While the traditional 12-lead ECG system will remain the mainstay, inexpensive wearable, smartphone-based ECG monitors are fast gaining popularity.

ecgecgECG has been used as a basic cardiac diagnostic for a century, and while the premise remains the same, testing systems are evolving to meet today's technology demands. This includes increased mobility, ease-of-use, streamlined workflow, and interoperability so that the data can easily be interfaced with electronic medical records. There has been a trend over the past decade toward smaller and more compact mobile ECG monitoring systems. These can be used either inside a hospital, or a clinic, or on the road with a visiting nurse or on a cart for mobility between patient rooms. Another innovation offered by several vendors includes small box systems that connect via a USB to convert a standard PC or tablet computer into a resting ECG system.

Indian Market Dynamics

In 2015-15, the Indian ECG market was valued at 175 crore, with sales at 28,770 units. The metros and Tier I show a preference for the 12-channel systems and Tier II and III cities are able to afford only the 6-channel and lesser channel machines.

As in other segments, the physician is showing an increased dependence on machines for clinical decision support. There is a marked preference for interpretation technology and equipment with more accurate measurements.

ECG monitoring equipment with enhanced connectivity capabilities has been a primary driver of revenue growth. Smarter, smaller, and lighter ECG devices with Bluetooth-enabled data transfer and cloud-based EMR solutions are gaining steady popularity among corporate healthcare and organized home-healthcare service providers. Advances in ECG interpretation software are also huge game changers that are assisting more and more primary care physicians with quality interpretation backed with credible clinical data.

ecgTechnology Update

The resting ECG has been used as a basic cardiac diagnostic for a century, and while the premise remains the same, testing systems are evolving to meet today's technology demands. There has been a trend over the past decade toward smaller, more compact, mobile ECG monitoring systems. These can be used either inside a hospital, clinic, or on the road with a visiting nurse or on a cart for mobility between patient rooms. Another innovation offered by several vendors includes small box systems that connect via a USB to convert a standard PC or tablet computer into a resting ECG system.

Automation for diagnosis and anatomical detection. ECG interpretation algorithms now come standard on many systems. These use gender- and age-specific criteria to provide a virtual second opinion for resting ECG interpretation. This includes ST segment elevation myocardial infarction (STEMI) detection and diagnostic aids to provide interpretation of rhythm and morphology for a variety of patient populations. Some systems include critical values, ST maps, and culprit artery identification. Some systems have anatomical interfaces to help reduce improper lead placement or detection systems for the presence of a pacemaker.

Workflow improvements. ECG systems have been simplified to ease workflow. Examples of this include simplified step-by-step operation, introduction of touch-screen systems, and better connectivity with ECG management systems, electronic medical records (EMRs), and cardiovascular information systems (CVIS). The interoperability component will become increasingly important, as healthcare reforms and meaningful use requirements for information technology (IT) systems call for tight integration and easy interoperability to enable paperless healthcare and free flow of all patient data among departments, hospitals, and referring physicians. A major roadblock to interoperability has been that older-generation ECG systems were not built using proprietary software and the fact that there is no standard format for waveforms. Vendors are now addressing these issues and creating systems with more open IT standards to enable easier integration, even into software systems produced by other vendors.

Remote access. One advantage of paperless ECG review through an electronic ECG management system is the ability to access ECGs and enable remote viewing and reporting outside of the traditional workstation. Most modern CVIS offer remote, anywhere Web-based access to the ECG management system. This functionality includes access to ECGs and fully enabled reporting functions at home or anywhere in the hospital or clinics where a cardiologist finds some time to read cases. In addition to improved physician workflow, remote access and mobile device access to dynamic waveforms is a trend to enable faster reads on suspected STEMI cases. Immediate reads on mobile devices can help enable lower door-to-balloon times for heart attack patients with earlier cath lab activation times.

Road Ahead

While the traditional 12-lead ECG system will remain a mainstay in cardiac diagnostics in the clinical or hospital setting, the future of cardiac assessment may shift to patients triaging themselves before requiring analysis by these more complex systems. There is a trend in the Holter monitoring and consumer markets toward inexpensive wearable or smartphone-based ECG monitors. Unlike traditional Holter and cardiac event recorders, the new-generation devices are inexpensive or even disposable, and are much easier to use – with the elimination of electrode wires, devices are simply stuck on the patient's chest.

Some new devices interface with cell phones to eliminate the need for an external base station hardwired in the patient's home. These devices – combined with consumer-grade, app-based ECG monitors that interface directly with a patient's smartphone – will likely result in widespread expansion of basic ECG monitoring and represent a novel method for patient engagement in cardiology.

Dr Hem Chandra,Prof. and Head, Department of Hospital Administration,Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow

Offering high-quality diagnostic information, ease-of-use, portability, and a low unit cost, the ECG machine is a highly competitive product in the market. Starting from curative purpose to preventive one, now it has reached from urban to rural. Rapid growth and technological improvements varying from sector to sector since the past 3–5 years are witnessed by certain advanced specifications of the machines such as digital 3-channel ECG recording with 12-lead simultaneous acquisitions with auto summary, LCD display of patient demographics, real-time ECG data option, portability, Li-ion rechargeable battery, etc.

Dr Hem Chandra
Prof. and Head, Department of Hospital Administration
Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow

IT systems that currently handle ECG management may need to include ways to record data from these types of remote devices to include in a patient's EMR. This may be required to meet future patient engagement, remote monitoring, and other mandated health IT interoperability standards.

Indian Market Dynamics is based on market research conducted by Medical Buyer in March 2016.


 

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