2011 Healthcare Research Review

REPORT SCOPE

FOREWORD

Universal healthcare coverage has begun to slowly create ripples of efficiency within the enormous structure of the healthcare system. Globally, the rising costs of healthcare stand in contrast to contracting budgets and credit defaults. The percentage of GDP devoted in most countries to healthcare has not dropped, but has slowed in its ascent.

Science and technology improvements have continued, and we now see iPADs as prevalently as the stethoscope. iPhones that relate vital statistics are also becoming part of the clinician’s tool belt.

This Healthcare Research Review provides a sampling of the type of quantitative market information, analysis and guidance that has been aiding business decision making since BCC was founded in 1971. It includes highlights of reports published in 2011 on the following healthcare markets:

Endoscopy Devices: Applications and Global Markets
Fetal Monitoring, Diagnostics and Predictive Tests
Healthcare Information Technology
Medical Robotics and Computer-Assisted Surgery: The Global Market
Microelectronic Medical Implants: Products, Technologies & Opportunities
Telemedicine: Opportunities for Medical and Electronic Providers
The Blood Industry

Global E-healthcare Industry

Table of Contents

2011 HEALTHCARE RESEARCH REVIEW XVIII
FOREWORD XVIII
CHAPTER ONE: ENDOSCOPY DEVICES: APPLICATIONS AND GLOBAL
MARKETS (HLC093A) 1
INTRODUCTION 1
STUDY GOALS AND OBJECTIVES 1
REASONS FOR DOING THE STUDY 1
SCOPE OF REPORT 2
INTENDED AUDIENCE 3
METHODOLOGY AND INFORMATION SOURCES 3
RELATED REPORTS 4
BCC ONLINE SERVICES 4
DISCLAIMER 4
SUMMARY 5
TABLE 1 TOTAL ENDOSCOPY MARKET, BY SEGMENT, THROUGH
2016 ($ MILLIONS) 5
FIGURE 1 TOTAL ENDOSCOPY MARKET, BY SEGMENT, 2009–2016
($ MILLIONS) 6
OVERVIEW 7
TABLE 2 GLOBAL ENDOSCOPY REVENUES OF LEADING
COMPANIES, THROUGH 2010 ($ MILLIONS) 8
THE ENDOSCOPE AND ENDOSCOPIC PROCEDURES 9
THE ENDOSCOPE 9
THE ENDOSCOPIC PROCEDURE 10
MAJOR COMPANIES IN THE ENDOSCOPY MARKET 11
TABLE 3 LEADING PLAYERS IN VARIOUS ENDOSCOPY SEGMENTS 12
DRIVERS AND RESISTORS FOR ENDOSCOPY MARKET 13
DRIVERS 13
RESISTORS 14
ENDOSCOPY TRENDS AND FORECAST 14
ENDOSCOPY TRENDS AND FORECAST (CONTINUED) 15
CHAPTER TWO: FETAL MONITORING, DIAGNOSTICS AND
PREDICTIVE TESTS (HLC089A) 16
INTRODUCTION 16
STUDY OBJECTIVES 16
REASONS FOR DOING THIS STUDY 16
INTENDED AUDIENCE 17
SCOPE OF THE STUDY 17
METHODOLOGY 17
INFORMATION SOURCES 17
ABOUT THE AUTHOR 18
RELATED BCC RESEARCH REPORTS 18
EXECUTIVE SUMMARY 19
TABLE 4 GLOBAL REVENUE OF FETAL MONITORING AND
DIAGNOSIS, THROUGH 2016 ($ MILLIONS) 20
FIGURE 2 GLOBAL REVENUE OF FETAL MONITORING AND
DIAGNOSIS, 2009–2016 ($ MILLIONS) 20
OVERVIEW 21
DEFINITIONS 21
TYPES OF FETAL MONITORING 22
EXTERNAL FETAL MONITORING 23
Need of External Fetal Monitoring 24
Advantages and Disadvantages of External Fetal
Monitoring 25
TABLE 5 ADVANTAGES AND DISADVANTAGES OF EXTERNAL
FETAL MONITORING 25
INTERNAL FETAL MONITORING 25
Advantages and Disadvantages of Internal Fetal
Monitoring 26
TABLE 6 ADVANTAGES AND DISADVANTAGES OF INTERNAL
FETAL MONITORING 26
TABLE 7 EXTERNAL FETAL MONITORING VERSUS INTERNAL
FETAL MONITORING 26
TYPES OF FETAL MONITORS 27
FETOSCOPE 27
DOPPLER 27
ELECTRONIC FETAL MONITOR 27
Denigration of the Routine Use of Electronic Fetal
Monitoring 27
TELEMETRY 28
INTERNAL FETAL MONITOR 28
PRENATAL DIAGNOSIS 28
NEED OF PRENATAL DIAGNOSIS 29
PREREQUISITES OF PRENATAL DIAGNOSIS 29
ADVANTAGES OF PRENATAL DIAGNOSIS 29
TECHNIQUES FOR PRENATAL DIAGNOSIS 29
Noninvasive Prenatal Diagnosis Techniques 30
Fetal Cells in Maternal Blood 30
Preimplantation Genetic Diagnosis 30
Ultrasonography 30
Magnetic Resonance Imaging Test 31
Ultrasound Versus MRI in Fetal Diagnosis 31
TABLE 8 ULTRASOUND VERSUS MRI 32
Non-Stress Test 32
Florescence In Situ Hybridization 33
New Noninvasive Nucleic Acid Technologies 33
Cell-Free DNA Technologies 33
Transrenal DNA Technology 34
Less-Invasive Prenatal Diagnosis Techniques 34
Maternal Serum Screening 34
Transcervical Retrieval of Trophoblast Cells 35
Detection of Fetal Blood Cells in Maternal Blood 36
More-Invasive Prenatal Diagnosis Techniques 36
Amniocentesis 37
Chorionic Villus Sampling 37
Percutaneous Umbilical Blood Sampling 38
Skin and Organ Biopsy 38
CHAPTER THREE: HEALTHCARE INFORMATION TECHNOLOGY
(HLC048C) 39
INTRODUCTION 39
STUDY BACKGROUND 39
GOALS AND OBJECTIVES 39
INTENDED AUDIENCE 40
SCOPE OF REPORT 40
METHODOLOGY 41
AUTHOR CREDENTIALS 41
EXECUTIVE SUMMARY 42
TABLE 9 US MARKET FOR CLINICAL HEALTHCARE IT
TECHNOLOGIES, THROUGH 2016 ($ MILLIONS) 42
FIGURE 3 CLINICAL HEALTHCARE TECHNOLOGIES MARKET
SHARES, 2010–2016 (%) 43
TYPES OF CLINICAL IT TECHNOLOGIES 43
TABLE 10 MAJOR TYPES OF CLINICAL HEALTHCARE IT
TECHNOLOGIES 44
ELECTRONIC HEALTH RECORDS 44
PROVIDER ORDER ENTRY SYSTEMS FOR DRUGS, LAB TESTS,
AND PROCEDURES 45
ELECTRONIC PRESCRIBING SYSTEM 46
PICTURE ARCHIVING AND COMMUNICATION SYSTEMS FOR
FILMLESS IMAGING 46
LABORATORY INFORMATION SYSTEMS 47
CLINICAL DECISION SUPPORT SYSTEMS 47
TELEMEDICINE 48
OTHER RELATED AND SUPPORTING TECHNOLOGIES 48
PERSONAL HEALTH RECORDS 48
RADIO FREQUENCY IDENTIFICATION 49
VeriChip 50
BAR CODING 50
SPEECH RECOGNITION 50
MEDICAL EQUIPMENT INTERFACES 51
BENEFITS OF CLINICAL HEALTHCARE IT TECHNOLOGIES 51
BENEFITS TO PATIENTS 51
Improved Quality of Care 51
Improved Quality … (Continued) 52
Lower Costs 53
Wider Availability of Health Insurance 54
BENEFITS TO HOSPITALS, PHYSICIANS, AND OTHER
CAREGIVERS 55
Clinical Efficiencies and Improved Quality 55
Verification of Insurance Eligibility and Benefits 55
Patient Satisfaction 56
Image and Public Relations 56
Reduced Malpractice Risk 56
Employee Morale 57
BENEFITS TO THE PHARMACEUTICAL INDUSTRY 57
Pharmaceutical Manufacturers 57
Improved Drug Safety Surveillance 58
Clinical Trial Recruitment 58
Support of Regulatory Approval 59
Retail Pharmacies 59
Opportunities to Increase Revenues 59
BENEFITS TO HEALTH INSURANCE PROVIDERS 60
BARRIERS TO DEPLOYMENT 61
COST 62
LACK OF METRICS 62
Lack of metrics (Continued) 63
Lack of metrics (Continued) 64
LACK OF STANDARDS 65
Clinical Vocabularies 65
Clinical Ontologies 66
COMPATIBILITY 67
Backwards Compatibility 67
Sideways Compatibility 67
Forwards Compatibility 68
WIDE RANGE OF SOFTWARE CHOICES 68
LACK OF PERSONNEL WITH APPROPRIATE SKILLS 68
LIMITED FINANCIAL RETURNS ON HEALTH IT
INVESTMENTS 69
PRIVACY CONCERNS 70
Privacy Concerns (Continued) 71
CHAPTER FOUR: MEDICAL ROBOTICS AND COMPUTER-ASSISTED
SURGERY: THE GLOBAL MARKET (HLC036D) 72
INTRODUCTION 72
STUDY BACKGROUND 72
GOALS AND OBJECTIVES 73
INTENDED AUDIENCE 74
SCOPE AND FORMAT 74
METHODOLOGY AND INFORMATION SOURCES 75
ANALYST CREDENTIALS 75
RELATED BCC RESEARCH 76
EXECUTIVE SUMMARY 76
TABLE 11 GLOBAL SALES OF MRCAS EQUIPMENT, THROUGH 2016
($ MILLIONS) 76
FIGURE 4 TRENDS IN GLOBAL SALES OF MRCAS EQUIPMENT,
2010–2016 ($ MILLIONS) 77
OVERVIEW 78
GENERAL DESCRIPTION AND DEFINITION OF MRCAS 78
FIGURE 5 MEDICAL ROBOTIC AND COMPUTER-ASSISTED
SURGICAL SYSTEMS 79
HISTORY OF MEDICAL ROBOTICS AND COMPUTER-ASSISTED
SURGERY 80
SURGICAL IMAGING TECHNOLOGIES 80
IMAGE REGISTRATION TECHNIQUES 81
Image Registration techniques (Continued) 82
COMPUTER IMAGE PROCESSING 83
SURGICAL ROBOTS 83
“THE INTELLIGENT OPERATING ROOM” 84
SURGICAL SIMULATION 85
TECHNOLOGIES AND PRODUCTS 85
STANDALONE SURGICAL PLANNERS AND SIMULATORS 85
Technology 86
Modeling of Organs and Deformations 86
Simulation of Actions and Force Feedback
Reactions 87
Emerging Technologies 88
Web-Based Surgical Simulators 88
Virtual Reality Simulators 89
Recent Patents 90
Advantages of Surgical Planners and Simulators 91
Products 92
TABLE 12 STANDALONE SURGICAL PLANNERS AND SIMULATORS 92
TABLE 12 (CONTINUED) 93
Fifth Dimension Technologies 93
Haptica 93
CAE Healthcare 93
Mentice Medical Simulation 94
Merge Healthcare 94
Simbionix 94
SimQuest 95
SimSurgery 95
Surgical Science 96
VirtaMed 96
VOXEL-MAN 96
VRmagic 97
SURGICAL NAVIGATION SYSTEMS 97
Technologies 97
Imaging Technologies 97
Multimodal Imaging 97
Fluoroscopic Imaging 98
Video-Enhanced Imagery 99
Microscopic Imagery 100
Endoscopic Imagery 101
Dynamic (Interventional) Imaging 102
Compact MRI Scanners 102
Intraoperative CT 103
Intraoperative Ultrasound 104
Tracking Technologies 104
Optical Tracking 104
Electromagnetic Tracking 104
Display Technologies 105
Multiplanar Displays 105
Three-Dimensional Displays 105
Stereoscopic Displays 106
Virtual and Augmented Reality 106
Heads-Up Displays 106
Recent Patents 107
Recent Patents 108
Recent Patents 109
Advantages of Surgical Navigation Systems 110
Products 110
Image-Guided Surgical Navigation Systems 111
TABLE 13 IMAGE-GUIDED SURGICAL NAVIGATION SYSTEMS 111
Boulder Innovation Group 112
FlashPoint 5500 112
BrainLAB AG 112
VectorVision 112
Kolibri 113
Med Surgical Services 113
CBYON Suite (CBYON) 113
Medtronic 114
StealthStation 114
Praxim/Orthopaedic Synergy 114
Nano-Station 114
Siemens Healthcare 115
NaviLink 115
Smith & Nephew 115
Dash 115
Stryker Corp 115
Stryker Navigation System II 115
ENlite 115
NavSuite 115
Zimmer 116
ORTHOsoft 116
Interventional Navigation Systems 116
TABLE 14 INTERVENTIONAL SURGICAL NAVIGATION SYSTEMS 116
TABLE 15 COMPARISON OF NONFLUOROSCOPIC
INTERVENTIONAL IMAGING TECHNOLOGIES 117
B Braun Aesculap 118
OrthoPilot 118
Kinamed 118
NaviPro 118
SONOWAND 118
SonoWand Invite 118
Odin/Medtronic 119
Polestar 119
Smith & Nephew 120
PiGalileo 120
Surgical Navigation Accessories and Add-Ons 120
TABLE 16 SURGICAL NAVIGATION ACCESSORIES AND ADD-ONS 121
Ascension Technology 121
Viking Stems 121
3D-HD Personal Head Display and
Infomatix 121
4navitec 122
Pointers, Trackers, Adapters, and
Other Accessories 122
SURGICAL ROBOTS 122
Technology 122
Robotically Assisted Micromanipulation 123
Steady-Hand Systems 124
Robotic “Wrists” and Other Dexterity
Enhancements 124
Robotic “Wrists” …(Continued) 125
CHAPTER FIVE: MICROELECTRONIC MEDICAL IMPLANTS:
PRODUCTS, TECHNOLOGIES AND OPPORTUNITIES (HLC016D) 126
INTRODUCTION 126
MICROELECTRONIC MEDICAL IMPLANTS 126
STUDY BACKGROUND 126
STUDY GOALS AND OBJECTIVES 127
INTENDED AUDIENCE 127
SCOPE OF THE STUDY 127
METHODOLOGY AND INFORMATION SOURCES 128
ANALYST CREDENTIALS 129
RELATED BCC REPORTS 129
SUMMARY 130
TABLE 17 GLOBAL MARKET FOR MICROELECTRONIC MEDICAL
IMPLANTS BY APPLICATION, THROUGH 2016 ($ BILLIONS) 130
FIGURE 6 GLOBAL MARKET FOR MICROELECTRONIC MEDICAL
IMPLANTS BY APPLICATION, 2010–2016 ($ BILLIONS) 130
OVERVIEW 131
GENERAL DESCRIPTION 131
Definition 131
History of Microelectronic Implants 131
Early Origins 131
Early Pacemakers 132
Advances in Pacemaker Technology 133
First Implantable Defibrillator 134
Neurostimulators 134
First Implantable Drug Pump 134
Cardiac Assist/Replacement Devices 134
Ear Implants 135
Eye Implants 135
TECHNOLOGIES 136
MINIATURIZATION 136
MATERIALS 137
SENSORS 138
POWER SUPPLIES 139
RF TECHNOLOGY 139
APPLICATIONS 140
CARDIOVASCULAR DISEASE 141
TABLE 18 HOSPITALIZATIONS, PHYSICIAN OFFICE VISITS, AND
DEATHS DUE TO HEART DISEASE IN THE US, 2009 141
Brachycardia 142
Hypertrophic Cardiomyopathy 142
Tachyarrhythmia 143
Syncope 144
Heart Failure 145
NEUROLOGICAL DISEASES/CONDITIONS 145
Chronic Pain 146
Spinal Cord Injuries 146
Parkinson’s Disease 147
Epilepsy 148
Depression 150
Muscle Spasticity 150
Urge Incontinence 151
Other Conditions 151
Alzheimer’s Disease 152
BONE DAMAGE 152
DIABETES 153
CANCER 154
FIGURE 7 TRENDS IN US CANCER DEATHS, 1998–2010 155
IMPAIRED HEARING 156
BLINDNESS 157
PRODUCT TYPES 157
CARDIAC IMPLANT 157
Pacemakers 158
Description 158
Applications 158
Technology 158
Manufacturers 159
TABLE 19 HEART PACEMAKER MANUFACTURERS 159
FIGURE 8 US PACEMAKER-RELATED PATENTS ISSUED
THROUGH 3/1/2011 (% OF TOTAL PACEMAKER PATENTS) 160
Implantable Cardioverter Defibrillators 161
Description 161
Applications 161
Technology 161
Manufacturers 162
TABLE 20 IMPLANTABLE DEFIBRILLATOR MANUFACTURERS 162
Patent Analysis 163
FIGURE 9 US ICD-RELATED PATENTS ISSUED THROUGH
3/1/2011 (%) 163
CHAPTER SIX: TELEMEDICINE: OPPORTUNITIES FOR MEDICAL AND
ELECTRONIC PROVIDERS (HLC014D) 164
INTRODUCTION 164
STUDY GOALS AND OBJECTIVES 164
REASONS FOR THE STUDY 164
INTENDED AUDIENCE 165
Telemedicine Hardware Manufacturers 165
Telemedicine Software Providers 165
Telecom and Networking Companies 165
Telemedicine Service Providers 166
Healthcare Companies 166
Health Insurance Companies 166
SCOPE OF REPORT 166
METHODOLOGY AND INFORMATION SOURCES 167
ANALYST CREDENTIALS 167
RELATED BCC PUBLICATIONS 167
SUMMARY 168
TABLE 21 FORECAST FOR THE GLOBAL TELEHOME AND
TELEHOSPITAL MARKET, THROUGH 2015 ($ MILLIONS)* 168
FIGURE 10 FORECAST FOR THE GLOBAL TELEHOME AND
TELEHOSPITAL SERVICE MARKET, 2009–2015 ($ MILLIONS) 169
TELEMEDICINE OVERVIEW 169
STRUCTURE 169
FIGURE 11 STRUCTURE OF A TELEMEDICINE NETWORK 170
STRUCTURE (CONTINUED) 171
KEY PLAYING FIELDS IN TELEMEDICINE 172
FIGURE 12 WINNING IMPERATIVES FOR TELEMEDICINE:
TELEHOME CARE, TELEHOSPITAL B2B, TELEHOSPITAL B2C 173
MARKET DRIVERS 173
FIGURE 13 TELEMEDICINE MARKET DRIVERS 174
CHANGING HEALTHCARE PARADIGM: INEVITABLE NEED
FOR TELEMEDICINE 174
Increasing Chronic Diseases 175
Complexity of the Healthcare Network 175
FIGURE 14 TELEMEDICINE: KEY TO E-HEALTHCARE 175
Rising Cost of Home Care 175
Increasing Number of Aging Patients Requiring Daily
Care 176
Higher Spending on IT 176
Moving from Treatment to Early Intervention 176
NEED FOR BETTER CLINICAL OUTCOMES 177
GROWING INVESTMENTS IN TELEMEDICINE 177
TELEMEDICINE DRIVEN BY THE RISING E-HEALTHCARE
MARKET 177
INCREASING FOCUS OF COMPANIES ON TELEMEDICINE
AS A KEY MARKET DIFFERENTIATOR 177
IMPROVED TECHNOLOGY INFRASTRUCTURE SPURRING
GROWTH IN TELEMEDICINE 178
ENTRY OF TIER I PLAYERS EXPANDING MARKET SCOPE 178
CENTRALIZED EHR AND EMR ARE DRIVING THE NEED
FOR TELEMEDICINE 178
INCREASING ACCEPTANCE OF TELEMEDICINE BY
PATIENTS 179
FIGURE 15 INCREASING ACCEPTANCE OF TELEMEDICINE BY
PATIENTS 179
KEY CHALLENGES 179
FIGURE 16 MAJOR CHALLENGES FACED BY TELEMEDICINE
PROGRAMS (%) 180
FIGURE 17 CHALLENGES IN TELEMEDICINE: ECONOMICS
VERSUS CLINICAL OUTCOME 181
TECHNICAL 181
FINANCIAL 182
Reimbursement 182
Reimbursement (Continued) 183
Government Funding for Telemedicine Programs 184
Companies Afraid of Lower Returns from Telemedicine 184
Companies Afraid … (Continued) 185
CHAPTER SEVEN: THE BLOOD INDUSTRY (HLC008G) 186
INTRODUCTION 186
REASONS FOR DOING THE STUDY 186
STUDY GOAL AND OBJECTIVES 186
SCOPE OF REPORT 187
METHODOLOGIES AND INFORMATION SOURCES 187
ANALYST CREDENTIALS 188
RELATED BCC REPORTS 188
SUMMARY 188
MAJOR FINDINGS 189
TABLE 22 GLOBAL BLOOD COLLECTION, PROCESSING, AND
THERAPEUTICS MARKET, THROUGH 2015 ($ MILLIONS) 189
FIGURE 18 GLOBAL BLOOD MARKET, BY REGION, 2010 AND 2015
(%) 190
OVERVIEW 191
HISTORY OF THE BLOOD INDUSTRY 191
TABLE 23 TIMELINE OF THE BLOOD INDUSTRY 192
CONSOLIDATION IN THE INDUSTRY 193
TABLE 24 SELECTED ACQUISITIONS AND MERGERS IN THE
GLOBAL BLOOD INDUSTRY, 2006–2011 ($ MILLIONS) 194
DYNAMICS OF BLOOD DONATION 194
BLOOD COLLECTION AND PROCESSING MARKET STRUCTURE
AND SIZE 195
TABLE 25 US BLOOD COLLECTION AND PROCESSING PRODUCTS
MARKET, THROUGH 2015 ($ MILLIONS) 195
BLOOD AND ITS COMPONENTS 195
TABLE 26 COMPOSITION OF BLOOD 196
PLASMA 196
Uses for Plasma Proteins 197
TABLE 27 PERCENT OF PLASMA PROTEINS AND THE DISEASES
AND DISORDERS THEY TREAT 197
Immunoglobulin Products 198
CELLULAR ELEMENTS 198
Red Blood Cells 198
White Blood Cells 199
Platelets 199
TRANSFUSION-ASSOCIATED RISKS 199
DISEASES CONTRACTED FROM BLOOD TRANSFUSION
AND RELATED IDENTIFICATION TESTING 200
TABLE 28 DISEASES CONTRACTED FROM BLOOD TRANSFUSIONS 200
TABLE 28 (CONTINUED) 201
HIV/AIDS 201
TABLE 29 CBER-LICENSED HIV DONOR SCREENING TESTS 202
TABLE 29 (CONTINUED) 203