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Post market surveillance plan

  • 1.  Post market surveillance plan

    This message was posted by a user wishing to remain anonymous
    Posted 30-May-2019 12:06
    This message was posted by a user wishing to remain anonymous

    ​Hello Everyone,

    We already have a PMS procedure in place and then based on that we create our Post market surveillance report. My confusion is what should we include in our PMS plan.
    I am writing a template but I feel its redundant of what's included in the procedure. Can someone guide me please?

    Thanks!


  • 2.  RE: Post market surveillance plan

    Posted 30-May-2019 14:39
    Based on a Emergo video I saw last year and my subsequent notes, a PMS plan could be device/product family specific, outlining the procedure to collect PMS data, analyse it, establish thresholds for reassessment of risk-benefit analysis and also include the PMCF plan within it. Source of relevant data will be all recalls/field actions, adverse events, non-adverse events, relevant databases like FDA MAUDE, TPLC, Eudamed in the near future and interestingly publicly available information on similar and equivalent devices. The outputs of the PMS plan will be the PMS report and PSURs.
    Keep in mind, this is per the new EU MDR. The PMS reports we currently have do not stem from an overarching PMS plan as described above. In this case, the SOP needs major revisions.

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    Vidya
    USA
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  • 3.  RE: Post market surveillance plan

    Posted 30-May-2019 16:34

    The MDD approach won't work for the MDR. You need to start again with a different approach.

    The EU-MDR has a variety of systems which are also part of the Quality Management System, QMS. Article 10(10) requires the manufacturer to create a PMS system, PMSS, in accordance with Article 83. Article 10(9)(i) requires that the PMSS be part of the QMS.

    You should write an SOP in the QMS that implements the requirements of Article 83. It could have templates for the PMS Plan, the PMS report (PMSR), and the PSUR.

    For each device, or family of devices, you will then write a PMS Plan using the template from the SOP. Note that the PMS Plan requires a PMCF Plan and a Trend Reporting Plan. (In my course I show the concept of plans inside plans as Russian matryoshka dolls.) Then, you will implement the PMS Plan and use the results to write your initial PMSR or PSUR, depending on the device class determined from Annex VIII.

    You will apply to an NB, probably following Annex IX. Part of the application includes (Annex IX(2.1), eight indent) "the documentation on the manufacturer's post-market surveillance system and, where applicable, on the PMCF plan".



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    Dan O'Leary CQA, CQE
    Swanzey NH
    United States
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  • 4.  RE: Post market surveillance plan

    Posted 31-May-2019 05:02
    Thank you so much for a quick response. 
    If our PMS plan requires pmcf. Can we just provide a checklist to identify if a pmcf study is required? Most of our devices may not require pmcf study, so wondering if we will still need to have a template in place for PMCF study? Or the checklist is sufficient to justify "no pmcf is required"?

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    Akanksha Asbe
    Regulatory Affairs Specialist II
    Clinton MA
    United States
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  • 5.  RE: Post market surveillance plan

    Posted 31-May-2019 06:00
      |   view attached
    Dear Akanksha,

    I have attached a white-paper from BSI. It is a very good guidance document explaining the difference between proactive and reactive PMS and is in line with the new EU MDR.

    As a summary of the previous comments, 3 levels of documentation are required:
    • Procedure
    • Plan (Device or product family specific)
    • Report

    Good luck!

    ------------------------------
    Malcolm Applewhite
    QA/RA Manager
    Cape Town
    South Africa
    ------------------------------

    Attachment(s)



  • 6.  RE: Post market surveillance plan

    Posted 31-May-2019 08:28

    The first question relates to the need for PMCF. The MDR does not provide information or guidance to help make the decision, so, at this point I look to MEDDEV 2.12-2 Rev. 2. Although this is MDD guidance, Section 5 Circumstances where a PMCF study is indicated has useful information. The MEDDEV seems to default to no PMCF unless there are specific circumstances. The MDR seems to default to a PMCF unless there is a rationale to not perform a PMCF.

    The MEDDEV says, "Following a proper premarket clinical evaluation, the decision to conduct PMCF studies must be based on the identification of possible residual risks and/or unclarity on long term clinical performance that may impact the benefit/risk ratio."

    It further says, "PMCF studies may not be required when the medium/long-term safety and clinical performance are already known from previous use of the device or where other appropriate post-market surveillance activities would provide sufficient data to address the risks."

    There is no technical reason to prevent using a checklist. However, I would be nervous. The intent of the EU-MDR is to improve medical devices in the EU, so areas such as PMCF are important. The NB will review your decision. Even though a checklist may help with the determination, when I see the word "rationale" I envision a well-reasoned cohesive argument to make the case. When you apply to the NB under Annex IX, you will provide the rationale. The NB reviewer will be in an office someplace, and you will not have an opportunity to discuss your reasoning with her before she decides. You need to convince her on the first try.

    Also, Art. 56(3) says, "Notified bodies may impose restrictions to the intended purpose of a device to certain groups of patients or require manufacturers to undertake specific PMCF studies pursuant to Part B of Annex XIV."



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    Dan O'Leary CQA, CQE
    Swanzey NH
    United States
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  • 7.  RE: Post market surveillance plan

    Posted 31-May-2019 09:27
    Hello,

    I would support what Vidya and Dan have remarked that a PMS Procedure tells you what to do, how to do it, how to complete actions - therefore the PMS Plan, PMS Report, PSUR report in relation to the procedure are templates.  The PMS Plan template is then completed per product family or device grouping.  Then results in a PMSR or PSUR depending on classification of your device.  I have also seen some comments made that regulators/NB are expecting to see a PMS Plan for each product family or device family - meaning that an SOP can not take the place of a plan.  Maybe if you have one device and it is simple you could combine but would still recommend having a separate PMS Plan.

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    Richard Vincins RAC
    Vice President Global Regulatory Affairs
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  • 8.  RE: Post market surveillance plan

    Posted 31-May-2019 09:36
    Dear Colleagues,

    I believe, that the interpretations of PMS and PMCF plans and reports are diverse currently.
    The experience gained in the pharma industry are not directly applicable to the medical devices.
    My interpretation of the PMS and PMCF plans/activities and reports is shown in the table. Difficult to know, what will be the final approach/interpretation of the NBs and Health Authorities of the EU.

    Regards

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    Peter Mikó M.D
    ArtPharm Ltd.
    Gyermely
    Hungary
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  • 9.  RE: Post market surveillance plan

    Posted 31-May-2019 09:46
    Sounds good. Thank you everyone for providing your feedback.

    It seems the best way to go is to have a PMS procedure in place and create templates for PMS plan, PMCF and PSUR.

    - In the PMS plan we will reference the PMCF template (checklist) as well as the trend Reporting Plan(not sure about this plan).
    - A PMS procedure and the device specific (annual) report - The procedure will have to be updated with references of PMCF template and PSUR template.
    - A PSUR template; and 
    - A CER procedure updated with references to the PMCF template.

    Am I missing anything?

    Thanks for your input!

    ------------------------------
    Akanksha Asbe
    Regulatory Affairs Specialist II
    Clinton MA
    United States
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  • 10.  RE: Post market surveillance plan

    Posted 31-May-2019 12:22

    This doesn't look right to me.

    My model is a Quality Management System, QMS, that includes other systems, such as the PMS system, the PMCF system, etc.

    In general, each system requires a plan, the plan's execution, an initial report, and report updates. In the EU-MDR there are plans inside plans, but I'm going to pull them for this description.

    For PMS you will have an SOP at the QMS level that implements the requirements in Article 83. It will also have a template for writing a PMS Plan that implements Article 84 and Annex III(1.1)

    You will also have template for writing a PMSR or PSUR that implements Article 85, Article 86, and Annex III(1.2).

    Then for each device (or family of devices) you will write a specific PMS Plan using the template, execute the plan, and write the initial report using that template.

    The pattern carries forward. Write a separate SOP with templates for each system, and then use the templates to write the plans and reports.

     

    The systems involved here are:
    Clinical Evaluation System with a Clinical Evaluation Plan and a Clinical Evaluation Report

    A Clinical Development System with a Clinical Development Plan (as part of the Clinical Evaluation Plan) and a Clinical Development Report

    A PMCF System with a PMCF Plan (as part of the PMS Plan)  and a PMCF Evaluation Report

    A Trend Analysis System with a Trend Analysis Plan (as part of the PMS Plan) and a Trend Analysis Report


    You mention "PMCF template (checklist)". I infer that by PMCF template you mean PMCF Plan template. Looking at the requirements for the PMCF Plan Annex XIV(6.1) I don't think a checklist would be satisfactory.



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    Dan O'Leary CQA, CQE
    Swanzey NH
    United States
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  • 11.  RE: Post market surveillance plan

    This message was posted by a user wishing to remain anonymous
    Posted 03-Jun-2019 08:58
    This message was posted by a user wishing to remain anonymous

    ​Thank you all for your input.

    @Dan - The PMCF checklist is kind of like a plan, based on MEDDEV 2.12.2 we have considered identification of possible emerging risks and evaluation of long term safety and performance that are critical. The checklist helps us cover risk considerations that may justify if a PMCF study is required.

    For example, If the severity of disease or application of the product have an impact on the performance of the product in a way that may present additional harm to the patient?  Yes, NO or N/A.

    Thank you!


  • 12.  RE: Post market surveillance plan

    This message was posted by a user wishing to remain anonymous
    Posted 17-Jun-2019 15:13
    This message was posted by a user wishing to remain anonymous

    ​Dan
    In your response you call out a Trending Report Plan.  Can you elaborate on what is required in this plan?


  • 13.  RE: Post market surveillance plan

    Posted 17-Jun-2019 17:25

    Under Art. 10(9) the QMS has lots of stuff in it. One is PMS which requires a PMS Plan. The PMS Plan includes, if applicable, the PMCF Plan. It also describes trend reporting. While it doesn't ask for a "plan" by name, it describes the elements of a plan.

    In my model the QMS elements follow a structure. There is an SOP, a plan template, and a report template.

    When there are plans inside plans, such as a trend reporting plan inside the PMS, I pull them out as separate elements of the QMS. In this case, the QMS would have a trend reporting SOP, a trend reporting plan template, and a trend reporting report.

    Each device (or family) uses the templates for the device specific application. Based on Art. 88 and Annex III the plan has the following elements. For the template I would create a section for each element and describe the information. For the device, delete the description and add provide the information specific to the device. For each element I've included the source in square brackets.

    Specify how to manage the incidents in Art. 88 first paragraph [Art. 88]

    Methods and protocols to manage the events subject to the trend report as provided for in Article 88 [Annex III(1.1)(b) fifth indent]

    Specify the methodology to determine any statistically significant increase in the frequency or severity the incidents in Art. 88 first paragraph [Art. 88]

    Methods and protocols to establish any statistically significant increase in the frequency or severity of incidents [Annex III(1.1)(b) fifth indent]

    The observation period [Art. 88] [Annex III(1.1)(b) fifth indent]

    In my opinion, a good approach at the device level is:
    Frequency of analysis – six months
    Observation period – the prior twelve months
    Method, in general – for each month in the observation period calculate the incident rate. The numerator is the number of Art 88 incidents. The denominator is the average number of shipments in the observation period. Plot the time series and calculate the equation of the regression line. Select a confidence level (usually 95%). If the slope of the regression line is positive and the 95% confidence interval does not include 0.0, then inform the competent authority. Otherwise, do not inform.

    The report, is the analysis described above with the decision to inform or not inform.

    Using Excel, the analysis is easy. (Look at the Analysis Tool Pack.) The report is the Excel workbook with the data, the graphs, the Analysis Tool Pack output, and the documented conclusion.



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    Dan O'Leary CQA, CQE
    Swanzey NH
    United States
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