Some physicians are frustrated that key information about implantable medical devices rarely makes it into electronic health records (EHRs), despite a 10-year mandate on manufacturers to label these products with identifiers.
As a result of this siloing of information, patients are not getting the expected benefits of a regulation finalized over a decade ago by the US Food and Drug Administration (FDA).
In 2013, the agency ordered companies to include unique device identifiers (UDIs) in plain-text and barcode format on some device labels, starting with implanted devices that are considered life-sustaining. The FDA said that tracking of UDI information would speed detection of complications linked to devices.
But identifiers are rarely on devices. At the time of the regulation creation, the FDA also said it expected this data would be integrated into EHRs. But only a few pioneer organizations such as Duke University and Mercy Health so far have attempted to track any UDI data in an organized way, researchers say.
Richard J. Kovacs, MD, the chief medical officer of the American College of Cardiology (ACC), contrasted the lack of useful implementation of UDI data with the speedy transfers of information that happen routinely in other industries. For example, employees of car rental agencies use handheld devices to gather detailed information about the vehicles being returned.
"But if you go to an emergency room with a medical device in your body, no one knows what it is or where it came from or anything about it," Kovacs told Medscape Medical News.
Many physicians with expertise in device research have pushed for years to have insurers like Medicare require identification information on medical claims.
Even researchers face multiple obstacles in trying to investigate how well UDIs have been incorporated into EHRs and outcomes tied to certain devices.
In August, a Harvard team published a study in JAMA Internal Medicine attempting to analyze the risks of endovascular aortic repair (EVAR) devices. They reported an 11.6% risk for serious blood leaks with AFX Endovascular AAA System aneurysm devices, more than double the 5.7% risk estimated for competing products. The team selected EVAR devices for the study due in part to their known safety concerns. Endologix, the maker of the devices, declined to comment for this story.
The Harvard team used data from the Veterans Affairs health system, which is considered to be more well organized than most other health systems. But UDI information was found for only 19 of the 13,941 patients whose records were studied. In those cases, only partial information was included.
The researchers developed natural language processing tools, which they used to scrounge clinical notes for information about which devices patients received.
Using this method isn't feasible for most clinicians, given that records from independent hospitals might not provide this kind of data and descriptions to search, according to the authors of an editorial accompanying the paper. Those researchers urged Congress to pass a law mandating inclusion of UDIs for all devices on claims forms as a condition for reimbursement by federal healthcare programs.
Setback for Advocates
The movement toward UDI suffered a setback in June.
An influential, but little known federal advisory panel, the National Committee on Vital Health Statistics (NCVHS), opted to not recommend use of this information in claims, saying the FDA should consider the matter further.
Gaining an NCVHS recommendation would have been a win, said Sens. Elizabeth Warren (D-MA) and Charles E. Grassley (R-IA), and Rep. Bill Pascrell Jr. (D-NJ), in a December 2022 letter to the panel.
Including UDI data would let researchers track patients' interactions with a health system and could be used to establish population-level correlations between a particular device and a long-term outcome or side effect, the lawmakers said.
That view had the support of at least one major maker of devices, Cook Group, which sells products for a variety of specialties including cardiology.
In a comment to NCVHS, Cook urged for the inclusion identifiers in Medicare claims.
"While some have argued that the UDI is better suited for inclusion in the electronic health records, Cook believes this argument sets up a false choice between the two," wrote Stephen L. Ferguson, JD, the chairman of Cook's board. "Inclusion of the UDI in both electronic health records and claims forms will lead to a more robust system of real-world data."
In contrast, AdvaMed, the trade group for device makers, told the NCVHS that it did not support adding the information to payment claims submissions, instead just supporting the inclusion in EHRs.
Kovacs of the ACC said one potential drawback to more transparency could be challenges in interpreting reports of complications in certain cases, at least initially. Reports about a flaw or even a suspected flaw in a device might lead patients to become concerned about their implanted devices, potentially registering unfounded complaints.
But this concern can be addressed through using "scientific rigor and safeguards" and is outweighed by the potential safety benefits for patients, Kovacs said.
Patients should ask healthcare systems to track and share information about their implanted devices, Kovacs suggested.
"I feel it would be my right to demand that that device information follows my electronic medical record, so that it's readily available to anyone who's taking care of me," Kovacs said. "They would know what it is that's in me, whether it's a lens in my eye or a prosthesis in my hip or a highly complicated implantable cardiac electronic device."
The Harvard study was supported by the FDA and National Institutes of Health (NIH). Authors of the study reported receiving fees from the FDA, Burroughs Wellcome Fund, and Harvard-MIT Center for Regulatory Science outside the submitted work. No other disclosures were reported. Authors of the editorial reported past and present connections with F-Prime Capital, FDA, Johnson & Johnson, the Medical Devices Innovation Consortium; the Agency for Healthcare Research and Quality; the National Heart, Lung, and Blood Institute; and Arnold Ventures, as well being an expert witness at in a qui tam suit alleging violations of the False Claims Act and Anti-Kickback Statute against Biogen. Authors of the Viewpoint reported past and present connections with the National Evaluation System for Health Technology Coordinating Center (NESTcc), which is part of the Medical Device Innovation Consortium (MDIC); AIM North America UDI Advisory Committee, Mass General Brigham, Arnold Ventures; the Institute for Clinical and Economic Review California Technology Assessment Forum; Yale University, Johnson & Johnson, FD, Agency for Healthcare Research and Quality; the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH); as well as having been an expert witness in a qui tam suit alleging violations of the False Claims Act and Anti-Kickback Statute against.
Kerry Dooley Young is a freelance journalist based in Washington, DC. Follow her on Mastodon and Threads as @kerrydooleyyoung.
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Cite this: Kerry Dooley Young. Lack of Medical Device Tracking Leaves Patients Vulnerable - Medscape - Sep 27, 2023.