What are the 6 New Essential Requirements?

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Annex I of the European Medical Device Directive (http://bit.ly/M5MDD) is titled “Essential Requirements.” Most companies demonstrate that their device meets the 13 Essential Requirements (ERs) by creating an Essential Requirements Checklist (ERC). I have no idea what the origin of the ERC is, but you know that regulators love tables and checklists. This particular checklist is so commonly used that the Global Harmonization Task Force (GHTF) included an example of an ERC, called an “Essential Principles Checklist” (EPC) at the end of a guidance document on how to create Summary Technical Documentation (STED) for In Vitro Diagnostic devices (http://bit.ly/STEDIVD)—which is now maintained on the IMDRF.org website.

On September 26, 2012, the European Commission released a proposal for new EU Medical Device Regulations (http://bit.ly/EUProposal). This proposal still includes ERs in Annex I, but there are 19 ERs in the proposal. One regulatory professional recently sent me a follow-up question in response to an audio seminar I conducted in November (). Her question was, “What are the six new ERs?”

A few of the early reviews of the proposal indicated that there were no significant changes, but I have learned the hard way that you should always go to the source and verify the information for yourself (i.e. – Genchi Genbutsu). Here’s what I found:

General Requirements (ER 1-6a)

1. No real change to this requirement.
2. This requirement was reworded to clarify the intent (see Annex ZA of EN 14971:2012 for more info @ http://bit.ly/ISO14971-2012changes).
3. It appears as though the Commission thought the current ER 3 was redundant and the requirement was addressed by ER 1 and ER 5 already.
4. This is now the new ER 3, and the requirement now clarifies how Notified Bodies shall apply this requirement in cases where a lifetime of the device is not stated.
5. This is now the new ER 4, and there is no real change.
6. This is now the new ER 5, and the wording has been clarified.

ER6a is conspicuously missing from the proposed ERs, but don’t get excited. Clinical Evaluations are still required as part of the Technical Documentation in Annex II, Section 6.1c: “the report on the clinical evaluation in accordance with Article 49(5) and Part A of Annex XIII.”

Chemical, Physical & Biological Properties (ER 7)

ER 7.1 has one new requirement: “d) the choice of materials used, reflecting, where appropriate, matters such as hardness, wear and fatigue strength.” ER 7.2 and 7.3 remain unchanged. ER 7.4 has been simplified to what is proposed as the new, shorter ER 9. ER 7.5 is now the new ER 7.4, and the changes reflect the current status of phthalate regulations and similar issues. ER 7.6 is now the new ER 7.5, but there is no change to the content. The new ER 7.6 requires that manufacturers address the risks associated with the size and properties of particles—especially nanomaterials. The changes associated with this section will impact certain device types more than others—such as orthopedic implants.

Infection & Microbial Contamination (ER 8)

ER 8 is still ER 8, but ER 8.1 is now prescriptive regarding design solutions and the current ER 8.2 is now the new ER 10. The new ER 10 is expanded and references the new EU Regulations regarding devices manufactured utilizing tissues or cells of animal origin: Commission Regulation (EU) No 722/2012 of 8 August 2012 (http://bit.ly/AnimalTissueReg). The new ER 8.2 is a new requirement that was an oversight of the MDD, and the new ER 8.7 now clarifies that the labeling must differentiate sterile and non-sterile versions of the product; packaging is no longer an acceptable mechanism for differentiation. The balance of ER 8 remains unchanged.

Construction & Environmental Properties (ER 9)

This ER is now identified as the new ER 11, and this section is expanded. This reflects the emphasis on the need to evaluate the safety of devices with accessories, compatibility with other devices, and the affects of the use environment.

Devices with a Measuring Function (ER 10)

This ER is now identified as the new ER 12, but ER 10.2 from the current Directive appears to be missing. What’s up?

Take a look at the new ER 11. ER 10.2 is now the new ER 11.6.

Protection Against Radiation (ER 11)

This ER is now identified as the new ER 13, but there is nothing new.

Requirements for Devices Connected to or Equipped with an Energy Source (ER 12)

ER 12.1 and 12.1a are now ER 14. This section is specific to software requirements and has more detail than the current Directive. IEC 62304:2006, “Medical device software – Software life cycle processes,” is the Standard that will be expected by Notified Bodies as a reference for ER 14. ER 12.2 through ER 12.6 are now ER 15, but there is nothing new. This Section ER 12.7 and its sub-parts are now addressed by ER 16. ER 12.8 and its sub-parts are now addressed by ER 17.

Information Supplied by the Manufacturer (ER 13)

This is now identified as ER 19: “Label and Instructions for Use.” This section is simplified from ER 13 (i.e. – there are fewer sections), but this ER does not seem to be any shorter. ER 19.1 has sub-parts a-g, and this ER section incorporates the concepts previously addressed by ER 13.1, 13.2, 13.4 and 13.5. ER 19.2 is a new and improved version of the previous ER 13.3 specific to labeling requirements. This labeling section is expanded from sub-parts “a” through “n” to “a” through “q”. The UDI requirement is sub-part “h”. ER 13.6 is now ER 19.3 specific to the instructions for use (IFU). This section is expanded from sub-parts “a” through “q” to “a” through “t”.

The number of sub-parts to ER 19.3 doesn’t reflect the additional requirements for IFUs that are proposed by the Commission. The sub-sections of this part warrant special attention. Items that frequently are found missing from IFUs on the market today include:

1. ER 19.3c – performance intended by the manufacturer
2. ER 19.3h – installation and calibration instructions
3. ER 19.3k – how to determine if a re-usable device should be repaired/replaced
4. ER 19.3m – restrictions on combinations with other devices
5. ER 19.3o – detailed warning information
6. ER 19.3p – information about safe disposal of the device
7. ER 19.3t – notice to user/patient to report adverse events

ER 18 – Use by Lay Persons

This is a short section, but the requirement is new. There are now additional requirements for products intended for use by a lay person. The Risk Management Report, Design Validation, and Clinical Evaluation Report will need to include specific evidence to demonstrate conformity with this ER. The Post-Market Surveillance Plan for these products should carefully verify the accuracy of risk estimates. Post-Market Clinical Follow-up (PMCF) Studies would be challenging in the past, but the prevalence of social media and product registration databases may facilitate conducting PMCF Studies for these products in the future.

Australia & Canada

There is also an EPC that is required by the Therapeutic Goods Administration (TGA) in Australia (http://bit.ly/EPCTGA) and by the Therapeutics Product Directorate (TPD) in Canada (http://bit.ly/CanadianSTED). If you would like to learn more about the Essential Principles of Safety and Performance you should also review the GHTF guidance document on this topic (http://bit.ly/EPSafetyPerf) on the IMDRF.org website. This 2012 version of the document supersedes GHTF/SG1/N041:2005.

I have observed approval of products where the European ERC was submitted in lieu of an EPC for Australia and Canada. I guess they are a little more rationale than some other regulators, but if you have experienced any “push back” regarding this approach please share this by posting a comment or emailing me: rob@13485cert.com.

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Who’s Afraid of the Proposed European Scrutiny Process?

For those of you that are not familiar with the “Scrutiny Process”, I am referring specifically to Article 44 of the proposed EU regulations for medical devices. This process is first alluded to at the end of section 3.5 in the “Explanatory Memorandum” (i.e. – the 13 pages preceding the proposal for the regulation of medical devices).

I was looking for a video that matched up with my title and when I saw this TECHNO music video.

The US already has a pre-market approval process that we fondly refer to as the PMA process. In response to the PIP scandal, the European Parliament’s ENVI Committee (Committee on the Environment, Public Health and Food Safety) proposed a pre-market approval process as part of a press release issued on April 25, 2012. In response to this political pressure, the Commission has proposed a “Scrutiny Process” that involves preparation of a Notified Body “Summary Evaluation Report” and verification that the conformity assessment was adequate by the Coordinating Competent Authority. A similar process is outlined in MEDEV 2.11/1 rev. 2, a guidance document regarding animal tissues, and the Commission Regulation (EU) No 722/2012 of 8 August 2012. The proposed scrutiny process allows competent authorities to take a “second look” and review the findings of the Notified Body that would be issuing a CE Certificate for these high risk devices. The review process is supposed to be concluded within 60 days, but the review time limit is suspended if the Competent Authorities request additional information or product samples within the first 30 days.

In section 3.5 of the Explanatory Memorandum, the Commission states that this scrutiny process “should be the exception rather than the rule and should follow clear and transparent criteria.” The criteria for invoking the scrutiny process are defined in five points 5a) through 5e) of Article 44. The five points leave room for interpretation by Competent Authorities, and the medical device industry is concerned that the review process for Class IIb and Class III devices will be delayed by at least 60 days on a regular basis. The process could easily be delayed by as much as six months when there are requests for additional information and samples.

The “Legislative Financial Statement” (i.e. – the 19 pages immediately following the proposal for the regulation of medical devices) defines a monitoring process for the scrutiny process in the “Indicator of results and impact” (Section 1.4.4). The risk of delaying access to market for innovative devices is also identified in the “Risk(s) identified” (Section 2.2.1). Therefore, the need for a control mechanism is identified in “Control method(s) envisaged” (Section 2.2.2). This will be the responsibility of the Commission to draft a guidance document to define the control method(s). Until industry has an opportunity to review such a guidance document, executives will continue to voice their concerns and apply their own political pressure to the European Parliament.

How do you Learn New Regulations? Normal, Lazy or Strategically?

For those of you that want some background music while they read tonight, I offer you a doppio caffè macchiato this evening. The first shot is an amazing interpretation of the famous song “Somewhere Over the Rainbow”. As someone that has sung this song hundreds of times, I never expected to hear a version that I would like more than Judy Garland’s. Now I have. My favorite part of the song was when Stephan Braun is playing a cello like a guitar and Melody Gardot stops singing and starts to brush the snare drum—and I love her voice.

Last week I mentioned the draft EU regulations that were released, and I am still reading them. I am sure some of you have already finished at least one of the two regulations, but I am a slow reader. Sure I have skimmed the regulations, but I really need to read every word of the regulations several times before I have absorbed the bulk of the content. While I was reading during my lunch today, I was wondering how other regulatory experts learn new material. After all, there is nobody to take a course from yet and a one hour webinar is not enough.

Some people like to listen to books on tape during their morning ride, but I think the market might be a little small for medical device regulations. We could use technology to convert the PDF format into an eBook format that can be read electronically to us on our commute to work, but I learn Standards visually rather than verbally.

Last year I published a blog titled “Never Stop Learning.”

In that post, I presented a model for learning that I find helpful for explaining my philosophy for training people. The first step in my Learning Pyramid is to “Read and Understand.” I call this the “newbie” stage. That is the stage most of us are at right now for the draft EU regulations. The next stage of the Learning Pyramid is “Show and Tell”. A course or seminar related to the draft regulations would involve a training telling us about the draft regulations and showing us some PowerPoint slides to help us visualize the changes. I think the technical term for this type of torture is “Death by a Million PowerPoint Bullets.” If your instructor is thorough in their efforts to torture you, then you will conclude this training with a quiz to demonstrate training “effectiveness.”

If you are lucky, you will start using some of that new-found knowledge immediately after the course. If you just had your 400^th birthday, as I did last week, then you might have a little trouble remembering all the details you “learned” in that training course in a matter of weeks. Now what can you do?

Look it up! Isn’t that what your teachers told you when you were growing up?

If you need to know what the proposed requirements are for Authorized Representative Agreements, you can use the search function in Adobe Reader to search for the word “agreement”. After just six clicks of the mouse you will find where this is mentioned in Article 10 of the draft. As you read Article 10, you will rejoice! Instead of the 17-page voluminous guidance document identified as MEDDEV 2.5/10 (released in January of 2012), we now have 144 words with just four simple minimum requirements. This is streamlined.

Over the next year or two I expect that most the regulatory experts will gradually work their way up the Learning Pyramid to the top of the third level. This is the point where we can now claim competency.

So how do you become an expert? In order to achieve the mighty title of “Guru” you must teach others. My blog from 2011 on learning explains how the action of teaching actually teaches the instructor as much as it teaches the student.

So what’s my point?

Don’t be normal:

1. skim the draft regulations now
2. take a course on the regulations in 2013
3. start revising procedures and technical documentation in 2014
4. start developing an in-house training course on the new regulations in 2015
5. finish training all the employees in 2016

Definitely don’t be lazy:

1. wait for the final approval of the regulations in 2014
2. take a webinar on the new regulations in 2015
3. get a nonconformity for noncompliance in 2016
4. hire a consultant to fix your procedures in 2017
5. start looking for a course on the regulations in 2018

Instead, be a leader and accelerate your training strategically:

1. read and re-read the draft regulations now
2. read blogs and discussion threads related to the draft regulations for the next couple of months
3. take a webinar on the draft regulations this November 28^th (mark your calendar)
4. draft a plan for revising procedures in 2013 and updating technical documentation in 2014
5. get management approval for a training course in 2013 and resources to update procedures as per your plan
6. take a course on the draft regulations in the first quarter of 2013; you should have quite a few questions now that you have a plan and resources
7. make adjustments to your plan and execute it on-schedule
8. create a training program for the company just prior to final approval in late 2013
9. make revisions to the procedures based upon feedback from trainees in your in-house course
10. develop a detailed team plan for updating the technical documentation
11. retraining everyone and review the updating plan
12. make updates to technical documentation 2014 as a team
13. be one of the first companies to get a certificate to the new regulations in 2015

As I was writing my response to a request for additional information today, I was listening to one of my Pandora stations and one of my newest favorite singers was singing “Worrisome Heart.” Her soothing voice echoed in my head all the way home. I drive through 75 miles of beautiful countryside like my picture below, and now the autumn foliage is at its peak.

Typical Scenery on My Daily Commute

When I sat down to write my blog tonight, I decided to hunt for one of her recordings on YouTube for my background entertainment. Instead I decided to pick a double shot. For the second shot, I have selected one of the more popular videos by Melody Gardot: “Baby I’m a Fool.” This was the first time I have seen her play the guitar, because I have only listened to her on Pandora. The song has more of a country/blues sound to it than most of her other music, but I encourage you to listen to more of her music. Follow my rule…”A double shot is never enough.”

New Draft EU Regulations may be speculation now, but the crowd knows a secret.

Right now the precise content of the new draft EU regulation is defined but unclear. We know what is going to change, but the final language of the draft is still a “work in progress.”

Therefore, I am using the theory that the “crowd mind” collectively may be more accurate than any one source–at least until the release. I started gathering information from several different regulatory experts throughout Europe and the US.

Essentially what we know is:

1. this will be a regulation instead of a directive

2. the regulation will have a similar structure of articles and annexes, but we can expect the document to grow

3. the device classification section will be a risk-based classification similar to the GHTF guidance (IVD’s are expected to be A, B, C, D)

4. the requirements for Notified Bodies will be stricter, but we expect rotation of lead auditors–not actual Notified Bodies

5. the unannounced audits will probably resemble factory inspections as performed by other GHTF countries

6. the vigilance requirements and post-market-surveillance are expected to become more consistent between Competent Authorities and between Notified Bodies–including the addition of PMCF Protocols and Reports becoming part of the Technical Documentation required for Design Dossiers (the CMC should help achieve this)

7. there will be new requirements for economic-operators (i.e. – importers and distributors)

8. the Authorized representative agreements will become mandatory for the Technical Documentation as well (see the new MEDDEV from earlier this year…I wrote a blog about it on my 13485cert.com website, but Erik Vollebregt wrote a much more thorough blog on this topic)

9. tougher regulation of reprocessed / re-manufactured devices

10. minimum requirements for CE Certificates–including the addition of the GMDN codes to the certificate

11. implementation is expected in 2015/2016

As I gather more information, I am thinking about just editing this posting–instead of posting a new blog.

Please email me or comment on what information you have learned or what you want to know.

If you know of a website with information posted, please share it and I will add it to this posting.

The New EU Regulations – 21 Days and Counting!

The EU Directive will become Regulations…but when? September 26 the proposed regulations are scheduled to be released in draft form. Plans for implementation of the Interim Measures have already begun, but the regulations will not be finalized for 18-24 months while the politics takes over. My magic 8-ball tells me that there is a precedent on this side of the pond that can help us predict the future.

A few weeks ago I published a posting with a cheeky Brit–Lily Allen. Here’s one of Lily’s own favorites by a another talented British singer, song writer named Kate Nash.

Throughout the history of healthcare regulations worldwide there have been three rules that are never broken:

1. Regulations always get tougher.
2. Regulations are only partially effective.
3. Regulations cost everyone more money.

The PIP scandal lit a fire under the European Parliament, the Council and Notified Bodies. Now all three stakeholders are fighting to show the public that they are doing everything they can to ensure safety. Unfortunately, no matter what changes are made it is extremely difficult to prevent unethical behaviors.

Before I make predictions, we all need to remember that there is a larger news story–the European Economy.

The status of the European Economy will have the greatest impact on new regulations. My best evidence is the US FDA.

The FDA has been trying to improve the turnaround on submission reviews for my entire career. For a period of about 8 years, matching closely with the Presidential terms of George W. Bush, it seemed to get easier to get products through the FDA logjam. Then the global economy tanked and political winds changed in 2009.

Over the past three years, Republican’s have gained power and Congress is now pushing the FDA to actually improve the metrics for product approval. The FDA will now have 200 additional reviewers, and every plan for improving turnaround that has been tried is back on the table.  The FDA was given the funds to grow its army of inspectors first, and now the FDA is granted additional funds to hire additional reviewers and train them.

The European Union includes countries that are struggling to provide basic services, while other countries don’t want to bail their European neighbors out of debt. How is the European Parliament and the Council going to increase regulation of medical devices when everyone knows that regulations will cost more money?

The short answer is…they can’t.

One of two things must happen before true change can occur:

1. another healthcare scandal could trigger this change, or
2. the economy could improve.

Based upon the sluggish recovery of the US economy, I don’t see how #2 will happen in Europe during the next 18-24 months. I can’t predict #1, but historically scandals are years apart.

MAGIC 8-BALL TIME

I predict that the draft regulations will get watered down during the co-decision period. The most popular legislative tool is the “transition period”. For example, UDI legislation was passed in 2007 in the US but the proposed rule was not published by the FDA until 2012. The proposed rule includes a 7-year transition period for implementation of the new rule.

If the new EU regulation is finalized in 18-24 months, we can expect a long transition period during which various pieces of the regulations will be implemented. This transition period is essential for Notified Bodies to gradually increase their staff and for training new auditors. This will also give companies several years to organize their own plans for addressing the new regulations.

The one change I predict to happen quickly is consolidation. 60+ Notified Bodies are more expensive for the EU to support than a few large Notified Bodies. The FDA is a single, centralized regulatory body. The EU will not achieve the same degree of centralization, but I predict “a great consolidation”.

My final prediction is related to the vigilance process. In the US the MDR process has become highly automated and electronic submissions with a public database are the norm. This has allowed the FDA to rely on data analysis to identify problems and redirected the burden of data entry from the FDA to industry. We can expect Europe to follow this trend, by centralizing all vigilance reporting. The only remaining question about vigilance is how long will the transition period need to be for revision 8 (of MEDDEV 2.12/1).