Registry Assessment of Peripheral Interventional Devices (RAPID)
Pablo Morales, MD, FDA
Robert Thatcher, 4C Medical Technologies
Jack Cronenwett, MD, Society for Vascular Surgery (SVS), Vascular Quality Initiative (VQI)
MDEpiNet Key Advisors
Mitchell Krucoff, MD, Duke Clinical Research Institute (DCRI)
Phase I Working Group Chairs
Schuyler Jones, MD, DCRI (Clinical)
James Tcheng, MD, DCRI (Informatics)
Project Management and Informatics Support
Rebecca Wilgus, DCRI
Anne Heath, DCRI
Mary Williams, DCRI
The Registry Assessment of Peripheral Interventional Devices (RAPID) project emerged from the Predictable And SuStainable Implementation Of National (PASSION) Registries for Cardiovascular Devices program of the Medical Device Epidemiology Network (MDEpiNet), a public‐ private partnership supported by the U.S. FDA to advance the nation’s approaches to the evaluation of medical devices. It is one project in a series initiated to advance and demonstrate the interoperable flow of data and information across electronic health information systems as a precursor to the National Evaluation System for Health Technology (NEST) articulated by Drs. Shuren and Califf. The MDEpiNet RAPID project designed to advance the foundational elements of a total product lifecycle (TPLC) approach for the evaluation of medical devices used to treat and manage peripheral artery disease.
RAPID is focused on devices for peripheral arterial intervention as an archetype of the envisioned TPLC ecosystem. Standard data elements related to the care and treatment of patients with peripheral artery disease are being developed for use with data elements from the Global Unique Device Identification Database (GUDID) database to create a structured dataset that supports pre‐ and post‐market assessment, quality improvement, and safety surveillance of peripheral interventional devices (Phase I). Subsequent phases will validate the potential of the data elements for implementation in various healthcare information systems such that structured, interoperable data is collected at the point of care and is available for use by patient registries, clinical research and medical device evaluation initiatives. Additionally, the RAPID data elements will inform the development of a global case report form and data collection instruments needed in the interim. As such, this work facilitates peripheral interventional device development, addresses regulatory needs, and creates efficiencies that will reduce overall time and costs and support quality improvement efforts across the medical device lifecycle.
Shuren, J., & Califf, R. M. (2016). Need for a National Evaluation System for Health Technology. Jama. doi:10.1001/jama.2016.8708
Morales, J.P., Cronenwett, J, Thatcher, R. (2016). Registry Assessment of Peripheral Interventional Devices (RAPID). Endovascular Today 15.8 (2016): 85-94.
The following Learning UDI Community work groups are active:
- Catalog Number Fields: This work group will focus on the importance of catalog numbers in GUDID information.
- Clinically Relevant Size: This work group will discuss how to make the GUDID more useful and what device size types and Units of measure to capture.
- Search Criteria for High Risk Implants: This work group is being charged with developing a more user-based set of search criteria that would be run against AccessGUDID and return a search result to document implants in health IT— including those working with the automated billing process—and to be shared publicly.
- Device Categorization: GMDN/SNOMED Terminologies: This work group should review the pros and cons of GMDN and SNOMED terminologies and review findings of preliminary pilot exercises (RAPID), while also recognizing that additional vocabularies for medical devices, such as UMDNS, UNSPSC, or others, may provide value to GUDID device data and NEST priorities.
- Medical Devices Containing Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/P): The work group will focus on the tracking of medical devices containing HCT/P through the entire supply chain and will engage participants from all parts of that chain to develop educational material and guidance to address the issues described in the summary.
- UDI Benefits to Healthcare Supply Chain Processes: This work group will develop five important workflow processes as they currently work without UDI and then contrast these to future workflows where UDI is incorporated in hospital information systems and operations.
- UDI Capture: The ultimate goal of this work group is to identify opportunities for case studies, initiate them, and bring answers to the greater Learning UDI Community to foster learning and hopefully, shorten the adoption curve for capturing UDI's within healthcare.
- UDI Single Use Device (SUD) Packaging Exception and Distributor Low Unit of Measure Programs: The work group will explore cost effective and sustainable solutions around labeling at the lowest unit of measure/unit of use—where technically feasible—devices that meet the UDI final rule’s SUD packaging exception.
- *Unit of Use: This is an “unmarked” or “virtual” Device Identifier (DI); assigned to an individual medical device when a UDI is not labeled on the individual device at the level of its unit of use. This is usually applicable to situations when the Device Count in the base package is >1. This work group is working to identify legitimate UoU cases where a UoU UDI is applicable (i.e., products/situations where you would absolutely need a DI for each widget within the lowest package level). These examples will help assist in a potential solution rather than requiring a UoU UDI for all products with multiple widgets/eaches.
*denotes the group is full, and no longer accepting new participants.
The mission of the Augmented UDI (AUDI) workgroup is to provide the framework for expanding the FDA GUDID system to manage additional data about medical devices.
The Interoperability Proving Ground (IPG) is an open, community platform where you can share, learn, and be inspired by interoperability projects occurring in the United States (and around the world).
Supported by the Common Fund at the National Institutes of Health (NIH), the NIH Health Care Systems Research Collaboratory aims to improve the way clinical trials are conducted by creating a new infrastructure for collaborative research with healthcare systems. The ultimate goal is to ensure that healthcare providers and patients can make decisions based on the best available clinical evidence.
PCORnet, the National Patient-Centered Clinical Research Network, is an innovative initiative of the Patient-Centered Outcomes Research Institute (PCORI). The goal of PCORnet is to improve the nation’s capacity to conduct comparative clinical effectiveness research efficiently by creating a large, highly representative network for conducting clinical outcomes research that directly involves patients in the development and execution of the research.
Sentinel is the FDA’s national electronic system which has transformed the way researchers monitor the safety of FDA-regulated medical products, including drugs, vaccines, biologics, and medical devices.
The MDEpiNet BUILD Initiative encompasses efforts to demonstrate, implement, and apply unique device identification (UDI) in health care. The initiative focuses on implantable devices, leveraging UDI to connect data sources, to access the global unique device identification database (GUDID), to move information on devices to clinicians for patient care, to allow researchers to assess device effectiveness and safety, and to support device innovation across the device product life cycle.
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The Duke-Margolis Center brings together capabilities that generate and analyze evidence across the spectrum of policy to practice, supporting the triple aim of health care – improving the experience of care, the health of populations and reducing the per capita cost.
The Clinical Information Modeling Initiative (CIMI) is an international collaboration dedicated to providing a common format for detailed specifications for the representation of health information content. In this way semantically interoperable information may be created and shared in health records, messages, and documents. The mission of the CIMI is to improve the interoperability of healthcare systems through shared implementable clinical information models.
Pew’s medical device initiative seeks to enhance medical device safety and foster device innovation that benefits patients. Pew’s initiative has three main areas of focus, including:
- Improving the current state of medical device registries—databases containing information on patients who use or are treated with a specific device;
- Supporting the adoption of a unique device identification (UDI) system to better track medical devices; and
- Fostering medical device innovation with these and other new approaches without compromising patient safety.
The Global Unique Device Identification Database (GUDID) contains key device identification information submitted to the FDA about medical devices that have Unique Device Identifiers (UDI).
The data standards covered in this document are divided into 6 distinct tables. The first table covers general data elements common to all PAVDs, including demographic information, atherosclerotic risk factors, concurrent atherosclerotic diseases, comorbid conditions, medications, the cardiovascular examination, and relevant blood chemistries and hematology. The remaining tables cover data standards specific for lower extremity PAD, AAA, renal artery disease, mesenteric artery disease, and extracranial carotid and vertebral artery disease, respectively. Each of the disease-specific tables includes the following data elements: medical history, physical examination, laboratory testing, diagnostic procedures, invasive therapeutic procedures (both endovascular and open surgical), pharmacological therapy, follow-up, and outcomes.
Evaluation and Treatment of Patients With Lower Extremity Peripheral Artery Disease. Consensus Definitions From Peripheral Academic Research Consortium (PARC). The PARC, together with the U.S. Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, has developed a series of pragmatic consensus definitions for patients being treated for peripheral artery disease affecting the lower extremities. These consensus definitions include the clinical presentation, anatomic depiction, interventional outcomes, surrogate imaging and physiological follow-up, and clinical outcomes of patients with lower-extremity peripheral artery disease. Consistent application of these definitions in clinical trials evaluating novel revascularization technologies should result in more efficient regulatory evaluation and best practice guidelines to inform clinical decisions in patients with lower extremity peripheral artery disease.
The International Medical Device Regulators Forum (IMDRF) was conceived in February 2011 as a forum to discuss future directions in medical device regulatory harmonization. It is a voluntary group of medical device regulators from around the world who have come together to build on the strong foundational work of the Global Harmonization Task Force on Medical Devices (GHTF), and to accelerate international medical device regulatory harmonization and convergence.
The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness.
The Vascular Quality Initiative (VQI) is a collaborative of regional quality groups collecting and analyzing data in an effort to improve patient care. The VQI collects perioperative and one-year follow-up data to generate real-time benchmarked reports to assess quality of care and determine best practices in vascular surgery.
The Society of Interventional Radiology is a national organization of physicians, scientists, and allied health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapeutic interventions.