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Master Thesis – Business Administration
Track: Entrepreneurship and Innovation
The Potentials of The Internet of Things in
The Healthcare Industry.
Supervisor: Dr. G.T. Vinig
Date: 22 of January, 2015
Author:
Ognyan Filipov
Student number: 10846271
ognyan.filipov@yahoo.com
tel. : +359 887 825 675
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Statement of originality
This document is written by Student Ognyan Filipov who declares to take full responsibility
for the contents.
I declare that the text and the work presented in this document is original and that no sources
other than those mentioned in the text and its references have been used in creating it.
The Faculty of Economics and Business is responsible solely for the supervision of
3 | P a g e Abstract
This thesis will aim at giving an overview and discussion of the current situation of the
Internet of Things systems and wearable's, the challenges that are present and the
opportunities that have opened since the deployment of such technologies. More focus will
be shed on the technologies used in the healthcare domain, with detailed description of this
kind of systems and instruments some among them being remote patient monitoring,
mHealth, telemedicine, and telehealth. The thesis will try to answer if the implementation of
such IoT technologies in healthcare can increase the quality and/or reduce the cost of
delivered care. For this, multiple case study analysis following a qualitative research
approach was used. Data from six case studies where the implementation of IoT systems has
produced viable results has been obtained. The results are confirming the notion that IoT
technologies are in fact improving the quality of care, decreasing the costs of it and
increasing patient satisfaction.
Keywords:
Internet of things; healthcare; remote wireless monitoring systems; telemedicine; mHealth;
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Table of Contents
Abstract ... 3
1. Introduction and Research Question ... 5
2. Literature Review ... 8
2.1 Internet of Things and Wearable's ... 8
2.1.1 Internet of Things and Wearable's in Healthcare ... 13
2.3 Opportunity Recognition ... 23 2.4 Conceptual Framework ... 28 3. Methodology ... 29 3.1 Research Design ... 29 3.2 Data Collection ... 30 4. Empirical Evidence ... 30
4.1 Case Study 1 - Improving Health at Home: Remote Patient Monitoring and Chronic Disease for Care Transition Intervention Program at CHRISTUS St. Michael Health System ... 31
4.2 Case Study 2 - Remote Patient Monitoring and Chronic Disease Management implemented at Hackensack Alliance Accountable Care Organization (ACO) ... 33
4.3 Case Study 3 -Asthmapolis: Improving Asthma Management with Wireless Technology ... 35
4.4 Case Study 4 - Mobile PHR Improves Patient Engagement, Satisfaction and Care implemented at the Children's Medical Center in Dallas, Texas ... 36
4.5 Case Study 5 - Mobile Telemedicine Provides Cost Effective Patient Care in Low-Income Neighborhoods implemented at Children's Medical Center in Dallas, Texas ... 37
4.6 Case Study 6 - Enhancing Lehigh Valley Health Network (LVHN) ICU Patient Care Through 24/7 Remote Access and Monitoring ... 38
5. Results ... 40
6. Discussion and Conclusion ... 47
7. Limitations ... 50
5 | P a g e 1. Introduction and Research Question
Nowadays, humanity is being faced with numerous technological advancements that
are positively changing the life as we know it. Much attention has been given to one
technology in particular - The internet of Things and has been considered as a hype topic for
discussion over the news worldwide. Supporting the latter, a wide range of scientific
researches, whether business or technology related, are extensively present in journals, news
and the internet.
The development of the internet of things market, if it can be referred to one, is in its
infancy. According to the Internet of Things Business Index, introduced by the Economist in
2013, the Internet of Things is only at "in research" stage of a five stage implementation
process with stage five being the extensive adoption of the technology. The business
intelligence unit of The Economist has found that there are indications that the business
world is embracing the Internet of Things on a global level, showing an overall worldwide
investment over 10% to be 29% of the 779 surveyed participants. The opportunities appear to
be gargantuan with numerous potential possibilities for development in a broad range of
industries focused on improving environments such as: healthcare, manufacturing, retail,
transportation, logistics and smart environments (Gubbi, Buyya, Marusic, & Palaniswami,
2013).
The healthcare industry is experiencing huge economic and social challenges on a
global level thereby creating opportunities to tackle them. Among these challenges, are the
rising costs in medical care that essentially impact the life duration and well-being of the vast
majority of human beings (Santos, A.; Macedo, J.; Costa, A.; M. Joao Nicolau 2014).
According to a research on disruptive technologies by McKinsey Global Institute from 2013,
costs are rising even more in the case of chronic diseases. That said and combined with the
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Internet of Things technologies beyond expectations. The Internet of Things plays a
significant role in the healthcare domain creating room for opportunities that could solve a
wide range of issues, some amongst them being:
• Reducing the cost of medical care for patients and medical care institutions • Support prevention of diseases
• Early diagnostics and disease management
• Improving the efficiency in treating patients with chronic conditions, for example, heart diseases, diabetes, sleep disorders, asthma and others
• Reduce the time of readmissions • Make healthcare more accessible
Adding up to the latter, the healthcare domain has a definition for such technologies
that use the Internet of Things. These are mobile health technologies(or mHealth), which
represent medical and public health practice facilitated by mobile devices, such as wearable
devices, patient monitoring devices, mobile phones, and other wireless devices. They also
include applications (or apps) that are connecting to wearable devices, medical or
recreational, or sensors to continuously provide real-time information to both patients and
doctors.
Mobile health technologies, for instance, have the potential to make this enormous
difference in the lives of people suffering from chronic diseases while simultaneously
attacking a significant source of rising healthcare costs. This thesis will shed light in more
detail on case studies related to mHealth systems that have the potential to improve the
medical fight against chronic diseases. However, there are numerous challenges to deploying
such technologies for the general population, and one must not ignore them. Some of them
address critical issues such as data security and privacy, user acceptance, user awareness and
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Nonetheless, this innovative approach to improving healthcare by using wearable and
Internet of Things technologies can potentially disrupt the current market conditions, thus
creating an open field for new opportunities. The research will also focus on the how
entrepreneurs are turning current challenges in the healthcare domain into opportunities to
deploy Internet of Things solutions (J.Eckhardt & S. Shane, 2003).
TOPIC
The research will provide an overview of the current situation and potentials of the
Internet of Things and its wearable's in the Healthcare industry.
This research will be illustrated by six case studies, 5 of them provided by the
Healthcare Information and Management Systems Society (HiMSS) which is a worldwide,
cause-based, non-for-profit organization that is focusing on improving health through
information technology. The sixth case study is being sourced from Lehigh Valley Health
Network that is considered as one of America's best hospitals. The case studies are as
follows:
1) Improving Health at Home: Remote Patient Monitoring for Care Transition Intervention
Program implemented at CHRISTUS St. Michael Health.
2) Remote Patient Monitoring and Chronic Disease Management implemented at Hackensack
Alliance Accountable Care Organization
3) Asthmapolis: Improving Asthma Management with Wireless Technology
4) Mobile PHR Improves Patient Engagement, Satisfaction and Care implemented at the
Children's Medical Center in Dallas, Texas.
5) Mobile Telemedicine Provides Cost Effective Patient Care in Low-Income Neighborhoods
implemented at Children's Medical Center in Dallas, Texas.
6) Enhancing Lehigh Valley Heath Network (LVHN) ICU Patient Care Through 24/7 Remote
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The objective will be to explore and analyze the implications, challenges and results
that have been underlined in the process of implementing the technology and how they are
supporting the research questions. In addition, the research will try to link the relevant theory
on opportunity recognition with the findings in the multiple case studies to show how
entrepreneurial opportunities are being discovered through the new concept of internet of
things in the healthcare industry.
Research Question:
"What are the wearable device opportunities and challenges in the healthcare industry?"
Sub Question 1: "Are wearable devices and the internet of things able to improve the quality of healthcare and/or reduce the cost of it?"
2. Literature Review
In this chapter the relevant existing literature about internet of things, wearable's,
internet of things and wearable in healthcare and opportunity recognition will be discussed.
In addition, a conceptual framework will be provided.
2.1 Internet of Things and Wearable's
The concept of the Internet of Things is not new (Gershenfeld, 1999; Ferguson, 2002,
Kindberg, Barton, Morgan., 2002). Essentially, the main idea of the Internet of Things can be
summarized in the following sentence: "A worldwide network of interconnected entities". In
the vast majority of the cases, these mixed entities, or so called "things" - for instance
computers and humans, have an addressable and readable part on the Internet. This makes it
possible to collect, record and analyze new data flows faster and in a more reliable and
accurate way. It integrates all types of sensory, identification, networking, communication
and other wearable devices and systems, and smoothly connects all the people and things,
based on interests, to allow anybody, anywhere, at any point in time to access the information
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foundation blocks of this new hype technology, such as RFID(Radio-frequency
identification), WRMS(Wireless remote monitoring systems), Wireless communications
protocols (ex. Bluetooth), Smart Services(ex. real-time: breathing rate, pulse, distance
tracking), cloud services etc. For instance, Krogner's IoT-based system, Retail Site
Intelligence, serves as a single and independent platform of video analytics, wireless devices,
POS devices, handheld sensors, IP cameras, and video management software that helps
clients to have a better shopping experience by finding products more easily (Lee, I., & Lee,
K. 2015).
Wearable are facilitating the concept of the Internet of Things by having a group of
wearable devices and sensors connected to each other through Wireless Sensor Networks.
Thereby, making wearable devices and Internet of Things two inseparable technologies that
are used together. Furthermore, Internet of Things technologies will allow billions of objects
in the physical as well as virtual world to exchange data in an autonomous way to create
smart environments such as healthcare, environment monitoring, automotive, logistics,
manufacturing and many more. Firms will devote resources in the Internet of Things devices
and systems to revamp existing factory workflows, improve material tracking and decrease
distribution costs. For instance, UPS is already using Internet of Things-enabled fleet
tracking technologies to diminish costs and improve supply efficiency (Lee,I., et al. 2015).
According to the National Information Council 2008, the emerging technology of the
Internet of Things is expected to deliver promising solutions to the latter stated sectors.
Deloitte TMT Predictions 2015 has forecasted that 1 billion wireless Internet of Things
devices will be manufactured and shipped in 2015, which is a huge 60% increase on 2014.
They have concluded that these devices will add to an already installed base of approximately
3 billion devices worldwide and that the Internet of Things hardware will be worth in the
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Internet of Things devices will reach a global volume of 26 billion units by 2020, making up
for a vast incline from 0.9 billion in 2009.
Figure 1: Potential economic impact of IoT in 2025 (McKinsey Global Institute, 2015)
The evolution of the Internet of Things has already started taking place on a
worldwide level and is rapidly growing. Starting from various businesses, SME's and MNE's,
to large enterprise businesses that rely on this technology to optimize and enhance their
already robust operational structures. This statement can be supported with the example that
Google paid $3.2 billion to buy the smart thermostat business Nest in 2014 (Lee,I., et al.
2015). According to McKinsey Global Institute from June 2015, Figure 1, the potential
economic impact of Internet of Things in all industries in 2025, including consumer surplus,
is ranging from a low $3.9 trillion to a high $11.1 trillion.
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In line with the work of Bradley, Barbier, and Handler (2013), the Internet of Things
will create value of $14.4 trillion, this being a sum of increased revenue streams and lowered
costs that will migrate among firms from 2013 to 2022. They imply that four industries make
up for more than fifty percent of the latter projection of 14.4 trillion dollars. These four
sectors are manufacturing at 27%, retail at 11%, information services at 9% and finance and
insurance at 9% as well. In Table 2, the projected evolution of Internet of Things
technologies can be seen according to Lee,I., et al. (2015). As entailed by the authors of the
research network, technology is the foundation of the Internet of Things and it is moving to a
noninvasive wireless communication technology to be deployed more easily.
The benefits from Internet of Things (later referred to as IoT) applications and
wearable's can make room for opportunities for value creation and social impact (Perera and
Zaslavsky,. 2014). People are searching for user-friendly aiding systems which are not only
tracking their health, but also improving their personal life and other applications (Castillejo,
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wearable's can be concerned with the possibility to collect previously unavailable data, such
as data collected from sensors embedded in Smart watches to track the person's heart rate, or
to track what path does a client takes in the supermarket every time for retail reasons or
marketing. However, win-win situations would benefit most for both individuals and
companies, such as providing consumers with smart devices that track their likings, their
needs and their wants so to achieve convenience and efficiency. On the other hand,
companies would know those variables and hence make offerings customized to the
consumer's behavior.
As reported by, Beecham Research Limited from 2014, wearable's application chart, it
can be inferred that the applications of wearable technologies are differing across industries,
applications, functions and products (Appendix 1). Based on this spectrum and a range of
academic and online publications, examples and advantages of applications in each industry
will be provided.
Business Operations: Wearable devices are making accessibility to data and
interaction with data for field operations as well as non-field operations. Some advantages
that can be drawn from the use of these devices can be: diminished steps of management of a
controlled event, increased awareness of an on-going situation from the provided data and
controlled access (Skourup and Reigstad, 2002). For example, Disney's wearable MagicBand
is a novel wristband integrated with RFID chips that is used as a ticket and connects to
Disney's data warehouse regarding park visitors (Lee et al., 2015).
Security and Safety: Military application of wearable devices can be used to increase
the mission effectiveness. Wearable devices such as eyewear display, GPS tracing bands and
microphones integrated in soldiers gear can increase battlefield awareness (Military
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Sport and Fitness: Wearable devices in this sector can help people to lose weight,
motivate themselves to train and track their pulse. According to Buttussi and Chittaro (2008),
Mobile Personal Trainer System or MOPET helps users to achieve their fitness goals by
using data gathered by sensors. In addition, experts project that 130 million consumers
globally are using fitness trackers and with the rapid development and adoption of smart
watches and other wearable devices, that number of connected fitness monitors is projected
to top 1.3 billion units in 2025 (McKinsey Global Institute, 2015).
Life style Computing: This sector is using the wearable devices mainly for user
entertainment. For example, wearable devices in the gaming domain create a sensory,
emotional and feelings focused interaction between the gamer and the virtual reality. This can
be achieved by using headset display that shows your surroundings in a three-dimensional
view (Beecham Research Limited, 2014).
Communication: According to Beecham Research Limited, 2014, wearable devices
could change the way people and organizations communicate. While living in the shared
economy and the prevailing increased interaction between consumers will open gaps for
brands to develop and deploy new consumer experiences (Minsker, 2014).
Glamour: This sector differs from the stated above as their application is more
focused towards a non-functional usage. Rather it is focused on satisfying emotional,
aesthetic, and visual senses (Beecham Research Limited, 2014)
2.1.1 Internet of Things and Wearable's in Healthcare
Although the internet of things has projections to be very successful in many sectors,
the greatest potential lies in the healthcare industry, where its implementation has already
produced viable results in the context of increasing the quality of care, improving the ease of
access to care and reducing the cost of care for both patients and healthcare institutions
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2011). Internet of Things based healthcare systems have a significant role in Internet
Communication Technologies and have enormous contribution in the growth of medical
technology systems, which are underlining the most recent medical and economic
development strategies globally (Talpur, 2013).
According to McKinsey Global Institute from June 2015, if in the next ten years IoT
technologies that are monitoring and treating illnesses are being adopted globally, they have
the prospect to increase their economic impact in healthcare from $170 billion to $1.1 trillion
per year. New technologies are modifying the way healthcare services are delivered, allowing
patients to remain in their homes or not visiting healthcare establishments on a regular basis
to receive medical care while avoiding expensive hospital stays and transportation costs
(Chan, Estève, Fourniols, Escriba, & Campo, 2012). These systems are a combination of set
of devices such as wearable devices, mobile phones, tablets, weight scales, blood pressure
cuffs, pulse oximeters, health monitoring systems, bedside hardware and more (Hung, Zhang,
& Tai, 2004).
Figure two, shows a simple illustration of how in-home self-care works. Remote
patient monitoring is one of those systems. It consists of software and hardware solutions that
support disease management programs for continuous patient monitoring for cost,
high-risk conditions such being sleep disorders, diabetes and congestive heart failures (Field, &
Grigsby, 2002). Furthermore, this system includes analysis and real-time transmission of data
to all kinds of doctors, physicians and other personnel that may be included in the patient
treatment, and alerts them and the patients when there are irregular metrics or when
immediate help is needed (Field, & Grigsby, 2002). This internet-facilitated system is
supporting the need for patient self-care and better patient health management.
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Source: Reymond James Research (2014). "The internet of Things: A study in Hype, Reality, Disruption, and Growth"
For instance, remote monitoring systems can be applied with people suffering from
diabetes who have to keep a strict regime for measuring their blood glucose levels, keeping
their diet, and tracking insulin usage at home. The automated analytics provide sound alerts
or notification to the doctor and patient when there are abnormal levels or the patient forgot
to take his/hers medicine. Failure to take his/hers medicine, as prescribed, can triple the costs
of treating chronic diseases when non-adherence leads to emergency room visits, more
readmissions and consequentially new disease difficulties (Salas, Hughes, Zuluaga, Vardeva,
& Lebmeier, 2009). Companies that have already manufactured products to help patients
suffering from diabetes are Google, Dexcom, Insulin Angel, FreeStyle Libre System, Infra
Vitalis, Medtronic and others. There are pilot studies that have documented that remote
monitoring services such as mHealth, telehealth, and telemedicine are medically and
economically effective (Rosenfeld & Dorman, 2000). However, today's advances in the area
of IoT technologies is at the point where they can only be utilized to, firstly, benefit
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accidents and case specific diagnostics (Sundmaeker, Guillemin, Friess, & Woelffle, 2010).
The facilitators of that role are mainly mobile phones and their applications, which have an
incremental demand globally and which are no longer used solely for calling or social media.
Following this notion, the needs of the society and market trends hint that healthcare-related
app's will be vital and considerable in volume (Hung, Zhang, & Tai, 2004).
In addition, for the latter stated technologies and applications to create utmost benefits
in healthcare it will require changes in the healthcare industry. With technology developing
over the years, costs will incrementally decrease thereby enabling a wider adoption and use
by the vast majority of patients. The price of sensors such as accelerometers, pressure sensors
and gyroscopes that are employed into smartphones has fallen 9 percent a year on average
(McKinsey Global Institute, 2015). Another challenge that is considered vital is that a change
in the behavioral structure of care providers and insurance payers is needed to further
embrace the potential of the IoT (Henderson, Knapp, Fernández, Beecham, Hirani,
Cartwright, & Newman, 2013). For example, in the United States of America the normal
method of healthcare providers’ compensation is based on volume of care they provide, such
not necessarily being a key support index for efficient spending. Nevertheless, these
compensation methods could create incentives for providers to use IoT to improve the quality
of care and reduce the cost of care in the same time. For instance, providers could be paid for
a course of treatment for a specific condition, rather than for each examination and/or
procedure. This would as well provide an encouragement to use IoT technology to increase
adherence to medications and decrease the need for supplementary procedures (McKinsey
Global Institute, 2015). Another challenge for the implementation of Internet of Things
instruments is the user awareness, acceptance and perception. In a research of Chan, M., et al.
(2012) the authors imply that any technology or system that can increase independence is
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participants' mindsets towards the idea of wireless sensing networks (WSN) for health
management are generally positive. What is more, it that the systems based on WSN (systems
that are able to gather a wide range of environmental and structural sensory data such as:
weight, blood oxygen level, glucose level, ECG information, EEG information, sound,
temperature, humidity, light-intensity, vibration and acceleration) are indeed still under
development and most elderly patients have hard time to fully adapt and understand the
advantages of such systems. A crucial l challenge to o the implementation and fast
deployment of IoT systems is the privacy and security concerning personal data. More
specifically, the way the data is collected, processed and stored by different individuals: app
developers, health professionals, health institutions, companies and public authorities
(European Commission Green Paper on mHealth, 2014). Moreover, other main areas of
confidentiality concern in health care delivery are connected to data protection and avoidance
of information inaccuracies, with patients not necessarily having much assurance in the
current system (Leino-Kilpi, Välimäki, Dassen, Gasull, Lemonidou, Scott, & Arndt, 2001).
With all its advantages, internet of things has several disadvantages that are dire in its
applications. These disadvantages have been having different implications on the systems,
installation, application and maintenance. First, the compatibility of the system is a major
issue that has reduced its efficiency. On this, there is no currently any government body that
is in charge of ensuring a complete system where there has to be standards of application.
This is a challenge to the users but can be easily overcome by the companies that
manufacture the systems. It is a responsibility of the body to come up with a proper way of
handling the issue. Coming up with proper standards is a responsibility of the company and
determining the compatibility issue can be handled easily. For this reason, compatibility may
be a major challenge when an independent body is created to oversee several of such
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Secondly, there are issues of complexity that are to be addressed. In most cases, there
can be a chance of double case. Since the information in this system could be shared, a single
mistake that only affects one system can be sent to all the other ones that require no service.
This can create an opportunity of several dangers that will have to be handled at different
levels. The complexity in this application makes it hard to understand some of the given
information and ultimately, poor general service and lots of time wasting. The complexity
issues could be challenging to resolve unless there is proper education and perfect
communication systems that would be used in alerting people of possible dangers
(Saint-exupery, 2009).
Thirdly, there is a risk of overreliance on technology. Since the advent of the fast
growing technology, there has been a reduction in analogue data security. In the world today,
there has been an increase in security factors that affect the privacy of companies. Recently,
the federal government of the United States had their information that was meant to be
private leaked to the public. In this sense, the highest place in the United States got their data
leaked. It is expected that the government should be having the highest security measures that
take control of the issues to do with security. This factor proved the ease by which internet of
things is insecure and the data is not safe when kept in that sense. Other companies get their
information used carelessly by different company officials where the most secretive
information is shared to the public. Overreliance on the internet faces a great danger from
hackers and competitors who are much busy with this information (Saint-exupery, 2009).
In the past decade, there has been an idea of introducing the internet in the quest to
handle some crucial issues. There used to be messengers and office organizers. Since the
application of technology came to place, there has been a continuous loss of jobs from
several companies. Owing to the fact that there has been a reduction on the requirement of
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people lose their jobs with introduction of every new system. The idea that technology is
more reliable is majorly focusing on fewer jobs for people. In the past messengers were
trusted with certain information like letter delivery, information delivery and some parcels
since it was the only means of communication. There was no complaint of lost letters or
undelivered information. With the current internet of things, there is a high rate of
undelivered messages as hackers block some means of communication for their own benefits.
This has reduced the efficiency that was enjoyed in the previous years with the messengers
(Sundmaeker, Guillemin, & Friess, 2010).
There is only one company controlling the system. Internet of things has a monopoly
of control where all the information passes through. For the case of businesses it can be noted
that there is risk of certain companies losing their information to the competitors. The rich
companies are in a position of influencing certain things including manipulating some
information to their advantage. This does not work properly on the other companies since
they will be controlled and their information shared. If multiple companies control the
internet of things, it would reduce the security of the information in every aspect and there
would be no privacy at all. This factor has been criticized and reduced the salience of the
system. When several companies are given information that should be secret to the specific
organizations, government or companies, it would be a breach of privacy and such would
reduce the reliance and security of information. With the current increase in number of
hackers, companies will be struggling to keep crucial information that they have been
entrusted with (Roman, Najera, & Lopez, 2011).
In healthcare systems, internet of things can be the most inconveniencing. When
information of patients is shared between different people, it would impossible to come up
with a way of hiding the most crucial information on the system which might not public
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changes and be trusted with the other information. Internet of things could be so unreliable in
such cases and patients could suffer mentally from exposure on their conditions. Secondly,
some information can be changed and this can be the most dangerous to lives. When the data
of patients are interchanged because of ease of access, information of one patient can be to
another, which psychologically affects the lives of these patients. This problem has always
been noted in some places and hospitals where patients are given the results of other patients
that suffer diseases that are more serious. These patients have made some of the worst
mistakes out of the given information. In the end, these patients are told the results were
wrong when it is too late. Such conditions and matter can be traumatizing and these patients
tend to undergo a lot of psychological torture (Haller, 2010).
Technology Acceptance Model
This shows how an idea of technology is generally accepted and embraced by users.
in this quest, technology has been widely used today and the chances of accepting new ideas
are high. In several occasions, it can be seen that some of the ideas are influenced by
common factors that the users undergo and in this quest, there is a general acceptance of a
common system. The usage of technology has been on the rise especially in healthcare
sectors. Some of these applications are not friendly to the employees and the patients and in
such cases, it would be challenging to convince people to accept them. A number of factors
that would influence these decisions are discussed below (Roman, Najera, & Lopez, 2011).
Perceived usefulness involves the conviction that a particular system can enhance an
employees’ job. This is one of the most challenging factors in that in several cases,
employees see the introduction of technology as a means of losing a job and a possible
replacement for them. When this becomes the perception, there would be laxity in coming up
with a system that would be accepted by all the employees in a workstation (Bagozzi, 2007).
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systems to be handled and owing to this fact; it requires the most modern ways of handling
some challenges. With a perception that the introduced internet of things will make their jobs
easier, it can be readily accepted and the technology can be adopted with ease. The extent of
usefulness is an important factor since some of the introduced technology could be a liability
and not an asset. From this view, the users can have difficulty in accepting the system without
the conviction of its usefulness. The degree of acceptance and the general view of the users
are salient in this perception (O’LEARY, 2013).
Attitude is one of the most disturbing factors in acceptance of technology. When a
system is accepted without any challenges, the vigor and the morale of putting it to test will
be high. This attitude will be defined by how much the employees will want to put it to use.
In several cases, positive attitude defines the ways and the speed by which a system can be
accepted. Without a good attitude, the speed of operation and acceptance would greatly
reduce and the technology would be embraced in a low pace. Negative attitude would ensure
that the introduced technology is dead even before it is applied (Ning, Liu, & Yang, 2013).
When such systems are forced on employees, the rate and the morale of their application
would be low and the results would be much lower than they are expected to be. In healthcare
sectors, it would be the most convenient thing to embrace the application of technology and
to offer faster services for the benefits of the patients. In such places, a positive attitude
would be appreciated both by the patients and the attendants. It the system receives a
different attitude, it would amount to nothing since the morale and eager of application will
be lost. Attitude plays a major role in coming up with proper convictions and managing
issues properly (Miorandi, Sicari, De Pellegrini, & Chlamtac, 2012).
Facilitating conditions is a factor that focuses on the availability of a technical team
that would be ready to apply the given systems. Without this team, some of the employees
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mainly useful in ensuring that all the systems are functional and in good conditions. Owing to
the busy schedules in healthcare systems, it can be hard for the regular employees to balance
their time properly without straining. This would call for better ways of handling technology
and a special team to oversee their operations (Bagozzi, 2007). Technology can be
challenging to apply especially when different systems are introduced. With the current need
for perfection, it is salient to come up with a way of handling the systems that the regular
employees are not bothered. The work type in healthcare sectors is involving. Technology
requires a lot of time to learn and striking a balance between the work and technology would
be a challenge. With this in mind, the acceptance of new things will depend on the
availability of a special team that would ensure that all the systems are in place and better
controlled by special people. With a proper plan in existence, it would be relevant to have a
special team that would manage the systems and to train a few willing people to act as
substitutes just in case there is a bit of failure in the technical team (Bagozzi, 2007).
Effort expectancy is a factor that can motivate or reduce the morale of application.
When the introduced system will reduce the current efforts of the employees, it would be
easily embraced without many problems. When the technology would require a bit of more
efforts that the former systems, there would be laxity in its acceptance. In every organization,
there is a way and culture of doing work. Healthcare systems need a bit of easily managed
technology and when the introduced one is complicated, it would be hard to embrace. The
stress that comes with learning new things is at times discouraging when there is no
motivation (Benbasat, 2007). Healthcare requires systems that improve the operations of the
existing systems that patients will receive faster services. In such a manner, having a better
way of resolving the available challenges can be better. When there is a promise of better
services, it would be necessary to introduce the latest technology for the sake of speed and
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would only be satisfied if their work will be made easier. In such cases, there is a tendency of
having improved systems in every location within the workplace that would ease
communication and general services among the employees. When this is achieved, the
employees would easily accept the available systems and this will be a better step towards
improvement (Mattern & Floerkemeier, 2010).
Image is directly linked to the application of modern systems. Every healthcare
workplace wants to be linked with the latest technology in a way of improving how they
look. This image is salient to the customers as well especially when coming up with ways of
handling the more complex situations. The confidence in which the patients will have in these
organizations will improve their status and this will be a better step for their development
(Itu, 2005). Having the latest technology in the healthcare systems can be beneficial to the
overall outlook of the company and the employees will be satisfied with the current
situations. It is from this eagerness and motivation that most of the employees will embrace
the system application. The introduction of this technology is not dependent on whether the
employees can manage to apply them or not but it is specifically for the image. In the event
that the introduction of these systems does not affect the normal operation in the workplace
there would be an overwhelming acceptance of the system and this is their focus. Image is an
important factor in building trust and reliance in a sector and this can be easily achieved by
the latest technology (Benbasat, 2007)
2.2 Opportunity Recognition
First, what exactly does the term opportunity recognition mean?
Opportunity recognition in entrepreneurship are ways in which different entrepreneurs
identify their specific methods of coming up with ideas. The difference in the ideas is brought
about by difference in ways of handling businesses and the difference in business
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that try to explain its application. With the existence of all these theories, there is a major
deviation when it comes to the business being identified. The businesses can be competitive
of new in the market and their demands define the opportunity recognition. Population and
location are other major factors affecting the same. Opportunity recognition requires proper
knowledge on the business to be ventured and the possible market of its results (Timmons,
1994).
Opportunity recognition can as well be linked to academic findings. First, it can be
from previous academic research, done by other scholars on the missing links of an
opportunity in an area. This can be linked with the existing environment. In business today,
defining the opportunities is not solely linked to the specific missing area but an area with
similar conditions can be used to come up with a new idea or having something better. In this
recognition, it can be seen that an opportunity can be from scratch or can be innovated.
Making an existing idea better to suit the current environment is a recognition that works on
innovation. This will include different ways in which the chosen business will fit into the
selected environment and how perfect the business can be adopted (Sundmaeker, Guillemin,
& Friess, 2010).
Opportunity recognition has attracted several theories on its application and
relevance. In this concept, it is worth noting that some theories are based on innovation while
some are strictly on new ideas. First, social networking is a salient factor in this recognition.
In the identification of different opportunities and chances of expansion and innovation is
social networking. The social networking brings individuals together with different ideas and
insights on several chances. From this connection, people can apply different ways to connect
the ideas they have gathered from social network and come up with a perfect way of handling
their issues. Social networking gives more insight on the chances of expansion, the current
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When all these ideas are brought together, a perfect opportunity can be drawn and this can be
a selling factor in expansion or introduction of a new item. Social networking is split into two
distinct features. First, the weaker ties between and secondly, the stronger ones. In weaker
ties, social networking brings people unknown to each other that have different ideas about
businesses and environments. The application of these ties depends on the environment and
this has to be influenced by some circumstances (Tan, 2010).
In the environments where there is low transparency and availability of information,
stronger ties can be more applicable. This includes areas where there is so much competition
between people of different groups and sharing any information would mean losing them to a
competitor. This is more applicable in an individualistic environment where people are
majorly concerned with their own success than forming a partnership. Smaller groups tend to
benefit from sharing this information and it leads to success in different cohorts with different
ideas. When information sharing is high, opportunities are realized and the information is
spread to different people with different ideas. When there is high trustworthy, a lot of
information is shard and people tend to come up with shared ideas that lead to rapid growth.
Opportunities are realized and several innovation ideas are shared with high rate of
information sharing. From this discussion, culture has a salient role to play in social
networking and the information application in opportunity recognition (Timmons, 1994).
The second theory is the behavioral theory. Here, the first encouragement towards
identifying an opportunity is from the mentors. The mentors have a very salient role to play
in coming up with better entrepreneurs. The idea that there is a direct link between the things
that the mentors do and the actions of the entrepreneurs could not be possible. Some mentors
may have the knowledge of their mentees and some may not. The process and the ways
which they act and handle their operations, how they behave and manage their time can be
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that these people used to come up with whatever they came up with could be inspiring some
other upcoming people. Mentors help the young entrepreneurs to come up with better ways of
looking at opportunities, assessing risks and coming up with better ways of understanding
situations. There could be a recognized opportunity in an environment; when a young
entrepreneur looks at the idea, it appears to be like one of the best. When this idea is
presented to a mature entrepreneur, it would be turned down. Considering such factors, it
would be salient for the mentee to have a mentor who guides them on the occasions to take
risks and which specific risks to be considered (Haller, 2010).
In identifying opportunity recognition, it is important to have information and
knowledge. In entrepreneurship, these two factors go hand in hand. It is practically
impossible to have better opportunity recognition when only one factor is to be considered.
The factors to be taken into consideration must work together. Having the information
without the knowledge amounts could not be as helpful as having both. In this sense, there is
a higher chance that a mature entrepreneur who has a good experience in the field can make
good use of good information than a younger counterpart. When this factor is considered, the
mature entrepreneur should take an initiative of mentoring the younger ones regardless of the
fields of interest. This mentorship will bring more knowledge and understanding on how to
understand different operations and situations. The salience of this understanding is
applicable in forming different ideas and coming up with best ways of handling the available
opportunities (Skiba, 2015).
Cognition theory explains the need for alertness. This explains the need to be ready to
look out for the opportunities when they arise. Alertness is a factor that depends on the other
two theories discussed above. In this quest, there is need of a proper social network that will
bring into focus the possibilities and the timing of the opportunities. Alertness is linked with
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becomes high, as people tend to be on the look for the information. This becomes hard when
there is an economy of truth and information sharing. Cognition theory is based on a pattern
through which information is received and shared among different people. It brings a clear
way of how the opportunities will be defined and their seasons of existence. In this sense, for
the purposes of business opportunities, some entrepreneurs gather information by linking up
the missing links to come up with a complete reliable conclusion. When this information is
linked, it would be easier for the entrepreneur to form some basis of argument and prediction.
Cognition theory explains the need and the salience of coming up with these links for future
knowledge (Saint-exupery, 2009). Eckhardt J.T. and S. Shane (2003) have identified a
well-elaborated definition of the term and it has been widely adopted by researchers since then.
Researchers have laid out a wide and complex foundation for recognizing and
discovering entrepreneurial opportunities, basing their work on the difference in perception of
entrepreneurs for a given technological change (Shane et al., 2000). In order, for use of the
term to be consistent throughout the study, the proposed definition by Eckhardt J.T. and S.
Shane (2003) will be used: “situations in which new goods, services, raw materials, markets
and organizing methods can be introduced through the formation of new means, ends, or means-ends relationships” and continue to illustrate the entrepreneurial recognition process
as the process in which an individual can forge the mentioned means-ends framework.
However, as there is a wide range of articles on opportunity discovery researches and there is
no established agreement over what exactly creates an entrepreneurial opportunity, there
cannot be a straightforward way to providing the most adequate answer to how entrepreneurs
recognize opportunities.
Nevertheless, based on the research literature on opportunity recognition,
entrepreneurial opportunities are to be recognized, underlining two philosophies. The first
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processes, new products, new markets, and new ways of organizing, are developed
(Schumpeter, 1934). According to Schumpeter (1934) and Shane & Venkataraman (2000),
fluctuations in technology generate new information about how resources could be used in
different ways. They hold the believe that this information affects the price for resources,
providing market players who have early access to this information to purchase resources at
lower prices and use the information to create profit, by selling the products or services that
they have created.
Second, the Austrian economists argue that the uneven diffusion of information about
the state of the market between market players plays a critical role in discovering an
opportunity. Namely, different participants in the market will discover different opportunities
when a shift in technology occurs based on their prior knowledge and that opportunities exist
even in the absence of new information (Kirzner, 1973).
However, Austrian economic theory proposes two different explanations for the
discovery process that market participants can use. The search model is the first one, which
assumes that people look for opportunities when the benefit of the information outweighs the
cost of obtaining it. The second explanation, which the theory supports, is the recognition
model, which, on the other hand, argues that people do not discover opportunities through
search, but through recognition of the value of new information that they acquire,
supplemented by other means (Shane, 2000). Consequently, people can and will discover
entrepreneurial opportunities without actively searching for them.
2.3 Conceptual Framework
The conceptual framework consists of two parts that complement each other. The first
part will describe each individual case with its specific characteristics to set ground for the
second part of the framework, which in turn will demonstrate the results of every case study
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solution. Part two of the framework will try to give a clearer perspective on the research
question, and its sub questions, by showing how the case studies are adding up for the
development of a more technologically advanced and patient oriented healthcare industry. In
the framework, there is a link between the chosen systems and the healthcare organizations.
Finding the link between the internet of things and how things will be working out can be
hard when there is no proper format. Conceptual framework explains the relationship
between the available systems and the new technology. The first part of the framework will
take into account the individual case studies, finding the relationships between the systems
and how they can be related to each other. In this part, the chosen examples will be explained
differently without any link to the other case studies. This will give a clear idea of the
independent companies and help in understanding them better. In the second part of the
framework, the relationship between the companies are widened in comparing the companies
with the others and a clear relationship from the results is drawn. This will give an indication
of the effects as found in the results and how they are linked in all the other companies. The
outcomes of the analysis are to be found in section Results and section Discussion and
Conclusion.
3. Methodology
3.1 Research Design
The research is based on a multiple case study strategy with a qualitative research
approach. As of the complexity of the explored topic, this type of strategy will be preferred
because of the inconclusive answers, a vast variety of resources and information will be
required to create a foundation of knowledge in order to answer the questions. Due to the
short time frame in which this research has to be done, this method is considered best fit.
Secondary Data will be utilized from the case studies (challenges, solutions and results) as
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relatively short in comparison to Preliminary data collection. The design will take control of
the location of the healthcare organizations and their effects on the customer service. The
possibility and ease of access to the healthcare systems would be salient. The design should
achieve both qualitative and quantitative data collection method that would give a consistent
result when put to test (Yin, 2003).
3.2 Data Collection
The thesis concerns a desk research in which data from academic journals and
information from the internet has been utilized for the results. The objective is to summarize
and analyze available information as‐it‐is. The collection and utilization of information should be replicated in such manner that the operations of the research are confirmed as
reliable (Yin, 2003). This is secured by the conducted analysis on a wide variety of sources,
as mentioned above, in order to minimize errors and biases in this study (Yin, 2003). The
case study sample was selected in order to support the notion of the research question and to
create a visible and coherent link between the literature review and the results. The proposed
six case studies were selected to underline that wearable devices and the internet of things
able to improve the quality of healthcare and/or reduce the cost of it. Since there would be
case study involved, data collection will take into account both qualitative and quantitative
methods. Comparing the results from the chosen companies will also be useful in making the
overall conclusion and for proper analysis.
4. Empirical Evidence
This section will provide an overview of the collected information. The following
information is divided into six sub-sections each corresponding to a different case study. For
the overview of each case study, a framework for the analysis has been created. All six case
studies will have the following descriptive parts: Aim of the study, how the study was
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challenges/barriers during the implementation process, and what were the following
outcomes of each study. All six case studies have been carefully handpicked in order to
comply with the latter research method.
In empirical evidence, the unit of analysis will largely depend on the nature of the conducted
study. This study is based on quantitative, qualitative and case study. In the analysis,
aggregation would be used to determine a common lower point and a high point for the case
study. Within analysis would be helpful in comparing the two companies studied at a time
and the third unit will be combined and pooled analysis which will be used in a general
approach of conclusion. The variables will be based on the effects of the internet of things in
healthcare systems and the organizations that do not use them. Efficiency, work morale,
speed of completion and the effects of the latest technologies will be measured.
4.1 Case Study 1 - Improving Health at Home: Remote Patient Monitoring and Chronic Disease for Care Transition Intervention Program at CHRISTUS St. Michael Health System
• Aim and details: CHRISTUS St. Michael Health System includes more than 40 health institutions and facilities in seven states in the USA and six states in Mexico,
with assets above 4.6 billion US dollars. The hospital system in Texarkana, Texas
needed to enhance its current Care Transition Intervention program and to reduce
hospital readmissions of high-risk patients suffering from specific chronic diseases
such as congestive heart failure and coronary artery pulmonary disease by integrating
a Remote Monitoring Solution. Furthermore, the hospital needed this solution as the
latter illnesses were resulting in large number of complications and large increased
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wanted to "help patients both learn and apply self-care skills to help them assert a
more active role during care transitions".
• How: The program relies on a trained certified Care Transition Nurse(CTN) who ID's, enrolls and begins care cycles for underinsured patients prior to discharge in order to
successfully start the process of transition from hospital to home. Apart from this a
medication review and preparation of the patient to self-management is also provided.
Post discharge, the nurse makes a preliminary visit to the home of the patient to
review medication orders, to educate him/her about their condition and the possible
warning signs that might occur, review the Personal Health Record, and communicate
with family caregivers.
• Internet of Things tools: A RPMS cloud based (SaaS) Remote Care Management Platform provided by Vivify Health using the following devices: Android Tablet,
Bluetooth enabled personal health devices: weight scale, blood pressure monitor and
pulse oximeter. Customizable protocols and care plans with user-friendly interface for
all users were preloaded to the tablet. Furthermore, educational videos were available
to the patient and video conferences with caregivers were enabled as well. Surveys for
patients to fill in to provide better data were also provided to follow consumer
satisfaction. The wireless connectivity and cloud usage was provided by AT&T to
send data from the personal health devices to be shared with the hospital in a very
secure way.
• Challenges/Barriers:
-Patients were reluctant to invite the initial CTN to their homes.
-Some patients were living in rural areas thereby reducing the time for actual patient
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-the CTN has limited contact time with enrolled patients because of the time spent
driving to and from the initial home visit, as a result limiting patients engagement and
satisfaction.
-Inconsistent wireless connectivity
-Equipment problems resulting in defective tablets or oximeters.
-Bug infestation of the provided Kit's boxes • Outcome:
-90% Reduction in overall cost of care
-65% Reduction in hospital readmissions
-95% Patient adoption
-95% overall patient satisfaction
-Prior to enrollment in the RPMS program 44 patients had an average cost of care of
$12,937 compared to $1,231 post-RPMS program enrollment
-Improved quality of healthcare
-Improved access to healthcare
4.2 Case Study 2 - Remote Patient Monitoring and Chronic Disease Management implemented at Hackensack Alliance Accountable Care Organization (ACO)
• Aim and details: Hackensack Alliance ACO in New Jersey, USA is a well-established medical organization participating in the Medicare Shared Savings
Program serving a vast population of 40,000 patients, many of which are elderly,
disabled and living with chronic disease. Its mission is to make available high quality
service and care to patients, whilst decreasing costs through preventive care, superior
care management and patient empowerment by medical research. The study purpose
was to integrate an efficient and effective method for monitoring and caring for
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directed patient education on patient self-management of their chronic diseases.
Moreover, to assess the extent 30-day hospital readmissions decrease because of
patient disease self-management.
• How: via the implementation of patient engagement platform provided by Health Recovery Solutions (HRS). It allowed Hackensack University Medical Center and its
ACO to monitor remotely patient adherence to medications, weight monitoring,
glucose monitoring and compliance with diet. In addition, the platform helped
patients to detect symptoms on time so they were not drawn into unnecessary
emergency room visits and/or hospitalization. In addition, Nurse Navigators were the
acting "trainers" to educate patients on the technology and provide the necessary
devices prior to discharge from the hospital.
• Internet of Things tools: PatientConnect™ 4G Android tablet preloaded with personalized patient information, medications, educational videos and survey
questions. In addition to the tablet, Bluetooth enabled wearable devices were provided
such as: blood pressure cuff, scale, pulse oximeter and glucometer. • Challenges/Barriers:
-Perceived adoption by elderly people of the technology was unclear
-High volume and high cost diagnostics for chronic heart failure resulting in many
readmissions • Outcome:
-Decreased 30-day hospital readmission rate associated costs
-Improved patient compliance and patient activation
-Improved patient satisfaction
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4.3 Case Study 3 -Asthmapolis: Improving Asthma Management with Wireless Technology
• Aim and details: Asthmapolis developed inhaler sensors, mobile apps and analytic tools to capture critical information to identify patients suffering from asthma or
chronic pulmonary disease who are in need of initial intervention before a more costly
method of care takes place. The provider of the wireless solutions for chronic disease
management and medical information sharing is Qualcomm Life, delivering access
and usability barriers initially confronted by Asthmapolis with its solution: 2net™
Hub.
• How: Inhalers with sensors that are connected wirelessly to their smartphones to track adherence and to send timely reminders to patients via SMS or e-mail - when
medications are missed. In addition, the sensor provides a real-time indication of how
are patients doing with their self-care and the level of control of their condition, based
on the rate and timing of use.
• Internet of Things tools: FDA Class 1 MDDS plug-in-wall-socket medical device to manage and transport data from a broad range of medical devices - in this case,
inhalers with sensors. • Challenges/Barriers:
-Reach a wider range of patient demographics
-Incompatible smartphones or technology-challenged patients
• Outcome: before the implementation of the Qualcomm 2net™ Hub solution:
-Effective reduction of the percentage of people with guideline-defined poorly
controlled asthma by 75 percent
-Better self-management of patient condition
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-Improved quality of life
-Increased patient satisfaction
4.4 Case Study 4 - Mobile PHR Improves Patient Engagement, Satisfaction and Care implemented at the Children's Medical Center in Dallas, Texas
• Aim and details: The study was aimed to endorse consumer-mediated exchange by actively encouraging patients who had Stickle Cell disease and who were living
several hours away from the hospital to track and record their health metrics whilst
improving satisfaction and care by leveraging technology. Furthermore, the study is
not only focusing on the fore mentioned disease patients, but to a more board
spectrum of objectives: to create a new way of patients and families to be involved in
their care; to enable access to medical records to all care givers despite of location or
type of medical record; to make available notifications to patients when there is an
update to their record; to provide their information in a secure manner ensuring their
privacy and security; to improve patients dedication to taking their medicine in a
timely manner; and to remove the barrier for people living in remote areas to have
access to clinical information.
• How: by using Microsoft's HealthVault Personal Health Record Ignite program with medication reminders with a Drop Off and Pick Up Application (DOPU) hosted by
the hospital. The application is enabling information to be applied to a patient's PHR
from multiple care givers involved in the patients care. Thereby eliminating the need
of hefty use or transport of paper files.
• Internet of Things tools: HealthVault Application, DOPU application on Iphones to patients provided by the mobile carrier Verizon.
• Challenges/Barriers:
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-Devote time to educate patients how to use the technology • Outcome:
-Significant increase in patient satisfaction
-Increased patient involvement in managing their own healthcare
-Neutralized effect of patients living in remote areas
-Enhanced the field of care
-Reduced emergency visits
4.5 Case Study 5 - Mobile Telemedicine Provides Cost Effective Patient Care in Low-Income Neighborhoods implemented at Children's Medical Center in Dallas, Texas
• Aim and details: The case study was developed to enable care to families with children that have low income in the Dallas area of Texas, USA and to decrease
unnecessary emergency room visits. One of the main reasons for this was that in
Texas there is a lack in healthcare institutions to provide help to Medicaid patients.
Another reasons was because of the low income, parents were unable to drive their
children to the emergency department during the day, as they were working, and
during the night there were no such departments in the area.
• How: Children's created a MyChildren's Telemedicine School Program instead of building their own facilities around the area. The Population Health division of the
hospital identified trusted partners such as schools, preschools, daycares and churches
where the program would be best suitable. The pilot program was set out at two
locations of the Mi Escuelita Preschool that was considered as a place where patients
were using non-emergent care in less effective and more expensive ways. A clinical
team that was traveling on a daily basis to the school sites to give remote clinical
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that included an information services team, leadership of MyChildren's Hospital and a
project manager.
• Internet of Things tools: LadyBug device- wired network connectivity and 4G card to connect mobile and wirelessly to the hospitals network. Supporting common exam
procedures, which had external devices such as: stethoscope, ENT scope and general
exam camera all of which able to send out data to the telemedicine team remotely.
The unit had a large image of a lady bug, so children would feel at ease when they
were examined. • Challenges/Barriers:
-Lack of wired internet access that was needed to make primary care available
-Telemedicine consulting would never be as high at preschools as of the rule that
children do not have to be taken to school if sick. • Outcome:
-An access point for children who otherwise would not have access to primary care
was created.
-Significant decrease in emergency room visits in the Dallas area where the pilot took
place.
-Telemedicine prevented unnecessary emergency room visits
-Improved quality of life
-Reduction in the cost of care
4.6 Case Study 6 - Enhancing Lehigh Valley Health Network (LVHN) ICU Patient Care Through 24/7 Remote Access and Monitoring
• Aim and details: LVHN is one of the most prominent, large and old teaching establishments in Pennsylvania, USA. Complications and mortality rates were having
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intensive care unit (ICU) patients, LVHN needed a way to reduce the flow of
information from ICU patient bedside equipment. And to make the transmission of
data automatized to a central clinical information system(CIS) for continuous patient
monitoring, as there are numerous patients with several devices connected to them. • How: Through the help of Lantronix, a leading global networking company that
specializes in networking expertise in the field of Internet of Things technologies,
LVHN was recommended a EDS multiport device or a terminal server to unite ICU
equipment into a single platform and make the secure communication of data to the
CIS possible.
• Internet of Things tools: Lantronix EDS, a hybrid Ethernet terminal or multi-port device server that allows remote access and organization of any wearable device
and/or medical equipment. Such equipment was computer, high-resolution video and
two-way audio.
• Challenges/Barriers:
-Help LVHN to enhance ICU patient care through continuous remote patient
monitoring and access to medical data because of overwhelming volume of patient
data.
-LVHN needed a strong serial-to-Ethernet converter to communicate the patient
medical data to TCP/IP communications. • Results:
-Make proactive and possibly life-saving decisions quicker
-Significant decrease in documentation times and improved documentation quality
