As patient monitoring moves from critical to low-acuity areas within hospitals, and as telehealth increasingly lets patients be monitored in the home, the market for an expanding number of devices is expected to experience rapid growth.

by Dr. Kamran Zamanian and Sara Whitmore, iData Research

The total U.S. patient moni- toring market is expected to grow at a compound annual growth rate of 4.1% by 2018. Traditional monitoring prod- ucts including multi-parameter vital signs, telemetry, fetal and neonatal are stable and well established within hospitals and will continue to grow to replace outdated sys- tems. In addition, monitoring is becoming ubiquitous in all hospital departments, es- pecially in low-acuity areas such as wards where patients were previously unmoni- tored. Sales of wireless ambulatory telem- etry monitors and low-acuity vital signs monitors are expected in high volumes to help monitor previously unmonitored pa- tients.

Meanwhile, healthcare reform poli- cies are expected to result in an additional 50 million people receiving some form of health insurance. This will lead to a grow- ing number of people seeking treatment, which they previously may have deferred due to the high out-of-pocket expense. The increase in the in-patient population is expected to cause a surge in demand for patient monitoring. Proportional represen- tation of some of these market segments as of 2011 is shown in Figure 1.

Finally, all segments in the patient monitoring device market will experience growth through 2018. However, there will be a shift from the use of more invasive to less invasive device types as well as a domi- nant shift in the use of low-acuity patient monitoring devices from hospitals to al- ternate care and home sites. Notably, this shift will be driven by cost cutting at the hospital level and will be most prominent where home and alternate care reimburse- ment is granted or cost avoidance measures prove effective.

Telehealth for Chronic Conditions to Experience Double-Digit Growth

Telehealth, also referred to as remote monitoring or telemedicine, consists of two parts: synchronous (real-time) and asyn- chronous (store-and-forward). It is the pro- cess of transferring medical information via telephone, Internet, or networks for use in examinations, diagnosis and procedures.

This market is seen to be on the verge of significant growth within the patient mon- itoring device market as shown in Figure 2.

In 2011, the telehealth for the chronic conditions segment exhibited high growth at 14.5% over 2010. This was due to the growing awareness of the benefits of remote monitoring. In addition, large purchase volumes by the Department of Veterans Affairs helped drive growth in the chronic conditions segment, as they try to reach their goal of 100,000 patients using tele- health by 2014.

Telehealth systems may be purchased or leased to various customer groups. The purchase market model is driven by sales within the Veterans Affairs (VA) customer group and disease management companies. Telehealth in VA helps ensure veteran pa- tients get the right care in the right place at the right time, and aims to make the home into the preferred place of care whenever possible. The VA purchased a large volume of units in 2011, which resulted in a surge in market growth. Meanwhile, disease management companies provide healthcare to their patients with a focus on prevention. These customer groups have recognized the benefits that telehealth can provide, and will continue to purchase new units over the forecast period.

In most of the U.S. there is no formal- ized reimbursement policy for telehealth monitoring. Medicare, as well as certain insurance providers, will pay for telehealth solutions, but this is assessed on a case- by-case basis and is only valid for certain conditions. There is also reimbursement provided for the doctor or caregiver who is responsible for tracking the information sent through telehealth systems and guid- ing patient treatment remotely.

Remote Monitoring of Patients with Pacemakers

Adoption of remote monitoring for cardiac implantable electronic devices (CIEDs) has been steady over the last several years, as most manufacturers of pacemakers and implantable cardioverter defibrillators (ICDs) include remote moni- toring systems as part of the cost of the implantation surgery and provide them to their patients for remote follow up. Remote monitoring systems were provided for ap- proximately 75% of patients with ICD im- plants in 2011.Meanwhile, among patients with pacemakers, only 30-35% receive tele- health systems. As new clinical trial results are published, awareness of the benefits of remote monitoring of the pacemaker popu- lation will grow and drive adoption within the pacemaker patient population.

Although unit sales and placements have been growing at a rapid rate, patient compliance is not guaranteed. The majority of the population using telehealth is over the age of 65 and did not grow up using computers and cell phones. Learning how to use new technology can be complicated and confusing. When patients have dif- ficulty operating their telehealth system, they are less likely to comply with taking regularly scheduled measurements. Mean- while, among younger generations, the prevalence of cellular-only households is affecting market growth. In 2011, most remote monitoring systems operated over landlines, and could offer service over cel- lular networks for an additional fee. As cellular-only households become more common, manufacturers who can offer monitoring using this technology will ex- perience strong sales. The leading competi- tors in the cardiac implant markets include Medtronic, St. Jude Medical, Boston Sci- entific and Biotronik.

Smartphone Compatible Monitoring: Device Adoption in a New Demographic

In 2011, several pulse oximetry and blood pressure monitoring products that connect to smartphone devices became available or were announced in the U.S. market. Products typically include a pe- ripheral device, such as a blood pressure cuff or oximeter sensor, which connects to the smartphone. Data is then stored, dis- played and analyzed using downloaded applications or “apps.” Systems also offer the ability to send results to the patient’s physician or other care provider, or to display results on personal social media sites. In 2011, the average selling prices for smartphone-compatible pulse oximeters and blood pressure monitors ranged from approximately $100 to $150.

Factors that will drive the uptake of smartphone-compatible monitors include convenience of monitoring, ease of use, fa- miliar platform for smartphone users, new and exciting method for measuring blood pressure, and the ability to share and ana- lyze results. In addition, by making moni- tors compatible with a smartphone device, the market will become more attractive

to a different and potentially younger de- mographic, who may not have previously shown interest in blood pressure or pulse oximetry monitoring. However, the major- ity of iPhone users are under the age of 45 and come from affluent households. Con- versely, the majority of patients requiring blood pressure or oxygen saturation moni- toring are lower income and over the age of 45. This demographic disconnect will be a barrier for device adoption.

As healthcare professionals become increasingly reliant on medical smartphone apps, the FDA will need to determine protocols to help regulate them. In 2011, market participants were unsure whether smartphone-compatible pulse oximeters would become a novelty item, or if they would go on to prove useful in rural areas or countries where immediate medical care is not readily available. Pulse oximetry products include the Phone Oximeter from Electrical and Computer Engineering in Medicine Re- search Group at the University of British Columbia, as well as the Tinke from the Singapore-based Zensorium. Blood pressure monitoring products include the BP3 Blood Pressure Monitoring System from iHealth Lab and the Withings Blood Pres- sure Monitor. The information contained in this article was taken from a detailed and comprehensive report published by iData Research entitled “U.S. Patient Monitoring Device and Equipment Market.”

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