The presentation discusses the FDA's Electronic Submissions Gateway (ESG) and electronic submissions. It provides an overview of the ESG and what types of submissions it accepts from each FDA center. It emphasizes that requirements vary by center and preparing for electronic submissions takes time. The presentation encourages attendees to contact the speaker for assistance in navigating FDA's electronic submission processes.
ICD-10: A Payer Update with Aetna & United Health Group
Electronic Submissions Speech
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[slide 1]
Thank you Scott for your kind introduction. You and I have worked side by
side, as partners, over the past eleven years. Together, we have seen the
continued growth of China’s medical device manufacturing sector and strive to
keep industry well informed on regulatory requirements. We have seen new
regulations established by SFDA. Moreover, we have seen the US FDA increase
inspection and enforcement activities throughout China. We have participated
in the US-China joint meetings as advisors and I am so very glad to be able to
participate once again with you as a presenter to Medtec China 2011.
[slide 2]
In my presentation today, I provide to you an introduction of the US FDA’s
Electronic Submission Gateway, or ESG. This includes an overview of all
electronic submissions that FDA accepts from all industries they regulate. Most
importantly, I will focus on the initiatives of the Agency’s Center for Devices
and Radiological Health, or CDRH by introducing to you the electronic
submissions of Medical Device Reports, or eMDR. The proposed regulation was
introduced in 2006 and will soon become final regulation (the expectations are
the final regulations will be issued by the end of 2011). Finally, I have a 10-
minute video clip of the June 2011 FDA webinar on the use of the eSubmitter
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and WebTrader software which discussing some of the details you, as a medical
device manufacturer, must know in order to comply with the new regulations.
[slide 3]
Since beginning my career in the medical device sector, I have often seen many
regulations misunderstood. The misunderstandings remind me of a lady I once
knew who was visiting Shanghai for the first time. During her tour of this great
city, she becomes very hungry. With an empty belly and with high confidence,
she enters a local restaurant seeking some delicious meal to eat. She notices
the Chinese characters on the restaurant menu while eating her lunch. While
staring at these Chinese characters on the menu, she thinks to herself how
beautiful and interesting these characters are … she is really quite fascinated;
so, she copies them down as best she can and when she goes home she prints
them out and makes a t-shirt with the characters on it. Later that day, she
bumps into a Chinese person. The person looks at her and says, "Do you know
what your shirt says?" The lady admits that she doesn't know … this is the shirt
the lady has made for herself
[slide 4]
(Pause) and lady asks the Chinese person to translate her shirt. The man says,
"Your shirt says 'cheap but good'."
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[slide 5]
Misunderstandings and information are the key topics in today’s presentation.
The business between you (in this audience) and the Food and Drug
Administration (FDA) is extremely information intensive. There exists, at times,
too much information that easily leads to misunderstandings. What we read,
and put together (like a jig-saw puzzle) can lead to troublesome situations such
as the lady in the story.
In recognition of the fact that FDA is extremely information intensive, and of
the potential benefits offered by technology for information management, the
FDA has undertaken a number of projects supporting the electronic submission
of text and data from the industries it regulates.
[slide 6]
Electronic submissions, or eSubmissions, began in September 1997 with
Computer Assisted New Drug Applications (CANDA). From 1999 through 2001,
FDA’s various Centers began the publication of guidance documents such as
“Providing Regulatory eSubmissions for NDAs, BLA, ANDAs”. And, in the years
2006 and 2007 the medical device center, FDA’s CDRH, developed e-copy
initiatives and the turbo 510(k)s for In Vitro Diagnostic device submissions.
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The most recent activities of the Agency include the eMDR (Adverse Event
Reporting) and the mandatory use of FURLS (Electronic Registration and Listing
System) and DRLM (Device Registration and Listing Module). Despite the move
toward eSubmissions, the various Centers within FDA are debating on the
platform for providing electronic data to the Agency.
[slide 7]
The use of STDM, or statistical time division multiplexing, versus HL7, the
global authority on standards for interoperability of health information
technology, is under debate and has considerably slowed full implementation
of electronic submissions at FDA. None-the-less, electronic submissions are
expected in the coming months and China’s healthcare product manufacturers
need to stay aware of the requirements; else they will find more confusion,
delays in getting their products to America and trouble with FDA when
eventually the Investigators come for inspections.
Regardless of the debates, one of the main projects FDA has implemented is
the establishment of an Agency-wide solution for accepting electronic
regulatory submissions, referred to as the FDA Electronic Submissions Gateway
(FDA ESG)1.
1
Federal Register: August 8, 2006 (Volume 71, Number 152).
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[slide 8]
The Gateway (ESG) enables the submission of regulatory information for
review. The overall purpose of the Gateway (ESG) is to provide a centralized,
agency-wide communications point for securely receiving electronic regulatory
submissions. The Gateway (ESG) enables the FDA to process regulatory
information through automated mechanisms while also enabling:
• A single point of entry for receiving and processing all electronic
submissions in a highly secure environment,
• Automating current processes such as the electronic acknowledgment of
submissions, and
• Supporting the electronic Common Technical Document (eCTD) –
something familiar to those of you in the pharmaceutical sector.
The number of electronic submissions over the years is the best measurement
of the FDA’s success with the Gateway. The number of submissions has grown
exponentially as shown in this chart.
[slide 9]
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Each FDA Center has decided what may be submitted to them electronically.
Currently, Adverse Events represent 72% (almost three-quarters) of the total
electronic submissions to FDA, while premarket submissions for Devices
represents 12%, premarket applications for Drugs represents 9.5%, and
premarket applications for Biologics represent less than 1%. The methods of
electronic submissions vary by Center and guidelines for the proper electronic
submissions are published by each Center within the FDA. There is very little
harmonization.
[slide 10]
So what does FDA accept as electronic submissions? The answer varies by
Centers and this slide tells you the current electronic submissions accepted by
FDA by the various Centers.
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Consider, for example, the reporting of Adverse Events that are accepted by
CBER (the Center for Biologics), CDER (the Center for Drugs) and CDRH (the
Center for Devices). All use the Agency’s Electronic Submissions Gateway, but
setting up your company to submit to the different Centers are all done
according to the different guidelines published by those Centers. For example,
the FDA provides to drug and therapeutic biological product manufacturers,
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distributors, packers, and other interested parties the instructions on how to
electronically submit postmarketing individual case safety reports (ICSRs),
either with and without relevant attachments. Now, compare this with the
Center for Devices and Radiologic Health (CDRH) who have introduced the
electronic Medical Device Reporting (eMDR) project that provides the capability
for electronic data entry and processing of medical device adverse event
reports using two methods (server to server or via the World Wide Web).
[slide 11]
Consider a product that is regulated both as a drug and a device (of course this
exists and the situation is dependent on the product’s intended use). The
proper reporting, through the programs and Gateway setup by FDA, might be
confusing - unless the regulatory affairs responsible person at your company
maintains their competency.
This year’s Medtech China regulatory forum, as well as my presentation, is
designed to make you aware about such programs. However, in the short
amount of time I have for this presentation, I can only inform you on the
differences between Centers at the FDA so that you have the chance to be
successful in your own research and use of the FDA’s electronic programs.
However, I invite you to contact me directly if you need personal assistance.
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[slide 12]
The FDA Electronic Submission GATEWAY is an electronic submission process
that is defined as the receipt, acknowledgment, routing, and notification to a
receiving Center (within FDA) of the receipt of your electronic submission. In
this definition,
• "Receipt" means transfer of a submission from a sender’s system to a
temporary storage area in the GATEWAY (FDA ESG).
• "Acknowledgment" to the sender that the submission was sent from the
sender’s system and received by the Gateway.
• "Routing" refers to delivering a submission to a Center-level storage area
and initiating a load process to place a submission into a Center
receiving system
• "Notification" of a submission’s arrival is made to those individuals
responsible for the Center’s receiving system.
Each of these terms denotes a step in the process of electronic submission
delivery, and together, these steps comprise the whole scope of electronic
submission delivery.
[slide 13]
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The FDA Electronic Submission Gateway is the central transmission point for
sending information electronically to the FDA. Within that context, the
Gateway is a conduit, or "highway", along which submissions travel to reach
their final destination. The system does not open or review submissions; it
merely routes them to the proper destination. And one other important fact is
that the FDA Electronic Submissions Gateway uses a software application
certified to comply with secure messaging standards.
As described so far, I am sure you are telling yourself this should be relative
easy (I mean, after all, isn’t the whole process suppose to make submissions
easier for everyone?). Officials at AGA Medical – a client of MedTech Review
and one of FDA’s first low-volume electronic reporters – can attest that it’s not
possible to get an eMDR program up and running in the blink of an eye. It took
the company six to eight weeks to complete the appropriate testing and
training of staff before it officially began sending eMDRs. Choosing to submit
eMDRs to FDA – even though it’s not mandatory – was a no-brainer for AGA
Medical once it realized that it was “faster, much more accurate and much
cheaper” than sending paper MedWatch reports.
[slide 14]
Using the eMDR program “is less expensive. The company doesn’t have to put a
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stamp on an envelope, or spend $10 to $15 for a FedEx package to get to FDA.”
“Second, it’s more accurate, because what the company renders on the MDR
forms doesn’t require FDA’s contractor to print things out and retype them in,
so the company doesn’t have to worry about transcription errors.
“Third, it’s faster. Generally, when the company pushes the button to transmit
things they’ll get a response back in 10 minutes or less that says it’s been
loaded into FDA’s database.” “And then if the company needs to do their
reconciliations of what has been submitted versus what FDA has received, the
company can verify for the [agency investigator] or their internal auditors that
they actually have submitted that information. “And, of course, everybody will
have to get there eventually anyway, so go ahead and do it now.”
[slide 15]
What’s in it for you?
Collaboration: The entire concept behind the electronic submission tool is to
enhance the collaboration between an organisation and the FDA. The agency’s
goal is to not only provide an environment for easy and seamless submission of
adverse events, but to also speed up the time in which it is able to respond to
events. The tools also enhance the communication process with the FDA and
eliminates or reduces “crossover emails”. Those who use the electronic will
benefit from an immediate receipt and acknowledgement – within six to 12
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minutes – as opposed to waiting days or longer with the manual reporting
process.
Cost reduction: Use of the electronic tools will result in cost savings, as it will
eliminate the need for the administrative overhead incurred from traditional
communication. Through the use of batch event reporting, and immediate
interaction with the FDA, companies can literally “upload” multiple adverse
events in a single click to the FDA, saving time and resources in the process.
Record retention: One of the major challenges with the traditional MedWatch
forms is that they are recorded on paper. These manual processes require a lot
of paperwork and the forms usually end up in a filing cabinet or file server and
can take a long time to even locate. With the electronic submission, old
records will be able to be retrieved in real time, as everything is automated
and centrally stored in a data repository. Similarly, all related documentation
is available at the click of a button. For example, the electronic tools
automatically link the FDA’s acknowledgement to the original submission,
eliminating any confusion as to which acknowledgements belong with which
submissions. This provides complete transparency and accuracy of correlating
data and results in an efficient and reliable process.
Responsiveness: The electronic tool will enable involved parties to flag
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submission errors quickly, as opposed to the more manual and time-consuming
correspondences to and from the FDA. This allows for the efficient and real-
time response to all events from the agency. Furthermore, the electronic tools
provide a collaborative environment between companies and the FDA to
proactively review and correct errors and respond to questions. In the case of
major adverse events, time is a critical factor in responding to the market, and
electronic tools allow for significantly reduced response time from the FDA.
Single environment for all adverse events: Technology is all about the
consolidation of systems and providing a comprehensive, enterprise method for
storing data. Much like any business systems integration, the electronic tools
are designed to provide a holistic environment for all regulatory submissions.
They act as a single point of entry for processing all electronic submissions in a
highly secure environment. This is beneficial because complaints to the
company can be directly linked to a MedWatch form and integrated with the
FDA’s gateway. Within a single environment, companies can store not only
their internal compliance data, but also any FDA responses to the original
event. Complaints or adverse event data can also be linked to product lines in
external systems such as enterprise resource planning, customer relationship
management and laboratory information management systems, providing
multiple points of data throughout the business.
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[slide 16]
Preparing for ESG is not for the faint of heart
Most likely you are the Compliance Officer or at the very least an IT
representative, with little or no experience in Public Key Infrastructure, the
underlying policy and technology utilized behind digital certificates, let alone
familiar with terms like .cer and PKCS12 abundantly referenced in FDA ESG
user guides. ESG readiness includes numerous steps ranging from installing and
configuring Sun’s Java Runtime plug-ins to submitting letters of non-
repudiation needed to comply with 21 CFR part 11. Acquiring and preparing
x.509v 3 digital certificates to authenticate and sign submissions through the
ESG is just one of several readiness tasks that separate you from being able to
move from costly and slow paper intensive submissions to the speed and
efficiency of electronic submissions.
[slide 17]
Getting started with the FDA’s electronic submissions gateway.
Prior to registering for an ESG account, one must determine which submission
option to use, the FDA ESG Web Interface (WebTrader) or the AS2 Gateway-to-
Gateway. This determination is based on types of submissions to be
transmitted, infrastructure capabilities and business considerations. The
WebTrader is the low-cost option and has fewer set-up requirements than the
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Gateway- to-Gateway option. During the 2009 implementation, many
companies found that establishing their accounts was more time-consuming
than they had envisaged. Time to setup accounts are now reported as four to
eight months for establishing and testing WebTrader accounts.
Several preparatory activities precede the formal request to the FDA.
1. Procure a DUNS number for your establishment if required (one DUNS
number per address).
2. Set up a digital certificate. The digital certificate is required in order to
use an electronic signature and provides authentication, confidentiality,
integrity, and non-repudiation of data.
3. Prepare an electronic submission. This submission does not need to be
guidance- compliant (the submission will not be reviewed by the FDA),
but should be representative of the file types that would be submitted in
a typical submission (ie, a mixture of PDF, text files, MS Word files,
etc.).
4. Set up the computer system that will do the submissions through ESG;
the operating system should be Windows XP and the Java SE runtime
environment (JRE) 5.0. You will need a browser; ESG is compliant with
Internet Explorer 6, 7, 8 or Firefox 2.0.x. The digital certificate and
WebTrader account are specific for the computer on which they are set
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up.
5. Once the DUNS number is available, the digital certificate is set up, and
the computer is configured, submit a Letter of Non- Repudiation to two
separate locations within the FDA. Submit these letters in paper form,
on company letterhead, and signed with a traditional handwritten
signature. The letter certifies that the electronic signature is the legally
binding equivalent of a traditional handwritten signature.
Lastly, the electronic Medical Device Report (eMDR) application uses the Health
Level Seven (HL7) ICSR standard for the reports. Two options for preparing
eMDRs are available:
1. FDA eSubmitter (formerly CeSub), a free downloadable application,
allows submission of eMDR reports one at a time for low volume
reporters. The eSubmitter contains data elements of the MedWatch
Form 3500A which are manually entered and then packaged as an HL7
ICSR message.
2. High volume and frequent reporters do not require the eSubmitter. The
eMDRs are created directly from adverse event information in the
reporter’s system and formatted as a HL7 ICSR.
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I have edited a 2-hour web-training course that was presented by FDA this June
2011 as part of this presentation, which I will show to you now. This small
excerpt reiterates the commitment of FDA to mandatory electronic submissions
of Medical Device Reports and speaks in more detail about some of the items
you, the China medical device manufacturer, must consider as you plan and
establish your electronic system to communicate with FDA.
[play movie clip]