When does the evidence an auditor reads get produced?
It gets produced during the testing, because a reviewer picks a requirement and follows it to the test that covers it, then to the result and to any defect it raised. Assembling that trail afterwards means reading old tickets and reconstructing intent. IEC 62304 puts the trace inside the development process for that reason, and an auditor can tell which way round it was done.
What IEC 62304 asks you to keep
Do test environments need real patient data?
No. Production records in a test environment turn every export, every screenshot and every debug log into an incident waiting for someone to notice. Synthetic records and de-identified extracts cover the same test cases and remove that class of incident before the first case is written.
How we handle PHI, BAAs and test environments
Which defects reach patients?
The defects that reach patients are the ones that look correct on screen. A crash gets reported by the first person who sees it. A medication list that drops an entry after a patient merge, or an allergy flag that fails to survive an HL7 v2 to FHIR translation, is read as correct by the clinician acting on it. Those paths get tested as clinical workflows, with the data conditions that break them.
Testing against HL7 v2 interfaces
Who accounts for third party code?
You do. IEC 62304 calls it SOUP, software of unknown provenance. Clause 5.3 wants functional and performance requirements for each item, and clause 7.1 wants the published anomaly lists evaluated against your own hazards. A dependency list generated from a package manifest answers neither question.
Testing software of unknown provenance