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Navigating Grey Under EU Medical Device Regulation

  • 1.  Navigating Grey Under EU Medical Device Regulation

    Posted 14-Dec-2019 08:04

    As I read posts on RegEx regarding the new European Medical Device Regulation (MDR) I am reminded of the lessons from the implementation of the Medical Device Directive (MDD) in the 90's.

    In the early days of the MDD we got lots wrong and lacked enough guidance/clarification from the authorities. We learnt much as we worked through the transition and implementation of the MDD, clarity improved over years and refinement continued. Expectations from authorities evolved and sometimes changed. I think we are much better prepared to understand the MDR today and there are requirements that are quite clear, but there is also a lot still to interpret (significant grey areas – particularly calibrating how much is required). Where things need interpretation there are often many expert opinions, but not all expert opinions are aligned. All opinions need to be weighed and carefully considered against contrary opinions. There is sometimes more than one way to comply. Opinions are invaluable in helping to refine our thoughts and develop resilient solutions appropriate to our specific situations. We always need to look for and take account of guidance's and pay attention to the words from expert engagement organizations, Member States, competent authorities and notified bodies. With the MDR we hope for and expect much more consistency than we initially experienced under the MDD, but still we are all learning from implementing the MDR.

    We need to address the requirements and navigate the grey cautiously in a balanced, informed and measured way recording our supporting justifications/rationales. Grey is good, particularly during the transition period, it supports the development of practice that is pragmatic, can be defended and is compliant. As with the MDD over the years our understanding of MDR best compliance will improve, guidance and interpretations will evolve, expectations will be refined and we will all grow more confident of the compliance of our solutions.  

    Thank you for engaging and sharing on RegEx it is a wonderful example of members supporting as we as a regulatory affairs commuinity work through and navigate the grey.   



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    Paul Brooks
    Executive Director
    Washington DC
    United States
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  • 2.  RE: Navigating Grey Under EU Medical Device Regulation

    Posted 14-Dec-2019 11:04
    Edited by Gert Bos 14-Dec-2019 11:05
    Well said Paul, I could not agree more !!
    It is good to aim for clarity, for black and whites, for certainty for the time ahead when EU MDR and EU IVDR are completely upon us.
    But in times of transition we need grey; grey is good. It allows us individually to add some color as needed, or change grey tones. Adjusting in such a way that we are fully adhering to the intentions of the law, in a manner that allows a smooth transition in the interest of continued patient care, whilst initiating the continuous regulatory improvements.
    Also in terms of for article 120 (MDR) and article 110 (IVDR), let's not try and look for extreme clarity on what the minimum requirements are, but take them with the intent they were written: to allow for a smooth ride, using the old legislation for the major parts, and only on specific PMS and registration requirements follow the new legislation.
    If we are carefully using the grey that is embedded into the MDR and IVDR, patients and healthcare systems in EU, as well as supporting stakeholders, will all see the continuous care all strive for!
    With seasonal greetings, Gert Bos

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    Gert Bos FRAPS, PhD
    CTO, Executive Director & Partner at Qserve Group
    Baarn
    Netherlands
    Gert.bos@qservegroup.com
    ------------------------------



  • 3.  RE: Navigating Grey Under EU Medical Device Regulation

    Posted 14-Dec-2019 19:41
    Edited by Julie Omohundro 14-Dec-2019 19:47
    I posted some time ago that it was my sense that compliance and regulatory are now on a collision course.  I think you are mixing and matching the two, and that's probably how it is going to be for awhile.  I'm fascinated to watch this process play out, and look forward to seeing what kind of beast emerges out the other side.

    I would have to say that I both expected and hoped for LESS consistency in the MDR than in the MDD, but I would guess I'm in the decided minority here.  Perhaps a minority of one. :)

    As for the implementations of major regulations, in my experience, they never really get implemented.  Not the MDD, not the QSR, not FDASIA, and certainly not the MDR.  It's sort of like moving, where you start to unpack, put away, unpack, put away, but soon life takes over, and some boxes finally get shoved unopened into the attic, where they will sit until the next move.  Maybe you didn't need what was in them, or what you needed you replaced before you got around to opening that box, or you simply made do without them. 

    Everyone will finally settle on how things are going to be done, because everyone involved...EC, CAs, NBs, companies, healthcare providers, patients...need things to get done more than they need to comply with anything.


    ------------------------------
    Julie Omohundro, ex-RAC (US, GS), still an MBA
    Principal Consultant
    Class Three, LLC
    Mebane, North Carolina, USA
    919-544-3366 (T)
    434-964-1614 (C)
    julie@class3devices.com
    ------------------------------



  • 4.  RE: Navigating Grey Under EU Medical Device Regulation

    Posted 15-Dec-2019 02:05
    Very well stated Paul.  

    Personally, I remember navigating those grey waters with you:  I was in Singapore, and you were Head of the Notified Body.  We laugh now at what we remember, because we weren't always correct. But, we were always aligned, and that was important.

    I remind people that today's changing regulatory environment is not creating an unfamiliar one.  How many of us remember managing all of the following changes: 
     
    - ISO 13485:1996
    - FDA's Quality System Regulations, October 1996
    - FDA's QS Regulation, mandate for Design Controls, October 1997
    - EU MDD mandatory in 1998
    - Australia's TGA regulations, 2002
    - Japan's Pharmaceutical Affairs Law, 2002
    - ISO 13485:2003
    - CMDCAS in 2003
    - MHLW Ordinance 169, 2004
        ... what did I miss?  

    The point is "we struggled then" and we survived.  I'm going to do as I did back in those days.  I will communicate; I won't  be afraid to make a mistake; I will engage in healthy debate;  I will listen (even though you might believe I listed well); I will learn; I will work toward aligning with regulators and Notified Bodies, and I will share as much as I with all those willing to work.  If we can't find the answers ourselves, then let's find the answers together.

    John Beasley, RAC (US)
    MedTech Review, LLC
    M: +1 612-889-5168





  • 5.  RE: Navigating Grey Under EU Medical Device Regulation

    Posted 15-Dec-2019 19:53
    Mmmmm... @John Beasley  did you have to write that long list of past challenges (I won't say "Battles").  Remembering all of that I can certainly understand why all we old guys here are saying "Grey is Good" ;)​...

    ------------------------------
    Arthur Brandwood PhD FRAPS
    Director and Principal Consultant
    Brandwood CKC
    Sydney, Australia
    Arthur.brandwood@brandwoodckc.com
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  • 6.  RE: Navigating Grey Under EU Medical Device Regulation

    Posted 16-Dec-2019 07:35
    I remember all those too well John, but especially even ISO 9001 as the start, and the uproar over QSR and QS for Design Controls.

     I  switched from working in quality management in biologics and pharma in the early 90s with their own cGMPs, to quality management and regulatory affairs in devices in 1996.  The objection from device manufacturers to QSR was quite quaint then, since pharma had it much much earlier.

    But it is all complicated now, so let's all communicate clearly (if possible).




    ------------------------------
    Ginger Cantor, MBA, RAC
    Founder/Principal Consultant
    Centaur Consulting LLC
    River Falls, Wisconsin 54022 USA
    715-307-1850
    centaurconsultingllc@gmail.com
    ------------------------------



  • 7.  RE: Navigating Grey Under EU Medical Device Regulation

    Posted 16-Dec-2019 13:01
    I'm starting to think I might hold the record, having started in RA around the time of the Temple Report and the subsequent "purge at the top" at CDRH. 

    This strikes me as a bit odd.  This was a good 15 years after the 1976 Amendments were passed, so there were undoubtedly device RA professionals at work long before I arrived on the scene.  Plus RA was a mid-career change for me, so some of those who started long before I did are undoubtedly younger than I am, and therefore some should still be around, I would think.

    If I were to pick the most significant milestone in the regulation of medical devices, I would choose the 1976 Amendments first, and the Temple Report second.  It was a gift that just keeps on giving, including, IMO, the extensively expanded clinical evidence requirements that have emerged in the MDR.  Who knows, maybe Bob and I both might yet live to see the day....

    I must tip my hat to the MDR, though.  Until now, I would have said that, when it comes to grey areas, the rollout of expanded regulations or a new Rev or other modification has nothing on the sudden disappearance of virtually the entire upper echelon of your regulatory agency, along with untold numbers of other key staff.  That is less like navigating grey, more like fumbling in the dark.  But a total replacement of the device regulations in a well-established market?  The EU wins.

    ------------------------------
    Julie Omohundro, ex-RAC (US, GS), still an MBA
    Principal Consultant
    Class Three, LLC
    Mebane, North Carolina, USA
    919-544-3366 (T)
    434-964-1614 (C)
    julie@class3devices.com
    ------------------------------



  • 8.  RE: Navigating Grey Under EU Medical Device Regulation

    Posted 16-Dec-2019 15:44
    @John Beasley you didn't mention any of China's new regulations, just about weekly from 2014...​

    ------------------------------
    Arthur Brandwood PhD FRAPS
    Director and Principal Consultant
    Brandwood CKC
    Sydney, Australia
    Arthur.brandwood@brandwoodckc.com
    ------------------------------



  • 9.  RE: Navigating Grey Under EU Medical Device Regulation

    Posted 17-Dec-2019 07:05
    Good day Arthur. You are so correct. China regulations were in the mix then, as they are today.

    John Beasley, RAC (US)
    MedTech Review, LLC
    M: +1 612-889-5168




  • 10.  RE: Navigating Grey Under EU Medical Device Regulation

    Posted 15-Dec-2019 10:45
    Paul and Gert,

    Thank you for sharing your historical wisdom. I too remember the beginning of MDD implementation in the 90's. We all adjusted, as we will with MDR.


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    Penny Northcutt RAC, FRAPS
    President/CEO
    REGSolutions, LLC
    Santa Rosa Beach FL
    United States
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  • 11.  RE: Navigating Grey Under EU Medical Device Regulation

    Posted 15-Dec-2019 12:10
    Thank you for that beautiful image.

    And thanks to all the participants with the courage to share their struggles, the patience to share their wisdom and experience, and the tenacity to keep seeking ways forward that make sense.​

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    Anne LeBlanc
    Manager, Regulatory Affairs
    United States
    ------------------------------