Post-market and Maintenance of Medical Devices

By Monica Magnardini, Medical Device Compliance Expert - Biomedical Engineer @PQE Group

This article provides a comprehensive analysis of the regulatory frameworks governing post-market surveillance activities in Europe and the US. It identifies critical differences, challenges, and best practices for manufacturers operating in these markets. It is also essential to maintain medical devices, and the article elucidates the challenges faced by healthcare facilities and manufacturers while offering strategic insights for maintaining medical technology. The article also investigates the critical aspects of maintaining Software as a Medical Device (SaMD), providing assertive insights and best practices for ensuring these innovative solutions continue to meet regulatory standards while delivering optimal patient care.  


The journey of a medical device, from its inception to its release in the market, is an amazing feat of innovation and regulatory compliance. However, the responsibility of manufacturers does not end once the device is released on the market. In the European Union (EU) and the United States (US), the post-market phase is heavily regulated to ensure that medical devices continue to perform safely and effectively throughout their lifecycle. Moreover, maintenance is an essential aspect of all types of medical devices, even after they have been released in the market. In particular, the maintenance of Software as a Medical Device (SaMD) presents unique challenges and opportunities compared to traditional medical devices.  

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 Post-Market Surveillance Process in the EU and US


In Europe, the regulatory landscape for medical devices has undergone significant changes with the introduction of the Medical Devices Regulation (MDR) 2017/745 and the In Vitro Diagnostic Medical Devices Regulation (IVDR) 2017/746. These regulations mandate a continuous cycle of data collection, evaluation, and action to manage risks associated with medical devices post-market.

Key Components of the EU MDR/IVDR are: 
  • Post-Market Surveillance (PMS): Manufacturers must establish a systematic process to proactively collect and review experience gained from devices on the market, aiming to identify potential safety issues promptly. 

  • Vigilance and Reporting: There are strict timelines for reporting serious incidents and corrective actions to national competent authorities, enhancing transparency and safety. 

  • Post-Market Surveillance Report: For some classes of devices (e.g. class I or class A and B), manufacturers must summarize the results and conclusions of the analysis of the post-market surveillance data collected per the post-market surveillance plan. 

  • Periodic Safety Update Reports (PSURs): For some classes of devices, manufacturers are required to periodically update the EU authorities on the safety and performance of their devices, including the cumulative impact of any changes made to the device. 

Instead, the Food and Drug Administration (FDA) regulates medical devices in the US through a combination of pre-market approval and post-market surveillance. This regulatory framework is designed to ensure the safety and effectiveness of medical devices. The post-market requirements are in place to monitor any adverse events and take necessary measures to protect public health.

Key Components of the FDA's Post-Market Surveillance are reported below: 
  • Medical Device Reporting (MDR): Manufacturers must report certain adverse events and device failures to the FDA, providing a mechanism for the agency to identify and monitor significant health risks. 

  • Post-Market Studies: In some cases, the FDA may require post-market studies (also known as Post-Approval Studies) to further assess a device's risk, benefits, and performance. 

  • Recalls and Safety Alerts: Manufacturers are responsible for initiating recalls for devices that might pose health risks, with the FDA overseeing the execution and effectiveness of recall strategies. 

Key differences between PMS in Europe and the US:  
  • Regulatory Processes: The EU's MDR and IVDR emphasize a lifecycle approach, requiring continuous monitoring and periodic reporting. The FDA focuses on adverse event reporting, with targeted post-market studies as needed. 

  • Reporting Mechanisms: The EU has a more structured schedule for periodic reporting across device classes, while the FDA’s requirements can vary significantly based on the device’s risk profile and any conditions of approval. 

  • Approach to Vigilance: Both regions require vigilance reporting, but the EU's regulations are generally seen as more prescriptive in terms of the processes and timelines for reporting incidents. 


Navigating Post-Market Activities: Strategies for Compliance 


  1. Implement Robust Surveillance Systems: Both regions require effective systems for collecting, analyzing, and acting on post-market data. Investing in robust data management and analysis tools is crucial. 

  2. Understand Regional Requirements: Manufacturers must be intimately familiar with the specific regulations and guidance documents pertinent to each market in which they operate, tailoring their compliance strategies accordingly. 

  3. Engage in Continuous Improvement: Use post-market data as an opportunity for continuous improvement, leveraging insights gained from real-world use to enhance device safety, performance, and user satisfaction. 

  4. Foster Open Communication: Maintain transparent and proactive communication with regulatory authorities, healthcare professionals, and patients, ensuring that safety information is disseminated effectively. 

Medical Device Maintenance and Strategies for Effective Maintenance  


The maintenance of medical devices encompasses a broad range of activities — from routine inspections and calibration to software updates and repairs. These activities ensure devices function correctly, provide accurate readings, and remain safe for patient use. Moreover, effective maintenance strategies can significantly extend the lifecycle of medical devices, offering substantial economic benefits and reducing environmental waste. 

Maintaining medical devices is fraught with challenges, including: 

  • Technological Complexity: Modern medical devices often feature sophisticated technology, making maintenance tasks more complex and requiring specialized knowledge. 

  • Regulatory Compliance: Devices must be maintained per stringent regulatory standards, which can vary across different jurisdictions. 

  • Resource Constraints: Healthcare facilities, especially those in low-resource settings, may lack the necessary infrastructure, financial resources, or trained personnel to carry out maintenance effectively. 

Following are the strategies suggested for effective maintenance of a medical device: 

  1. Implement a Comprehensive Maintenance Plan that should include:  

    -Routine Inspections - regular checks to identify wear and tear or any potential issues before they escalate; 

    -Preventive Maintenance - scheduled maintenance activities designed to keep devices in optimal working condition and extend their usable life; 

    -Calibration - regular adjustments to ensure devices provide accurate measurements and operate within their intended specifications. 

  2. Ensure Compliance with Regulatory Standards: Staying informed about and compliant with relevant regulations is crucial. This includes, for example, adhering to manufacturer guidelines for maintenance and repair, keeping abreast of changes in regulatory standards and incorporating these into maintenance protocols, and maintaining detailed records of maintenance activities, as these may be required for regulatory audits or inspections. 

  3. Scheduled Maintenance and Calibration: Routine maintenance and calibration are fundamental to the device's reliability and accuracy. Manufacturers should provide clear guidelines on the frequency and scope of these procedures. Hospitals and healthcare facilities, in turn, need to adhere strictly to these guidelines, ensuring that the devices are operating within their specified parameters. 

  4.  Software Updates and Security: In an era where medical devices are increasingly interconnected and software-dependent, ensuring the integrity and security of software is crucial. Manufacturers must regularly roll out software updates to enhance functionality, fix bugs, and patch security vulnerabilities. A robust mechanism for timely and secure updates is essential to protect patient data and ensure the seamless operation of medical devices. 

  5. Training and Education: Ongoing education and training for healthcare professionals and technicians on the correct use, maintenance, and troubleshooting of medical devices are critical. Manufacturers should facilitate continuous learning opportunities, including workshops, online courses, and updated manuals, to ensure the devices are used and maintained correctly, maximizing their potential benefits for patient care.


Software as Medical Device Maintenance


In the rapidly evolving landscape of healthcare technology, Software as a Medical Device (SaMD) has emerged as a pivotal category, driving advancements in diagnosis, treatment, and patient monitoring. Unlike hardware-based medical devices, SaMD requires a different approach to maintenance, one that addresses the fluid nature of software, its lifecycle, and the regulatory environment. 

The Key Challenges in SaMD Maintenance are described below: 

  • Regulatory Compliance: Navigating the evolving regulatory landscape, including adherence to standards such as ISO 13485 for medical devices, ISO 14971 for risk management, and specific regulations like the FDA’s guidance on SaMD or the EU’s Medical Devices Regulation (MDR). 

  • Cybersecurity Threats: Ensuring ongoing protection against cybersecurity risks, given the potentially catastrophic impact of security breaches on patient safety and privacy. 

  • Software Updates and Version Control: Managing updates in a way that enhances the software without disrupting its use in clinical settings 

  • Interoperability: Maintaining compatibility with various hardware, operating systems, and other software, including legacy systems in healthcare settings. 


Strategies for Effective SaMD Maintenance


  1. Implement Maintenance Practices 

  2. Prioritize Cybersecurity Throughout the Lifecycle 

    -Security by Design: Integrate security measures from the earliest stages of development, adhering to principles like minimum privilege and encryption. 

    -Regular Security Assessments: Conduct periodic security audits and vulnerability assessments to identify and mitigate potential threats. 

    -Incident Response Plan: Develop and regularly update an incident response plan to ensure preparedness for potential cybersecurity events. 

  3. Adopt a Robust Framework for Updates and Version Control: Ensure that software updates are delivered in a controlled manner, with clear version control and rollback capabilities to address any issues arising from new releases and engage with regulatory authorities as necessary when updates change the intended use or add significant new functionalities, as these may require reevaluation or notification. 



As we conclude our exploration of post-market surveillance and maintenance in the medical device industry, it becomes evident that these processes are not just regulatory obligations but integral components of a broader commitment to patient safety and device effectiveness. By harmonizing efforts across regulatory jurisdictions, manufacturers can navigate the complexities of compliance more efficiently while ensuring that medical devices continue to meet the highest standards of quality and performance worldwide. As we look to the future, let us continue to rank collaboration, innovation, and continuous improvement to safeguard patient health and advance the field of medical technology on a global scale. 



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