Remote monitoring equipment has come in the forefront of wearable devices and sensors, and advances in data integration and interoperability have revolutionized patient monitors.

New patient monitoring systems are emerging in response to the increased healthcare needs of an ageing population, new wireless technologies, better video and monitoring technologies, decreasing healthcare resources, reducing hospital stays, and proven cost-effectiveness. There is extensive interest in using wireless technologies in patient monitoring in various environments including hospitals and nursing homes. This system is more useful for elderly people as they are more prone to chronic diseases and need continuous health monitoring. They provide real-time the condition of patients to doctors immediately. The system offers faster, reliable, effective, and cost saving therapy so it has become more popular. Wireless technology requires three key aspects of accessibility to information, convenient usage, and cost effectiveness. 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.

Indian Market Dynamics

Patient Monitoring

The Indian patient monitoring equipment market estimated at Rs.420.56 crore, with 37,530 units in 2014 is poised to reach Rs.432 crore at 38,500 unit by 2015. Most of the equipment is imported, with Chinese products cannibalizing the market. Skanray, offering an indigenous range is perhaps the exception. Emco, and Nasan also offer some indigenous products.

The patient monitoring market is highly technology based and manufacturers have to keep upgrading the product range with latest technology before they become obsolete. The products range is highly segmented based on technology and price range. The Indian market has a pool of underserved patients in the rural and tier 3 cities of the country. Manufacturers have formed strategies to target that section of society. High population base and improved purchasing power of patients are the major drivers.. In India, despite significant progress within the monitoring device industry, the widespread integration of wearable sensors technology into medical practice remains limited.

Global Market

The global market for patient monitoring equipment is projected to reach USD 4.7 billion by 2023 from USD 3 billion in 2014. The increased adoption of portable multi-parameter patient monitoring equipment is a major trend in the upcoming market. Clinicians and home users are increasingly adopting portable, compact, and low-cost multi-parameter monitoring equipment. The increasing ageing population is a key driver that is expected to propel growth. Improved standards of healthcare and sophisticated treatment options have led to an increase in life expectancy rates leading to rise in ageing population. Further, high cost and low accuracy of equipment is a key challenge in the market.

The high-acuity monitors segment accounted for the largest share of over 40 percent of the market in 2014, on the back of increasing admissions to intensive care units with respiratory and cardiovascular diseases. The forecast is of expansion ofĂ‚ low-acuity monitors at the fastest rate with a growing need for ambulatory and transport monitoring services.

Technology Trends

Remote patient monitoring. The technology remains a vital aspect of strengthening patient health outcomes and quality of care across the medical field. The technology has a wide variety of functions including determining respiration rate, cardiac output, oxygen and carbon dioxide levels in the blood, and body temperature. A variety of healthcare organizations have already begun utilizing remote patient monitoring systems including cloud-based technologies to better track chronic medical conditions among their patient base. These remote patient monitoring (RPM) tools, if properly integrated into a medical facility and interoperable or connected among a variety of necessary medical devices, could lead to the reduction of medical errors and drop in the rates of hospitalizations throughout the healthcare industry. One of the key technologies that are making an impact on RPM is videoconferencing capabilities or telehealth services. RPM needs a wide variety of differing technologies including electronic messaging and remote telemedicine-based consultations. Essentially, these tools will offer greater access to care for patients living in remote, rural areas as well as those living in communities that are facing doctor shortage.

Patient MonitoringCloud computing. The integration of Internet of Things (IoT), sensor technology, and cloud computing is aimed at overcoming resource constraints as it enables different networks to cover large geographical areas so that they can be connected and used by several users at the same time when required. In addition, the recent emergence of cloud computing and sensor awareness of infrastructure architecture methods, service-oriented architecture, software delivery, and development models are also contributing factors to a smart environment. In order to provide real-time healthcare informatics, hospitals need some type of monitoring system to track objects and medical equipment in which security, efficiency, and safety are ensured, with reduced occupational risks. The key feature of the smart monitoring system is to provide identification of users and objects, so that an adequate service customization can be obtained. The increase in competition between companies that provide and produce smart sensor technologies, which cover large areas to meet rapid changes and users' needs, has contributed to competitive advantage in location-based services.

Advent of nanotechnology. Nanotechnology incorporated in sensors has changed the outlook of patient monitoring. A silver nanowire sensor overcomes the deficiencies of traditional technology with the potential to significantly improve long-term monitoring of a patient's health. Electrocardiograms (EKG) and electroencephalograms (EEG) comprise some of the traditional technologies used in long term patient monitoring. Despite their sophistication in keeping healthcare workers updated about a patient's vitals, the drawback with this existing technology is the method in which information is obtained using electrolytic gel. These sensors are known as wet sensors because of their requirement for the gel, which needs to be replaced regularly for the devices to function effectively. If the gel dries out, not only does it cause discomfort to the patient, but it can also skew the sensor readings. Also, these sensors do not allow patients to move around much, keeping them confined to the bed. The most prominent advantage of this silver nanowire sensor is that it is a dry sensor, with no requirement of an electrolytic gel. With the difficulties associated with regular reapplication of gels out of the picture, the silver nanowire sensor can be used for hassle-free long-term patient monitoring. The sensor also has signal quality that is as good as an EEG or EKG, a factor that keeps its readings accurate. And while the EEG and EKG are associated with a bunch of wires and general bulkiness, the silver nanowire sensor is a small device that can be placed on the wrist and fastened securely by a band allowing the patient using it to be mobile. Its small size, dryness, and signal quality make it a more accurate and effective electrophysiological sensor as compared to other existing technologyies.

Advances in perioperative monitoring. Minimal mandatory monitoring in the perioperative period has become an integral part of anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, trans-oesophageal echocardiography, advanced neurological monitoring, improved alarm system, and the technological advancement in objective pain assessment. Newer perioperative monitoring techniques include depth of anesthesia (DOA) monitoring, goal-directed fluid therapy (GDFT), transesophageal echocardiography (TOE), neurological monitoring, the advancement in the alarm system, and technological advancement in perioperative pain assessment.

Challenges

While there have been major improvements in intensive care monitoring, including the development of clinical information systems, the medical industry, for the most part, has not incorporated many of the advances in computer science, biomedical engineering, signal processing, and mathematics that many other industries have readily embraced. Acquiring, synchronizing, integrating, and analyzing patient data remains difficult with insufficient computational power and lack of specialized software, incompatibility between monitoring equipment, and limited data storage. All of these technical problems are now surmountable. Today, being on the verge of the data-intensive science era, hypotheses will be generated automatically among the enormous amount of data available by using computational science with inductive reasoning. In this new era, information technology enabling the development of an integrated critical care informatics architecture that supports clinical decision-making at the bedside will be essential. While modern clinical information systems do provide end-to-end platforms for the ICU, there are several limitations too. First, they remain limited in terms of functionality and the acquisition of high-resolution physiologic data; second, there is currently neither processing nor analysis of data. While a few monitors can display raw trends, even basic analyses (mean, median, standard deviations) are difficult to perform at all let alone in real-time and higher-level analyses are impossible. New physiological models are now emerging suggesting that nonlinear changes in dynamics over time may have more predictive value. Understanding this complex physiology can lead to more timely intervention and better outcomes.

Industry Speak
Extending Wings in Patient Care Segment

Recent advancements in technology have developed a number of new aspects in patient monitoring. In today's growing technology scenario, there is an urgent need for finding new ways to improve access to patient care.

Advanced patient monitoring market has been benefited from the demand to move on more toward wireless or anywhere accessible patient monitoring. This demand has given a platform to move the market toward remote patient monitoring.

Earlier, we used to discuss about bed-side patient and hospital-side patient information at most. But in today's world, assumptions have been changed and the new healthcare reforms have proved this limited access is not sufficient as there is a need for the clinician to touch base with patients outside the hospital also, and the only solution to this is with remote patient monitoring technology.

Remote patient monitoring enables remote monitoring to be accessed from anywhere and anytime on any networked computer or mobile device across the globe. Real-time monitoring, trending data, early detection of emergency condition or deterioration in health act as the supporter to the clinician to provide proper assistance in exigencies. It provides the clinicians and the patients to be virtually attached and linked at any point of time. This helps clinicians get expert advice for any particular patient with help of live and detailed patient information for vital signs and analyze patient historical data. This technology has also taken care of patient data security by providing authorization to clinicians via dongles. Remote patient monitoring is not only limited to bed-side monitors, but also adds value to telemetry device, so that patients can also be monitored on the same system simultaneously with the help of this technology.

The technology not only assists the doctors to track patient information and provide aid but also lets them improve quality of patient care and strengthen patient health outcomes.

Manju Goyal
Senior Application Manager,
Mindray Medical India Private Limited

Industry Speak
Technological Advancements and Emerging Trends

Patient monitors have revolutionized critical care delivery to increase the efficiency and effectiveness of the intensivists and nurses in ICUs. But big improvements in monitoring technology in the near future is expected to change how healthcare is delivered, not just in ICUs but also in places of work and residence. The emerging trends that are changing the way doctors, nurses, and staff keep track of the physical status of patients, and in some cases, even interact with them.

Remote patient monitoring. With increasing ageing population, the need for monitoring patients wherever they live and work is increasing, as much as the need to reduce expensive hospital stay. One solution is telehealth, or remote transmission of a patient's medical data. Home medical devices that assist with the treatment of chronic illness are already commonplace, but now they are being integrated with distant healthcare facilities to track patient health and set off alarms when dangerous situations arise.

Use of Big Data. Combining the ability to track information on patient health with the explosion in the number-crunching capacity of advanced computer networks, one has access to a treasure trove of knowledge for medical research and treatment. For example, big data can help identify patients who are susceptible to specific conditions and prescribe preventive measures.

Electronic patient portals. Interoperability is the key to a range of ongoing and potential improvements in our healthcare system. Electronic health records (EHRs) are 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 people with knowledge, support, and the feeling that they are not alone.

Wireless sensor technology. The iconic image of a hospital patient is a frail figure lost in a tangle of wires and cables connected to large, noisy machines. Those wires and cables are beginning to be replaced by wireless technologies similar to those that have cleaned up the thickest of cables in our office workstations. But for the more personal needs of healthcare, that technology is becoming wearable. In addition to increasing the comfort of patients and enabling staff to more easily assist and move them, wireless will improve the devices in their main function - alerting staff to changes in vital signs.

These and other developments in healthcare technology will provide more comprehensive, uninterrupted attention to patients. At the same time, they have the potential to lower costs and improve medical outcomes.

Raghavendra H S
Project Lead-Patient Monitoring and Cardiology,
Skanray Technologies Private Limited

Industry Speak
Semi-Modular Concept Is Catching Up

On market trends

There has been a slowdown in government and private purchase in 2014, and the market for patient monitoring equipment did not achieve expected growth.

On technology trends

Even though there has been no significant change in technology, the industry is working on how to reduce the cost and offer the monitors at much cheaper prices without compromising on technology, features, or quality.

On key growth drivers

Many ambulance services are expanding and new home care services are being introduced in the country. Big corporate service providers and funded private services are starting this new concept of home care services, which demands monitors that are capable of relaying the vital data of the patient on real-time basis to the hospital so as to provide emergency measures as and when it is required.

On buyer's perspective

Buyers want best technology at the lowest prices. This is a big challenge for the industry. Minimum 5-parameter requirement has become the standard. With this, 2-3-parameter monitors are slowly becoming obsolete and the Low Acuity products are losing its shine. On a long run, there would be only mid acuity and high acuity monitors existing. Touchscreen feature is slowly becoming the standard of the industry. Semi-modular concept is slowly catching up.

On challenges and opportunities

Low value monitors made in China is the major challenge. While these products are affordable, their measurements are not always accurate, and thus a lot of money is wasted because customers who bought these low-cost products end up having to junk them. 2014 did not see many tenders from the government and hopefully we expect each state government to come out with a program to fully equip all the PHCs in the district places through NRHM.

On growth prospects

We expect the market to grow at least 10 percent in 2015.

V Balakrishnan
Sr. Vice President,
Schiller Healthcare India

Industry Speak
Advances in Patient Monitoring Systems

Assessment of patient parameters, such as heart rate and oxygen saturation, is critical to providing high-quality care. Patients with serious conditions need more frequent, if not continuous, monitoring of multiple signs and symptoms because their conditions may change swiftly. Clinicians caring for them must make timely decisions based on accurate clinical data. Accuracy of clinical data in patient monitoring plays a significant role in decision making and patient management for clinicians. Patient monitoring systems have contributed a great deal to computerized clinical-decision support systems. Besides feeding information to support systems, monitoring systems warn clinicians of patients' critical conditions. Computer-assisted patient monitoring, such as continuous electrocardiography (ECG) monitoring, began in intensive care settings in the 1960s. Since then, it has become far more sophisticated and its use has expanded significantly. It is now used not just in acute-care hospitals but in a range of other practice areas, such as long-term-care and community settings.

Constant progress in information technology and clinical information systems has brought more advanced equipment and software. Many clinicians use personal devices to communicate with hospital information systems through Internet. In today's information era, it is no longer sufficient for a system to simply monitor physiologic parameters and display them on screen but need same data to be seen and monitored remotely. Now this facility is available to clinicians, and they can monitor patients in real time at their convenience while seeing other patients, traveling or be at home at their ipad, mobile phones, or laptops, promoting more effective patient management, thanks to information technologies. If a patient needs critical intervention in the middle of the night, offsite providers can access the system to review clinical data and thus instruct the attending caregiver remotely. An increasing number of systems are equipped with remote access. This trend is growing at faster pace world over.

This helps in patient monitoring and contributes to patient safety and error prevention. Most monitoring devices can set thresholds for critical parameters; if the patient's measurements exceed these preset limits, the system alerts clinicians. These features can significantly improve medical safety. This improves economic as well as patient outcomes. Providing optimal care and preventing errors can shorten hospital stays and reduce medical expenses. Same is available with Nihon Kohden as ViTrac.

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

Second Opinion
Pulse Oximetry - The Fifth Vital Sign

We are all well aware of the four vital signs - temperature, pulse rate, respiratory rate, and blood pressure. It is about time non-doctors and the general public woke up to the 5th vital sign. The 5th vital sign of pulse oximetry reading has been in use for the past many years by doctors. Unfortunately, it is still underutilized. The pulse oximeter gives oxygen saturation of the blood flowing in the body non-invasively by using the principle of transcutaneously. Any part of the body can be tested but the most common areas where pulse oximeter probe is placed are fingers, toes, and ear lobes.

In the pediatric population, an important component of disease is congenital (before birth). Congenital heart defects (CHD) are the most common birth defects. One in every 100 newborns has some form of congenital heart defect. Major CHD impacts on newborn are in a life threatening way. A large proportion of major CHD manifests as cyanosis. Cyanosis can be detected by pulse oximeter reading. The normal value is more than 95 percent. A cyanotic baby typically has a reading of 70-85 percent or lower.

Infants with low reading can be referred for echocardiography and presence of CHD can be ascertained. Picking up major CHD early is life saving and enable early treatment in the form of surgery. The American Academy of Pediatrics recommends the use of pulse oximetry on each newborn before discharging from the hospital. This screening test should be implemented in India as it is non-invasive, simple, cost effective, highly sensitive for cyanotic CHD, and a positive result (and subsequent management of CHD) can save lives.

There are various types of pulse oximeters in the market. The ones that display a pulse rate or a wave form along with the pulse oximetry reading are preferred as the additional information of heart rate that can be cross checked manually.

Dr Swati Garekar
Pediatric Cardiologist, Fortis Child Heart Mission,
Fortis Hospital, Mumbai

 

Way Forward

Remote patient monitoring technology can be a key method for reducing costs and boosting patient health outcomes. This type of continuous stream of data could truly revolutionize patient care, as it would allow medical providers to analyze information on a larger population health management platform. Additionally, the government's efforts in both reducing the costs of care while improving the quality of services throughout the medical industry, will further aid patient monitoring. Many factors are critical to the rising demand for remote patient monitoring devices, chiefly including the rising availability of user-friendly, portable devices, and the rising prevalence of chronic conditions such as diabetes, respiratory diseases, and a number of cardiovascular diseases across the globe. A major ongoing trend in healthcare today is the accumulation and analysis of big data. This offers a major area of research and new treatment opportunities for patients. New technologies like remote monitoring systems offer a clear path for collecting more information and boosting the analysis of big data. Clearly, healthcare trends today are leading to a greater need for remote patient monitoring technology and health IT systems. New and improved monitoring techniques have undoubtedly led to dramatic changes in anesthesia practice. Various factors that need to be considered with the use of improved monitoring techniques are the validation data, patient outcome, safety profile, cost effectiveness, awareness of the possible adverse events, and knowledge of technical principle and ability of the convenient routine handling. The integration of cloud computing, wireless sensor technology, and IOT in a healthcare environment along with the use of wireless sensor technology is emerging as a significant element of next-generation patient monitoring services in real-time.


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