatal to patients that sometimes they may lead the patients to death3). Although the researches on medication errors have been performed by pharmacists for about 40 years and it has been reported that the effects of medication errors are much more serious than we realize, it do not draw sufficient attention4).

In 1984, Harvard Medical Practice Study (MPS) addressed that 3.7 of every 100 inpatients were suffered from iatrogenic mishaps. These injuries were most commonly related to medication use (19.4%). Although these results were reported in early 1990s and additional researches were performed in Colorado and Utah, the importance of medication errors did not draw much attention until Institute of Medicine (IOM) published that iatrogenic events resulted in 44,000-98,000 deaths and 13 millions injuries every year in United States5). It is estimated that the costs of treating healthcare errors would be about 3 billion per year in United States. However, hospitals were not actively adopting Information Technology (IT) for patient safety. Therefore, the leading groups like Joint Commission on Accreditation of Hospital Organization (JCAHO) or Hospital Information Management System Society (HIMSS) began to emphasize the importance of patient safety and assign high priority on medical errors in their recent conferences on the issue6).

A medication error indicates any medicine-related mistake made by healthcare professionals. It is recommended that they have to keep five rights principles (right patient, right drug, right dose, right route, and right time) in order to reduce medication errors7)8).

In a survey on nurses' recognition and experience of medication errors in Korea, it was also revealed that most medical errors were related to medication administration. The other errors include giving wrong drugs to patients, over-dosage and wrong medication route to the prescription, and administrating drugs over the term of validity9). In the survey, nurses proposed methods for reducing medication errors such as adopting efficient and effective communication tools (99.0%), providing standardized guidelines (98.3%), rapidly presenting drug information (98.3%), storing similar drugs apart (98.1%), and enforcing five right principles (97.8%)10).

According to JCAHO, the most remarkable method for patient safety is to exactly identify patients to administrate medications. Therefore, it is no wonder that adopting IT like barcode or RFID to identify patients, drug bags, and blood bags for transfusion is prevalent in healthcare sector. Castle et al. also suggested such auto-ID technologies should be applied to nursing activities because IT can help prevent misusing drugs1). Actually, Concord Hospital in New Hampshire revealed that a barcode-based medication system reduced administration error up to 80%5).

Dzik suggested that advanced technologies should be used to improve patient safety and healthcare professionals such as physician and nurses who utilize the systems for reducing errors should devote themselves to reducing errors6).

There have been 3 types of previous studies related to medication errors including transfusion. They are illustrated in Figure 1. The first type is a research on methods for reducing errors occurring during the dispensing process at the pharmacy, which was performed by Poon et al.15). The second type is a research on methods for reducing medication errors by checking identification of patients and drug bags at the bed-side, which was performed by Sun, Wang, and Wu8). The third type performed by Dzik is a research on methods for reducing errors in transfusion processes.

Poon et al. studied the effect of adopting a barcode-based medication system at the pharmacy of a tertiary university hospital having 735 beds, which is issuing about 6 million prescriptions every year. They analyzed the results after adopting the system and compared them with the previous outputs before adopting it. They tried to improve the accuracy of medication during the dispensing process by setting up a new barcode-based dispensing system in 2003. Consequently, the system enabled the hospital to reduce medication errors. For example, the error rate was 0.37% before implementing the system, which improved up to 0.06% after using the system. This indicates 85% reduction of errors. Therefore, Poon et al. suggested that barcode-based medication systems would be very prominent tools for improving medical errors at the hospital pharmacy2).

Fan Wu recommended that nurses should observe 'five rights' principles in administrating medication for patient safety. He suggested that in order to facilitate the observation of these principles a POC environment should be established. IT like barcode or RFID enables the establishment of the POC environment. When nurses administrate medications to patients, in order to check right patients and right drugs they scan drug package and patients' wrist band using PDAs equipped with the capability of reading barcodes and RFID. And then, after nurses check the formulation, dose and time of drugs, and patients' records with their eyes, they provide drugs to the patients. Fan Wu performed a survey on users' satisfaction in order to assess the usefulness of the system. The survey results showed that degree of users' satisfaction was high and the evaluation values about quality and information were very satisfactory8).

Dzik addressed that barcode technology is adopted by lots of hospitals to reduce errors of transfusion and improve patient safety, because adoption costs of barcode-based systems are much lower than RFID systems6). After the University Hospital of Iowa installed a barcode-based medication system connected with Hospital Information System (HIS) using wireless LAN, the system could capture errors up to 10 times more than previously used manual processes. The research pointed out that despite the apparent advantages of barcode or RFID technologies designed to enhance patient safety, the low rate of application of those technologies can be ascribed to the following reasons. First of all, nurses and physicians may feel uncomfortable using those machines or technologies. Furthermore, medical information managers cannot be convinced of the satisfaction level of technological quality and easiness of application of such technologies.

Recently, as the importance of medication errors are recognized significantly, researches on barcode-based or RFID-based systems have been performed. However, those researches are focusing on the clinical results of adopting those systems for reducing medication errors. Few published studies have analyzed technical obstacles of introducing IT and proposed practical solutions for successful implementation of such a system in healthcare area. The objective of this research is to identify technical barriers in implementing a barcode-based medication system and propose practical solutions to overcome those barriers. Various factors hindering the successful application of the barcode-based medication are identified and a successful business model is discussed.

As we found in the previous researches, the efforts for reducing medication errors and improving patient safety by adopting IT such as barcodes and RFID will lead to positive results. However, in order to implement a more successful and effective business model in clinical settings, the following issues including technical stability and standardization, establishment of barcode standards, and mitigation of user's resistance to emerging technologies should be considered and resolved.

In healthcare sector, HIS and mobile solutions supported by wireless network are becoming prevalent. Wireless network is a core infrastructure to enable POC, as described earlier in Section II. However, it is required to provide some improvements to make the barcode-based medication system stable. The urgent one is about the standardization of the communication protocol between APs and mobile devices such as PDA, especially for the case that several APs are competing to make a connection with a PDA. Initially, we had a huge trial and error in organizing PDA into the barcode-based medication system which have used wireless network for POC. We wasted a half of project time to resolve this kind of problem. If manufacturers or vendors of various wireless APs and PDAs would set a standard protocol between them, mobile solutions like the barcode-based medication system could be implemented in the hospital without difficulty. Otherwise, the same problems will happen at other sites where similar systems are to be implemented, which may induce a nation-wide waste of costs and negatively influence the effort for improving patient safety.

As mentioned in the previous section, a major failure type of the barcode-based medication system has been confusion in reading barcodes. It is expected that this type of failures will last continuously in the future until standardization of barcodes is accomplished. As happened in our system, several barcodes on the blood bags for transfusion might generate confusion in reading barcode information at the bedside. Recently, Korean government is endeavoring to adopt standardized barcodes for drugs named Korea Drug Code (KDC). Standardized barcodes will be a substantial assistance to improve patient safety and reduce medical errors.

During the pilot period, discharge of PDA was one of the common types of failures. Confusion in reading barcodes and standardization of barcodes are problems resulted from the industry-wide issues in healthcare sector. Actually, it seems that users are reluctant to utilize the barcode-based medication system because they are not sure the system is effective in administration of drugs to patients. According to a recent paper, although the proportion of time nurses spent on medication administration activities remained unchanged, the proportion of time spent in providing direct patient care increased because of streamlining the administration process15). Therefore, it is very important to make users be assured of the system and adopt it actively.

It is very hard to exactly estimate return on investment (ROI) of the barcode-base medication system. However, we believe the system is definitely providing an essential benefit concerning reducing medication errors and improving patient safety. If the issues discussed in this section such as standardization of wireless network protocols, standardized barcodes, and enhancing user acceptance of emerging technology would be resolved, it will be possible to effectively implement similar medication systems to reduce errors and improve safety or save human lives.

Recently, lots of studies on reducing medical errors by adopting emerging auto-ID technologies such as barcode and RFID are reported. However, there has been little research that implements such a technology and practically analyzes technical barriers in hospitals in Korea. We hope that in order to verify the clinical effects of the system, more studies on improving patient safety in both clinical and technical aspects would be performed in the future.