QR codes in healthcare

Introduction

Earlier in the year I presented my research poster at the Annual Scientific Meeting of the College of Intensive Care Medicine at the National Convention Centre in Canberra. It was recommended that flyers for each poster be printed for the benefit of the viewers. I employed a QR (Quick Response) code instead of the flyers, which enabled the viewers to directly download my poster and the associated abstract instantly to their mobile phones. It generated significant interest among the viewers, more than the actual content of the poster! This prompted me to write an article on this technology, which has great potential for improving various domains of healthcare.

We are very familiar with bar codes. But, bar codes require special laser equipment to read them and the reading equipment has to be in close proximity to the code. Unlike bar codes, QR codes can be read in ordinary light by standard mobile phone cameras, and from a distance. The use of QR codes outside of industry, for personal use, has increased in the last few years. This increase is because of the widespread, rapid adoption of smart phones (iPhone, Android, BlackBerry etc) that can easily decode the information contained in the codes and execute a variety of commands, particularly when coupled with mobile Internet connectivity. The uses for such a technology in healthcare are manifold.

History

The history of QR codes dates back to 1994 when a Japanese company by the name of Denso Wave decided to improve on the existing bar-codes. The new code was developed with a main objective of "Code read easily for the reader". The QR code carries meaningful information in the vertical direction as well as the horizontal. By carrying information in both directions, QR code can carry up to several hundred times the amount of data carried by an ordinary bar code. But the technology seems to have found new applications since last year with the exponential growth of smart phones.

Technical details

QR codes can carry up to 7,089 numeric characters, 4,296 alphanumeric characters and 2,953 bytes of binary (8 bits) information. By contrast, conventional bar codes can store only 20 digits. In addition, the footprint of QR codes is much smaller than bar codes, and there is even a "Micro QR" format available.

A unique feature of QR codes is their ability to be scanned, even when partially impaired by dirt or damage. This is made possible by built-in error correction, which permits up to 30% of code words to be restored. The codes can be easily read by mobile phones with cameras and there are freely available software products (code readers) which enable instant decoding of QR codes.

Traditional uses

Initially used for tracking parts in vehicle manufacturing, QR codes are now used in a much broader context. Specifically, convenience-oriented applications aimed at mobile phone users (termed mobile tagging), has grown in usage. Generally, QR codes can be used to display a small text passage to the user, to add contact details to the user’s mobile device, to go to a website, or to compose an e-mail or text message. The technology has been called paper‑based ‘hyperlinks’ by some.

Potential uses in healthcare

The technology has the potential to help patients, clinicians, medical administrators and research personnel. It could help reduce healthcare costs and improve processes both at an individual practitioner level and at an organisational/state/country level.

Imagine walking past a general practice, pointing your phone’s camera at a QR code posted on the door and having an appointment booked automatically! It is very possible with QR codes. Not only can patients book appointments, but they can also get practice information like opening and closing hours, the contact details of the practice and its healthcare providers, and can even download health related information while they are waiting by simply scanning the QR enabled posters. This may reduce the need for printing of pamphlets.

Clinicians can instantly access patients’ health records by scanning the QR code. This can aid their practice management by adding patient information easily to their database. They can advertise their practice efficiently and potentially reduce the workload of office staff.

Hospital administrators can use QR codes for circulation of notices, which can be instantly downloaded by the user to their mobile device. Rosters can be made to be easily download-able straight into the employees’ mobile phone calendars. Information for visitors and patients, location and mapping to direct visitors within the hospital can be much simplified with QR codes. There exists a potential for utilising this technology for automated patient tracking. Strategically installed code readers can potentially track and time stamp a patient’s location within the hospital. This will be especially useful in areas with high patient turn-over like Anaesthesia.

Messages to the general public like health promotion activities can be made more interactive and potentially yield better involvement from the public by utilising QR codes. For example, people can be invited to book an appointment with the nearest breast screen centre just by pointing the mobile phone to a roadside advert.

The utility of QR codes in research is enormous. Patient recruitment can be made very easy which could potentially increase patient recruitment numbers. QR codes can simplify access to research related documentation. Users can easily participate instantly in online surveys and the ease of participation with a mobile device might improve turnout significantly. Medical posters at major conferences can be made downloadable. This saves printing off flyers and makes the information contained, more interactive. QR codes can be potentially used for anonymising research participants and can become an easy-to-implement ‘individually re-identifiable’ data collection system. Research references could be easily accessed among the many other possible uses.

Issues

The major issues concerning the wide use of QR codes in healthcare pertain to health information confidentiality and data security. Current QR mechanisms generally lack encryption. Until the security issues are addressed, utility of this technology in the health records domain will remain limited. But other uses that do not directly involve patient health records can be easily implemented. Studies are urgently needed in implementing this technology in the various areas mentioned above to assess the feasibility, cost-effectiveness and to specifically tailor this technology to the healthcare domain.

Reading QR codes

Many newer mobile phones come built-in with QR code reading software. For those that don’t there are large number of QR code readers available at no charge for various mobile phones (iPhone, Android, BlackBerry etc). One example is Qrafter, a free program for iPhone available from the iTunes app store. When reading a QR code, the user has to start the ‘code reader’ program in the mobile phone and point the camera to the posted code. The phone will then instantly decode the information and execute it. This could involve directing the user to a website, downloading a file or sending a message. Depending on the size of the posted code and the visibility, mobile phones could read it from various distances (from just under a metre to many metres). Many code readers prompt the user to authorise the automated action to prevent wrong usage.

Generating QR codes

QR codes can be easily generated by the end user. There are many freely available on-line QR code generators, the following being a short selection:

Dr Balaji Bikshandi
MB BS, FCICM
Dept. of Intensive Care Medicine, Royal Brisbane Hospital
This email address is being protected from spambots. You need JavaScript enabled to view it.

Dr Balaji Bikshandi is a member of the College of Intensive Care Medicine (ANZ) and the Australasian College for Emergency Medicine (ACEM), about to be awarded the fellowship in Intensive Care. His interests are diverse ranging from medicine & surgery to computers & technology. Specifically, he is interested in the utility of advanced technology for helping patients and clinicians by the bedside. He is a proponent of creative thinking in Medicine.

Posted in Australian eHealth

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