Artificial Intelligence Driven insights for Regulatory Intelligence in Medical Devices: Evaluating EMA, FDA and CDSCO Frameworks
Main Article Content
Keywords
Regulatory framework, Patient Monitoring, Diagnostics, Neural Networks, Machine Learning
Abstract
The current review elaborates Artificial Intelligence (AI) in medical devices is changing the landscape of diagnostics allowing for more accurate and efficacious treatments leading to better patient care. An overview of AI technologies and their application in medical devices elaborates on AI technologies, such as neural networks and advanced data analytics being applied in diagnostic imaging and patient-monitoring preventative analytic models. Machine learning, a subset of AI, enables devices to learn from data and improve their performance over time, enhancing diagnostic accuracy and personalized treatment plans. An elaborated critical review is presented for the regulatory strategies implemented by relevant global leaders, such as the European Union (EU), the United States (US Food and Drug Administration, FDA), and India (Central Drugs Standard Control Organization of India, CDSCO). This is indicative of the EU regulatory approach as observed through reflection paper by the European Medicines Agency (EMA) on a methodology to assess AI technologies used in conjunction with medicinal products, and the Software as a Medical Device (SaMD) guideline by the FDA in the United States. The discussion is on adaptive regulatory strategies, an overview of some pre-certification programs, and detailed advice to manufacturers about compliance with the processes. Also, India aligning with the International Medical Device Regulators Forum (IMDRF) guidelines shows its appetite to help build an extensive regulatory framework for AI-powered medical devices. The current review concludes by highlighting the need for continued coordination between regulators, manufacturers, and healthcare players so that AI advances are safe and adherent to the regulations that improve overall patient care.
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References
2. Food and Drug Administration (FDA). Artificial intelligence and machine learning in software as a medical device. Available online: https://www.fda.gov/medical-devices/software-medical-device-samd/artificial-intelligence-and-machine-learning-software-medical-device.
3. Shick, A.A., Webber, C.M., Kiarashi, N., et al. Transparency of artificial intelligence/machine learning-enabled medical devices. NPJ Digit Med. 2024;7(1):21. https://doi.org/10.1038/s41746-023-00992-8.
4. Parenteral Drug Association (PDA). A comprehensive review of regulatory intelligence: Exploring tools and program maturities. Available online: https://www.pda.org/pda-letter-portal/home/full-article/a-comprehensive-review-of-regulatory-intelligence-exploring-tools-and-program-maturities.
5. Koli, P., Raut, S., Mande, R., et al. An overview of regulatory intelligence. Int J Creat Res Thoughts. 2023;11(4):b953–b964. http://ijcrt.org/viewfull.php?&p_id=IJCRT2304232.
6. Zhou, K. and Gattinger, G. The evolving regulatory paradigm of AI in Med Tech: A review of perspectives and where we are today. Ther Innov Regul Sci. 2024;58(3):456–464. https://doi.org/10.1007/s43441-024-00628-3.
7. Wenzel, M. and Wiegand, T. Toward global validation standards for health AI. IEEE Commun Stand Mag. 2020;4(3):64–69. https://doi.org/10.1109/MCOMSTD.001.2000006.
8. Rajkomar, A., Dean, J., Kohane, I. Machine learning in medicine. N Engl J Med. 2019;380(14):1347–1358. https://doi.org/10.1056/NEJMra1814259.
9. Wenzel, M.A. and Wiegand, T. Towards international standards for the evaluation of artificial intelligence for health. In 2019 ITU kaleidoscope: ICT for health: Networks, standards and innovation (ITU K), Atlanta, GA, USA, 04–06 December 2019; IEEE Xplore: Piscateville, New Jersey, USA.
10. European Parliament. EU AI Act: First regulation on artificial intelligence 2013. Available online: https://www.europarl.europa.eu/topics/en/article/20230601STO93804/eu-ai-act-first-regulation-on-artificial-intelligence.
11. European Medicines Agency (EMA). Artificial intelligence workplan to guide use of AI in medicines regulation. Available online: https://www.ema.europa.eu/en/news/artificial-intelligence-workplan-guide-use-ai-medicines-regulation.
12. Muehlematter, U.J., Daniore, P., Vokinger, K.N. Approval of artificial intelligence and machine learning-based medical devices in the USA and Europe (2015–20): A comparative analysis. Lancet Digit Health. 2021;3(3):e195–e203. https://doi.org/10.1016/S2589-7500(20)30292-2.
13. Sharma, K. and Manchikanti, P. AI-based medical devices and regulations: A cross-country perspective. In Artificial Intelligence in Drug Development. Springer Nature: Berlin, Germany; 2024; pp. 67–115. https://doi.org/10.1007/978-981-97-2954-8_3.
14. Importance of compliance with regulations in the pharmaceutical industry. Available online: https://doi.org/10.2139/SSRN.4679812.
15. EU reach political agreement on AI act – Key areas of impact for life sciences companies. Available online: https://www.sidley.com/en/insights/newsupdates/2023/12/eu-reach-political-agreement-on-ai-act.
16. European Medicines Agency. Medical devices. Available online: https://www.ema.europa.eu/en/human-regulatory-overview/medical-devices.
17. Lexology. EU EMA proposes risk-based approach to AI in pharma lifecycle. Available online: https://www.lexology.com/library/detail.aspx?g=2debbf90-5595-412d-b05d-744a5f116c27.
18. European Medicines Agency (EMA). Reflection paper on the use of artificial intelligence in the lifecycle of medicines. Available online: https://www.ema.europa.eu/en/news/reflection-paper-use-artificial-intelligence-lifecycle-medicines.
19. European Medicines Agency (EMA). Reflection paper on the use of artificial intelligence (AI) in the medicinal product lifecycle. Available online: https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-use-artificial-intelligence-ai-medicinal-product-lifecycle_en.pdf.
20. Benjamens, S., Dhunnoo, P., Meskó, B. The state of artificial intelligence-based FDA-approved medical devices and algorithms: An online database. NPJ Digit Med. 2020;3:118. https://doi.org/10.1038/s41746-020-00324-0.
21. Joshi, G., Jain, A., Araveeti, S.R., et al. FDA-approved artificial intelligence and machine learning (AI/ML)-enabled medical devices: An updated landscape. Electron. 2024;13(3):498. https://doi.org/10.3390/electronics13030498.
22. Food and Drug Administration (FDA). Proposed regulatory framework for modifications to artificial intelligence/machine learning (AI/ML)-based software as a medical device (SaMD). Available online: https://www.fda.gov/files/medical%20devices/published/US-FDA-Artificial-Intelligence-and-Machine-Learning-Discussion-Paper.pdf.
23. Food and Drug Administration (FDA). Marketing submission recommendations for a predetermined change control plan for artificial intelligence/machine learning (AI/ML)-enabled device software functions. Available online: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/marketing-submission-recommendations-predetermined-change-control-plan-artificial.
24. Food and Drug Administration (FDA). FDA releases artificial intelligence/machine learning action plan. Available online: https://www.fda.gov/news-events/press-announcements/fda-releases-artificial-intelligencemachine-learning-action-plan.
25. Food and Drug Administration (FDA). FDA action plan for AI/ML in SaMD (software as a medical device). Available online: https://starfishmedical.com/blog/fda-action-plan-for-ai-ml-in-samd-software-as-a-medical-device/.
26. Akin. FDA releases action plan for artificial intelligence/machine learning-enabled software as a medical device. Available online: https://www.akingump.com/en/insights/alerts/fda-releases-action-plan-for-artificial-intelligencemachine-learning-enabled-software-as-a-medical-device-providing-another-iterative-step-forward-on-the-long-road-ahead.
27. Zhu, S., Gilbert, M., Chetty, I., et al. The 2021 landscape of FDA-approved artificial intelligence/machine learning-enabled medical devices: An analysis of the characteristics and intended use. Int J Med Inform. 2022;165:104828. https://doi.org/10.1016/J.IJMEDINF.2022.104828.
28. Food and Drug Administration (FDA). Artificial intelligence and machine learning (AI/ML)-enabled medical devices. Available online: https://www.fda.gov/medical-devices/software-medical-device-samd/artificial-intelligence-and-machine-learning-aiml-enabled-medical-devices.
29. Ropes & Gray. Getting smarter: FDA publishes draft guidance on predetermined change control plans for artificial intelligence/machine learning (AI/ML) devices. Available online: https://www.ropesgray.com/en/insights/alerts/2023/05/getting-smarter-fda-publishes-draft-guidance-on-predetermined-change-control-plans-for-ai-ml-devices.
30. LeCun, Y., Bengio, Y., Hinton, G. Deep learning. Nature. 2015;521:436–444. https://doi.org/10.1038/NATURE14539.
31. Gerke, S., Babic, B., Evgeniou, T., et al. The need for a system view to regulate artificial intelligence/machine learning-based software as medical device. NPJ Digit Med. 2020;3(1):53. https://doi.org/10.1038/S41746-020-0262-2.
32. Bharadwaj, M.S. Regulatory insights in digital health. In Multi-sector analysis of the digital healthcare industry, Chatterjee, L., Gani, N., IGI Global Scientific Publishing: Hershey, PA; USA, 2024; pp.164–197.
33. DDReg Pharma. Regulatory guidelines for software and AI medical devices. Available online: https://resource.ddregpharma.com/blogs/regulatory-guidelines-for-software-and-artificial-intelligence-as-a-medical-device/.
34. Central Drugs Standard Control Organization (CDSCO) Directorate General of Health Services Ministry of Health and Family Welfare Government of India. Available online: https://cdsco.gov.in/opencms/resources/UploadCDSCOWeb/2018/UploadTenderFile/Corrigendum_to_CDSCO_EoI_SSP_01st_Dec.pdf.
35. Freyr Solutions. Regulation of software as medical device (SaMD) in India. Available online: https://www.freyrsolutions.com/blog/regulation-of-software-as-medical-device-samd-in-india.
36. International Medical Device Regulators Forum (IMDRF). Essential Principles of Safety and Performance of Medical Devices and IVD Medical Devices. Available online: https://www.imdrf.org/sites/default/files/2024-04/IMDRF%20GRRP%20WG%20N47%20%28Edition%202%29.pdf.
37. International Medical Device Regulators Forum (IMDRF). Medical device regulatory review report: Guidance regarding information to be included. Available online: https://www.imdrf.org/sites/default/files/2024-04/IMDRF%20GRRP%20WG%20N71%20%28Edition%202%29_0.pdf.
38. International Medical Device Regulators Forum (IMDRF). Principles of labeling for medical devices and IVD medical devices. Available online: https://www.imdrf.org/sites/default/files/2024-04/IMDRF%20GRRP%20WG%20N52%20%28Edition%202%29.pdf.
39. Rajpurkar, P., Chen, E., Banerjee, O., et al. AI in health and medicine. Nat Med. 2022;28:31–38. https://doi.org/10.1038/S41591-021-01614-0.
40. Comparative analysis of artificial intelligence on medical device regulations and legislation in US and EU. Available online: https://www.theseus.fi/bitstream/handle/10024/506136/Nawar_Bushra_2021_Comparative%20Analysis%20of%20Artificial%20Intelligence%20on%20Medical%20Device%20Regulations%20and%20Legislation%20in%20US%20and%20EU.pdf?sequence=2.
41. How the challenge of regulating AI in healthcare is escalating. Available online: https://www.ey.com/en_gl/insights/law/how-the-challenge-of-regulating-ai-in-healthcare-is-escalating.
42. Onitiu, D., Wachter, S., Mittelstadt, B. How AI challenges the medical device regulation: Patient safety, benefits, and intended uses. J Law Biosci. 2024;lsae007. https://doi.org/10.1093/jlb/lsae007.
43. Raji, I.D., Kumar, I.E., Horowitz, A., et al. The fallacy of AI functionality. ACM Int Conf Proc. 2022:959–972 (Published online June 21). https://doi.org/10.1145/3531146.3533158.
44. Matheny, M.E., Whicher, D., Thadaney Israni, S. Artificial intelligence in health care: A report from the National Academy of Medicine. JAMA. 2020;323(6):509–510. https://doi.org/10.1001/jama.2019.21579.
45. Khan, B., Fatima, H., Qureshi, A., et al. Drawbacks of artificial intelligence and their potential solutions in the healthcare sector. Biomed Mat Devices. 2023;1:731–738. https://doi.org/10.1007/S44174-023-00063-2.
46. Henry, E. and Thiel, S. Using existing regulatory frameworks to apply effective design controls to AI/ML in medical devices. Biomed Instrum Technol. 2022;56(4):114–118. https://doi.org/10.2345/0899-8205-56.4.114.
47. Palaniappan, K., Lin, E.Y.T, Vogel, S. Global regulatory frameworks for the use of artificial intelligence (AI) in the healthcare services sector. Healthcare. 2024;12(5):562. https://doi.org/10.3390/HEALTHCARE12050562.
48. Center for Devices and Radiological Health. (2022, September 26). Digital Health Software Precertification (Pre-CERT) pilot program. U.S. Food And Drug Administration. Available online: https://www.fda.gov/medical-devices/digital-health-center-excellence/digital-health-software-precertification-pre-cert-pilot-program.
49. Gerke, S., Minssen, T., Cohen, G. Ethical and legal challenges of artificial intelligence-driven healthcare. Artificial Intelligence in Healthcare (1st edition); Bohr, A. and Memarzadeh, K. (eds.);2020:295–336. https://doi.org/10.1016/B978-0-12-818438-7.00012-5.