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How can we get high quality routine data to monitor the safety of devices and procedures?

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2782 (Published 07 May 2013) Cite this as: BMJ 2013;346:f2782

Rapid Response:

Re: How can we get high quality routine data to monitor the safety of devices and procedures?

To the Editor,
 
The robust tracking and tracing of implantable medical devices is well overdue. It is unbelievable that in an age where Toyota can raise a safety issue from its post-production surveillance, and successfully recall thousands of vehicles for correction of the defect before any harm comes to the customer (1), we still put implants into patients without any system to monitor them and keep our patients safe.
 
Campbell et al. suggest several measures that would allow safety alerts to arise from signals in meta-datasets, and full device traceability to identify affected patients (2). However their proposals distinctly lack a patient perspective. To continue the car analogy, if a customer hears that there is a recall for their type of car, they do not need to wait anxiously by the letterbox to see if their car is to be recalled. Instead they can simply check online by entering their car registration number on the manufacturer’s website.
 
For patients with a medical device, there is currently no robust way for worried patients to find out if they are affected by a safety alert, and the proposals by Campbell et al. do not go far enough to enable this. Currently, details of implants should be entered into medical records. These are often paper-based and in a proportion, unobtainable, incomplete, lost or destroyed. In the case of the Poly Implant Prosthèse (PIP) implants, although most patients managed to either keep their own records or obtain past records from their original provider, some were lost or destroyed. The Data Protection Act 1998 specifies that records should only be kept for as long as necessary but does not specify a time period (3). British Medical Association guidance suggests that hospitals keep records for 8 years after the conclusion of treatment or death (4). Therefore some medical records may be legitimately destroyed. Medical imaging may be able to characterize site, contour and integrity of some implants, but is rarely capable of obtaining an adequate level of information to identify the exact make, model and batch.
 
We ran an anonymous survey of patients with PIP implants, advertised through social media. Eighty-three patients responded, of which 59 originally had their surgery in a private UK clinic, 23 outside UK and one in the NHS. Fifty-five (66%) needed to make enquiries to ascertain the make of their breast implants. For 38, this took longer than two weeks, and for 19, longer than six weeks. In response to "how much has the uncertainty regarding implants affected your life?" 70 (84%) rated eight or more (1=not at all, 10=completely).
 
The human impact of failed medical devices cannot be understated. We conducted a semi-structured interview with a solicitor handling claims for women who have had, or think they have had PIP implants. Commenting about the type of implant he stated, “a significant proportion [of women] don’t know”. This is because women were never told or given a choice of implant. Hundreds of women are affected and some are experiencing high levels of anxiety. “Many are extremely worried. Some women are finding ruptures… and wanting to get them out as soon as possible”.
 
The Medicines and Healthcare products Regulatory Agency have recently consulted on introducing a unique device identifier (UDI) and it is intended to eventually pass through European legislation (5). This will improve traceability of devices along the supply chain. However, once implanted, the only way to know the UDI of a medical device will be from the medical records. With the unreliability of current record systems as highlighted above, and with the previous failure of expensive central registries (6) (with the exception of the National Joint Registry), there is currently an unsolved need, from the patient’s perspective, to be able to identify the exact details of medical devices whilst still in situ.
 
In our survey, when asked about their agreement with "all implants should have a readable ID that doesn't require medical records or x-rays", 62 (73%) either agreed or strongly agreed. We believe that technology that would allow this to become a reality should be investigated, so that the safety of medical devices are not only addressed from a systems’ perspective, but also from, and arguably more importantly, the patients’ perspective.
 
References
 
1. Moulds J. Toyota recalls 242,000 Prius cars. The Guardian [Internet]. 2013 Jun 5 [cited 2013 Jul 10]; Available from: http://www.guardian.co.uk/business/2013/jun/05/toyota-recalls-prius-cars...
2. Campbell B, Stainthorpe AC, Longson CM. How can we get high quality routine data to monitor the safety of devices and procedures? BMJ. 2013 May 7;346(may07 3):f2782–f2782.
3. Information Commissioner’s Office. Data Protection Act: Retaining personal data (Principle 5) [Internet]. [cited 2012 Apr 2]. Available from: http://www.ico.gov.uk/for_organisations/data_protection/the_guide/inform...
4. BMA. Retention of health records [Internet]. British Medical Association. 2011 [cited 2012 Mar 5]. Available from: http://www.bma.org.uk/ethics/health_records/retentionrecords.jsp#.T1S-Hn...
5. Medicines and Healthcare Products Regulatory Agency. The revision of European legislation on medical devices. The response to the public consultation. [Internet]. London, UK; 2013 Apr. Available from: http://www.mhra.gov.uk/home/groups/comms-ic/documents/publication/con260...
6. Healthcare Quality Improvement Partnership. HQIP reaction to breast implant debate - registries crucial to identifying risks to patients [Internet]. 2012 [cited 2012 Apr 2]. Available from: http://www.hqip.org.uk/hqip-reaction-to-breast-implant-debate-registries...

Competing interests: No competing interests

13 July 2013
James B Haddow
Specialist Registrar Colorectal Surgery
Charles H Knowles
National Centre for Bowel Research and Surgical Innovation
1st Floor Abernathy Building, 2 Newark St, London E1 2AT