Regulating the future of laboratory medicine: European regulatory landscape of AI-driven medical device software in laboratory medicine

Artificial intelligence (AI) is rapidly transforming laboratory medicine, impacting medical devices and healthcare practices. Despite these advancements, AI-based medical device software (MDSW) introduces a new layer of complexity in regulatory compliance. This paper outlines the regulatory landscape for MDSW and AI-driven MDSW, clarifying the responsibilities of laboratory professionals and manufacturers under the In Vitro Diagnostic Regulation (IVDR), ISO 15189:2022, and the Artificial Intelligence Act. An analysis of 89 MDSWs approved under the IVDR, derived from the European Database on Medical Devices (EUDAMED) reveals a diverse landscape of applications, ranging from digital pathology and molecular diagnostics to laboratory automation and clinical decision support. While Germany currently dominates the EU market for these devices, and the majority of approved MDSW remain non-AI driven and classified as low-risk, the increasing presence of AI-powered Class C devices underscores the growing potential of software in complex diagnostic scenarios. However, realizing the full potential of AI in laboratory medicine requires careful navigation of the evolving regulatory landscape. Key challenges persist, including defining intended use, ensuring robust clinical evidence, mitigating data bias, and establishing rigorous post-market surveillance. Balancing regulatory oversight with innovation is critical to fostering the development of trustworthy AI systems without stifling progress. As regulatory frameworks continue to evolve, establishing clear validation methodologies and transparent compliance pathways will be essential to unlocking the full potential of AI in laboratory medicine while ensuring the highest standards of safety and clinical effectiveness.