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BSi have issued a document about their best practise when it comes to MDR. Considering that they are the first and only approved MDR notified body this is of coarse very interesting reading. Download your copy here

Did you know that from April 1st you must provide your invoices to public hospitals, communities and states electronically! This is an European requirement.
what is an E-invoice then? It is not a pdf copy of your normal paper invoice! It must meet the requirements in PEPPOL BIS Billing 3. Read more about the standard here

If you do public business better ask your system provider if they meet the requirements, if not you must act now!

The new requirements are valid for new tenders or direct buy and hence not valid for tender that was won before the date.

You can read more about the new law here. This link is in Swedish.

Keeping up with new regulations or guidance can be troublesome or at least take valuable time from your day to day business. New documents releated to MDR are gathered at this page. Other sources are of coarse linkedin, each authorities web pages, but uou never know for sure if something has been posted or not

The first suggested changes to IVDR/MDR are now out for comments. I could not find any bigger changes, but important to review if it effects you! Plan is to get this through Brussels before the EU elections. The suggestion are 125 pages! But dont be scared, it contains all languages! For all Swedes the last 5 pages are for us!

Here you find the MDR propsal
Here tou find the IVDR proposal

To be an EU Authorised representative in the new MDR add many new requirements to be meet. In future posts I will go through these.

In addition to what the role is in MDD the representation means a large undertaking of responsibility. In most corporations this are inhouse task that typical someone at the Quality or Regulatory department have. Going forward this most likely will land at the designated persons desk! What will this mean from a personal risk perspective? Right now no one really knowes! Hopefully the law firm speaking about this at the Regulatory Summit

will shed some light, at least for the people in Sweden. The personal risk will probably differs between countries due to the national view and traditions. Clearly something to make some reasearch about before signing up for the role.

FTC, FDA and DOJ, is this how it will work with
the new MDR?

Most people working with medical devices that are sold in USA
knows what FDA do and their role in promotion and labelling activities.
Not all people understand Federal Trade Commissions (FTC)
role and escaping or handling FDA does not always mean that you are safe! FTC
are perhaps more known for approving deals from a competition perspective, but
that’s also why they look at advertisement and promotion.

FTCs basic requirements are quite straight forward and can be
found on this link. However even
though it should be simple to follow many companies get into trouble.

FDA warning letter
Department of Justice, DOJ typical gets involved when FTC or
FDA have found issues, A FDA warningletter itself does not mean that you
directly get into trouble but often leads to that DOJ looks into the case. If
DOJ determine that they can claim money back from companies or hospitals they
will act.

A typical case:

In case of warning letters due to promotion or advertisement (often
off label claims = not within intended or indication for use) DOJ often can
find wrongly assigned reimbursement codes. If they find this they will claim
that money back. And trust me, if you think FDA can be difficult to handle in a
non-compliance situation, that’s a walk in the park vs DOJ! In the
future I will show several cases in the blog.
One example on this!

The connection to MDR?
In the past promotion and advertisement in Europe have been a national
regulation if regulated at all for B2B type of transactions. With MDR this change
completely, now it will be the law in all EU countries. The rules can be found
in article 7 copied below:

In the labelling, instructions for use, making available,
putting into service and advertising of devices, it shall be prohibited to use
text, names, trademarks, pictures and figurative or other signs that may
mislead the user or the patient with regard to the device’s intended purpose,
safety and performance by:

(a) ascribing functions and properties to the device which
the device does not have;

(b) creating a false impression regarding treatment or
diagnosis, functions or properties which the device does not have;

(c) failing to inform the user or the patient of a likely
risk associated with the use of the device in line with its intended purpose;

(d) suggesting uses for the device other than those stated
to form part of the intended purpose for which the conformity assessment was
carried out.

Who will this apply to?
The rules could apply to most economic operators. The manufacturer, importers
or distributors are probably the ones that most likely could get into trouble
if they do not have this under control. However currently the reimbursement system
does not have the direct relation to intended use why the monetary penalties
most likely will be tied to harm instead. Enforcement will most likely be on
national level due to language used.

Enf of February 42 Notified Bodies had applied for MDR, 25 joint assessments have been done and another 4 is scheduled. These figures looks clearly much better than just a month ago and I know that a few other are in the progress of applying.

However more important, when are they approved that companies can start plan for a life after May 25, 2020. Very few of the Notified Bodies communicates where they are in the process and I understand them. No one want to promise to much!

Also folllow Medtech Europe for their updates here,

We often get questions on what requirements there are in certain countries. Not that easy to answer since this clearly depends on what product you have! What we know for sure there are changes ongoing all the time. To much regulations will have negativ effect on the average health index in the world, and small vountries might not even get any manufacturers entering the market. WHO publish reports about regulations on an overall level. The latest we know about are from 2016. The below picture can be found there, explaing what out of 3 main factors exist in the country.

Interesting to read statistics sometimes. According to the statistics it is not always better to spend most money. US clearly sticks out. Would be interesting to know factors behind this, both for ”how to avoid” but also things we work with, approval process, reimbursment systems and private vs public systems. This specific data is from ourworldindata that are several universities in the world working togheter.

That FDA plan to change the QSR to follow ISO 13485 has been know for a while. The plan is to introduce this in the fall 2019. In a presentation made in December 2018 FDA points out that it will be a transition period partly because they need to trainbthe personnel but also that they need to revise the QSIT inspection handbook