The explosion of healthcare devices developed specifically for home use is a component of a much larger evolution of an overall reduction in the complexity of healthcare. Equipment and supplies that are appropriate in lower-acuity settings, including the home, have become a natural extension of this evolution.

The combined US market for home healthcare products reached $4.2 billion in 2007, according to a report from Life Science Intelligence. This market is expected to expand by nearly 7% annually, reaching more than $5.9 billion in 2012. It is led by strong growth in the respiratory and wound management sectors. In addition, the report forecasts the second-to-largest durable medical equipment market, worth more than $1.2 billion, to grow at a rate of nearly 4%, reaching more than $1.5 billion in 2012.1

Many more patient-friendly devices from ventilator technology to drug delivery are being redesigned and recreated as they make their way into the home. The trick is keeping the functionality while simplifying the design.

“If you look at surgery, even though we’re not to a point yet where we’re doing surgery at home, procedures that used to require a five-day hospitalization and full recovery in the acute-care setting now sometimes require just a 23-hour hospitalization,” says Roger Mecca, MD, vice president of medical affairs for Covidien, Mansfield, MA. “There is a transposition of what used to be considered acute care to lesser levels of acuity, which oftentimes involve home,” he says.

Driving devices home

The pressures of today’s healthcare environment, including healthcare costs and reform, are driving device makers and other players in the healthcare industry to develop creative solutions in addressing these issues, says Ryan Shafer, director of consumer healthcare for Ximedica, Providence, RI.

The trends come from several different directions, converging to drive devices into the home at a greater pace than ever before. “Yes, the comforts of ‘aging in place’ and downward pressure on healthcare costs are key drivers, but also the impact of an increasingly college-

educated, more technology savvy generation of baby boomers and their children have driven a lower tolerance for poor product performance,” says Shafer. 

Shafer points out that the Internet has established unlimited access to health information and innovative resources like patient communities, peer reviews, and online purchasing. “As a result,” he says, “the patient is a more discerning, interrogating consumer.”

The design of devices destined for home use is also different from those headed to a clinical setting. “The influence of more powerful, sleekly designed, user-friendly consumer products has transformed how the professional medical community views healthcare devices—ones they use in professional settings as well as those they recommend for in-home use,” explains Shafer. “Another driver is the decline in national homogeneity. The citizenship of countries is becoming more multicultural and is creating a need for products that are multilingual or language-neutral.”

As a result of the converging trends, equipment and supplies that are appropriate for safe use in lower-acuity settings, including the home, is a natural side effect, says Mecca. “So it’s not so much that everyone says, ‘We need devices that can be used in the home.’ The devices used in the acute-care setting need to become much more home-friendly and much more different-circumstance friendly.” For example, he says, people who are on mechanical ventilators used to be bed bound. Not anymore. “Now people on mechanical ventilators want to go watch grandson Johnny play his first T-ball game. Or, maybe little Johnny on the ventilator wants to play the T-ball game,” says Mecca.

Another significant trend involves patients administering medication themselves in different environments, whether it’s in the home environment or from a travel point of view. This trend has been on the rise for the last few years and will continue to grow, says Graham Reynolds, vice president of marketing and innovation, pharma delivery systems, West Pharmaceutical, Lionville, PA.

“We participate through a couple of areas today. There’s huge growth in diabetes, for example, and so there is a trend toward more-sophisticated devices to administer insulin, for example,” says Reynolds. “Traditionally, you may find the drug packaged in a vial with a syringe so you draw the liquid out of the vial and then inject it and throw the syringe away. That transitions to more disposable pens where you have multiple doses in one unit and then you throw the unit away.” Lately, he says, the trends include producing devices such as reusable pens with electronics, user-feedback, and compliance tools, as well as a shift toward the development of pump systems or patch systems that enable the user to actually have a pump attached to his or her body for continuous or intermittent dosing.

Jessica Willing-Pichs, Principal, Research and Product Strategy for Ximedica, notes three drivers that are pushing more devices into the home. “The length of hospital stays is decreasing as hospitals discharge patients faster.  As a result, patients are expected to perform more self care, renting hospital grade equipment and purchasing their own supplies,” she says. She also notes that through wide prevalence of Internet access, both at home and on smart phones, patients have more health information resources available to them more often. “This has given them the ability to be much more informed about their medical conditions.” Finally, she says that patients themselves are becoming much more deft with new technologies in their consumer lives, and this sophistication is raising expectations of healthcare device functionality. Patients expect their devices to provide the same sort of features that they see on their smart phones: smaller footprint, portability, intuitive interfaces, quick power up, and seamless interconnectivity with other devices.

There are other things to consider and one of those is cost-effectiveness, says Mecca. He says another major driver is availability of resources and impact on people’s lives. If recovery can be achieved with a 23-hour hospital stay and then home, he says that is much more desirable than a five-day hospital stay in terms of cost and impact on the patient. Shafer echoes that point. “The economy is having an impact in this area as the costs can be lower at home,” he says.

In terms of drug delivery, other forces come into play. One driver is the continuing growth in drugs for treating chronic conditions that have to be administered on a regular basis. Drugs for conditions such as rheumatoid arthritis or multiple sclerosis “tend to be biologic drugs that must be administered usually by injection, typically on a very frequent basis, either daily or weekly or monthly, depending on the nature of the drug,” says Reynolds. “So there’s a real trend toward devices that can help make that process as easy and as effective as possible for patients who are typically not trained doctors or nurses with fairly minimal complexity and skill. And then, if you consider that as the underlying trend, you get into issues like whether they can administer this dose only once a week by having a slightly bigger dosage volume or different formulation of the drug instead of twice a week,” he says.

“That has benefits to the patient because they actually have fewer injections than in an ordinary situation. So, there’s a general trend in the market toward self-administered drugs, primarily driven by chronic conditions, such as diabetes, autoimmune diseases, and hemophilia, where people are typically treating themselves at home. And then within that growth, there are trends toward different types of devices that give the usability benefits, whether it is reusable, electronic, or dose-frequency.”

Home is where the heart is

It is impossible to ignore the fact that people simply feel more comfortable in their own homes than in a cold sterile environment. “Consumers are more comfortable at home versus the inconvenience of sitting in a doctor’s office,” says Shafer. Willing-Pichs adds that the expanding capabilities of mobile computing technologies, more powerful and more reliable wireless communications, longer battery times, and a more demanding consumer are driving consumers to demand the same performance from their medical devices.

Willing-Pichs says device capabilities already enable communication of data between patients and clinicians. And although not consistently implemented, data sharing to alert family members is also already available. 

“The diabetes world is a good example of where there’s been a transition in the method of delivery—the drug itself really hasn’t changed much but the method of delivery has changed. Also, many companies see the device and its method of delivery as a differentiator. So, if you’re supplying insulin, you might want to leverage the fact that you have the best pen, or a better pen, or it’s better for patients, than some of your competitors,” says Reynolds.