Indian Patient Monitoring Equipment Market Value-Wise

The all-pervasive patient monitoring devices not only monitor the patient's physiological signs but can do so from any location, and send the information to the physician at any location.

Despite high level of medical observation, medical monitoring, and record maintenance, it was difficult to keep track of various types of patient information over a period of time. Hence came the patient monitoring systems. Over time, monitoring patients from any location with the use of GSM network and very large scale integration (VLSI) has become possible and improved versions which can get wireless patient monitoring system (WPMS) into the patient's life. WPMS made patient monitoring much sophisticated and reliable for patients living in remote areas. The patients can easily send their health information to the respective physicians at any given time from any location at any time. This has led many innovations in the present healthcare sector with many therapeutic areas covered through WPMS.

A trend that is currently prevailing relates to the adoption of less-invasive, more accessible, patient-centric monitoring device configurations. This is exemplified by the movement toward minimally and non-invasive modalities within the cardiac output market and the uptake of wireless telemetry solutions and remote patient monitoring platforms in both hospitals and alternate care sites.

Furthermore, emphasis is now being placed on patient comfort and mobility across lower-acuity care settings, wherein gaps in monitoring are further filled with portable solutions. With respect to consumables, there is a shift in demand toward disposable units in many regions as a proactive means of reducing cross-contamination risk and liability concerns. Each of these are in line with the general drive to improve patient outcomes through reduced complication and mortality rates, thereby promoting long-term cost savings. This will help, in turn, to improve the quality of care while also alleviating pressure associated with budgetary constraints across the care continuum.

Indian Market Dynamics

Indian Patient Monitoring Equipment Market Value-WiseThe Indian patient monitoring equipment market which was valued at Rs.466.45 crore, with 46,700 units in 2015 is poised to reach Rs.500 crore by 2016. This includes the organized and unorganized segment. Most of the equipment is imported. Skanray, and some models by BPL constitute the indigenous range, which are primarily popular in Tier-II and Tier-III cities.

Philips is the clear leader in this segment. Mindray and GE have aggressive presence. Nihon Kohden has had excellent sales in 2015, and has joined the leading brands. Mindray and Philips have had good success with their recently launched entry level models.

The patient monitoring market in India primarily finds its place among the urban and metro population of the country. The Indian patient monitoring market is highly fragmented and is catered by many domestic and international players. The patient monitoring market is highly technology based and thus manufacturers have to keep upgrading the product range with latest technology before they become obsolete. The product range is highly segmented based on technology and price range. The Indian market has a pool of underserved patients in the rural and Tier-III cities of the country. Manufacturers have strategies in place to target this class of consumers.

High population base and improved purchasing power of patients are the major drivers. Despite significant progress within the monitoring device industry, the widespread integration of wearable sensors technology into medical practice remains limited.

Global Market

Indian Patient Monitoring Equipment Market Unit-WiseThe patient monitoring equipment market is expected to grow from USD 16.9 billion in 2015 to almost USD 23.8 billion in 2020, reflecting a 5-year compound annual growth rate (CAGR) of 7.1 percent. The segment is expected to grow at a fast pace majorly driven by government regulations to control rising healthcare costs. Technological innovation and development of products are also contributory elements. Growth may be hampered by the economic slowdown, stringent regulation of hospital operations and processes, and unstable reimbursement policies.

In 2015, hospitals were the largest segment of the end-user market, accounting for a 51 percent share. However, in term of growth, home users are the fastest-growing end-user segment, and poised to continue being so. The most prominent high-demand areas for patient monitoring devices include cardiac, critical care (e.g., intensive care units), operating rooms, emergency rooms, and high-dependency units.

The patient monitoring devices market may be segregated into nine main segments: hemodynamic, neurology, cardiac, respiratory, fetal and neonatal, multi-parameter, remote patient, and temperature- and weight-management monitors.

The cardiac monitors segment had the largest share of the total patient monitoring devices market in 2015 and will continue to grow in the next 5 years to retain the leading position till 2020. The high growth in this segment is attributed to the growing demand for ECG devices. Moreover, rising incidences of cardiac and diseases such as diabetes and hypertension are major contributory factors.

The neuromonitoring devices segment, on the other hand, will be the fastest-growing segment in the coming years. With the evolution in technology, neuromonitoring devices can predict the occurrence of neurodegenerative diseases.

The respiratory monitors segment is also expected to grow at a high pace over the next 5 years. Under this segment, capnography products are the fastest growing.

Among all segments, remote patient monitoring devices should grow the fastest with a CAGR of 16.6 percent from 2015 to 2020. The shift in the healthcare sector from a physician-centric market to a patient-centric market is a key driver.

Major Vendors in Indian Patient Monitoring Equipment Market-2015Multi-parameter monitoring devices segment was the second-largest in 2015. This segment is a high-volume market that has demonstrated continuous growth primarily driven by expanding healthcare infrastructure, increasing demand of critical care (e.g., ERs, ICUs, etc.) and broad usage of multi-parameter products. These devices can monitor various physiological parameters of a patient in order to have an overview of the patient's health and status. Due to tremendous increase in the number of hospitalizations, ranging from extremely serious to basic monitoring, hospitals are increasing their spend in this segment.

There have been multiple recalls of several types of multi-parameter patient monitoring equipment over the recent past owing to several reasons. A key reason for product recalls was the misinterpretation of sensory data to give the wrong reading, thereby leading doctors to make false conclusions.

It is not just medium- and small-scale manufacturers that have had to issue recalls; several globally prominent entities have also been subject to consumer grievances and large-scale product recalls.

The future of multi-parameter patient monitoring equipment could very well lie in emerging economies. Nations in Asia-Pacific, for instance, are showing a high rate of healthcare evolution and will surely give wide berth to manufacturers of advanced medical equipment.

Close to 71 percent of the total value of global multi-parameter patient monitoring equipment market was taken up by the top three players - Philips Healthcare, GE Healthcare, and Drägwerk AG & Co. KGaA. Product innovation is a key strategy adopted by them and other prominent players in this primarily oligopolistic market.

A large part of the demand for multi-parameter patient monitoring equipment is currently for high-acuity monitors. These monitors are expected to generate revenue at a CAGR of 5.2 percent from 2015 to 2023, which is expected to reach close to USD 2 billion.

One of the greater shifts in the market for multi-parameter patient monitoring equipment that manufacturers need to look out for is the growth in demand for mid- and 
low-acuity patient monitoring equipment in the coming years. Home healthcare services are witnessing an enormous demand and it will continue to increase over the coming years, owing to a growing geriatric population and the advancement of remote monitoring healthcare services. Home healthcare services offer significant advantages such as reducing overall expenses and the number of hospital visits for patients.

Technical advances in measurement of gas exchange in ICUs have enabled the use of metabolic monitors for estimation of energy expenditure, assessment of pulmonary physiology, oxygen utilization, success of weaning, and measurement of metabolic stress. The evolution of metabolic sensors has made in 
situ measurements of blood gases and electrolytes possible in patients with an arterial catheter or a central venous catheter. They allow on-demand measurements and quick results without any blood loss. Besides their ability to record and transmit vital signs, these sensors have the potential to measure electrolytes and lactates in skin fluids. They may further bring opportunities such as remote metabolic monitoring in patients with chronic diseases once their reliability is established.

Growth Drivers

A decrease in the physical size of monitoring devices, enhanced utility, performance and sensitivity, usability and portability of devices, and increasing availability of remote/wireless patient monitoring equipment and systems are fueling growth. Other key drivers include continuous product development and technology advancements, and expanding healthcare awareness.

Key restraining factors include high level of competition, creating price pressure and increasing market challenges as well as regulatory and reimbursement issues, and challenges in technology and adoption of new products. Cut-throat competition is driving the prices to artificial low levels and is hurting the profit margins of manufacturers.

Technology Trends

The digital technology revolution in healthcare has changed the way the hospitals connect and communicate. Convergence of new measurement technologies, patient demographics, and managed care cost initiatives is driving patient monitoring away from caregiver facilities and into patients' homes. Remote monitoring equipment has come in the forefront of wearable devices and sensors, and advances in data integration and interoperability have revolutionized patient monitors.

Toward Home Monitoring

For decades, cardiovascular monitoring belonged to high-level specialists working in specific locations such as catheterization laboratories, operating rooms, and intensive care units. Today we enter into a new era where, thanks to wearable or implantable sensors, patient monitoring will become possible from home. It will create as many opportunities as it raises questions: Who should regulate the use of these new products and software applications; what and where is the frontier between medical and consumer products; can patient trust the measurements; what should be monitored and in whom; who is going to receive, interpret, and protect the information; what is the impact on patient care; and who is going to pay for this?

Connectivity and Data Integration

Interoperability is the key to a range of ongoing and potential improvements in our healthcare system. Electronic health records (EHRs) is just the beginning. The goal is for doctors, nurses, patients, family members, researchers, and insurers to share useful medical data. This holistic approach could create communities of healthcare awareness to provide patient with knowledge, support, and the feeling that they are not alone.

Besides its safety advantages, connectivity opens the door to data integration. First, it allows the automatic calculation of derived parameters such as oxygen delivery (requiring cardiac output, hemoglobin, and arterial oxygen saturation at the same time) or transmural pulmonary artery occlusion pressure (requiring simultaneous pressure measurements from the pulmonary artery catheter and the mechanical ventilator), just to mention a few.

Second, data integration is the opportunity to build a more holistic representation for every patient. Integration of all monitored variables together with the patient's history and laboratory tests coming from electronic medical record (EMR) system opens the doors to the development of smart systems (artificial intelligence) able to suggest a diagnosis or a treatment, and even to deliver therapy. Connectivity and data integration may allow the development of controllers able to process multiple parameters at the same time and guide or unload clinicians in more complex clinical situations.

Data integration is also the cornerstone of predictive analytics. This is an intense area of research for experts in medical informatics. The complexity of predictive algorithms is limitless, but the principle is simple: The combination of several parameters (usually vital signs) and the automatic recognition of specific patterns allow detection of adverse events earlier than the classical side-by-side monitoring of single parameters. Algorithms have been developed to predict cardiorespiratory deterioration. In this regard, predictive analytics may be useful to trigger the intervention of a rapid response team (RRT) and accelerate ICU admission (for patients in the ward or the emergency department) or to postpone ICU discharge for patients who are about to leave the unit. The simplification of monitoring systems, becoming smaller, smarter and even wireless, should boost the clinical applicability of predictive analytics. Although a very exciting and promising research field, one has to acknowledge that these systems will never be able to predict the unpredictable, i.e., external interventions (vasoactive or inotropic drug administration or mechanical ventilation) or accidents (surgical bleeding due to vessel injury), which are often the cause for changes in hemodynamic status and patient outcome.

Way Forward

In the future, clinicians will use medical devices that communicate and integrate the clinical, physiologic, and biological information necessary to predict adverse events, prevent medical errors, propose the most rational therapy, and ensure it is delivered properly. Many questions remain unanswered, and studies will have to demonstrate that in silico progress has clinical value and ideally it is cost-effective. But considerable intellectual and financial investments are already made, from small and innovative start-ups to giants, to ensure that some of these new ideas and products soon become a reality.

Sri Harsha, Project Lead-Patient Monitoring, Skanray Technologies Private Limited
Industry Speak
Brain Waves

We have come a long way in the field of extracting important electrical signals from human bodies. But we are yet to master the brain's electrical activities.

Let me call any electrical signal that can be captured from brain as brain waves. I believe that the brain waves tell us much more than what we can decode as of today. And the research and advancements in this field certainly support my belief.

Brain waves have already found many applications in clinical sciences, for e.g., we have various medical devices that can assess the level of consciousness of a person, diagnose various brain disorders, interface brain and computer, and so on. Bi-spectral Index uses brain waves to monitor the depth of anesthesia. Neuro-feedback uses brain waves for self-regulation of brain, finds large number of therapeutic uses in chronic pain, sleep disorders, and many other neuro-pathological conditions. There is growing awareness amongst people on use of these devices. The market for such devices is expected to grow steadily in the next few years.

There is a good amount of research in progress to extract relationship between brain waves and other physiological parameters such as ECG, respiration, etc. Positive outcome of this research will prove propitious in patient monitoring area as we can monitor most of the vital parameters of a patient with the help of only brain waves. This will certainly transform the entire patient monitoring system solutions market.

Not just in patient monitoring applications, this technology will also play a major role in diagnostics as well. Brain waves differ in some diseased conditions and it might be possible to diagnose and arrive at the prognosis by just analyzing the brain waveforms.

This technology has got immense potential in the fields such as forensics, psychology, biometrics, neuro-marketing, robotics and artificial intelligence, to extract information from a person's memory, to analyze human characteristics and for studying consumer behavior. As our capabilities expand the applications of brain wave monitoring and analysis will only keep growing, going forward.

Sri Harsha
Project Lead-Patient Monitoring,
Skanray Technologies Private Limited

Anil Srivastava, National Sales Manager-Medical Equipment, Nihon Kohden India Private Limited
Industry Speak
Cardiac Output Measurement in Patient Monitors

Cardiac output (CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. Moreover, it gives important information about tissue perfusion and oxygen delivery. CO can be measured by various methods, and thermodilution method using pulmonary artery catheter (PAC) is till date considered as the gold standard method. Complications associated with PAC led to development of newer methods, which are minimally invasive or non-invasive. Newer methods fulfill other properties like continuous and reproducible reading, cost effective, reliable during various physiological states, and have fast response time. These methods are validated against the gold standard with good level agreement.

Minimally invasive and non-invasive methods of estimation of cardiac output were developed to overcome the limitations of invasive nature of pulmonary artery catheterization (PAC) cardiac output and are the primary compensatory mechanism that responds to an oxygenation challenge.

Ideally, the technology which provides CO estimation should be non-invasive, accurate, reliable, continuous, and compatible in adults and pediatric patients. Recent advances in technology incorporated in patient monitors have led to the development of minimally invasive and non-invasive methods to measure cardiac output. A new technology has been recently launched; this technology allows non-invasive measurement of continuous cardiac output from ECG and SpO2. This new technology is to determine the cardiac output - continuously using pulse wave transit time (PWTT), which is obtained by the pulse oximetry and ECG signals from each cycle of the ECG and peripheral pulse wave. This technology provides real-time, continuous, and non-invasive cardiac output measurement. Ease of operating and ease of access to technology will be the key in future.

Anil Srivastava
National Sales Manager-Medical Equipment,
Nihon Kohden India Private Limited

Manju Goyal, Sr. Application Manager-PMLS and SU, Mindray
Industry Speak
Remote Areas Coming Closer via IT to Provide Safe Healthcare Environment

Healthcare is at the next level altogether in metro and Tier-I cities, but as healthcare industry is extending its reach toward remote areas so it has created a need for efficient communication system for better results. IT is emerging like a bridge to zero down that gap to provide better patient care. It has brought innovational changes in healthcare practice and final outcome.

In Tier-II cities, the time gap between the time when the patient enters the ambulance and reaches the hospital is considerably high, and in certain conditions it can decide the fate of the patient. In that case, what is needed the most is a virtual connection between the patient and the hospital. IT establishes that connection much before then; actually the time taken by the patient to reach the hospital (considered as lost from clinical care point of view) is not actually lost. Nowadays much of information required for clinical investigation like patient's vital signs and 12-lead ECG reports with reliable diagnosis tools is accessible to the clinician the moment the defibrillator-cum-monitor is connected to the patient. So now with limited resources, treatment can be started, if required, while patient is on his way to the hospital. If it is a cardiac patient, the healthcare IT can be as good as lifesaving tool for him.

IT has become a fast and reliable live patient clinical information exchange tool when there is a requirement to connect a remote hospital to principal hospital while there is a need of expert opinion for some critical condition. Nowadays many hospitals are connecting there peripheral wings to their central hospital to give patients the best of care without any delay and information loss.

Time is moving fast, so we can expect many more revolutionary changes in healthcare with IT stepping in various areas of patient care.

Manju Goyal
Sr. Application Manager-PMLS and SU,
Mindray


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