Latest monitoring devices available in the market allow recording and transmitting of digitized vital signs from an individual device to the physicians’ computer or handheld device instantly, thereby reducing the duration of evaluation and treatment.
Patient monitoring is a first-line defense for staff and having monitors that work accurately is non-negotiable. Patient monitoring equipments (PMEs) have advanced over the years as new technology continues to extend the capabilities of these life-saving tools. The market is witnessing more patient monitoring devices with color touch screens for ease of use and wireless capabilities allowing continuous connectivity to central monitoring and electronic medical records (EMR). Many of the devices are also being designed to be more portable/wearable offering patients the freedom to move around the hospital.
One of the most significant shifts that is being seen is a convergence of the biomed and IT sectors as patient monitoring is moving away from a device-based business model to a clinical information system solution. These systems can be individually designed and scaled to meet a healthcare organization’s changing care models and clinical workflows. The new wearable technology holds a huge opportunity in today’s market and will alter the work of professionals because the patient can be monitored wherever they are. It can help keep track of their vital signs, and shows promising benefits to automating hospital processes, that is smart hospitals.
Indian Market Dynamics
The Indian PME 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, counter shock. 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 PME 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 6 years, estimates Allied Market Research.
Asia-Pacific possesses high market potential for growth of the 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.
Globally, the 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. For instance, launch of portable IntelliVue X3 patient monitor by Philips in June 2017; introduction of patient monitoring and clinical decision support (CDS) platform Vital Sync in the United States by Medtronic in May 2017.
M&A is another key strategy adopted by the leading companies to acquire smaller organizations to improve their product portfolio and gain additional market share. For instance, Hill-Rom signed a definitive agreement to acquire Mortara Instrument in January 2017 to expand its offerings in the market. Collaborations between companies, hospitals, and academic institutions are expected to positively impact the market growth.
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 PME market is expected to take multifold leaps over the next few years.
Evolution of remote patient monitoring equipment. 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 handheld PDA of the 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.
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 PME 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 increase their future demand.
Outlook
Patient monitoring at its core has not changed. What has changed is the new way of looking at data. Due to advances in mobile technology the physicians can have access to complete data from wherever they are, which leads to better patient care.
The industry has come a long way so far, but there is still huge potential for growth as new technologies are developed and new care settings begin to arise. The future of patient monitoring is very exciting and innovations play a large role in potentially helping patients and clinicians alike.
Second Opinion
Evolution of ICU Equipment
Considering the field of intensive care, it has developed from just ECG monitoring to advance monitoring of patients to E-ICU management. Intensive care is developing all over the country and is reaching even small towns of India. With respect to ICU infrastructures, they are advancing from small units to well-developed units capable of managing all kinds of patients. This has been possible because of availability of advanced equipment. This development in equipment has started from standalone ECG monitoring to now available monitors, ventilators, CRRT machines, defibrillators, advanced software to manage ICUs remotely etc.
If we talk about monitors now we have an option to monitor (apart from routine monitoring) cardiac output, continuous EEG, sedation, EtCO2, bispectral index monitoring for evaluating anesthesia etc. Monitors are capable to summarize and visualize complex clinical data and their interactions. Even patients’ monitors can be viewed from distance. Monitors can send and receive patients data in a way can talk to each other.
If we move from monitoring to ventilators, new advanced ventilators with new modes are available to make ventilation safe for the patients and smart loop feedback to manage ventilation smoothly avoiding complications. Other advanced equipment like syringe pumps, infusion pumps, sequential compression device, cooling devices, rapid infusion device, continuous feeding devices – all have made the patients care advanced and precise by putting less burden on nursing staff and allowing care of patients with minimum errors.
E-ICUs. Nowadays, the management of critical patients in the remote areas has been possible with E-ICU management with the help of an expert managing remote ICUs with the help of junior staffs sitting in the units. Apart from monitoring this has extending to teaching and training of junior doctors as well as nursing staffs. This can be incorporated to reduce errors and improve care at this place.
Virtual reality and augmented reality. In few years it will be possible to manage patients and train the staff virtually. One can therefore be present at a remote location without being physically there. This is what I see in the future.
Dr Mohammed Faruk H Memon Consultant Intensivist,
Head of Department – Critical Care Unit,
Rajasthan Hospitals,
Ahmedabad
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