QR Codes – applications and innovations for pharma

Nick Plank

C&amp,C Group

QR what? Reading this in a recent email from a friend of mine who I have always thought to be super switched on to high-tech and is a Psych. PhD and TV star no less – I thought I’d try and de-mystify the area.

TV star? It’s all relative. If you saw Celebrity Love Island with Fearne Cotton a few years back and remember the guest shrink analyzing the celebs behavior then not only am I about to explain Quick Recognition codes but I’ve just explained the theory of relativity too.

Because I’m a techy – I’ll start with a baffling technical explanation of QR codes. If you can survive that then we’re good to go with applications in pharma.

Imagine a printed code which could be scanned quickly with a mechanical reader. A code which holds a max (approx) 20 digits. That’s a barcode.

“A picture speaks a thousand words and a QR code encodes a maximum of 4,296 alphanumeric characters.”

The data in this barcode can be held in a QR code the size of the example below.

Figure 1: The data in this barcode can be held in a QR code of this size

Remember the last time you waved the frozen peas at the Tesco self service checkout? In that frozen pea gesture the scanner read the barcode from left to right and charged your bill. Gesture is a modern word courtesy of Steve Jobs (RIP) and Apple’s iPad touch screen interface so I’m pleased I got that in.

The NHS have a patient monitoring system. Nurses take patient bloods and place them in sample tubes before sending to central labs. Barcodes label each tube from a printed sheet of labels. Those labels are generated from the patient database to identify the sample. The lab uses a scanner attached to their LIMS matching the sample to the relevant electronic patient record. Simple, effective, and the NHS avoids laborious data entry.

It helps a lot that the patient identifier is no longer than 20 digits.

Now consider a printed code which scans not only left to right but also bottom to top. Omni-directionally meaning you can hold the scanner at any angle to the code.

This is a two dimensional code also known as a QR code. In this way a QR code is capable of handling several dozen to several hundred times more information than the bar code.

A picture speaks a thousand words and a QR code encodes a maximum of 4,296 alphanumeric characters.

A QR code symbol of the size below can encode 300 alphanumeric characters.

Figure 2: A QR code symbol of this size below can encode 300 alphanumeric characters.

There are many specialist hardware scanners for QR codes used in areas such as supply chain and logistics.

A scanner comprises a photo-optical scanner, a decoder chip, and some software on the end to receive the scanned decoded data.

This sounds complicated but in fact many modern mobile devices such as the iPhone and even some optical mice (of the computer peripheral type) are capable of reading a QR code.

A thermal printer uses 4 thermal dots to make 1 module. Since printer resolution is measured in dots per inch (dpi) – if you use a printer with a 600dpi resolution you can create QR codes with a module size of .17mm.

“In this way a QR code is capable of handling several dozen to several hundred times more information than the bar code.”

Tiny dots – plenty of storage!

Here ends our baffling technical explanation of QR codes.

For brevity we have not covered all the QR code versions or the Reed-Solomon Code mathematical error correction which reliably reads a QR code even if damaged or soiled.

Or that under a magnifying glass you will see many small dots making the code pixilated and that each pixel is called a module. And that the small squares in the corners are position detection patterns supporting the omni-directional scanning.

How is this of relevance in pharma? Here are some examples:-.

In the US a company is promoting a product called the Glow Plug. It requires some hardware. A cap which fits prescription bottles. A light which plugs into the wall. An internet gateway device. Wireless connections. The light glows to remind you to take a tablet. The gateway talks to the internet and tells a website when the patient removes the cap supporting self-management and carers.

Enter the QR code

A QR code is capable of coding the dose regimen for a medicine. We print this on the PIL or the pack outer.

Our QR code drug adherence App scans the regimen. It places reminders in the calendar to alert the patient to take a dose. A schedule of alarm alerts is created to match the regimen. Each time the patient takes a dose they rescan the pack. By presenting the pack outer to the App for each dose the App can update the regimen and silence the appropriate reminder.

The mobile is connected to the internet so it can update a central site to support carers. The App itself holds data for self management such as medical history. The data is encrypted, uses GxP clinical security, and the data is transient and held in a Cloud meaning it is accessible anywhere and never lost.

“The patient can log on and see trends or send the data to the physician.”

No hardware required. Just some smart software.

There are opportunities for enhancement. For example the App can check for contraindications– using existing online resources such as the eMC. The patient can opt to share data with the physician or de-identified with the manufacturer. Product recalls are delivered direct. Geographical and socio-demographic adherence trends are gathered delivering valuable insights.

In the US, companies are promoting wireless diabetes glucose monitors. The hardware varies – a wireless internet gateway device,.a glucose monitor which plugs into mobile phones, cables, blue-tooth and wireless networks. The monitor sends the data to the mobile phone. The data is sent to the internet where it is compiled on a website. The patient can log on and see trends or send the data to the physician.

Enter the QR code

A glucose monitor with an LCD screen can display test results as a QR code. Our diabetes partner App scans the QR code adding the result to the mobile patient database. If the patient opts to share data with their doctor they can do so online or in-App. The mobile is internet connected and holds data securely in a Cloud so it can be retrieved anywhere even if the device is lost. Data can be shared via the Cloud to parents, carers, medical professionals (both emergency and routine).

Opportunities for enhancement exist. Pair monitor with mobile using a unique serial passed to the mobile within the QR code. Now the logon sequence to the App only works if you scan a QR code on that meter– similar to online banking security. Multiple monitors can be used with one App since it recognizes individual monitors. Crowdsourcing becomes an option – the App detects other users in the event that a patient loses or forgets a testing consumable. For younger patients integrate an iPod game with the results – players achieving consistent testing get free in-App purchases of new game levels.

No wires, no wireless, no cables, no Bluetooth, no docking, no USB, no PC, no need for FDA approval of wiring, no fuss.

Low tech solutions for high-tech devices using a simple visual data exchange.

“QR codes are powerful because they are software. A software approach is portable, works on any device, and works with any data.”

There are many other possible applications

In a pharmacovigilance safety scenario you can track specific packs with particular patients. Register the patient using a mobile App. Only dispense if the App confirms it can scan the QR code on the pack outer. The App transmits the pairing of patient and pack to the manufacturer for monitoring.

In the drive against counterfeit medicines an encrypted micro QR code can be placed on foil packaging. Only genuine products decrypt correctly.

QR codes are powerful because they are software. A software approach is portable, works on any device, and works with any data.

The QR code is a reliable validation-ready (for GxP settings) means of passing data from one device to another.

The prevalence of mobile devices (tablets and phones) supporting Apps with QR code support is a powerful combination and securing electronic data can be achieved using approaches such as our PDI (perimeter based data integrity) framework, encryption, and transient Cloud data.

We expect to see many more innovations around visual data exchange and mobile Apps.

About the author:

Nick Plank is a Director at C&amp,C Group and has been working in the life sciences industry for 15 years, providing enterprise, SaaS, and digital technology based solutions throughout the brand life cycle for branded and generic companies, delivering global, European, and UK focused projects.

You can follow C&amp,C Group on Twitter @candc_group

What innovative use of QR codes have you seen in healthcare?