M3290B Patient Information Center iX

K183387 · Philips Medical Systems · MHX · Aug 6, 2019 · Cardiovascular

Device Facts

• Record ID: K183387
• Device Name: M3290B Patient Information Center iX
• Applicant: Philips Medical Systems
• Product Code: MHX · Cardiovascular
• Decision Date: Aug 6, 2019
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 870.1025
• Device Class: Class 2
• Attributes: Software as a Medical Device, Pediatric

Intended Use

The intended use of the Philips Patient Information Center iX software application is to: Receive, aggregate, process, distribute and display physiologic waves, parameters, alarms and events at locations other than at the patient, for multiple patients. Determine alarm conditions and generate alarm signals for Philips approved medical devices, that send physiological data and do not have the ability to determine the alarm condition. Algorithms present in the software are limited to the ST/AR ECG (for arrhythmia, ST Segment and QT Segment Monitoring) and SpO2. Generate alarm signals for user notification, based on the alarm signal determined and sent by Philips approved medical devices. Perform diagnostic 12-Lead analysis and interpretation based on raw ECG data samples provided from Philips approved medical devices. Result may be displayed, printed and/or distributed to Philips approved medical devices. Provide review and trend application data, designed to contribute to the screening of patient condition. All information or visual indications provided are intended to support the judgement of a medical professional and are not intended to be the sole source of information for decision making, thus these applications are not intended for diagnoses or active patient monitoring where immediate action is required. Provide connection to other systems not associated with active patient monitoring, such as information systems. The software performs the action to transfer, store, convert from one format to another according to preset specifications, or to display medical device data.

Device Story

PIC iX is a centralized software platform for professional healthcare facilities; receives, aggregates, and displays physiologic waves, parameters, and alarms from networked Philips medical devices. Operates on off-the-shelf Windows PCs/servers. Provides retrospective review of alarms/trends; performs diagnostic 12-lead ECG analysis; enables secondary annunciation of alarms and configuration of telemetry monitors. Healthcare professionals use output to support clinical judgment; not intended for primary diagnosis or active monitoring requiring immediate action. Enhancements include user-adjustable QRS detection thresholds (150-350uV), increased system scalability (up to 1600 beds), improved cybersecurity (encryption, authentication), and expanded alarm reporting capabilities. Benefits include centralized patient surveillance and streamlined data management across clinical environments.

Clinical Evidence

No clinical data performed. Substantial equivalence supported by bench testing, verification, and validation activities, including system-level performance testing, safety testing, and risk analysis.

Technological Characteristics

Software-based central station running on Windows 10 IoT Enterprise/Windows Server 2016. Features include ST/AR ECG and SpO2 algorithms, network connectivity for physiologic data, and diagnostic 12-lead ECG interpretation. Connectivity via HL7/PPIS. Cybersecurity includes encryption and authentication. User-adjustable QRS detection threshold (150-350uV).

Indications for Use

Indicated for use when monitoring adult and/or specified pediatric subgroups (Newborn (neonate), Infant, Child, Adolescent) patients as indicated by labeling of the medical device providing the data. Not intended for home use.

Regulatory Classification

Identification

The arrhythmia detector and alarm device monitors an electrocardiogram and is designed to produce a visible or audible signal or alarm when atrial or ventricular arrhythmia, such as premature contraction or ventricular fibrillation, occurs.

Special Controls

*Classification.* Class II (special controls). The guidance document entitled “Class II Special Controls Guidance Document: Arrhythmia Detector and Alarm” will serve as the special control. See § 870.1 for the availability of this guidance document.

Predicate Devices

• M3290B Patient Information Center iX Release C.01 (K163584)

Reference Devices

• Philips ST/AR, ST and Arrhythmia Algorithm Software (K014261)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image contains the logos of the Department of Health and Human Services and the Food and Drug Administration (FDA). The Department of Health and Human Services logo is on the left, and the FDA logo is on the right. The FDA logo includes the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue text.

Philips Medical Systems Peng Cui, Regulatory Specialist 3000 Minuteman Road Andover, Massachusetts 01810

### Re: K183387

Trade/Device Name: M3290B Patient Information Center iX Regulation Number: 21 CFR 870.1025 Regulation Name: Arrhythmia detector and alarm (including ST-segment measurement and alarm) Regulatory Class: Class II Product Code: MHX, DSI, MLD, MSX, OUG Dated: April 26, 2019 Received: April 29, 2019

#### Dear Peng Cui:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmp/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see

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https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

Nicole Goodsell Assistant Director DHT2A: Division of Cardiac Electrophysiology, Diagnostics and Monitoring Devices OHT2: Office of Cardiovascular Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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## Indications for Use

510(k) Number (if known)

K183387

#### Device Name

M3290B Patient Information Center iX Release C.03

#### Indications for Use (Describe)

The intended use of the Philips Patient Information Center iX software application is to:

- Receive, aggregate, process, distribute and display physiologic waves, parameters, alarms and events at locations other than ● at the patient, for multiple patients.
- . Determine alarm conditions and generate alarm signals for Philips approved medical devices, that send physiological data and do not have the ability to determine the alarm condition.
- Algorithms present in the software are limited to the ST/AR ECG (for arthythmia, ST Segment and QT Segment — Monitoring) and SpO2.
- Generate alarm signals for user notification, based on the alarm signal determined and sent by Philips approved medical devices.
- Perform diagnostic 12-Lead analysis and interpretation based on raw ECG data samples provided from Philips approved ● medical devices. Result may be displayed, printed and/or distributed to Philips approved medical devices.
- Provide review and trend application data, designed to contribute to the screening of patient condition. All information or visual indications provided are intended to support the judgement of a medical professional and are not intended to be the sole source of information for decision making, thus these applications are not intended for diagnoses or active patient monitoring where immediate action is required.
- Provide connection to other systems not associated with active patient monitoring, such as information systems. The software ● performs the action to transfer, store, convert from one format to another according to preset specifications, or to display medical device data.

The Information Center Software is intended for use in professional healthcare professionals. The Information Center Software is not intended for home use.

Indicated for use when monitoring adult and/or specified pediatic subgroups (Newborn (neonate), Infant, Child, Adolescent) patients as indicated by labeling of the medical device providing the data.

#### Rx only.

Type of Use (Select one or both, as applicable)

X Prescription Use (Part 21 CFR 801 Subpart D)

| Over-The-Counter Use (21 CFR 801 Subpart C)

#### CONTINUE ON A SEPARATE PAGE IF NEEDED.

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This section applies only to requirements of the Paperwork Reduction Act of 1995.

#### *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.*

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

> Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff [e-mail]

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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## M3290B Patient Information Center iX Release C.03

This summary of safety and effectiveness information is submitted in accordance with 21CFR 8807.92

#### 1. Submitter's name, address, telephone number, contact person.

- Manufacturer: Philips Medical Systems 3000 Minuteman Road Andover, MA 01810, USA
- Peng Cui, Contact person: Sr. Regulatory Affairs Specialist 3000 Minuteman Road Andover, MA 01810, USA Email: peng.cui(@philips.com Tel: [phone]

Date prepared: July 10, 2019

- 2. Name of the device, including the trade or proprietarv name if applicable, the common or usual name, and the classification name, if known:
Common/usual name: Central Station M3290B Patient Information Center iX Proprietary name: Classification panel: Cardiovascular

This device is classified as follows:

| Classification | Classification Name | Product Code |
|----------------|--------------------------------------------------------------|--------------|
| 870.1025, II | Physiological Monitor, Patient Monitor | MHX |
| 870.1025, II | Arrhythmia Detector and Alarm | DSI |
| 870.1025, II | Monitor, ST Alarm | MLD |
| 870.2800, II | Recorder, Magnetic Tape, Medical | DSH |
| 870.2300, II | System, Network and Communication,<br>Physiological Monitors | MSX |
| 880.6310 I | Medical Device Data System | OUG |

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Image /page/5/Picture/0 description: The image shows the word "PHILIPS" in large, bold, blue letters. The font is sans-serif and the letters are evenly spaced. The background is white, providing a strong contrast that makes the word stand out. The overall impression is clean and professional, reflecting the brand's image.

### 3. Predicate device information

Philips Medical Device believes the M3290B Patient Information Center iX (PIC iX) Release C.03 is substantially equivalent to the following legally marketed device:

| Predicate device | Manufacturer | 510(k) |
|------------------------------------------------------|-------------------------|---------|
| M3290B Patient Information<br>Center iX Release C.01 | Philips Medical Systems | K163584 |

#### 4. Device description

The Philips Information Center uses off-the-shelf Windows PCs and servers, combined with the M3290B Patient Information Center iX software Release C.03 to provide centralized display of physiologic waves, parameters, and trends, format data for strip chart recordings printed reports, and secondary annunciation of alarms from other networked medical devices. The M3290B Patient Information Center iX software Release C.03 provides for the retrospective review of alarms, physiologic waves and parameters from its database.

Additionally, the M3290B Patient Information Center iX software Release C.03 provides primary annunciation of alarms and configuration and control access for networked telemetry monitors.

Compatible Accessories include: Mobile Caregiver - a medical device data system, viewing only, mobile application associated with the Enhanced Web Viewing feature cleared in the predicate device.

#### 5. Intended use/Indications for use

The intended use of the M3290B Patient Information Center iX software application is to:

- Receive, aggregate, process, distribute and display physiologic waves, parameters, alarms and events at locations other than at the patient, for multiple patients.
- Determine alarm conditions and generate alarm signals for Philips approved medical o devices, that send physiological data and do not have the ability to determine the alarm condition.
- 트 Algorithms present in the software are limited to the ST/AR ECG (for arrhythmia, ST Segment and QT Segment Monitoring) and SpO2.
- Generate alarm signals for user notification, based on the alarm signal determined and ● sent by Philips approved medical devices.
- Perform diagnostic 12-Lead analysis and interpretation based on raw ECG data samples provided from Philips approved medical devices. Result may be displayed, printed and/or distributed to Philips approved medical devices.

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Image /page/6/Picture/0 description: The image shows the word "PHILIPS" in a bold, sans-serif font. The color of the text is a medium blue. The letters are closely spaced together, creating a solid block of text.

- Provide review and trend application data, designed to contribute to the screening of patient condition. All information or visual indications provided are intended to support the judgement of a medical professional and are not intended to be the sole source of information for decision making, thus these applications are not intended for diagnoses or active patient monitoring where immediate action is required.
- Provide connection to other systems not associated with active patient monitoring, such ● as information systems. The software performs the action to transfer, store, convert from one format to another according to preset specifications, or to display medical device data.

The Information Center Software is intended for use in professional healthcare facilities by trained healthcare professionals. The Information Center Software is not intended for home use.

Indicated for use when monitoring adult and/or specified pediatric subgroups (Newborn (neonate), Infant, Child, Adolescent) patients as indicated by labeling of the medical device providing the data.

Rx only.

The intended use/indications for use of M3290B Patient Information Center iX Release C.03, provided above, are same as that of the legally marketed and predicate device, Philips M3290B Patient Information Center iX Release C.01 (K163584).

### 6. Comparison of technical Characteristics with the predicate device

The M3290B Patient Information Center iX Release C.03 and the legally marketed and predicate device, Philips M3290B Patient Information Center iX Release C.01(K163584), employ the same fundamental scientific technology. The primary difference is the change in the QRS detection threshold. In M3290B Patient Information Center iX Release C.01(K163584), the minimum QRS detection threshold is fixed at 150uV and is not user adjustable. In M3290B Patient Information Center iX Release C.03, a manual mode of QRS detection has been added so that the minimum QRS detection threshold can be user adjustable. Note that the user adjustable minimum QRS detective threshold feature was cleared on Philips ST/AR, ST and Arrhythmia Algorithm Software (K014261).

A comparison of the proposed M3290B Patient Information Center iX Release C.03 to the legally marketed and predicate device, Philips M3290B Patient Information Center iX Release C.01(K163584), is provided in Table 1 below:

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| Key<br>characteristic | M3290B PIC iX C.01<br>K163584 | M3290B PIC iX C.03 | Comment |
|-----------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------|
| | (Predicate Device) | (Subject Device) | |
| Intended Use/<br>Indications for<br>use | The intended use of the M3290B<br>Patient Information Center iX<br>software application is to:<br>Receive, aggregate, process,<br>distribute and display<br>physiologic waves,<br>parameters, alarms and<br>events at locations other<br>than at the patient, for<br>multiple patients. Determine alarm conditions<br>and generate alarm signals<br>for Philips approved<br>medical devices, that send<br>physiological data and do<br>not have the ability to<br>determine the alarm<br>condition. Algorithms present<br>in the software are<br>limited to the<br>ST/AR ECG (for<br>arrhythmia, ST<br>Segment and QT<br>Segment<br>Monitoring) and<br>SpO2. Generate alarm signals for<br>user notification, based on<br>the alarm signal determined<br>and sent by Philips<br>approved medical devices. Perform diagnostic 12-Lead<br>analysis and interpretation<br>based on raw ECG data<br>samples provided from<br>Philips approved medical<br>devices. Result may be<br>displayed, printed and/or<br>distributed to Philips<br>approved medical devices. Provide review and trend<br>application data, designed to | Same | No change |
| | contribute to the screening of patient condition All information or visual indications provided are intended to support the judgement of a medical professional and are not intended to be the sole source of information for decision making, thus these applications are not intended for diagnoses or active patient monitoring where immediate action is required. Provide connection to other systems not associated with active patient monitoring, such as information systems. The software performs the action to transfer, store, convert from one format to another according to preset specifications, or to display medical device data. The Information Center Software is intended for use in professional healthcare facilities by trained healthcare professionals. The Information Center Software is not intended for home use.<br>Indicated for use when monitoring adult and/or specified pediatric subgroups (Newborn (neonate), Infant, Child, Adolescent) patients as indicated by labeling of the medical device providing the data.<br>Rx only. | | |
| Minimum QRS detection threshold | fixed at 150 $\mu$ V | User adjustable with the following choices: 150 $\mu$ V 200 $\mu$ V 250 $\mu$ V | User adjustable Minimum QRS detection threshold feature was cleared on |
| | | 300 μV 350 μV | Philips ST/AR,<br>ST and<br>Arrhythmia<br>Algorithm<br>Software<br>(K014261) |
| Applications | Retrospective Review<br>Caregiver Assignment<br>Surveillance Display Management Patient Alarm measurement and<br>device control | Same | No Change |
| Domain-<br>Specific<br>Service | Physiological Data Source<br>Controls Wave Rendering Data Storage SR/AR Algorithm Alarm management Patient & Equipment<br>Management | PIC iX Release C.03 supports the<br>software version N.0 of the<br>existing IntelliVue Patient<br>Monitor (IPM) family and the<br>software C.01 of the MX40<br>monitor. PIC Ix Release C.03 cam show<br>the body sites where the Masimo<br>measurements (SpO2<br>measurements) are taken can.<br>There is no change to the Masimo<br>measurements themselves. | Non-significant<br>change. There is<br>no new clinical<br>feature added nor<br>new risk<br>identified. |
| Common<br>Services | Logging Event Notification Watchdog Audit Trail User Management Licensing | Same | No change |
| Outbound<br>Data Services | HL7/PPIS Paging Bed to Bed Overview Web/Mobility 12 Lead Data Warehouse | With PIC iX Release C.03, the<br>system scalability is increased to<br>Support up to 1600 beds 1600 subscriptions to a<br>dedicated web server 1600 subscriptions to a<br>dedicated mobility server two Data Warehouse Connect<br>repositories Currently, PIC iX sends partial<br>alarm information to CareEvent<br>reports. PIC iX Release C.03 | Non-significant<br>changes. There is<br>no new clinical<br>feature added. |
| | | allows all alarm information be<br>sent to CareEvent reports.<br>The PIC IX Release C.03 allows<br>user to select which alarms from<br>3rd party devices to display on<br>PIC iX and propagate through<br>PIC iX to HL7 and<br>CareEvent. This feature have no<br>impact to the 3rd party devices.<br>The alarms are always available<br>on the 3rd party devices PIC iX Release C.03 enables 3rd<br>party devices to do HL7 export of<br>alarm limit information through it<br>to EMR, in addition to the<br>currently available function of<br>passing numerical data. | |
| Platform | Windows 8.1 OS Windows Server 2012 R2 | Windows 10 IoT Enterprise 2016<br>LTSB<br>Windows Server 2016 | MS OS update. |
| Patient<br>Monitoring<br>Database | Database Database Access | Same | No Change |
| Data<br>Acquisition<br>Services | MDIL TeleMDIL Network Services | The PIC iX Release C.03 further<br>improves the cybersecurity, including<br>PIC iX-to-PIC iX Encryption and<br>Node, Authentication and STIG<br>implementation. | Cybersecurity<br>improvement. |
| Reporting | Printing Recording | With PIC iX Release C.03, user can<br>select printers to print information<br>from PIC iX. | Minor SW<br>enhancement. |

#### Table 1: Comparison Table

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# M3290B PIC iX Release C.03

## 510(k) Summary

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# M3290B PIC iX Release C.03

## 510(k) Summary

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Image /page/10/Picture/0 description: The image shows the word "PHILIPS" in large, bold, blue letters. The font is sans-serif and the letters are evenly spaced. The background is white, providing a strong contrast that makes the word stand out. The overall impression is clean and professional, reflecting the brand's image.

## M3290B PIC iX Release C.03

#### 7. Nonclinical Performance Data

The M3290B Patient Information Center iX software Release C.03 was tested in accordance with Philips verification and validation processes.

Quality Assurance measures were applied to the system design and development, including:

- o Risk Analysis

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- Product Specifications
- Design Reviews ●
- Verification & Validations ●

### 8. Clinical Data

Clinical Performance testing for M3290B Philips Patient Information Center iX software Release C.03 was not performed, as there were no new clinical applications that had hazards or risk mitigations that required a clinical performance testing to support equivalence.

#### 9. Conclusion

Verification, validation, and testing activities, where required to establish the performance, functionality, and reliability characteristics of the new device with respect to the predicate are performed. Testing involved system level tests, performance tests, safety testing from hazard analysis and the non-clinical testing which complied with the requirements specified in the international and FDA-recognized consensus standards. Risk assessment was conducted to identify potential hazards, to estimate and to mitigate the risks. The identified risk control measures have been implemented, verified. and finally evaluated. The identified risks have been found to be reduced to an acceptable level. The testing and the risk controls demonstrate the subject device is as safe, as effective and performs as well as its predicate devices without raising any new safety and/or effectiveness concerns. Therefore, M3290B Patient Information Center iX software Release C.03 is substantially equivalent to the legally marketed predicate device Philips M3290B Patient Information Center iX software Release C.01 (K163584) in terms of design features, fundamental scientific technology, intended use, and safety and effectiveness.