As the monitoring device itself becomes a smaller part of an overall service offering, manufacturers will need to identify where they want to position themselves in the value chain and avoid becoming commoditized.
The monitoring of patients within a clinical setting is changing; new market entrants, new business models, and the IoT revolution are providing more insight into the patient condition through novel data feeds and analytics. The drivers for change are numerous like the containment of cost, improvement of patient care, and better clinical outcomes. The shift from treating illness to managing health is also demonstrated by an increase in the use of monitoring outside of the clinical setting, in addition to a change in the breadth of what is monitored.
This includes both physiological measurements (like blood pressure, heart rate, and stress) and behavioral measurements (like medication adherence and compliance). These changes require experts to re-think their traditional approach to the development of patient-monitoring technology and to ensure they harness the technical enablers safely and effectively to develop products that improve on current monitoring methods, both within and outside of the hospital setting.
There is tremendous pressure on healthcare systems to provide holistic, efficient, and personalized healthcare plans, improving outcomes while containing costs in the face of growing demand. With the shift to value-based healthcare, payers are increasingly unwilling to reimburse care costs arising from adverse events and avoidable care complications. This places a strong economic incentive on healthcare providers (HCPs) to implement procedures and protocols that minimize the incidence of complications along the entire length of the patient pathway, through data collection and predictive analytics.
This is epitomized in the case of enhanced recovery programs for surgery, where a care package is designed to cover the entire patient journey. Firstly, patients are screened for conditions associated with increased risk of complications and poor outcomes. This data supports pre-habilitation recommendations to optimize functional capacity, such as smoking cessation, anemia treatment, and control of glucose levels. Next, the intraoperative care bundle aims to minimize inflammatory response, manage pain with a minimum of opioid use, and allow early mobilization of the patient. Lastly, arrangements are put in place to discharge the patient as soon as possible to recover and rehabilitate in the home environment, which is associated with improved satisfaction and outcomes.
Remote monitoring and home healthcare
Remote patient monitoring (RPM) has seen exponential growth in recent years, boosted further by the widespread adoption of consumer wellbeing monitoring and, more recently, its subsequent convergence with long-term healthcare monitoring in the home and other non-clinical environments.
Traditional medical device players like Abbott, Philips Healthcare, and Medtronic are entering the home healthcare market, leveraging the widespread usage of smartphones with their existing presence and expertise. Abbott has already launched an implantable cardiac monitor that syncs with the patient’s smartphone via an app, and which continuously monitors for syncope, palpitations, and atrial fibrillation. Scheduled transmissions ensure continuous patient care while minimizing clinical staff burden. By utilizing an implant, their platform is firmly within the realm of medical devices, yet the platform works by means of pairing it with an app that focuses on user experience, ease-of-use and accessibility. Experts believe that the quality of user experience seen in consumer products and services will set the bar and become the expected standard in the medical device space.
The market is expected to witness the increasing use of behavioral and physiological monitoring, using variables such as mental health symptoms and medication adherence, driven in part by the pharmaceutical industry. Medication non-adherence costs the global pharmaceutical industry USD 637 billion per annum in lost revenue. This is driving the adoption of home monitoring to nudge behavior toward compliance, through a combination of sensing, analytics, and great digital design.
Non-traditional players enter the market
With changes in the reimbursement environment and mounting evidence pointing to the as-yet untapped potential of tele-health in many countries, non-traditional medical device manufacturers are increasingly eager to enter and disrupt the healthcare market. Technology companies that more traditionally operated in the consumer space like Apple, Google, Microsoft, and Amazon understand the value of structured data and AI, coupled to a well-designed user experience when driving consumer engagement. All of the Big 4 tech companies in healthcare have amassed huge amounts of consumer data, have generated significant insight from that data, and have patented many sensing technologies that aim to disrupt the current monitoring market. Furthermore, they are highly skilled at offering useful digital services alongside beautifully designed wearables and electronic products. Out-of-hospital care, therefore, seems set to become a viable and increasingly competitive route for new players to enter the healthcare industry, although there will be significant privacy and data ownership hurdles to doing this in the medical space.
Unlike hospital-based monitoring, being able to provide a direct-to-user healthcare offering that can work outside the clinic, will shift demand and, therefore, directly compete with the offerings of traditional medical device players, introducing disruptive business models in doing so.
While products and services need a continuing focus on clinical performance and how this impacts the delivery of life-saving and sustaining services, companies will also need to focus on improving the patient and caregiver experience. Device manufacturers will need to understand the value of earlier patient mobility, of less invasive monitoring and of more agile care environments. Unless they go through this cultural change, it is likely that they will face intense competition from the technology companies that know how to exploit data from devices and can use this to demonstrate improved outcomes and gain reimbursement.
Companies will need to adopt technologies that can deliver systems and devices that redefine usability. Care of the future will be more agile and patient monitoring systems more easily deployable, particularly if this means converting the home to a care environment. Similarly, this agility needs to be supported by access to data management platforms, which share a high level of integration. Models of workflow management and remote support that optimize the use of healthcare staff without compromising the quality of care need to be developed. Only then will they overcome the challenge of building continuity across multiple hospital sites and with out-of-hospital care.
The companies best placed to make the most of this changing environment are those with a robust digital health strategy that can navigate the transformational changes inherent in moving from offering monitoring as a product, to monitoring as part of a broader service offering. Building out the digital ecosystem to take advantage of a wider set of data streams and products requires partnerships with a range of non-traditional vendors and companies that give access to a broader set of capabilities, spanning technical, organizational, and clinical domains.
Patient care will be transformed in the next 10 to 15 years and new types of products, services, and applications will emerge. In this environment, patient monitoring will play a central role in helping to enable the actual transformation. For patient monitoring companies to remain competitive in this changing landscape, they will need to adapt business models and product roadmaps.
Monitoring of the future is expected to be more flexible and reflect the needs of value-based healthcare provision. Required improvements in the quality of care and the avoidance of adverse incidents will drive growth in the use of monitoring in all areas of the hospital. Continuous monitoring of patients’ condition while in the hospital will make it easier for treatment teams to respond to any sudden or gradual deterioration. Although the number of parameters and patients measured will increase dramatically, advances in monitoring capabilities and careful user-centered design will make this process seamless for healthcare professionals. Advances in analytics and CDS will be necessary to counteract staff becoming overwhelmed by the rising volume of data.
Patients will be mobilized early and further reduction in hospital stays are expected. This will not only be driven by the quality of care in the hospital but also by enabling good quality care away from hospitals. Monitoring technology will allow a more seamless and fast transfer of stable patients to home. Access to data will allow the same therapeutic team to be responsible for their treatment along the care path, something that will allow greater levels of treatment continuity.
Technology will allow clinicians to be more efficient. Improved monitoring systems, with more accurate alarms, will minimize time wasted while telemetry will permit them to attend patients remotely. Integrated data systems and data analytics will enable access to the right patient’s information at the right time. Moreover, technology will allow more efficient knowledge transfer between therapeutic team members and even access to other experts who may not be on site. It is also worth noting that the collection of large amounts of data, often longitudinal in nature, will provide an opportunity to identify trends, patterns, and correlations at both the population level and at the systems level within a patient, benefitting treatment regimens and clinical decision support.