FDASIA Taxonomy Subgroup

1. FDASIA Taxonomy Subgroup HIT Policy Committee FDASIA Workgroup On Site Meeting 30 May 2013

2. Subgroup Co-Chairs • Patti Brennan • Meghan Dierks

3. 1 Charge 1Charge, Anticipated Output of Subgroup

4. Taxonomy Subgroup To identify the scope of Health IT that should be consideredor included in deliberation by the full workgroup … as the full workgroup develops strategy and recommendations on an appropriate, risk-based regulatory framework for health IT that promotes innovation, protects patient safety, and avoids unnecessary and duplicative regulation. Charge – Anticipated Output

5. Taxonomy Subgroup To identify the scope of Health IT that should be consideredor included in deliberationby the full workgroup Taxonomy subgroup scope not to be interpreted as being the final recommendation for what is to be regulation Charge – Anticipated Output

6. 2 Charge 2Statutory Definitions

7. Statutory Definitions The term “health information” means any information, whether oral or recorded in any form or medium, that— (A) is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and (B) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual. Health Information [ SSA § 1171(4); 42 U.S.C. 1320d]

8. Statutory Definitions “The term ‘health information technology’ means hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for or support the use by health care entities or patients for the electronic creation, maintenance, access, or exchange of health information.” Health Information Technology [ HITECH Act (2009) ]

9. Statutory Definitions ” … an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is: recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them, intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or intended to affect the structure or any function of the body of man or other animals, and which does not achieve its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes." Medical Device [ Federal Food, Drug and Cosmetic Act 21 CFR 800 -1299 ]

10. 3 Scope Options

11. Scope Options Considered EXISTING TECHNOLOGY FOCUS: Explicitly limit scope to existing, named types or categories of Health IT EXCLUSIONARY FOCUS: Explicitly exclude named types of Health IT as Not-in-Scope; assume all else is In-Scope PRESCIPTIVE/INCLUSIONARY FOCUS: Explicitly include named types of Health IT as In-Scope, assume all else is Out-of-Scope

12. Scope Options Considered STATUTORY DEFINITION FOCUS: Explicitly state the scope as any software useable by patients or providers to create, maintain, access, or exchange health information Explicitly exclude from scope products that meet definition of medical device, hence fall under existing regulatory framework

13. Scope Options Considered USER TYPE FOCUS: Create a scope based on user type FUNCTIONALITY/INTENDED USE FOCUS: Create a scope where scope driven by Health IT’s functionality and intended use RISK-HARM FOCUS: Create a scope based on potential for injury or harm with failures, malfunctions, foreseeable misuse

14. 4 Organizing Principles

15. Organizing Principles • Platform agnostic • e.g., Scope is not defined by • ‘Wireless’/wired • Mobile/fixed • Installed versus Software as a Service (SaaS) • Avoid creating list of specific examples • Attempt to define generically • For product categories – focus on functions/intended use

16. Organizing Principles • Part-Whole: • If ‘component’ or part is in-scope, the whole is in scope

17. Scope Dimensions Considered • Product Categories • … • User Type • … • Phases of product lifecycle • … • Developer/ ‘Manufacturer’ Type • … • Distribution Model • … • Conditions of use • …

18. 5 Scoping

19. User Types In Scope Potentially Out of Scope • Health Care Providers – institutional and individual • Clinical Researchers using on human subjects • Patients under care by a provider • General public user/consumer under own use/health management

20. Product Lifecycle In Scope Potentially Out of Scope • Design phase: use of risk-mitigating design controls, standards, requirements, documentation, labeling • Implementation-Installation: Configuration mgmt, interfacing with other systems, interoperability as systems-of-systems

21. Product Lifecycle In Scope Potentially Out of Scope • Design phase • Implementation-Installation • Maintenance: Routine updates/upgrades, performance tuning, defect and safety-related corrective, enhancements and Δto base functionality

22. Product Lifecycle In Scope Potentially Out of Scope • Design phase • Implementation-Installation • Maintenance • Recall: Managing entire install base (vs. index customer), maintaining configuration log

23. Product Lifecycle In Scope Potentially Out of Scope • Design phase • Implementation-Installation • Maintenance • Recall • End-of-Life Support: De-installation of out-dated or non-conforming product (vis-à-vis contemporary standards)

24. Product Lifecycle In Scope Potentially Out of Scope • Design phase • Implementation-Installation • Maintenance • Recall • End-of-Life Support • Cybersecurity: Control of PHI, assuring protection against malware-based risks

25. Product Lifecycle In Scope Potentially Out of Scope • Design phase • Implementation-Installation • Maintenance • Recall • End-of-Life Support • Cybersecurity • Methods and modes of end-user training

26. Developer/ ‘Manufacturer’ Types In Scope Potentially Out of Scope • Entity who develops/markets/licenses/distributes products with commercial interest • Healthcare provider* who develops products de novo for use on patients, even if no direct or indirect commercial interest • Healthcare provider* who modifies functionality of previously licensed, ‘finished’ products *institutional or individual provider

27. Developer/ ‘Manufacturer’ Types In Scope Potentially Out of Scope • Independent entity who develops/ advertises/distributes via public channel products intended for general public users, even if no commercial interest

28. Developer/ ‘Manufacturer’ Types In Scope Potentially Out of Scope • Entity who develops/markets/licenses/distributes products with commercial interest • Healthcare provider* who develops products de novo for use on patients, even if no direct or indirect commercial interest • Healthcare provider* who modifies functionality of previously licensed, ‘finished’ products • Independent entity who develops/ advertises/distributes via public channel products intended for general public users, even if no commercial interest • Individuals who develop for personal private use • Individual who develops/distributes via private channel to limited individuals without commercial interest • Independent non-commercial developers who advertise/distribute via public channel products intended for general public users *institutional or individual provider

29. Distribution Model In Scope Potentially Out of Scope • Marketed-licensed-distributed-sold in a restricted manner, with credentialing requirements • Marketed-licensed-distributed-sold in a restricted manner, without credentialing requirements • Made available for download via an unrestricted public channel, with or without credentialing requirements • Available under a SaaS model

30. General Conditions of Use In Scope Potentially Out of Scope • Intended use • Foreseeable misuse • Non-foreseeable, willful misuse • Use clearly beyond labeled intended use

31. General Conditions of Use In Scope Potentially Out of Scope • By prescription, recommendation or under direction of licensed/credentialed healthcare provider • Independently by general public consumer/user • For management of defined illness or chronic condition • ? For health maintenance or fitness

32. Specific Product Types - Categories In Scope Potentially Out of Scope

33. Decision Tree Approach Functionality – Intended Use – Potential for Harm

34. Diagram Does product currently meet FDA (Act 21 CFR) definition of Medical Device (including MDDS) ? NO Potentially in-scope YES Out-of-scope … defer to existing regulatory framework

35. Diagram 2 • Does malfunction, foreseeable misuse have • potential to cause patient injury, via: • Delay or failure to present clinical data/ • information at time of need • Presentation of outdated information • Patient-data mismatch ? YES Potentially in-scope NO Potentially out-of-scope

36. Diagram 3 Is the data/information that is managed by system the sole or 1o source of data at point of care (i.e., no alternate sources of data /info that can be used for confirmation) ? YES Potentially in-scope NO Potentially out-of-scope

37. Diagram 4 Through design and intended use, is patient or provider reliant on data/information to initiate or modify prescribed intervention or tx ? YES Potentially in-scope NO Potentially out-of-scope

38. Diagram 5 Through design and intended use, is patient or provider reliant on alerting or function about a change in clinical status and/or a need to initiate or modify tx ? YES Potentially in-scope NO Potentially out-of-scope

39. Products Types - Categories In Scope Out of Scope • Claims processing • Health benefit eligibility • Practice management / Scheduling / Inventory management • Healthcare provider communication tools (e.g., email, paging) • Population management tools • Software using historical claims data to predict future utilization/cost of care • Cost effectiveness analytic software

40. Products Types - Categories In Scope Out of Scope • Diseases severity scoring algorithms • Electronic guideline distribution • Disease registries

41. Products Types - Categories In Scope Out of Scope • EHRs (installed, SaaS) • Hospital Information Systems-of-systems • Decision support algorithms • Visualization tools for anatomic, tissue images, medical imaging and waveforms • ? Health Information Exchanges • Electronic/robotic patient care assistants • Claims processing • Health benefit eligibility • Practice management / Scheduling / Inventory management • Healthcare provider communication tools (e.g., email, paging) • Population management tools • Software using historical claims data to predict future utilization/cost of care • Cost effectiveness analytic software • Diseases severity scoring algorithms • Electronic guideline distribution • Disease registries

42. Words of Caution Strive to: develop a framework that is able to meet future undefined needs avoid a discrete, static and specific defined list of named products Favor the decision tree approach that emphasizes functionality as a primary scoping criterion

43. Questions and Discussion