FDA’s Software Pre-Certification (Pre-Cert) Program is intended to create a new streamlined regulatory process for software as a medical device (SaMD) (see our earlier blog posts on the program here, here, here, here, and here). On September 14, 2020, FDA updated the Digital Health Software Precertification (Pre-Cert) Program website with a new summary document, Developing the Software Precertification Program: Summary of Learnings and Ongoing Activities (Summary) and updated Frequently Asked Questions. The Summary highlights FDA’s key learnings from the initial testing and the next steps planned for the program. In short, the Agency appears to be addressing important questions in their development and testing of the Pre-Cert program. However, three years into the process it is not clear when the program might be ready to move into its next phases of beta testing and eventual launch.
As a refresher, the Pre-Cert program has four key components following a Total Product Lifecycle (TPLC) approach:
- Demonstrate a culture of quality and organizational excellence through an Excellence Appraisal (pre-certification),
- Determine the SaMD’s required review through a Review Determination Pre-Submission (Pre-Sub) meeting,
- Conduct a Streamlined Review, and
- Verify a SaMD’s continued safety, effectiveness, and performance and the organization’s commitment to culture of quality through post-market Real-World Performance.
The Pre-Cert program was initially formed in 2017. The Agency conducted research in 2018 and in 2019 entered what it refers to as the “build and iterate phase” with publication of the Working Model 1.0 and 2019 Test Plan. FDA has said that upon completion of the build and iterate phase, the program will move to beta testing with scaled-up testing of the program and finally transition from Pilot to Program. No proposed dates have been given yet for these next phases.
During the last year, FDA has continued to work with the nine pre-cert pilot companies and has also worked with new companies that volunteered to participate in the 2019 Test Plan. While the test plan sought to include software developers that develop both low- and high-risk SaMDs as well as those that intend to develop a SaMD but are not considered a traditional medical device manufacturer in the test phase, it is not clear in the current Summary the type and number of companies that have been included beyond the nine pilot companies.
Mock Excellence Appraisals were conducted with an interactive approach and a draft framework for a library of activities, processes, and Key Performance Indicators (KPIs) used by high performing organization has been developed. FDA also tested and continues to test the Streamlined Review process. Comparisons are made between premarket submissions that have undergone traditional review with the outcomes of a Streamlined Review package. The Streamlined Review package includes extracted elements from the Excellence Appraisal, Review Determination Pre-Sub, and the traditional premarket submission. FDA’s summary notes that “FDA found that there was variability regarding the specific information needed from the masked software review elements to achieve a comparable outcome to current review practices,” concluding that further work is needed. Summary at 4. The Summary additionally notes challenges with defining SaMD products consistently and collection of ongoing Real-World Performance data.
Next steps for the Pre-Cert Program include refinements across the program to “drive repeatability of the processes, improve the quality and quantity of information, provide clarity to internal and external stakeholders, and reduce the time burden on both internal and external stakeholders.” Id. at 6. Per the Summary, the following are notable plans as the Pre-Cert programs continues to unfold:
- Explore improvements to Excellence Appraisals to reduce variability and develop consistency across different SaMD developers,
- Evaluate the usefulness and relevance of the software submission content in determination of SaMD market authorization and use that information to evaluate how information collected in Excellence Appraisals, Review Determinations, and Real-World Performance monitoring can be used for Streamlined Review,
- Explore the use of technology, such as automated remote access to digital data, for collection of Real-World performance data,
- Simulate scenarios to test interdependencies between the four components of the Pre-Cert program,
- Determine criteria for maintaining Excellence Appraisal status, and/or the need for re-appraisals, and
- Consider obtaining legislative authority to fully implement the Pre-Cert program as a new pathway for SaMD.
With this update, the Agency is acknowledging several challenges that this program presents. In moving Agency oversight from a periodic, product-focused review to a continuous review of both product and company, new burdens are introduced, and, for the program to be successful, it is imperative that the overall burden to industry is not increased over the current premarket review of design documentation and test results. The Agency’s planned approaches to further refine and test the program appear sound and, if successful, should result in a useful program. However, this update shows that there is still much work to do and that the promise of a streamlined regulatory process for SaMD that will allow developers to more quickly release new and modified products is not yet a reality.