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Solutions that track, identify and manage in a fast-moving world THE ZEBRA PRODUCT PORTFOLIO
Transcript

Solutions that track, identify and manage in a fast-moving world

ThE ZEbra ProduCT PorTfolIo

Zebra helps companies to identify, track and manage assets, transactions and people with on-demand specialty digital printing and automatic identification solutions.

Trusted all over the world, more than 90 percent of Fortune 500 companies use Zebra® printers, supplies, RFID products and software to increase productivity, improve quality, lower costs and deliver better customer service.

We’re helping businesses to succeed in a wide range of markets, including:

Transportation and logistics•

Manufacturing•

Retail•

Healthcare•

Post and parcel•

Government•

Hospitality•

Mobile workforce•

Education•

Banking•

Specialty Printing Group We offer specialty printing and auto-ID products and solutions including a wide range of bar code, card and kiosk printers, plus supplies and software products.

Zebra Enterprise Solutions We are also delivering emerging technologies and widening our portfolio of track, locate and trace products and services. Learn more at www.zebra.com.

Improving customers’ business performance

Bluetooth® Ethernet Infrared Parallel Serial USBIrDA®Connectivity key:

high-Performance printersZebra’s high-performance printers stand up to the most demanding needs, delivering the power and reliability required for your mission-critical applications.

Series Media widths Connectivity Print resolution Max. print speed

XiIIIPlus™

4.5"/114 mm5.51"/140 mm7.1"/180 mm8.8"/224 mm

1

802.11b/g1

203 dpi (all) 300 dpi (exc. 140XilllPlus™) 600 dpi (110XilllPlus™ only)

12"/305 mm per second2

1 Optional feature. 2 Dependent upon model and resolution.

Stay in front with ZebraIn a fast-track world, Zebra’s on-demand digital printing and automatic identification solutions help identify, track and locate assets, transactions and people. So you’ll always be one step ahead.

Midrange printersZebra’s midrange industrial and commercial printers offer reliable and economical solutions for a wide range of applications and environments.

Series Media widths Connectivity Print resolution Max. print speed

105SL™ 4.52"/115 mm

1

802.11b/g1

203 dpi 300 dpi 8"/203 mm per second

Z Series® 4.5"/114 mm7.0"/178 mm

1

802.11b/g1

203 dpi 300 dpi 600 dpi (4" only)

10"/254 mm per second 8"/203 mm per second 4"/102 mm per second

S4M™ 4.5"/114 mm

1

802.11b/g1

203 dpi 300 dpi 6"/152 mm per second

1 Optional feature.

desktop printersWhere space is limited, Zebra desktop printers are a compact, affordable and easy-to-operate solution.

Series Media widths Connectivity Print resolution Print language

LP (direct-thermal only)

1.97"/50 mm3.94"/100 mm

1203 dpi EPL™ or ZPL®

TLP (thermal-transfer)

1.97"/50 mm3.94"/100 mm

1 203 dpi 300 dpi 2 EPL or ZPL

G-Series™(direct-thermal or thermal-transfer)

3.94"/100 mm 1

1

802.11b/g1203 dpi and 300 dpi (model-dependent)

EPL & ZPL (coexistence)

1 Optional feature. 2 Only available for TLP 3844-Z™ and TLP 3842™.

Model Wristband sizes Connectivity Colors availablePrint resolution Max. print speed

HC100

Adult Z-Band® Direct 3: 1” x 11” (25 mm x 279 mm) Adult Z-Band QuickClip™ 4: 1.1875” x 11” (30 mm x 279 mm) Child Z-Band Direct:1” x 7” (25 mm x 178 mm)Child Z-Band QuickClip 4: 1” x 7” (25 mm x 178 mm) Neonatal Z-Band Direct: 1” x 6” (25 mm x 152 mm)

All bands available in white. 3 Also available in Red, Blue, Yellow, Green, Orange, Pink, and Purple 4 White band with clip closure available in Red, Blue, Yellow, Green, Pink, and Purple

300 dpi 2"/51 mm per second

1 Optional feature. 3 Also available in Red, Blue, Yellow, Green, Orange, Pink, and Purple. 4 White band with clip closure available in Red, Blue, Yellow, Green, Pink, and Purple.

Mobile printersZebra’s broad range of mobile printers, combined with wireless technology, enable on-the-spot label and receipt printing in almost any environment.

Bluetooth Ethernet Infrared Parallel Serial USBIrDAConnectivity key:

Wristband printersThe HC100™ wristband printer with integrated media cartridge offers a total solution for wristband printing.

Kiosk printersZebra’s robust kiosk printers offer a range of features designed to provide fast, reliable and versatile printing performance across many applications.

Series Media widths Connectivity Type Print resolution Max. print speed

Receipt printers2.28"/58 mm 3.25"/82.5 mm2.36"/60 mm 4.41"/112 mm3.15"/80 mm 4.57"/116 mm

Embedded 203 dpi/300 dpi Up to 6"/150 mm per second

Ticket printers1.97"/50 mm 2.60"/66 mm2.12"/54 mm 3.15"/80 mm2.36"/60 mm 3.25"/82.5 mm

Embedded, desktop 203 dpi 1 ticket per second or 6"/150 mm per second

Series Printer type Media widths Connectivityruggedness (drop specification)

WeightPounds (kg) IP rating2

EM 220™ (direct-thermal)

Receipt 2.28"/58.0 mm 1 4'/1.2 m 0.52 3

(0.24) N/A

QL Plus™ series (direct-thermal)

Receipts, tags and labels2.12"/53.8 mm3.12"/79.2 mm4.12"/104.6 mm 802.11b/g1 1 5'/1.5 m 1.04/1.65/2.0 3

(0.47/0.75 /0.91)

14 (54 with optional soft case)

RW™ series (direct-thermal)

Receipt and limited label 2.37"/60 mm4.12"/104.6 mm 802.11b/g1 1 6'/1.8 m 1.45/2.0 3

(0.66/0.91) 54

MZ™ series (direct-thermal)

Receipt 2.0"/50.8 mm3.0"/76.2 mm 802.11b/g1 1

IrDA4'/1.2 m 0.70/0.75 3

(0.32/0.34) 42

P4T™ (direct-thermal or thermal-transfer)

Receipts, tags and labels 4.12"/104.6 mm802.11b/g1 1 5'/1.5 m 2.91 3

(1.32)

14 (54 with optional soft case)

1 Optional feature. 2 The IP rating indicates the level of protection that the printer has against the ingress of solid objects (dust) and liquids (rain). The higher the value, the better the protection offered.3 Weight indicated includes battery.

1

802.11b/g1

Bluetooth Ethernet Infrared Parallel Serial USBIrDAConnectivity key:

Print enginesOEM print engines are designed to be integrated into label-applicator machinery, providing reliable high-performance label printing for unattended applications.

Series Media widths Connectivity Print resolution Max. print speed

PAX4™ series4.5"/115 mm7.1"/180 mm

1

802.11b/g1

203 dpi 300 dpi 12"/305 mm per second2

1 Optional feature. 2 Dependent upon model and resolution.

Card printersZebra card printers provide enhanced security and increased productivity. Card after card, Zebra printers deliver reliable performance and excellent print quality.

Series Printer typesColor/ monochrome Print speed

Connectivity options uhf Gen 2 rfId lamination Card feeder

ValueSingle- or double-sided Mono and color 90/102/120/500

cards per hour1

Magnetic stripe/ contact smart card/ contactless smart card

N/A Single/low-capacity

PerformanceSingle- or double-sided Mono and color 102/144/710

cards per hour1

Magnetic stripe/ contact smart card/contactless smart card/UHF Gen 2 (P330i & P430i models only)

N/A High-capacity

Security Double-sided Mono and color 120 cards per hour

1Magnetic stripe/ contact smart card/ linear bar code reader

Single- or double-sided Mid-capacity

rfId printer/encodersRadio frequency identification (RFID) printer/encoders assist in the implementation of instant, measurable improvements in operating efficiency, accuracy and supply-chain visibility.

Model/Series Media widths Connectivity hf/uhf Print resolution Max. print speed

R2844-Z™ 4.25"/108 mm 3

HF 203 dpi 4"/102 mm per second

RXi™ series4.5"/114 mm7.0"/178 mm

1

802.11b/g1UHF 203 dpi

300 dpi 12"/305 mm per second

R110Xi HF™ 4.5"/114 mm

1

802.11b/g1HF 203 dpi

300 dpi

10"/254 mm per second 8"/203 mm per second

R110PAX4™ 4.5"/114 mm

1

802.11b/g1UHF 203 dpi

300 dpi

12"/305 mm per second 8"/203 mm per second

RZ™ series4.5"/114 mm7.0"/178 mm

1

802.11b/g1UHF 203 dpi

300 dpi

203 dpi: 10"/254 mm per second300 dpi: 8"/203 mm per second

RP4T™ 4.12"/104.6 mm802.11b/g1 1 UHF 203 dpi 1.5"/38 mm per second

1 Optional feature.

1 Optional feature.

Corporate Headquarters Asia-Pacific Headquarters EMEA Headquarters Latin America Headquarters+1 800 423 0442 +65 6858 0722 +44 (0)1628 556000 +1 847 955 2283 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] E-mail: [email protected]

Other Locations USA: California, Georgia, Rhode Island, Texas, Wisconsin Europe: France, Germany, Italy, Netherlands, Poland, Spain, Sweden Asia Pacific:Australia, China, Japan, South Korea Latin America: Argentina, Brazil, Florida (USA), Mexico Africa/Middle East: India, Russia, South Africa, United Arab Emirates

GSA#: GS-35F-0268N

P1008441 (11/08)

Specifications subject to change without notice.©2008 ZIH Corp. All product names and numbers are Zebra trademarks, and Zebra, the Zebra head graphic and ZPL are registered trademarks of ZIH Corp. All rights reserved. Bluetooth is a registered trademark of Bluetooth SIG, Inc. IrDA is a registered trademark of Infrared Data Association. All other trademarks are the property of their respective owners.

From traditional compliance labelling and security needs to business-improvement solutions that deliver impressive ROI, you can rely on Zebra.

Genuine Zebra™ suppliesSpecifically developed for Zebra printers, our supplies are all made to a high standard.

We supply labels, tags, wristbands, cards •and ribbons

All labels and ribbons are laboratory-tested •for optimum performance

Genuine Zebra supplies minimize wear and •tear on printheads

A wide range of materials supports the full •Zebra printer range

ZipShipSM suppliesIf you need supplies fast, the ZipShip program delivers. The specially-selected array from Zebra comprises the most popular media, at great prices, with shipment within the next business day. And we’ve made it easy for you to identify the right supplies for your application with our online ZipShip Selector Tool.

Custom suppliesWe also manufacture custom or preprinted colored labels on a range of materials to meet customer requirements. These custom designs can also be branded with your logo.

Connectivity and printer managementOur advanced centralized printer-management tools and connectivity options, from ZebraLink™ Solutions to wireless capabilities, make integrating and maintaining remote Zebra printers in a distributed environment easy.

Product supportZebraCare™ service agreements deliver quality, security and peace of mind. We’re committed to offering customers the highest-quality customer care in the industry, delivering outstanding customer service and providing a global network of high-quality support.

Quality, reliability and innovation

A Zebra Technologies White Paper

Patient Safety Applications ofBar Code and RFID Technologies

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Executive Summary

The recent focus on patient safety in U.S. hospitals has yielded a flood of new technologies and tools aimed specifically at improving the quality of patient care at the bedside. This has been accomplished by integrating the physical process of care delivery with medication information and software applications that provide clinical decision support, and quality and safety checks. Error reduction at the bedside is the lightning rod of industry efforts to address patient safety. Among technology approaches, bar coding solutions have risen to the top of industry preference due to their relative ease of implementation, demonstrated return on invest-ment (ROI), and broad array of applications.

Bar code solutions are being deployed in a variety of healthcare applications, including producing hospital wristbands and labeling for pharmaceutical unit-dose medications, IV mixtures, lab and pathology specimens, blood products, asset tags, file labels and more. Bar codes can be matched with radio frequency identifica-tion (RFID) tags to create two-tiered identification, resulting in more robust point of care, patient-specific medical media. Pharmaceutical companies can locate and track each dose of medication produced in vast batches. Hospitals can monitor and utilize equipment with greater efficiency, and healthcare staff can more efficiently create and maintain healthcare records.

The application of RFID technologies in hospitals has been modest, however, primarily due to cost issues. Like most electronic technologies, RFID unit costs have fallen dramatically within the past few years, but have not yet reached the “tipping point” of economic rationality for cash-conscious hospitals. In the 2008 Annual HIMSS Leadership Survey, 15 percent of respondents said their organization uses RFID and 43 percent anticipated using it within two years.i To date, RFID in healthcare has been limited primarily to asset management and supply chain applications. Ultimately, a mix of both technologies—RFID and bar coding—will provide the optimal return on investment (ROI) for most healthcare providers.

From an ROI perspective, bar coding has been proven to generate not only clinical benefits but also measurable financial benefits. If each adverse drug event (ADE) adds an additional $8,750 to the cost of a hospital stay (a figure cited by the Institute of Medicine [IOM]), and there are an estimated 400,000 in-hospi-tal preventable ADEs per year in the United States, the annual cost, in 2006 dollars, is $3.5 billion.ii In addition to the cost-avoidance aspect of patient safety that bar coding provides, bar code data greatly improve the accuracy of charge capture, pharmaceutical inventory management, drug utilization and best practice compliance.

The market for healthcare bar code solutions is ripe with opportunity, not only in terms of patient safety, but also in terms of unmet demand for broader applications of the technology within healthcare organizations. Integrated medication management, automated identification, asset management and inventory control are just a few industry opportunities that are poised for growth. According to the American Hospital Association, more than half of all hospitals have fully or partially deployed bar coding for at least one reason, and 26 per-cent of hospitals already use bar coding for pharmaceutical administration.iii

Introduction

In 1999, the Institute of Medicine (IOM) issued a landmark report entitled “To Err is Human,” that described the prevalence of widespread and often preventable medical errors throughout the U.S. healthcare industry. The IOM report stated that preventable medical errors cause up to 98,000 deaths and 770,000 adverse events in the U.S. each year. Since the IOM Report was published, subsequent industry evidence has revealed that the problem not only persists—it appears to be getting worse. In fact, a 2003 study

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conducted by HealthGrades, Inc. found that nearly 200,000 patient deaths each year are attributable to medi-cal errors—twice the worst-case forecast in the IOM report. A 2006 follow-up to the 1999 IOM study found that at least 1.5 million preventable ADEs occur each year: 400,000 in hospitals, 800,000 in long-term care settings and approximately 530,000 among Medicare recipients in outpatient clinics.

In each of these studies, ADEs have been identified as a primary cause of preventable medical errors and one of the single greatest threats to patient safety. The term ADE describes drug administration errors that take a variety of forms, including incorrect drug selection, incorrect dosage or frequency, and negative drug interactions. ADEs can result from the wrong medication being prescribed, the wrong medication being distributed by the pharmacy, or the wrong administration of the medication at the bedside. A 2002 report from the Archives of Internal Medicine found that almost one in five medication doses administered in hospitals is given in error. The two most common errors cited were medication dispensing at the wrong time (43 percent of incidents) and omitting a dose (30 percent). Seven percent of errors were found to be potentially harmful. In a 300-bed facility, this translates into 40 potentially harmful errors each day.iv

In the wake of these reports and their message that the issue of preventable medical errors remains unsolved, the U.S. healthcare industry has focused its collective attention toward developing tools, technologies, and techniques to promote patient safety. Industry leaders have taken note—for the second consecutive year, participants in the Annual HIMSS Leadership Survey placed a high priority on using IT to reduce medical errors and promote patient safety. This priority was ranked first in 2007 and second in 2008.v

FDA Regulation and Industry Goals

In recognition of the urgency of patient safety issues, government agencies and industry regulators have established goals and guidelines to reduce medical errors. On February 25, 2004, the U.S. Food and Drug Administration (FDA) issued a Bar Code Rule that requires drug manufacturers, re-packers, and re-labelers to apply unit-dose bar codes containing products’ National Bar Code (NDC) numbers to the immediate package of most prescription drug products, including biological products. While the rule imposes no requirements on hospitals, it does encourage hospital compliance. The FDA estimates that “the bar code rule will result in more than 500,000 fewer adverse events over the next 20 years, thereby reducing medical errors by 50 percent.” vi An estimated $93 billion is likely to be saved by reducing healthcare costs, patient pain and suffering, and lost work time due to adverse events.

The Joint Commission, a healthcare regulatory agency, has established a set of National Patient Safety Goals, which require that healthcare personnel check two patient identifiers when providing care, treatment or services. Bar coded wristbands easily accommodate two identifiers and can improve accuracy and safety by enabling correct identification of patients prior to medication administration, specimen collection, surgery, patient transfer, x-rays, or performance of other diagnostic tests. The U.S. Department of Defense requires that its suppliers mark their medical and surgical products with a UPN bar code. Large pharmaceutical companies like Pfizer, large health plans like Kaiser Permanente, and large health systems like HCA have also taken a leadership position in implementing bar code solutions.

Patient Safety at the Point of Care

The recent focus on patient safety has yielded a flood of new technologies and tools aimed specifically at improving the quality of patient care at the bedside by integrating the physical process of care delivery with medication information and software applications that provide decision support, and quality and safety checks. In the hospital environment, patient safety tools and technologies must translate into the correct

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administration of medications at the bedside, and from a strategic perspective, the key element of patient safety at the bedside is the process of medication administration.

The cornerstone of medication administration safety is the principle of the “Five Rights”—right medication, right dose, right time, right patient and right route. These describe the elements of an optimal patient medication administration process. Information about the patient and the medication at the point of care is critical to the success of such a program, and must be accessible in a concise, on-demand, and process-specific manner in order to expedite rather than impede the clinical activity of hospital staff. Figure 1 depicts the stages of medication management during which errors typically occur—and can be prevented. Without technology, it is at the final stage of this process, during which the nurse administers the medication, that no “second check” is available to ensure the “Five Rights” of patient safety.

Figure 1

Industry efforts to address patient safety are focused on error reduction at the bedside. Among technology solutions for medication errors, bar coding solutions have risen to the top of industry preference due to their relative ease of implementation, demonstrated ROI and broad array of applications. Bar coding is also viewed by healthcare CIOs and clinicians as a forerunner of more comprehensive patient safety initiatives such as e-prescribing, computerized physician order entry (CPOE) and the electronic medical record (EMR). With such technology tools, healthcare organizations can achieve true digital and clinical transformation of patient care—and make healthcare “faster, better and cheaper.”

How Bar Coding Works

Bar codes record text information in an encoded format, and the bar code serves as an index key in clinical databases. In a medication administration application, bar code architectures often include a bar coded wristband issued to the patient at the time of admission. Nurses’ ID badges and medications also carry bar codes. At the time that a medication is administered, all three bar codes are scanned at the bedside. This assures an identical match between patient and medication, and also identifies the practitioner administering the medication. The system is supported by software that references expert databases to comply with the

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“Five Rights” of patient medication administration. In other clinical applications, hospitals and health systems use bar coding to “tag” unlabeled unit-dose medications, manage clinical inventory and assets, and record in-terventions for each patient receiving medications. Hospital pharmacies scan unit-dose packaging to improve security, build an audit trail and automate inventory record keeping.

Bar Coding for Patient Safety

Bar codes of various types are deployed in producing hospital wristbands, as well as in the labeling of pharmaceutical unit-dose medications, specimens, blood products, IV mixtures, patient-chargeable medical supplies, surgical supplies, asset tags, file labels and more. Bar codes can be matched with RFID tags to create two-tiered identification and more robust point-of-care, patient-specific medical media. Pharmaceutical companies can locate and track each dose of medication produced in vast batches, equipment can be monitored and utilized with greater efficiency, and healthcare staff can more efficiently create and maintain healthcare records.

WristbandsWristbands containing one- or two-dimensional bar codes are issued to patients upon hospital admission. Prior to administering a medication at the bedside, a nurse scans the patient’s (Joint Commission and HIPAA compliant) bar coded wristband to confirm the patient’s identity; the scan acts as a key to open the patient’s record in a centralized medical database where each patient record contains indications, advisories and restrictions concerning care administered to that patient. Once the accuracy of the patient/medication has been confirmed, the nurse scans his/her badge to record the time and source of the medication administra-tion. In a study conducted by the U.S. Veteran’s Administration, this method of medication administration was found to reduce the incidence of medication errors by 86.2 percent.

Unit-Dose MedicationBar codes accurately identify medications by type, recommended dosage and frequency of administration at the unit-dose level, thus providing nurses with a “second check” and decision support tool in the admin-istration of patient meds. Nurses can combine the information contained in the unit-dose bar code with the patient wristband to ensure the “Five Rights” of patient safety.

Specimen CollectionBar code systems compare specimen collection orders, stored in a handheld or bedside laptop, with information scanned from the patient wristband, and confirm that the specimen container is the correct one for the tests ordered. A new bar code label for the specimen container is printed at the bedside with the time and date of collection, helping to minimize the potential for labeling errors. In the lab, bar code tracking technology can eliminate processing errors, starting at sample collection and continuing through the process of accession, testing and results reporting.

Blood AdministrationOne of the Joint Commission’s National Patient Safety Goals is to improve accuracy in positively identifying patients prior to drawing blood or administering blood products. The FDA estimates that there are 414 an-nual blood transfusion errors. A study by Sharma et al has shown that nearly 80 percent of blood transfusion errors are related to bedside or labeling errors.vii A bar coding system for blood administration can reduce such errors by as much as 90 percent. Point-of-care bedside bar coding applications are being integrated with blood product administration activities to combine patient identification, medication and blood product

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verification. Phlebotomy and blood banking are current focal points of bar coded blood administration, and operating room (OR) bar coded blood type/patient confirmation is currently in development.

Track-and-Trace SystemsIn compliance with the FDA rule requiring bar coding of unit-dose medication packaging, anti-counterfeiting bar code technology is being developed and deployed in pharmacies, hospitals and elsewhere to improve tracking and tracing. Bar coded lot numbers, expiration dates and unit-dose identifiers help healthcare manu-facturers, distributors and consumers manage medications throughout the supply chain. Track-and-trace systems are the key component of anti-counterfeiting programs, by providing an accurate drug “pedigree” that is a secure record documenting the drug’s source and date of manufacture.

PharmacyToday, some medications still arrive at the hospital pharmacy without a bar code—which requires the phar-macy to produce its own bar code label. Pharmacies use bar coding to tag unit-dose medications derived from bulk items and mixtures. For many medication fulfillment processes in the pharmacy, bar code printers and automated dispensing equipment produce on-demand, unit-dose bar codes that are legible, secure and cost-effective.

Bar coding is an extremely adaptive technology whose total applications in the hospital environment have yet to be fully explored. Today, bar coding in hospitals encompasses many areas of clinical and business activity, including:

• Patient registration

• Patient identification

• Patient tracking

• Patient charge collection and billing

• Medical record document assimilation and indexing

• Physician and caregiver order entry

• Laboratory specimen tracking and verification

• Radiology—film tracking

• Medication administration verification

• Blood transfusion verification

• Respiratory therapy treatment at the bedside

• Dietary management

• Supply chain management

• Receiving

• Storage and unit labeling

• Picking and internal transfer

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• Replenishment order

• Cycle counts

• Annual equipment inventories

• Preventative maintenance

• Linen inventory and distribution

• Sterile reprocessing

• Security

• Employee identification

In addition to the stand-alone applications of bar coding, systems can also be linked to CPOE and EMR sys-tems, and pharmaceutical and supply systems. This allows institutions to access financial information and to drill down to the patient level to report on the cost of providing care, as shown in the following illustration.

Figure 2

At the bedside, integrated medication management links bar code scanning, clinical knowledge databases, wireless networking and patient record technologies. Reporting capabilities from such input can include real-time queries on patient care activities, pharmaceutical and supply usage trends, and internal performance benchmarks. This capability can contribute to the development of standardized care paths by tracking and reporting on pharmaceutical, equipment and supply usage by various patient groups.

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Who Benefits from Bar Code Solutions for Patient Safety?

First and foremost, the patient benefits from bar coding because it helps in preventing ADE-related patient pain, suffering and extensions of hospital stays. Throughout the healthcare value chain, manufacturers, distributors and providers of healthcare products and services have a professional responsibility to adopt best practices, enact processes, and deploy tools and technology solutions that positively impact patient care. That’s a lofty concept, but in many cases technologies like bar coding must be sold on the basis of benefits that can be measured by traditional clinical and financial metrics. Today, there are clear regulatory and business drivers serving as a catalyst for bar coding adoption, particularly in the hospital and pharmaceutical verticals.

HospitalsThe FDA estimates that purchasing bar coding equipment and training staff on the technology will cost about $53.1 million, but will result in 413,00 fewer ADEs in the next 20 years and will avoid related hospital stays, saving an estimated $41.4 billion.viii In addition, hospitals are expected to avoid litigation associated with preventable adverse events (reducing malpractice liability insurance premiums), and increase receipts from more accurate billing procedures (in excess of the bar code implementation and maintenance costs, according to the FDA). Hospitals also benefit from the marketing and patient preference benefits associated with quality care and industry leadership in the adoption of new technologies and clinical processes. Less obvious, but of vital importance, are the collateral benefits of bar coding to nursing and pharmacist productivity, charge capture, inventory management, asset utilization, commodity tracing and tracking, and the market value of patient safety leadership.

PharmaceuticalsSince April 2006, the FDA has required that pharmaceutical manufacturers bar code their products at the unit-dose level. As a result of the FDA’s mandate, benefits are being realized in a number of areas, including patient safety, brand protection and fraud detection, supply chain, and return and recall processes.

Business Case

Return on investment is never far from any serious consideration of a new technology deployment, and bar coding has been proven to generate measurable clinical and financial benefits. According to a 2006 report issued by the Institute of Medicine, each preventable ADE adds about $8,750 to the cost of the hospital stay.ix An article published in the journal Legal Medicine reported that approximately 30 percent of all malpractice suits involve drug-related injuries. In addition to the cost-avoidance aspect of patient safety that bar coding provides, bar code data greatly improve the accuracy of charge capture, pharmaceutical inventory manage-ment, drug utilization and best practice compliance.

Worldwide, fraudulent pharmaceuticals pose serious health risks and cost manufacturers more than $32 billion annually.x Bar coding of pharmaceuticals establishes their pedigree, combats drug counterfeiting and creates an audit trail through the value chain. Drug makers who implement bar code and RFID control systems can reduce diversion by 18 percent in the first year and lower inventory holding costs by 6 percent, according to a study by A.T. Kearney. Recent studies have shown that 68 percent of lab errors are related to pre-analytical procedures, and about half of those errors are the result of misidentification of the patient or mislabeling of the specimen. Bar coding can reduce such errors by one third. xi

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Bar Coding Versus CPOE

Bar coding is not the only patient safety technology available to hospitals; there are several alternative strat-egies, including e-prescribing, electronic patient records and CPOE. As shown in the following illustration, bar code systems are faster and cheaper to implement and offer a higher ROI for patient safety.

Figure 3

Representative cost data describing the total cost of ownership of bar coding systems is difficult to obtain—there are simply too many variables, including the number of nurses to be equipped, the extent of infrastruc-ture and systems architecture investments, training, maintenance and other factors. The FDA has estimated that the average hospital will spend $448,000 to implement a computerized medication administration system, but according to HIMSS, the projected cost for a hospital to implement bar coded medical admin-istration (BCMA) systems to read and capture bar code data at the bedside is slightly less than $2,000 per bed (including hardware, software, data management systems, service costs and user training), with operat-ing expenses of approximately $1,000 per year. For a 200-bed hospital, this translates into acquisition costs of $400,000 and annual operating costs of about $200,000. When contrasting these figures with the CPOE base cost of $2 million to $5 million, the business case for bar coding becomes even more compelling.

Notes from the Field

Bar coding as a tool of patient safety has proven to be an unqualified success at hospitals across the country, in ways that can be measured in both clinical and economic terms. In some cases, bar coding has served as the forerunner of “closed-loop” patient safety initiatives that include e-prescribing, CPOE and EMR applications. In other cases, bar coding has been implemented as a stand-alone solution to patient safety at the point of care. In still other situations, bar coding is being deployed in new clinical applications. A few examples:

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Atlantic Health System (Morristown, N.J.)As of 2005, Atlantic Health System had embraced bar code technology but had not yet standardized on one bar code symbology across the enterprise. The health system sought a symbology that could ultimately sup-port bedside specimen collection, blood administration and a range of additional applications. Wristband reli-ability was also a concern. Labels tended to come off the wristbands or get damaged, requiring caregivers to create replacement bands, which increased the potential for errors. In fact, at one location, as many as 15 percent of glucometer test results were being attributed to the wrong patient due in large part to this issue.

Since implementing dedicated thermal wristband printers and wristbands, the health system has seen sig-nificantly improved bar code read rates and wristbands now remain intact throughout the average patient’s stay. Atlantic rolled out bedside bar code medication administration in the summer of 2007. In addition to helping caregivers ensure the “five rights” of patient medication administration, implementing bar coding at the point of care has enabled the health system to increase the accuracy of charge capture by enabling staff to charge patient accounts at the point of administration rather than when medication is dispensed by the pharmacy.

Aurora Health Care (Milwaukee, Wis.)Bar coding is part of a larger patient safety initiative at Aurora Health Care, an integrated healthcare system with 13 hospitals and more than 100 clinics. With the long-range plan of leveraging electronic medical re-cords and computerized physician order entry to establish a closed-loop, integrated point-of-care medication administration system, Aurora has implemented bar-code-based automated identification.

Seeking to ensure that it labels all medications, Aurora has deployed on-demand thermal bar code printing in a wide variety of settings, including hospital pharmacies. The health system is also transitioning to a central-ized medication repackaging operation for all hospitals, which will enhance labeling efficiency. For patient identification, Aurora has identified and implemented a bar code symbology and wristband material combi-nation that is easy for nurses to scan, less disruptive to the overall patient experience and durable enough to withstand the everyday challenges of the hospital environment.

There are many operational benefits to medication and patient auto-identification. For example, Aurora’s method of processing charge credits resulting from medications returned to the pharmacy is more efficient and more accurate than previous manual methods. Most importantly, however, Aurora has successfully laid the foundation for closed-loop medication administration, which will help reduce the incidence of medica-tion errors and further enhance patient safety across the organization.

Hamilton Medical Center (Dalton, Ga.)Every year, more than 160,900 adverse events occur in hospitals nationwide because of sample identifica-tion errors. The possibility of errors like these prompted Hamilton Medical Center to deploy a patient safety strategy that utilizes bar code technology for phlebotomy services. At the time, the phlebotomy staff was handling more than 1,000 specimen labels each day. By labeling specimen containers at the bedside, the 282-bed hospital hoped to eliminate the potential for error as well as many of the inefficiencies associated with manually printing, sorting and organizing specimen labels in the lab before starting rounds. Hamilton was already issuing bar coded patient identification wristbands in the admissions department, which pro-vided the foundation for the lab’s bar coding efforts.

Phlebotomists now collect samples and generate patient-specific labels at the bedside using a mobile thermal printer and a personal digital assistant (PDA) device. Hamilton reports that the system saves staff members an average of 45 minutes per day, as they no longer have to return to the lab for additional labels

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as new tests are ordered but instead can view order updates through real-time collection lists on the PDA. Turnaround times have improved and re-draws are down, helping to lower the overall cost of care. Most importantly, by printing labels one-at-a-time at the point of care, Hamilton has virtually eliminated the possibility of applying the wrong label to the wrong specimen. The hospital has also expanded its use of bar coding to the blood bank to ensure that the correct patient receives the correct blood product.

Southern Regional Health System (Riverdale, Ga.)The hospital laboratory at Southern Regional Health System, a 406-bed medical/surgical facility, performs more than one million billable medical tests each year. Seeking improved efficiencies and a reduction in errors, Southern Regional decided to update its manual specimen labeling process, which required staff to print batches of specimen labels every two hours, sort them and then distribute them to phlebotomists. With a point-of-care specimen labeling system, implemented in September 2005, the hospital aimed to provide positive patient identification, reduce mislabeled specimens and meet the Joint Commission’s patient safety recommendations.

Today, Southern Regional’s 27-person phlebotomy staff uses a mobile software application running on a handheld device and a mobile printer to support its specimen collection at the point of care. The application is integrated with Southern Regional’s laboratory information system. Bar coding and real-time data transmission have significantly reduced the number of steps in the specimen collection process, enabling Southern Regional to decrease staff by 30 percent and reduce the number of labeling errors from an average of two per month to none.

Southwestern Vermont Medical Center (Bennington, Vt.)An early adopter of healthcare IT, Southwestern Vermont Medical Center (SVMC) began implementing bar coding for bedside medication verification in 2007 as part of its organization-wide initiative to enhance patient safety. Even though the incidence of errors was rare at SVMC, the hospital hoped to decrease the potential for medication transcription and administration mistakes through the use of bar coding and e-MAR technologies.

As part of the initiative, the hospital reviewed both bar code symbologies and print technologies. For patient identification and medication labeling, SVMC opted for two-dimensional (2-D) bar codes over linear bar codes, as they provide more flexibility than linear codes. To ensure that the printed bar code labels would be durable and reliable enough to produce the consistently high scan rates necessary for ongoing patient identification and medication verification, the hospital selected direct thermal printers to produce their patient identification wristbands. SVMC had previously used laser printers to output adhesive-backed bar code labels, which were then attached to wristbands. However, the wristbands were easily damaged and fell apart quickly.

In addition to installing printers at admission, SVMC located five direct thermal printers on the nursing floors, so staff could generate replacement wristbands on demand. Not only are the bar codes more durable, but the wristband printing process is now much more efficient. By February 2008, bedside medication verifica-tion was live in the ICU and in both the east and west wings of the medical center. Within the first two weeks of implementation, the hospital administered 10,000 medications with a 93 percent scan rate.

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Challenges and Barriers to Bar Code System Integration

Bar coding solutions span a variety of areas, including patient management, order entry, medication management, specimen management, asset management, accounting and more. Integration of bar code technologies and tools across multiple systems and technology environments requires interoperative software applications, robust infrastructure, adequate staff resources, process and workflow changes, and culture adaptation. Bar code formats are also an issue, since no standard exists and a number of bar code formats are currently being used in healthcare. In many cases, a single vendor solution cannot satisfy these requirements, requiring hospitals to buy multiple components—scanners, printers and software—from dif-ferent manufacturers to meet bar code integration requirements. As a result, bar code integration with other clinical systems in the hospital remains challenging.

To achieve true integration of bar code technologies and tools with complementary systems such as CPOE and e-prescribing, interoperability and system architecture issues must be resolved. This is a difficult task, since historically vendors have tended to build proprietary features into their products, in an effort to “lock in” customers. That market dynamic is changing, however, as hospitals demand open system architecture and vendor-neutral applications that can work seamlessly with other products. Similarly, equipment must be multifunctional to avoid duplication and unnecessary capital consumption for related patient safety processes. A case in point is bar code printing solutions.

Thermal or Laser Bar Code Printing?

There are a number of bar code print solutions available today, including traditional packaging presses, as well as laser and thermal printers. However, these methods differ greatly in terms of bar code production speed, quality, edge definition, flexibility, label formats supported, print sizes and cost. Among the most common bar code production methodologies are thermal and laser printing.

Thermal is the dominant technology for producing bar code labels in all industries. Thermal printing technology has been developed specifically for bar coding applications, and is particularly suited to healthcare since it addresses the need for compact, highly defined, durable codes for vials, electronic components, sample containers and small items such as unit-dose medications. Thermal printers can handle all bar code symbologies and data structures endorsed by the FDA and come in many configurations, includ-ing mobile units that can be carried or worn on a belt, small desktop models and industrial-strength printers capable of 24-hour operation. The range of sizes makes thermal printers a convenient option for use in pharmacies, nursing stations and other healthcare settings. They are the least costly method of producing both batch and unit-dose bar codes at the nurse workstation, in the pharmacy, lab or other healthcare setting. Thermal printers can produce on demand wristbands, specimen labels and unit-dose labels that meet the rigorous requirements of the everyday healthcare environment.

Laser printers are available in both office and industrial configurations. Of the two, only industrial laser print-ers are suitable for unit-dose bar coding. Industrial laser printers burn a permanent image into a variety of materials, and are capable of producing high-speed, high-quality, small images and two-dimensional bar codes. Office-style laser printers are not intended for labeling, require special sheets of labels not typically used in office applications and are prone to jamming. From a total cost of ownership view, laser printers are significantly costlier to operate than thermal alternatives.

A key requirement of bar coding for healthcare is clarity and definition; as bar codes become smaller (in order to accommodate more data), the need for readability and precision increases. Edge definition, which

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refers to the clarity and contrast of the dark and light edges within a symbol, is a problem for laser printers because they apply ink to a surface; this causes spreading of the media, resulting in blurring of images, and can lead to misreads. Conversely, thermal printers produce outstanding edge definition, since the method of bar code application does not utilize ink. In addition, laser toner may degrade when printed on high-quality adhesive labels; and, for unit-dose applications, commercial printers that are suited to sheet-feeding applica-tions waste expensive supplies.

Bar Code Print Solutions

While there are many bar code print solutions across industries, Zebra Technologies, a leading producer of on-demand bar code print solutions, offers the widest range of bar code label and wristband printers in the healthcare market. A variety of Zebra® printer models are ideally suited for use in hospitals for manual or automated dispensing operations, bedside delivery and documentation, blood bag and lab sample tracking, employee identification, file management and more. Zebra is the preferred patient safety bar code printing solution of hospitals nationwide, thanks to the flexibility, durability, and reliability of its products.

Zebra bar code patient safety solutions:

• accurately and automatically identify patients and staff with accurate, legible and tamper-proof patient identification wristbands and employee ID cards;

• provide medication controls with label printers for use both in the pharmacy and at bedside;

• prevent administration of the wrong drug or procedure with identification systems for patient care, lab, research, pharmacy and blood bank management;

• provide unit-dose coding with RSS;

• support multiple bar code formats; and

• offer unparalleled scalability and flexibility. Zebra printers can operate in a stand-alone environment or be integrated with EMR, lab, pharmacy or patient accounting systems.

Zebra bar code print solutions are fully compliant with regulatory standards for patient safety and patient pri-vacy. Zebra’s proprietary thermal printers, in conjunction with its white thermal polypropylene face stock with a protective UV varnish, produce durable patient wristbands that are in compliance with the privacy issues outlined in HIPAA. The bar code can provide a unique patient ID number that is the key to a database contain-ing the patient’s medical information, and that can only be accessed by authorized persons. Zebra thermal wristbands also comply with the FDA ruling designed to reduce medical errors. Zebra’s direct thermal print-ers can also print a bar code wristband while simultaneously encoding an RFID chip embedded in either label material or the wristband itself where circumstances require the added patient security provided by RFID technology.

What Will Drive Healthcare’s Adoption of Bar Coding?

Considering the demonstrated value and economic rationality of bar coding as a patient safety mechanism, rates of adoption remain lower than anticipated. One reason is the ongoing issue of allocating scant tech-nology dollars; clinician resistance and system integration challenges present additional hurdles. There are several obstacles that must be removed in order to spark wider adoption of the technology regardless of its economic attractiveness. These obstacles include:

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“No Fault” ReportingFrom the nurse and physician viewpoint, technology solutions often translate into layers of process that produce only modest improvements in patient care. Technology solutions in healthcare are routinely over-sold and clinicians are wary of disruptive alterations to established clinical activities. In the case of medica-tion management, automated error detection is sometimes viewed as a punitive measure intended to aid management’s attempts to interfere with patient care—or worse, to punish clinicians. To address this issue, bar coded medication management schemes must feature a “no fault” reporting policy in which clinicians—mainly nurses—are encouraged to report errors with the following provisions: 1. there are no penalties for reporting errors in medication administration; 2. error reporting is intended to identify process issues and technology glitches—not to discipline staff; and 3. error reporting will generate stronger decision support tools and medication administration accuracy at the point of care.

StandardsThere is at present no single industry standard governing the use of bar codes; this is a significant chal-lenge to the wider adoption of bar code technologies in healthcare. In fact, there are more than 200 bar code symbologies, but only a few are suitable for unit-dose identification. Of these, the RSS family of symbologies was specifically developed to help identify pharmaceutical products. The most commonly used healthcare bar coding symbologies in use today include the Universal Product Code (UPC), which is used to identify medical and surgical products at each packaging level, and the National Drug Code (NDC) identification system that the FDA uses to uniquely identify all pharmaceuticals. Other bar coding schemes in use today include Data Matrix, the ISBT 128, the Healthcare Identification Number (HIN), and the Labeler Identification Codes (LIC) systems, developed by the Health Industry Business Communication Council (HIBCC) to identify trading partners in e-transactions. The GS1 DataBar™ system will eventually replace UPCs globally. The new system will be administered by GS1 US (formerly The Uniform Code Council), a standards organization that provides integrated standards and business solutions for all industries, including healthcare.

Other systems that have been adopted include the EAN.UCC bar coding system, an internationally accepted standard with an estimated 22,000 adherents in the hospital and pharmaceutical industries. Additionally, there is RSS, an all-numeric bar code symbology that can encode an NDC code in a fraction of the space required for a traditional UPC symbol. The lack of a single all-embracing industry standard is not necessarily a significant hindrance to broad-scale adoption of bar coding tools and technologies—current printers and scanners can support multiple methodologies and bar code symbologies. But integration and interoperability issues will continue to be obstacles to overcome as bar coding is blended with collaborative technologies such as CPOE, e-prescribing and the EMR.

Industry LeadershipCollectively, through advocacy associations such as HIMSS, the National Alliance for Healthcare Technology (NAHIT) and the Institute for Healthcare Improvement (IHI), which have established bar code task forces and patient safety campaigns, the healthcare industry hopes to build the critical mass and industry awareness necessary to “bootstrap” bar code adoption. These grass-roots efforts will generate momentum towards bar code adoption in healthcare. In addition, a number of professional associations, regulators and group pur-chasing organizations are supporting bar coding.

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RFID in Healthcare

The term RFID (radio frequency identification) describes a wireless identification technology that communicates data by radio waves. Data is encoded in a chip, which is integrated with an antenna and packaged into a finished “tag.” RFID tags may be passive (requiring close proximity to a reader, and usually applied to track supplies), or active, in which the RFID tag contains a small battery to allow continuous monitoring (used mostly to track equipment). RFID technologies offer different rewritability options, memory sizes and tag forms, and can be read from anywhere within range of the RFID reader. xii RFID labels can hold more data than bar codes, and can be read automatically without any user intervention.

Today, the application of RFID technologies in hospitals is modest, primarily due to cost issues. Like most electronic technologies, RFID unit costs have fallen dramatically within the past few years, but have not yet achieved the “tipping point” of economic rationality for cash-conscious healthcare organizations. RFID in healthcare has been limited primarily to asset management and supply chain applications. Even within this sphere, there’s a lot to keep track of. In early 2004, Bon Secours Health System (Richmond, Va.) installed an RFID equipment tracking system to monitor 12,000 pieces of equipment at its three facilities. In less than a year, Bon Secours documented benefits that include capital avoidance (by being able to locate and use otherwise idle equipment) and utilization efficiencies (by distributing equipment where it is needed) among the three facilities. Additionally, the nursing staff gained approximately 30 minutes per nurse per shift in time saved not hunting down equipment. In financial terms, Bon Secours estimates that it has gained a $200,000 benefit per year over and above the cost of the RFID system installation and maintenance costs—and this does not even include staff productivity gains. An interesting side benefit for Bon Secours has been the ability to piggyback a WIFI network onto the RFID project, since both systems use the same architectures and hardware.

Other deployments of RFID include:

• Advocate Good Shepherd Hospital (Barrington, Ill.) has utilized inventory RFID tags with the result that inventory losses (previously running at 10 percent annually) were cut in half.

• Holy Name Society Hospital (Teaneck, N.J.) purchased an RFID asset tracking system that allows nurses to use PCs in each nursing unit to locate one of 2,000 tagged pieces of equipment.

There are other intriguing applications of RFID in the patient sphere. For instance, RFID tags can be used:

• in long-term care to track elderly and disoriented patients;

• in the maternity ward to track mothers and babies;

• and for surgical patients who can be tagged to ensure that the right procedure is being performed on the right person at the right time.

One of the more innovative uses of RFID today involves tracking and monitoring surgical equipment. At St. Vincent’s Hospital (Birmingham, Ala.), surgical instruments are monitored to determine their location, last sterilization, maintenance record and other key statistics. This technology can further identify individual surgi-cal supply items and their purchase date, description, cost and utilization data. In addition, some healthcare organizations are placing RFID tags on surgical sponges, surgical devices or other materials to help prevent these objects and materials from being left in a patient following surgery.

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Other applications of RFID in the healthcare setting include the use of RFID to streamline pathology specimen tracking. Passive RFID tags placed on specimens uniquely identify the sample and maintain a record of each instance the specimen is handled. New information can be written to the tag and/or readers to note the tag’s changing location.

The FDA Anti-Counterfeiting Task Force has strongly suggested the use of RFID to safeguard against pharma-ceutical counterfeiting and the pharmaceutical industry continues to test RFID technologies to track and trace their products. In one trial deployment, medicine bottles were fitted with RFID tags in order to detect fake drugs moving through the supply chain. Other pharmaceutical deployments include recall management and return management, inventory management, product authentication, pedigree management and sample man-agement. While a 2004 FDA report envisioned that all pharmaceutical drugs within the United States might incorporate RFID tags at the pallet, case and unit levels by the end of 2007, that has not yet happened. xiii

There are obstacles to deploying RFID in hospitals, including interference with other devices (such as cell phones and telemetry), user acceptance and privacy (the Civil Liberties Union and Consumer Groups have taken positions against RFID). And, from a business perspective, the return on investment for RFID remains an elusive proposition, due to unattractive price points and tactical deployments in healthcare venues.

RFID vendor Radianse gauges the cost of tags, receivers, software, implementation and training at $1,200 to $1,600 per licensed bed. xiv Despite the cost, Gartner predicts that RFID spending worldwide will increase from an estimated $1.2 billion in 2008 to more than $3.5 billion by 2012. xv In healthcare, it is estimated that the market for RFID tags and systems will rise rapidly, from $120.9 million in 2008 to $2.03 billion in 2018. xvi

Conclusion

The market for healthcare bar code solutions is ripe with opportunity, not only in terms of patient safety, but also in terms of unmet demand in broader applications of the technology. Integrated medication manage-ment, auto-ID, asset management and inventory control are just a few industry opportunities that are poised for growth. The clinical utility, cost advantages and collateral benefits of bar coding will spur growth of these technology solutions. To the extent that hospitals can receive a “second bounce” from their investment in bar coding and RFID (e.g., bar coding imbedded into CPOE, and RFID architecture that coincidentally provides the backbone of a WIFI network), these technologies will become increasingly attractive. However, industry-wide adoption is unlikely to occur suddenly; widespread adoption of RFID is estimated to be at least 10 years away. xvii

Will RFID ultimately surpass bar coding as the primary auto-ID and point-of-care patient safety technology in healthcare? It is more likely that bar coding and RFID will complement each other, based on relative function-ality, cost and ease of use. Hospitals will be reluctant to abandon their investments in bar coding simply to introduce a sexier replacement technology—particularly if there is no substantial gain in utility, and certainly not if the ROI equation doesn’t add up. RFID will continue to make inroads into healthcare via track-and-trace solutions, first as asset and inventory management tools, then gravitating towards personnel, patient and clinical monitoring devices.

Zebra ProfileZebra Technologies Corporation improves customers’ business performance through products and solutions that identify, track and manage assets, transactions and people. In more than 100 countries around the world, more than 90 percent of Fortune 500 companies use innovative and reliable Zebra printers, supplies, RFID products and software to increase productivity, improve quality, lower costs and deliver better customer service.

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Bibliography

Bar Coding“Healthcare IT’s Perfect Storm?” Healthcare Informatics. (November 2003). www.healthcare-informatics.com/issues/2003/11_03/trends.htm

“The Toll of Medical Errors.” Healthcare Information and Management Systems Society (HIMSS). www.himss.org/content/mindmaps/barcode/multi-maps/overview/doc/Overview-43.htm

Marietti, C. “Vigilance in the Lab.” Healthcare Informatics. (May 2003). www.healthcare-informatics.com/is-sues/2003/05_03/safety.htm

Ochs, J. “Bar Coding: Old Technology to the Rescue.”Managed Care. (June 2003). www.managedcaremag.com/archives/0306/0306.tech.html

U.S. FDA. “Federal Register: Bar Code Label Requirement for Human Drug Products and Blood.” (March 14, 2003). www.fda.gov/OHRMS/DOCKETS/98fr/03-5205.pdf [This report is the detailed document issued by the FDA regarding requirements for bar coding on medications.]

United States Department of Health and Human Services. “Secretary Thompson Announces Steps to Reduce Medication Errors.” (March 13, 2003). www.hhs.gov/news/press/2003pres/20030313.html [This press release summarizes the FDA’s proposals to require bar codes on medications and enhance safety reporting require-ments.]

U.S. FDA. “FDA Proposes Drug Bar Code Regulation.” (March 13, 2003). www.fda.gov/oc/initiatives/barcode-sadr/fs-barcode.html [This is a fact sheet detailing the steps involved in using bar codes on medications at hospitals.]

RFID“Frequently Asked Questions.” RFID Journal. (2004). www.rfidjournal.com/article/articleview/207

“Survey: RFID Technology Could Improve Safety.” iHealthbeat. (December 2, 2003). www.ihealthbeat.org/in-dex.cfm?Action=dspItem&itemID=100305

Collins, J. “Tracking Medical Emergencies: A Pilot Project at a Memphis Trauma Center Uses RFID in a Search for Ways to Speed Treatment of Critically Injured Patients.” RFID Journal. (April 22, 2004). www.rfid-journal.com/article/articleprint/901/-1/1

Schoenberger, C. “Radio RX.” Forbes. (September 15, 2003): 126. www.forbes.com/forbes/2003/0915/126.htm

Phillips, Tagsys, and Texas Instruments. “Item Visibility in the Pharmaceutical Supply Chain: A Comparison of HF and UHF RFID Technologies,”White Paper. (July 2004). www.tagsys.net/modules/tagsys/upload/news/finaltiwhitepaper.pdf

“RFID Asset Tags Tested in 22 US Hospitals.” ContactlessNews. (February 13, 2004). www.contactlessnews.com/weblog/2004/02/13/rfid-asset-tags-tested-in-22-us-hospitals/

“FDA Predicts RFID on Drugs by 2007.” iHealthbeat. (March 18, 2004). www.ihealthbeat.org/index.cfm?Action=dspItem&itemID=100780

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Mittman, R. “Technology Foresight: Electronic Tags—RFID Will Track Everything.” iHealthbeat. (February 4, 2003). www.ihealthbeat.org/index.cfm?Action=dspItem&itemID=98963

End Notes

i. “19th Annual HIMSS Leadership Survey, ”February 25, 2008. Health Information Management Systems Society.

ii. “Preventing Medication Errors: Quality Chasm Series,” 2006. Board on Health Care Services/Institute of Medicine.

iii. “Continued Progress: Hospital Use of Information Technology,”2007. American Hospital Association.

iv. “Bar Code Applications In Life Sciences,” Zebra Technologies White Paper, 2003.

v. “19th Annual HIMSS Leadership Survey. ”February 25, 2008. Health Information Management Systems Society.

vi. “FDA Issues Bar Code Regulation,” February 2004. U.S. Food and Drug Administration, Department of Health and Human Services.

vii. R.R. Sharma, S.Kumar, and S.K. Agnihotri. “Sources of Preventable Errors Related to Transfusion,”Vox Sanguinis 2001 81, 37-41.

viii. “Hospital bar code rules expected soon: drugs, blood products,” Frieden, Joyce. February 15, 2004. OB/GYN News.

ix. “Preventing Medication Errors: Quality Chasm Series,” 2007. Board on Health Care Services/Institute of Medicine.

x. “Pharmaceutical Shifts Towards UHF RFID for Savings,” 2009. RFID Switchboard/Alien Technology.

xi. “Automation Advances, Information Systems Help Labs Meet Demand,” August 1, 2003. BBI Newsletter/The Clinical Laboratory Management Association.

xii. “EPC and Healthcare Distribution: Current State of the Industry,” November 2004. Healthcare Distribution Management Association White Paper.

xiii. “Pharmaceutical Shifts Towards UHF RFID for Savings,” 2009. RFID Switchboard/Alien Technology.

xiv. “Where’s My Defibrillator?” Wright, Christopher M. January 2007. APICS.

xv. “Gartner Says Worldwide RFID Revenue to Surpass $1.2 Billion in 2008,” February 25, 2008. Gartner.

xvi. “RFID for Healthcare and Pharmaceuticals 2008-2018,” Harrop, Peter and Trevor Crotch-Harvey. IDTechEx, 2008.

xvii. “FDA Counterfeit Drug Task Force Report: 2006 Update,” 2006. Food and Drug Administration.

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Zebra’s RFID Readiness Guide:Ensuring a Successful RFIDImplementation

A Z E B R A B L A C K & W H I T E P A P E R

Copyrights©2008 ZIH Corp. All product names and numbers are Zebra trademarks, and Zebra and the Zebra head graphic are registeredtrademarks of ZIH Corp. All rights reserved. Electronic Product Code, EPCglobal Inc and EPCglobal Network are trademarks ofEPCglobal Inc. GS1 US is a trademark of GS1 US, Inc. Uniform Code Council is a registered trademark of Uniform CodeCouncil, Inc. All other trademarksare the property of their respective owners.

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I n t r o d u c t i o n

Radio frequency identification (RFID) has evolved into a reliable, cost-effective technology used for personalidentification, asset management, security, shipping and receiving, inventory control, and many other perations.Improved performance, falling prices, and developing standards continue to move RFID into the mainstreamand have made it practical for many organizations to consider its use. This white paper will help you determineif RFID is right for your organization. It describes how RFID works and how it is used, and provides tips forstarting an RFID project.

What Is RFID and How Does It Work?RFID is an identification technology that uses wireless readers to access data encoded in chips. The chip ismounted to an antenna, which receives RF signals from the read/write device. The basic form of a chip attachedto an antenna is called a transponder or tag. An inlay is created by mounting the tag on a substrate. The inlaycan then be layered into or attached to a label or other form factor, such as a wristband, and the result isreferred to as smart media. The smart media can then be attached to an object and carry all kinds of data aboutthat object.

Most inlays used today are passive, which means they are powered up by the read/write device and do not havetheir own power source. Active RFID technology includes a power source—usually a long-life battery—for thetag to power data transmission to the reader. Active tags provide much more range than passive tags, but arealso bulkier and more expensive.

Data is written to and read from an inlay with an RFID reader/encoder, also called an interrogator. Thereader/encoder creates an RF energy field at a specific frequency. Passive inlays receive the reader signal throughtheir antenna, which “wakes” them up and allows them to broadcast data. All inlays within the energy field automatically respond to the reader, which accepts and decodes the data. Many tags are rewritable and mostreaders can also encode. Specialized middleware is used to manage the flow of and hierarchy of the data as it istransmitted from reader/encoders into the information system.

RFID tags are also rewritable. Data can be added or updated throughout the life of the tag, which makes thetechnology suitable for creating a pedigree to associate with an object throughout its useful lifecycle. Tags canalso be reused by erasing them and encoding new data.

The characteristics described above apply to most RFID systems. There are many variations of RFID tags orinlays which work essentially the same way but have major differences in their read range, speed, chip memory,security, resistance to interference, physical construction, and other characteristics.

Frequency is one of the biggest and most important differentiators. RFID systems are available at many frequencies. RFID technologies most commonly used in commercial applications operate in either the 860–960MHz ultrahigh frequency (UHF) band, or at 13.56 MHz, which is classified as high frequency (HF). Highfrequency RFID is usually used for short-range (less than 24 inches) applications such as access control,ticketing/fare collection, and some item tracking and electronic shelf-management applications. UHFtechnology has an upward range of around 20 feet and is used for shipping and receiving, production control,material handling, and many other industrial and supply chain operations. There are numerous technical andindustry standards for both UHF and HF RFID.

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The EPC UHF Gen 2 protocol was created specifically to meet RFID user needs for traceability and supply chainoperations. It has been widely accepted by government agencies, retailers, logistics providers, andmanufacturers, and particularly in the consumer goods, retail, pharmaceutical, and defense industries. Best Buy,Target, the U.S. Department of Defense (DoD), and Wal-Mart are among the organizations that have specified Gen 2 for their compliance tagging programs. Following is a brief outline of the EPC standard and thebody that oversees developments.

The EPC SystemThe Electronic Product Code™ (EPC) system is developed and administered by EPCglobal Inc.™ The completeEPC system includes technical specifications for interoperable tags and equipment, a numbering system to categorize and uniquely identify billions of items, plus database and network services to help organizationsprocess and share EPC data. As a joint venture between GS1 (formerly know as EAN International) and GS1US™ (formerly the Uniform Code Council, Inc.®), EPCglobal leverages a nearly 30-year heritage of successfullypartnering with industry. EPCglobal is a neutral, consensus-based, not-for-profit standards organization.

The EPC number is used to uniquely identify an item and convey its manufacturer and product type. The latestEPC standard, Gen 2, specifies a 96-bit EPC identifier. The number is divided into four sections: header,manager number, object class, and serial number. The header identifies the length, type, structure, version, andgeneration of EPC, so equipment and software applications can accurately process the information that follows.The manager number identifies the company or entity that assigned the EPC number. The object classcategorizes the object, similar to a stock keeping unit (SKU). The serial number is what sets EPC numbers apartfrom U.P.C./EAN and other numbering systems. The serial number uniquely identifies the item within theobject class.

The EPC system was designed to facilitate supply chain operations and object tracking by multipleorganizations. EPC Discovery Services and the EPC Information Service (EPC IS) facilitate informationexchange.

EPC Discovery Services help users locate and access data related to specific EPC numbers. Object NamingService (ONS) is a Discovery Services component that provides a network address to where actual data for aspecific EPC is held.

EPC Information Services let organizations exchange data about specific EPCs through the EPCglobalNetwork™, a collection of technologies and components for identification and data sharing. Companies thatassign EPC numbers can maintain EPC IS servers with item information. Using EPC numbers does not requireorganizations to share EPC data or use other components of the system. Visit www.epcglobalinc.org for moredetails about the EPC system and technologies.

There are EPC specifications for UHF and high-frequency technology, and passive and active tags. By far themost activity, interest, and product commercialization has been for passive UHF technology, especially the EPCGeneration 2 (Gen 2) UHF standard.

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H o w I s R F I D D i f f e r e n t T h a n B a r C o d e ?

It is important to understand the significant differences between RFID and bar code to appreciate the benefitsRFID can provide. Bar code and RFID are both identification technologies that hold data that is accessed bysome type of reader. In actuality, they complement each other very well and can be used effectively side by sidein many applications. Bar code is an optical technology, and RFID is a radio technology. The ways thesetechnologies exchange data account for most of the differences between RFID and bar code and help determinewhere each identification technology is best put to use.

As a radio technology, RFID requires no line of sight between the reader and the tag to exchange data. RFIDtags therefore can be read through packaging, including cardboard containers and plastic wrap used to sealpallets. RFID is subject to interference, however, particularly from metal, so potential sources of interferencemust be recognized and accounted for during system planning. Because no line of sight is required, taggedobjects can be read regardless of their orientation through the use of optimized RFID systems. Items don’t haveto be placed label side up onto conveyers to be read, paving the way for unattended handling. If workers arerequired to place items on conveyers to be read, they will be more productive if they don’t have to locate andalign labels when handling objects.

RFID readers can automatically recognize and differentiate all the RF tags/inlays in their reading field. Thissimultaneous processing capability provides additional flexibility for material handling, packaging, and sortingoperations because there is no need to maintain spacing between objects to ensure they will be read. The abilityto read dozens or even hundreds of tags per second makes RFID ideal for high-speed sorting, receiving,crossdocking, and other applications. The data capacity of RFID tags/inlays enables them to carry all the sameinformation as bar codes and more. Just as bar codes differ in data capacity, RFID tags/inlays are available withvarious memory-size and encoding options.

S m a r t L a b e l P r i n t i n g a n d E n c o d i n g

Smart labels are an extremely practical and effective option for satisfying shipment tagging requirements and formany other RFID applications. According to research firm IDTechEx, a total of 2.16 billion tags will be sold in2008, up from 1.74 billion in 2007 and 1.02 billion in 2006. Smart labels are produced by a smart labelprinter/encoder that programs an RFID tag embedded inside label material and prints text and bar code on theoutside. Smart labels are a convenient option because they can be produced on demand and a single smart labelcan meet RFID, bar code, and text marking requirements. For example, in addition to EPC and other identifica-tion data, the RFID tag in a smart shipping label could include shipment manifest data or an Advance ShipNumber (ASN) reference number to help match the physical shipment with an EDI message. Location andhandling histories, time stamps, pedigree information, and other data to support different business processes ortraceability requirements can also be encoded and updated in smart labels.

Smart label media must be carefully matched to the printer to ensure reliable performance. Media must be optimized both for the object being identified and for the specific make and model of printer/encoder used. It’snot uncommon for organizations that have to tag different products to use several smart label media variationsto get optimum read performance. User organizations should work with experienced smart media providers tofind the best-performing and most cost-effective supplies.

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For a comprehensive guide to smart label printing and encoding, visit www.rfid.zebra.com, which has extensiveinformation about Gen 2 technology plus a lot of practical advice that applies to any smart label system.

R F I D A p p l i c a t i o n s

Many companies may first get involved with RFID as part of compliance tagging. Compliance programs andhigh-profile projects get most of the attention, but the real driver for the explosive growth in RFID use is business value. Because RFID requires no line of sight, it can be used for unattended, high-speed identificationthat removes labor requirements from operations. RFID can also be used in environments that are unsafe orimpractical for other types of data collection or manual labor. Another key advantage is that RFID can deliverreal-time updates of information as opposed to batch downloads. The data capacity available on RFID chipscontinues to grow. Tags can be used as mini-databases and traveling records that can be updated as needed toprovide information about the tagged object. RFID-based storage and handling records are invaluable for tracking pharmaceuticals, perishable commodities, and other goods with strict pedigree or traceability requirements.

Shipping and ReceivingOne of the powerful drivers behind compliance tagging programs is the clear benefits to shipping and receivingprocesses that are enabled by RFID-tagged shipments. For shipping and receiving, a reader positioned at a dockdoor can instantly identify pallets of tagged goods that pass through. Shippers can use the data to verify that allthe products required for the shipment have been packed and loaded. The process helps eliminate costlyshipping errors and the manual labor associated with order checking. The receiving organization uses the dock-door read to verify that the shipment matches the order or manifest, and to automatically record the itemsinto inventory. No bar code scanning or other manual labor is required. Because RFID readers can identifyhundreds of items per second, portal readers are especially useful for cross-dock applications, where incominggoods must be quickly identified, sorted, and redirected.

Compliance TaggingMany companies will be drawn into using RFID to satisfy shipment tagging requirements from customers whowant to automate their receiving processes. Implementing a “slap-and-ship” system that complies withcustomers’ tagging requirements but has no applications at the supplier rarely provides value. Companies canbegin to realize value from their compliance tagging systems by adding internal applications, which may notrequire major investments. For example, suppliers can read their tagged pallets to verify that the shipment isaccurate and complete. The data can also be used to generate Advance Ship Notices (ASN) and other documentation. Capturing EPC numbers from shipments and associating them with the customer’s ship-toaddress in a database will create a chain-of-custody record useful for pedigree and other traceabilityapplications. If companies transfer tagged shipments to their own distribution centers prior to final delivery tothe customer, RFID tags can be leveraged in automated receiving applications that can give the shipper,customer and all entities in the supply chain real-time visibility into tracking of goods.

Some consumer product manufacturers considered bar code shipment labeling a nuisance and a burden whenretailers first began requiring it. Today, these manufacturers wouldn’t think of operating their distributioncenters without bar codes because of the proven efficiency the technology provides. RFID holds the same potential to improve operations. RFID will not replace bar code technology, but can effectively enhance barcode-based data collection systems where additional visibility or automated processing is desirable.

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Material HandlingRFID readers may be mounted on forklifts or conveyor systems to support cross docking, sortation, and othermaterial handling applications. By integrating the reader with sensors and the material handling system, taggedcases, cartons, and totes can automatically be recognized and diverted to the desired location.

Inventory Control, Replenishment RFID has shown very promising results for improving inventory management. RFID-enabled processes help inthree primary ways:

• Accurate data collection eliminates identification errors that lead to out-of-stocks and excess inventory;

• Fast reading and real-time report eliminate data latency that can lead to inaccurate forecasts and inefficient storage, handling, and replenishment;

• RFID can provide unattended monitoring, thus reducing labor costs for inventory counting and auditing, and reducing shrink.

These benefits have been validated by Wal-Mart and METRO Group, a leading European retailer, who are eachusing RFID to manage inventory in the back rooms of retail stores and at distribution centers. Wal-Mart andMETRO reported retail out-of-stock reductions attributed to their RFID applications at 16 percent and 14percent, respectively.

The principles of RFID inventory management can be applied to many operations beyond retail and consumergoods. Inventory tracking applications can be modified for raw materials management, kanban and other shop-floor replenishment, sample management, materials management, and other operations.

Production TrackingSimilar to material handling, RFID can be used to track and route assemblies through production processes.RFID tags can withstand exposure to heat, moisture, solvents, abrasives, and other conditions that impair barcode performance in industrial environments, so the technology provides a way to gain new visibility intomanufacturing operations.

WarehousingRFID’s unattended, orientation-independent reading capabilities can be highly valuable for warehouseprocesses. Reading zones can be created to automatically monitor certain areas of the facility—such as shelflocations, secure storage areas, or even a container yard—and automatically record all movements. Businessrules can be created to issue alerts if certain conditions are present, such as items being moved after hours,unusual transaction volume, or any movement of items with a certain dollar value. By integrating the RFIDsystem with enterprise networks and applications, monitor and alert data can be automatically communicatedto managers or security personnel, plus integrated into warehouse management system (WMS), asset management, and other software applications.

Imagine picking operations where workers scan shelves and bins with an RFID reader to automatically detectthe storage location of the sought items. Readers would also automatically detect items stored in the wronglocation and alert operators to the problem. Using RFID for these applications enables items to “self-report”their locations, rather than requiring workers to find them, thus reducing errors, saving labor, and loweringcosts.

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Asset ManagementRFID is highly advantageous for asset management applications because tags can provide a durable, permanentidentifier, with extra memory that can be updated repeatedly with configuration settings, inspection records,service information, and other dynamic information. RFID asset tagging also facilitates efficient audits andinventories because assets can be detected and recorded at a distance, without requiring a worker to manuallyread and record information from the asset tag. Asset movements can be tracked and recorded automaticallywith RFID reading portals, which can be programmed to issue alerts if assets are removed from the area.

Logistics assets represent another excellent opportunity to benefit from RFID. Many returnable containers arenever brought back from customer sites after shipment, forcing companies to carry excess inventory to ensureadequate supplies of shipping materials where they are needed. Almost half of the respondents to an AberdeenConsulting study reported that logistics asset operations consume 5 percent or more of corporate revenue.Twenty-five percent of companies say they lose in excess of a tenth of their container fleet each year. Identifyingreturnable containers with smart labels or fixed tags enables companies to augment their legacy bar code shipping applications by automatically recording materials shipped to customers. Companies can then find theirown pallets in shipping yards or docks stacked with thousands of items belonging to dozens of companies.Higher degrees of tracking will enable organizations to lower their material costs and will provide an audit trailthat can be used to bill customers if materials are not returned. The value of these applications has been provenin multiple real-world implementations.

Check-in/CheckoutMany large libraries around the world have implemented RFID to speed material check-in, checkout, shelfinventory, and security applications. Low-cost, flexible smart labels are inserted in books and can be made invisible to patrons. Counter personnel check dozens of books in or out in mere seconds without manuallyhandling and orienting each item. The tags can also be used for theft detection, much like anti-shoplifting technology currently used by retailers. Librarians using portable computers with RFID readers can takeinventory and find misfiled materials simply by walking down an aisle of bookshelves. The reader can automatically detect missing materials and alert the operator.

Video rental stores use RFID for similar applications. Readers are positioned at the checkout, unattended returnbins, and doorways to record transactions and detect shoplifted items automatically. These library and videostore operations are essentially in-store inventory management applications that can be adapted for use in manyother industries. The application can also be adapted to manage tool crib operations, evidence management, filetracking, and other check-in/checkout applications.

Product SecurityA smart label can provide secure, lifetime tracking that can facilitate accurate warranty and returnsauthorization and anti-counterfeiting protection. In 2004 the U.S. Food and Drug Administration (FDA) Anti-Counterfeiting Task Force recommended wide-scale adoption of RFID to stop counterfeiting, which nowaffects between 6 percent and 10 percent of all pharmaceuticals worldwide. The task force report, which earnedwidespread industry support, singles out RFID as the “most promising” tool to combat counterfeiting. For moreinformation about how RFID can be used to protect pharmaceuticals, see Zebra’s white paper Track and TraceSolutions for the Life Sciences Supply Chain. RFID systems and business processes to prevent counterfeiting,provide brand protection, and improve channel integrity can be adopted for use in many industries. Zebra’swhite paper Brand Protection in the Supply Chain: Protecting Products and Profits with Secure Media Solutionsdescribes these applications in more detail.

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Access Control, Personal Security, and Patron ManagementPersonal identification is a longtime and very widespread application for RFID. Tags embedded in employee IDcards provide hands-free access to secured buildings and a tamper-proof form of identification that ensuresonly authorized personnel are admitted. Similar systems are used to identify hospital patients and patrons attheme parks, where the ID card or RFID wristband is also used as part of a cashless payment system.

Cashless PaymentCashless payment is an effective retail application unrelated to item or shipping container tagging. The mostwidespread example of RFID cashless payment is ExxonMobil’s Speedpass program, which is saving millions ofdrivers countless hours at the pump. When the tag enters the reader field at a gas pump, it turns on the pumpand automatically charges the gas purchase to the driver’s registered credit card account, promoting quickerservice while maintaining complete account number confidentiality. McDonald’s restaurants are now offering asimilar application to speed transactions at the counter and drive-thru window.

RFID-based cashless payment is also used for electronic toll collection applications in use on toll roads andbridges. Participating drivers have either a passive tag, which is clipped to their key chain, or a battery-poweredactive tag attached to the vehicle. Drivers receive their tags after subscribing to the program and depositingmoney into an account. The fare is deducted from the tag automatically whenever the vehicle passes through thetoll gate. Drivers don’t need to stop, or even slow down in some cases, to pay the toll.

L a u n c h i n g R F I D i n B u s i n e s s O p e r a t i o n s

The applications described above only scratch the surface of how RFID can be used, and there are many moreapplications possible. Regardless of the application, there are several steps you can take to help your RFIDproject be productive and successful. One of the most important issues to consider is where and how to begin.As you’ve seen, RFID has characteristics quite unlike other technologies, and can be difficult to implement forthe uninitiated. Determining how best to harness RFID’s capabilities is one of the first challenges projectmanagers face. Zebra is a pioneer in RFID smart label technology and applications. We’ve been involved innumerous projects and gained valuable insight into the questions that organizations face and the informationthey need, which we share in the following sections. Examining the questions and guidelines that follow willhelp build a strong foundation for your RFID efforts.

Determine the Business BenefitsCompanies who already have some form of auto-ID—such as bar codes—for business processes can reap strongbenefits by selectively using RFID to enhance operations. For example, making only a small, incrementalimprovement to shipping accuracy can produce strong benefits, as the following calculation illustrates. Variousanalyses have established that shipping errors cost between $60 and $250 to resolve, depending on labor rates,shipping expenses, and the amount of clerical and administrative time required. Therefore, each one percentimprovement in shipment accuracy should reduce shipping expenses between $60 and $250 per every 100 shipments. For a company that ships 100 orders a day, each one percent improvement in shipment accuracywould produce annual savings of $15,600 to $65,000.

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Identify the Specific Business Issue That Is to Be Solved or EnhancedFor those facing compliance mandates, the issue at hand is keeping a customer that now requires RFIDshipment tagging. Compliance tagging mandates set a clear requirement for what the RFID system must do.Companies that only wish to comply with customer requirements and make no other use of RFID do not needto concern themselves with considering how RFID could improve inventory, warehousing, distribution, logistics,and security. However, the most successful RFID project managers determine what other business value can bederived from leveraging the investment made to meet a compliance mandate. RFID-enabled processes can overcome environment, reliability, and throughput limitations that restrict alternative identification methods.RFID should be used where it meets a specific need or solves a problem.

For ideas on how RFID could improve your business, review operations to determine if there are any consistentchoke points or processes that require excessive human handling, such as placing items a certain side up on aconveyor. These processes are candidates to be automated with RFID, which can provide a good return oninvestment by reducing labor requirements and improving efficiency.

Determine What Information Is RequiredLook at your business processes and limitations, and determine if things could be improved if moreinformation was available, or if current information was available more quickly. Consider where RFID datashould be collected and how often you should update related software applications.

The durability, memory, and remote reading capability of RFID tags make it practical to access information inenvironments where alternative technologies can’t perform. In particular, the memory on RFID tags makes itpossible to include information to support efficient business processes. RFID users commonly encode lot codes,expiration dates, warranty information, configuration settings, and maintenance/inspection histories that enableitems to be processed or serviced when there is no access to a host database.

Identify Needed Performance Characteristics Once data content, collection points, and communications goals have been determined it will be easier to definethe performance the RFID system must provide. Application requirements drive decisions on RFID frequency,tag types, encoding method, reading equipment, and supporting software.

Test and ExperimentPilot projects and pre-deployment testing should uncover any interference, quality, or performance problemsthat need to be resolved before the system is deployed. RF interference is the main concern—usually producedby other wireless or RF technologies at work in the environment. An experienced RFID solutions provider canprovide an assessment of potential interference and suggest remedies. The assessment is similar to the sitesurvey that is conducted before wireless LANs are installed. Interference can be avoided or mitigated by usingdifferent styles and sizes of RFID antennas and tags, and experimenting with different frequencies, poweroutput levels, and tag mounting options, all within the scope defined by the application requirements. Testingmay not reveal every hurdle, but thorough planning can mitigate them.

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Smart label printing/encoding systems should also be thoroughly evaluated. As with any labeling system, themedia and adhesive must withstand all the environmental and usage conditions the label will be exposed tothroughout the supply chain. It is crucial to test all the different items that will be labeled under as many conditions as possible to ensure proper performance. Because smart labels must be both encoded/write verifiedand printed, they can take slightly longer to produce than non-RFID labels—and in a high-speed, automatedlabeling environment, this must be taken into account to ensure adequate throughput.

Determine Which Standards and Regulatory Considerations ApplyThere are many RFID technical standards, industry standards, and compliance guidelines, plus various nationalregulations for RF transmission. Companies in compliance tagging relationships will have their conformityrequirements spelled out for them. Most compliance programs and other RFID initiatives in the consumergoods, retail, pharmaceutical, and defense industries specify the use of Gen 2 and other EPC standards, althoughthere is variation among the specific requirements.

The ISO 15693 standard is prevalent for high-frequency (13.56 MHz) RFID technology. Companies who basesystems on ISO 15693-standard technology benefit from a competitive vendor market that provides a choice ofinteroperable products. Cashless payment systems, and personal identification applications such as accesscontrol and automated time and attendance recording, frequently use ISO 15693-compatible tags andequipment.

There are other ISO and industry standards that cover a variety of RFID uses, including electronic cargo seals,logistics container identification, toll and fare collection, animal identification, and more. When considering anRFID project, check with industry associations or user groups to see if relevant RFID standards exist or are indevelopment.

B u i l d a n I n f r a s t r u c t u r e T h a t C a n E v o l v e a s Y o u rN e e d s C h a n g e

Standards continually evolve as user needs change, new features are developed and technical limitations areovercome, and, of course, entire new standards are created. Creating a flexible RFID architecture makes it easyto manage changes. “Multi-protocol” RFID equipment can process tags with different specifications. Forexample, Zebra’s multi-protocol printer/encoders can encode Gen 2 chips, plus previous-generation EPC protocols and proprietary tags from several leading vendors. Multi-protocol readers can process different tags,just as most bar code scanners can auto-discriminate and recognize multiple symbologies.

RFID products built from the start to support multiple protocols are the best option. Multi-protocol readersand printer/encoders with software-defined radios (SDR) are very easy and cost-effective to upgrade. Softwaredefined radios use software to control the RF signal modulation and demodulation and the transfer of data.Support for frequencies, standards, and options are written into the software and are not hard-wired into thehardware. Therefore, upgrades and changes are accomplished simply by downloading new software to thedevice. There is no need to install new components or replace the device itself. SDRs give the advantages ofproviding a relatively simple and expedient way to allow end users to support multiple RFID protocols and newfeatures as they emerge.

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Multi-protocol equipment with software-defined radios protects RFID investments by providing a clear andconvenient upgrade path that minimizes total cost of ownership.

C o n c l u s i o n

This paper has presented an overview of RFID capabilities and usage considerations. It may seem like a lot tolearn, but remember, thousands of companies have successfully completed the RFID evaluation and implementation process, and are profiting because of it. The topics presented here provide an excellent startingpoint from which you can begin to identify areas for further investigation and develop specific questions toadvance your project. For more information and assistance, look to RFID industry associations such as AIMGlobal (www.aimglobal.org) or EPCglobal (www.epcglobalinc.org), and professional societies in your specificindustry. Zebra offers more white papers, implementation tips, RFID case studies, and FAQs atwww.rfid.zebra.com.

Zebra is playing a leading role in the development of smart label technology, standards, and applications forsupply chain and business improvement programs. Zebra has provided solutions to many RFID early adopters,including suppliers in the Wal-Mart and U.S. Department of Defense (DoD) compliance programs. Zebra, as amember of the EPCglobal Hardware Action Group, was also a leading contributor to the development of theGen 2 standard.

Contact Zebra Technologies to learn more about setting up an efficient smart labeling system for your organization. As a member of EPCglobal, and a technology sponsor of the former Auto-ID Center at MIT,Zebra Technologies Corporation helps companies identify, track and manage assets, transactions and peoplewith on-demand specialty printing and automatic identification solutions. In more than 100 countries aroundthe world, more than 90 percent of Fortune 500 companies use innovative and reliable Zebra printers, supplies,RFID products and software to increase productivity, improve quality, lower costs, and deliver better customerservice. For more information about Zebra’s RFID printer/encoders, call +1 800 423 0442, or visitwww.rfid.zebra.com.

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N o t e s

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GLOBAL/AMERICAS

HEADQUARTERSZebra Technologies Corporation333 Corporate Woods ParkwayVernon Hills, IL 60061-3109 U.S.A.

T: +1 847 793 2600 or+1 800 423 0442

F: +1 847 913 8766

EMEA HEADQUARTERSZebra Technologies Europe LimitedZebra House, Unit 14, The Valley CentreGordon Road, High WycombeBuckinghamshire HP13 6EQ, UK

T: +44 (0)1494 472872 F: +44 (0)1494 768251

ASIA-PACIFIC HEADQUARTERSZebra Technologies Asia Pacific, LLC120 Robinson Road#06-01 Parakou BuildingSingapore 068913T: +65 6858 0722 F: +65 6885 0838

OTHER LOCATIONSUSA

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Web: www.zebra.comGSA#: GS-35F-0268N©2008 ZIH Corp.14027L Rev. 1 (3/08)

When, Where, How and Why to UseWireless Printers

A Z E B R A B L A C K & W H I T E P A P E R

Copyrights©2008 ZIH Corp. All product names and numbers are Zebra trademarks, and Zebra and the Zebra head graphic are registeredtrademarks of ZIH Corp. All rights reserved. Bluetooth is a registered trademark of Bluetooth SIG, Inc. OpenView™ is a trademark of Hewlett-Packard Company. IBM® and Tivoli® are trademarks or registered trademarks of International BusinessMachines Corporation in the United States, other countries, or both. Wavelink Avalanche® is a registered trademark ofWavelink Corporation. All other trademarks are the property of their respective owners.

I n t r o d u c t i o n

Cables can't go all the places where organizations need to produce labels, receipts, invoices and other printeddocumentation. So, organizations must choose whether to base operations around where they can cable aprinter, or use wireless connectivity so printing can be done wherever it's needed. Wireless printing providesflexibility for facility layout and workflow, while improving printer ease of use and reliability by eliminatingcables. It can also reduce the inefficient labor practice of having workers go to a central printer to pick up labelsand forms.

Wireless thermal printers can be used in environments ranging from offices and shops to factories and fleets,and can produce a variety of specialized output including bar code and radio frequency identification (RFID)labels, tags, tickets, receipts, invoices and wristbands. They are proven time savers and reduce costs in manyapplications, while performing reliably without specialized or excessive IT support. This white paper covers thefundamentals of wireless thermal printing technology and applications. The paper:

• Explains wireless connectivity options for thermal printers, including Bluetooth® and 802.11-standardnetworking;

• Describes how stationary, cart-mounted and mobile printers can be wireless-enabled;

• Highlights security capabilities and options for wireless printers;

• Describes wireless printing applications;

• Documents the labor savings, cost reductions and other benefits of wireless printing, including examples from real-world users.

B a s i c s : T h e T w o T y p e s o f W i r e l e s s C o n n e c t i v i t y

A printer may use a wireless interface for network connectivity to a wireless LAN, or as a cable replacement forcommunication with a handheld computer or other device. Multiple technologies and standards are supportedwithin each of the two main categories.

Cable ReplacementWireless connectivity for cable replacement is common when the printer is carried, worn, or mounted in avehicle. In these operations, the printer often interfaces with a handheld or vehicle-mounted computer.Common applications include route accounting, direct store delivery (DSD), field service and forklift-basedprinting operations. Output may include invoices, receipts, delivery confirmation notices and order forms, pluspicking, putaway and shipment labels.

In cable-replacement applications, there is a direct wireless connection between the printer and computer withno communication through an access point, server or hub. Bluetooth® is very popular and effective for cablereplacement, and adoption continues to grow rapidly. A Bluetooth-enabled printer can connect easily andsecurely with a variety of other standardized Bluetooth devices, including handheld and vehicle-mountedcomputers, laptops, PDAs, smart phones, and even electronic scales and other peripherals. Bluetooth can beused concurrently in environments where 802.11-standard wireless LANs are operating.

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In contrast to wireless LAN technology, Bluetooth poses a very low security risk because its limited range (typically 30 feet or less) requires would-be hackers to remain very close to the devices to attempt to intercepttransmission, and their presence would likely be noticed in most business environments. Bluetooth's relativelyslow transmission speeds and the limited amount of data typically exchanged also make hacking difficult.

Nonetheless, Zebra has implemented several security measures in its Bluetooth wireless printers. First, Zebra®Bluetooth printers only support the Serial Port Profile (SPP), which somewhat limits the devices they can associate with. The Discovery Mode is turned off in the default configuration, which means the printer itselfwill never initiate a link with another Bluetooth device. It will only communicate if a handheld computer initiates the exchange, and the printer can be configured to authenticate the computer. Zebra Bluetooth printersautomatically provide 128-bit authentication, and support data encryption up to 128 bits. Bluetooth devices canalso be configured to require a PIN code every time they attempt to associate with a new device.

Wireless NetworkingPrinters connected to enterprise wireless networks can receive print jobs directly from ERP, WMS and otherenterprise applications and be monitored with legacy network management systems. Wireless LAN connectivityis available for mobile, stationary and cart-mounted printers. Like wireless networking technology itself, wirelessprinters have evolved to support the latest standards for connectivity, security and management.

Printers communicate to the wireless network either by an internal radio card or a wireless print server, whichcan be an internal or external configuration. Printers that support IEEE 802.11b and 802.11g networking standards are widely available.

Internal radios and print servers provide a direct connection between the printer and the wireless network.Internal print servers are boards installed inside the printer that are compatible with multiple radio types andprovide additional connectivity features. They are typically used in stationary, tabletop printers.

Zebra high-performance and industrial/commercial tabletop printer families and OEM print engines canconnect to 802.11b/g networks through a print server installed on the printer. Wireless security for tabletopprinters and print engines depends on the version of the print server used and the radio (older print serverssupported multiple radio options).

• ZebraNet® Internal Wireless Plus is Zebra's newest print server, released in spring of 2008. It provides802.11b and 802.11g network connectivity. The ZebraNet Internal Wireless Plus print server featuresan internal radio that supports the same securities as Zebra's advanced mobile printers, including802.11i, WPA2, and VPN compatibility. Previous-generation protocols like WPA, LEAP and WEP arealso supported.

• ZebraNet® Wireless Plus, released in 2007, has some support for WPA2 protocols (support varies byradio) and older securities.

• ZebraNet® Wireless Print Server is Zebra's original print server and has been discontinued. It supportsWPA, LEAP, WEP and other 802.11b-standard securities.

Zebra developed an external print server to meet the special needs of cart-mounted wireless printingapplications, the ZebraNet® PS 4000™. Cart-mounted printers connect to the ZebraNet PS4000 by USB cable.Up to four different printers can share one print server and a single IP address. The print server handles allsecure communication with the wireless network and directs print jobs to the appropriate printer ports.

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Network SecurityThere is no reason for a printer to be a weak link in wireless network security. Wireless printers are fully capableof supporting the leading protocols and architectures used to protect enterprise wireless networks today,including virtual private networks (VPNs), and WPA, WPA2, 802.11x, 802.11i, and LEAP among other securityprotocols for 802.11b and 802.11g networks. Therefore, system administrators should not compromise onprinter security and should commit to hardware that supports the enterprise's preferred security protocols.

Security support varies according to the printer model and its firmware, the radio used and the print server, if aprint server is used. Available support also changes frequently as new networking and security technologies aredeveloped. Zebra's white paper Securing Zebra Wireless Printers provides a comprehensive guide to securityoptions for wireless printing, and our Web site, www.zebra.com, has the most up-to-date information aboutsupported security protocols.

W i r e l e s s P r i n t e r M a n a g e m e n t

Wireless thermal printers can be managed the way enterprises like to manage - whether through general IT assetmanagement application like HP's OpenView™ portfolio or IBM® Tivoli®. Management applications developedfor mobile and wireless devices, such as Motorola's Mobility Services Platform (MSP) or Wavelink Avalanche®software, also can be used to manage wireless mobile printers. Printer-specific management systems are alsoavailable. Printer management applications should support common networking, interface and security protocols, and take advantage of them to leverage legacy IT management resources as much as possible.These management capabilities do exist for thermal printers, although they are frequently overlooked or misunderstood.

IT administrators can use their favorite and familiar general-purpose IT management programs to monitorwireless thermal printers, but these applications provide very limited control over thermal printers and theirspecific settings. Similarly, management systems developed for mobile and wireless devices don't provide controlover all the features and settings for optimizing thermal print quality, such as printhead temperature, printspeed, bar code scaling and more. Management applications developed by the printer manufacturer provide themost control, but may not support other wireless devices, although some can be used together with other ITmanagement applications.

For a complete overview of printer management options, including examples and formulas for comparingprinter management costs associated with each, see Zebra's white paper Managing Printers for MaximumReliability, Performance and Value.

A p p l i c a t i o n s a n d B e n e f i t s

There are few limitations on where bar codes and RFID tags can go. They can be read at assembly lines,shipping and receiving docks, patient bedsides, retail checkouts, offices-practically anywhere information isneeded. The traditional limitation on bar code systems has been the location where the symbols could beproduced. By eliminating the need for a hardwired connection, wireless printers remove the final obstacle tocreating bar code and RFID smart labels in real time where they are needed.

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As with most technology, many of the benefits users receive from wireless printing are derived from the newbusiness processes it enables. Wireless network connection allows printing to be done in places where it was notpossible before. Changing procedures and business practices to take advantage of this capability can producestrong efficiency and quality improvements. Following are some examples of how different industries canbenefit from wireless printing.

ManufacturingAssembly line workers typically walk to a central computer and printing station to pick up the labels, or usepreprinted labels stored at their workstations. Installing a wireless printer at the point of activity is animprovement over either of these procedures.

Requiring workers to leave their assembly stations to pick up labels results in nonproductive time being builtinto every product. Even if the printing station is nearby, label pickups may serve as unscheduled breaks asworkers converse around the printer. If workers gather labels for several items at a time, they run the risk ofmislabeling, which defeats the tracking system. The results may seem inconsequential when observed during afew shifts, but over the course of time the minutes saved for each worker translate into significant productivitygains and labor cost savings.

“When we used stationary bar code printers throughout our facility, workers had to walk to a central printstation when they needed a shipping label. More often than not, this meant waiting in line behind two or threeother users while their print jobs were being processed,” said the network administrator at Four Seasons, anautomotive parts manufacturer that raised productivity by installing wireless cart-mounted printers (see box).

Using preprinted labels at the workstation eliminates distractions and lost productivity, but at a cost. Preprintedlabels cannot carry variable information, such as the date of manufacture or identification of the worker whomade or inspected the product. The ability to produce variable-information labels in real time is critical inmany automated production environments, particularly for ERP systems and ISO-certified operations. In addition, preprinted labels must be held in inventory to ensure adequate supplies, leading to ordering,processing, and storage expenses.

Wireless printers are advantageous to manufacturers that change their production lines or use flexible workcells. By not having to retool and set up workstations based on the availability of cabled network connections,manufacturers can greatly reduce their changeover time and take full advantage of their facility space and flexibility options.

Manufacturers also can use wireless printers at testing and quality control stations to ensure items are identifiedand tracked correctly. More applications exist for materials management, finished goods inventory, assetmanagement, and other operations.

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Shipping and ReceivingA technology manufacturer conducted a time-motion study of receiving operations, in which the warehouseworker only had to take nine steps to travel from the pallet with items to be labeled to the workstation wherelabels were printed. Pallets were labeled in 42 percent less time (28.11 seconds compared to 49.74) when wirelessmobile printers were used to eliminate the short walk to the central printing station. Putaway transactions werecompleted 62 percent faster, even though the stationary printer previously used for putaway labels was only oneaisle away from the putaway location. Based on the volume of materials processed at that particular distributioncenter, managers quickly determined that a mobile printing system would provide significant productivity gainsand a rapid return on investment.

Wireless printers also are valuable when used to support cross docking. A wireless printer at the receiving areacan be used for relabeling incoming shipments. By eliminating the need for workers to go inside for labels,wireless printers provide the time savings and responsiveness demanded by cross-docking operations. Theprinters also can be used to generate manifests, safety labels, or temporary ID badges for delivery drivers.

For traditional receiving, wireless printers can be used to relabel incoming pallets or create new identificationlabels for cases and individual items when pallets are broken down for item putaway. For large items storedoutside of the warehouse, wireless printers can be installed in the receiving yard to label items as they enter thefacility-without requiring a trip inside to pick up a label.

Driscoll Strawberry Associates is a produce supplier that receives strawberries from growers. Operations get verybusy at peak harvest times, and because the products are highly perishable, efficient operations are crucial.Using wireless printers at the receiving dock to issue goods receipts to growers, instead of processing paperworkin a central office, helped Driscoll reduce the time needed to process receiving transactions by 25 percent, whichproduced a rapid return on investment. The full case study, “Driscoll Picks Perfect Mobile Solution forDistribution Account Reconciliation,” is available at www.zebra.com.

Wireless printers can also aid busy shipping operations. If a surge of orders exceeds the capacity of a company'sshipment labeling system, wireless printers can be temporarily deployed to meet the increased demand.Operations and IT professionals appreciate how quickly wireless printers can be set up and configured in busytimes, especially when compared with traditional wired models. See Zebra's white paper Productivity ThroughPortability: Mobile Printing Delivers ROI in the Warehouse for more application ideas and user profiles.

Retail Mobile wireless printers are widely used by retailers for shelf price labeling, returns processing, inter-storetransfer labeling, price auditing, portable POS, item marking, signage, and other applications. Wearable,handheld and cart-mounted models are all widely used for retail operations. Stationary wireless printers mayalso be installed with scales for bulk-food sales or other self-service applications to create accurate price labels.Retailers that frequently reconfigure their stores or set up temporary POS or returns processing stations afterthe holidays are good candidates for wireless printing.

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Jumbo, the largest toy retailer in Greece, provides a good example of the accuracy and labor efficiency that wireless mobile printing provides. Store associates walk through store aisles to monitor which items need to bereplenished on the shelf. Jumbo equipped its store associates with handheld computers and belt-worn printersso it could automate and decentralize its price labeling. Associates now produce price, promotional, and markdown labels while they are in the aisle. Jumbo reports associates are 80 percent more productive and savebetween 45 and 90 minutes per day by avoiding walking back and forth to the central office. Plus, pricing errorshave been reduced by 80 percent.

A major supermarket chain eliminated a 20-person, six-hour night shift after changing processes that includedswitching to wireless mobile printers to create new shelf labels and conduct price audits. Now, a smaller teamcompletes the same work in just one hour before the store opens using Zebra mobile label printers. Many additional retail case studies and white papers are available at www.zebra.com.

Hospitality

Hotels, conference facilities, and convention centers easily can set up extra registration and VIP check-in/checkout stations virtually anywhere by using computers and printers on a wireless network. Wirelessprinters can produce name tags, admission tickets, and other materials on demand, saving the expense ofprinting and transporting materials for registered guests who never check in. At front desks and other check-in/checkout locations, wireless networks enable multiple users to share a printer without running a tangle ofugly cable. With their advanced bar code and graphics capabilities, wireless printers also can be used to createshort-term security passes, eliminating the security risks associated with keeping an inventory of preprinted,non-personalized passes. Mobile printers are commonly used with mobile computers for hospitality foodserviceoperations to take orders and process payments at tableside, poolside, lounge and other convenient locations.More uses and considerations are presented in Zebra's white paper Printing Technology for Hospitality Venues.

C o n c l u s i o n

Wireless printers offer all the capabilities and performance of their cabled counterparts, with the added advantages of flexibility and convenience. When you remove cables, you gain flexibility. Using wireless connectivity to enable printing at the point of activity reduces the chance of mislabeling and makes workersmore productive. Gaining these benefits does not require a trade off in IT support, because enterprise networkmanagement and security systems can be leveraged and extended to wireless printers.

Freedom from network cables also makes it easy to add new printers to the workplace. If operations expand ormore printing capacity is temporarily needed, new printers can be up and running in minutes, instead ofwaiting hours or even days for busy IT staff to run cables to the work area.

Zebra Technologies was the first printer manufacturer to offer integrated wireless capabilities, and its productswork with products from all of the leading network technology vendors. Zebra also has a staff of engineersconstantly developing to meet emerging wireless and security standards, making Zebra products the broadestand most secure wireless offering in the industry. Zebra has the experience, partners, and comprehensiveproduct line to help you create the optimal wireless printing system. Contact Zebra at +1 800 423 0442 or visitits Web site at www.zebra.com for more information regarding wireless printing.

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GLOBAL/AMERICAS

HEADQUARTERSZebra Technologies Corporation333 Corporate Woods ParkwayVernon Hills, IL 60061-3109 U.S.A.

T: +1 847 793 2600 or+1 800 423 0442

F: +1 847 913 8766

EMEA HEADQUARTERSZebra Technologies Europe LimitedZebra House, Unit 14, The Valley CentreGordon Road, High WycombeBuckinghamshire HP13 6EQ, UK

T: +44 (0)1494 472872 F: +44 (0)1494 768251

ASIA-PACIFIC HEADQUARTERSZebra Technologies Asia Pacific, LLC120 Robinson Road#06-01 Parakou BuildingSingapore 068913

T: +65 6858 0722 F: +65 6885 0838

OTHER LOCATIONSUSA

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France, Germany, Italy, Netherlands,Poland, Spain, Sweden ASIA-PACIFIC

Australia, China, Japan, South KoreaLATIN AMERICA

Florida (USA), MexicoAFRICA/MIDDLE EAST

India, Russia, South Africa,United Arab Emirates

Web: www.zebra.comGSA#: GS-35F-0268N©2008 ZIH Corp.14575L (4/08)


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