I was reading an article the other day on "smart" pumps, and was struck by the comment that one might want to, "wait to buy a "smart" pump system until the market is mature." I doubt that any medical device market will mature then remain constant and unchanged.

Over time medical device's basic technology (data acquisition, image quality, infusing meds, etc.) matures and becomes undifferentiated to the point that vendors find themselves competing more and more on price, services, and "value-add" - this is a mature medical device market. This very "maturity" gives rise to new market requirements - since everyone's device delivers great data (or whatever) users start to think about ways vendors could help manage the data (or whatever) their devices produce. At the same time vendors are looking for anything to differentiate their products and add value besides price. This is the very market maturity that gives rise to "smart" pumps today or `5 years ago, cath lab recorders like Marquette's MacLab that helped kill off E for M. Most device markets have either started this value migration or market transition; or, like the cath lab, already gone through it. This type of medical device connectivity has a narrow scope of workflow automation, focused on a single vendor's one device (or maybe two). The resulting transitions, while firmly outside the comfort zone of most device vendors, allowed them to use the same kind of product strategies to artificially create changing costs, locking in their installed base.

I used to think that was it until a few years ago. Now it seems there's a new wave of market requirements (and technologies to support them) that go beyond device centric workflow that is automated with proprietary single-vendor solutions. Its like the first wave was automating the broader use of a device, and the second wave deals with automating the workflow of clinicians using multiple devices.

Point in case is the point-of-care, where you will find nurses struggling to deliver care with overhead pages, wireless phones, pagers, and nurse call systems for communications while juggling numerous surveillance and therapy delivery devices out of view in patient rooms demanding attention and alarming (frequently with false positive alarms). All of these devices are highly optimized as if each existed in a world devoid of any kind of device (a world that sadly does not exist). Is it any wonder there's a nursing shortage? To date, individual device vendors have been locked in their tried and true product strategies offering better patient monitoring systems or "smart" pumps (or whatever), but nothing that addresses the caregiver's environment beyond the single device. These vendors appear to be abandoning the next generation of solutions to a new group of competitors eager to fill the apparent vacuum. Really, anyone who's willing to step outside the box has a chance to be the next Marquette MacLab and knock some E for M's of the world off the top of the heap.

On a philosophical plane, it is as if market requirements are never truly met, but that certain requirements are met with current technology. Once this current set of achievable requirements is fulfilled, customers are grateful. Then the technology matures becoming undifferentiated and commoditized. Customers are once again demanding and surly (just kidding), wanting even more from device vendors. Then a new wave of innovation (technology again) sweeps through the market, temporarily sating customer's never ending demands for greater capabilities and general expection of more for less. Of course this is the health care market so "sweep" is a relative term, and these transitions take years to unwind.

Oops, I almost forgot to answer the question, "when to buy?" The short answer is go ahead and buy, but caveate emptor. The only no-brainer time to buy is with the market laggerds on the backside of the adoption curve. But if you waited until then you'd miss out on years of ROI, your "mature" product would be soon obsolete, and there'd be no vendors left to buy from (having gone bankrupt waiting for customers). Of course the earlier you buy the higher risk and theoretically the greater competitive advantage. Sadly the risk is not theoretical, but it takes lots of theory, i.e., needs assessment, planning, specialized knowledge, etc., to minimize risk and realize the potential advantage. Over time risk falls along with the benefit (opportunity cost of delayed purchase) until you safely buy an obsolete product.