Constructing the informatics and information technology foundations of a medical device evaluation system: a report from the FDA unique device identifier demonstration

Abstract

Objective: The US Food and Drug Administration (FDA) has recognized the need to improve the tracking of medical device safety and performance, with implementation of Unique Device Identifiers (UDIs) in electronic health information as a key strategy. The FDA funded a demonstration by Mercy Health wherein prototype UDIs were incorporated into its electronic information systems. This report describes the demonstration's informatics architecture.

Methods: Prototype UDIs for coronary stents were created and implemented across a series of information systems, resulting in UDI-associated data flow from manufacture through point of use to long-term follow-up, with barcode scanning linking clinical data with UDI-associated device attributes. A reference database containing device attributes and the UDI Research and Surveillance Database (UDIR) containing the linked clinical and device information were created, enabling longitudinal assessment of device performance. The demonstration included many stakeholders: multiple Mercy departments, manufacturers, health system partners, the FDA, professional societies, the National Cardiovascular Data Registry, and information system vendors.

Results: The resulting system of systems is described in detail, including entities, functions, linkage between the UDIR and proprietary systems using UDIs as the index key, data flow, roles and responsibilities of actors, and the UDIR data model.

Conclusion: The demonstration provided proof of concept that UDIs can be incorporated into provider and enterprise electronic information systems and used as the index key to combine device and clinical data in a database useful for device evaluation. Keys to success and challenges to achieving this goal were identified. Fundamental informatics principles were central to accomplishing the system of systems model.

Keywords: device research; medical devices; safety surveillance; system of systems.

Figure 1.

UDI System Information Flow. DI = Device Identifier; EDI = electronic data interchange; ETL = extract, transform, and load; FDA = US Food and Drug Administration; GHX = Global Healthcare Exchange (Louisville, CO); GUDID = Global Unique Device Identifier Database; PI = production identifier; SUDID = Supplemental UDI Database; UDI = Unique Device Identifier; barcode = UDI barcode scan.

Figure 2.

Data flow to the Unique Device Identifier Research Database.

Figure 3.

Unique Device Identifier Research Database (UDIR) high level data model. Key: Boxes represent specific tables while circles represent subject areas comprised of multiple tables. Note that the full UDI is not currently captured in Merge (a technical gap that will be rectified in the future) so the matching algorithm between OptiFlex™ CL and Merge Hemo™ is primarily by patient identifier and date.