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Medical Device CE Marking: Writing a Classification Rationale

%name Medical Device CE Marking: Writing a Classification RationaleThe author reviews considerations in “how to” write a classification rationale for medical device CE marking (i.e., questions for applying classification rules).

 CE Marking of medical devices requires technical documentation (i.e., – a Technical File or Design Dossier). One of the requirements of this technical documentation is to establish the risk class of a device in accordance with the classification rules in Annex IX. The requirement to include this classification rationale in the Technical File is not well defined in Article 9, Classification, of the Medical Device Directive (http://bit.ly/M5MDD), but the guidance document for Technical Documentation (http://bit.ly/NBMED251Rec5) clearly defines this requirement in Section 3.2 (viii). Establishing a classification rationale is the first step to establishing the regulatory pathway that will be required to CE Mark your medical device.

What are the Classifications?

There are four different classifications of medical devices in Europe: Class I, Class IIa, Class IIb and Class III. These four classifications are also referred to as “risk class.” The lowest risk classification is Class I, and the highest risk classification is Class III. Class IIa is considered a “medium risk,” while Class IIb is considered a “high risk” medical device. Notified Body involvement and a CE Certificate from the Notified Body is required for almost all medical devices distributed in Europe, however, Class I devices that are non-sterile and do not perform a measurement function do not require Notified Body involvement. Class I devices that are sterile are often referred to as “Class I-S,”but this is not a term used in the Directive. The same is true of “Class I-M” for Class I devices with a measurement function.

Applying the Rules for Medical Device CE Marking

In order to apply the classification rules as defined in Annex IX of the MDD, the following questions must be answered for the device or device family:

  1. Is the device invasive? –  Invasiveness of a device is an important criterion, because non-invasive devices are generally Class I, and there is typically no Notified Body involvement required for these devices.
  2. Is the device surgically invasive, or invasive with respect to body orifices?  If a device is surgically invasive with respect to a body orifice, Rule 5 is the most likely classification rule. For all other devices that are surgically invasive, the duration of use is important
  3. How long is the device used inside the body? The primary difference between Rules 6, 7 and 8 is the duration of use. In general, permanent implants are subject to Rule 8, and are Class IIb devices. The other surgically invasive devices are generally Class IIa devices. Devices under Rule 6 are for “transient” use (i.e., – intended for continuous use for less than 60 minutes). Devices under Rule 7 are for “short-term” use (i.e., – intended for continuous use for between 60 minutes and 30 days.). There are multiple exceptions to each rule, and these exceptions should all be considered.
  4. Is the device electrically powered (i.e., – an active device)? Active devices are subject to rules 9, 10, 11 and 12.
  5. Do any of the “Special Rules” apply? It is recommended to actually start with Rules 13-18 to ensure that one of the special rules do not apply. For example, if you are making blood bags, there is no need to read anything in Annex IX except Rule 18.
Guidance Document for Classification

Annex IX defines the classification rules for Europe, but there is also a guidance document (http://bit.ly/EUClassification) published that helps to explain the classification rules with examples. This guidance document is extremely important, because it provides clarification of rules based upon interpretations that have been made by Competent Authorities with Notified Bodies and companies. For example, critical anatomical locations are defined in Section 3.1.3: “For the purposes of the Directive 93/42/EEC, ‘central circulatory systemmeans the following vessels:…”.

When you write a classification rationale for your technical documentation, it is important to reference this document—as well as Annex IX of the MDD. Your rationale should address each of the questions above for applying the classification rules. In addition, your rationale should indicate that none of the “Special Rules” (Rules 13-18) are applicable to your device or device family.

Mixed Classifications

It is possible to have a device family, contained within one Technical File or Design Dossier, that has more than one Classification. For example, you could choose to group a family of vascular grafts together in one Technical File that are permanent implants and non-absorbable. Normally, these devices would be Class IIb in accordance with Rule 8. However, if one or more of the grafts is intended for vessels included in the central circulatory system, then these grafts would be Class III devices. If a graft can be used for either indication, then the higher classification should be applied.

Proposed EU Regulations

On September 26, 2012, the European Commission released a draft proposal for a new medical device regulation. The expected implementation transition period for these proposed regulations is 2015-2017. In Annex II of the proposed regulations (http://bit.ly/EUProposal), it specifies that the risk class and applicable classification rationale shall be documented in the technical documentation. This appears as item 1.1e) under the heading of “Device description and specification.”

The MDD defines the classification rules for medical devices in Annex IX, while in the proposed EU regulations classification, rules are now in Annex VII. The MDD also has 18 rules, while the proposed regulations have 21 rules. In order to download a Gap Analysis of the Classification Rules for CE Marking, please visit the following page on this website: http://bit.ly/gapanalysiscmda.

If you need assistance with medical device CE Marking, or you are interested in training on CE Marking, please contact Medical Device Academy at: rob@13485cert.com. Medical Device Academy is developing a webinar series specifically for this purpose. You can also call Rob Packard by phone @ 802.258.1881. For other blogs on the topic of “CE Marking,”please view the following blog category page: http://robertpackard.wpengine.com/category/ce-marking/

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EU Medical Device Directive: 6 New Essential Requirements

%name EU Medical Device Directive: 6 New Essential RequirementsEssential Requirements (ER) changes in the proposed EU Medical Device Regulations versus the ER in Annex I of the EU Medical Device Directive are reviewed.

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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. Still, 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 risks associated with the size and properties of particles, especially nanomaterials. The changes related to 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 August 8, 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 effects 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 is now ER 15, but there is nothing new. Section ER 12.7 and its sub-parts are now addressed by ER 16. ER 12.8 and its subparts 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 subparts 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 subparts “a” through “n” to “a” through “q.” The UDI requirement is subpart “h.” ER 13.6 is now ER 19.3 specific to the Instructions For Use (IFU). This section is expanded from subparts “a” through “q” to “a” through “t.”

The number of subparts to ER 19.3 doesn’t reflect the additional requirements for IFUs that are proposed by the Commission. The subsections 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 reusable 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 no additional requirements for products intended for use by a layperson. 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. Still, 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  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 the approval of products where the European ERC was submitted in place of an EPC for Australia and Canada. I guess they are a little more rational than some other regulators, but if you have experienced any “push back” regarding this approach, please share this by posting a comment or by sending an email.

If you need assistance with medical device CE Marking, or you are interested in training on CE Marking, please contact Medical Device Academy at rob@13485cert.com. Medical Device Academy is developing a webinar series specifically for this purpose. You can also call me by phone @ +1.802.258.1881. For other blogs on the topic of “CE Marking,” please view the following blog category page: http://robertpackard.wpengine.com/category/ce-marking/.

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EU Medical Device Proposed Regulations: The “Scrunity Process”

This blog discusses the “scrutiny process” of the proposed EU medical device regulations, whereby authorities can take a 2nd look at audit findings…

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).

The U.S. 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 the 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 August 8, 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 regularly. 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 the market for innovative devices is also identified in the “Risk(s) identified” (Section 2.2.1). Therefore, the need for a control mechanism is recognized 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.

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What is an NB-MED?

The author defines what an NB-MED is, Team NB and their role, provide a regulatory update and some information sources.

Each time I review a list of external standards, I notice at least a few references that are out-of-date. Occasionally, I am surprised, and everything appears to be current, but it is almost impossible to stay current with all the external standards. The most demanding standards to maintain are those that are untracked. Untracked standards are difficult to keep current with because it requires manually checking each source to determine if a standard has been updated. One of these sources is Team NB.

Team NB

Team NB describes itself as the “European Association of Notified Bodies for Medical Devices.” Team NB is an organization comprised of Notified Bodies (NBs). These NBs create guidance documents to clarify the interpretation of regulations in the EU. Since NBs are generating the documents, rather than Competent Authorities (CAs), it is possible for Team NB to reach a consensus more quickly than CAs. Since these documents are guidance documents, the NB-MED documents are not enforceable or binding. However, in all likelihood, your NB will interpret ISO 13485 and the MDD (93/42/EEC as modified by 2007/47/EC) in accordance with these guidance documents.

The website link I provide in my “Helpful Links” page includes many links to important guidance documents. Among the recently updated NB-MED documents is NB-MED 2.5.2/rec 2. The “rec” is not the same as a revision. For example, rec two is “Reporting of design changes and changes of the quality system,” while rec 1 is “Subcontracting – QS related.” The link I have provided will land you directly on the list of NB-MED documents, and the right-hand column identifies the date the document was added to the list. Therefore, if you want to know about new and revised NB-MED documents, you merely need to read the documents that are identified as being added since your last visit.

NB-MED 2.4.2/rec 2

At this time, NB-MED 2.5.2/rec 2 is the only recent addition—and you should read it. Many companies struggle with design changes, and they don’t know if the change is significant or not. Revision 8 of this document includes helpful examples. I recommend reading this document carefully and then revising your own change notification procedure to match the document. If you don’t have a change notification procedure, your QMS auditor has been lazy. Don’t let them give you the excuse of “It’s just a sampling.” This document has been published for a long time, and the intent has not changed since 2008—just new examples to clarify the interpretations.

There is a posting from 1/14/11. This is an excellent list of all the NB-MED documents. I recommend printing this document and using it to compare against your current external standards list. There is a very recent posting from 2/7/12 that answers frequently asked questions about the implementation of EN 60601. If you don’t know what this is, you probably don’t have an active device.

On 3/27/12, there was a letter from Team NB indicating that they condemn Poly Implant Prothèse (PIP) for committing fraud (well duh). Who would endorse them?

Finally, on April 17, 2012, meeting minutes were posted from an April 5 meeting of Team NB. The NBs indicated that the medical device authorization system is excellent! This is not a surprise since any other response would be self-criticism and potentially career-limiting. The minutes also indicate that the Team wants as many of the members to endorse the “Code of Conduct” (CoC) that was recently drafted by the “Big 5” NBs. So far, the acceptance of this Code is limited, but the Competent Authorities have other plans.

Competent Authorities (CAs) are currently evaluating the NBs with regard to competency for handling Class III devices. In addition, there is a plan to revise the regulations in Europe (2014 is the guess). These changes will be major. The Team NB website could be a source of information about rapid changes in the next 12 months, but for now, it’s the quiet before the storm. The Great Consolidation of European Regulators is about to begin (or maybe all the NBs will endorse the CoC, and the CAs will forget about it).

 

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What is a MEDDEV?

The author defines what a MEDDEV is, recent updates, and information resources to learn more.

The most important part of my website is “Helpful Links.” These are the links that I use most in Regulatory Affairs. It started as an auditor’s toolbox, but now I am morphing it into a place to review updates to regulatory requirements and external standards. The MEDDEV’s are on the top of my list. These are the guidance documents written by Competent Authorities. Still, most of the Notified Bodies treat them as requirements and often write nonconformities against at least one of them: MEDDEV 2.12/1 – Medical Device Vigilance System.

Many companies rely on RSS feeds to keep them current on the latest external standards, but this doesn’t work for a MEDDEV. For MEDDEV’s, your best bet is to go to the source. Sure, you can hire a consultant that will try and keep you current. You can also wait until your NB auditor lets you know the hard way (i.e.,. – time to write another administrative CAPA).

For those of you who don’t know the source, it is my #1 “Helpful Link”:

http://ec.europa.eu/health/medical-devices/documents/guidelines/index_en.htm 

When asked how to keep current, my advice is to have a systematic process for checking various sources of external documents. At a minimum, you should be checking all of the possible sources just before each Management Review. This will give you something to include for the requirement in clause 5.6.2h) of the ISO 13485:2003 Standard. “More preferably,” as lawyers would say, check out the website link above at least once per month. For those of you that are completely out of touch, and those that just fell off the University hayride, the following explains why you can’t get away with saying:

“There haven’t been any new or revised regulatory requirements since the last Management Review.”

MEDDEV Updates

There were several updates to the MEDDEVs released as supporting documents for the M5 version of the MDD (93/42/EEC as modified by 2007/47/EC). Specifically, there were four in December 2009 and one in June 2010. Then there were two more MEDDEVs released in December 2010 related to clinical study requirements in Europe. In January 2012, another six MEDDEVs were released, and one more was released in March. Not all of these updates apply to every company, but every RA professional working on CE Marked products has been busy readying themselves to sleep at night.

I could spend some time here telling you a couple of sentences about each of these new MEDDEVs, but someone already did that for me:

http://www.eisnersafety.com/eu-medical-device-meddevs-guidance-docs-newly-rlsed-or-updated/#.T8Oml7Dy-So

One fellow blogger indicated that the MEDDEV 2.5/10, about Authorized Representatives (ARs), was disruptive:

http://medicaldeviceslegal.com/2012/02/09/new-meddev-on-authorised-representatives-everything-you-know-is-wrong/

I don’t agree with Erik Vollebregt about it being disruptive. Erik feels that we can all expect substantial revisions in the AR contracts, but I think the Germany AR’s I have worked with were already moving in this direction. Emergo has been a strong AR all along—with a distinctly more friendly Dutch style to their processes. In the end, I just don’t see Notified Bodies (NBs), making these contracts a priority initiative. I think we’ll see more auditors verifying that contracts are in place and current, but I don’t expect auditors to receive guidance on how to review contracts anytime soon.

The real changes will be in the smaller AR’s that are not European Association of Authorized Representatives (EAAR) members. The Competent Authorities (CAs) have been knocking on the door of various “wannabee” AR’s for a few years now. I think they have done an excellent job of shutting down illegitimate representatives, and the member companies of EAAR (http://www.eaarmed.org/) have done well in raising awareness. The next logical step was to provide some guidance so that there is more consistency among the ARs. I see this as just the beginning of the CA’s moving toward one approach.

Erik wrote another article about MEDDEV 2.12/2 on the subject of Post-Market Clinical Follow-up (PMCF):

http://medicaldeviceslegal.com/2012/01/17/new-eu-guidance-on-post-market-clinical-follow-up-studies-published-and-other-meddev-guidance-announced/

Erik just touched on this MEDDEV briefly, but if your company is a manufacturer of a Class III device that is CE Marked—YOU NEED TO READ THIS MEDDEV!

MEDDEV Whitepaper

As in all things post-market related, BSI has taken the lead by publishing an article that is almost as long as the original MEDDEV. This white paper was written by Dr. Hamish Forster, BSI’s Orthopedic & Dental Product Expert, and the document is called “The Post-Market Priority.” I think you can only obtain a copy of this white paper by requesting it from BSI online, but the customer service person that follows up is quite polite.

BSI’s leadership role in PMCF is not new, either. Gert Bos gave a presentation that highlighted the importance of PMCF back on March 31, 2010:

http://www.bsigroup.nl/upload/Presentatie%2031%20maart%20-%20Gert%20Bos.pdf

My advice for anyone that has a Class III device that is CE Marked is to read this MEDDEV a few times, Annex X 1.1c of the MDD, read the whitepaper, and review these presentations by Gert Bos. This will help you prepare for what is coming. For those of you that think you know something about PMCF and have justified why your company doesn’t need to do it, think again. You should review the 16 bullet points in the MEDDEV on pages 14 and 15 (17 bullets in the whitepaper, but one was just split into two parts). Identify how many of these points apply to your Class III device. The more points that apply to your product, the more extensive the NB’s will expect your PMCF plans to be.

 

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