Continuity of care

Device manufacturers and technology startups are continuously introducing devices to improve patient care.

Geriatric population is growing with the rising global population, and rising patient base suffering from sleep disorders and respiratory diseases has been a major growth driver that have surged the anesthesia and respiratory device market. In the next few years, the demand for anesthesia and respiratory devices is expected to increase significantly in the emerging economies such as China and India.

The global anesthesia equipment market was valued at USD 7.78 billion in 2016 and is projected to reach USD 13.50 billion by 2021, at a CAGR of 11.64 percent.

Continuous growth in this market can be attributed to the rapid adoption of anesthesia information management systems (AIMS), which have been implemented in an effort to move the industry away from the paper-based record keeping systems to more efficient electronic solutions. The establishment of several government-supported national statistical databases is driving this market as well. The demand is also rapidly increasing with the growing safety awareness and technology enhancements in anesthesia machines. The low-flow anesthesia and electronic medical records dominate the current global anesthesia market technology, which indirectly leads to lesser significant savings across the healthcare industry.

Rapid advancements in the anesthesia industry make it increasingly difficult for the anesthesiologist to keep up with various anesthesia machine technologies. Additionally, the latest anesthesia technology does not come at a low price, and even the most basic configuration of the equipment can cost a fortune. The decrease in reimbursements provided by governments for medical equipment, and increased availability of aftermarket service that prolongs the life of a facility’s existing equipment are also the challenges involved that this market may have to face with respect to its growth.

North America has the highest market share followed by Europe. The North American market share is as high as 34 percent. Recent economic advances in emerging markets have become a comparative threat to the developed nations market. The reason for this can be attributed to higher per capita income of the North American population and the rapidly rising patient population in this region. Following North America is Europe with the second-biggest market share at 29 percent. Recent trends show that emerging countries will register a greater growth in the market share in the near future, due to the increasing per capita income in emerging nations and the rapidly rising patient population in these regions as well.

Key players of this market include 3M, Airsep Corporation, GE Healthcare, AstraZeneca, Johnson & Johnson, Teleflex Inc., Draegerwerk AG, Getinge Group, Smith Medicals, OSI Systems, Mindray, Carefusion, Covidien, Philips Healthcare, ResMed, Masimo, Fisher and Paykel, and Smiths Medical among others.

Technology Trends
Anesthesiologists work in an increasingly complex technological environment inside and outside of the operating room. Every day, they rely on sophisticated devices to provide safe care to patients. Those devices include anesthesia machines, drug delivery systems, physiologic monitors, diagnostic imaging equipment, and electronic health records (EHRs). Device manufacturers and technology startups are continuously introducing new devices to improve patient care.

Quality Measurement and Health Information Exchange. Federal quality programs continue to require more data from anesthesiologists. The Anesthesia Quality Institute’s National Anesthesia Clinical Outcomes Registry (AQI NACOR) has collected over 22 million cases since its inception in 2010. Practices that report to NACOR also can submit quality measures. While only three of the Federal Physician Quality Reporting System measures apply to anesthesiologists, in 2016 AQI has authored 22 additional quality measures specific to anesthesiology. AQI is a qualified clinical data registry and can submit these measures to the federal government for anesthesiology practice.

Technology to assist with collection and reporting on outcomes data is improving, but the nature of quality measurement means that there is no silver bullet program or device to immediately measure the outcomes of an anesthesiology group. The perioperative consult service at Vanderbilt University, in Nashville, Tennessee, used the existing perioperative data warehouse and EHRs to collect outcomes data that showed how a restructuring of perioperative care for colorectal surgery patients improved hospital length of stay and lowered hospital costs.

Anesthesia Machines. Anesthesia machine manufacturers continue to introduce technological advances in their newest machine models. New technology focuses on patient safety as well as optimizing the efficiency of anesthetic delivery and minimizing anesthetic gas wastage. Target-controlled low-flow anesthesia systems automate the fresh gas flow rate and vaporizer settings to achieve a specific end-tidal percentage that is set by the anesthesiologist. All leading brands have implementations of target-controlled low-flow anesthesia. Each manufacturer continues to explore opportunities to integrate anesthesia machines with hospital information systems, including data sharing with anesthesia information management systems (AIMS) for automatic documentation. Improved connectivity and integration will offer new opportunities to enhance workflow efficiency and patient safety.

Carbon Dioxide Absorbers. A novel, lithium-based carbon dioxide absorber offers potential advantages over conventional absorbers. The lithium-based absorber by SpiraLith is reusable and can be recycled by the manufacturer. This technology offers certain advantages, including no desiccation and no generation of dust or workplace contaminants. However, this absorbent requires some practice adjustments, as it does not visibly change color as it nears the end of its life span. Anesthesiologists must remain attentive to continuous capnography when using SpiraLith to identify expired SpiraLith canisters when inspired carbon dioxide is greater than zero.

Physiologic Monitors. Accelerometers, magnetometers, and gyroscopes in consumer devices such as smartphones and activity trackers allow for monitoring various aspects of individuals’ daily lives, from exercise to sleep. Medical device manufacturers are exploring the role of wearable devices integrated in physiologic monitors. Research groups such as ORCATECH are integrating wearable devices and motion sensors in patients’ homes to detect cognitive impairment in vulnerable populations, such as older adults.

BioStamp Research Connect System by MC10 is a small device approximately the size of two ECG leads that records complex physiologic data for up to 36 hours. The device can monitor patient activity, respiratory rate, single-lead ECG, and surface electromyography. There is potential for growth in this sector, particularly to maximize patient safety on both inpatient and ambulatory basis. However, the benefits of monitoring physiologic data remotely on outpatient basis require scrutiny, particularly if such monitoring requires significant time and resources for implementation.

AIMS and CDSS. Anesthesia information management systems (AIMS) were primarily designed to assist anesthesiologists in documenting the anesthesia record in electronic form. Many current AIMS not only record data from the anesthesia machine, but also integrate with hospital EHRs to facilitate the flow of information into and out of the perioperative environment.

Clinical decision support systems (CDSS) have been integrated into AIMS to improve multiple aspects of patient care, including medication administration reminders, hemodynamic monitoring alerts, and completion of required documentation. A recent review of CDSS research within anesthesiology found multiple studies concluding that CDSS improves compliance with quality measures and documentation. However, demonstrating improved clinical outcomes as a result of CDSS interventions remains a challenge. A recent study of clinical decision support to alert anesthesiologists to critically low systolic blood pressure based on consecutive low blood pressure measurements found no change in the observed rate of hypotension or on hospital length of stay.

Commercial perioperative decision support with FDA 510(k) clearance is available from vendors such as AlertWatch, a University of Michigan Health System spin-off. AlertWatch functions as a secondary alert system that integrates physiologic data from existing monitors and displays animated alerts that are based on specific organ systems. Additional CDSS abstracts of note this year at STA include a mathematical model for detection of endotracheal intubation and data visualization for respiratory status assessments.

Way Forward
Manufacturers of anesthesia machines are constantly making efforts to upgrade their technology to manufacture better products. Widespread technology advancements have spurred market growth, stemming mostly from the need for advanced and innovative new machines and equipment. The evolution of stand-alone machines to fully integrated systems combined with ongoing innovation has increased productivity, efficiency, and efficacy of data. The demand for anesthesia workstations will continue to be supported by the drive for integration of medical devices across the healthcare continuum. Nonetheless, vendors that can offer both stand-alone and workstation configurations are likely to be the most effective, allowing customers to choose the best option suited to their needs. Manufacturers need to be flexible in their strategy surrounding selling patient monitors with anesthesia machines to be able to continue to compete in the dynamic anesthesia market.