Patient Monitoring – The Future Of Connected Care

Increased demand is prompting vendors to develop new products in this highly competitive segment.

The industry expects a continued push for more monitoring outside the walls of the traditional hospital. Whether it is urgent care, long-term care, or a hospital-at-home concept, there is a desire for care to be delivered in more places than ever before.

Healthcare around the world is under increasing pressure with many healthcare providers now recognizing the urgent need for a wider system transformation. A large number of healthcare organizations are evaluating clinical systems that provide the potential of improving patient care in areas of the hospital that previously did not monitor patients. An example of this is monitoring of patients in general care areas to identifying subtle signs of deterioration in a patient, hours before a potential adverse event. By identifying which patients may need more focused attention, healthcare providers can make a significant difference in patient care.

Today, technological advancements have made it possible to have sophisticated and detailed analysis, compact equipment, and have also led to the development of specialized monitoring systems – designed to suit healthcare professionals’ specific requirements like cardiac monitors which include basic parameters with cardiac output, IBP; anesthesia monitors which can measure the depth of anesthesia and neuromuscular transmission. The introduction of modular technology has enabled professionals to change the features of their monitor by simply changing the modules as per the 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. Advances in cloud computing and IoT are slowly catching up with patient monitoring equipment (PME). Various IoT startups are focusing on manufacturing PME, with key focus on areas such as telemedicine, remote monitoring, and behavior modification.

India is amongst the lucrative investment destinations for PME and is expected to show high growth opportunities in the years to come. However, 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 low-cost alternatives that are neither reliable nor a medical marvel. Subsequent years need to focus on lowering the price without compromising on technology.

Indian market dynamics
The Indian market for patient monitoring equipment in 2017 is estimated at Rs. 462 crore, and 62900 units. This is a 4.5 percent growth in value terms and 14.5 percent increase by volume over 2016. This includes the HLL procurement of Rs. 80 crore.

The premium segment has an 11.93 percent contribution by value and a 2.94 percent contribution by volume. The high-end systems constitute 21.6 percent share in value terms and 9.87 percent in volume terms. The belly of the segment continues to be competitively priced systems, the mid-end and low-end segment, also referred as the value and super value segments dominate with a combined share of 87.2 percent in volume terms and 66.4 percent in value terms. 

The government hospitals were large buyers in 2017. HLL invited bids in 2017, and then again in 2018. It is gearing up to equip the MCH hospitals planned by the government. 2019 is expected to see this trend continue, as the government has decided that private sector companies can provide healthcare services in district hospitals to those who suffer from non-communicable diseases, as there is a visible growth in demand for these services after the launch of Ayushman Bharat-National Health Protection Mission (NHPM). NITI Aayog has presented guidelines and a model concession agreement that will enable private companies to start operating in district hospitals, which were exclusively government-run earlier.

With the recent emphasis of the government on procuring only indigenous equipment, this segment is seeing a major drop in quality of equipment. Some leading brands, earlier marketing products from Japan and USA switched to sourcing from China and also introduced competitively priced products, so as not to be absent in a fast moving segment. Indigenous players, which were dominant in this segment, are in turn finding it tough to match these prices and are now facing competition from the leading brands too.

Patient monitoring, which needs to be of the highest quality, as it monitors vitals, from the moment the patient gets into an ambulance for the hospital, till he is discharged and plays a very large role in determining the treatment administered is finding a shift in the country to basic, low-end systems being procured. Hospitals in tier 2 and tier 3 cities, having to provide a patient monitoring system with every bed, give very low priority to what it is capable of doing.  Medical colleges with the recent change in fee structure, facing a financial crunch, have revised the specifications for the patient monitoring systems they are seeking. On the other hand, globally the segment is maturing to a never-before level.  Boxes are making way for state-of-the-art; customized end-to-end solutions that provides seamless data flow from devices to monitors to EMRs, absolutely the highest levels of clinical excellence.

Global market
The global PME market is projected to reach USD 25.31 billion by 2023 from USD 19.14 billion in 2018, at a CAGR of 5.7 percent. The device that is expected to contribute to the growth of the global PME market is the cardiac monitoring device. These monitoring devices currently hold the largest share of the market in regard to sales and revenue within product segmentation during 2018–2023. Heightened growth in cardiovascular disease is expected to significantly fuel the overall growth of the PME market on a global scale. An estimated 17.7 million people perished worldwide as a result of cardiovascular diseases. Patient monitoring devices could lower the incidence of death as a result of heart-related conditions.

There are a variety of factors that are expected to provide impetus to the PME market on a global scale.

The increase in size of the aging population will largely contribute to the augmentation of this market. As people age, they are at risk for developing health conditions that require monitoring; for example, type 2 diabetes, high blood pressure, and cardiac conditions.

An increased rise in chronic diseases is also expected to push demand. It is also believed that a greater demand for home-based monitoring devices will boost the value of this market. The aging population and those who have chronic diseases prefer to receive care in their homes instead of in a hospital, which has led to the increased need for home-based monitoring devices.

Medical facilities need to contain the average cost of healthcare. These devices can help to bring down the expenditure of healthcare, as they make it easier for patients and medical professionals to keep track of health concerns and provide rapid and more improved treatment, thus reducing the amount of money spent on the treatment and care of certain medical conditions.

Though the PME market is expected to experience significant growth during 2018–2023, there are factors that could inhibit its growth, preventing it from reaching its fullest potential. The biggest factor that will pose a challenge for this market is the resistance of healthcare professionals regarding the adoption of patient monitoring systems. A lack of a proper reimbursement policy, as well as stringent regulations are also restraining factors.

Vendor update
Mindray to incorporate Eastman’s medical polymers into patient monitors. In September 2018, Mindray selected Eastman’s medical polymers into its current generation of patient monitors. Mindray’s devices provide innovative and scalable patient monitoring from the bedside to transport and mobility monitors. Eastman’s medical polymers provide excellent chemical resistance and durability, ensuring compatibility and efficacy when using today’s aggressive disinfection solutions. In addition, the strength of the polymer overcomes the daily impact stresses that come with greater portability and patient-worn devices. This is important because it reduces costs directly related to patient care delays (due to device failure) and results in a reduction in the total cost of ownership of medical equipment.

New alarm management solution from Dräger. In August 2018, an integrated clinical alarm management solution will integrate Ascom Unite Connect for clinical systems software with Dräger Infinity patient monitoring systems in North America. The joint clinical alarm management solution extends the reach of patient alarms generated by Dräger’s patient monitoring system to mobile caregivers. The alert message provides critical data and related contextual information right to the caregiver’s mobile device. The mobile delivery of waveform images adds a contextual dimension by helping increase awareness of the patient’s condition and distinguishing between artifacts, false alarms, and real alarms. Patients benefit from quicker response times to events.

Nihon Kohden launches a new remote monitoring system. In March 2018, Nihon Kohden released its NK-HiQ wireless patient monitoring system, a smart, secure data acquisition, and management platform for hospital settings. The NK-HiQ uses wi-fi technology to capture and manage patient data from admission to discharge via its suite of central station, bedside, transport, and wearable patient monitors. All monitors come premium as standard, or fully featured in a base configuration, to quickly capture changes in patient condition. In addition, a proprietary algorithm in the wearable monitors helps detect falls and wandering. In addition, the system enables continuous remote monitoring and robust data collection even during transport, one of the most high-risk times in the care continuum. The NK-HiQ system’s smart design ensures patient data is captured and managed without compromise.

Hill-Rom releases enhanced features for Connex monitoring devices. In March 2018, Hill-Rom debuted enhanced workflow efficiency and security features for its Welch Allyn Connex vital signs monitoring portfolio. The devices now integrate secure access technology from Imprivata, a healthcare IT security company, to enable stronger protection of patient data collected or stored on Connex devices used in EMR-connected workflows, while providing clinicians a faster, easier way to access or update patient data. This faster, more efficient log-in to the device helps clinicians move quickly to their primary focus – patient care – while also protecting data integrity into the EMR.

Philips debuts a fully integrated suite of enhanced patient monitoring solutions. In January 2018, Royal Philips has launched next-generation patient monitoring solutions in the United States of America. The enterprise-wide system consists of bedside, transport, mobile, and central station monitoring technology backed by a new approach to consulting, training, service, and customer support, including a full range of product support and expert services. The latest offering features the IntelliVue X3, a transport monitor with intuitive smart-phone-style operation released in 2017. By harmonizing monitoring system updates and improved service agreements, the solution is designed to help clinicians improve patient care, drive clinical performance, and assist health systems in lowering costs.

Medtronic sells off part of its patient monitoring business. In August 2017, Medtronic plc completed the previously announced sale of its patient care, deep vein thrombosis (compression), and nutritional insufficiency businesses within the patient monitoring and recovery (PMR) division of its minimally invasive therapies group (MITG) to Cardinal Health Inc for USD 6.1 billion in cash.

Patient monitoring biosensor gets expanded FDA clearance. In August 2017, VitalConnect Inc received its fifth 510(k) market clearance from the US FDA that extends the wear duration for the company’s existing Class 2 wearable patient monitoring biosensor, the VitalPatch. The clearance means the device can now be worn for up to 120 hours (5 days). The VitalPatch biosensor is a single-patient use and fully disposable device, providing convenience for caregivers and comfort for patients. The device is also used beyond the hospital walls where continuous monitoring is needed, including post-discharge monitoring, remote patient monitoring, and in clinical trials.

On the horizon
The industry expects a continued push for more monitoring outside the walls of the traditional hospital. Whether it is urgent care, long-term care, or a hospital-at-home concept, there is a desire for care to be delivered in more places than ever before. The healthcare industry will see the shift of medical wearables from the experimental phase to mainstream healthcare. Wearables will become an integral part of the patient monitoring market, with the potential to address stress monitoring, blood glucose monitoring, and cardiac monitoring. There is potential for wearables to monitor otherwise undetectable behavior and physical changes in patients that could advance to a disease like Alzheimer’s, whose symptoms progress gradually over time. For the longer-term evolution of patient monitoring, artificial intelligence will continue to drive the technology for improved clinical decisions and the analysis of patient data.

Connected care technology with machine learning capabilities will empower clinicians to make proactive care decisions. By aiding clinicians with the most crucial data points at the time needed most, they have the opportunity to reduce unfavorable patient outcomes and improve patient care. As for patient data analysis, the industry is beginning to understand specific use cases for the immense amount of patient data collected by connected technologies, and the industry expects much more specialization to improve patient care as a result of this data in the next few years.