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Patient Monitoring Equipment

Technologies revolutionizing patient monitoring

Next-generation patient monitoring will provide filtered, pertinent clinical information to improve workflows for speedy, accurate patient progression, and to broaden the indication of a patient’s condition to represent successful progress along a care pathway.

Health systems across the globe are faced with a rising population with chronic conditions, clinician shortages, resource constraints, and threats to security. At the same time, many are on the cusp of incorporating groundbreaking innovations like artificial intelligence, machine learning, and predictive analytics – all with the potential to dramatically change the way healthcare is delivered.

In today’s high- and low-acuity settings, the pressure is on to provide caregivers with fast, accurate information. They are looking to move beyond siloed workstation thinking, to developing workflow solutions that avoid unwanted outcomes, clinical variation, and unnecessary cost. Yet patient data is growing exponentially. Hence, organizations are urgently seeking strategies to filter this information to inform their clinical decision-making, especially as current complex networking systems can become outdated and not speak to each other, and technical staff may not have visibility into the status of their devices – risking downtime and disruptive breaches.

A powerful patient-monitoring solution has the capacity to confront all this. At its most basic, a patient-monitoring system is designed to acquire patient data, aggregate it and display it in a format that is meaningful and actionable. It can capture a steady stream of patient data from monitors and other medical devices, then feed it securely to an electronic medical record for virtually gap-free patient records from admission to discharge – even during transport.

Technological advancements, such as biosticker, artificial intelligence (AI), wearable patient-monitoring devices, functional near-infrared spectroscopy (fNIRS), a tricorder phototype for diagnosis and monitoring of multi-parameter, smart speakers for monitoring cardiac arrest and wireless neonatal body monitors have led to patient-monitoring devices that utilize faster, more accurate results. The biosticker is a highly developed on-body sensor that allows for effortless continuous monitoring of vital signs and actionable insights delivered to clinicians from patients in the home setting, thereby creating unique opportunities for early detection of potentially preventable complications. Through the platform’s data sets and analytics, highly efficient care is now achievable at a fraction of the cost of traditional remote patient monitoring devices. It is intended for use by healthcare professionals for continuous collection of physiological data at home and in healthcare settings while the patient is at rest.

Leading healthcare providers around the globe are experiencing firsthand how the latest AI and machine learning solutions can improve patient care. Each stage of the patient care journey can be transformed with the right types of AI-assisted healthcare solutions and applications. Many of the healthcare providers and companies working with AI are making impacts on inference times, resource management, and remote patient monitoring. Using the latest technology, healthcare organizations can deliver a more accessible, personalized, and enhanced care experience.

Wearable technology in healthcare includes electronic devices that consumers can wear and are designed to collect the data of the user’s health and exercise. The advancement of wearable technology and growing demand from consumers to take control of their health has influenced the medical industry, including insurers, providers, and technology companies to develop more wearable devices. Wearable EEG monitors and blood pressure monitors are the examples of wearable patient monitors; wearable sensors can detect hidden anxiety and depression in children.

Smart technologies enhancing remote patient monitoring
Nandini Shukla
Deputy Product Manager-Patient Monitor,
Mindray India

Remote patient monitoring is becoming increasingly popular; backed by growing clinical needs, it is helping to expand access to patient care. Mindray M-Connect IT Solution provides a universal central monitoring platform, which fully integrates bedside medical devices, using a standard interface to connect with other information system. With the help of such technologically advanced solutions, digitization is being done through internet, and patient’s medical devices data situated in one location can be reviewed by an expert clinician at a different location. Hospitals are now implementing such systems, making it an important part of care delivery by enabling patients’ data accessed on smartphones. Remote monitoring solution has enabled clinicians to observe patients real-time through CCTV along with necessary medical data, and take decisions to improve care outcomes.

The primary driver in healthcare is a rising demand for RPM solutions. Innovations, based on interconnectivity of medical devices, are connecting healthcare providers to bring infinite value of IT into healthcare. The digitization of healthcare in the world continues to accelerate with demand for virtual care. With automated data capture into electronic medical records, flow of patient information is increasing exponentially from many connected medical devices, improving quality of patient care. The core of such solutions is multiple devices integration.

M-Connect allows medical staff to see the patient’s condition anytime and anywhere, respond promptly, and ensure patient safety. It provides a patient-centric distributed monitoring solution, integrating all connected devices for data visibility across your department. Such solutions are designed in a way that provides collected patient information in a manner, which is easy and fast to interpret and helps in reducing time needed to detect any sudden changes in the patient’s condition.

The Covid-19 pandemic has highlighted the need to protect care providers so that they can avoid exposure and continue to treat patients. Tele-ICU has the potential to link all semi-urban/urban hospitals to tertiary care ICUs and improve the ICU services of these remote hospitals, thus, ensuring better care and providing real-time services to multiple care centers, regardless of their locations. Many available IT solutions are linking the entire pre-hospital, intra-hospital, and inter-hospital journeys of each and every patient for seamless transfers and faster remote guidance. Mindray M-Connect IT solution is a cost-effective solution, which has high-end medical equipment backed by sophisticated software solutions. India needs such an affordable solution, which can link critical patients of rural cities with highly trained clinical experts at minimal cost, and maintenance of such solutions must not be expensive so that they can be utilized in an optimal way to provide better, safer, and a healthier Bharat.

Functional near-infrared spectroscopy is a wearable and portable brain-monitoring technology that tracks and monitors the cortical hemodynamic response, using near-infrared light sources and detectors placed over the scalp. It measures the changes of cortical deoxygenated and oxygenated hemoglobin concentrations non-invasively, safely, and ecologically.

The tricorder is a portable multi-functioning device that diagnoses, monitors, and analyzes several parameters such as diabetes, atrial fibrillation, chronic obstructive pulmonary disease, urinary tract infection, sleep apnea, leukocytosis, pertussis, stroke, tuberculosis, and pneumonia. The device is named as DxtER and has been developed by Frontier Medical Devices as part of Basil Leaf Technologies. It is a combination of smart tools, including a digital stethoscope, wrist sensor, chest sensor, spirometer, and blood pressure calibrator that feeds AI program data to provide accurate diagnosis.

Smart speakers like Google Home and Amazon Alexa may detect the gasping sound of agonal breathing and call for help. The device is developed by researchers at the University of Washington, who have developed a new tool to monitor patients for cardiac arrest, while patients are asleep, without touching them. The device works by continuously and passively monitoring the bedroom for an agonal breathing event; it detected agonal breathing events 97 percent of the time with almost no false alarms in a proof-of-concept study.

Neonates who are admitted to neonatal intensive care or pediatric intensive care are monitored through a complex collection of sensors, which has a wire connected to a patient monitor. It is very difficult for parents to bond with their children and for clinicians to access the patients, hence Northwestern University engineers have developed flexible, wireless sensor patches that are capable of collecting the vital signs as wired devices. The new sensors can track the heart rate, respiration rate, temperature, and blood oxygenation as well as conventional sensors, and they also allow for monitoring of body movement and orientation, recording heart sounds, crying, and other audio biomarkers, and even provide a pretty accurate estimate of systolic blood pressure.

The increase in the rate of surgeries and diseased population, who requires continuous monitoring, increasing demand for portable and remote patient monitoring, increasing funding and investment in patient monitoring devices, and technological advancements are expected to drive patient-monitoring devices market in coming years.

The Indian market for patient monitoring equipment in 2021 is estimated at ₹600 crore, and 94,450 units. The market had recovered from the 2020 drop, albeit the prices went south. Buyers opted for the mid-end and low-end models, which were now offered at lower price points. High-end systems constituted 3 percent in 2021, in contrast to 4.6 percent share in value terms (it was 15.9 percent share in 2019, and 100 units of super-premium sold in 2019, that seemed to be missing this year) and 0.6 percent in volume terms (it was 7 percent in 2019). The belly of the segment continues to be the mid-end and low-end systems, and it further gained share in 2021; it has progressively been increasing since 2018. The two segments dominated with a combined share of 89.7 percent by value and 96.5 percent by volume.

Philips and Contec, with its many resellers dominated the market in 2021, with a combined share of 42 percent, by value. However, the balance may shift away from the Chinese brands, with Central Drugs Standard Control Organisation (CDSCO) making registration mandatory for medical devices from October 1, 2022, and while home country approval is not required, applicants will need to submit proof of a reference country’s approval.

Indian patient monitoring equipment market

Leading players – 2021

Segment Vendors
Tier I Philips and Contec
Tier II Mindray, Nihon Kohden, BPL, and Skanray
Tier III Schiller, Comen, GE, Edan, and Drager
Others Clarity, Creative, and GMI
ADI Media Research

As imports faced supply chain issues in 2021, and prices subsequently were also increased by some brands, indigenous brands as Skanray saw strong traction. This trend is expected to stay over the next couple of years, as the government’s thrust on Make in India initiative is not waning. Skanray has had success in 2021 with orders from almost all AIIMS centers; the vendor is active in both GeM and HLL Infra Tech Services Limited (HITES) portals.

2021 was a mixed year. The government largely stayed away, as the focus of the spend was more Covid related. The private buying moved away from the high-end premium equipment to the value segment. The CSR-related buying, that commenced April onwards was for mid-end equipment, with barely any negotiation being done on pricing. Some of the large donors included Tata Trust, Infosys Foundation, Aziz Premji Foundation, ICICI Foundation, Capgemini, and HDFC Bank.

During the Covid-19 pandemic, remote patient monitoring came of age. The medical fraternity revisited the feasibility and utility of remote monitoring, and it has gradually become a way of life.

2022 has seen a slump in the first quarter. The second quarter was better, since many new greenfield projects are coming up, with some sophisticated hospitals being set up in smaller cities. Price negotiation is also an important part of the deal. Many pending tenders are expected to be finalized and orders placed in the latter half of the year.

Indian health systems are turning to remote patient-monitoring technology to ensure improved outcomes and reduced costs. It is a healthcare delivery technology to monitor patients outside of a traditional clinical setting. Such patient care extends the reach of physicians, enabling a constant relationship between patients and caregivers.

There has been a significant government push to enable healthcare for the underserved, making technology adoption imperative. With the release of the telemedicine guidelines by the Ministry of Health & Family Welfare (MoHFW), the regulatory environment has become clearer.

The guidelines prepared in collaboration with the NITI Aayog allow consultations via multifarious communication channels, such as text, audio, and video, and crucially permit registered medical practitioners to prescribe medicines. Along with structured regulatory guidelines and technological advancement in terms of reconfiguration and statistical analysis of a vast-vivid database with the Government of India, India’s patient-monitoring market is predicted to have its market opportunities increased by up to 20 percent by 2030.

The global patient-monitoring devices market is projected to reach USD 80.75 billion by 2030 from USD 39.46 billion in 2021, at a CAGR of 8.3 percent. Integration of monitoring technologies in smartphones and wireless devices is a key trend in patient care, resulting in the introduction of remote monitoring systems, mobile cardiac telemetry devices, mobile personal digital assistant systems, ambulatory wireless EEG recorders, and ambulatory event monitors.

Globally, there is an amplified awareness among both physicians and patients as to the benefits of monitoring in a wide selection of areas, including continual monitoring both in hospital as well as in the home. This is not only driving demand for current devices, but also motivating innovation in the market across multiple segments. As devices continue to lower their costs and improve their array of features, the healthcare population will be more motivated to act on this awareness to purchase new devices.

Patient monitoring is a relatively long-standing component of healthcare being offered in most regions around the world and, as such, certain markets have begun to saturate in terms of the installations of monitoring devices.

Although somewhat buffered by technological advancements, the market for many patient-monitoring devices is already saturated in certain key regions, such as North America and Western Europe. This market characteristic constrains the growth of the market, limiting the majority of sales to replacement sales.

The cardiac-monitoring systems segment held the largest revenue share of more than 21.7 percent in 2021, by product. It is estimated to garner USD 10.26 billion by 2027, registering a CAGR of 4.8 percent from 2022 to 2027. According to WHO, cardiovascular diseases are the major causes of death across the globe, and approximately 30 million people suffer a stroke and heart attack annually. The rising incidence of cardiac disease is increasing the demand for cardiac-monitoring system devices; hence, major market players are trying to meet the needs by launching new products.

As remote patient-monitoring (RPM) devices can be used remotely to monitor critical parameters of patients, the segment is rapidly gaining popularity among patients with chronic diseases, such as diabetes, hypertension, and chronic respiratory diseases. Thus, it is expected to be the fastest growing segment, registering a CAGR of 16.3 percent from 2021 to 2031. Moreover, raising investments in digitization and automation in the healthcare units in order to increase the operational efficiency of the healthcare units is fueling the adoption of the RPM systems across various markets. The RPM systems provide enhanced diseases and health management by detecting the deteriorating health conditions early and track the progress in the health condition of the patients, which helps the healthcare units to offer improved patient care. The RPM systems can reduce hospitalization and chronic conditions that cost higher and hence help to save healthcare costs for the consumers. Hence, this factor may boost the adoption of the RPM systems in the forthcoming years. The future of RPM is really bright. Although patients may not opt for expensive clinical devices in their homes, the healthcare providers seek valuable solutions that enhance the healthcare industry in 2022 to drive improved patient outcomes, along with revenue growth.

Remote monitoring connectivity solutions are gaining importance
Kannan N
VP Sales,
BPL Medical Technologies

Patient monitors, also called vital-signs monitors, having advanced parameters with remote monitoring connectivity solutions, are gaining importance. BPL MT offers both pre-configured and modular monitors with international certifications.

We, from BPL Medical Technologies, strive to make the world a better place to live, hence working on adding more and more advanced parameters along with remote monitoring connectivity solutions like HL7, wired or wireless FTP, remote CNS monitoring, nurse call, USB data capture, and bed-to-bed monitoring.

In addition to that, in the last few years, we have seen significant increase in demand for additional parameters like 12-channel ECG monitoring, IBP (invasive blood pressure), ETCO2 (end tidal CO2), AGM (anaesthesia gas monitoring), NMT (neuro-muscular technology), BIS (bispectral index) and CO (cardiac output). Monitors are being used together with anaesthesia machines.

Cardiac output (CO), invasive and non-invasive, has become an important parameter for monitoring cardiovascular function.

BIS (bi-spectral index) is used to measure the depth of anesthesia.

Neuromuscular transmission (NMT) is the transfer of an impulse between a nerve and a muscle in the neuromuscular junction to locate nerve precisely for giving regional anesthesia.
AGM (gas monitor module) is used to measure the anesthetic and respiratory gases of the patient under anesthesia.

Medical devices providers are creating awareness programs to emphasise the importance of the above parameters monitoring for increasing patient safety and comfort. Exclusive neonatal monitor is another segment which is rising in demand with focused neonatal care centers and special wards.

The vital-sign monitors segment is projected to hit remarkable growth during 2022–2027. This is attributed to the increased usage of these monitors for common purposes. The heart rate monitor is extensively used across the healthcare sector all over the globe. Furthermore, the surging prevalence of cardiovascular diseases is expected to boost the growth of this segment.

The other segments for the market include hemodynamic monitoring, neuromonitoring, fetal and neonatal monitoring, respiratory monitoring, multi-parameter monitoring, weight monitoring, and temperature-monitoring devices.

North America dominated the patient-monitoring devices market and accounted for the largest revenue share of more than 43.2 percent in 2021. The increasing incidence of chronic diseases, coupled with the presence of advanced technology, demand for wireless and portable systems, aimed at cutting out-of-pocket expenditure, are some of the factors attributed to the growth of the market in the region. Also, major market players, such as Edward Lifesciences, GE Healthcare, Masimo Corporation, and Natus Medical are investing in R&D for more advanced patient-monitoring devices facilities, which, in turn, will boost the market in the coming years.

Leading brands are going in for acquisitions and simultaneously launching new products to strengthen their position in the market.

In January 2022, MDLIVE launched patient health monitoring to drive health improvements for people living with chronic conditions. This digital-first program aims to improve health outcomes for people living with chronic health conditions like diabetes, heart disease, or high blood pressure.

In January 2022, Omron Healthcare launched heart-focused remote patient monitoring. This launch would expand digital health services to consumers, and monitor risks of heart disease and other ailments.

Such developments altogether are likely to bolster the growth of the patient monitoring market in coming years.

Major players operating in the market include Koninklijke Philips N.V., Nihon Kohden Corporation, GE Healthcare Ltd., Abbott Laboratories, Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Medtronic, Inc., Biotronik, Masimo Corporation, Johnson and Johnson, Omron Healthcare Co. Ltd., PLC, Dexcom, Inc., Edwards Lifesciences Corporation, Dragerwerk AG & Co. KGaA, Hill-Rom Holdings, Inc., and Natus Medical, Inc.

Health is characterized as a full state of physical, mental, and social well-being and not merely a lack of illness. Health is a fundamental element of people’s need for a better life. Unfortunately, the global health problem has created a dilemma because of certain factors, such as poor health services, the presence of large gaps between rural and urban areas, and physicians’ and nurses’ unavailability during the hardest time.

IoT is making objects internally connected in the recent decade and it has been considered as the next technological revolution. Smart health-monitoring mechanism, smart parking, smart home, smart city, smart climate, industrial sites, and agricultural fields are some of the applications of IoT. The most tremendous use of IoT is in healthcare management, which provides health and environment condition tracking facilities. IoT is nothing but linking computers to the internet, utilizing sensors and networks. These connected components can be used on devices for health monitoring. The used sensors then forward the information to distant locations like M2M, which are machinery for computers, machines for people, handheld devices, or smartphones. It is a simple, energy-efficient, much smarter, scalable, and interoperable way of tracking and optimizing care to any health problem. Nowadays, modern systems are providing a flexible interface, assistant devices, and mental health management to lead a smart life for human beings.

Heart rate and body temperature are the two most significant indicators for human health. Various methods exist to invasively and noninvasively assess the heart rate and body temperature. For the consumer, noninvasive approaches over a while have proven accurate and convenient.

Some important works have been done in the field of medical science using IoT to monitor patient’s health.

Tamilselvi, et al., developed a health monitoring system that can monitor basic symptoms of a patient like heart rate, percentage of oxygen saturation, body temperature, and eye movement in IoT network. For this purpose, the system used heartbeat, SpO2, temperature, and eye-blink sensors as capturing elements and Arduino-UNO as a processing device. The developed system was implemented but no specific performance measures are described for any patient. Acharya, et al., introduced a healthcare monitoring kit in IoT environment. The developed system monitored some basic parameters of human health like heartbeat, ECG, body temperature, and respiration. The major hardware components, which are used here, are pulse sensor, temperature sensor, BP sensor, ECG sensor, and raspberry pi. The data was collected from sensors and sent to raspberry pi for processing and again transmitted to the IoT network. The major drawback of the system is that no interfaces for data visualization are developed.

Banerjee, et al., proposed a pulse rate-detection system based on a noninvasive technique. The proposed system used plethysmography process and correspondingly displayed the output digitally that made it a real-time monitoring device. The method has proved reliable for patients, compared to other invasive techniques. Gregoski, et al., introduced a smartphone-based heart rate-monitoring system. The system used a mobile light and camera to track finger blood flow and calculated blood flow-based cardiac output.

The developed system is described as an integrated device that wirelessly transmits a person’s pulse to a computer, empowering people to test their heart rate by merely looking at their phones instead of using hands each time. This is an excellent design but it is not feasible if continuous heart monitoring is needed. Oresko, et al., mentioned a fully functional cardiovascular disease-sensing system for smartphones, identifying a tool that is developed to be the same, given sufficient time and monetary resources. The developed prototype only tracked coronary rhythm in real time, did not track heart rate over time, and could not detect any cardiovascular disease.

Trivedi, et al., suggested a mobile device-regulated Arduino-based health parameter surveillance framework. The collected sensor data, which was in analog form, was sent to the board of Arduino Uno. By the integrated analog to digital converter, the recorded analog values were converted into digital data. Bluetooth transmitted the physical qualities to the developed device. The Bluetooth device used a module not covering a wide area. Kumar, et al., developed an adaptive IoT safety-monitoring device. The configuration of the framework is separated into three layers, such as the control layer, the device layer, and the transport layer. A DS18B20 sensor was used for the measurement of body temperature in the control segment and a pulse sensor is used for the pulse measurement. The data was loaded from Arduino into the cloud through the Wi-Fi module and Ethernet shield on the transport layer. The framework layer finally collected the server details. However, Arduino Uno was used here, and hence, many sensors could not be treated properly. Desai, et al., developed a wireless sensor network (WSN) to track smart homes and heartbeat. Here, Spartan3 is used in parallel data processing with FPGA architecture. The MCU results are shown by an LCD, and all sensors are connected with a microcontroller. Nevertheless, all machine elements are not integrated in one unit.

The future of patient monitoring systems in ICUs
Vysakh V
Senior Design Engineer,
Skanray Technologies

With the advent of comorbidities and demographic changes, the requirement for providing quality care, especially in ICUs, is increasing. Also, the healthcare providers are facing stiff challenges with increasing workloads, shortage of medical staff, and increasing financial burden. In addition, the technology behind the most present-day monitoring methods like ECG, SpO2, or NIBP with alarm thresholds for each sensor date back to the 80s or 90s.

The introduction of rapid and sustainable advanced digital technologies could pave a new way to alleviate the situation and provide better healthcare. With advancements in the field of semiconductors and communication technologies, new options are available for patient monitoring that would readily enhance the quality of healthcare and improve patient safety. Many research groups across the globe have developed technologies to remotely monitor ECG, pulse oximetry, and non-invasive measurement of hemodynamic parameters.

In addition, artificial intelligence and machine learning-powered clinical decision support systems would support the physicians in interpreting data from multiple parameters, and aid in an early indication of respiratory failure, internal bleeding, or onset of sepsis.

Future developments of patient monitor systems will be more focused on making the system more interoperable, intuitive, and capable of predictive analysis. Systems with options to add advanced and individual features based on patient needs will enhance patient safety and ensure precise care. Specificity in vital parameter measurement, providing options for wireless monitoring and explicit alarms, would enhance job satisfaction for the frontline healthcare staff, reduce noise pollution, optimize the detection of false alarms, and, then augment the quality of care provided to the patients.

Also, replacing the fixed-screen display with mobile tablets or using IoT technology would help the clinical experts monitor the patient’s health status remotely.

The advancement in machine learning, IoT, artificial intelligence, wearable technology, and communication fields will be the frontrunner in the development of the healthcare sector in the coming decade. This would make the future patient monitoring system and medical treatments provide quality, efficient, and affordable healthcare to the patients admitted to critical care units.

Industry trends. By all accounts, industry is at an inflection point, as powerful trends are shaping the field.

New AI capabilities. In terms of current market interests, AI connected to data analytics is at its peak; yet, in fact, AI is still developing on a comprehensive and integrated market scale.

Regulatory changes. In the United States, the value of patient monitoring is recognized at the federal level. Centers for Medicare and Medicaid Services have called for expansion of reimbursement for remote care, seeking to make sure home health agencies can leverage innovation to provide state-of-the-art care.

Transforming business models. There is a need for technology providers to take a solutions-focused approach. Instead of being a B2B provider of products, the industry is transitioning to become service providers through strategic partnerships.

The demand for benchmarking. International benchmarking of performance is an increasingly sought-after capability. Health systems are also looking for opportunities to work with international groups to do collaborative research, and to help them pull together robust clinical data elements.

Education. For future clinicians to use telemedicine effectively, a growing number of medical schools, and teaching hospitals are including telehealth in the classroom setting. Students learn how to monitor the flow of real-time data from a patient’s wearable device, for example.

The need for security. Cybersecurity continues to be critical, especially as patient data flows beyond the hospital and into the home. The shift of healthcare and patient data from multiple physical devices into the cloud also brings a host of software and security challenges.

User-centric design. With monitoring technology increasingly being placed in the hands of the patient, design and well-tested, well-researched ideas are more important than ever.

The Internet of Medical Things. IoMT is creating an expansive opportunity across the continuum of care to learn about, optimize, predict, intervene, and experience healthcare in new ways. It is expected to grow at a 26 percent CAGR to more than USD 70 billion by 2022.

From bedside to webside. Predictive analytics is enabling preventive health management on the population level, and the growing importance of care beyond the hospital increases demand for population health solutions. Remote monitoring technologies are continuing to play a critical role in home monitoring, potentially preventing readmissions.

Next-generation patient monitoring will provide filtered, pertinent clinical information to improve workflows for speedy, accurate patient progression and to broaden the indication of a patient’s condition to represent successful progress along a care pathway.

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