Greek Health Service and Networking Technologies

Summary

The constant escalation of modernization and technological use in various aspects of Business-to-Business (B2B) and Business-to-Consumer (B2C) applications had projected them as an incredibly valuable instrument for the enhancement of numerous existing procedures. The diagnostic health industry, as an element of the Health Sector, represents a B2B market that possesses all the requisite features for the successful implementation of electronic technology.

In recent times, various public health groups as well as the governments are putting in strong efforts for adoption of networking technologies not only in the supply chain but also in different other processes of the health infrastructure. Diagnostic organizations which work together with other health institutes are ready and prepared for the implementation of such technologies.

The rationale underlying this paper is to explore the embracing of novel frameworks and particularly networking technologies in the Greek health service sector. The document attempts to draw conclusions on the implications of the application of internet as an improvement to the productivity of the health service sector and to find out what are the requirements of the consumers that are affected owing to this adoption.

An analysis of the status quo in the Heath sector and the measures that have by now been implemented such as e-Health along with a literature review in relation to the modernization and the internet constitutes the theoretical aspect of this paper.

The outcome of the study indicates that the adoption of networking technologies and predominantly the use of internet alongside the contemporary processes is favourable. The settings for adoption of networking technologies in the Greek Health Service sector are in a very advanced phase and the consequences of this adoption and bears immense significance for productivity of the entire industry.

Introduction

The adoption and use of internet has allowed the Greek Health sector to innovate unique and novel strategies in developing their business plan. The change in the socio-demographic patterns and shortage in healthcare manpower has increased the need to adopt information technology. Internet provides an opportunity to “fundamentally reinvent medicine and health care delivery” (Coile, 2000, p.8). Internet has transformed both the medicinal practice as well as the business side of the healthcare industry. Studies show that healthcare is a high transaction cost based industry and the use of internet is expected to reduce the cost of transactions considerably (Coile, 2000).

The healthcare industry is said to be lagging behind in the adoption of information technology based communication (Landro, 2001) and thus need to adopt this technology to benefit its functions. This essay is a proposal for the final paper which will deal with the strategies for adoption of internet in the Greek healthcare service industry, specialised in the diagnostic sector.

Aim and Objective

There are various needs for the adoption of internet to facilitate business operations which are also applicable to introduction of internet in healthcare. Ritter and Walker showed that there are various strategic decisions that need to be taken in order to implement an internet based business (Ritter & Walker, 1999). So it is imperative to understand as to what situations which need to be considered while adopting a business strategy around the use of information technology or internet. According to Ritter (1999), there are five factors which influence the adoption of internet on which previous research has been conducted.

First is the factor related to corporate strategy like long term planning, market segmentation, distribution channels, etc. second is the related to characteristics of the executive and their qualification. The third factor is the nature of the company and its inclination to innovate or risk taking attitude, etc. fourth factor is related to the character of external environment which affects the company’s operations like technology or competition. The fifth factor is related to the usage of internet as an innovative resource wherein it allows strategic business innovation.

In case of healthcare, the industry has an extensive use of data transaction and transfer (Coile, 2000) which will definitely be facilitated by use of internet. This enhances the usage on internet in the industry for even for the basic requirements. One such example will be patients trying to find out the latest availability if scientific treatment of a particular ailment, which can easily be downloaded from the internet instead of the customer contacting the healthcare facility for the information. In the proposed paper, I will demonstrate the factors which affect the decisions of adoption of internet in healthcare service in Greece.

So we come to the following objectives for the adoption of internet. the first aim of the proposed paper will be to try to understand the characteristics of the internet as an innovation and the how the internet’s relative advantage, compatibility, triability, and complexity affect the decision to or not to adopt the internet in the Greek healthcare services. Then ,as a second objective, the proposed paper will try to ascertain the relation between the adoption of internet and usage on the performance of the healthcare service. And the third objective will be to determine the areas of adoption of the internet trade ,where the electronic trade will facilitate business, i.e. to determine the areas where internet will facilitate the healthcare business and its operations.

Given these aims of the proposed paper, I will now provide a brief literature review of the research area which will be enhanced in the final paper.

Greek Health Care Sector

The Greek public health care segment is principally constituted by approximately130 hospitals which are public sector non-profit organizations with a hospital bed facility ranging from 50 beds to 1100 beds. As per research figures, the total quantity of hospital beds approximately adds up to 39000 among which 40 percent are located in Athens and its surrounding regions, 11 percent in Thessalonica and the remaining 49 percent in the rural districts.

Greece possesses a burgeoning hospital industry and it is supposed that there are momentous potentials resting in the medical segment, as the economic positioning of the nation is progressively being enhanced. As various research figures indicate, the overall returns of the organizations in this market segment adds up to 220 million Euros and records an average annual growth rate of roughly 5% for the last five years, mainly as a consequence of the initiations of new methods and policies, and novel fully automated procedure frameworks. This rate is very likely to shoot up considerably during the upcoming years on account of the emergent promising healthcare system and the enhancement in the field of applied medicine in Greece.

The Health Care sector constitutes one from the main sectors of economic activity.

The supply of health services is overseen by the Ministry of Health and Social solidarity and is conditioned by a determined and complicated legal frame with various provisions.

The Health Care distribution of the nation incorporates 17 Health regions, called DYPE and was formerly known as PeSYP, which oversees coordinative tactical and managing operations of the hospitals under each jurisdiction. The healthcare services in Greece are supplied by the following groups of institutions as can be categorized in the order of magnitude based on the deciding principle of the extent to which they represent a diagnostic products market:

• The state-owned hospitals and healthcare facilities.
• The ORGANISATION OF SOCIAL SECURITY and the variety of actuary funds which deal out health services, for example Funds of banks, National Electrical Company, legal representatives, reporters etc.
• The Private health organizations, health centres and diagnostic facilities.
• The private nursing homes with operating facility along with the privately owned microbiological and biochemical research and test centres.

The segment of ex vivo diagnostic product markets comprises of those entire systems that advance after research and development, fabricate, freight in goods that are used for laboratorial purposes. The primary sales of ex vivo diagnostic produces are pulled together most of the times in the first few grouping. Time and again, it is observed that even privately owned medical centres and hospitals do not possess internal laboratorial frameworks and they operate under the structure having one outsourcing service.

Legal Framework

The legislative framework that applies to the general State supplies is also applicable to the health supply markets. The officially permitted settings with reference to the dealings of diagnostic products are aligned with the legal scaffold of the European Union (EU). Manufactured goods, which are fabricated in nations under the EU, must comply with the disclaimers recognized by the joint Ministerial Decrees. The conformity to these prerequisites is required to be confirmed by a public administrative authority. The power issuing and the management of the specifications rest with the National Drug Organization popularly known as the NDO.

In accordance with the European Legislation for IN VITRO Diagnostic Devices IVDD 98/79/EC on each produce a mandatory CE mark should be placed which certifies that the item adheres to all legislative necessities which are consistent with the European Directive as transplanted into the national legal acts.

The CE mark is also a verification of quality standards on account of the very comprehensive “essential requirements” embarked in the legislative scaffold to take care of appropriateness for application, safety issues and performance factors related to the item. In addition, an item which is to be acquired by a hospital must be accounted for in all different hospital tender records. The main attribute of a tender grant is that it documents the conformity of the product with the tender stipulations and the lower all-inclusive item price.

For the reason that these products are often manifestations of technological research and development, the manufacturing companies also are required to offer specialized services like scientific data, guidelines relating to the handling of the item and clinical explanation of upshots, and troubleshooting of technical and chemical difficulties.

E-commerce viewpoints in Greek Diagnostic Health Sector

The electronic produces in the Greek Health industry are presently undergoing the stage of development and the escalation and the practices vary as compared to other nations of the EU. The phases of electronic product enhancement take account of:

• The prospect of accessing available tenders by means of the Internet.
• The sellers can acquire tender information by downloading the pertinent documents of the tender from Internet web pages or obtain them via transmission by means of the e-mail.
• The corporations can spread their proposals by electronic means.

As per records, the following types of electronic products are put into use by public establishments in Europe:

• Issuing of online tender by means of the Internet.
• Electronic issuing of documents which relates to publication of the entire set of tender related documents.
• Electronic submission: Several public authorities have embarked on the enhancement of automation of all procedures which also includes the online submission of offers.
• Electronic auctions: Some public authorities apply “experimental” legislation that lays down a set of rules for the control and smooth execution of electronic auctions.
• Electronic marketplaces: Jointly with electronic lists e-Marketplaces facilitates the state-owned as well as private institutions to place and receive orders for items of consumption.
• Electronic lists (e-catalogues): Various organizations can go through, analyze and then place orders for required products amongst those which are incorporated in the lists, and thus avoid the time-consuming procedures in the supply chain activities.
• Pre-selection systems: These systems help reduce the overbearing processes for the reason that the deeds of each company are verified once, and subsequent to the initial submission the document is made accessible on-line to be used public organizations.

The foremost essential requirements and purposes of Electronic provisions in Healthcare Industry are:

• Support of efficient system of management of goods and products: Conception of a system that facilitate the interoperability amongst the various Health Units. The rationale underlying the implementation of such systems is also to facilitate the methodical and planned expenditure of resources.
• Provisions and Management of conventions: The goals of electronic provision system are the mechanization, the follow-up and the administration of products in using a better method for the hospitals and other supply chain entities to interact in an efficient manner.

Work procedure to analyze adoption of networking technologies in Health Service sector

The Health Service Sector deals with products and supplies which involve a great extent of scientific and technological applications. The purchasing systems that are traditionally followed in Greece involve a lot of bureaucratic process and extensive formalities, and results in wastage of time and increased costs. Such shortcomings could be circumvented if entire product tenders or even parts of were executed on-line by drawing on technical advantages that technologies such the Internet and other informational technology tools has to offer.

Evidently, this signifies that Public Health Care organizations and Diagnostic enterprises posses or will posses the requisite means to facilitate on-line collaboration. Apart from such collaboration amongst the Diagnostic concerns and the governmental procurement offices, the collaboration linking Diagnostic firms and laboratories that apply or will put use those products into use emerges as a major issue. Adoption of the internet in consort with other Informational technology and networking tools has a potential to make things easier in many aspects of this alliance.

For instance, efforts such as on-line educational initiatives, remote post sales maintenance and support, and on-line information about new and inventive products are immensely helpful processes in this regard. To facilitate this sort of collaboration both parties must have or initiate adoption of suitable technology and promote requisite education.

This paper makes an effort to study and analyze the extant and the prospective potential of all the aspects of Health Service Sector in Greece. It explores Greek Health policies which aim at achieving a novel and innovative collaboration by implementation of networking technologies and its various components. A methodical approach is adopted to put forth the contents of this paper which are presented in this dissertation subsequent to the careful determination of the Aims and Objectives of the research.

A theoretical exploration is undertaken in relation to the implementation procedure of novel technologies, trends observed in the health service market and the adoption of networking technologies such as the Internet along with other information technology tools in health service sector. Furthermore, the intensification in the electronic trade procedures and particularly its application from the health sector perspective is also carefully studied.

Aims and Objectives

The most significant research topics with reference to the issues that have an effect on the adoption process as generally identified by researchers are:

• Factors associated with the corporate policies, for example the long-term plans, the customers’ classification, the competitive market position, the growth policies, the distribution networks and the prospect of exporting processes.
• Factors which correlate to type of the administration, for instance the credentials, level of edification and approach of the executives.
• Factors associated with the features of the organization, for example the propensity to innovate, the risk management policies, the exposure to business information, training issues, market orientation, the market potential, and the functional significance.
• Factors concerning the behaviour of the peripheral business environment, for example technology turbulence and the extent of impact of the competitive issues.
• Factors in relation to attributes of the Internet as a modernization technique, for example its comparative benefits, complications, trial ability, and finally compatibility.

The in vitro laboratorial and diagnostic segment is an integral component of the health industry and it forms a B2B trade market, which pulls together the attributes for the implementation of electronic business (understanding and implementation of informational technology tools from the procurers, large informative substance of supplies, detailed determined specifications etc.).

The primary objectives of this research paper are to carry out a detailed study of the following:

• The research makes an effort to explore how the beneficial attributes of the facilitate modernization techniques. The impacts of comparative benefits, the compatibility, the intricacies and the trial capabilities on the decision to implement and exploit Internet technologies in the Greek Health Service Sector are studied. Specifically, the Internet, its scope and other associated components are examined as a modernization technique.
• The association amongst the extent implementation and exploitation of Internet technologies and the productivity of the Health Service Sector in Greece.
• The requirements of procurers in diagnostic segment which is a significant potential area of application of the electronic trade process, particularly, in terms of the information prior to a supply process, technical support from remote locations, post-sales maintenance services, and transaction of purchase orders).

The development and intensification of electronic trade within organizations of the health sector is progressing at a comparatively slower pace. Thus the paper endeavours to examine the requirement for dissemination of modernization and adoption of electronic technologies in health service enterprises taking into account the wants of the consumers. This progression will allow the organizations and by and large the entire market much more suppleness, superior accuracy and lesser costs. For the effectual implementation of this transformation, an appropriate restructuring of technical and human resources within the organization is essential in order to develop knowledge, awareness and a proper understanding.

Here I will discuss previous researches which have been conducted in the area and their view regarding the issue of adoption of internet to facilitate business operations.

Then we will demonstrate the healthcare sector’s experience with the internet.

Natesan (2005) ,found that internet affects six areas of the healthcare service which are “web enabling of medical records, web enabling of clinical computing systems, web enabling of medical information for health care providers, web enabling of medical information for the public, evaluation and accreditation of public health care websites and privacy issues on the web” (Natesan, 2005, p.247). He pointed out six areas which need to be looked for the adoption of internet.

First is to enable medical records of a patient which assumes critical information for the development of this will help in driving down medical errors wherein centrally stored medical records can be accessed by all practitioners. The second area which will be helpful with internet is clinical information delivery like medical literature searching or medication delivery. The third usage will be enable medical information to be published of general public to access.

But Natesan also believes that internet may cause problems for information validity and delicacy. But in the end, he concludes that even though the information theft is a major issue that is faced by healthcare services, the advantages of using internet are far greater than their disadvantages.

Coye, Jacks, Everett, and Akay (2001) studied the physician leaders and office-based practicing physicians regarding their use and facilities they were deriving from using internet in their administrative and clinical systems. Their aim was to study understand the medical practitioner’s use of internet and the barriers or promoters of technology adoption in healthcare services. According to their survey, more than 85 percent of the respondents were using internet enabled services and 35 of the respondents reported to use more than 5 internet enabled services.

These services included both business and clinical applications. The reasons for adoption of the internet enabled services was clear from their survey were “reduced administrative costs, faster payments, and improved quality of care are the most important benefits derived from Internet-enabled applications” (Coye et al, 2001, p.67). 96 percent of the respondents expected internet to have positive impact of the business and clinical practice of the healthcare services.

The research identified a few barriers to the adoption of internet which are “lack of industry wide standards for health information and the inability of current computer systems to exchange information across health care delivery networks” (Coye et al, 2001, p.67). The research was based on quantitative survey method. The sample was randomly selected from American Medical Association Group Practice File and the Physicians List.

They surveyed a total of 215 practitioners and an online survey was conducted. They were asked questions regarding their internet usage, benefits of internet adoption, and barriers to the process of adoption, and organizational strategies which will enable adoption of the internet. The outcome of the survey show that the practitioners widely think that internet is a good option for it will ease away the “Existing paper-based systems frustrate both patients and physicians because they require complex administrative tasks and commonly result in incomplete or lost medical records.” (Coye et al, 2001, p.74).

They believe that their study shows that usage on internet in the healthcare services should be a concern for the planner sand believes those who are not yet using it are not exploiting the opportunities the technology holds.

Diamond and Shirky argue that information technology (IT) adoption in healthcare services will not be facilitated by the assuming that IT will act as a “magical thinking” and will solve all the problems of healthcare services. (Diamond & Shirky, 2008). They believe this is one of the biggest barriers in adoption of IT in healthcare services. According to the authors all the stress on formulating policies for IT adoption, healthcare services have neglected the requirement to remove other barriers. So they suggest, “…it would require clear policy statements that will guide the design of technology” (Diamond & Shirky, 2008, p.389).

Frank (2000) believes that internet has the potential to result in substantial positive impact on medical care which will enable fastest possible medical care. He divides the internet based health care companies into three business categories: “content, connectivity and commerce” (Frank, 2000, p.8). The companies who provide these services try to capture various sections in the healthcare industry. Frank provides a list of benefits from the point of view of the medical consumers (i.e. the patients) which are

1. Disseminate information,
2. Aid informed decision making,
3. Promote health,
4. Provide a means for information exchange and support—the community concept, and
5. Increase self-care and manage demand for health services, lowering direct medical costs” (Frank, 2000, pp.15-16).

Frank is convinced that adoption of internet in health care functions will definitely help the industry both through increased business and through easier and correct diagnosis. This will also reduce the gap between the medical practitioner and the patient (Frank, 2000).

Bernstein, McCreless and Côté (2007) discusses five constraints which they feel affect the proper implementation of IT in healthcare service. They are

1. budget,
2. supportive leadership,
3. project management,
4. implementation, and
5. end user involvement.” (Bernstein et al, 2007, p.17).

The authors believe that these are the main constants for all healthcare company to check before implementing an internet based business strategy.

Kleinke (2000) argue that the internet will not drive the structural cost down, but rather raise them up. He does a case study analysis of the Vaporware.com to provide a study of the failed case of internet and IT utilization in the healthcare sector in the United States. He believes the adoption problems of IT are mostly economic, cultural, legal, regulatory, and organizational (Kleinke, 2000). The author argues that in medical diagnosis, there are various aspects which need to be considered and there cannot be a thumb rule for a particular case. So he states:

“As every practicing physician knows (or should know), when the survival of a human being is the “work product,” an information system that is not 100 percent reliable is 0 percent useful. This hard, unalterable fact has made building usable closed clinical IT systems extremely difficult. This same fact will make building a usable clinical IT system out of the slew of emerging “open” technologies—collectively described as “Internet-based computing”—next to impossible.” (Kleinke, 2000, p.64)

But the author does not neglect the benefits that internet provides to the customers as well as to healthcare business: “The Internet provides the first feasible way of transforming large data sets into provider and health plan performance information for consumer use.” (Kleinke, 2000, p.66).But the author argues against the popular notion that internet based business will drive down healthcare cost for he believes that customers are highly sensitive in regards to their health and they tend to choose the product which is prices higher than the others due to a perception of better quality than those which are low priced (Kleinke, 2000).

Eysenbach (2000) has shown that internet has become a platform of interaction between the doctor and the patient. He uses a non-exhaustive review focus on the topic to understand the impact of IT on healthcare. He searched Medline for the terms “consumer” and “informatics” and other sources like the American Medical Informatics Association’s symposiums for 1998 and 1999 and the proceedings of the ninth World Congress on Medical Informatics of 1998 and AltaVista search engine (Eysenbach, 2000). He found that there are certain areas of research which has been done on the area which showed the following success of IT in transforming the traditional healthcare service:

1. “Health care in the information age” (p. 1713),
2. “Bringing medical knowledge to consumers” (p. 1714),
3. “Electronic health records accessible to patients” (p. 1715),
4. “Decision aids to support consumers’ choices” (p. 1716), and
5. “Quality control of health information on the internet” (p. 1718).

Thus, he believes that information system has the potential to bridge the knowledge gap between the patients and the doctors. This view has been shared by other researchers who feel that healthcare will transform the business aspects of healthcare services (Goldsmith, 2000). Apart from bridging the gap of knowledge transfer from doctor to patient, internet is thought to be helpful in licensing, long distance monitoring, and e-pharmacy (Goldsmith, 2000). But unlike Kleinke (2000), Goldsmith believes that technology’s impact on healthcare cost will be neutral (2000).

From the literature review, it is apparent that there are various issues that have been discussed regarding the adoption barriers of internet and the benefits of the technology. There are studies which have tried to ascertain the performance benefits that the internet has helped healthcare service to gain. There are gaps in beliefs and findings of different researchers regarding the cost reduction effect of internet on healthcare. Further, there are various strategies that the healthcare services have adopted in utilizing the internet and technology to benefit their operations. But there is not substantial research which will provide the comprehensive understanding of the whole situation.

Research Questions

Given the literature review and the gap in the present literature on healthcare services’ adoption of internet, I propose to work on the following questions : The literature suggests that internet adoption has certain barriers but the range of barriers differ from research to research (Bernstein et al, 2007). There are various constraints which cause hindrance in the adoption of internet as an innovation in healthcare services due to various reasons. In the proposed paper, I will try to ascertain the barriers which are the sector faces for adoption of internet. Some demographic questions combined with questions about the today s use of internet in the hospitals will expose some of the barriers for the adoption of internet in the healthcare service.

Then it is important to understand the strategies wherein internet can be used innovatively. Internet is said to help in making consumers make the right choice (Eysenbach, 2000). Natesan (2005) identified six areas wherein application of internet has helped in the operations. But there may be more innovative areas where use of internet will improve the situation considerably. Internet also helps in business operations like licensing, etc. easier. Thus, it must be seen as to what are the novel areas where internet is being applied and used. This question will deal with the ways and means of applying internet as a technological aid to the development of the business and clinical operations in healthcare service. So the second question is related to the application of internet in healthcare services.

There is a gap in the understanding regarding the performance benefit of internet and the cost effect it has. Some researchers believe that internet will effectively increase the cost of healthcare (Kleinke, 2000) some believe that they reduce the cost (Frank, 2000) while others believe that its effect is neutral (Goldsmith, 2000). This implies that the effect of internet on the performance of the healthcare service and the cost reduction effect are widely debated upon in the literature. So I will try to find out the performance and cost effect of the usage on internet in the Greek healthcare service.

So the proposed research questions are:

1. Demographics-Use of Internet in the Hospital.(Barriers or hindrances in adopting internet as an innovation?)
2. Where can internet be used to the healthcare services operations in order to get optimum performance?
3. What is the performance benefit of the usage of internet? Are there any cost benefits that can be received from adoption of internet?

Ethical Considerations

As the study of the internet adoption in healthcare is closely related to the sector’s business and clinical strategy, it is imperative that the information must be kept guarded closely which is not desired to be made public. As there are various areas that go unnoticed, the ethics committee will be responsible to review the method and the information. Further, no information will be provided in the proposed paper which has not been gained from an authentic source.

Research Methodology

A research methodology is an important part for establishing how a research can be conducted. A research methodology is a plan as to how a study should be conducted. There are various research methodologies which are in use. First is quantitative, qualitative or combined research method can be used. In this section I will discuss and disadvantages of using the before mentioned research methodologies and finally will justify the research methodology I choose for the proposed paper.

Quantitative Research Methodology

A quantitative research method may be defined as the process of collecting numeric data and using that data to show what those, observations reflect (Babbie, 1992). The one of the important factors of quantitative research methodology is data collection which is done through various processes such as interviews, questionnaire surveys, tests/measures, and observations (Easterby-Smith et al, 1991). Questionnaires have been used as a survey method for data collection in the research of internet adoption in healthcare was done by Coye, Jacks, Everett, and Akay (2001).

Types of Quantitative Research

Quantitative research is of different types. First is descriptive research. A descriptive research approach provides an exact portrayal of the account of the characteristics of an individual or a group’s (Burns & Grove, 2005). This is usually used to

1. discover something through the research,
2. providing description,
3. determining the number of times something occurs, and
4. categorizing information (Burns & Grove, 2005).

A descriptive study is conducted when there exist little information regarding the observable fact. This research method often uses questionnaires, psychological measurements to describe a situation.

Correlation research is based on the methodical examination of relationship between two or more variables which has been identified through secondary research. The relationship can be positive or negative and the degree of strength of the relationship can be determined through this process. But they fail to determine cause and effect. They are used when the nature of the relationship has to be determined.

Quasi-experimental research is conducted when it is important to identify a relationship, examine the significance, clarify why, and/or combine these of a causal relationship (Burns & Grove, 2005). They are usually used to see the effect of medical intervention in the patient’s outcome (Burns & Grove, 2005).

Experimental research is an “objective, systematic, controlled investigation” in order to predict and control an occurrence (Burns & Grove, 2005, p.27). This is a method used for the study of the causality. These researches have highly controlled settings as in laboratory.

Advantages and Disadvantage

Now I will discuss a few advantages and disadvantage of quantitative research. Quantitative method is widely used for its objectiveness. Quantitative methods are systematic and are based on positive perspective. Further, quantitative research is replicable as it is possible to collect the same data in another situation or place and get some other outcome which can be compared. But quantitative research methodology has been criticised for its positivism (Tashakkori & Teddlie, 1998). Further arose a question of internal and external validity which was thought to be not present in the quantitative method by some psychologists.

Further quantitative method has been criticised for being limited to hypothesis testing. Further it is also called a simplistic process wherein data related to the research question are gathered which are then analysed with little concern for the historical background of the situation (Grbich, 1999). Further as quantitative analysis are related to “cause, effect and objectivity” they fail to be an appropriate method of research for events which are dynamic (Grbich, 1999). This shows that the quantitative method is not a full proof method for acceptance.

Qualitative Research

Qualitative research is described as alpha numeric examination of the observations with the aim to discover the hidden meaning beneath it and a pattern of relationship, if any (Burns & Grove, 2005).

Types of Qualitative research

First is the phenomenological research which is the process of studying the event to describe the experience as lived by the participants of the study and in interpreted by the researcher. As the study is based on humanistic experiences, there is no singular experience common to all, on the contrary there are various experiences, each distinct for different human beings (Burns & Grove, 2005, p.27). It is a complex research process as it is lived by the researcher and participant.

Grounded theory is a process of inductive research which is used to discover the problems exists in a social scene and how persons handle them. The methodology emphasizes the use of “observations and intuitive relationships among variables” (Burns & Grove, 2005, p.27).

Ethnographic research method has been developed from the field of anthropology and is used to understand cultures. It is mostly used to determine the character of the cultures or subgroups and analyze their behaviour.

Historical research is a process of narrating the different aspects of an incidents and describing the process and the event which has occurred in the past. Data is collected from the “records, artefacts, or verbal aspects” (Burns & Grove, 2005, p.27). This is used to study the past, the mistakes, or the rights of the past events and the reasons or the success or failure of the event can be recorded.

Advantages and Disadvantage

Qualitative study is said to be more dynamic and suitable for studies which are occurring and are still in the process of change. They are useful in order to understand the reason for the development of the theory from the present understanding or studying prior historical data. But the advantages of the method are that they fail to be objective and are difficult to be replicated. So generalization is difficult in a qualitative research method.

Qualitative researches are also known as constructivist approach refuse positivism (Johnson & Onwuegbuzie, 2004). Further these researches are value bounded and it is very difficult to differentiate between cause and effect. Johnson & Onwuegbuzie (2004) further identifies that qualitative research encompases a “a dislike of a detached and passive style of writing, preferring, instead, detailed, rich, and thick (empathic) description, written directly and somewhat informally” (p. 14). Thus there exists extensive literature on the differnce between quaniltative and quantitative research methods.

Combined Method

There exists extensive debate regarding the validity and supremacy of one of the research methods (Tashakkori & Teddlie, 1998) but it has again been criticised by scholars who believe that the two metthodologies are compatible (Johnson & Onwuegbuzie, 2004; Casebeer & Verhoef, 1997). So these group of scholars believe that even thoguh the two paradigms are different, there lies certain elements of similarities which can provide fruitful research: “The goal of mixed methods research is not to replace either of these approaches but rather to draw from the strengths and minimize the weaknesses of both in single research studies and across studies.” (Johnson & Onwuegbuzie, 2004, p.15).

This methodology is identified through the use of both the qualitative and wiantitative methodologies. This emthod identifies the similarities in the traditional methodologies which has been used. According to Casebeer & Verhoef “Careful review of the full spectrum of both major research paradigms will confirm that both methods can be used in less “usual” ways, i.e. it is possible to quantitatively describe observable events in the real world and to collect qualitative evidence within pre-specified, experimental situations.” (Casebeer & Verhoef, 1997).

This method has gained acceptance in various research fields. Sociologists and nursing researches widely use this methodology. As has been suggested by Corner, “the use of different research methods within a single study can provide a richer and deeper understanding of the area under investigation than would otherwise be possible” (cited in Casebeer & Verhoef, 1997). Recently medical research has also started using both the metraditional methods together (Casebeer & Verhoef, 1997).

Types of Combined Methods

Combined methods are divided into five catagories (Tashakkori & Teddlie, 1998). First is the Triangulation technique. This the method of using more than one type of quantitative method. This process is further divided into four parts:

1. data triangulation,
2. investigator triangulation,
3. theory triangulation, and
4. methodological traingualtion (Tashakkori & Teddlie, 1998).

It is the methodological triangualtion that uses both quantitatibe and qualitative method. Then there is monomethod studies which uses only one type of research emthod.

Then there si the mixed model research method which is defined as the “studies that are products of the pragmatist paradigm and that combine the qualitative and quantitative approaches within different phases of the research process.” (Tashakkori & Teddlie, 1998, p.19). these are further divided into sequential study, parallel/simultaneous studies, equivalent studies and dominant-less studies (Tashakkori & Teddlie, 1998).

Advantages and Disadvantages

As the mixed research model is evolved through the disadvantages of quantitative and qualitative research method, it is important to understand the various areas where in the method can be applied. Further it is important to understand the areas wherein the two traditional methods will be applied to reap full benefit of their combinations. A mixed research method comprises of the following steps:

1. determine the research question;
2. determine whether a mixed design is appropriate;
3. select the mixed method or mixed-model research design;
4. collect the data;
5. analyze the data;
6. interpret the data;
7. legitimate the data; and
8. draw conclusions (if warranted) and write the final report. (Johnson & Onwuegbuzie, 2004, p.21).

Proposed Methodology

Given the extensive discussion on the three different kinds of methods of conducting research, it is important to understand which method will be useful for the proposed research. The research methodology that I propose to use is a mixed research methodology. In the following section, I will enumerate the reasons behind my choice of methodology wherein I will use a case study approach to study approach to determine the problem.

Information system research methodology has been dominated by mixed strategy wherein case study approach has been extensively used (Benbasat et al, 1987). Qualitative research methods have been used extensively used in studying the study of adoption of internet in healthcare where mostly the scholars have provided their analysis of the situation as they have seen through their experience or through interviews or secondary research. Very little research has been done on the area of internet adoption in healthcare which will help in analyzing the situation objectively.

I propose to do a mix of qualitative and quantitative research. In the qualitative research section, I will follow the historic data of the healthcare services and try to determine the areas where the internet has been adopted and the existing usages of internet in the Healthcare services in Greece. In this part, I will do an extensive secondary research on the healthcare industry of Greece, try to ascertain the benefits that healthcare has achieved through internet and then do constructive interviews to ascertain the complete picture. The interviews will be based on one organization were I will conduct my quantitative study. This organization will be my case study for the proposed paper.

From the qualitative research, I will gain adequate information regarding the organization’s present adoption status of internet and the barriers to it. The quantitative research section will follow a questionnaire survey in the designated organization or sector. The survey will be directed to understand the profile of the respondents, the usage of internet for them and the internet services which they are presently using. The next section of the questionnaire will discuss the benefits that the sector has gained from the usage of internet. The perceived benefits of internet usage have to be captured through the questionnaire. Then the questionnaire will discuss the barriers which the sector faced in adopting the internet for its business and clinical purposes.

The survey result will be evaluated through factor analysis of the data collected. Here it must be kept in mind that barriers or usage of internet may be enhanced not only due to organizational factors but also due to individual factors. This has to be kept in mind while working on the questionnaire. The questionnaire will also evaluate the adopter’s decision and the criteria for choosing internet as an innovation. The business and clinical benefits that the internet can provide to the sectors will be asked in the questionnaire.

Further in order to determine the performance growth with the use and adoption of internet has to be correlated to the degree of usage of internet to the operational, financial, and performance success of the sector. This can be done through the data on internet usage and the perceived level of adoption to the financial performance over the years of adoption, number of patients treated, cost aspects, etc. can be correlated which will provide the level of acceptance of the internet and the success of using it. This can be validated through the study of the perceived benefits of the internet of the respondents with that of the financial and operational data. This process is important to be done in order to understand the performance benefit of the internet adoption in the Greek healthcare sector.

Conclusion

Why both the qualitative and quantitative research methods are proposed to be used in the research process? The reason is due to the use of qualitative tool in the information system research in the literature is rich and has been validated as one of the most accepted tool (Benbasat et al, 1987). Further, quantitative research is a well accepted methodology for measuring the benefits and barriers of internet adoption (Coye et al, 2001). This is so because it provides the objectivity and positivism that the research method presents. The combination of the two methodologies will be used to identify the factors which are the benefits, barriers, and usage of internet and quantitative method will validate the factors that we draw from the qualitative research.

This research method is apt for the proposed study, as it will provide a case of the healthcare industry with a micro-view on a particular company. The case study analysis will provide the background and the details of the process of internet adoption and the usage in the organization, while the quantitative analysis will provide the objective view of the benefit of using the internet and the usage wherein they are put to. This will validate the findings of the qualitative research.

Internet & the Health Service Sector

The general frame

An incessant evolution exemplifies the modern era. Without doubt, the transformations pursue an emergent trail but what differentiates it from other time phases is the verity that these alterations come about at a never before pace. In his works, Toffler (1982) articulates this epoch as the “Third Wave”. In particular, he states that the first wave – the agricultural revolution- came into existence approximately 10,000 years ago and it took several years to spread out. The second Wave –the emergence of the industrial revolution – came into view during the late 1700’s and took nearly three hundred years so as to turn into a wide-spread movement.

The Third Wave, which is the ongoing phase, took just a few decades to spread extensively and encompass all it came across. This developing new way of life is exceptionally technological in its ways bringing along new and innovative practices. The most significant convergence of the Third Wave is the narrowing of the long-established gap among the producers and the end users, thus fabricating the futuristic producer/consumer economies.

His ideals are extensively reflected in the expressions and operations of the entire market in terms of Mass Customization, Disintermediation and reduction of length of the Distribution Networks, Customer-oriented Administration and Process Integration. Interactive Information and Communication technologies (ICT), which exhibit immense fruitful possibilities, facilitate all the aforementioned.

The improvements in the technological field and their undeviating implementations have brought about key transformations and restructuring in the communication and transportation sphere to such a degree that the entire planet is now conceived as a global village. Besides, the most significant consequence owing to these transformations and improvements has made the present world to be exemplified by means of the notion of “disconnection between time and space” (Thompson 1995).

This means that now, as a result of adopting technological amenities, geographical distances does not necessarily translate into wastage of time. These alterations have engulfed all facets of human existence: communal, cultural, political, trade and commerce, among which the most notable is the rising magnitude and the ever increasing necessity of making use of the Internet in almost all business processes.

International Director of the Research International Group for the development of new products- Julian Bond stipulates four trends of the modern global society that have a significant influence on present-day marketing and also promote the application of Internet mechanisms:

• Globalization – The attenuating globe: The notion of global village seems to facilitate the convergence of diverse markets increasingly into a global market. This inclination marks the preponderance of a large-scale oligopoly, where not many but incredibly large organizations compete amongst themselves. This occurrence is powerfully reflected in advertising, banking, manufacturing, media, retail and wholesale, and various other market segments.
• Constant and speedy advances in technology: The increase in scope, power, and productivity of networking technologies such as the Internet in addition to the decreasing cost and increasing performance of computer devices, such as processors, motherboards and software devices is taking place at an unbelievable pace as a result of extensive research and immense interest of large corporations in the computing field.
• Social Alterations: Factors like aging populace, rise in number of female employees, and time-pressured culture all play a major role in this context. The organizations are urged to acclimatize themselves to this, long-standing but constantly changing issue. This reality also manifests itself on the whole as a uniform markets segment of a comprehensive dimension.
• Political modifications on a global scale: This issue has two faces: The foremost one is the structuring of associations of integration on the economic front- a phenomenon that has taken place all around the globe (the European Union, in the case of Greece). This is a fact that has resulted in the development of only some but huge integrated markets instead of the numerous, miniature and fragmented markets. At the same time, another important issue comes in the form of the market fragmentation at a national level. A second aspect of the finding relates to the incessant threat of armed conflicts. Several small, neighboring wars have prospective grave implications. In addition, the trend of deregulation and the restricted Government positioning is also a factor that should be kept in mind.

21st Century: Post – modernism, new economy and the role of the Internet

In the article “The foreseeable future” by Mercer, the author draws attention to four “revolutionary” social trends: the communication / IT revolution, the post-materialism, the post-Fordism wherein the person is perceived as the fundamental business resource and finally the post-modernism. The author, in addition to several other scientists and academicians from a range of renowned scientific spheres, endorse the verity of an ongoing transformation from the modern to the post modern age. Nevertheless, Firat et al (1995) reports that, weighed against other sciences as sociology, politics, trade and commerce, the Marketing discipline lagged behind in acknowledging the existence and impact of the post modern period.

The post modern age is typified by fragmentation, uncertainty and skepticism in consentaneous explanations. The post modern viewpoint puts forward a condition wherein a person who lacks the confines of ideals in the likes of family, edification, reference groups, can craft out individuality by means of several and various experiences, of few confines and numerous options. The post-modern society is not an anthology of social assemblage like socio-professional groups.

On the other hand, it is a mesh of tiny unstable clusters or races wherein the community shares common emotional ties, a common way of life (Selden and Widdowson, 1993). Each post-modern individual may fit into more than a few races wherein he takes up a separate role and dons a special mask. Internet plays a fundamental part in the conceptualization and maturity of the aforementioned races (Kozinets, 1999).

Modernism was a progressive thinking had the potential to set free the individual of his lack of knowledge and illogicality. Post-modernism challenges scientific suppositions and attitudes of the past few decades and discards the thought of modernism that the human communal understanding is rooted in commonly established “true” bases.

However, the modern marketing bibliography (Firat and Schultz, 1997, Brown, 1993) acknowledges that the fundamental attributes of the new-fangled post modern period in the likes of broadmindedness / liberty, over-reality, incongruity, fragmentation, lack of obligations, devolution of the issues and re-description of notions such as consumption and creation, importance of the approach / representation and recognition of the disorder due to the chaos effect in the marketing philosophy, the sectionalization and positioning policies.

Apart from these, other scope / perceptions concerning marketing, for example, the consumer requirements and background, the consumers autonomy, the behavioral uniformity, the customer’s orientation and belief, the supply’s reflection and also the distinct roles: manufacture – consumption, produce – procedure, supplier –customer and individual – organization (Firat et al 1995) are impacted by the new trends as well. Nevertheless, one of the most frequently received findings reveal the indispensable role of networking technologies in Modern Marketing as an instrument for the structuring and accomplishment of post-modern policies.

The Internet, as a cornerstone for the progression of the electronic commerce, plays a key role and functions as an important instrument in the New Economy. Anderson and Hoyer (1991) bring under consideration the information age as it is known, recognizing the three major development areas which have been focused on during the last few years and have resulted in ground-breaking consequences in every category of organisation. They have identified the advances in computer technology, enhancement in communication technology and the networking expertise that unite the former two as key development areas.

The adoption of the Internet by enterprises presents a vast number of interesting prospects along with its attractive benefits. It amplifies the volumes of business in addition to market shares and at the same time reduces the costs, facilitates an enhanced appreciation of the market and its requirements, fabricates new techniques of marketing and selling products and services along with developing new communication frameworks (Hoffman and Novak, 1996). In addition, it globalizes and speeds up the operative procedures of a business (Hamill, 1997). It promotes self-education and provides a suitable foundation for continuous enhancements of its efficacy (Hoffman et al, 1995).

The Internet

The Internet being the most prominent manifestation amongst networking technologies it is essential to put together a short account of the advent of Internet technologies by looking at its short record and its technological structure.

The foremost aspect that is required to be brought to notice concerning the Internet is the significance of interconnection. The termed coined as Internet is most fruitfully exemplified as a net of the nets. Therefore the Internet is comprised by an extended appearance of an established network among unlimited number of computers across the planet. The networks which are smaller in terms of scope of the network are the Local Area Networks known as LANs, and are applied wherein they are able to provide for the requirements of the employees within a company, and the Wide Area Networks also referred to as WANs which are applied in order to provide for the requirements of the employees of a enterprise who are spread across different locations.

The computers are linked to the Internet by means of a universal standard protocol. This, in effect, is the element that brings about the involvement of differently configured computer systems like IBM PCs, Apple Macintosh PCs, and Game Consoles etc. The data that is transmitted across the network can be of diverse nature like graphics, texts, videos, audios or a combination of all of these.

The Internet’s advent began way back in the 1960’s as an instrument for safeguarding the integrated computer servers of the USA through the cold war period. The fundamental concept underlying this technology was a network which was devoid of a central control mechanism. This aimed at improving the reliability of the network so that if a component of the network malfunctioned, the entire network would not be impacted and could be insulated from the ill-effects as well. During the early 70’s, the US defence authorities endorsed the Advanced Research Projects Agency (ARPAnet), with the intention of connecting different military and research bodies, and to facilitate data and information exchange.

One of the salient accomplishments of this facility was the structuring of the TCP/IP protocol (Transmission Control Protocol / Internet protocol) in 1974 which facilitated successful communication amongst heterogeneous computer systems with different hardware and software profiles. The operating platform UNIX, which was conceived during this period, became roughly indistinguishable with the TCP/IP protocol in view of the fact that it was drawn on by scores of academic institutions in the US. Its most fundamental services like file transfer using FTP- and the e-mail, took shape during the mid 70’s.

The Usenet system which was a means of electronic news came into existence in 1981 while the Internet Gopher which was a management system for archiving in different computers also materialized during the same time.

During the later part of the 80’s the National Science Foundation (NSF) employed the ARPAnet technology with the purpose of enhancing their own network (NSFnet). The earliest end users of the internet were defence scientists, academicians and researchers. At the onset of the last decade of the 20^th century the Internet had started drawing the common public’s attention.

The World Wide Web framework materialized during the late 80’s and the early 90’s. With the establishment of the Commercial Internet Exchange Association in 1991, which intended to promote the participation of more companies, not only did businesses enterprises show keen interest but the technology also attracted common people. These settings set in motion a rapid development of business websites, which till date constitutes the most prevalent and rapidly expanding component of the Internet.

Although, majority of the initial users of the Internet were students, researchers and other academicians based in technologically developed countries like the US, the technology has grown fast featuring a scope which is of a truly global scale encompassing not just technologically superior but also developing economies.

Finally, on the economic front, as the projections of the American research firm “Forester Research” indicate, that the worldwide fiscal activity over the Internet is slated touch the staggering value of 3.2 trillion dollars by the fiscal year 2003. This assessment assumes particular significance when the fact that in 1998 the Internet’s economic worth was 80 billion dollars is taken into consideration. As mentioned by Kiani (1998), the Internet and the World Wide Web (www) emerges as the second most momentous creation while the crown of most significant invention remains the formulation of language.

Innovations and Internet

Internationalisation, requirement and innovation, straightness and the speedy pace in production operations and offering of superior services facilitates the ongoing transition from the industrial epoch to the digital age. The business environment is undergoing a drastic alteration on account of the feats of superior and advanced technology.

This transition is articulated in three layers: In the administrative framework, in terms of growth / expansion and also in the wide-ranging practices of a traditional business. This helps businesses organise themselves in better fashion discarding the rigid hierarchical structure. Increasingly, they tend to rely on digital communication processes in place of physically attended conventions / seminars, and thus forming a more direct and novel relationships with consumers, suppliers and middlemen, re-assessing their responsibilities in the supply chain activities.

As the same time, trends of intensification of their business operation by offering superior services and enhancing customer support indicates that firms are inclined to expanding in the worldwide market by means of strategic collaborations as they focus their attention on incessant innovation, fabricating new, tailored products and services best suited to the consumers’ desires.

The premise of Innovations diffusion is primarily founded on Rogers’ work “Diffusion of Innovations” (1995) and it is demonstrated as a conjecture of the adoption’s forecast of something that is believed to novel and/or innovative. Diffusion of Innovation is not only regarded as a presumption but also as an instinctive evolution of individuals’ outlook, passion and conduct in relation to the recognition of a new / innovative idea. Going by the author’s views, Innovation is described as a perception or idea, practice, method or a point that is observed by as something new by an entity embraces the concept. On the other hand, diffusion is regard as a social transformation and is identified as the process by means of which an innovation is passed down across certain networks in a certain time phase among the affiliates of a social organization.

Innovation can be primarily classified into three categories:

• Continuous Innovation, which is a straightforward transformation or the enhancement of a subsisting item that the adopters carry on using in an unchanged manner. The evolution of the cars can be considered as a classic illustration of continuous innovation.
• Dynamically Continuous Innovation, which is a remarkable and significant alteration to an already existing item, which results in a drastic modification in the manner of consumption. A distinctive case in point is the advent of the Compact Disc as a system of recording and storing music and data.
• Discontinued Innovation, which is the fabrication of an entirely new item that has certainly not been present before and the manner of consumption, altogether alters the adopter’s approach.

In their works, Prescott and Van Slyke (1997) put their attention of the issue of The Internet as a form of Innovation asserting that Internet is an exceptionally dynamic innovation fitting into to the classification of Information Technology (IT). Going by their findings, the Internet appears to be undergoing the early phases of the diffusion process with regards to the Theory of Diffusion. The researchers find that the categorisation of Internet is a very complicated, and it is extremely difficult to be entirely comprehended and to be comprehensively analysed as an innovation on account of its technological complexity, its dynamic temperament and its frame (scope) of application.

Furthermore, researchers assert that the most suitable means of exemplifying and exploring the attributes of the Internet is as an assemblage of associated innovations in the field of Information Technology in view of the fact that it is comprised of a number of different but co-related technologies. Dunphy et al (1996) in their works state that the Internet is a flourishing form of innovation given that just like any other fruitful innovation it is a new concept that is being enhanced and is undergoing consecutive macro- (technical needs, social and civil drifts, political and economical settings) and micro – (industry configuration, company attributes, competition etc.) sifts in anticipation of the conceptualization and diffusion of a economically viable translation of the original form.

However, most researchers are of the opinion that the Internet can very much be aligned with the description of a fruitful innovation and the rate of adoption of the technology in the world market being the only issue of contemplation.

The Adoption of Internet

Chen and Crowston (1997) investigated the practice of implementation of the Internet technologies as evaluated against the theory of diffusion. In their study they contrast Internet’s diffusion and the telephone’s diffusion process. Both these technologies can be regard as as interactive communication applications which facilitate the expansion of human awareness beyond the confines of the spatial dimensions.

The researchers point out that telephonic technology required 50 years so as to be adopted by merely 10% of the residences only in the United States while on the other hand, Internet required just five years for the same amount of diffusion and the most consistent rationalization of this piece of evidence can be attributed to the entirely altered social frames of the two different ages. The rapidity of the Internet’s diffusion rate seems to be incredibly high and the underlying rationale of this high rate is reflected by Pisanias and Willcocks (1999) in their work.

Their research in the shop-broking market discarded the assertion that the advantages of the Internet’s use on the sector’s transactions would have a considerable impact on the sector’s configuration and came to a conclusion that the acceptance / implementation of technical innovations hinges on the market requirement. These demands are determined by the users’ understanding of the technological potential and users’ requirements with regards to communication and information systems.

An added literature on the subject of the Internet’s high adoption rate and the innovation class to which it belongs can be found in works of La Rose and Hoag (1999). The authors are of the view that the acceptance of Internet is a correlated with the embracing of associated assemblage of innovations. These assemblages are comprised of hi-tech innovations which on the surface are distinct but they typically share a common framework and is better equipped to explicate the phenomenon of adoption than the extent of innovativeness of the organizations and the characteristics of the innovation given that their adoption make way for adoption of comparable innovations and particularly that of the Internet.

There also exists other informative and valuable literature on this subject. Research work by Press, 1997 and Press et al, 1998 provides key insight on observing the Internet’s diffusion and on the operational framework of the enterprises that have embraced such technologies. Examining Internet’s diffusion is regarded as a venture of immense significance in terms of the design, application and the enhancement of the telecommunication framework of every country which in turn has an effect on the Internet’s adoption rate. Exploring the different aspects of the Internet’s diffusion is founded on factors such as the geographical breadth, the depth in terms of the quantity of parameters scrutinized and finally, the cost.

The researchers concentrated on the assessment the above three factors, putting forward a framework under which the Internet can be monitored universally. They assert that the countries, the global organisations, the multi-national firms, active human resources and the technical advancements all assume a major role in the diffusion of Internet and in addition state that that Internet has stronger penetration effects in economies where the contest in the telecommunications market and the IT segment is very severe.

A number of researchers consider that there are certain issues which promote (catalysts or accelerators) or hinder (inhibitors) the process of adoption of the Internet, the corresponding e-commerce and other IT tools. Those elements can be classified into five distinct groupings.

The first grouping involves the issues that fit in to the external backdrop of an organisation and relate to the performance factors of the others organisations. As mentioned by Storrosten (1998), the vast number of web locations and the huge quantity of information they provide over the Internet deter users from concentrating on or perhaps even noticing the items they are interested in.

Further, as per the works of Nielsen, 1997, there are elements in the supply chain which do not acquire or retain the infrastructure that facilitates them to transport all of their operations over to the Internet, thus hampering a further diffusion. On the other hand, the attempts of an enterprise to rise up to the existing online competition, either by duplicating or differentiating, ensure a smooth progress of the adoption of Internet technologies (Doherty et al., 1999), which in conjunction with the marketing efforts of IT service providers speeds up the diffusion process (Dos Santos and Peffers, 1998).

The second classification also incorporates elements that fit into the external backdrops of the business but are linked with the traits and the activities of the market. Hart et al (2000) point out the dimensions, the development rate and the latency of this market as key factors which can influence Internet’s diffusion. Several experts are in agreement that electronic trade would emerge as the focus of the business operation in the times to come and the critical mass of the customers would be a decisive factor that they bear in mind for the diffusion rate to be accelerated.

In the third class, elements associated with the attributes of the organization itself are incorporated. McIvor et al. (2000) reveal that there are certain barriers obstructing the process of adoption brought about by lack of assimilation of different business operations instead of the technology sections themselves.

The fourth classification again incorporates elements belonging to the peripheral environment and in particular the upshots of political / governmental and legislative decisions and restrictions. These decisions have a huge impact on regulative features of an organization and the association of the market with other independent organizations which help in further diffusion processes.

The last grouping incorporates one of the most significant elements, the characteristics of Internet and the collaborative framework. Several researchers refer to the dearth of confidence and protection in the transactional procedures and the payment modes and the risk of exposure to hacking. Those apprehensions relate to the deficiency of authorized documents that validate the financial transactions (such as the invoices) and the inadequate use of signature that emerge as the most noteworthy impediments in Internet’s diffusion process.

Electronic Health

The implementation of networking technologies from the healthcare perspective is an element of the larger e-health model. Electronic health is viewed as a continuous innovation with its origins lying in Tele-health. Tele-health is described as the employing of telecommunications and information technology to present easy access to remote health evaluation, diagnosis, intervention procedures, consultation, monitoring, learning and other information services (Nickelson, 1998).

E-health may e considered to be a form of Tele-health that draws on the Internet as a communication channel. Behavioural e-health is the implementation of that very technology to offer behavioural health provisions. Technological progressions have increased the number of alternatives made available to mental healthcare providers for the offering of mental health facilities (Jerome et al., 2000). It is projected that in excess of 300 private health service web sites or ‘e-clinics’ are present online, which offer the expertise of more than 500 e-analysts.

An explanation that Eysenbach (2001) provides in his paper with respect to e – Health is that it is as a growing sphere in the network of health information technology, public health projects, rooted in various services of Healthcare that are offered or enhanced by means of the Internet and the associated technologies.

Marconi (2002) provides a analogous description of e-health stating that it may be considered as the implementation of Internet and other associated technologies in the Health Service sector to enhance the accessibility, competence, productivity, and quality of medical and business procedures employed by healthcare institutes, specialists, patients, and other consumers in an attempt to better the health position of the patients. In both events, the Internet technology assumes a decisive role for the adoption of e-health services.

However, the expression of E-Health is not just used to refer to the concept of “medicine by means of Internet” but also more widely for all that has some association with Medicine as well as computers. It is the endeavour to integrate Health and all the beneficial elements of the notion of e – commerce.

The characterization was brought into application by the top and technically advanced endeavours of the health segment, with the intention of making the most of the benefits that implementations of Internet and new-fangled technologies offered in the Health domain.

E-Health provides an opportunity for efficient interactions and communication in the health sector in the following ways:

• B2C: Transactions involving enterprises and end users
• B2B: Transactions involving enterprises and health organizations
• C2C: Transactions involving end users and health services

Broderick and Smaltz (2003) brings to notice, the framework which acts as the foundation of e-health. This infrastructure includes several components which facilitate the operation of e-Health services. Broadly they may be seen in the following forms:

1. Internet: Widespread access to information and web locations including or exclusive of stipulated security authorizations;
2. Extranet: Protected, remote links between predefined entities;
3. Intranet: Support for a communications framework within the organization, which may provide access to in-house and core data structures to all entities in the healthcare supply chain;
4. Core Data Systems: Function-based arrangements that act as the foundation of the key operations of the organization. These may be economic, medical or managerial in nature.
5. E-Mail: Information exchange among two or more entities using some arrangement of the internet/extranet/intranet.
6. Telecommunications: the physical and mechanical layer that facilitates the establishment of the connections and transaction of data by means of various media: wireless, fibber, cable, satellite, and other novel and up-and-coming technologies. Recording, storing and spreading of such information falls within the confines of E-Health.
7. Hardware: Computer systems, pagers, personal digital assistants (PDA’s), PC tablets, telephones, servers and other hardware that act as the keystone and the facilitate physical support for this framework.

All such need to be pooled together so as to create an apt e-health atmosphere. In such an event it is crucial to for the individuals working in the health industry to indorse the entire process and positively approve and implement the whole innovation.

E-health elements which find the most wide-ranging applications are the Electronic Medical files or the EMR (Electronic Medical Records) that facilitates superior quality of health facilities, lessening of the cost by reducing the number of dispensable assessments, on-line link with the pharmacies which helps the patient and minimises the likelihood of errors. Furthermore, e-health makes possible the easy accessibility of scientific bibliography for the medical professionals. In this context, Thielst (2007) reveals that there is a distinction between the electronic medical records and the electronic health records.

An electronic medical record (EMR) accumulates clinical information and is possessed, accessed, and administered exclusively by the healthcare provider (e.g., doctor, clinic, hospital). In some specific events, laboratory or radiology reports, and session descriptions may be added to or possibly even downloaded into an EMR. An electronic health record (EHR), in contrast, extends beyond the capacity of an EMR. It refers to where other health related information in relation to a patient can be accessed, facilitates the patient’s contribution and interaction with the healthcare provider, and supports clinical understanding to make clinical information easily transformable into suitable actions.

Another significant component of E-health applications is the telemedicine that provides the opening for expert medical understanding in remote regions, and follow-up the pathological state of the patients (Padeken et al., 1995). As per the findings of Miller et al., 2003, the advent of enhanced representation of telemedicine has already had a notable effect, for the reason that it is continuously developing which is an established criteria and operational prerequisite for the application of the models.

Furthermore, Kurihara et al. (1992), in their article, talk about the conceptualization of database technologies for clinical utilization that emerges as an innovative issue. As per the findings of Riva (2000) the most important domain in which e-health can prove to be a competitive advantage factor is that of medical consultation and diagnosis. Remote video sessions, for instance, could provide consumers easier accessibility to skilled health expertise irrespective of geographic distances. The effectiveness of the utilization of remote consultation in e-health is substantiated in a number of research documents.

For example, Craig et al. in recent times evaluated the consequences of neurological patients being admitted to two small medical facilities. In one of the hospitals, all patients exhibiting neurological symptoms were attended to by a neurology specialist from a remote location by means of an communicative video-link broadcasting at 384 kbit/sec. While in the other case, patients complaining about neurological problems were dealt with as per standard protocols. The results of this evaluation revealed no substantial differentiation between the two cases in the final outcome of the treatment procedure. Furthermore, even educational initiatives can be carried out on-line (Lincoln et al., 2005).

Of course the aspect of implementation of e-Health which is more pertinent in this paper is that of the B2B collaboration and the fabrication of synergies amongst contributors in the health industry. A classic example in this context is provided by the electronic formulary (B.C.G., 2003). The primary objective of the implementation of electronic health services is the optimisation of the treatments procedure that is offered to the patients (Tabriziani, 2005). Raghupathy and Tan (2002) in their works bring to notice two major aspects of systems integration that may be used to formulate a efficient framework:

• Internal integration. The extent to which systems and technologies are assimilated with one another across all levels in an enterprise; and
• External integration. The extent to which systems and technologies interact with variables exterior to the organizations and agency computer systems.

Computerized patient record (CPR) schemes, document management systems, data warehouses, and intranets are all possibly important elements that facilitate enhancement of the information exchange process and assimilation of in-house systems within health care establishments. These technologies are can be drawn on to eradicate data redundancy and inconsistency in order to accomplish paperless transmission of information across an enterprise. The Internet, jointly with extranets, ATM technology, and other networking technologies may be employed to provide integrated solutions, collaborating with external organizations and establishments.

The application of E-Health in Diagnostics sector

The diagnostic segment makes up a dedicated component of the Health sector. Several laboratories acquire systems based on information technology (LIS: Laboratory Information Systems) for receiving orders and forwarding them for examinations to the analysers. They gather the results, create a comprehensive responsive report, monitor files and on several occasions by using cross-correlations with databases they put forward clinical interpretations (Expert Systems).

With the assistance of such systems diagnostic establishments are able to automate their ordering process to the provider concerns, simultaneously downplaying possible losses on account of excessive orders. LIS systems act as the fundamental stipulation for potential automatic interconnection system enabling collaboration with the clinical specialists, the administrative service providers, and perhaps even with the suppliers. The assistances that these systems offer are: reduction of work pressure, increased dependability of results, and prospect for new interconnections. (Markin and Hald, 1992).

Several multinational diagnostic firms allocate Websites which have the following characteristics:

• Usually appearing in the English, but at times in German, French and Spanish languages are also used;
• Introductive pages for facilitating ease of navigation;
• Interactive pages for authorized affiliates;
• News and Updates relating to Scientific events;
• Dedicated sections for questions, feedbacks, remarks and interactive communication;
• Files: User guidelines, manuals etc.;
• Market: Tools, software, brochures and in a lot of events on line orders.

Also by means of exploiting newer technologies and combining them with extant e-health processes and functions, databases for clinical or research oriented exploitation can be established which could also offer the possibilities of remote access (Benett and Kern, 2002). However, it should be noted that Greek diagnostic firms normally do not upload Web pages that offer the aforementioned facilities. The findings of Starner (2001) reveal that large organizations, health planners and specialists suppose that the networking technologies can be made use of to simplify health care practices like bill payments and even offering patient care.

In general, health related costs are escalating, and care providers and consumers are demonstrating a keen interest in Web-based technologies that have the potential to cut down their expenses. Programs in the sphere may entail promoting online Web visits to healthcare providers or utilizing the Web to enhance the effectiveness in medical claims dealings for the benefit of the consumers, workforce and also the administrators. Organizations are introducing self-directed profit plans that entail more dependability on human resources. Companies become apprehensive while adopting e-health designs if their employees show reluctance to use them.

In order to be structured and equipped for e-health plans, health establishments should put into practice comprehensive informational technology systems for both the internal and external communication. Several health organizations have already set up systems for the enhancement of their operational procedures but generally that is in parts and do not encompass all processes of the organization.

The description of hospital information system that Winter and Haux (1995) provide in their article talks about “a system that deals with the collection treatment and storage of data and information that is created and trafficked in a health institution”. The Lang et al (1995) articulates that the information system for a healthcare providing organization is a socio-technical subsystem of the entire establishment.

The socio-technical premise regards the systems as a comprehensive unit that attempts to accomplish an elementary objective. This contemplation is reflected in the Winter et al, 2001 article which articulates that: “hospital informative system (NPS) is the social- technical sub system of a hospital that includes all the actions of data processing, and also the human or technical factors who are taking part in this”. Evidently, as a general rule the computer aided systems are referred to also as informational systems.

Electronic Health in Greece

The amount of Internet exploitation by purchasers or customer to obtain health related information is considerably undersized in Greece. In point of fact, in keeping with an widespread public survey from Eurobarometer (2003) merely 11.7% of the Greeks population are the end users of this facility.

As indicated by the above table an increase of 4.9% was observed in the health expenses in Greece during the period from 1998 to 2003. From the above table it is observed that relative health expenses in terms of a percentage of the GDP does not exhibit a drastic change, and is moderately stable. However, in absolute measures the increase in the GDP translates into a rise in health expenditure.

Apparently the issues that drive such demands are demographic, such as the ageing of the population, and technological, such as advent of new technologies, in nature. With additional enhancement of health infrastructure driving factors of the demand are bound to intensify.

In Greece, there are a number of laboratories which have installed LIS systems but most of the times they make use of such facilities for a small number of operations. The primary explanation for this fact is that those facilities are intended for the integration of functions all the departments of a health establishment and that necessitates an appropriate organizational structure and the implementation of informational systems in each department.

In Vaggelatos’ (2002) article concerning the diffusion of such information systems in the Greek public health outfits, it was reported that:

• In relation to the equipment possession status the ratio of number of workstations per bed was 1:10. That implies there are approximately 27 workstations per organization on an average.
• Most public health organization have already implemented information system applications for managerial purposes, which encompasses the activities of the administrative departments adequately.
• Nearly half of the organizations have implemented applications for clinical purposes. However, in most cases these applications are isolated, and are not integrated with the other organizational and laboratorial applications. Furthermore, the extent to which needs are met is considerably less.
• Not more than the one third of public health establishments has laboratorial applications installed. Nevertheless, in the establishments which have, the price of encompassing all procedures is substantially high. Generally, these applications cater for the needs of three primary laboratories: Biochemical, Microbiological, and Haematology.
• The strength human resources employed in information technology departments of public health facilities is visibly inadequate. The findings of the research revealed that out of 112 hospitals, there existed hardly 48 workers who held an university degree, 37 members of staff with a degree granted by a technical institution, and merely 141 who held a technical diploma.

The reports presented the Information Society (2003) are reinstate the facts reported by the findings of the previous research. It states that:

• 8 out of 10 public health establishments assign separate roles to departments of Information technology. Yet, only in a small number of cases are the departments properly structured and organized so that it can facilitate the successful implementation of information technology applications within the Hospitals.
• The ratio of work-stations per Hospital is typically 25:1. This ratio is amplified considerably in healthcare outfits with a bed capacity in excess of 300 (80:1), whilst it falls radically for small scale establishments with bed capacities less than 100 (6:1).
• Among all the applications that have been implemented in the Hospitals, approximately 80% relates to administrative functions.
• Only a small number of Hospitals which is less than even 5% of the total number of healthcare establishments have set up completely integrated systems for administrative and clinical applications.
• There exists no hospital that possesses the necessary infrastructures so as to provide comprehensive services for email and Internet access for the entire workforce.
• Only 15% of the total number of Hospitals has an authorized presence (web page) over the Internet, although the substances of these web pages are most of the time not exceptionally informative.

It is essential to point out that it has been observed that there is a large amount of inconsistency which exists in the health establishments in Greece in relation to the extent of informational technology diffusion. The primary cause for such a fact is the quantity and the quality of informational technology infrastructure in the cases where they exist. The organizations which have an appropriate workforce are more productive in their alliance with the ministry of health and other components in the supply chain.

In order to implement of newer technologies in the Health Service Sector, in the recent times, there has been an extensive effort put in by the Greek state-owned health institutions which manifests itself in the form of various initiatives relating to the Society of Information.

Such ongoing efforts aim at enhancing the infrastructure of information technology services not only in terms of Hardware but also through proper implementation of Softwares in the Health establishments (Public Hospitals and regional Services DYPE). The primary objectives of such initiatives are the enhancement of service offering, superior productivity, and the cutting back of operation cost. It has been realized that information technology and adoption of networking technologies is a potent means of accomplishing these objectives. (Pagalos & Aggelidis, 2003)

Another major e- Health solution which has been implemented in Greek Health outfits located in Crete is known as Hygeia-net. HYGEIA-net, a Regional Health Information Network (RHIN) of Crete is the product of a mindful and methodical initiative towards the fabrication, enhancement and implementation of quality e-Health services at different echelons of the healthcare structure, comprising of primary care, pre-hospital health emergency management, and general hospital care.

Particularly, e-Health provisions for well-timed and valuable patient management are regularly applied in pre-hospital emergency services. E-Health initiatives facilitating synchronous and asynchronous association of clinical specialists in Primary Healthcare Institutes and medical experts at the General Hospital of Heraklion “Venizelio – Pananeion” are characteristically used in the department of Cardiology and Radiology.

Services facilitating remote management (tele-management) of asthmatic patients have also been brought into application. Finally, an e-Health service making possible access to a comprehensive, lifetime electronic health record (I-EHR) is being implemented to ensure continuity of care processes which can be transmitted across organizational confines. This service is also offered in the South and Eastern Belfast Health and Social Services trust in the United Kingdom for beyond normal Hours GPs with noteworthy impact on the eminence of care delivered (GGET, 2007).

Some diagnostic laboratories have implemented Integrated Telematics Networks with the purpose of connecting their diagnostic test reports facilities with mostly the hospitals and health centres that place orders to them. It is critical for Diagnostic firms to integrate their processes with the network services in order to ensure that the services offered are effective. However, this is just one of the several challenges that health establishments face while adopting technical applications in order to make the most of digital technology.

In the Private healthcare segment the infrastructure for the adoption of the practice of Electronic trade already exists, but with the constraint that is not viable to provide access of such technologies to all the employees. It should also be noted that the employees in the laboratorial division are habituated with the use of computers as it is a component of their everyday work, making them one of the ideal elements in Electronic Trade.

The budgetary decisions of the E.U. in relation to e-Health in the future will provide various prospects for E.U. affiliate nations like Greece to realize the objective of completely automated systems by means of adoption of digital technology. Bearing in mind the benefits and the rapid diffusion of Internet in the form of a communication and collaboration instrument, the necessity of internet adoption from the Greek health industry perspective is crucial.

Key Findings

Internet Adoption criteria

Amongst the issues with regards to the decisive factors of Internet’s adoption, the most imperative group of criteria were the ones concerning the enhancement of the associations and collaboration amongst the suppliers and employees of the enterprise, marketing of the organisation itself along with its products, and the effectiveness of communication with components of the supply chain. Besides this, institutes are making efforts to enhance the services which are provided to the customers and are laying enough stress on the level of training and awareness with the key players in this effort being the collaborators, management and finally the consumers.

The least important issue relating to the adoption was identified as the operational costs and the apparent explanation for this is that the employees in public health centres are not conscious and interested in financial aspects.

Reasons for the organization adopting Internet now and not earlier

A second important issue requires the analysis of the reasons that resulted in organizations adopting technologies recently instead of doing it earlier. Among those groups of rationales, the undefined scope of Internet’s application and the incongruity as compared to other entrepreneurial resources had a major role to play.

Purposes of Internet use

The primary reason of using the Internet by health organization employees appeared to be the information gathering, principally for querying databases and data stores demonstrating less application in Communication and Service management. For employees of diagnostic firms, the most noteworthy purposes of use were identified as the marketing of products and company and to some extent intra company use. The extent of Internet adoption appeared to be high when used for operations within the company.

Collaboration satisfaction

Finally, regarding the collaboration satisfaction factors it is essential to evaluate the extant levels of satisfaction about collaboration processes and the feasible enhancement of contentment post Internet adoption. In most instances, the extent of satisfaction was found to reach satisfactory levels. This implies that the existing collaboration amongst health organization and diagnostic firm is adequate. Nevertheless, the level of expectations that people have from outcomes of Internet adoption appears to be considerably high. More specific in information about products in general, products supply processes, order transaction and post-sales support is becoming a necessity.

It has been observed that there is an immense requirement for electronic edification particularly in the field of products usage guidelines and laboratory management. For a Diagnostic firm benefits like improved brand value, improved services and enhanced communication subsequent to internet adoption are understandably very essential.

Attributes of Internet & Its Impact on Adoption

Factor Determination

It is important to analyse how Internet attributes influence the extent of adoption and the application of Internet based on certain factors with regards to Internet’s characteristics as Innovation. These factors on which the analysis is based are:

• Perceived relative advantage that involve the following issues:
  • Enhancement of the provided services in terms of time and cost;
  • Enhancement of the associations and the mutual aid with intermediates / collaborators;
  • Operational costs;
  • Promotion of company as well as its products along with betterment of communication processes with intermediates and consumers.
• Compatibility which involves the following issue:
  • Compatibility with the Information Technology tools.
• Complexity which relates to the following issue:
  • Extent of training and understanding of processes related to the Internet.
• Obstacles in adoption which involves the following issues:
  • Difficulty in the adoption process and application of Internet by consumers and associates;
  • Undefined scope of Internet’s exploitation;
  • Operational costs;
  • The ambiguous operational frame of Internet particularly in the legal framework;
  • Incongruity with the other entrepreneurial resources.
• Expected Improvement after adoption which involves the following issues:
  • Enhancement of information relating to products;
  • Enhancement of contentment in relation to product orders processes;
  • Enhancement of approval of orders transactions;
  • Enhancement of satisfaction with regards to post-sales scientific and technical support;
  • Requirement for electronic edification;

Relative advantage

It is essential to realize the association among the aforementioned four issues pertaining to the relative advantage. The extant state of affairs in Greece entail that an enterprise which regards the exploitation of the Internet as a technique to enhance the provided services as evaluated against the subsisting conventional practices, are likely to make use of the Internet with the intention of gathering information for its consumers and associates so as to interact with them and as a result managing a section of the sales and the services offered to its consumers. A strong relation between the factor- “Enhancement of the associations and the mutual aid with intermediates / collaborators” as a decisive factor for the increased adoption of Internet by organizations is observed with all the other issues with regards to Internet’s uses.

It is implied that establishments firmly believe that if the adoption process and exploitation of the Internet facilitates to the enhancement of associations with collaborators, employees of the organization, and other elements of the supply chain they will have the propensity of making use of it primarily for the aforementioned functions but in a lesser degree for the management of sales for the reason that they do not consider that Internet as a means to enhance the process of sales management.

They also believe that if Internet can acts as a means of enhancing the promotion and communication process, they would make use of the Internet for such purposes resulting in a greater rate of adoption. This judgment is absolutely cogent, particularly when an enterprise considers the benefits in promotional activities that the exploitation of Internet can provide as a vital measure for Internet adoption. Consequently, subsequent to the Internet adoption process executed by a diagnostic firm, product promotion would be one of the primary reasons for its use of Internet.

It must be mentioned that, even though it is not so strong, there exists a cohesive correlation amongst the “Promotion and communication” and the “Information gathering” issues. Lastly, the outlay for the development, handling and maintenance of the Internet is not considered as an ultimate deciding criterion for the utilization of the Internet, particularly in the cases of public health outfits, and consequently, it does not impact the extent of its consumption by the organizations.

Compatibility

The examination of compatibility factor demonstrates that the more compatible Internet is considered by the organization with the existing technological framework of the establishments and that of their associates, the greater is the extent of its adoption and usage in the various activities and procedures of the organizations.

An organization is more likely to make use of the Internet in the management of its distribution network primarily if it is attuned with the company’s current technology and the technical infrastructure employed by its consumers and associates. Thus, it can easily be concluded that more compatible the Internet proves to be with the current technical framework of all the entities involved, the more is the propensity for organization exploiting it for use in its supply chain.

Complexity

No relationship between the training and the level of understanding of the Internet with regards to the workforce of the organization, collaborators and consumers has been established as a condition for the adoption process, the decision relating to utilization and the extent of utilization of the Internet, in the various activities of the enterprises. This fact entails that the organizations do not consider the complexity of the Internet as a criterion for its use and consequently, it does not have an effect on the extent of the usage of the Internet in their various operational activities.

Obstacles in adoption

The organizations and enterprises consider that the outlay for the adoption of the Internet is not remotely greater than the scores of advantages they expect to capitalize on with regards to the marketing of their products. In addition, the organizations also appear to consider that they can accomplish enhanced upshots with more traditional means of promotion. This verity entails that the more superfluous the managerial body of an organization considers the Internet to be, the more reluctantly it would use the Internet for promotional operations. On a more general not it may be asserted that the more critical the organizations perceive the existing Internet’s hindering factors, more will be the delay in Internet adoption and/or the less they would make use of it.

Expected Improvement

It has been observed that there exists a constructive cross-correlation in the consumer’s contentment from the information provided concerning the products in relation to the degree of obtaining profit that they would acquire as a result of adoption of the internet. However, maximum enhancement is expected to come in the form of betterment of the product offering procedure. This appears to be rational for the reason that the electronic offer documents can be more rapidly and very easily be evaluated.

A statistically significant cross-correlation amongst the level of satisfaction for the service of order submission and the extent of facilitating enhancement regarding all the issue that concern the order placement by means of the implementation of Internet technologies is also observed. There is also a substantially affirmative cross-correlation amongst the satisfaction level for significant factors such as post sales services and scientific / technical support and the facilitating enhancement as a result of putting Internet into application. It is essential to state here that the necessity for electronic edification is much higher in the domain of analyzers and reagents behavior and laboratory administration but considerably lower in the domain of financial issues.

In conclusion it may be said that, the soaring positives obtained in the benefits of Internet implementation is clear evidence that the exploitation of internet technologies is an essential need for health service firms even if the Greek market is not yet geared up to put them into application. Linking this factor with the significance of the organization’s brand value in the choice of a supplier it may be asserted that inventive firms definitely would have a competitive advantage in terms of increased consumer base.

Suggestions for Performance Improvement

Organizational Structure in Health Institutes

The firms belonging to the diagnostic health care sector in Greece are usually small organizations. Their dimensions range from less than ten employees for the small concerns to approximately one hundred and fifty employees for larger organizations. They are segmented into various departments that encompass all the activities that guarantee assistance to the consumers of all forms of services that require attention at the time of sales in addition to post sales support.

The fundamental core of the organisational configuration is constituted by the sales department that involves various activities such as sales promotion by means of scientific briefing, the formulation of product related offers, engagement in the different phases of purchasing assessment made by the consumer and the follow-up meetings that results in enhanced customer relations.

The Marketing department operates in a cohesive manner with the sales section. Proportionate to the business compositions and market share of the organization, it is made up by product managers who are responsible for the identification of all the components of the marketing mix with regards to their product lines.

The scientific and technical support division makes sure the smooth post-sales implementation of the products, problem troubleshooting and scientific explanation of diagnostic approaches and systems. This division also handles the installation, repair, upgrading and precautionary maintenance of the analyzers.

The financial section incorporates the accounts division and the logistics branch. The department dedicated to quality management makes sure the productive operation and incessant enhancement of quality systems that the diagnostic firms are obliged to comply with and are enforced by the legislation so as to operate in the sector.

The Informational Technology branch (IT) is allocated to the maintenance and the upgrading of the information technology framework not just within the organization, but also the systems that have been installed at the consumer’s site. This department too, acts in collaboration with the technical support team. It surfaces as the most critical division for the implementation of networking and other automated tools.

On various occasions it has been observed that some degree of synthesis among the above mentioned departments and their affiliates can lead to multiple functionalities in operational activity of the company. Standard groupings of department that are usually conceptualized are sales and scientific support, technical and scientific support, technical support and IT. The diversity of duties is more frequently observed in the smaller organizations. These aspects about the configuration and the operational approach of diagnostic firms can bring about schemes that could enhance their productivity and quality of collaboration with its consumers.

On the other hand, the conventional health organization segment is formed by both small as well as organizations with a number of divisions. The most important among these departments are administration, finance, clinics, laboratories, technical and logistics.

Recommendations for performance improvement

Bearing in mind the requirements of consumers in the health service sector, the consequences that the utilization of Internet and networking technologies would have in relation to the redistribution of work procedures are examined for a typical Greek health service sector company. It is recommended that there should be a parallel utilization and that there is no need for instant transformation of an organization into a fully electronic outfit. Research shows that organizations suppose that the Internet would involve enhancement of a majority those services which would incorporate new technologies into its technical frame.

Sales department

Without a doubt, an imperative portion of the activities of sales division can be performed in conjunction with the parallel exploitation of the Internet. At present, all the organizations assign several salesmen with generally high educations qualifications who approach the prospective consumers as technical and scientific consultants. The employees in the sales section represent the larger fraction of human resources in diagnostic firms. On account of the conventions that are adhered to the salesmen visit the consumers at their place of work as well as their residences. Thus the process of sales is typically protracted and painstaking. Also the geographic spread of laboratories adds critical costs to the budget.

Company benefits on account of Internet adoption:

1. Additional sales medium: Apart from the conventional salesmen, the endeavour of sales and marketing is also supported by a website that contains information about the product range and their features.
2. Direct access to the customer: By means of websites and various search engines, organizations can approach consumers who most likely were not incorporated in prospective customer records of the organization and possibly would not have come in contact with the sales department.
3. Decreased expenses for the movement of salesmen: It is a logical consequence of internet adoption that the movement expenses of sales people can be cut down.
4. Information structured and controlled from the company: The supplied information and the presentation arrangement are developed and supervised by the organization itself.
5. Reduction of promotional material expenses: A large part of printed marketing material that is distributed by organizations for promotional purposes can be substituted in the from electronic prospectus and brochures.

Laboratories Benefits on account of Internet adoption:

1. Direct and fast access to the supplier: Consumers can come in contact of the supplier from any geographic location and at any convenient time.
2. Validity and plenitude of provided information: The supplied information is more legitimate and authorized and can easily be verified.
3. Direct update of innovative products: Consumers can be informed about innovative product updates speedily via e-mails.

Although easing of salesmen work is likely due to Internet adoption, the reduction of the number of salesmen is not recommended. Subsequent to the adoption of Internet the quality of salesmen responsibilities should be refined. They should be entrusted with the responsibilities of follow-up visit to the site visitors with the intention of making sure the communication is complete, the formation of personalized relationships with the prospective consumers, and the engagement in the different phase of purchasing assessment in order to complete the sales process.

Logistics department

In the segment of order transaction (Logistics) that involves the order reception, packing, delivery etc., the implementations of Internet technologies can result in significant advantages for all the entities in the supply chain of health related products.

Company benefits on account of Internet adoption:

1. Submission convenience: With regards to the existing procedures of orders submission by means of telephone or fax, there is a considerable cost and other complexities involved. The implementation of Internet can prove to be immensely beneficial in the order receiving processes and would suppress the impact of overheads in the system.
2. Reducing of errors: The attachment of less number of phases in a process significantly diminishes the possibility of error occurrence, allowing the company to gain competitive edge of better facilities and lessening simultaneously the cost of products.
3. Automatic submission in the deposit department: Application of “Just in Time” technologies in the supply framework comes with several obvious benefits.

Laboratories Benefits on account of Internet adoption:

1. Simplification of order submission: It stems the time constraints of standardised procedure and facilitates more speedy submission processes.
2. Reducing of errors: For the same reasons that mentioned above.
3. Information about product availability: With the use of suitable softwares, the availability of automatic information for the products is ensured.
4. Information about the order stage: In an identical manner which is mentioned for the availability.

It is evident that in this instance progressive reduction of overheads in the logistics department is possible by means of encouraging the customers to adoption electronic submission processes. A very crucial step could be the probable control of deposits for the auxiliary firms of trans-national companies. Repression of deposits for the firms that are subsidiaries of other corporations in Greece is not suggested.

Departments of Scientific and Technical support

This division plays an immensely significant role in the levels customer satisfaction, formations of purchasing norms and the various types of post-sales support services that organizations provide. On account of necessity of the directness of intervention which is required it is believed physical presence of support staff is desirable. These interventions involve smooth implementation of existing structures, without drastic inversions of extant framework.

Company benefits on account of Internet adoption:

1. Improvement of support-directness: As a result of the implementation of the Internet and the networking between analyzers, the scientific associates of the organization or the engineer can intervene into the analyzer’s operation from a remote location and with working together with the user can successfully complete the insistent troubleshooting of the problem with added cost benefits.
2. Directness in the supply of user manuals: Enhancement of the supply pace of user guidelines as measured against the existing procedures is possible and this too can lead to reductions in cost.

Laboratories Benefits on account of Internet adoption:

1. Improvement of support-directness: The immediate solution of critical problems is a extremely indispensable factor considering the significance of the work.
2. Directness in the supply of user manuals: As mentioned in case of the company benefits.

E-learning

Bearing in mind the interests of an establishment for knowledge management a trend of providing electronic education has begun in a number of sectors. The education with regards to the product, such as usage of analyzers and reagents bears particular significance for the consumers. The proper management and the safety instructions for laboratories are also significant in this regard.

There already exist e-learning software initiatives that instruct the employees working in laboratories in addition to programs for employees in other domains too. The expenditure on the software is accounted for in the development budgets by diagnostic organizations. However, typically these programs make use of the English language and costs for the translation in Greek entails an outlay of about five to seven thousands Euros. Nevertheless, this expense gets counterbalanced by the cost-saving from the scientific associates working hours.

Company benefits on account of Internet adoption:

1. Provides an alternative training method in unison with the conventional modes of training.
2. Decrease of working pressure
3. Cost saving resulting from no requirement of lessening work duration and savings on movement expenses.

Laboratories Benefits on account of Internet adoption:

1. Received education irrespective of the laboratory location.
2. Received education at a convenient time of the learner.
3. Certificates of education: An exceptionally significant advantage bearing in mind the quality standard requirements for laboratories.
4. Repeated and renewed education, with the addition of enhancements and upgrades.

Marketing department

The part that the Marketing department plays in the course of changes resulting from the implementation of Internet refers to maximization of anticipated profits for the organization as well as the customer by engaging in a vital contribution to the formation of the configuration and the fostering of electronic benefits.

Company benefits on account of Internet adoption:

1. Profit Maximisation by determining a competitive edge through providing of enhanced facilities and from reduction of the operational expenditure.
2. Configuration of an extended product that outshines in the intense competitive environment.

Laboratories Benefits on account of Internet adoption:

1. Upgraded and extended product according to his needs: The proper implementation of internet produces new forms of gains for the laboratory processes and reinforces the eminence of the service provided.
2. Continuous communication with the entities of the supply chain.

With the intention of reaping more benefits from the implementation of Internet technologies, the companies should be able to provide electronic Marketing training programs to the executives. The solution of tutoring of the executives can prove to be an important activity for the reason that the utilization of the electronic Marketing procedures calls for thorough knowledge of the intricacies of the sector.

Informational Technology department

The Informational Technology division is entrusted with the responsibility of configuration of the technological infrastructure and supporting all Internet aided processes together with all the related departments. If an appropriate technological framework does not exist, the initial requirement can be met by employing the services of an external collaborator. For the maintenance and support of the provided services the company should form a dedicated team to facilitate faster and more flexible solution for electronic issues.

Administration department

The management should promote the implementation of new forms of electronic technology for providing better services so as to achieve increased productivity. The administration should also monitor and intervene to control divergences from the plans, and to restructure the procedures when they do produce desirable results. An imperative responsibility of the administration should be to ensure a smooth transition on account of changes that are put on and not to upset the working balances and to make sure the a suitable working atmosphere is maintained.

Conclusion

In conclusion it may be said that the more the organizations believe that the networking technologies would assist them to provide their clients with an enhanced level and quality of services, the more will they utilize it with the aim of gathering information, managing their sales and interacting with their clients or collaborators. All these benefits of such technologies are interconnected and pertinent. By gathering information for its consumers and interacting directly with its patrons, an enterprise can handle its operational activities in a better fashion and provide a higher quality of service.

Research findings indicate that the settings for the implementation of networking technologies in the Greek Health service sector is going through a very advanced phase. It is also an established fact that the suggested improvements of enhancing services through electronic means pose higher degrees of profitable opportunities for health organizations to exploit. The implementation of Internet technologies makes up a very central development topic for Healthcare providers as well as consumers.

The high growth rate, the substantial dimensions of the market and the increasing intense competitive business environment entail innovative actions in order to acquire a competitive edge by means of offering better and more comprehensive services, drawing on an alternative distribution networks and the feasible reduction in operational outlays.

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