Moving Toward an Optimal Design

Moving Toward an Optimal Design

The growing ability to connect multiple technologies, devices, and the data they generate is likely to shape the future of healthcare.

Demand for real-time continuous data, including personal health information, early warning scores, and alerting when a patient’s condition is deteriorating, is driving the market for complete monitoring systems in hospital and home care settings globally.

Patient monitoring has evolved significantly since its inception. Not too long ago, remote monitoring represented a convenient alternative to frequent visits to the arrhythmia clinic. However, breakthrough advancements in technology have now enabled remote patient monitoring (RPM), virtual patient–clinician interactions, fitness, and activity tracking through passive home and body sensors. The growing ability to connect multiple technologies, devices, and the data they generate is likely to shape the future of healthcare. The latest technologies in patient monitoring equipments allow to record and transmit digitized vital signs in the form of signals from an individual device to the computer or handheld personal digital assistant (PDA) of a healthcare professional instantly, thereby reducing the duration of evaluation and treatment. The use of multiparameter patient monitoring equipment is transitioning from ICU units to transport and mobile applications. Vendors have established a new paradigm in the connectivity of monitoring devices by incorporating wireless technology, which allows devices to communicate directly and securely to the application downloaded onto a patient’s smartphone. Traditional remote monitoring requires bulky handheld or bedside transmitters, which limit patient mobility. The new interactive mobile application replaces these passive transmitters and empowers patients to participate in their own care.

In the near future, expect medical professionals to develop more holistic applications for patient monitoring technology. Instead of targeting a single condition, such devices could track patient health at a large scale – think of this as a yearly physical examination performed on a rolling basis, with no need for an in-office check-up until an issue actually arises.

If these technologies continue to advance at their current pace, one will likely see a widespread adoption across patient demographics in no time at all. As these monitoring applications become more widely implemented, they are poised to revolutionize both quality of life and quality of care one patient at a time.

Indian Market Dynamics

 The Indian patient monitoring market in 2016 is estimated at Rs. 442 crore, with 55,000 units. The market saw a 15 percent growth by quantity over 2015 with it gradually becoming skewed in favor of the value and super value range. With India being a price sensitive market, Chinese brands and indigenous players are finding favor.

The preconfigured systems are gradually making way for the modular ones, as the buyers are becoming discerning and pay for what they use. A preconfigured monitor comes with certain, fixed parameters to monitor. The modular units can be changed by the addition or removal of certain parameter modules which gives the staff greater flexibility in patient care. Typically these types of monitors are more often procured for the emergency room or the intensive care unit where long-term, in-depth monitoring is required. Some vendors also offer preconfigured and modular systems, which have both features, some of the parameters are fixed but others are modular.

The single-channel patient monitoring systems have more or less exited the market. The low-end segment typically includes three-parameter and five-parameter monitors; the mid-end monitors include cardiac monitoring, hemodynamic monitoring, and respiratory monitoring; the high-end systems offer capnography which involves CO2 referred to as EtCO2, and in the premium models additional specialized parameters are also added.

Neurological monitoring, such as of intracranial pressure is gaining popularity, for instance to monitor a patient while in coma or when a defibrillator delivers a dose of electric current, countershock. There are special patient monitors which incorporate the monitoring of brain waves (electroencephalography), gas anesthetic concentrations, bispectral index (BIS), etc. They are usually incorporated into anesthesia machines. In neurosurgery intensive care units, brain EEG monitors have a larger multichannel capability and can monitor other physiological events, as well.

In 2016, BPL gained market share; Schiller had success with some government tenders; Chinese brands, Contec, Edan, and Comen established a firmer foothold; and Medtronic plc completed the previously announced sale of its patient care, deep vein thrombosis (compression), and nutritional insufficiency businesses within the patient monitoring & recovery (PMR) division of its Minimally Invasive Therapies Group (MITG) to Cardinal Health Inc. for Rs. 40,870 crore (USD 6.1 billion) in cash.

Global Market Dynamics

The global patient monitoring equipment market is valued at USD 21,127 million in 2016, and is expected to garner USD 32,435 million by 2023, at a CAGR of 6.2 percent over the next six years, estimates Allied Market Research.

Asia-Pacific possesses high market potential for growth of the patient monitoring devices market due to rise in the geriatric population and increase in the purchasing power of populous countries. The increase in the use of these devices has led to rapid developments in the patient monitoring devices market. Owing to the rise in the prevalence of lifestyle diseases, governments of numerous countries have taken an initiative to improve the healthcare facilities by improving the overall healthcare infrastructure, which is expected to propel the market growth.

The patient monitoring equipment market is dominated by the presence of established players with strong product portfolios and high development activities. Leading manufacturers are investing in product development and expansion in growing geographical regions to sustain their positions in the market. Several other vendors are adopting organic growth strategies to sustain the level of competition in the market. Acquisition and collaboration is another key strategy adopted by the leading companies to acquire smaller organizations to improve their product portfolio and gain additional market share. Collaborations between companies, hospitals, and academic institutions are expected to positively impact the market growth.

The year 2017 witnessed the major strategies adopted by the leading manufacturers to gain a hold of their market positions.

In June 2017, Philips launched the IntelliVue X3 patient monitor, designed for portable, uninterrupted monitoring during in-hospital transport and at the bedside.

In May 2017, Medtronic released its patient monitoring and clinical decision support (CDS) platform Vital Sync in the United States. The platform combines remote monitoring software with wireless monitoring devices and a series of customizable CDS mobile applications to improve clinical protocol implementation and management of patients on medical-surgical floors and in the ICU.

In April 2017, Masimo equipped its existing monitoring platform Root with a supplemental display system Kite, to expand the visibility of patient data for clinicians by allowing data from Root to be viewed on bigger screens, in customized configurations, in operating rooms, cardiac theaters, and emergency rooms via a wired or wireless connection network.

In January 2017, Hill-Rom signed a definitive agreement to acquire Mortara Instrument for an estimated USD 330 million to expand and enhance Hill-Rom’s offerings in the diagnostic cardiology and vital sign monitoring markets, as well as accelerate growth for Mortara technology on a global scale.

Market Trends

The escalating demand for home monitoring products like RPM and mobile health (mHealth) has gained significance with vendors increasingly establishing partnerships and joint ventures with telcos, healthcare providers, insurance companies, governments, and other stakeholders. With spurring advances in innovation and technology, the patient monitoring equipment market is expected to take multifold leaps over the next few years.

Evolution of remote patient monitoring equipment. Advances in wireless communication technology and wearable devices for medical telemetry have enhanced the scope of monitoring solutions for individuals inside and outside the hospital premises. The latest monitoring devices available in the market allow to record and transmit digitized vital signs in the form of signals from an individual device to the computer or hand-held PDA of healthcare professional instantly, thereby reducing the duration of evaluation and treatment. With such robust R&D activities, the market has witnessed the development of first-generation monitoring services, which involve the collection and transmission of data within a hospital using wireless local area network (L.AN).

Increasing demand for better algorithm-based monitoring equipment. The worldwide research is focusing on measuring parameters through a noninvasive or less-invasive approach, developing improved algorithms, and integration of information for medical records that improves workflow for the hospital staff. Development of new algorithm-based monitoring equipment will overcome the issues related to alarm management and analytics in the near future.

Paradigm shift of multiparameter equipment from hospital care to ambulatory and mobility services. With the emergence of technological advances, multiparameter patient monitoring equipments are finding use in emerging applications such as transportation and ambulances, outpatient care, sleep screening applications, ambulatory and gastroenterology departments, and home healthcare. This is expected to shift the demand in the market owing to the higher potential in transport and ambulatory applications, as compared to ICU departments, which usually require less number of multiparameter patient monitoring equipments.

Increase in demand for homecare monitoring equipment. With the individuals giving higher priority to reduce their hospital cost and longer hospital stays, home-based healthcare monitoring is gaining momentum. As the focus on quality care and disease management escalates, adoption of portable, self-care, multiparameter patient monitoring equipment is expected to flourish in the years to follow.


The patient monitoring equipment industry is witnessing a gradual shift from traditional monitoring methods to smart wireless remote monitoring technologies, driven by innovation and the development of state-of-the-art monitoring devices and technologies. With advances in wireless communication technology and wearable devices, RPM is evolving from a nice-to-have to a must-have.

Wearable monitoring technologies hold tremendous promise to transform patient care in the future, with the companies working to integrate wearable sensors into software. Healthcare providers can now deploy wearable devices and mobile applications to process and analyze massive amounts of data, which can be used to improve patient well-being and living standards.

The future of healthcare will be driven to a large extent by the design and development of new innovative technologies. Researchers and leading manufacturers are leveraging their capabilities to develop more holistic applications for RPM by investing in the development of technologies with improved battery life and easy portability in the next few years to meet the requirements of end-users.

If technologies continue to advance at their current pace, one will likely see a widespread adoption across patient demographics in no time at all. As these monitoring applications become more widely implemented, they are poised to revolutionize both quality of life and quality of care – one patient at a time.

Industry Speak

 The Future is Already Here: Why You Should Choose Modular Patient Monitors

Patient monitors are found in virtually every care setting in a hospital especially so in critical care units where the patient’s health condition is monitored intensively for timely intervention. Monitors allow caregivers to track all relevant clinical parameters on a single dashboard to get a holistic view of the patient’s clinical condition. The right monitor would enhance the healthcare provider’s efficiency by predicting risk ahead of time.

Monitors are either pre-configured or modular. Most pre-configured monitors and associated central monitoring systems are economical in the short term but prove to be inflexible to accommodate other critical parameters and expanding needs. Therefore, when the hospital wants to upgrade and buy modular monitors with advanced features and parameters, many a times the preconfigured monitors end up being redundant because the central station supporting modular monitors and even accessories are different.

With advancing technologies and newer devices being brought into clinical practice, preconfigured monitors would prove to be a short-sighted solution. Typically, a pre-configured monitor from the same manufacturer will not have the same set of must-have clinical features such as multilead arrhythmia monitoring as they would have in their modular solution.

Modular monitors allow scalability in terms of connectivity to HIS, charting, and web viewing solutions as well as parameters to be measured. In an ICU it is very important to have modularity of parameters such as EtCO2 for patients with an artificial airway and invasive blood pressure measurements. Some studies have shown that failure to use capnography in patient’s dependent on an artificial airway contributed to more than 70 percent of ICU related deaths or persistent neurological injury.

Modular monitors allow better work flow between beds and aids in correct monitoring of patients from central stations, while preconfigured monitors require resetting parameters and changing service menu settings by the biomed engineer every time the monitor is moved across beds (because all monitors in the ICU do not have the same configuration) thus adversely impacting workflow in an already stressed ICU.

It is a wise decision to invest in a modular type of monitor that fulfills the clinicians’ requirements for now and for the future, delivering better healthcare outcomes and providing the right return of investment.

Cyrus deSouza
Business Manager – Critical Care Monitoring,
GE Healthcare South Asia

Industry Speak

 Commitment to Innovation and Customer Service

We strongly believe that growth of any company depends on its attitude toward customer needs, support, and the changing market conditions. Growth totally depends on co-operations and synergy rather than unhealthy competition. Our vision emphasis is defined and we are focusing on our innovative technology and providing effective solutions to customers. India as an emerging market offers ample opportunities to us. Nihon Kohden has the evident advantage of being one with its enormous strength in R&D, innovation, manufacturing, and marketing for Indian and emerging markets.

We at Nihon Kohden corporation have many innovations to our account including invention of pulse oximetry in 1972, world’s first wearable, mainstream CO2 sensor for nonintubated patients, redefining quality of care with esCCO (estimated Continuous Cardiac Output), by introducing volumetric information to all care levels. Synthesized 18-lead ECG: A new technology for more informative ECG exam.

Capnography continually and instantaneously monitors a patient’s carbon dioxide concentration in respiratory gases and is an indirect monitor of oxygenation that helps in the diagnosis of hypoxia.

The Nihon Kohden lightweight Cap-ONE is the world’s first mainstream CO2 sensor specifically designed for both intubated and non-intubated patients. This is world’s first mainstream CO2 sensor with fastest warm up time of five
seconds, IPX 7. Most importantly it is strong, unlike traditional mainstream sensors, which
are very fragile. Also it does not need any calibration.

We have also launched the Cap-ONE mask, which is an originally designed open face oxygen mask for patients who are receiving supplemental oxygen. The combination of Cap-ONE and Cap-ONE mask reliably detects respiratory depression and avoids serious complications at all care levels.

Nihon Kohden intends to keep growing as a leading medical electronic equipment company.

  • We will develop innovative products based on our engineering specialty, the human–machine interface
  • We will continue to develop competitive, extraordinary quality products in our core market areas
  • We will use our strong distribution network and experience in medical equipment to expand into a wider range of markets

Anil K. Srivastava
Medical Equipment – Sales & Marketing, Nihon Kohden

Industry Speak

 The Past, Present, and Future

Patient monitoring has been around since the dawn of mankind, though there was no umbrella term for the methods used to track heart rate, body temperature, breath rate, and other factors. Compared to the 1600s when spirit thermometers were
used to measure body temperatures and pulse rate was timed with the help of a pendulum, patient monitoring has come a long way.

Today, technological advancements have made it possible to have sophisticated and detailed analysis, compact equipment etc., and have also led to the development of specialized monitoring systems – designed to suit healthcare professionals’ specific requirements like cardiac monitor which includes basic parameters with cardiac output, IBP; anesthesia monitor which can measure the depth of anesthesia, neuromuscular transmission etc.

The introduction of modular technology has enabled professionals to change the features of their monitor by simply changing the modules as per requirement. However, this was all in the past. What we look forward to now is to know what the future has in store for us.

Talking about patient comfort, remote patient monitoring will gain more prominence. As of 2016, India’s aging populace comprises 13.39 percent of the total population and is expected to go up in the coming years. This gives rise to the need for monitoring patients where they live. Telemonitoring in India is not yet commonplace, despite its adoption worldwide. In those rare cases which require remote monitoring, medical institutions still rely on old technologies. The very near future will see a change in the way a remote patient’s data is transmitted, mainly through a 3G (and hopefully 4G) cellular network. Also, transport patient monitors will be further lightweight with massive battery backup.

For medical institutions, acquiring a patient monitor is a huge investment. Rapid technological advancements result in a discovery that attempts to change the face of healthcare. At the same time, it also increases the cost of monitors. This is where professionals end up choosing cheap alternatives that are neither reliable nor a medical marvel. Subsequent years need to focus on lowering the price without compromising on technology.

To conclude, monitors are a prime source for doctors to understand their patients’ live condition. These and various other developments in patient monitoring technology have the potential to improve medical outcomes. Here is to hoping that 2018 is the year of significant breakthroughs.

Sreenath Jayan
Product Specialist,
Heyer Medical AG

Industry Speak

 The patient monitoring market seems to be on a growth curve with an approximate growth of 20 percent over previous years with not much increase in players. Hence, the current players are only increasing their market share.

With not much new technology coming, noninvasive technologies are increasing with features like cardiac output and, CNAP (continuous non-invasive arterial pressure measurement), and PWA (pulsed wave analysis).

Some of the factors driving the market include new hospitals, expansion of current hospital beds, replacement market, and mainly state government spending money on developing healthcare system delivery through district hospitals and PHCs.

Customers want the best quality at the lowest possible prices and this is the biggest challenge all the suppliers are facing and this is applicable even to the established companies in the field.

To provide best quality at an affordable price is our challenge with the increase in demand for the monitoring products.

Overall it is a growth-oriented market but it is very difficult to sustain the market share. Homecare market is expected to pick up in the years to come and there can be a significant change in the way patients are treated and the patient care provided.”

V. Balakrishnan
Sr. Vice President,
Schiller Healthcare India Pvt. Ltd.

Industry Speak

Recent Trends in Blood Pressure Monitoring Devices

India’s healthcare spend as a percentage of GDP (2.5 percent) is still amongst the lowest globally and there are significant challenges to be addressed, both in terms of accessibility of healthcare services and quality of patient care at an affordable price. In the recent years, the burden of cardiovascular diseases has increased exponentially in emerging economies creating a huge need for diagnostic equipment of good quality that can help in early detection and diagnosis of disease and thus facilitate suitable and timely treatment.

Patient monitoring is a dicey game wherein monitoring remotely becomes immensely important as the symptoms may set in well after the patient leaves the physician’s set up. Just like Holter monitors being used in patients with suspected cardiac arrhythmias, the need for remote continuous monitoring is the need of the hour when it comes to blood pressure monitoring.

The traditional auscultatory measurement of BP has limitations such as momentary BP values that are influenced by external circumstances, observer bias, or whitecoat hypertension. Many patients with controlled hypertension at the medical settings show BP levels above the thresholds of out of the medical settings and vice versa.

Recent advancements in technologies have helped us solve exactly this problem by helping us measure BP continuously within a 24-hour time period. An ambulatory blood pressure monitor (ABPM) is a device that measures blood pressure, tracks the changes, and reports the trend. An ABPM can be provided to the patient to carry along and thus helping with 24-hr BP measurement outside of a standard hospital or outpatient care setting. ABPM correlates more closely with end-organ complications than BP levels measured in the clinic. Especially for patients with uncontrolled hypertension, ABPM turns out to be a handy tool. With the varying levels of BP measured over different time intervals, it gives as many data points as possible to the physician to diagnose the conditions and circumstances that lead to varying levels of blood pressure.

Newer technologies are on the rise which helps consumers measure BP through a wrist band. While the increasing trend in monitoring is welcome, whether or not a wrist type measurement will be accurate remains to be tested.

Sunil Khurana
CEO and Managing Director,
BPL Medical Technologies Pvt. Ltd.

Industry Speak

 Clinical Assistive Applications: An Ideal Associate

In today’s scenario, patient monitoring in high-acuity areas provides enormous data to the clinicians for decision making but it is troublesome to draw inference regarding its full strength from this complex data. As the interpretation of these complicated and interlinked parameters is a tedious job, so the result is only half of the displayed parameters are taken into account for further diagnosis.

In ICU, the biggest challenge for clinicians is to focus on three important aspects, hemodynamics, ventilation, and sepsis control. Each aspect is flooded with bundles of numerical data, which create a lot of mental workload
to draw a conclusion on implementation in patient treatment.

This problem can be handled in an effective way by transforming these numerical values into more informative visual graphics and step-by-step guided procedures. It is obvious that graphical displays absorb the large amount of data quickly and allow a faster detection of changes in physiologic variables as compared to alignical numerical display. So, this need has created a demand for support tools such as Clinical Assistive applications.

These applications are designed as per clinical workflow in different care areas, which help clinicians to achieve their goal directed therapies in a time saving and convenient way. These tools are meant to track the patient progress, which aids in detecting critical conditions earlier and improving the outcome. CAA tools like graphical representation of ST, QT/QTc analysis, 24 hours ECG summary make a difference in the cardiology segment.

For tracking real time patient progress on the hemodynamic and ventilation front, Hemosight is an ideal companion to trust. SepsisSight, is a vigilance tool which continuously checks the patient data and if required, it prompts the user for necessary interventions indicated by protocol.

Balance of anesthesia display reveals the patient’s response to changes of anesthesia conditions by an intuitive triangle and may help in titrating analgesia requirement of each individual.

These tools are designed with an intention to provide enormous benefits to clinicians in the sense that they allow a check of hundreds of criteria and act as an ideal associate to help in decision making.

Manju Goyal
Sr. Application Manager – PMLS and SU,
Mindray Medical India Pvt. Ltd.

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