and competitiveness in today†s business and economy are the main generators of the cooperation
Today networking has moved towards strategic enterprise networks (e g. Jarillo 1993; Mchugh et al. 1995; Hines et al. 2000.
the need for communication and for information technologies and software support that communication. Information and communication technologies (ICT) have made possible new business models and even new business structures.
There are many opportunities for developing business through new processes, models and methods and, of course, with new ICT solutions.
On the other hand, some problems could arise, when the business development lives its own life without taking care of real business needs Internal Auditing & Risk management Anul V, Nr. 4 (20), Decembrie 2010 2 and co-operation
These kinds of problems are sometimes real in enterprises where business developers follow all the new waves and"trendy"business methods like
A dynamic business environment requires changes in core competencies. Core competence is one aspect of companies'business vision.
This vision usually moves as customer requirements and the business environment moves. It depends on the business as to how far ahead the vision states are targeted.
Porter (1998) has defined five driving forces in industrial competition: Suppliers, Substitutes, Potential Entrants, Buyers and Industry Competitors.
The essence of formulating business strategy lies in relating a company to its environment (Porter, 1998.
"The technologies, competition and legislation are changing rapidly, so the strategies should be changed also. Then there are new emerging business models
which make business more and more competitive. It is not wise, however, to take all new waves seriously
and provide their help in implementing new business models. Those models and methods are not good for every kind of business.
Information and communication technology (ICT) is seen to be an enabler but sometimes ICT is also an encumbrance.
telecommunication networks and technical expertise that support information processing and communications activities at all levels of a company (Marchand et al. 2001).
The potential sustainable growth of a business lies with services created on the back products.
New emerging technologies like smart materials, micro-mechanical sensors and wireless and faster data transfer solutions etc. have presented new opportunities to develop product features, especially those intangible features
of extended products and value-added services. The advance of technology has created new requirements also for business;
the companies should change their operational environments and change is needed for business models and operation models.
Technological development is not easy, especially for small-and medium-sized enterprises (SMES. Technological development needs a lot of effort on the part of a company.
It is not easy for the SMES to utilize new emerging technologies, but it is not easy for bigger companies either.
just as vision and a roadmap are needed in business model development. Organizations, moreover, also need strategies to implement roadmap activities
1. Set the IT mission 2. Assess the environment 3. Assess existing systems'availabilities and capabilities 4. Assess organizational objectives and strategies. 5. Set ICT objectives,
whose responsibilities include the co-ordination of cross-functional or horizontal processes and communication with partners like suppliers and customers.
which products and services are provided and distributed. All these levels need different kinds of ICT and these levels have four Internal Auditing & Risk management Anul V
Companies have chosen their business models and structures. This means that companies also need strategy management, which leads the company in the right direction.
Companies chosen business models are dependent on their core business. Companies, furthermore, have individual structures, locations, types of organization and so on.
for example Business intelligence solutions to manage business data and information from marketing and customers. Markets are providing a huge number of different solutions to different needs,
i e. the kind of investments needed to achieve the vision state of technology. After the creating a vision and a roadmap,
Companies do not have a clear idea of how to implement new business models or new enabling technologies.
The utilization of different ICT solutions requires understanding of the business environment and business requirements,
and also of market opportunities. The other aspect is the understanding of ICT solution providers.
as Finnish companies are focusing on providing value-added services for their products. The concept of the extended product is not enough;
companies are responding more to customers'processes References 1. Anthony, R.-Planning and control systems, a Framework for Analysis. Boston:
How balanced Scorecard Companies Thrive in the New Business Environment. Harvard Business school Press, 2000.7. Marchand, D.,Kettinger, W.,Rollins, J.-Information orientation-The link to Business Performance.
10.1179/175330310x12736577732764 Rachelle Kaye is the Director of the Maccabi Institute for Health Services Research and the Deputy Director of the Division of Planning and Finance in Maccabi Healthcare Services, Israel.
Ehud Kokia is the Director General of Maccabi Healthcare Services and Professor at the School of Public health Sackler Medical Faculty, Tel aviv University.
Varda Shalev is a practicing family physician and the Director of the Medical Informatics Department, Maccabi Healthcare Services.
Dalia Idar heads the Clinical Computerisation Department in the Division of Health Information technology at Maccabi Healthcare Services, Israel.
A review of the health IT literature supplemented by an analysis of the experience of successful IT implementation in Maccabi Healthcare Services,
marketplace competition and privacy legislation. Critical success factors are integrated innovative leadership management and collaboration with the doctors based on concrete needs, benefits, incentives and support.
Dilemmas for managers include proof of return on investment for health IT versus leadership and tough management decisions;
the optimal balance in the tradeoff between market dynamics, competition and choice, and the value of an integrated system that can generate significant benefit to clinicians, patients and payers;
Rachelle Kaye Maccabi Institute for Health Services Research Israel E-mail: Kaye r@mac. org. il Keywords:
health information technology, e-health, critical success factors, critical enablers, leadership, physician collaboration investment remains difficult.
we consider the lessons added by the Maccabi experience to the growing literature on the use of these technologies in healthcare services.
The study showed that effective e-health investment does indeed result in better quality and improved productivity,
along with new opportunities presented by the technologies themselves, such as telemedicine and internet-based chronic disease management.
lack of clarity regarding the specific cost-benefit to each of the stakeholders (payers, physicians, patients) resulting in †conflict†with regard to
which of the stakeholders should foot the bill; absence of financial rewards (particularly for the physicians,
and the lack of a strategic organisational process to develop the commitment of all of the stakeholders.
even if there is a lack of sufficient empirical and quantitative evidence regarding return on investment, particularly in the area of cost containment.
Partnership and collaboration with clinicians and other stakeholders have also been demonstrated to be a critical factor in the successful implementation of health IT.
Maccabi Healthcare Services was the first of Israel†s four national health plans to develop
Maccabi Healthcare Services is the second largest health fund in Israel providing comprehensive medical coverage to more than 1. 8 million people.
It was established in 1941 as an independent, mutual, not-for-profit health insurance fund. It underwent a change in status in 1995 following the passage of the Israeli National Health insurance Law,
Maccabi Healthcare Services is organised into five districts, encompassing 140 branches, which provide both administrative and healthcare services throughout the country.
Most of the services are provided by independent contracted providers, at the core of which are 4,
000 independent physicians including primary care physicians and specialists. The care they provide is supplemented by 300 senior consultants,
These contracted services are complemented by over 600 salaried physicians and Maccabi owned services including a centralised laboratory system,
a tele-radiology system, telemedicine services (both diagnostic and home monitoring) in cardiology, specialty clinics, a chain of 50 pharmacies and a private hospital network.
In 1983, the leadership of Maccabi Healthcare Services concluded that the healthcare system of the future would require sophisticated information and communication technology for efficient management of the healthcare system,
as well as effective and innovative healthcare services delivery. Maccabi embarked upon the development of its health management information system in 1984.
In 1986, the Maccabi Independent Physicians Barriers and success factors in health information technology  W s. Maney & Son Ltd. 2010.
which all healthcare providers use electronic health records and all providers and health services are interconnected electronically online
at a time (1989†94) when computer and communication technology was sophisticated much less than today. Many of the same barriers mentioned above were encountered by Maccabi as it made key decisions in the process of developing its system.
JUNE 2010 171 †the insertion of the membership card generated an online connection to the Maccabi database for verification of the patient†s eligibility to receive services,
In addition, in all cases, there was a major investment on the part of the Health System Integrator organisation in training,
Discussion The analysis of the Maccabi Healthcare Services experience in developing and implementing an EHR-based health information system identified ten critical success factors.
and †return on investment†studies under the assumption that these will convince leadership to make the commitment and the necessary investment.
the added value of being connected electronically to other providers such as the laboratory, imaging services, consultants and others, is one of the more visible benefits that clinicians seek from such a system.
competition and choice need to be weighed against the value of an integrated system that can generate significant benefit to clinicians, patients and payers.
and investment in the communication infrastructure for clinical data exchange is a must for a system that will be sustainable over time, in terms of benefit to doctors, patients and the healthcare system.
, especially in Information and Communication Technologies (ICT) have enhanced greatly the competition spurred by the globalization of the world economies.
Even small and medium-sized enterprises (SMES) are no more immune to the challenges that the globalization brings about.
and in certain instances worrisome, situation since SMES play a key-role in most economies,
However, opportunities presented by the globalization and the entwined, simultaneous pressure to innovate opens for SMES new arenas to engage in
and Labour Affairs in Hamburg and co-financed by the European union (EU). The findings of this survey are matched here against perceived opportunities
Barriers to Innovation, Globalization of Innovation, Internationalization of R&d, Research & development, Small and Medium-sized Enterprises (SME) This Paper should be referred to as following:
4 2. 2 Small and Medium-sized Enterprises (SMES...5 2. 3 Connecting SMES to Innovation...
21 4. 3 Leveraging Market Opportunities...21 5-Challenges of Global Innovation...22 5. 1 Finding â€oequalified†Personnel...
22 5. 2 Cost Explosion in Booming Economies...22 5. 3 Protection of Intellectual Property rights...
22 5. 6 Cross-cultural Issues and Communication...23 5. 7 Acceptance Issues...23 6-Implications and Research Outlook...
R. Tiwari and S. Buse (October 2007) Page 4 of 31 1-Introduction Technological advancements, especially in Information and Communication Technologies (ICT) have enhanced greatly the competition spurred by the globalization of the world economies.
Even small and medium-sized enterprises (SMES) are no more immune to the challenges that the globalization brings about.
and in certain instances worrisome, situation since SMES play a key-role in most economies,
Innovative ideas and products are becoming increasingly important to counter the price-oriented competition from low-cost producers from emerging economies
services or processes, see e g. Herstatt et al. 2007b). ) Opportunities presented by the globalization and the entwined, simultaneous pressure to innovate,
opens for firms, also for SMES, new arenas to engage in what we may call are â€oeglobal innovation†activities
and Labour Affairs in Hamburg and co-financed by the European union EU). The findings of this survey are matched here against perceived opportunities
while elaborating the crucial role that SMES play in the economy. 2. 1 Innovation Innovation,
For the purpose of this paper, we may regard innovation as invention and commercialization of new (or betterment of existing) products, processes and/or services (Tiwari, 2007.
Innovations usually do not take place in a given, static environment. They are rather a result of a dynamic process in an organisation that involves interplay of several internal and external factors.
Three Phases of a Simplified Innovation Process 2. 2 Small and Medium-sized Enterprises (SMES) The term â€oesmall and medium-sized enterprises†(SMES) consists of two components:
An enterprise, as defined by the European commission (EC) in Article 1 of its recommendation on â€oedefinition of micro,
small and medium-sized enterprisesâ€, may be understood as â€oeany entity engaged in economic activity, irrespective of its legal form†(EC, 2003a).
•Development/Construction •Prototype Dev. •Pilot Application •Testing •Production •Market Launch and Penetration (national/international) 3
¢Development/Construction •Prototype Dev. •Pilot Application •Testing •Production •Market Launch and Penetration (national/international) Conception Implementation
•Prototype Dev. •Pilot Application •Testing •Production •Market Launch and Penetration (national/international) •
•Project Planning •Development/Construction •Prototype Dev. •Pilot Application •Testing •Development/Construction •Prototype Dev
even though SMES play an important role in the national economy as discussed in the following.
which represented 99%of all enterprises in the enlarged European union of 25 countries while providing around 75 million jobs (EC, 2003b).
In Germany, according to Ifm Bonn1, SMES accounted for 99.7%of all enterprises in year 2005
Recent calculations by the authors of this paper, based on Germany†s official â€oestatistics portal†data, show that the high percentage of SMES amongst all enterprises continues to remain high.
As on 31.12.2006 large firms (with 250 employees or more) constituted a miniscule 0. 33%of all enterprises.
Of 3, 215,238 enterprises active on the aforementioned date an overwhelming 3, 204,519 were SMES (with less than 250 employees.
2 These data exemplarily demonstrate the key-role which SMES play in Germany†s economy.
For detailed discussions on SMES€ role in the German economy see Hamer (1997), Bundestag (2002), Gà nterberg and Kayser (2004),
and Idw (2004). 2. 3 Connecting SMES to Innovation Notwithstanding their large share in all enterprises
For instance only 39.1%of the total turn over generated by all enterprises in Germany in 2005 went into SMES€ account (Ifm, 2007b.
At the same time, the increasing globalization is bringing in more competition in the home market, the traditional stronghold of many SMES.
and find themselves faced with tough price-oriented competition from low-cost producers from emerging economies in Asia
blocking international competition is not a solution to such problems (Smith, 1994). For the increased competition is ultimately beneficial for the consumer in the form of cheaper
and/or better goods and services. â€oeconsumption is the sole end purpose of all production;
†observed Smith, â€oeand the interest of the producer ought to be attended to, only so far as it may be necessary for promoting that of the consumer†(Smith, 1994).
Moreover, blocking foreign firms from doing business in the country may lead to trade retaliations abroad that could severally affect an export-oriented economy like that of Germany.
but also presents an opportunity to internationalize sales in new, rapidly growing markets and thereby to generate additional revenues.
New markets however (may) also require products and services which are adapted to the local needs and tastes of those markets.
and cost-effective production distribution and after-sales services; see e g. Dangayach et al. 2005) and Spielkamp & Rammer (2006.
and have direct contact to customers thereby potentially gaining valuable impulses in the form of customer feedback.
and services faster Develop products and services cheaper Develop better products and services Improve competitive position Enhance profitability,
strengthen stability Quality Costs Time Develop products and services faster Develop products and services cheaper Develop better products
and services Improve competitive position Enhance profitability, strengthen stability BARRIERS TO INNOVATION IN SMES: CAN THE INTERNATIONALIZATION OF R&d MITIGATE THEIR EFFECTS?
R. Tiwari and S. Buse (October 2007) Page 8 of 31 more informal manner and confronted with fewer intra-firm hierarchy levels than large firms,
SMES seem to be, in many respects, better placed for innovations than their large counterparts.
This potential edge in normal course, should enable them to develop products better suited to market demands
and thus bring more success. In practice, however, the resource constraints coupled with market uncertainties (and a few other factors) limit the ability of SMES to indulge in dedicated R&d
and Hamburg Institute of International Economics (HWWA, 2004). Comparing the findings of the aforementioned surveys it would not be an unreasonable assumption that SMES in the respective countries
and other developed economies we conducted a new set of investigation. The methodology and selected results of this study are explained in the following. 3. 2 Findings of the Survey â€oeris-Hamburg†To identify barriers to innovation in SMES in the Metropolitan Region of Hamburg we at first conducted an empirical study in form
the survey targeted mainly SMES from the fields of IT, Media, Civil Aviation, Electronics, Machinery Manufacturing, Maritime Economy, Medical Equipments, Logistics,
and Services sector. To reduce the time needed to fill out the questionnaire, respondents could choose to answer only questions from modules which,
R. Tiwari and S. Buse (October 2007) Page 10 of 31 Services; 11%Electronics; 16%IT;
Many projects were aborted in late phases, causing significant losses in the form of sunk costs and lost opportunities. 42%42%16%0%10%20%30%40
11%Communication problems; 5%n=33 Figure 13: Problems in International Cooperation with Universities The discussion above has brought to fore the chances and challenges that firms,
but in many other Western countries are faced with scarcity of skilled labour owing primarily to two reasons:
According to some preliminary calculations the shortage of skilled (technical) labour, primarily of engineers and scientists, is leading to a loss of over 20 billion euros a year in the form of unrealized business opportunities.
The study carried out by Cologne-based Institut der deutschen Wirtschaft (Idw) on behalf of Germany†s Federal Ministry of Economics
SMES with a staff of 50 to 249 employees were found to be suffering more from this scarcity (60%)than did large firms (40%)(BITKOM, 2007b.
e g. attractive brand names or access to human capital abroad. 3. 3. 2 Financial Problems and State Support As stated in section 3. 2 the lack of financial resources
It is therefore not surprising that many SMES have started recognizing the opportunities that the globalization enables not only in the production but also in R&d.
fast-growing markets such as China and India, may offer tremendous opportunities, e g. in the form of vast pools of qualified human resources in science and technology, cheaper labour costs and access to new, fast
R. Tiwari and S. Buse (October 2007) Page 20 of 31 Setting up offshore R&d centres provides firms with an opportunity to tap into a larger talent pool
emerging economies in Asia are rapidly taking over the role of â€oelead markets†by their openness for consumption
or they may cause high opportunity costs in the form of lost business opportunities (in case of prohibition).
or is possible with significantly lower restrictions then it may make sense to locate R&d efforts in that country. 4. 3 Leveraging Market Opportunities
In addition to knowledge and cost factors there might be significant market opportunities abroad in the form of demand for localized products in fast-growing markets.
More and more people in emerging economies are having financial resources to buy high-end products (EIU, 2004), and the number of the middle class consumers is growing rapidly in emerging countries particularly China and India.
The urban incomes are set to rise significantly providing ample opportunities for the manufacturers to sell not only items of basic necessities but also of a â€oediscretionary†nature (MGI, 2006.
2007). 5-Challenges of Global Innovation The section above has given us a broad overview over how global innovation may be used as a chance to mitigate the effects of innovation barriers prevalent in Germany and inter alia in advanced economies.
%The shortage of qualified personnel is also felt in the booming economy of China, where German firms are finding it increasingly difficult to recruit local technicians,
2006). 5. 2 Cost Explosion in Booming Economies The cost advantage of many â€oeemerging†nations with booming economies is disappearing in many respects, for instance,
which â€oeraise the cost of coordinating offshoring projects†(Farrell, 2004). 5. 6 Cross-cultural Issues and Communication Global innovation invariably involves multi-disciplinary teams of international backgrounds.
and of business environment conditions in the country concerned. 4 The investigation report is under preparation.
which do not require a high level of capital investments. Potential strategies, for instance, could be: o Cooperative agreements with local research institutions and/or firms o Outsourcing of parts of the innovation process o To limit the financial burden of setting up
This sensitization to mutual cultural issues may play a key-role in the success of an international venture. •The motivation (potential benefits) as well as the necessity behind global innovation activities (e g. tapping new markets
In this respect the internationalization of R&d seems to be a useful instrument to mitigate the effects of barriers to innovation often faced by SMES in Germany, the EU or anywhere else in industrialized economies.
At the same time these â€oeglobal†opportunities are associated invariably with challenges that need to be mastered in order to fully exploit the chances of global innovation.
as well as a profound analysis of business environment conditions of the target offshore country are prerequisites of a successful global operation.
Commission Recommendation of 6 may 2003 concerning the definition of micro, small and medium-sized enterprises, Annex Title I †DEFINITION OF MICRO,
SMALL AND MEDIUM-SIZED ENTERPRISES ADOPTED BY THE COMMISSION€, European commission (2003/361/EC). EC (2003b:
The globalisation of research and development, Economist Intelligence unit. Ernst, D. 2006: Innovation Offshoring: Asia†s Emerging Role in Global Innovation Network, East-West Center Special reports, No. 10/2006.
Die Position Norddeutschlands im internationalen Innovationswettbewerb, Hamburg Institute of International Economics, Hamburg. Idw (2004: Mittelstand in Deutschland †Stiefkind der Wirtschaftspolitik, Institut der deutschen Wirtschaft, Cologne:
Opportunities and Challenges In public-Private Partnership",in: Asia Pacific Tech Monitor, Vol. 24, No. 1, New delhi, pp. 32-37.
World Investment Report 2005: Transnational Corporations and the Internationalization of R&d, United nations Conference on Trade and Development, Geneva.
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