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ORIGINAL ARTICLE
Microsystems in medicine – results of an international survey
S. SCHOSTEK1, H. FISCHER2, D. KALANOVIC1 & M. O. SCHURR1
1IHCI – Institute of Healthcare Industries, Steinbeis University Berlin, IHCI Office Tuebingen, Germany, and2Forschungzentrum Karlsruhe, Institut fur Biologische Grenzflachen (IBG-1), Eggenstein-Leopoldshafen, Germany
AbstractThe utilization of microsystems technology (MST) in medical applications is instrumental in opening up new marketsegments, in the creation of novel, more effective diagnosis and therapy options in medicine, as well as in the furtherdevelopment of MST. However, the players in the healthcare industry are faced with technical and non-technicaldifficulties. The present study analyzes this emerging field from the viewpoint of medicine, market, and MST. It identifiesapplications of medical devices with microsystems components and analyzes their potentials in great detail. Thus, especiallythe creation of new market segments is expected from a broad use of MST in medicine. Furthermore, problems andconditions during the entry of microsystems into medical products are illuminated, in particular considering the specificmarket features of the healthcare industry. The high expenditure necessary for establishing this technology in healthcareindustry is the most significant obstacle, since this market is dominated by small and medium-sized enterprises (SMEs). Butthere are non-technical difficulties as well. This article presents selected results of the study, which was carried out in thescope of the EU project netMED (virtual institute on micromechatronics for biomedical industry).
Key words: Microsystems technology, MST, micro-electromechanical systems, MEMS, micromechatronics, medicaltechnology
Introduction
Microsystems technology (MST) is a young discipline
whose importance for the present as well as its potential
for the future is undisputed. The main characteristic of
MST is the possibility to integrate sensing, signal
processing, and actuating capabilities into a single
miniaturized device of only a few millimetres or less.
With these capabilities, microsystems can actively
influence their environment on the basis of stand-alone
decisions which are based on data acquired from their
environment. Further, the spectrum of sensing and
actuating components is very broad, comprising
micromechanical sensors, micro-optical elements, bio-
chemical depositions, micro-fluidic structures, and a
great number of mechanical actuators. Due to these
features, microsystems are good for use in numerous
biomedical applications (1,2). Cardiac pacemakers,
implantable hearing aids (3), and insulin pumps (4) are
only some examples of successful medical devices
whose function is based on MST. Those devices have
already achieved a remarkable importance in healthcare
industry, but the future potential of MST for medical
applications could only be exploited to a limited extent
so far. Material compatibility, electrical hazard, energy
supply, heat dissipation, and device stability are
current medicine-specific technical problems of
MST devices to be solved (5). Future medical
microsystems e.g. may enable knives to cut only
selected tissues (6), surgical grippers to feel grasped
objects (7), or self-propelling endoscopes to locomote
through tubular organs for diagnostic and therapeutic
purposes (8); implantable drug delivery devices may
drastically improve the medical care by means of
measuring respective parameters and delivering drugs
on demand in appropriate doses (9); the possibility to
simultaneously monitor multiple biomedical para-
meters may lead to significant progress concerning
novel treatment options due to more reliable data
about physiological and pathological mechanisms of
the human body.
The penetration of the medical technology market
with MST components is by far not as high as e.g. in
Correspondence: S. Schostek, Steinbeis University Berlin, Dorfackerstr. 26, D-72074 Tuebingen, Germany. Fax: +49-(0)7071-763574. E-mail:
Minimally Invasive Therapy. 2005; 14:6; 360–368
ISSN 1364-5706 print/ISSN 1365-2931 online # 2005 Taylor & Francis
DOI: 10.1080/13645700500393870
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the transportation industry, since the entry into the
healthcare market represents a considerable chal-
lenge for many companies working in the field of
MST (10). Research and development activities
in the healthcare industry are mainly carried out in
small and medium-sized enterprises (SMEs), in
contrast to the transportation industry. Those
organizations often cannot handle the high expendi-
tures which are necessary to implement microsys-
tems technology. In addition, innovative products
are traditionally judged conservatively in medicine.
A new technology has to be fully understood and
accepted, along with the proof of the medical
effectiveness of course, in order to be broadly used.
Furthermore, medical indications often require
highly specialized medical devices; thus, high lot
numbers, which are necessary to produce micro-
systems in an acceptable price range, are often
hardly achievable.
Since these problems are commonly known, high
effort has been made to overcome them. Special
funding programmes aimed at promoting the devel-
opment of microsystems for medical devices, the
creation of specialized foundries and interdisciplin-
ary research and development centres enabled SMEs
to develop microsystems on their own, and training
centres are increasing the acceptance of innovative
products among the customers.
The Institute of Healthcare Industries (IHCI),
Steinbeis University Berlin has conducted a study
among experts in medicine, technology, and indus-
try. The goal of the study was to learn more about
the actual market situation regarding medical
devices based on MST, and to obtain information
about the importance of specific medical applica-
tions and innovation requirements in this field. In
addition, a strategic orientation of an international
R&D network was developed, which can solve
current entry problems and, at the same time, uses
the specific chances and potentials of microsystems
in the biomedical sector.
This study was carried out in the scope of the
netMED project (GIRT-CT-2002-05113), which
was funded by the European Commission in the 5th
FP, and aimed at facilitating the applications of
R&D results of MST in the biomedical sector.
Within this project, a virtual institute was set up,
which is supposed to be a one-stop shop for users
looking for innovative and marketable solutions for
their needs. A total of nine partners located in six
European countries constituted the project consor-
tium (Table I).
Material and methods
The core element of the study was a formalized
questionnaire consisting of 35 main questions with
altogether 850 variables. It was designed in co-
operation with opinion leaders in medicine, MST,
and the healthcare industry. With this survey we
equally addressed experts from science and industry
about both technical and medical aspects, in order to
obtain representative data.
Structure of the questionnaire
The questionnaire was thematically structured into
six topics (Table II). In question block A, the
participants were asked demographical data (free
response) and information about their organizations
(categorized answers), while the blocks B to F
interrogated specific questions concerning different
aspects of medicine, microsystems technology, and
the related industries.
In blocks B to F essentially two question types
were used; the dominating type were questions with
a Likert scale, i.e. a rating scale for measuring the
strength of agreement with a clear statement, from
zero for ‘‘no importance’’ to four for ‘‘high
Table I. netMED consortium.
N Scuola Superiore di Studi Universitari e di Perfezionamento Sant’Anna, Italy (Project Coordinator)
N Katholieke Universiteit Leuven, Belgium
N Institute of Healthcare Industries, Steinbeis University Berlin, Germany
N Universita di Pisa, Divisione Chirurgia Generale e Trapianti, Italy
N Swiss Federal Institute of Technology, Switzerland
N Centre National de la Recherche Scientifique (CNRS), Laboratoire de Physique et Metrologie des Oscillateurs, France
N Institut fur Medizintechnik und Biophysik, Forschungszentrum Karlsruhe, Germany
N Consejo Superior de Investigaciones Cientifica, Spain
N El.En S.p.A, Italy
Table II. Topic-related subdivisions of the questionnaire.
Block A General data
Block B Applications in medicine
Block C Medical technology and medical products
Block D Components and interfaces
Block E Co-operations
Block F (Appendix) Medical applications in detail
Microsystems in medicine 361
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importance’’. The second question type asked to
pick up the three most important out of various
alternative answers, which were presented in a
special cross-tabled format. An alternative answer
was composed by marking the appropriate crossing
fields of a category out of the lines and a category out
of the columns.
A further characteristic of most questions from
parts B to F was the evaluation of the questions from
two perspectives: on the one hand from the view-
point of the healthcare market in general, on the
other hand from the viewpoint of the respondent’s
organization in particular. Thus, an organization
could rate specific aspects for the business in
general, even if these aspects are currently not
important for the organization itself. The reason
for this distinction was that we wanted to be able to
obtain representative data for the industry in general,
taking into account the high specialization of
individual organizations.
Body of data
A total of 109 experts from science and industry
participated in the survey. Almost every second
responding organization (48%) was a small and
medium-sized enterprise (SME) with between 10
and 499 employees. 12% of the answers came from
very small companies (one to nine employees), the
remaining 40% of the respondents were large
organizations with more than 500 employees.
The primarily targeted groups were significantly
represented, with 55% of the respondents belonging
to medical device companies and every third (33%)
coming from the MST domain. 56% of the
responding organizations were active in the field of
research and development; 28% were hospitals /
doctor’s practices. Other participants were active in
the fields of production, service, consulting, supply,
pharmaceutics / biotechnology, distribution, public
administration, and financing. The end users were
represented with 14% of the answers.
Statistical analysis
The data of the questionnaire were analyzed with the
statistics software SPSS (SPSS Inc., Chicago, USA).
The analysis relied mainly on descriptive statistics, in
particular mean values. We also computed standard
deviations, which describe the distribution of the
answer values around the mean value. With respect
to the explorative character of this study, inference
statistical methods were used sparingly. They were
used wherever ex ante hypotheses could guide
meaningful analyses to valid prognoses.
Results
Applications in medicine
Key finding: The application of microsystems technology
in medicine is focused on several specific indications. The
market demand for technologies to improve disease
prevention is still underestimated by industry.
The cardiovascular system, followed by the sensory
and metabolic organs, was identified as the most
important field of application for microsystems in
medicine (Figure 1). The continuously high discre-
pancy between the rating of MST for the healthcare
industry in general and for the individual organiza-
tion in particular, concerning the importance of
microsystems for different applications in medicine,
indicated a high grade of specialization of the
enterprises. Many of the respondents are interested
in one or few of the mentioned topics and therefore
gave high ratings of the topic for their own
organizations, while they were still recognizing the
importance of other fields for the branch. Especially
the end users of medical products, hospitals and
Figure 1. The importance of microsystems for different medical applications (extract).
362 S. Schostek et al.
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medical practices, showed a high sense for the
importance of the utilization of microsystems in
medical devices from the viewpoint of the healthcare
industry in general, in particular for the cardiovas-
cular system (M53.6, SD50.5) and diseases of the
endocrine system (M53.0, SD51.2).
The analysis of the importance of MST for
specific diseases in block F confirmed the leading
role of the cardiovascular system. The importance of
all cardiovascular diseases was rated by the respon-
dents as very high (M52.9 to 3.3, SD50.7 to 0.9),
while the field of metabolic organs was dominated by
diabetes mellitus (M53.0, SD50.9) and the field of
sensory organs by the sense of hearing (M53.3,
SD50.8) and the sense of vision (M53.2, SD50.8).
Microsystems turned out to be most important for
diagnostic, therapeutic, and monitoring purposes
(Figure 2). This situation was proven for both the
medical industry in general and the individual
organization in particular. Also the different market
participants generally agreed with the high impor-
tance of diagnosis, therapy, and monitoring as fields
of application for microsystems.
Prevention and rehabilitation turned out to be less
important in this context, according to the opinion
of the responding experts. While the importance of
these phases of medical care was almost equivalent
from the viewpoint of the industry, the activities of
the individual organizations were obviously more
focused on the field of prevention.
However, a clear discrepancy showed up by
comparing the opinion of the end users with the
opinion of the medical device industry (Figure 3).
While the medical device industry interpreted the
attractiveness of prevention as field of application for
microsystems as relatively low, the end users stated
to see a potential which is comparable to that of
diagnosis, therapy, and monitoring. This may
indicate that the healthcare industry is currently
underestimating the potential of MST for use in
preventive measures.
Future potential
Key finding: The future potential of microsystems
technology in medicine is assessed differently by indivi-
dual market participants. The creation of new products
as well as the expansion of functionality and miniatur-
ization of existing products are the most important issues.
The expectations regarding a positive effect due to
the use of microsystems in medical devices were
generally higher for the future than for the pre-
sence. Especially pharmaceutical and biotechnology
Figure 2. The importance of microsystems for specific phases of medical care.
Figure 3. The importance of microsystems for prevention, rated by the end users and the medical device industry for the own organization.
Microsystems in medicine 363
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enterprises as well as companies of the MST domain
were optimistic. According to the responding
experts, miniaturization (importance within five
years: M53.6, SD50.6; importance for today:
M53.3, SD50.9) was the essential advantage on
the product level achieved by the use of MST.
Furthermore, positive effects for the opening up of
new market segments (importance within five years:
M53.4, SD50.8; importance for today: M52.9,
SD51.0) as well as for present markets (importance
within five years: M53.3, SD50.8; importance for
today: M52.8, SD51.0) were expected.
The main expectation beyond the product level
was a general technological progress (M53.3,
SD50.8). Since a broad utilization of microsystems
in medical devices could hardly be achieved without
a corresponding adaptation of the workers, the
creation of new, specialized jobs (M53.1, SD50.9)
was by far more expected than the maintenance of
existing jobs (M52.3, SD51.1). Also, an increasing
competition among different companies was highly
expected (M52.9, SD51.0), in particular by phar-
maceutical and biotechnology enterprises.
Components
Key finding: The medical domain is paying particular
attention to microsensors. Piezoceramic and microfluidic
structures are dominating the field apart from the sensors.
The production of components of microsystems technology
is mainly carried out in small and medium-sized
enterprises.
In this study, the components of MST were grouped
into sensors, actuators, and structures. The partici-
pants were asked to rate the future importance of
altogether 29 components. Table III shows the
three most important components of each group,
respectively.
The end users of medical devices, hospitals and
medical practices, highlighted the importance of the
measurement of mechanical parameters, in particu-
lar pressure (M53.8, SD50.4), force- and bending
sensors (M53.1, SD50.9), torsion sensors (M52.5,
SD51.2), and length sensors (M52.5, SD51.1).
The pharmaceutical and biotechnology industry was
most optimistic regarding the future importance of
piezoceramic (M53.4, SD50.5) and fluidic
(M53.1, SD51.1) actuators as well as microfluidic
structures (M53.7, SD50.5).
SMEs were the most important suppliers of MST
components in the medical industry (M52.1,
SD51.5), followed by in-house production
(M51.9, SD51.7). Companies of the pharmaceu-
tical and biotechnology industry (M53.1, SD51.6)
and of the MST domain (M53.0, SD51.2) stated
that they produce the majority of microsystems on
their own, while the customers (M50.8, SD51.3)
didn’t have these capabilities.
Market entry problems
Key finding: The main problem of the introduction of
microsystems technology in medicine is the initial
investment.
First of all the results indicated a certain self-
confidence among the market participants, since the
responding experts rated the importance of specific
hurdles higher for the medical industry in general than
for their own organization. However, the high expen-
diture which is necessary for the establishment of MST
in medicine turned out to be the most important road
block concerning the utilization of microsystems in
medical devices (Figure 4). The different players of the
healthcare industry generally agreed on this point.
Compared to the problem of high initial costs,
every single remaining barrier was rated as signifi-
cantly less important. Difficulties due to insufficient
reimbursement, scepticism of the users, and low
reliability of the systems were judged to be delicate
but solvable. It is remarkable that problems con-
cerning the reliability of microsystems were playing a
comparatively big role for the individual organiza-
tions. Social aspects like an impairment of the
patient-doctor relationship (M51.5, SD51.1) or a
low social acceptance (M51.3, SD51.0) were
generally rated as least problematic.
Among the functional barriers, the risk of product
liability in the medical domain turned out to have
high importance for the industry in general, while
Table III. The future importance of specific sensors, actuators,
and structures (extract).
Future importance for
medicine / medical products
(05no importance, 45high
importance)
Sensors
Bio sensors M53.6, SD50.7
Chemical sensors M53.4, SD50.8
Pressure sensors M53.3, SD50.8
Actuators
Piezoceramic / ultrasound
actuators
M53.1, SD50.9
Electromechanical actuators M52.7, SD51.0
Hydraulic- / liquid-operated
actuators
M52.6, SD51.0
Structures
Microfluidic structures M53.3, SD50.8
Valves M53.3, SD50.8
Electrodes M53.2, SD50.8
364 S. Schostek et al.
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difficulties in implementation of new MST compo-
nents was very significant for the individual organi-
zations in particular (Figure 5). Further important
hurdles, from the viewpoint of the industry in
general, were mainly of a non-technical nature, such
as strong competition with established conventional
products (M52.6, SD51.1) or problems in search-
ing partners in the industrial environment (M52.6,
SD51.1) or in judging the healthcare market
(M52.4, SD51.0).
Preconditions
Key finding: The access to international R&D networks
is an important precondition for a widespread use of
microsystems technology in medicine. The experiences
concerning the commercialization of R&D results focus
on the phase of research and development.
The preconditions for a broad use of MST in
medical devices were different for the healthcare
industry in general and for the individual organiza-
tions in particular. The most important precondition
for the medical industry in general was a good
availability of integrated MST solutions. Other
preconditions, which were relatively important as
well, were of a non-technical nature: Increase of
acceptance among the payers / health insurances
and special funding programmes. Most important
for the individual enterprises was an easy access to
international research and development networks,
followed by special funding programmes and the
creation of interdisciplinary development centres
(Figure 6).
Know-how in the commercialization of R&D
results was available basically for the R&D phase
(technical research, consulting, filing patents). With
increasing concretization of a product development
(foundation of a start-up company, joint ventures,
licensing), the experiences were decreasing
(Table IV).
Networking
Key finding: Co-operations are dominated by technical
issues. Medical technology enterprises are favoured as co-
operation partners due to their reliability; creativity is
assigned to universities.
Co-operations turned out to be dominated by topics
concerning technical issues during the research and
development phase, in particular technical research
Figure 4. The importance of specific hurdles for the broad utilization of microsystems in medicine (extract).
Figure 5. The importance of specific functional problems / barriers for the utilization of microsystems in medical devices (extract).
Microsystems in medicine 365
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(M52.8, SD51.3), test / assessment (M52.7,
SD51.2), and design of prototypes (M52.6,
SD51.4). They were followed by non-technical
topics during the product development, which were
consulting (M52.3, SD51.3), financing (M52.1,
SD51.6), and market research (M52.0, SD51.4).
Issues with regard to the manufacturing of products
played a subordinate role (Limited-lot production:
M51.9, SD51.5; Assembling: M51.8, SD51.4).
Topics related to the commercialization of R&D
results have lowest importance in co-operations with
external partners (Distribution / marketing: M51.7,
SD51.4; Licensing: M51.6, SD51.4).
The most important criteria for the assessment of
the work of an external co-operation partner were
professionalism, reliability, and creativity / innova-
tivity, according to the opinion of the responding
experts. Regional presence, reputation, as well as
promptness were less important in this context.
The most important quality of universities and
non-university research institutes turned out to be
their creativity. Consulting firms and medical device
companies were thought to be the most professional
and reliable organizations.
Networks
Key finding: Assistance is required both on functional
and strategic level. Small organizations as well as
research institutes will have most profit by the use of a
R&D network.
The present study paid attention to the general
conditions for the establishment of an international
R&D network by means of netMED as a virtual
institute. The netMED network was supposed to be
a ‘‘one-stop shop’’ for users looking for innovative
and marketable solutions for the conversion of R&D
results of microsystems technology into applications
in medicine.
A certain demand addressed to an international
R&D network emerged for the assistance particularly
at an early stage of a product development process.
Thus, assistance in acquiring grants (M52.9,
SD51.2) turned out to be the most important
offering of such a network, followed by technical
research (M52.8, SD51.2) and services for product
regulatory approval (M52.7, SD51.1). The market
participants showed a great willingness to provide
assistance in technical research to other netMED
partners in return (M52.6, SD51.4). The largest
discrepancy between supply and demand emerged in
Figure 6. The importance of specific preconditions for an increased utilization of microsystems in medical devices (extract).
Table IV. Specific experiences concerning the commercialization
of R&D results.
Experience (05no
experience, 45high
experience)
Contract research and development M52.7, SD51.4
Consulting / expertise M52.5, SD51.3
Filing patents M52.3, SD51.4
Foundation of a spin-off company M51.7, SD51.5
Joint venture M51.5, SD51.3
Licensing M51.5, SD51.3
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the case of assistance in market research. The high
demand (M52.6, SD51.3) faced only a reserved
offering (M51.8, SD51.4).
The preferred business connection turned out to
be membership in an industry liaison programme
(M52.5, SD51.2) in most cases. Purchase orders /
contracts (M52.1, SD51.2) were preferred by large
SMEs with 250 to 499 employees (M52.8,
SD51.5). Joint ventures (M51.8, SD51.4) and
licensing (M51.6, SD51.3) were particularly
favoured by very small (joint ventures: M52.3,
SD51.3; licensing: M51.8, SD51.2) and very large
enterprises (joint ventures: M52.1, SD51.5; licen-
sing: M52.1, SD51.4).
Discussion
Microsystems technology (MST) can improve both
the quality and safety of healthcare delivery.
Although several medical devices based on MST
have been successfully brought to the market, the
potential of MST for medical technology has not
been exploited to the full extent so far since the
different players of the healthcare industry have to
cope with certain difficulties, both of a technical and
a non-technical nature. But our study demonstrates
that the efforts in utilizing MST for medical
applications are still ongoing.
MST will have a positive effect on existing
products, due to their miniaturization capabilities
mainly. It will further facilitate the opening up of
new market segments since microsystems make
many biological systems accessible for the first time
and they combine sensing, signal processing, and
actuating capabilities on the smallest space, which
may enable future intelligent medical devices
to reach stand-alone-decisions on therapeutic
measures. Widespread health disorders like diseases
of the cardiovascular system or diabetes represent
important indications for novel medical devices
based on MST. Thus, those medical indications
seem to be attractive for the application of MST
which promise high lot numbers, involve anatomical
and/or physiological structures that are delicate to
influence, and have a significant social and economic
impact. However, this outline of the market might
not be crucial for the realization of novel medical
products, but an analysis of the field of application,
restricted to the use of the respective product, since
MST allows an adaptation of a medical device to
highly specialized fields of application.
But there are significant information deficits,
on the one hand about characteristics of related
industries, on the other hand with regard to the
phase of product concretization. Basic research and
development (R&D) is carried out mainly in
universities, due to their creativity and innovativity.
But with increasing proximity to the product phase,
non-technical competences gain importance, and
the responsibility shifts more and more to private
enterprises. Especially in the case of the transfer of
MST into medical applications, various interfaces
between different phases of product development,
like adapting basic R&D results into a customer
orientated development process, further founding a
start-up company, and launching the product
successfully and sustainably into the market, neces-
sitate certain experience and special knowledge.
Our study demonstrates that the approach to
accompany the whole development process by an
international R&D network is a promising option to
overcome the said difficulties. Further, the concept of
the netMED project to encourage the users to provide
own services to the network in return seems to be
sustainable. The only discrepancy between demand
and offering emerges in the case of market research.
We of course have to acknowledge that our study
only represents a snapshot of the fast changing
healthcare environment. Writing this, changes on
organizational and monetary issues go into effect.
However, all players of the healthcare market, in
particular university and non-university entities, care
providers, and, last but not least, insurers and
politicians, have to work together in order to create
a positive atmosphere, in which the potentials of
MST in medicine can be exploited with positive
effects for all involved.
Acknowledgements
The research for this study was funded by the
European Union in the scope of the project netMED
(virtual institute on micromechatronics for biomedical
industry, GIRT-CT-2002-05113) in the 5th FP.
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