Software as a Medical Device (SaMD): What You Need to Know

Getting FDA clearance or CE marking is just the opening act. True Software as a Medical Device (SaMD) excellence means anticipating cybersecurity threats, automating adverse-event reporting, and adapting to evolving AI/ML guidelines—all while delivering better patient outcomes. Let’s discover the roadmap beyond clearance: the full SaMD lifecycle that takes your software from initial concept to continuous, post-market innovation. 

Software is reshaping healthcare delivery, evolving from embedded device code to standalone applications that diagnose, treat, and monitor patients. This trend has given rise to Software as a Medical Device (SaMD)—software intended to perform one or more medical purposes without being part of a physical medical device. As market forecasts project global SaMD revenues to grow from $19.5 million in 2023 to $96.2 million by 2033—a 17.3% CAGR—innovators face unique regulatory and technical complexities. This guide will equip product leaders, quality managers, and regulatory professionals with a clear, step-by-step understanding of SaMD—from core definitions through post market obligations, AI/ML considerations, and best-in-class QMS strategies. 

What is Software as a Medical Device (SaMD)? 

The IMDRF defines SaMD as “software intended to be used for one or more medical purposes that perform these purposes without being part of a hardware medical device”. Unlike embedded software (SiMD), which resides within a physical medical device, true SaMD operates independently—often on smartphones, tablets, or cloud platforms. Key to this distinction is the intended medical purpose: if software actively diagnoses, treats, or informs clinical decisions, it qualifies as SaMD; if it merely displays or stores data, it falls outside this scope. 

Challenges with Software as a Medical Device 

SaMD developers navigate a unique set of challenges: 

• Cybersecurity Risks: 89% of healthcare organizations report at least one cyberattack per week, averaging 43 breaches annually—putting patient data and device integrity at risk. 

• Rapid Development Cycles: Continuous deployment models accelerate innovation but strain traditional validation processes, leading to uncertainty and approval delays. 

• Validation Pitfalls: Manual change tracking and fragmented testing can introduce errors; up to 30% of SaMD projects face setbacks due to inadequate validation planning. 

• Interoperability & Data Integrity: Seamless integration with EHRs, imaging systems, and wearables is critical—yet inconsistent standards often hamper reliable data exchange and traceability. 

SaMD Regulatory Overview and Framework 

To harmonize global oversight, the IMDRF’s SaMD Working Groups published two foundational documents: 

1. Key Definitions (WG N10): Establishes a common vocabulary for SaMD across regulators and manufacturers. 
2. Risk Categorization Framework (WG N12): Introduces a four-category risk schema based on “significance of information” and “healthcare situation”. 

These guidelines serve as the backbone for region-specific regulations, promoting consistency in classification, validation, and surveillance. 

SaMD Regulations in the US 

The U.S. Food and Drug Administration (FDA) regulates SaMD under its general medical device authorities, classifying products by risk: 

• Class I: Lowest risk—often exempt from premarket submission. 

• Class II: Moderate risk—typically cleared via 510(k). 

• Class III: High risk—requires Premarket Approval (PMA). 

• Class IV: (Emerging for certain software functions under draft frameworks.). 

Premarket Pathways: 

• 510(k): Demonstrate “substantial equivalence” to a predicate device. 

• De Novo: For novel, low-to-moderate risk devices lacking a predicate. 

• PMA: Rigorous clinical and manufacturing review for high-risk SaMD as per FDA guidelines. 

Quality Systems: Every SaMD maker must comply with 21 CFR Part 820 (QS Regulation) and Part 11 (electronic records/signatures). 

FDA Guidance on Software as a Medical Device 

Key FDA guidance documents include: 

• “Software as a Medical Device” Guidance (2017): Clarifies definitions, classification, and submission content. 

• Digital Health Innovation Action Plan: Establishes a pilot Pre-Cert program to streamline oversight of trusted developers. 

• Predetermined Change Control Plans: Allows pre-approved software changes without new submissions—accelerating updates while ensuring safety. 

Medical Device Software Regulations in the EU 

Under EU MDR 2017/745, standalone software falls under the “medical device software (MDSW)” umbrella, which mirrors SaMD concepts but uses local terminology. The MDCG 2019-11 guidance details software qualification and classification rules—introducing Rule 11 to reflect the IMDRF risk framework. Conformity assessment often involves a Notified Body and requires a Technical File, clinical evaluation, and post-market surveillance plan in compliance with Annex III and Article 83 MDR. 

How is SaMD Classified Across Global Regulatory Markets 

While IMDRF provides a unifying risk model, regional schemes vary: 

• US: Class I–III (and emerging IV) via FDA’s product database sequenex.com. 

• EU: Classes I–IIa–IIb–III under MDR’s 22 classification rules makrocare.com. 

• Others (e.g., China, Japan): Often mirror IMDRF but with local nuances in classification and clinical data requirements sequenex.com. 

Understanding these differences is essential for global market entry and minimizing redundant submissions. 

Software as a Medical Device (SaMD) Categorization According to IMDRF 

The IMDRF risk framework pairs two axies: 

1. Significance of Information
   Defines what the software does for patient care: 
2. Treat or diagnose: Directly provides a diagnosis or drives therapy (e.g., an algorithm that identifies stroke on CT scans). 
3. Drive clinical management: Recommends specific clinical actions (e.g., insulin‐dosing calculators). 
4. Inform clinical management: Offers supportive data without immediate action (e.g., trend graphs of vital signs).
5. Healthcare Situation
   Defines where and when the software is used: 
6. Critical: Immediate, time‐sensitive decisions—delays can cause death or serious harm (e.g., ICU monitoring). 
7. Serious: Significant health impact over time—suboptimal decisions worsen long‐term outcomes (e.g., chronic heart failure management). 
8. Non‐serious: Less acute contexts—informational support with low immediate risk (e.g., lifestyle or wellness tracking). 

The Four Risk Categories 

By crossing these axes, you land in one of four categories (I–IV). The higher the category, the greater the potential patient impact—and the tighter the regulatory controls and QMS rigor required. 

Healthcare Situation	Inform Clinical Management	Drive Clinical Management	Treat or Diagnose
Critical	II	III	IV
Serious	I	II	III
Non‐serious	I	I	II

Category I (Lowest Risk) 

What it covers: 

• Informing clinical management in serious or non‐serious contexts (e.g., dashboards that display historical blood‐pressure trends). 

• Driving clinical management in non‐serious contexts (e.g., reminders to schedule routine follow-up). 

QMS & Regulatory Implications: 

• Typically Class I (US) or Class I (EU MDR). 

• May be exempt from premarket submission but still requires a basic QMS (21 CFR 820, ISO 13485) and technical documentation. 

Category II 

What it covers: 

• Informing clinical management in critical contexts (e.g., real-time alerting of arrhythmias). 

• Driving clinical management in serious contexts (e.g., dosage calculators for chemotherapy adjustments). 

• Treating/diagnosing in non‐serious contexts (e.g., smartphone skin‐lesion screening apps). 

QMS & Regulatory Implications: 

• Generally Class II (US 510(k)) or Class IIa/IIb (EU MDR Rule 11). 

• Requires documented risk management per ISO 14971 and a full Technical File/510(k) submission. 

Category III 

What it covers: 

• Driving clinical management in critical contexts (e.g., ventilator‐weaning decision support). 

• Treating/diagnosing in serious contexts (e.g., CAD for cancer detection on mammograms). 

QMS & Regulatory Implications: 

• Typically Class II (De Novo) or Class IIb/III (EU MDR). 

• Demands clinical evaluation reports, usability testing, and comprehensive software validation. 

Category IV (Highest Risk) 

What it covers: 

• Treating or diagnosing in critical contexts (e.g., closed-loop insulin delivery systems). 

QMS & Regulatory Implications: 

• Generally Class III (PMA) or Class III (EU MDR). 

• Requires the most rigorous controls: extensive clinical data, architecture risk analysis, cybersecurity documentation, and full PMA or CE Certificate from a Notified Body. 

Why This Matters 

• Regulatory Strategy: Your SaMD’s category dictates which premarket pathway you use—510(k), De Novo, or PMA in the US; Class I–III in the EU. 

• Quality Management Priorities: Higher categories demand stronger risk management, more exhaustive testing, and detailed post market surveillance plans. 

• Resource Allocation: Early categorization focuses your engineering and regulatory teams on the right documentation, testing protocols, and stakeholder engagement—saving time and avoiding costly rework. 

By mapping your SaMD into this IMDRF risk matrix, you gain a clear, globally harmonized blueprint for compliance—ensuring patient safety and accelerating your path to market. 

What Are Some Examples of Software as a Medical Device (SaMD)? 

• Smartphone MRI Viewer: Allows diagnostic image review on mobile devices. 

• Computer-Aided Detection (CAD): AI-driven breast cancer screening tools. 

• Clinical Decision Support (CDS): Algorithms that flag sepsis risk or optimize insulin dosing. 

• Digital Therapeutics: Apps delivering cognitive behavioral therapy or chronic disease management. 

These real-world examples highlight SaMD’s potential to expand access, improve outcomes, and reduce healthcare costs. 

Postmarket Requirements for Software as a Medical Device (SaMD) 

After clearance or approval, manufacturers must execute robust postmarket activities: 

• Section 522 Post-market Surveillance: FDA can require studies for Class II/III devices, with surveillance plans initiated within 15 months of an order. 

• Medical Device Reporting (MDR): Mandatory reporting of adverse events and corrections/removals under 21 CFR 803. 

• Recalls & Field Corrections: Coordinated under 21 CFR 806. 

• Cybersecurity Management: Ongoing vulnerability monitoring, patch management, and reporting per FDA’s Post-market Cybersecurity Guidance. 

• Periodic Safety Update Reports (PSUR): EU MDR requires annual PSURs under Article 86. 

Continuous performance monitoring—leveraging real-world data—ensures SaMD evolves safely through its lifecycle. 

Artificial Intelligence and Machine Learning in SaMD 

AI/ML-enabled Software as a Medical Device brings transformative benefits but demands new oversight approaches: 

• FDA’s GMLP Principles: Ten guiding principles for “Good Machine Learning Practice,” co-authored by FDA, Health Canada, and MHRA, to ensure ethical development, validation, and monitoring. 

• Lifecycle Considerations: The FDA’s Jan 2025 draft guidance on AI-enabled device software functions outlines tiered evidence requirements for adaptive algorithms. 

• Transparency & Explainability: Developers must document data provenance, model training, and clinical significance to gain regulatory trust. 

• Performance Monitoring: Post-market performance monitoring—collecting real-world clinical data to detect drift or bias—is now industry best practice. 

Adhering to GMLP and FDA draft recommendations positions AI/ML SaMD for smoother approvals and stronger market acceptance. 

Future of Regulatory Approval for Software as a Medical Device (SaMD) 

Regulatory landscapes are shifting toward agility and harmonization: 

• Pre-Certification Models: FDA’s pilot Pre-Cert program evaluates organizational excellence, enabling faster market access for low-risk updates. 

• EU AI Act Synergy: Emerging EU regulations for AI will likely intersect with MDR requirements, driving integrated compliance strategies. 

• Global Convergence Efforts: IMDRF continues to refine SaMD frameworks, aiming for a single global dossier and streamlined review pathways. 

• Real-Time Monitoring & Virtual Trials: As cloud-based SaMD captures continuous real-world data, regulators may embrace adaptive approval—updating labels and functionalities based on ongoing evidence. 

Staying ahead of these trends ensures your SaMD investment remains future-proof and competitively positioned. 

Qualityze EQMS for SaMD Companies 

A robust enterprise quality management system (eQMS) is critical to tame SaMD complexity: 

• Document Control & Versioning: Centralize policies, design history files, and change records with electronic signatures compliant with 21 CFR Part 11. 

• Risk Management: Implement ISO 14971 workflows—linking hazards to mitigations and postmarket surveillance data. 

• Change Control & Predetermined Plans: Automate SaMD release pipelines, triggering reviews only for high-risk modifications. 

• Adverse Event Management: Capture, triage, and investigate AEs with standardized workflows, assign corrective actions, and analyze trends to prevent recurrence. 

• MDR Reporting: Generate FDA 21 CFR 803 eMDR submissions automatically, maintain audit-ready electronic records, and track report status end-to-end. 

• Audit Readiness: Real-time dashboards track CAPA, nonconformances, and supplier quality—eliminating the last-minute scramble for evidence. 

Qualityze’s cloud-native, Salesforce-based eQMS accelerates audits, reduces time-to-market, and fosters continuous improvement—letting your team focus on innovation rather than compliance. 

Ready to transform your SaMD journey with a future-proof quality framework?  

Request a personalized demo of Qualityze EQMS today and discover how automated risk management, seamless change control, and real-time audit readiness can fast-track your regulatory approvals—while keeping patient safety front and center. Elevate your software quality, accelerate market entry, and stay ahead in the age of digital health.