PME – Empowering healthcare professionals

The spectrum of advancements in patient monitoring spans from central station monitors to EEG monitors, enhancing the devices’ capabilities, applications, and connectivity.

Significant advancements have revolutionized the patient monitoring equipment (PME) sector in the last decade, particularly in India. Previously limited to basic bedside monitors, PME has evolved. Driven by the increasing demand for remote and continuous access to patient data, particularly during the Covid-19 pandemic, the ability to monitor patients from any location has gained remarkable traction, enhancing healthcare outcomes in various settings.

Patient monitoring devices are now indispensable for continuously measuring critical parameters such as heart rate, respiratory rate, blood pressure, oxygen saturation, and glucose. These devices are vital in high-stakes environments like ICUs, emergency rooms, operation theaters, and home care settings. The availability of single-parameter monitors (e.g., EEG, EMG, blood glucose monitors) and multi-parameter devices, which track several physiological signs, has transformed patient care by delivering real-time, actionable insights.

The rise of cutting-edge technologies has reshaped PME even further. Developments, such as AI integration, biostickers, functional near-infrared spectroscopy (fNIRS), and wireless monitoring systems, allow healthcare providers to identify high-risk patients and intervene early. For instance, the biosticker is a breakthrough on-body sensor that enables effortless continuous monitoring of vital signs in home care settings. Its data analytics capabilities offer clinicians crucial insights at a fraction of the cost of traditional remote monitoring devices.

Imagine entering a bustling hospital, where each patient is connected to sophisticated, data-driven machines that continuously monitor and report vital signs. These systems, silent yet critical, support healthcare professionals by quickly alerting staff to any changes that may require urgent attention, ensuring the safety and well-being of patients. These technologies work tirelessly to reduce preventable complications, providing more efficient, cost-effective healthcare.

Indian market dynamics
The Indian market for patient monitoring equipment finally turned the corner in 2023. It has been declining every year since 2020. It is estimated at ₹700 crore and 90,000 units in 2023. Of this, 30 percent of the market contribution is from patient monitoring accessories and parts.

Sixteen AIIMS hospitals procured equipment in 2023, with a preference for advanced patient monitoring equipment with features like invasive blood pressure monitoring, capnography, and arrhythmia detection. This included digital gas flowmeters and anesthesia monitoring for operating rooms. The GeM portal invited bids for central institutes and medical colleges.

 

Leading players* 2023
Tier I	Philips and Mindray
Tier II	Nihon Kohden, Contec, Drager, BPL, Skanray, Allied Medical, Recorders & Medicare, Comen, and GMI
Tier III	Biolight, GE, Edan, Schiller, Creative, and Mediana
*Vendors are placed in different tiers on the basis of their sales contribution to the overall revenues of the Indian patient monitoring equipment market. ADI Media Research

The new hospitals being set up by the private sector continue to drive this segment. The demand for equipment in the mid-end segment is finding traction, with 5-parameter equipment being the norm. A couple of brands are offering the corporate hospitals soft terms as a 5-year payment plan, with payment starting from year the third year.

While Mindray and Philips remain the leading brands in this segment, BPL, Skanray, and Allied Medical are reaping the advantage of being Made in India brands. However, the threshold minimum incremental sales of manufactured goods under the PLI scheme are perceived as too high. Nihon Kohden’s growth strategy is innovation and strategic partnerships. Comen is attempting to make inroads with Genworks as its marketing partner. Yonker and Bioloight’s presence can no longer be ignored. Some brands lost market share, as one of the mandatory requirements for an import license by CDSCO is the CE mark.

Hospitals increasingly demanding patient monitors with the invasive blood pressure (IBP) parameter to measure the patient’s vital signs accurately and in real time, particularly in critical care units, operating rooms, and emergency departments. During surgeries, especially those involving anesthesia, continuous monitoring enables timely adjustments to medication dosages or ventilation strategies. Furthermore, in critical care units, IBP monitoring helps identify and manage fluctuations in blood pressure, ensuring immediate intervention in case of a hypertensive crisis or hypotension.

Capnography is increasingly becoming a routine part of Indian anesthesia practice. It is now part of the standard of care for all patients receiving general anesthesia and is part of routine monitoring in the pre-hospital and acute care settings. Knowing how effectively CO₂ is being eliminated by the pulmonary system (ventilation), perfusion, and metabolism is helpful. Every operating theater is equipped with capnography monitors providing numerical EtCO₂ values. As the demand for high-quality pre-hospital care continues to grow, the role of EtCO₂ monitoring in emergency vehicles and portable monitors will only become more critical.

Remote patient monitoring continues to gain traction in other cities of the country. And there has been much innovation in this space. Powered by AI and ML technology, it allows for reliable predictions and analyses. It has now progressed toward a more advanced phase, acute care monitoring. The focus has shifted to remotely addressing more severe and immediate health conditions, requiring continuous and real-time sensors. The next phase of RPM’s advancement will converge telehealth with chronic and acute monitoring into an integrated platform. As a result, healthcare services will be streamlined, providing a comprehensive solution for ongoing and immediate health concerns.

Moreover, India’s healthcare sector is transforming remarkably, thanks to the adoption of artificial intelligence (AI) and machine learning (ML) in patient monitoring. These powerful tools enable the analysis of vast amounts of patient data, allowing healthcare providers to uncover subtle patterns and anomalies in vital signs and medical history. This capability facilitates early detection of potential health issues before symptoms arise, enabling timely interventions and improved patient outcomes.

Advancements in sensor technology and connectivity options, such as the widespread adoption of 5G networks, are driving the development of accurate and reliable patient monitoring devices. These innovations ensure that healthcare professionals receive real-time and precise data, enabling them to make informed decisions promptly.

Remote patient monitoring (RPM) is a transformative technology in healthcare, enabling continuous monitoring of patients outside traditional clinical settings. The Indian hospitals are not far behind.

In December 2023, AJ Hospital and Research Centre adopted Dozee’s advanced AI-based contactless and continuous RPM and warning system (EWS) on 50 beds in its private ward. The technology is patented and made in India, and it significantly impacts patient safety, clinical outcomes, and operational efficiency.

Dozee was founded in 2015 by IIT graduates Mudit Dandwate and Gaurav Parchani. The solution for non-ICU ward beds with the next-generation ambulatory connected patient monitoring systems enables contactless continuous vital monitoring, which is cloud-enabled and comes with a central and remote patient monitoring capability.

Dozee’s early warning system (EWS) tracks the trends of vital parameters and provides alerts to healthcare providers for early detection of patients’ clinical deterioration, enabling timely medical intervention. Dozee uses Al-based ballistocardiography (BCG) for contactless vitals monitoring.

In January 2024, Apollo Hospital Seshadripuram partnered with LifeSigns to adopt a cutting-edge 24/7 wireless remote patient monitoring system. This collaboration marks a significant milestone in precision healthcare and proactive patient management, showcasing the transformative potential of AI in revolutionizing healthcare delivery. This innovative system utilizes biosensors worn by patients to continuously track vital signs, including ECG, blood pressure, SPO₂, and more. Real-time data is securely transmitted to a platform accessible to medical professionals, facilitating continuous monitoring and early identification of potential complications. The system aids in effective healthcare expert resource allocation, prioritizing patient care based on real-time needs and minimizing unnecessary interventions.

That said, it has its challenges. Integrating and using these advanced systems by itself is a challenge. Several issues need to be taken care of:

• Technical. Ensuring device interoperability, reliable data transmission, and accurate calibration is crucial. Incompatibilities between devices and network issues can disrupt data flow and accuracy.
• Data security. RPM systems must comply with regulations like GDPR and HIPAA to protect patient data. Cyber-security threats and ensuring patient consent and data ownership are also significant concerns.
• Patient engagement. Encouraging consistent use of RPM devices and addressing digital literacy barriers are essential. Providing adequate training and motivation can improve patient compliance.
• System integration. Seamless integration with EHR and adapting clinical workflows to incorporate RPM can be complex. Effective coordination among healthcare teams is also necessary.
• Financial challenges. High initial costs, developing reimbursement models, and measuring return on investment (RoI) are key financial hurdles for RPM implementation.
• Regulatory and legal issues. Staying updated with evolving regulations, managing legal liabilities, and ensuring quality standards are crucial for successful RPM deployment.

Technological innovations
Technological innovations are critical in addressing healthcare challenges worldwide, particularly by enhancing patient care and mitigating staff shortages. These advancements, such as AI-based remote patient monitoring systems, wearables, and automated vital signs capturing devices, are improving efficiency. They allow real-time tracking of vital signs like heart rate, oxygen levels, and blood pressure, even from remote locations. This reduces the strain on healthcare workers, streamlines workflows, and minimizes errors due to manual data entry, enhancing patient outcomes and enabling personalized care.

By automating routine tasks and integrating predictive analytics, PME supports clinical decision-making and alleviates nurse workload, addressing burnout and staffing shortages. Additionally, features like alarm fatigue management and universal user interfaces reduce stress, making technology more accessible and efficient for new healthcare staff and ensuring better patient monitoring even in the face of workforce limitations.

Moreover, PME has seen significant advancements, transforming healthcare delivery. Multi-parameter monitors integrate data from various devices, providing a centralized patient profile for improved decision making. Central station monitors transmit real-time data to mobile devices, enabling faster access for healthcare providers. Remote monitoring solutions, supported by wireless networks, allow professionals to track patients outside traditional settings.

In addition, bluetooth technology has recently standardized how sensor data is collected from personal health devices (PHDs) for remote monitoring. This new bluetooth standard enhances interoperability, enabling more PHD options for healthcare providers and improving patient engagement in their health management. These innovations drive a more connected, efficient, and patient-centric healthcare ecosystem.

Global market dynamics
The global patient monitoring devices market is estimated to reach USD 107.93 billion by 2034, up from USD 48.18 billion in 2024, growing at a CAGR of 8.4 percent. The growth rate of the patient monitoring devices market is rising rapidly. These machines are useful in home settings as well as hospitals.

The pressure on the health sector is high. The patient population is rising exponentially, leading to the massive growth of patient monitoring devices. The adoption rate of these devices is higher as they provide quick and digital results. The higher investment in the medical devices and product market is creating more development in the patient monitoring devices market. The market analysis of patient monitoring devices shows that expansion will be high.

Although Covid-19 pandemic initially caused a decline in demand for patient monitoring devices, the market has since recovered. In 2020, the market faced a downturn as access and sales of these devices diminished. During the pandemic, hospitals primarily focused on Covid patient care. However, the need for remote monitoring grew significantly during this period. The patient monitoring devices market expanded its production to meet the increased demand.

The remote segment of the patient monitoring market experienced high growth, and the need for respiratory, cardiac, glucose, and temperature monitoring devices also surged during the Covid-19 period. These devices proved essential during the pandemic. Supply disruptions that affected the market began to improve in 2021. Post Covid-19, the market has shown positive growth prospects, with the adoption of patient monitoring devices rising.

Infant wearable devices, designed for newborns, are in high demand, driving the patient monitoring devices market. These wearables enable in-home monitoring. Advances in sensor technology, which are key to wearable devices, ensure accurate and reliable patient results. These factors positively impact the demand and revenue growth of the patient monitoring devices market.

The major restraints of the patient monitoring devices market include risks associated with invasive procedures, such as discomfort, pain, and complications like nerve damage, thrombosis, and necrosis. These factors can discourage adoption, particularly in cardiac monitoring. Additionally, the high cost of devices and competitive pricing pressures may lead to lower-quality products and reduced affordability, further limiting market growth. These challenges could hinder the widespread adoption of patient monitoring devices in the coming years.

Within the region, North America is a leading region of the patient monitoring devices market and holds a market share of more than 43 percent in 2023. Growing R&D efforts, rising infectious diseases, and the presence of key market players are driving the rapid expansion of advanced patient monitoring devices in the region.

The Asia-Pacific region is growing significantly, with over 23 percent market share in 2023, driven by the rise of chronic diseases due to poor lifestyle habits. Regular monitoring of these conditions fuels market expansion.

The hospital segment is estimated to contribute the largest market share by end-use, holding 52 percent in 2023. The surge in demand for better-quality medical services and effective disease diagnosis in hospitals has fuelled the market’s growth.

Major players in the global market include 3M, Boston Scientific Corporation, Covidien, Schiller, Drägerwerk AG and Co. KGaA, GE Healthcare, Medtronic Plc., Mindray Medical, Omron Healthcare, Nihon Kohden Corporation, Biotricity Inc., Natus Medical Incorporated, BD, Edwards Lifesciences Corporation, Koninklijke Philips N.V., and DexCom, Inc.

Unveiling different types of systems
Patient monitoring systems offer a range of innovative technologies to track and assess patients’ vital signs continuously.

• Cardiac monitoring systems monitor the heart’s electrical activity and overall cardiovascular health. They are instrumental in diagnosing and managing cardiovascular conditions, enabling healthcare providers to deliver timely interventions and optimize patient care.
• Respiratory monitoring systems are designed to assess and monitor respiratory function, measuring parameters like oxygen saturation and respiratory rate. They help detect respiratory distress and optimize ventilator settings.
• Neonatal monitoring systems are specially designed for newborn infants; these track vital signs to ensure early detection of health issues and promote optimal neonatal health.
• Neurological monitoring systems focus on assessing and monitoring brain function and neurological activity.
• Blood pressure monitoring systems measure and track blood pressure levels, which is crucial for assessing cardiovascular health and managing hypertension.
• Temperature monitoring systems measure body temperature continuously, and are vital in critical care settings for detecting changes that may indicate underlying health conditions or infections.
• Remote monitoring systems have become particularly valuable in home healthcare settings, enabling patients to receive continuous care while minimizing the need for frequent hospital visits.

Understanding various types of patient monitoring systems empowers healthcare professionals to deliver timely interventions, optimize patient care, and improve outcomes. Each type serves a unique purpose, catering to specific medical needs and enabling personalized patient care.

Real-time, non-invasive technologies
The future of patient care is here, driven by advancements in real-time, non-invasive monitoring technologies. Worcester Polytechnic Institute (WPI) is at the forefront, developing groundbreaking sensors that enable the simultaneous monitoring of thousands of patients, particularly infants, without the need for cumbersome equipment. Their innovative approach, utilizing Cadence tools, enhances the accuracy of vital variable measurements, such as oxygen and carbon dioxide levels, which are crucial for assessing and optimizing patient care.

Patient monitoring systems now offer unparalleled convenience and precision. From cardiac and respiratory care to neonatal and neurological monitoring, these systems provide continuous, real-time data, empowering healthcare professionals to make timely, informed decisions. Wireless technology has further revolutionized this field, allowing patients to move freely while maintaining seamless data exchange with electronic health records (EHRs).

Integration with EHR
Integrating patient monitoring systems with EHRs revolutionizes patient care by providing a unified view of health data. This integration bridges the gap between patient monitors and clinical records, offering numerous advantages that enhance the quality of care.

Historically, patient monitoring systems operated in isolation, leading to disjointed information, incomplete data, and limited analytical capabilities. Manual data transfers were prone to errors, resulting in fragmented patient histories and missed opportunities for proactive care.

Integrating patient monitors with EHRs addresses these issues by centralizing data, offering real-time updates, and improving clinical decision making. The benefits include consolidating all patient information into one EHR, providing up-to-the-minute patient status, and facilitating accurate diagnoses and treatment adjustments through comprehensive data access. It also automates data transfer, saving time and reducing manual entry errors, and utilizes integrated data to anticipate and address potential health risks.

Successful implementation requires assessing system compatibility, adopting data standards, ensuring robust security, and providing staff training. Integrating patient monitoring systems with EHRs represents a pivotal evolution in healthcare, enabling more precise, timely, and proactive patient management. By leveraging this technology, healthcare providers can deliver enhanced care and better patient outcomes.

Wireless technologies
Wireless technologies and IoT are significantly advancing remote and mobile patient monitoring, primarily through advanced camera systems. IoT-enabled cameras are integral to these systems, providing high-resolution, real-time video feeds that support effective patient monitoring from a distance.

These cameras are designed to operate seamlessly within hospital networks, offering features such as high resolution for detailed imaging, low-light and near-infrared (NIR) capabilities for 24/7 monitoring, and pan-tilt-zoom functions for close-ups or broader views. They ensure continuous observation, even in varying lighting conditions, and can be remotely adjusted to capture critical patient data without physical presence.

Equipped with built-in microphones, these cameras can also detect and transmit sounds such as coughs or snoring, providing additional insights into a patient’s condition. Enclosed in tamper-resistant housings, they are installed in strategic locations like ICU rooms or operating theaters to ensure secure and discreet monitoring.

IoT connectivity allows these camera systems to integrate with other medical devices and electronic health records, delivering a comprehensive view of the patient’s status and enhancing healthcare providers’ ability to make informed decisions promptly.

Decentralized clinical trials
The rapid expansion of RPM solutions is revolutionizing the landscape of decentralized clinical trials (DCTs). Traditionally, pharmaceutical companies have been cautious about decentralized trials due to concerns about monitoring patient safety and data integrity without in-person visits. However, the advancement of RPM technologies makes it feasible to conduct these trials across various therapeutic areas, from cancer treatments to chronic disease management, while maintaining rigorous oversight of patient health data.

RPM enables real-time health data collection through various devices, allowing for continuous patient monitoring outside traditional clinical settings. This shift is particularly beneficial for enhancing patient engagement, improving trial accessibility, and increasing the representation of diverse populations in clinical research. Patients benefit from the convenience of participating from home, which significantly reduces the burden of travel and frequent site visits.

RPM industry’s growth is about to triple. It provides a wide array of technologies for tracking patient health, which can be seamlessly integrated into clinical trials. The use of RPM in decentralized trials not only improves data accuracy and patient adherence but also leads to significant cost savings.

As the RPM sector continues to evolve, its integration into clinical trials will likely become more prevalent. This will enable pharmaceutical companies to conduct more efficient, patient-centric research and accelerate the development of new therapies.

IoMT and blockchain-enabled patient-centric agent
The Covid-19 pandemic has accel- erated the adoption of the IoMT, which leverages medical devices and software to enable remote healthcare services. However, ensuring the privacy and security of patient data in this online ecosystem remains a major challenge. Blockchain technology has emerged as a potential solution for these security concerns. Recent research has integrated blockchain with intelligent agents in patient monitoring systems, though traditional configurations have introduced complexities.

To overcome these issues, a new architectural framework combines software-defined networking (SDN) with blockchain technology, tailored for remote patient monitoring in a 5G environment. This framework features a patient-centric agent (PCA) within the SDN control plane, designed to manage and secure patient data effectively.

Integrating a hyperledger fabric network supports the secure and efficient handling of medical data, ensuring compliance with healthcare policies. Future developments include a mobile application that will adapt this model, enabling more accessible access to IoMT services and enhancing the overall effectiveness of remote healthcare monitoring systems.

Outlook
The future of PME is set to transform healthcare with the rise of advanced wireless devices and sensors that allow remote, continuous monitoring, especially for chronic patients. Initiatives like hospital-at-home will deliver acute care through telehealth and remote technologies, reducing hospital visits. However, challenges, such as data security, reimbursement models, and equitable access, need to be addressed. By overcoming these hurdles, continuous monitoring systems will lead to better health outcomes, lower costs, and improved patient engagement, making healthcare more accessible and patient-centered.