April 2010

Monitoring the Growth Signs – Patient Monitoring Technologies

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A fundamental segment in the healthcare sector, the patient monitoring industry has evolved over the years owing to deeper penetration of technologies that have enhanced the development of best-of-the-class products.

Divya Chawla explores the emerging technologies and opportunities for growth in the patient monitoring sector in India and tries to capture the key growth indicators to provide a complete overview of this industry.


Emerging technologies in the healthcare arena have created exciting opportunities for improving the way care is provided across the globe. Patient monitoring, one of the biggest occupants of the medical technology pie, has been infused with several new technologies, ever since it was developed. Emergency rooms, intensive care, and critical care units cannot function without a patient monitoring module. Patient monitoring module enables physicians to have instant access to crucial parameters that allow them to measure the severity of illness because of which they can allocate their resources in an optimum way. The technology has also proven invaluable for recovery rooms, outpatient care, transport, radiology, ambulatory and home care applications. The overall productivity of a clinical setting can be bolstered by the instantaneous information provided by patient monitoring devices at the bedside, during transport and at the point-of-care.

Important Parameters Measured via Patient Monitoring

  • Heart Rate (HR)
  • Oxygen Saturation (SpO2)
  • Systematic Pressures (SSAP, SDAP, SMAP)
  • Core Temperatures (Inside the Heart)
  • Respiratory Rate (RR)
  • Electrocardiogram (ECG)
  • Peripheral Temperature Cardiac Output Index (CI)
  • Central Venous Pressures (CVP)
  • Pulmonary Pressures (PSAP, PDAP, PMAP)
  • Oxygen Saturation in Lung Artery (SVO2)
  • Outcoming Carbon Dioxide (ETCO2)
  • Ingoing Oxygen (FIO)
  • DiureticsDrip DrugsBolus DrugsPatient’s WeightFluid Balance (Incoming and Outgoing)
  • Intracranial Pressure (ICP)
  • Electroencephalogram (EEG)

Market Intricacies

Like all other medical technology segments, growth in the market for patient monitoring is primarily driven by increasing awareness among medical professionals and growing incidence of diseases. As per reports, the global patient monitoring market was valued at USD 4.9 billion in 2008 and is expected to cross USD 7 billion sales by the end of 2015. The average annual growth rate can be estimated at 3.8 percent, which considering the global meltdown is a decent ascent. In India, per se, Srinivas Iyer, National Manager, Critical Care, Trivitron, estimated the market to be roughly around Rs. 230 crores. In all, five crucial product segments have been identified in this market, which includemulti-parameter patient monitors, wireless and ambulatory patient monitors, remote patient monitoring, non-invasive blood pressure monitors and micro-electromechanical systems.

A significant feature of the patient monitoring market is that certain segments within patient monitoring are developing rapidly, as compared to others, and are expected to follow similar growth patterns in future, as well. However, there are other segments that have yet not reached that level of growth and development. This has created unequal development of different segments as some are progressing faster than the others. Reports identify, wireless and ambulatory monitoring and micro-electromechanical systems to be the key segments driving growth globally. Wireless multi-parameter patient monitors are currently the hottest selling products in this market. Reasons being the multiple benefits they offer in terms of allowing the healthcare professional to monitor patients from anywhere and the increased productivity and cost-efficiency these systems offer.

Patient Monitoring Systems

Healthcare market is emerging as one of the best business opportunities and largest service sectors in the country. Increased life expectancy, rising literacy leading to increased health awareness, rising per capita expenditures on healthcare are some of the factors leading to increase in tertiary care setups. India’s disease profile is expected to follow the same pattern as in developed economies. Based on demographic trends and disease profiles, lifestyle diseases such as cardiovascular illnesses, asthma and cancer have become the most important segments. With increase in tertiary care hospitals and other demographic factors, patient monitoring equipment, being the basic requirement, is bound to grow in its demand. Market OverviewThe Indian patient monitoring systems market grew to over 240 crores in 2009 at 20% over the corresponding year. In terms of volume, Indian market is estimated at around 26000 units in 2009. The patient monitoring equipment market is divided into high acuity, mid acuity and low Acuity. Volume-wise, mid acuity leads the market with almost 60-65percent market contribution. Value-wise high acuity is estimated at around 40 percent, whereas mid acuity accounts for approximately 35 percent. With change in healthcare practices, the demand for multi-parameter monitoring systems has grown.

Clinicians wanted patient monitors to provide more physiological measurements that are less invasive and manage informatics in a better way. Technology has played a significant role to change the patient monitoring systems market. The central station patient monitoring market has been evolving rather rapidly in the recent years. Demand for bedside and telemetry patient monitoring systems has been growing for the last few years. Novel technologies in patient monitoring systems are adding to sophistication. Key Drivers Increased demand for tertiary care, life style disease especially cardiovascular illnesses and technological advancements in patient monitoring systems such as home healthcare and remote monitoring are some of the significant market growth drivers. Demand for multi-parameter monitoring systems will be on higher side. Some of the specifications in demand are heart rate, peak flow meters, etc. Primary care with improved therapeutic outcomes as well as preventive care are also contributing to the market growth. Barriers / Challenges Low pricing, lack of regulatory authority for certification for manufacturing of patient monitoring systems in the country and government’s initiative to incentivise manufacturing within country with international standards/players. Leading Players Nihon Kohden, Philips, GE, Draeger, Mindray, Spacelabs, L&T, BPL, Schiller. Product Range Nihon Kohden range of products including PVM270 basic 5 parameter monitor, Lifescope I, Lifescope L and Lifescope A with unique multi-connector technology. Trivitron exclusively markets patient monitoring system of Nihon Kohden, Japan which is a pioneer in patient monitors and other products like defibrillators, EEG and EMG machines.

“Novel technologies in patient monitoring are emerging to meet the increasing demands of an aging population. A few of these latest technologies include wireless communication systems that “sort” the vast amount of data collected in order to put it into the context of a patient’s condition, portable and ambulatory monitors, web-based access to the patient record, systems that transfer data to an electronic medical record (EMR), and full-service outsourcing that includes a clinician to uate data and send a report to the attending physician”, describes Srinivas Iyer from Trivitron. “Recently Nihon Kohden has launched their new Basic 5 Parameter monitor with its latest software and eC1 technology. This technology filters of the unwanted alarms and reduces the number of false alarms making it much convenient to the hospital staff. Also PVM 2701 has a unique signal separation algorithm which filters the noise to a great extent and thereby giving much reliable Spo2 reading. Nihon Kohden monitors have a very unique technology to calculate the pulse wave transit time (PWTT). By doing so, it automatically triggers the measurement of non invasive blood pressure whenever the patients’ other vital parameters show abnormality thus it gives the doctors an additional perspective to the patient’s condition”, he adds.

There is also a constant rise in demand for continuous pulse oximetry monitoring. Technologies such as sophisticated algorithms, reduced level of false alarms, ease-of-use and flexibility of the remote alarm management solutions, ability to adjust the alarm levels on a patient by patient basis and the easy to follow patient vital sign display at the central nursing station enables healthcare workers to provide better care with existing resources in this segment.

Patient Monitoring Market in India

Leading technologies in patient monitoring segment Wireless technology to transmit data to central nursing station the advantage is that the monitor can be moved around, along with the patient in the hospital from ICU, OT, recovery rooms with complete data reception at CNS. GSM data transmission for ambulances transmitting real-time data to the receiving centre at the hospital enabling immediate treatment. Opportunities and challenges for manufacturers/suppliers of patient monitoring equipment in India Opportunity: Patient monitoring market is steadily growing at 20 percent on an annual basis. Insurance sector and government funding for healthcare are the actual boosters for growth of this market. Challenge: Too many players are in the market. However, companies having good customer service will eventually succeed. Leading players in this segment Philips, GE, Schiller India, L&T, BPL, Mindray and Draeger.

Product Segment Features

Truscope mini

Low Acuity

Configurations available: ECG + RR, ECG + RR + SpO2, Only SpO2, ECG + RR + SpO2 + NiBP, ECG + RR + NiBP, ECG + RR + SpO2 + NiBP + Temp (all five parameters)

Truscope II

Mid Acuity

  • Standard monitoring parameters: ECG, SpO2, NiBP, temperature and RR
  • Optional Parameters: ETCO2 (mainstream/side stream), dual channel IBP, anaesthetic gas monitoring

Truscope Classic

  • Standard monitoring parameters: ECG, SpO2, NiBP, Temperature and RR
  • Optional Parameters: ETCO2 (mainstream / sidestream / microstream), dual channel IBP, cardiac output, anaesthetic gas monitoring

Argus LCX

  • Standard monitoring parameters: ECG, SpO2, NiBP, temperature and RR
  • Optional Parameters: ETCO2 (mainstream), dual channel IBP

Truscope Elite

Multi-parameter touch screen modular monitor with:

  • Standard EMS module providing monitoring of 3/5 lead ECG, RR, SpO2,  dual temperature, NIBP
  • Modular upgradations: ETCO2 (mainstream / sidestream / microstream), Nellcor SpO2,, dual IBP, cardiac output, anaesthetic gas monitoring

ARGUS PRO SL

High Acuity

Multi-parameter monitor with 17″ colour TFT touch screen. Parameter box:

  • ARGUS PB-1000: HR, respiration rate, NIBP, peripheral oxygen saturation (SpO2), peripheral pulse, transcutaneous CO2 measurement, invasive pressures P1, P2, endocranial pressure measurement with CPP calculation, ETCO2, FiO2, N2O and all standard anaesthetic gases, cardiac output
  • ARGUS PB-2000: standard: two invasive blood pressure; optional: second SpO2 interface, a transcutaneous CO2 pressure
    ARGUS PB-2200: mainstream or sidestream CO2 measurement or both measuring techniques combined.

Schiller is developing a special multi-parameter patient monitor, which can transmit real time data of vital parameters via wireless communication. When a patient is taken in an ambulance the doctor at the hospital will be able to see the real-time data of the patient and accordingly suggest immediate treatment and thus save the patient’s life.

In terms of region-wise market, although, till now the US has been contributing for maximum sales in the global patient monitoring market, yet the future may witness a shift in this as several emerging economies are now accounting for larger shares than ever before. Countries such as India and China, with their huge populations comprising of an increasing number of chronic disease patients and rising number of healthcare delivery centres are expected to grow at a higher than the average global growth rate. In future, these countries may surpass the current overall patient monitoring market spread in the US to account for largest share of the global patient monitoring sector.

However, certain key impediments to growth in the developing countries include old equipment and hardware, trend of maintaining records on paper, lack of proper communication channels, and shortage of information and skills. These countries are required to make an effort to address these issues through developing low cost monitors, re-engineering cheap electronics to monitor crucial parameters in a cheap and efficient way, and developing and implementing solutions for maintaining and retrieving data provided by these systems. It, therefore, becomes imperative for developing countries to focus on developing their internal infrastructure to be able to achieve the optimum level of growth they are capable of.

To enhance their individual sales and have a larger footprint in the market, manufacturers are now increasingly focussing on providing strong and efficient customer support services. Owing to the importance of patient monitoring equipment in various clinical care settings, this component is highly crucial as breakdown of equipment can cause dire results in case timely repair services are not provided. Success for vendors, also depends on implementing unique sales tactics coupled with providing efficient after-sales and maintenance services to have an edge over other suppliers. With the accelerating growth in technology, it also becomes imperative for all vendors to emphasize on product development by incorporating new features backed by the latest technology in their products. This not only provides them to be able to have a better hold over over the market owing to the unique products they offer, but also provides the users with the best technologies available globally to enhance the quality of care offered by them.

Latest developments in patient monitoring equipment are now focussed on enhancing interoperability within various departments within a clinical setting. Development of IT-integrated patient monitoring systems is already taking place and vendors across the globe are rolling out such products into the market. Although, some research papers also suggest that manufacturers are limiting market growth because of their reluctance towards interoperability, yet there are availability of products which are able to communicate with each other within a clinical setting. Suggested reasons for vendors to limit interoperability options include lack of incentives to allow this to happen more quickly than technology permits and have a control over the market by making customers dependent on proprietary systems that do not integrate with systems manufactured by other vendors.

The Road Ahead

Sales of patient monitoring products that are currently in the pipeline, will be driven by effective monitoring parameters and increased acceptance of technologies aimed at home care settings. Factors such as awareness, affordability and an ever improving healthcare infrastructure in developing economies will drive the global market for patient monitoring equipment. The challenges that will always remain include reimbursements and lack of awareness and limited innovation issues in certain segments of the society. Device manufacturers across the globe are struggling because of limited reimbursements being provided by the government. While the government is required to take an initiative, the industry must look at including the  best technologies in their products and make them available at the best possible price. 

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