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​Are you ready to electrify your QMS system?
 
If you’re at a point where you’re finally ready to consider bringing in an electronic Quality Management System (eQMS) tool, or perhaps you’re looking to re-evaluate better options on the market, there’s naturally a litany of things to do and consider BEFORE you decide which tool to move forward with.
 
This article covers most of the steps and considerations you’ll need to think through as you evaluate different electronic Quality Management System (eQMS) for your medical device company.  I’ve had the good fortune to help dozens of clients select eQMS tools and scale them to operational status.  Here’s what I’ve seen from a decision-making perspective, and of course some learned lessons along the way.
 
WHAT IS AN EQMS:
The folks at Praxie did a superb job defining what an eQMS is, so we’ll borrow their definition: “An eQMS is a technology-driven solution designed to manage and monitor quality standards across an organization’s manufacturing processes. It replaces traditional paper-based systems, offering a centralized platform where all quality-related data and processes are stored and managed digitally. The primary role of an EQMS is to ensure consistent quality by automating and standardizing processes such as document control, audit management, and training management.
 
KNOW YOUR WHY:
As you look to bring in a QMS, including eQMS, one of the biggest considerations is to know your why – what’s driving the need.  What’s the reason you’re thinking of bringing in a tool in the first place?  Do you really need the tool or is it nice to have? 
 
PRO-TIP – if you’re a pre-clinical startup there’s a good chance you might not need an eQMS just yet.  The old-fashioned traditional paper-based approach, while simple and cost effective, can be a realistic option.  That said, the manual paper-based QMS isn’t a long-term solution as it can bring about complications with time-consuming processes, human error and traceability.    
 
Most startups typically think about bringing in a QMS once they reach the design phase of the product development lifecycle as at that point implementing design controls becomes critical. (image credit: Medical Device Quality Management System (QMS) - SimplerQMS)

From there, the next thing your WHY will help you understand is how robust a system you need.  Read section ‘System Functionalities’ for further insights.
 
REGULATORY REQUIREMENTS:
A good QMS ensures compliance with standards such as ISO 13485, FDA 21 CFR Part 820, and EU MDR, and helps maintain product quality and safety.  Is your company seeking to go outside the US (OUS) or remain domestic?  While you can certainly pick a QMS without knowing 100% what your regulatory strategy will be, it’s advisable to know that ahead of time as different tools offer different modules and layouts which may work more efficiently with a domestic strategy vs an OUS one.  The reality is you must still be compliant to FDA regulations if operating in the US due to site registration requirements.
 
Secondarily, I’m of the opinion if I’m looking for a tool to support medical device QMS related needs I’m only going to look for tools which are largely, if not exclusively, designed for this purpose.  Trying to appropriate a tool which was initially designed for another industry, even pharma, into your medtech space is more of a band aide than a real solution.  Buy the right tool for the right purpose.
 
ORGANIZATIONAL NEEDS:
Inevitably we may be splitting hairs here as some of this information will be similar in thought and approach to ‘Know Your Why’.  Picking the best QMS tool relies on you also knowing what you need out of it.  Things to consider are your company size (# employees and product lines), growth plans (scaling strategy and how a tool would need to grow in parallel with you), budget (what can you afford now, while taking into account setup costs, maintenance fees, licensing fees, etc.).  You’ll also want to think through the complexity of your technology as the more complex a product is the more advanced your QMS functionality needs to be in order to appropriately address areas like risk management and product/ process traceability.
 
SYSTEM FUNCTIONALITIES:
QMS tools, like any other software tool, offer a variety of different features and user experiences.  No two tools are the same, or so they say.  When we’re considering a software tools functionality, we first need to be able to answer our WHY (why we need the tool) and what we’re hoping to do with it.  This will then help you determine if the functionality of a tool you are evaluating is appropriate.  For example, a popular QMS tool in the medical device industry is Greenlight Guru.  It does it all, and has a modern user interface experience, but it isn’t cheap and could be overkill for a pre-clinical startup.  Think about it like this – if you’re buying a car just to get you to the office 15 miles away, strictly for commuting, do you really need a car that has every bell and whistle on it?  Think about QMS tools this same way.  If you only need the basics you might want to stay away from the flash and glitz that comes with the bigger tools.  To further complicate things, and to play both side of the fence, robust tools like Greenlight Guru offer starter packages that allow you to add on modules as your company scales.  Is a starter package the right route?  You’ll need to read on to decide.
 
Core functionalities to look for may include:

• Document Control: Automated version control, electronic signatures, and easy document retrieval.
• CAPA (Corrective and Preventive Action) Management: A robust CAPA system to identify, investigate, and prevent quality issues.
• Risk Management: Integration with ISO 14971 (Risk Management for Medical Devices) for proactive risk identification and mitigation.
• Audit Management: Tools to schedule, track, and document internal and external audits.
• Training Management: Managing and tracking employee training, which is crucial for regulatory compliance.
• Supplier Management: Evaluate supplier performance and ensure the quality of supplied components.
• Complaint Management: Streamlined processes to track, evaluate, and resolve customer complaints.
• Change Control: A well-structured process for managing changes to products, processes, or documents.
• Validation Capabilities: Ensure the QMS software itself is compliant and validated for FDA or ISO regulations.

 
Tool Ownership/ Storage:
Many, if not most, QMS software tools today are offered as an online cloud-based tool.  For smaller companies this may be advantageous as the tool supplier owns, manages and maintains the tool on your behalf.  This of course comes with a cost, but it’s minimal in comparison especially when considering the cost of buy, install and maintain a data center of any size.
 
If cloud storage and access isn’t right for your business most of the prominent tools offer an on-premise option which can offer more control over data. OEMs typically choose this option if data security is a high priority, and the company prefers to keep control in-house.
 
UX AND SUPPORT / TRAINING:
While not everyone is going to care about the user experience (UX) of the tool, I’ll candidly admit I fall in the camp of ‘caring’, and consider this to be a big deal for me.  I was recently evaluating several business operations tools, like an ERP, and outright declined one of the options that had all the functionality we needed, at a price that was good, yet the actual experience using it was stale and 20 years old. If I’m going to pay a healthy subscription fee for a tool, like a QMS, I want it to be modern and easy to use, intuitive, as if it was built by people in the industry.
 
When considering support and training for the tool, this may not be an issue with the larger tools like MasterControl or Arena, it may however be an issue with some of the smaller tools like QCBD. (right, you’ve probably never even heard of that one).  My comment here in reality has nothing to do with QCBD as its quite a good tool, however you need to consider the size of the company who makes the tool and how easy or difficult it will be to get support when you need it, not when they can get to you.
 
Take the added step to do some preliminary research on the tools you’re evaluating to see what user forums are saying, how are the tool developers rated, etc.  You can learn volumes of information in short order by doing this.
 
INTEGRATION:
Even if you don’t need it now, it’s advisable to pick a tool that can eventually integrate with other tools your company already has in use this way when the time comes you can increase efficiencies with your operation.  Ideally, your QMS should integrate seamlessly with your existing systems such as ERP (Enterprise Resource Planning), PLM (Product Lifecycle Management), CRM (Customer Relationship Management), and MES (Manufacturing Execution Systems).
 
According to Allan Murphy Bruun with Simpler QMS, “It typically takes 3 to 9 months to fully establish a medical device QMS. Still, medical device consultants suggest starting preparations at least 18-24 months before commercialization.”
 
CUSTOMIZATION:
This may fall into the same camp as the UX comments above, however I would caution you against selecting a tool that has little to no customization ability.  Every medical device company is different as their technology, people and processes all have their own flavor to contend with. Choosing a QMS tool that allows customization based on your company's specific workflows is key. The more adaptable the tool, the better it can cater to your unique processes without requiring excessive manual work. 

​PRO-TIP – while a tool may offer customization many times it can come with at a price.  Ask about this during the evaluation phase so you can manage your own expectations accordingly on the backend as the tool is being integrated into your operations.
 
Regulatory and Quality (RAQA) expert Robert Lahaderne further shares, “Being able to customize your eQMS is a big deal since your QMS must be aligned with the tools and therefore becomes your QMS.  Not being able to adjust things like titles or work flows leads back to the UX considerations within this article.”
 
TOOL DEMO:
Never, ever buy a software tool without first going through an in depth demonstration, to do so otherwise if foolhardy. Request a demo and ask for a pilot test period to evaluate the tool in your actual working environment. During this time, test the core functionalities that align with your company’s key regulatory and operational needs.
 
COST & ONGOING FEES:
A large portion of software tools, including medical device QMS tools, operate on the subscription model from a pricing standpoint.  Like it or love it, this pricing model will probably be around for a while.  When looking at the cost associated with a software tool purchase make sure you get the following information upfront of your decision:

• Upfront Cost: Licensing fees and implementation costs. (can licenses be shared?)
• Maintenance Fees: Ongoing costs related to support, upgrades, or additional features.
• Hidden Costs: Consider training, downtime during implementation, and future scalability costs. If you already have a QMS tool and you’re looking to replace it with a new one just know that you may have to run both tools, the new and the old, for several months in parallel while the new tool gets fully integrated and tested.  Running two tools simultaneously naturally adds cost into the grand scheme of things.

 
COMPLIANCE AND VALIATION
In the medical device industry one can’t just buy or use any tool without risks on to your operation on the backend.  If you’re going to consider a formal QMS tool, you’ll want to take it a step further and ensure the tool is compliant with electronic records and signatures requirements. (ie 21 CFR Part 11 Compliance)
 
When selecting a tool, you’ll also want to choose a QMS tool which can be easily validated and offers validation templates or support.  This way if you’re using a simplified tool you can get it up and running and do so with limited additional costs.
 
SECURITY
Since medical device companies deal with sensitive information, the QMS should include data encryption, access control, audit trails, and secure backups.  While not all devices and tools require it, you’ll want to talk with your prospective tool developer, and regulatory folks, about the potential need for Secure Product Development Framework (SPDF) and Quality System Regulations (QSR) as outlined by the Federal Drug Administration (FDA).  It’s always better to be in the know, then have to plead ignorance down the road should regulatory action come about.
 
WHICH TOOL SHOULD YOU PICK:
By now you’ve probably concluded there is a lot to keep in mind when bringing in a QMS tool to your operation.  There is a good chance many different tools can solve your problems while also meeting your business needs.  Below is a quick rundown of QMS tools we often come across in our clients’ operations (note – we are not advocating for one tool vs the other, please make sure you do your own research before you make the commitment):
 
Larger Company Tools:

• MasterControl
• Greenlight Guru
• Arena QMS
• ETQ Reliance
• Qualio

 
Small Company Tools:

• Quality Collaboration by Design (QCBD)
• Veeva Vault QMS
• Intellectt QMS
• QT9 QMS
• QAD eQMS

 
PAST LESSONS LEARNED
If you’ve been in business for any length of time you’ve inevitably made some mistakes along the way, hopefully you learned from them and got better as a result.  When it comes to eQMS, we’ve seen many mistakes made which have translated into lessons learned for future projects and advisory needs.  RAQA expert Robert Lahaderne further shares his PRO-TIPS and lessons learned when evaluating and integrating eQMS:

• Be prepared that success will be tied to resources that are dedicated to the project. Consider what experience the current/future team members have with these tools,
• Don’t be afraid to adopt different facets of the QMS into an eQMS system instead of doing it all at once,
• An eQMS does not eliminate paper from your company, it changes, but an eQMS is the first step in reducing papers,
• It is a big decision; it is hard to change after you have started down one path. As you grow, plan on assessing whether the eQMS can grow with you.

 
 
IN THE END
When selecting an eQMS tool for your medical device company, it is my opinion one must prioritize regulatory compliance, ease of use, scalability, integration capabilities, and robust vendor support as the primary decision factors when evaluating an eQMS.  Opt for a solution that can grow with your company while ensuring compliance with critical medical device regulations.  Remember, no tool is perfect, so if you get most of what you need at a price you can live with then the next step is making sure the tool is used as intended and maintained after implementation.  That’s another article and another read for next time.

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Medical device companies play a critical role in advancing healthcare as their ability to diagnose, monitor, and treat medical conditions allow patients like you and I the opportunity to recover and live longer.  Device companies carry a heavy burden on our behalf and that burden starts with product risk.
 
One of the biggest challenges an OEM medical device organization will be faced with is managing risk, especially during the early stages of product development.
 
The integration of risk management into design control (ISO 14971) is essential for identifying, assessing, and mitigating potential risks associated with the design and development of a medical device. Given risk management is a part of nearly every development process, and is a primary focus of all regulatory agencies like the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA), why is it then so many medical device companies struggle with sound risk management strategies?
 
The failure to address risks adequately can lead to a whole host of problems ranging from regulatory non-compliance, compromised patient safety, financial setbacks, and in severe situations criminal prosecution of executives.  Needless to say, understanding why medical device companies come up short with their risk management strategy and how you can avoid that for yourself is key to your future success. In this article, we will explore some of the key reasons behind risk management failure.
 
Most Common Risk Failure Factor - Inadequate Understanding of Regulatory Requirements:
One of the primary reasons for failure in risk management is an insufficient understanding of the complex and evolving regulatory landscape. Medical device companies must navigate a web of regulations, standards, and guidelines to ensure compliance. Failing to keep abreast of these requirements can result in flawed risk assessments, inadequate risk mitigation measures, and ultimately, regulatory sanctions.
 
Poor Integration of Risk Management into Product Development:
Successful risk management should be an integral part of the product development lifecycle. However, some companies make the mistake of treating it as a standalone process rather than integrating it seamlessly into every stage of development. When risk management is an afterthought, essential risks may be overlooked, leading to suboptimal product designs, increased failure rates, and compromised patient outcomes.
 
Lack of Cross-Functional Collaboration:
Effective risk management requires collaboration across various departments, including research and development, regulatory affairs, quality assurance, and manufacturing. Failure to establish clear communication channels and encourage cross-functional collaboration can result in siloed decision-making. This lack of coordination can lead to critical risks being underestimated or missed entirely.
 
Insufficient Resources and Expertise:
Some medical device companies fail in risk management due to resource constraints and a shortage of expertise. This can manifest in inadequate training for personnel responsible for risk management, insufficient allocation of time and budget, and a lack of access to external expertise. Without the necessary resources, companies may struggle to conduct comprehensive risk assessments and implement effective risk mitigation strategies.
 
Overemphasis on Short-Term Goals:
Pressure to meet short-term financial goals can sometimes lead companies to prioritize speed to market over thorough risk analysis. This can result in hasty decision-making and inadequate risk identification and mitigation. Companies need to strike a balance between meeting market demands and ensuring the safety and efficacy of their medical devices in the long run.
 
Failure to Learn from Industry Incidents:
The medical device industry has witnessed several high-profile incidents related to product failures and patient harm. Failure to learn from these incidents and implement lessons learned into future risk management strategies can perpetuate the same mistakes. Companies must actively analyze industry incidents, update risk management processes accordingly, and continuously improve their practices.
 
Ineffective Communication with Stakeholders:
Communication is crucial in risk management, both internally and externally. Companies that fail to communicate effectively with their stakeholders, including regulatory bodies, healthcare professionals, and patients, may face increased scrutiny and regulatory challenges. Transparency and open communication are essential for building trust and demonstrating commitment to patient safety.
 
In the highly regulated and dynamic field of medical devices, effective risk management is not just a regulatory requirement - it is a fundamental aspect of ensuring patient safety and the success of a company. Understanding the pitfalls that lead to failures in risk management can help medical device companies proactively address these challenges. By prioritizing compliance, integrating risk management into every stage of product development, fostering cross-functional collaboration, and learning from industry incidents, companies can enhance their risk management strategies and contribute to the advancement of healthcare with safe and reliable medical devices.