Contributor: Karen Gierszewski

It’s been interesting to note that in the past few months several companies have chosen to separate their medtech and pharma units. One of the first notable moves was in mid-2011 when AstraZeneca, a pharmaceutical giant, sold off Astra Tech , which sells dental and urological products. Later in the year, Covidien and Abbott Laboratories announced their intentions to sell off their pharmaceutical units to focus more on their medical product lines. Most recently, Smith & Nephew has distanced itself from its biologics unit to create a joint venture with Essex Woodlands . Although Smith & Nephew’s Biologics and Clinical Therapies division isn’t strictly a pharmaceutical unit, selling products such as the EXOGEN long-bone stimulation device, it’s certainly much closer to that end of the spectrum compared to the rest of Smith & Nephew’s orthopedic device portfolio.

Anyway, it’s probably too soon to label this a full-blown trend, but might be something to keep an eye on.

Contributors: Karen Gierszewski, Sara Scharf and Aaron McCracken

The popularity of robotic-assisted surgery has exploded in recent years, with these systems rapidly becoming a “must have” for high-end health care facilities. This technique has been particularly rapidly adopted for urology procedures such as prostatectomies due to the fact that the angles used in these procedures make traditional laparoscopy uncomfortable and difficult for surgeons—nearly 80% of prostatectomies removed in the US were removed with Intuitive Surgical’s da Vinci system, by far the most common surgical robot in use. But do the benefits of these robots really justify the cost?

This question was examined recently in an article in the French newspaper Le Monde . This article argued that these robotic systems have largely become a showcase item for health care facilities—the presence of these systems can have a very positive effect on the reputation of a hospital and can help it to attract industry-leading surgeons as well as more patients. In fact, Intuitive Surgical actively helps in this respect by maintaining a list of trained surgeons on its Web site, which is a great marketing tool for both surgeons and hospitals. During the surgery itself, these devices are more comfortable for physicians than conventional surgery because surgical robots allow them to perform it from a seated position while manipulating the robotic arms. The robots are also thought to eliminate human error in fiddly procedures, potentially reducing some of the blame that could be associated with the surgeon if the procedure went wrong.

The article argues that the benefits of these devices for patients are, however, questionable and unproven. While some publications have reported reductions in bleeding and quicker recover times, others have found the opposite, such as the study covered in this article . Other studies have also found less than stellar results; for example, a recent study examining laparoscopic repair of vaginal prolapse versus robotic-assisted laparoscopy found that while both groups yielded excellent results one year postsurgery, the women treated via robotic-assisted surgery suffered from longer procedure times as well as greater postoperative pain at 3 to 5 weeks. And these systems are not cheap—one robot in the US can cost as much as $2.3 million, not including the high cost of training and of the surgical accessories, which need to be frequently replaced.

So with extremely high costs and unproven benefits, how has the adoption of these systems managed to be so high? Intuitive Surgical definitely deserves some credit in this respect—the popularity of these systems has been an absolute marketing win. And Intuitive Surgical is definitely patting itself on the back for achieving stunning 24% revenue growth in 2011 over 2010. Of course, for the reasons mentioned above, surgeons have a strong reason to demand their hospitals purchase these systems as well. Unless clinical evidence can prove the conclusive benefits of these devices for patients, however, it’s possible that the adoption of these devices will subside to some extent in the coming years, especially until the economy shows signs of stability...but there definitely hasn’t been evidence of this yet.

Contributors: Karen Gierszewski and Sara Scharf

A lot of companies lately have been heading over to the emerging Chinese, Indian, and Brazilian markets to set up research & development (R&D) and manufacturing facilities. This is usually a smart move for large companies because they can benefit from lower manufacturing and labour costs while having convenient access to these large and fast-growing markets.

But maybe there’s something to be said for investing in facilities in Europe as well, especially for small- to mid-sized companies. The emerging markets come with a variety of barriers, including complicated distribution networks, compliance issues, and cultural differences. As a result, it might be better for smaller companies with fewer resources to stay closer to home, a sentiment that was brought up by medtech CEOs at the OneMed conference in San Francisco. Given the depressed economies in Europe, now could be the perfect time to establish facilities in the region at a relatively low cost. In particular, Ireland stands out as an interesting candidate. Ireland has become a high-tech hub over the last 20 years and has a young and highly educated population already fluent in English, making it easier to communicate with the global scientific and commercial community. Similar to other European countries, health care is covered under a public system, which means that potential employers face less of a burden in terms of paying for employee benefits. Finally, Ireland’s location offers easy access to the large and lucrative European market and eliminates the need to navigate cultural differences.

One company seems to have already caught on to this trend—Cook Medical has recently announced that it plans to invest $20 million in its Limerick, Ireland location, which will be the key site for R&D on the Zilver product line. The new Zilver PTX drug-eluting stent—which is solely manufactured in the Limerick location—shows very strong promise in Europe where it will be one of the key stent brands to be used in the femoropopliteal indication. Millennium Research Group predicts that the European femoropopliteal stent market (including France, Germany, Italy, and the UK) will reach a value of almost $110 million by 2016.

Contributor: Mickel Phung

Family Practice Management, an American Academy of Family Physicians (AAFP) journal has conducted a national Electronic Health Record (EHR) User Satisfaction survey semiannually. Kenneth Adler, M.D., a family physician and medical director of information technology at Arizona Community Physicians in Tucson, conducts the surveys in conjunction with Robert Edsall, editor-in-chief of Family Practice Management. The survey’s sample size has steadily grown over the years from 408 respondents for the 2005 survey to 2719 respondents for the latest rendition in 2011.

The results of the most recent survey? Only 50% of family practitioners stated they were satisfied overall with their EHRs, and 30% stated they were dissatisfied. The most interesting statistic however from a vendor’s perspective is that only 38% of practitioners stated they would purchase their system again! While there are clear leaders in the ambulatory EHR market, there were only 30 EHRs with more than 13 respondents (87%), it’s clear that there is definite opportunity in the future for market shares to shift and for less-established vendors to grow.

What are vendors doing right? Well in the ambulatory segment, family practitioners are reasonably satisfied with their ability to customize their EHRs (78%), e-prescribing (70%), and e-messaging (69%). There has been great emphasis on the vendor side to have flexible EHRs, so there is definite success there. Where EHR companies fell very short is vendor support with only 39% of practitioners happy with the support companies provide, in fact over 30% were dissatisfied. Take note vendors, customer service is key!

It has been established that there are clear leaders in the market, yet this survey found that the major companies in the market were the vendors which were rated the lowest in terms of satisfaction. Despite these low satisfaction scores, certain vendors are still thriving. This may be due to the market itself and just how many players there are. The selection of an EHR is a daunting task and choosing well established big name companies is the safe option. So these large vendors are thriving and will likely continue to thrive, but there are clearly factors they can improve.

One attendee noted, “Some of the highest rated EHRs were the ones in general that were the most simplistic and least costly.” Indeed, this view was echoed by a programmer that works with physicians, “When the system is simple, physicians are happy. When you build the system, make it more powerful, they are less satisfied.” End of the day, it all comes down to usability, and it’s clear that certain vendors are succeeding because they have a simpler system, “I should not notice I am using an EHR, it should not intrude in hearing the patient’s story, and evaluating them. The only thing that is tied to my satisfaction is usability,” remarked a family physician from Ottawa, Canada who has used a comprehensive EHR for 10 years.

Contributor: Mickel Phung

“Here we come, interoperability and exchange,” remarked Farzad Mostashari, MD, at the start of the ONC’s unveil of the proposed rule for Meaningful Use Stage 2.

HIMSS 2012 has been eagerly awaiting details of Stage 2, and Farzad along with other officials from ONC and CMS, packed the conference room and even required the opening of a second space to accommodate everyone. The buzz is for good reason. The American Recovery and Reinvestment Act (ARRA) and meaningful use has been huge for the healthcare information technology (IT) market, driving adoption of electronic health records (EHRs) with more than $3 billion dollars in incentive payments being handed out to date.

So what details were announced? Only a cursory overview was given, with subsequent deep dives into the details over the coming days. The actual proposed rule will be posted online on Thursday February 23rd and a 60 day public commenting period will ensue. What has been revealed is that Stage 2 will take great steps towards advancing interoperability with provisions for the use of specific standards. The goal is to move away from testing exchange between health facilities to doing actual exchange.

In terms of measures, decision support will be increased to five quality measures. There will be more emphasis on patient engagement, with a new requirement that more than 50% of all unique patients seen will be required to provide timely health information reports that can be viewed, downloaded, and transmitted within four business days. A new proposed menu item will be the ability to view images in the system. Batch reporting will now be allowed so now each individual physician will no longer be required to submit data.

Certification has now also been changed for Stage 2. The concept revolves around a center core “base EHR” with defined fundamental technology that every vendor will need to provide. There will then be additional layers of functionality on top of the base EHR. To great applause, it was also said that providers will only need to have technology to demonstrate meaningful use for the stage that they are currently in.

What does this mean in terms of the EHR market? Many hospitals and eligible professionals were waiting on the announcement of stage 2 to understand what will be required to qualify for incentive payments in the coming years. Now with a clearer picture, albeit the final rule will be significantly different, care delivery organizations will likely be more inclined to move forward towards adoption of an EHR.