A healthy market?
Is the use of AV technology in healthcare on the verge of a rapid expansion?
You may remember that back in November last year, InAVate carried an interview with Professor Bill Heald, who was using HD technology to teach his ground breaking surgical procedure for the treatment of certain colonic cancers.
In this feature we take that a step further and examine the EMEA market as a whole for AV in the healthcare sector. Are high-end applications such as Professor Heald’s still well out of the main stream? Where do we stand now with the use of technologies such as video conferencing and HD, and what does the future hold?
One man, who is at the very head of his field, as well as the use of AV technologies in medicine, is Dr Didier Decannière of the Erasme Hospital in Brussels. The hospital is the academic medical centre of the “Université Libre de Bruxelles” and as such is largely dedicated to the teaching of surgical practice. Dr Decannière is the head of the cardiac surgery department and a pioneer in the practice of minimally invasive surgery. His service has been one of the first to start a program of minimally invasive heart surgery, and he believes he was the first to perform robotic heart surgery.
When carrying out surgery, effectively without any first hand view of what you are doing, the visualisation of what is going on is of paramount importance. Dr Decannière has, to this end, recently taken delivery of brand new surgical facility, designed and installed in partnership with Sony Healthcare and their Professional Services team. He described the system as it now stands, and the necessity for clear communication and sharing of imagery amongst and surgical team.
“The installation essentially consists of three main video sources, which allow the whole team to see exactly what is going on. When you work in a restricted environment, surgery is all about visualisation and manipulation. You need to see what you are doing, and be able to move your tools around inside the incision.
“We have different sources of visualisation. The first is a general camera, which shows an overview of the whole operating theatre. Then there is a very high definition camera. This enables us to capture the image, which the surgeon sees while he is operating. It’s positioned directly above his head and can focus on details down to 1.5mm in size.
“The third camera is the endoscopic camera, which allows us to visualise what we are doing remotely. Displaying on a screen again allows the whole team to see what is going on during a minimally invasive procedure. All of these procedures have in common the requirement to visualise very remote parts of the heart through very small incisions.
“In the room we have large flat screen displays, and a switching system enabling us to select what images are displayed. This includes picture in picture functionality, which aids in navigation inside the patient. So, we could have the image from one of the camera, and on top of that, superimpose the images of examinations that were done prior to the operation. We can put up to four images on the wall, including images from the teaching or conference rooms so we can communicate with students. Students and lecturers can also select any of our video sources to be displayed on their projectors in conference rooms or lecture theatres.”
Whilst Dr Decannière’s primary concerns are the benefits to patient treatment and teaching of his students he sees other gains from the advanced visualisation systems.
“We are of course able to record everything that goes in an operation, either to a hard drive or DVD. I think in the long term it’s not unlikely that it will be a legal requirement to record operations, so that if there is a problem you can prove that it was done correctly. I also think it will increase the transparency of medicine. Medicine has no need to hide. If you are confident, you have a good team and you want to have very high standards of care, you must be able to show what you are doing.”
Are such glittering examples of the use of AV technology, which surely have installers in the field rubbing their hands, set to become the norm? How common are they now?
For his part, Dr Decannière cites only a handful of such facilities across mainland Europe. However, he also firmly believes that this is the way of the future. Outside of the cardiac unit, the entire Erasme Hospital is engaged in a large project called “The Filmless Hospital” which is intended to shift all film x-rays and paper documentation to digital storage.
Another group, apart from the surgeons themselves, who are enthusiastic about the movement towards increased use of technology in healthcare environments, are of course, the technology providers.
One company that claims to be making significant headway in mainland Europe is Sony. A combination of their Medical Solutions division and the Professional Services group is allowing them to sell and install solutions for hospitals.
Phil Vallender is EMEA marketing manager for Sony Healthcare Solutions. “For the solutions side of the business the Nordic region is leading the way, and then we have a kind of even spread across the rest of mainland Europe, but the Scandinavians are way ahead.
“Their adoption of technology is in advance of the rest of Europe in terms of healthcare. Their expenditure on healthcare per head of population is higher than a lot of European countries. As a result of this they are able to invest in technologies with a little bit more foresight and innovation than many other countries are able to.
“Norway and Sweden are primarily where we’re seeing the best business, then Denmark and Finland are not quite so progressed, but certainly close. We’re having some success in Benelux, in Germany and we’re starting to see some potential in the UK. Because of the NHS the UK is a slower market incubate to newer propositions. The NHS is all about evidence based purchasing so those already in the market have head start on us in that respect.”
However despite these growth areas, the market still seems unable to put a figure on its own value, as Sony’s Vallender explained:
“The market for advanced communications around surgery is very much an emerging market, and as such I don’t think I can quantify it. The opportunity is large because the market for things like endoscopy and microsurgery are very large, and growing. There’s always a shift towards these less traumatic methods of operating and therefore the market for sharing the activities that go on in them is a growth potential as well. However, it’s not something that’s well understood by people in the market, or the market researchers. It really is not quantifiable at this stage. For example, I’ve just picked up some research that can tell me how big the market for endoscopes is, but it can’t tell me how big the market for visualisation devices is.”
If it’s not possible accurately to quantify the market, it is at least possible to look at some trends. One thing that is clear, is that, as with so many other vertical markets, HD technology is playing an increasingly important role. Phil Vallender again:
“The key trend is the introduction of HD. In terms of camera and display technologies, the medical market normally follows the broadcast market, but with HD they’ve snapped up the technology because of the benefits it can offer within this minimally invasive surgical paradigm that’s formed.
“There’s another subtle trend within this, and that’s an over-all increase in the use of AV. When HD cameras are used in surgery, then AV systems across a hospital will have to become HD capable as well.
“I think this will move very fast. The market driver will be improved patient outcome, and the market restraint will be the availability and the budgets. I think by the end of this calendar year HD surgical equipment will be widely available from a number of manufacturers. Once availability becomes greater, costs will slowly go down and take-up will increase.”
One of the anomalies thrown up here is the UK’s National Health Service. Whilst all healthcare provision across Europe is primarily state-backed, no country, outside the United Kingdom, has a unified system such as the NHS. The unique way in which the system is run, and funded, by central government makes it a tricky one to get into.
Someone who has been supplying AV solutions to the NHS for some considerable time is Alistair Holdoway, MD of Video South Medical Television. For him, one of the keys to working for the NHS is reliability of equipment.
“We have to be very agile with the product we use and keep up closely with what’s going on. There are many other factors in play than functionality. In our particular market place, reliability and longevity are more highly thought of than a lot of others. A hospital may actually say they are planning on purchasing a system to last eight years without replacement.
“Hospitals are very keen in advance to spot suppliers who are unable to meet quality standards. Elsewhere in our industry that just seems to get lost in the wash, the scramble, to get a good price. I mean, how many clients can focus down on a matrix switch and say, well this one will me more reliable over an eight year period than that one. It’s beyond what most people can take on, but hospitals do actually get quite good at it, although to an extent they are still reliant on brand identity.”
Alistair also had some comments on the issue of high definition video: “Leaving video conferencing applications aside, there are several aspects to the HD issue. In endoscopy, where the fight for image quality has always been important, because you are putting the equipment between the surgeon and reality, the drive to do it has been very great. However, it’s difficult to get the HD technology down to that size. HD in edoscopy will be very important.
“It’s already available in gastroenterology and it’s easier there because they use a different way of generating colour. They only use a single chip camera. Three chip cameras are the norm for endoscopy and keyhole surgery and they are bigger.”
John Johnston MD of Cameron Communications also works with the NHS. His company is a relative newcomer to the market.
“The market is doing quite well, we are fairly new to it. We’ve always been on the periphery of the Healthcare market but a couple of years back we decided that rather than stick to the usual education or oil industry stuff, perhaps we should branch out into medicine. I think it was about two years ago, we’d been doing some work with one of the departments of medical physics in Inverness, and having a chat with them. We’d done some bits and pieces and thought, hey not only is there some money here, but also this is a darn site more interesting. This is all NHS stuff, we’ve never done any work in the private sector. That’s partially because it’s such a small part of the market.
“Over all I think the market is growing. Certainly in Scotland, being a pretty dispersed population there is a need is a remote medicine. The health minister in Scotland is very keen on tele-medicine and remote healthcare because it costs the NHS a fortune to move people around.”
On the other side of the coin stands Brendan Major, Director of ICT services for the Barts and The London NHS Trust. Unlike those working on the provision side of the AV industry, he’s a great deal more sanguine about the move towards AV technology in medicine.
“As far as I’m concerned it’s very much tomorrow’s idea. Whether or not they will become today’s idea is somewhat moot. Nothing of any substantial size has ever gotten off the ground. There are some pilots around, and some bespoke bits that in themselves are very interesting but for one reason or another have never really fulfilled their full potential.
“Video conferencing is typical of these things. It follows one of those universal truths of ICT, if you build it they might not come. It doesn’t automatically follow that a good idea, well deployed makes it happen. That said, there are some interesting things. We’ll be launching a telepathology service, which is a specialist application using cheap, in the medical technology sense of cheap, online capable microscopes, where pathology slides will be viewed, manipulated and analysed remotely.
“I’m also responsible for picture archiving, which is the system we’ve installed now that takes digital images or x-rays or mammograms or CT scans and captures them, holds them and then delivers them to any viewing device around the trust. This puts us partially down the road to the film-less hospital. The next step after that is to go live with PACS, which is the picture archiving communication system. All of the medical imaging devices will be configured to work digitally rather than analogue, and will be connected to the system.”
But what about the glittering surgical facilities that are the domain of Messrs Heald and Decannière? Well, they do exist, but not in quite the same integrated fashion.
“Most of our surgical AV is still stand-alone. I mean it is network capable but the vast majority of our operating equipment is configured stand-alone. Some of these allow for recording, because we are a teaching hospital, but the big problem is the whole issue of consent. We don’t need permission to record, as that’s part of the diagnostic process, but we do need permission to show it to 400 medical students in a next-door lecture theatre.”
If the technology providers are to be believed, then we are only a few years away from some very significant changes in that AV technology is used in medicine. At least on mainland Europe, an image of healthy investment in technology and services points to a strong, if as-yet not quantified, market. The UK will probably lag a little behind, but ultimately will also adopt the same standards.
One other point of interest is that, whilst this report as concentrated squarely on the “sexier” end of AV use in medicine, something like 2/3 of most hospital budget is spent on “hotel services”. This covers a world of evils – everything from catering services to ceiling speakers for a voice evacuation system. If InfoComm’s recently printed market research, which estimates the value of the “Healthcare” sector for AV products & services to be €0.5Bn, is to be believed, then there’s a considerable potential out there. Even if you aren’t a specialist operating room installer.
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