I (as a medical device consultant, US TAG member of IEC SC 62A & 62D & Convener of SC62D JWG9 {IEC/ISO/AAMI/CENELEC 80601-2-58} and a past Notified Body Auditor) am really pleased to see the extremely hard work that has gone into this document and also in the value that it will pass on to all the stakeholders.  There are many stakeholders that were involved in this process including Notified Bodies, NB-MED EN 62304:2006 issues team (Thank you for your hard work.), NB-MED, COCIR (European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry), Manufacturers, OEMs, Standards Developers for EN & IEC & other national standards bodies, Test Houses, Consultants, other countries regulatory bodies (i.e. FDA, Health Canada, etc.) and more.  By use of so many different stakeholders that submitted some of these and other questions this document has a much more consistent view on the implementation issues with the complexity of the topic of medical device software.  

This document is good for learning about your specific implementation issue(s) or if you have the time I would highly recommend reading the whole document, as this will help you understand the intricacies of some of the situations of implementing EN 62304 with respect to the Medical Devices Directives (I’m sure there are more issues but a good portion have been captured by this first version).  I believe this document would be of great help to implement similar guidance documents for many other national medical device regulatory agencies around the world for IEC 62304:2006 (or their national version of the standard).

The Table of Contents gives a good glimpse into the realm of the issues covered in this document and covers the following topics.  I also provide a further glimpse into the document by summarizing some of the specific issues within those sections (these are the indents furthest to the right):

• Introduction (background of the purpose, rationale, the main team members, and how to provide more feedback on the document)
• Abbreviations (Section 1)
• Questions and Answers (Section 2 – Heading of sections 2.1 – 2.7)
• Scope of EN 62304 (Section 2.1)
• Goes into various different scenarios and discusses the implication and implementation issues around these scenarios: such as SAAS, Embedded software including FPGA’s (a hotly contested issue) with single chip computers, Hardware Description Languages specifying FPGAs, Stand alone software, Medical apps, Excel macros, Open & closed systems, Internet or cloud based, Server based systems, Network devices.  In addition to this list of scenarios this section also goes into questions about certification; is Validation included in this standard & if not where does it get covered; what are the expectation of the Notified Bodies with regard to the standard; can you use only part of the standard; why do class A software to EN 62304; what is IEC 82304 about (software only products); among other questions.
• Placing Software as Medical Device on the Market (Section 2.2)
• Explain ‘placing medical device (in this case software or software {s/w} as part of a system) on the market’ in EU if EN 62304 is sufficient, by itself to do this; can I change my intended use and avoid these EU guidelines and regulations; Conformity Assessment routes of the MDD; other countries acceptance / requirement of the standard; can you sign-off on documents electronically; classification of software as a MEDICAL DEVICE; how do Notified Bodies (NB’s) confirm compliance to the standard; among other questions.
• Life-cycle Processes (Section 2.3)
• If s/w development is an outsourced activity what does NB expect; does this std have an equivalent expectation to requirements such as those addressed in FDA Part 11 (Electronic Records & Signatures) in the US; details on the review process at the end of each iteration when updated versions are available during the design and development of the software; does the std require a specific development process; how split up the requirements/responsibilities of the std between the manufacturer and s/w sub-contractor; how do the maintenance activities in the std relate to ISO 20000/ITIL; what are the artifacts (documents) required by EN 62304; at what level does the Problem Resolution Process apply; does software refactoring require a formal change request; what to include in the Technical File to show compliance with EN 62304; how can agile processes be EN 62304 compliant; among other questions.
• Risk Assessment and Risk Management (Section 2.4)
• How deal with risk control measures; when & why can the safety class of a s/w SYSTEM be reduced; how use ISO 14971 with EN 62304; explain Hazard, Cause, Sequence of Events in the context of software; when should we expect additional Software Hazard Analysis guidance within EN 62304; among other questions.
• Classification and Segregation (Section 2.5)
• What is segregation and how do I prove effective; use of a specific class(es) of s/w using COTS (commercial off-the-shelf) what criteria used; how does severity under intended use relate to s/w safety class; is s/w class optional; can you downgrade the classification of the system without a fully hardware protective system; does the compiler need to be classified under EN 62304; how are development platforms & tools related to s/w safety class; relation between Risk Analysis at System level & S/W Safety Classes; explain how the 3 safety classification in the std differ from the FDA’s 3 levels; correlate IEC 61508 SIL levels to EN 62304 safety classifications; s/w classification is a real issue with big implications; among other questions.
• Specifications, testing and tools (Section 2.6)
• I’m a manufacturer of medical devices – how do I document my requirements and tests; web-based medical s/w – does the std have specific requirements related to digital cert’s, (http or https) server requirements; in regard to the std how deal with risk analysis and functional specs; appropriate level of granularity of requirements as design input, design description; which (if any) of the tracing requirements are meant to be bi-directional; questions around deployment of the s/w; what is required of open source code from the std; among other questions.
• SOUP (Software of Unknown Provenance) and Legacy Software (Section 2.7)
• How assess & qualify suppliers of SOUP s/w, when the s/w hasn’t been developed for incorporating into a medical device; what testing & documentation does EN 62304 require for SOUP to meet the std; s/w that is either stand-alone or embedded which was designed prior to publication of EN 62304 but still being placed on the market (legacy product) – what needs to be done; if legacy s/w needs significant change, what processes & documents are required to achieve &/or maintain compliance with EN 62304 and when are changes considered significant;
• References (No Section Number – just after Section 2.7)
• Software Problem Resolution Process (Annex 1)
• Helpful diagram – There are several entry points to the problem resolution process, both during development and maintenance of the software (refer to question 2.3.12).
• SOUP selection, assessment & qualification (Annex 2)
• Flowchart & text to explain an example
• Traceability (Annex 3)
• The 3 flowcharts show an overview of the dependencies which need to be traced according to EN 62304 for all 3 classes – refer to note in bottom left corner of page to know which class the flowcharts apply to (refer to question 2.6.7).
• Position paper on direct diagnosis (COCIR, 2011) (Annex 4)
• As the different stakeholders may interpret this term differently, COCIR and EUROM VI wanted to share their understanding of the term “direct diagnosis”. (Refer to question 2.5.13)

Click on the weblink to see the initial request for questions that we posted on our website 26 May 2012.  To see the posting please go to http://www.eisnersafety.com/do-you-know-how-to-use-en62304-med-dvc-sw-life-cycle-as-implemented-under-themdd-aimdd-doc/

A request for practical questions and issues has just been launched and the invitation letter for FAQ on EN62304 (a short 2 page document) and publication of the FAQ is expected by end of September 2012.  The request document is asking for your questions and any proposed answers (if you have those too) to be submitted by the end of May 2012 so you better hop on the bandwagon and get those off to the e-mail address of FAQ62304@VDE.com.  I think some of these dates may slip a little but that is not confirmed yet.  If I get confirmation of any changes in dates I will advise as soon as I can.

This may sound familiar as this is a similar process to the FAQ document that was issued in Jan/Feb of this year for the EN 60601-1, 3rd ed. Implementation FAQ document.

I (as a medical device consultant, US TAG member of IEC SC 62A & 62D & Convener of SC62D JWG9 {IEC/ISO/AAMI/CENELEC 80601-2-58} and a Notified Body Auditor) am really pleased to see the extremely hard work that has gone into this document and also in the value that it will pass on to all the stakeholders.  There are many stakeholders that were involved in this process including Notified Bodies, NB-MED EN 60601-1:2006 issues team (Thank you for your hard work.), NB-MED, Manufacturers, OEMs, Power Supply Manufacturers, Standards Developers for EN & IEC & other national standards bodies, Test Houses, Consultants, other countries regulatory bodies (i.e. FDA, Health Canada, etc.) and more.  By use of so many different stakeholders that submitted some of these and other questions this document has a much more consistent view on the implementation issues with the complexity of a series of more than 60+ EN 60601 standards.  It is expected that this document will get revised again but when that will happen is not clear at this time.  I would assume once Amendment 1 (A1) to EN / IEC 60601-1:2006 / 2005 is released approximately end of 2012 / Sept 2012 there will be more implementation questions in addition to the ones in section 3.9 (Q & A 3.9.1 thru 3.9.5 related to A1) of this excellent resource.

This document is good for learning about your specific implementation issue(s) or if you have the time I would highly recommend reading the whole document, as this will help you understand the intricacies of some of the situations of implementing EN 60601-1 with respect to the MDD (I’m sure there are more issues but a good portion have been captured by this first version).  I believe this document would be of great help to implement similar guidance documents for many other national medical device regulatory agencies around the world that are transitioning to the 3rd edition of IEC 60601-1:2005 (or their national version of the standard).

The Table of Contents gives a good glimpse into the realm of the issues covered in this document and covers the following topics.  I also provide a further glimpse into the document by summarizing some of the specific issues within those sections (these are the indents furthest to the right):

• History (background of how we got to this point and document)
• Introduction (Section 1 – document intended to clarify many questions as related to implementation of EN 60601-1:2006 within the EU under the MDD)
• Abbreviations (Section 2)
• Questions and Answers (Section 3 – Primary purpose of the document)
• Process how to place products on the EU market (Section 3.1)
• Explain ‘placing med dvc on the market’ in EU; If med dvc doesn’t change, regulation hasn’t changed, why need provide different evidence with new Harmonized Std; are harmonized stds mandatory; do you have to retest to 3rd ed, when product been on the market for years;  why bother with transition date 1 June 2012 when my EC certificate has a 2014 expiration date; does the product in a distribution center equal ‘placed on the market’; Medical Electrical Equipment(MEE)  met 2nd ed. & breaks down after transition period what std applies now for replacement MEE; why does EU require 3rd ed. compliance with new & legacy products;

• Transition process in general (Section 3.2)
• Is use of newest Harmonized stds even if product hasn’t changed after transition date; Would it have been better to have all the stds in the 60601 series have the same transition period; Is there the bandwidth for all the testing that will be required by the EN 60601-1:2006 deadline of 1 June 2012 (for only 3rd ed. without particular stds) that it may hit a critical point;
• Application of EN 60601-1 (Section 3.3)
• Does EN 60601-1:2006 apply to AIMD products; Are mechanical rqrts of 3rd ed. applicable to non-active products; power supply questions – external pwr supply compliant to 2nd ed., pwr supply approved against EN 60950 (ITE equipment), pwr supply part of a complete 2nd ed. compliant medical electrical equipment, my pwr supply mfr isn’t ready for 3rd ed. yet – my options; What do if applying to several countries and the other country(ies) requires 2nd ed. vs 3rd ed. in EU; EN 62304 in relation to 3rd ed. of EN 60601-1; software development issues; if for some reason major redesign needed to meet 3rd ed. are there smart ways to deal with this; how obtain test protocol TRF version G of 3rd ed.; is there a 3rd ed. delta list available for evaluation of an approved 2nd ed. product
• Role of collateral standards (Section 3.4)
• Are Harmonized Standards binding; what happens to collateral stds (i.e. EN 60601-1-XX) that have been integrated into 3rd ed. of 60601-1; how deal with collateral stds that don’t have an edition aligned with 2nd ed. of EN 60601-1 (i.e. EN 60601-1-11 & -1-12)
• Role of particular standards (multiple or late particulars) (Section 3.5)
•  multiple stds related to x-ray; if x-ray equipment has interventional & non-interventional procedures do both EN 60601-2-43 & -2-54 apply; some particular stds that don’t references 3rd ed. of 60601-1 what happens then; is compliance with 3rd ed. required after 1 June 2012 even if part 2 std won’t be released til after transition period; how deal with EN 13544-1:2007 + A1:2009 which is aligned with 2nd ed. of EN 60601-1 and currently there is no development of a 2nd ed. of EN 13544-1; van every kind of IEC or ISO std act as a particular std
• Transition period of EN 60601-1:2006 (Section 3.6)
• Should there be a 3 year transition period for brand new particular standards Harmonized per the Directive {i.e. EN 60601-2-XX}; particular stds with a transition period ending after 1 June 2012; transition date known for EN 60601-2-49; transition issues with EN 60601-2-43; how deal with EN 60601-2-2 & -2-10 which have different transition dates
• Duties of Notified Bodies (Section 3.7)
• ZLG paper 3.5 A1; How an N.B. audit of technical file or design dossier of product that hasn’t started the process, or plan set-up but not start testing, or partially start testing
• Application of Risk Management (Section 3.8)
•  What are the different roles of the applicable stakeholders in this process including the mfr., Notified Body, test house, etc.; equivalent safety (clause 4.5 of 60601-1 3rd ed.); how to deal with the differences between EN 14971:2001 (equivalent to ISO 14971:2000) and EN 14971:2007; mapping rev. G of TRF  for IEC 60601-1:2005 with Risk Management documentation that is required per EN 60601-1:2006
• Amendment 1 related questions (Section 3.9)
• Amendment 1 of 3rd edition of IEC & EN 60601-1 will be published approximately Sept 2012 & around end of 2012.  This is a major amendment with more than 100 changes some very minor and some that will mean more work for the manufacturers to prove compliance and some changes that will benefit the manufacturer.  It is recommended to review the A1 as soon as you can get your hands on it to see what type of impact it will have on you.
• References (Section 4)
• Recommendation for usage (Section 5)
• Applicability of horizontal and role of particular standards (multiple or late particulars) for use in combination with IEC/EN 60601-1, 3rd.ed with respect to X-ray equipment (Annex 1)
• General – applicability of standards (Annex 1, section 1)
• Categorization of X-ray equipment related to its intended use and applicable standards (status 2012-01-20) (Annex 1, Section 2)
• Summary (Annex 1, Section 3)

On October 1, 2011 the DRAFT “FAQ related to Implementation of EN 60601-1:2006 Clarification of open issues” was issued and this DRAFT document is being sent to NB-MED for commenting on the document.  NB-MED is also known as TEAM NB.  This organization is the European Association of Notified Bodies for Medical Devices which covers the MDD (93/42/EEC), AIMDD (90/385/EEC), and IVDD (98/79/EC).  This group publishes guidances that are agreed on by the Medical Device Directives (93/42/EEC, 90/385/EEC, and 98/79/EC) Notified Bodies. Once all the responses are agreed to it is anticipated that the document will be released as an NB-MED guidance document.

The History of this DRAFT document is restated below.  Note that any “click here” links are not live in the below text but are live in the actual DRAFT document.

History

During spring 2011, it was realized that the use of EN 60601-1 and its many family members in demonstrating compliance with the relevant and applicable requirements of the European medical device regulatory framework was not too trivial. While relevant guidance on the matter had been published at the CENELEC website as a Q&A document (click here), some Notified Bodies were giving advice that was felt to be not in line with that guidance. On other occasions, questions were raised that were not covered in the guidance.

So, it was concluded that the situation for electrical equipment in medical practice was not totally clear and that additional guidance would be useful. Further contact with the chair of the NB-MED confirmed this desirability, and a small group of experts was established. This group developed an enquiry asking for “practical issues in the implementation”, that was sent to many stakeholders in June 2011(see Annex 1). Also at the international level of IEC the request was distributed (62A/769/INF).

The response to the request was beyond expectation and the small team of experts, initially consisting of three, was expanded with Dr. Klaus Neuder of DKE (Frankfurt, Germany).

End of July 2011, the work on digesting the issues submitted until then started and it took until end of September 2011 until all material had been thoroughly discussed and answers formulated to the questions that were raised. In some cases, the questions were slightly amended to make them a little more general, and a few additional “connecting” questions were developed by the team.

It is believed that the answers, developed in close team cooperation, present a fair response to the issues brought forward and that they can be used as a reference for all stakeholders.

Now it is time for the NB-MED to scrutinize the proposed responses and see if they are also acceptable to all members of NB-MED. The NB-MED comments are kindly awaited by the end of October 2011, at the same e-mail address that was used for the initial submission of the issues: 60601Ed3.NBMED.issues@gmail.com, using the form supplied together with this document.

Happy reading!

The 60601-1 Issues Team:

Dr. Wolfgang Leetz, Dr. Peter Linders Dr. Klaus Neuder Mr. Martin Schneeberg