Healthcare Industry: IT Systems

Healthcare Industry: IT Systems Healthcare services have seen several changes throughout the years to respond to changing demands of the population. The present key drivers and issues that stakeholders (patients, healthcare providers, vendors and government) in the healthcare sector face are ageing population, increased burden of chronic conditions, rising public demand/expectation for quality healthcare, fragmented and uncoordinated healthcare services and rapid advances in information technology. At present, information technology is considered a strategic necessity by world class organizations instead of just a supporting tool. To obtain a competitive advantage in an environment with intense competition, it is vital for organisations to use more sophisticated information technology tools to address the challenges of building and deploying system in the short term and the identification, research and design of future system. Information technology (IT) is rapidly becoming integrated with healthcare to improve processes and communications, support decision making, reduce inaccuracies, and improve patient safety. The advancement of medical science through the years has made possible the use of more expensive equipment and the latest technology. This will allow healthcare providers and patients to gain access to health information easily and thus has the potential to improve the quality, safety, and efficiency of health care. As the healthcare industry is information intensive and knowledge intensive, there is also a need to publish health care information and knowledge. Healthcare systems vary from country to country but they all have a common aim that is to meet the healthcare needs of target populations. In this report, I will be focusing on healthcare IT in Singapore context. Healthcare System in Singapore Singapore has a dual health care system where individuals can choose between public and private providers. The government through Ministry of Health (MOH) manages the public healthcare system. MOH plays a major role in formulating national health policies, coordinating the improvement and planning of the public and private healthcare sectors and regulating health standards. MOHs mission is to promote good health and reduce illness, to ensure Singaporeans have access to good and affordable healthcare and to pursue medical excellence (Ministry of Health, 2007). MOHs vision is to develop the worlds most cost-effective healthcare system to keep Singaporeans good health. Delivery Structure Healthcare services in Singapore are provided by different types of providers from primary care to tertiary care and to step-down care. Primary Care Primary care includes primary medical treatment, preventive healthcare and health education (Info-communications Development Authority of Singapore, 2009). In Singapore, primary health care is provided through outpatient polyclinics and private medical practitioners clinics. 80% of the services are provided by private practitioners while the remaining 20% by government polyclinics. Conveniently located in town centres all over the island, polyclinics are one stop health centres which offered services such as outpatient medical care, maternal and child care health. Secondary and Tertiary Care For the secondary and tertiary care, 80% of the hospital care being provided by the public sector and the remaining 20% by the private sector. This public sector is organised into two vertically integrated delivery networks, National Healthcare Group (NHG) and Singapore Health Services (SingHealth) that operate as not-for-profit private companies. Having these two groups enable more integrated and better quality healthcare services through greater cooperation and collaboration among public sector health care providers. Each cluster consists of both general hospitals that provide multi-disciplinary healthcare services and specialised hospitals in various disciplines e.g. obstetrics and gynaecology and ophthalmology. The private sector provides similar specialist disciplines and comparable facilities to the public clusters. The two main providers are Raffles Medical Group and Parkway Group Healthcare (Info-communications Development Authority of Singapore, 2009). Step-Down Care Voluntary welfare organisations (VWOs) provide most of the step-down care services. They run nursing homes, inpatient hospices, community hospitals and chronic sick hospitals. Four of the public acute hospitals also provide geriatric units (Info-communications Development Authority of Singapore, 2009). Public Healthcare Delivery Structure One of the objectives of forming the two clusters is to facilitate integration of healthcare services at the various levels. The clusters have begun introducing measures to integrate primary healthcare at the polyclinics and secondary care at the hospitals. A Vision for 21st Century Healthcare Intelligent Nation 2015 (iN2015) is a 10-year masterplan to help Singapore realise the potential of infocomm. The vision of iN2015 is An Intelligent Nation, a Global City, powered by Infocomm. The goal for the Healthcare and Biomedical Sciences sectors is To accelerate sectoral transformation through an infocomm-enabled personalised healthcare delivery system to achieve high quality clinical care, service excellence, cost-effectiveness and strong clinical research. (IDA, 2006) Refer to Figure 1 in Appendix to see how it will look like. Key drivers of change in Singapores healthcare sector were identified and a number of likely shifts and changes to the system were predicted (IDA, 2006). Key Drivers Shifts/Changes Ageing population of chronic conditions Focus on prevention, health promotion and wellness care Rising public expectations of healthcare services Integrated and patient-centred system of delivery Fragmented and relatively uncoordinated healthcare services Consistent widespread application of evidence-based medicine Very rapid advances in infocomm, medical science and technologies and biomedical research Greater role of members of the public in managing their own health Greater facilitation of data flows between healthcare sector and biomedical sciences Strategies and Programmes (IDA, 2006) The targeted outcome is a well-integrated quality healthcare, cost effective healthcare services and greater ability of public to manage their health. To bring about successful business change using IT, healthcare providers should ensure that IT works in performance with meaningful changes in organisational functions and processes (Rothenberg, 1995). How IT can be used? In the healthcare industry, one suite solution is not common because certain user departments will need to have more in-depth functionalities than others. A more common approach in the industry is best of breed where it attempts to give full equal weight in terms of functionalities and features to individual user departments. Some considerations for best of breed approach are: It deals with more than one vendor A need to connect or interface the different applications to provide a fully integrated solution Future upgrades issues. Therefore, there is a need to strike a balance between having too many application platforms and departmental requirements or functionalities (Online Consultant Software). IT Infrastructure for the Healthcare Industry Functional interoperability is needed in order for computers to be able to share clinical data with one another. Computers must have functions to be able to physically communicate, send and receive documents and data files, share data and information. Therefore, there is a need for integration, standards and interface engines to build the healthcare industry infrastructure. MediNet MediNet forms the backbone of medical system in Singapore (IDA, 2006). It is Singapores nationwide computer network for medical and health care community that focuses on five components (Lim, 1990): Central Claim Processing System(CCPS) processing of claims in hospital bills National Patient Master Index (NPMI) consists of patients risk factors, drug allergies and demographic data Procurement Electronic procurement of medical and surgical supplies Notification Transmission of notifications to government agencies Information Services Access to local and foreign databases MediNet links up computer systems of all participants (MOH, Central Provident Fund Board (CPFB), Government Bodies, restructured hospitals, private hospitals, general practice clinics) in the healthcare delivery system so that they will be able to communicate, exchange data and access common applications on the network (ANNEX C: FACTSHEET: Infocomm Milestones, 2006). Health Level 7 A group of healthcare computer systems users who founded the Health Level 7 organization in 1987 started developing the HL7 protocol to create that common language that allows healthcare applications to share clinical data with each another. Over time the HL7 interoperability protocol became a nationally, internationally and globally accredited standard (HL7 Singapore). Health Level Sevens domain is clinical and administrative data. Interface Engine Interface engine is a software program intended to simplify the creation and management of interfaces between separate applications and systems, either within the organization or with other affiliated organisation (McLeod CG, Inc., 2006). It carries out messaging between systems and usually handles any mapping, translation and data modification required to ensure the effective exchange of data. Examples of common interface engines used in the healthcare industry are Cloverleaf, Datagate and Openlink (MDI Solutions, 2009). Imagine in a hospital where there are different departments needing different functionalities and features, different applications might be running. It would be very complex and technically difficult to maintain separate interfaces between them. Healthcare Applications Enterprise Resource Planning (ERP) The public healthcare sector uses SAP industry solution for hospital (IS-H) (SAP, 2008). It supports patient management, medical and nursing documentation, and patient accounting, and integrates these with financial accounting, controlling and materials management. The information system contains evaluations of patient and hospital data that can be used both internally and externally. It also contains a communication component that enables data transfer both within the hospital and to external parties. The picture below shows the SAP footprint in Singapore Healthcare Industry. Only Parkway Health (Private Sector) and Republic Polytechnic (for educational purpose) are not under the public healthcare sector. Source: (SAP, 2008) Case Study: Hospital Information System at St Andrews Community Hospital (InfoComm Singapore Portal, 2008) St Andrews Community Hospital was relocated in April 2005 to a larger premise in Simei. The change in hospital and care processes was the drive to upgrade the Hospital Information System (HIS) at St Andrews Community Hospital from its manual administrative system and record stock which require tedious work to a more efficient way to process information by technology. The project team were focused on being user-centric rather than IT-centric in the choice of an HIS. User departments were pro-active and committed during the pre-selection brainstorming and consultancy and during the implementation stages of the new system. The VESALIUS, a complete HIS provided NovaHealth which covers front-end modules such as Appointments, Registrations, ADT and billing and ancillary support modules such as Pharmacy, Medical Records, back-end Inventory and integration to the Financial System. The benefits of the system are: Assisting management to track costs down to the minute details Increasing efficiency as manual and administrative work are being minimised Enabling links to the MOHs Elderly and Continuing Care system for online submission of information to receive government subsidies; and the CCPS for automated submission for Medisave claims Serving as a check and balance for inventory audit and reducing waste. As a result, there is no need for Pharmacy staff to spend time physically checking stock levels when transferring items from the various stores in St Andrews Community Hospital. Having a lean and efficient team complemented by the HIS, paperwork is also minimised. An Integrated Electronic Medical Database Electronic medical record (EMR) stores patients medical information through IT to enable sharing across healthcare institutions (MOH; SingHealth; NHG, 2004). It can be made more secure through appropriate IT access and security safeguards. The MOH holds the vision of One Singaporean, One Family Physician, One Medical Record to improve long term care. EMR provides medical staff involved in patient treatment with quick and accurate access to patients essential medical information (Yong, 2007). The integrated patient database system was thus vital in Singapore as there is a need to get the right information to the right people especially in an industry where a second could mean a difference between a life and death situation. EMR Adoption Model The EMR Adoption Model is devised by HIMSS Analytics to track the progress of hospitals towards creating a paperless patient record system. It is based on an eight-stage scale which starts at zero (HIMSS Analytics). The EMR Adoption Model Structure ensures all application capabilities must be operational before that stage can be achieved as it sets a foundation for subsequent stages. Refer to Figure 2 in Appendix for the EMR Adoption Model. Electronic Medical Record Exchange (EMRX) EMRX is an initiative by MOH and the two public healthcare clusters (SingHealth NHG) to share electronic medical record across all public hospitals and polyclinics in Singapore. The EMRX will have the following information (MOH; SingHealth; NHG, 2004): Discharge summary which summarises recent hospitalization records including the treatment received and clinical course; Operation reports and laboratory results, including radiology images and scanned medical records Medicines prescribed with drug allergy history It was launched in April 2004 to focus on the improvement of patient care outcomes. It is a pragmatic and incremental implementation where SingHealth and NHG first developed the key systems within selected institutions and then replicate in other institution within the cluster and eventually across clusters and where practical with the private sector. The benefits of EMRX are (MOH; SingHealth; NHG, 2004): Better coordinated care for patients moving across different providers and improved levels of healthcare delivery. Better clinical decisions, with access to complete and legible clinical histories, and updated test results at the providers fingertips. Reduce the risks of transcription errors and missing records. Save cost through the avoidance of unnecessary repeat tests and investigations Better distribution of care Facilitation and follow up of other IT based applications such electronic prescriptions and clinical decision support systems Potential for 24 hour access to real-time data for up to date results reporting Provision for data security and audit features to be built into the system. Current EMRX Implementation The aim of the clusters is to implement the EMR in all institutions within each cluster incrementally. SingHealth and NHG manage their clusters EMR independently. SingHealth started using an EMR system in SGH in year 2000. The main application SingHealth has used to develop its EMR system is iSOFTs iClinical Manager Solution (E-HEALTH-MEDIA LTD, 2004). Similarly, the National Healthcare group has also started using EMR systems in Tan Tock Seng Hospital and National University Hospital. EMRX was developed to enable secure cross-cluster exchange of patient information. This is to ensure that a patients record can be retrieved regardless where he or she seeks treatment. EMRX was later extended to healthcare partners, providing a central capability for effortless movement or records across the public healthcare clusters, community hospitals and Ministry of Defence (MINDEF), facilitating care delivery. SAF Electronic Medical Records The SAF healthcare system is centred on the SAF EMR system which is known as Patient Care Enhancement System 2 (PACES 2). It has clinical data repository, administrative function for manpower and logistics and also has the feature for research or analysis (Wong, 2009). The system connects all SAF medical centres across Singapore to allow for online and real time medical info retrieval and simultaneous viewing. Figure 3 in Appendix shows how it is connected. NHG Polyclinic Bukit Batok Polyclinic was the first to adopt the electronic medical records system. With paperless medical records, patients medical records can now be retrieved while diagnoses are entered into the system (Hoe, 2009). This move is part of MOH vision of integrating services between the healthcare providers. Benefits to Patients: Enhanced safety as there is a reduced patient risk through improved legibility of orders. Reduced waiting times due to the improved process Better care coordination and disease management through sharing of medical records Benefits to the polyclinic: Quality: Continuous improvement of quality care and patient service through error monitoring and elimination of unnecessary procedures Productivity: Saving time and effort that would otherwise be spent on correcting lost and illegible orders. Furthermore, there is no longer need to go to the records office, retrieve the physical paper records and bring it up to either the doctors or nurses room which can take up to 20 minutes or half an hour. Access: More readily available information and data of patients for healthcare professionals to make faster critical decisions Future Outlook National Electronic Health Record (NEHR) The next phase of electronic health record is moving towards creating a health record that is in fact personalised and accessible everywhere to be implemented by April 2011 (ChannelNewsAsia, 2010). With NEHR, all key information such as a patients demographics, allergies, clinical diagnoses, medication history, X-rays, laboratory investigations and discharge summaries will be fully exchangeable between various healthcare providers. Due to the costly implementation, only a number of primary and step-down care providers, including GPs, polyclinics and a community hospital will be linked up first (ChannelNewsAsia, 2010). The full implementation of NEHR will take many years as it has to cover the entire healthcare ecosystem and not just the public sector. The decision on whether to implement each phase will have to be justified on cost-benefit analysis. Refer to Appendix for an attached article on What could healthcare in Singapore look like in 2020? (Ministry of Health, 2008). Medical Information Services IT is also widely used as an information tool by both medical professional and the public. Several government and privately initiated websites provide information for health care services and databases for medical related issues. Web portals provide the following services: Searching for medical professionals within Singapore The MOH has a list of online resources to search for healthcare professionals in Singapore (MOH, 2007) Online pharmacies For example, Changi General Hospital myPharmacy is the first online hospital pharmacy in Singapore (Changi General Hospital, 2004). Medical publications One example of medical publications is PubMed (PubMed). Health related publications Some examples of health related publications from SingHealth (SingHealth Academy ). Health service reports Queue watch provide patients with timely information to arrange their visit. The number of patients waiting for registration and consultation, live webcam images showing the waiting areas for registration, consultation and pharmacy/payment and peak non-peak periods are displayed online (Government of Singapore, 2007). Medical schemes such as Medifund, Medisave MediShield Information regarding these schemes can be found in CPF Board website (Central Provident Fund Board, 2009). Competitive Advantages The growth and survival in the healthcare industry depends on how well Singapore is able to compete in this highly and competitive market. With the integration of the healthcare infrastructure, the advanced medical technology and the highly skilled professionals, Singapore has managed to establish a reputation of being a world class healthcare hub, the ability to deliver innovative healthcare solutions, a complete range of services and quality healthcare providers (EDB, 2009). There will be a strong demand from the population for quality healthcare and value added services with rising economic affluence and longer lifespan. Thus, there is a need to ensure that healthcare research and development continues to be supported so that Singapore healthcare services sector can excel and be a source of competitive advantage. To sustain the competitive advantages, Singapore should be aware of their strengths and weaknesses and also of their competitors. The approach for the future must be one that focuses on possible improvements, supporting innovations and facilitating changes. The focus will have increasingly to be on openness to new influences, a willingness to recognize different schools of thought and methods of training and a search for the best available expertise from around the world (Desker, 1991). Innovation is needed to overcome the future challenges ahead to maximise Singapores competitive advantage. Healthcare providers should enhance their medical and service offerings, develop new healthcare products, and promote a pioneering spirit that will help in dealing with evolving patients needs, and in creating holistic and flawless experiences for patients (Tan, 2009). Thomson Medical Centre The Business Times reported that Thomson Medical is leading the healthcare sector (Ramchandani, 2010). Focusing on three core areas patient expectations, perceived quality and perceived value to improve patient satisfaction, Thomson Medical Centre has been continuously innovating to provide greater value-added services to its patients. Their redesigned patient-centric workflow had helped them gain a competitive advantage over their rivals: Use of technology and raise in service and product standards has improved patient care and satisfaction Improve in-patient , out-patient and administrative processes by using touch screen billing in place of a key-in method, which has halved the time spent on billing and has resulted in cost savings of $2000 a month. Reduce waiting time for admission and discharges with express check outs, direct admissions and courtesy and in-room discharges. Act on service recovery. When there is an unhappy patient with service, they move fast to resolve the problem. Train front line staff to raise service standards which resulted in an increase in the number of compliments as compared to complaints (4.9:1 to 9.2:1). Create a positive patient experience by having a resort style ambience, offering concierge service, a welcome drink and, in the case of premier rooms, luxurious dà ©cor and relaxing spa music. Introduce value added services such as the interactive website ThomsonBaby.com to help new mothers prepare for the parenthood journey and save them time and money. The hospitals efforts in cultivating lasting relationships have also led to an increase in patient loyalty. 32.2% of its patients were repeat patients in 2009, compared to 26.8% in 2008. Besides that, there was an increase in the number of babies born. Thomson Medical Centres dedication in understanding patient needs and receiving feedback on their stay and their expectations at key hospital touch points has thus improved patient satisfaction level. Challenges The vision for an integrated and continued patient- centric healthcare system requires interoperable IT systems, active engagement of patients and suitably aligned financial framework. In the development of the Singapore healthcare system, there are some issues that hinder the implementation of healthcare integration due to unique specificities. In general, the problems faced by the players involved can be classified into five categories: Clinical and medical practices: Often built around specialization but could be better oriented towards integrated care Financing framework: GPs, Specialist Outpatient Clinics (SOCs) and patients does not see the incentive for integration of care Establishment of a new idea mindset towards integration of care for players involved Organizational processes: Enhanced by bridging communication and IT gaps, coordinating across sectors and defining workflows for the smooth move of patients between caregivers IT systems: Better connected across sectors and allow for the transferability of patient records. As shown in Figure 4 in the Appendix, these challenges have over the years led to ingrained mindsets and behavioural practices of parties at multiple levels of the system, further hindering the integration of care (Ministry of Health, 2008). The various challenges and loophole that currently exist are the result of institution-centric and tertiary-centric system of healthcare. As EMRX becomes widely accessible, there are concerns over patient confidentiality and privacy. For instance, legal implications of providing EMRs beyond cluster boundaries were considerable and attaining consent from individual patients would have been burdensome and stalled widespread accessibility of EMRs (MOH; SingHealth; NHG, 2004). This shows that there are vital ethical concerns over the privacy of personal medical records. Furthermore, the infrastructure for data standardisation needed to achieve this integrated healthcare system is getting more intricate and costly due to the vast amount of data involved from different independent systems. Despite SingHealth and NHG adoption of the HL7 v2.3, data exchange could not be easily achieved in spite of HL7 v2.3. This is because the standard was open to variations that hampered direct interoperability. Moreover, modification of systems to enable data interoperability would have been costly, without direct benefits to the clusters (Lee, Lim, Tan). Conclusion Previously, healthcare sector has lagged behind other sectors in the adoption of IT for its key process. Healthcare providers need to review the way businesses are conducted. IT can be a powerful enabler for an information intensive industry like healthcare through automation, knowledge management, business process reengineering, and even artificial intelligence. A pragmatic approach should be adopted to consider the current status and to focus on implementing immediate goals that would bring about meaningful changes in organisational functions and processes within a reasonable time frame. The use of IT to create value in a patient-centric approach to care is likely to contribute significantly to the overall level of care that patients can benefit from. Innovation can help healthcare providers to gain a competitive advantage. The success of some healthcare provider as mention above has shown that IT can help in the healthcare sector to improve healthcare quality, reduce costs and to meet some of todays trends in demographics and disease burden. This quote which is published in NHG annual review 2007-2008 shows the importance of IT, Technology is our enabler. We use technology to record and disseminate information with higher precision, accuracy and safety. More importantly, it allows healthcare to be delivered safer, faster and better. (National Healthcare Group Polyclinics, 2008) In the enthusiasm to adopt and invest in IT, it is important to note that there are some barriers in the move toward an integrated healthcare system as stated in the abovementioned section. Addressing and overcoming these challenges will involve the collaboration and cooperation of players at all levels of the system, across both the public and private sectors. Learning points / Opinions Strategy Technology should be used as a supporting tool not to steer health care reform. To transform Singapores health care system into a modern and responsive 21st-century health care system, a practical IT strategy which is consumer-focused is needed. In particular, it needs to be competitive in terms of price and quality because that is what consumers look for. A tripartite model of health care regulation, involving the active participation of empowered consumers, is Singapores best hope for containing costs and ensuring quality of care. What is done well? A committee to plan for the future development in healthcare iN2015 Healthcare and Sub-Committee came out with strategies and programmes to help address todays challenge and support the developmental opportunities. It aims to achieve high quality clinical care, service excellence, cost-effectiveness and strong clinical research. Improve business process with IT IT has played an important role in the delivery and development of healthcare services in this information age with applications ranging from finance and personnel administration to medical equipment operations. Healthcare service administrations have become more efficient and responsive, reducing patient waiting time and paper work. Medical equipments have become more accurate, laboratory results can be processed more quickly and effective communication among medical staff in Singapore and those overseas has become easier. What more can be done User Involvement IT investment decisions must serve the best interests of the key players involved. It is important to understand the users and their work flow and requirements as a one size or solution may not fit all. Flexibility is needed as each department requires different functionalities. Express clearly the benefits and value for the change Users involved need to understand the strategic goals of the organization and understand how IT, from technical and managerial perspectives, can help to achieve them. The success of IT investments is to ensure users see the benefit and value of IT so that they will be motivated to make the change. Limitations of IT Healthcare providers should be mindful of the limitations of technology and have a deep understanding of the information search behaviours of their target audience. Health care is still a hi Are Consumers Central to Marketing Activities? Are Consumers Central to Marketing Activities? In view of the dynamic nature of the marketing environment, to what extent do you consider consumers to be, in practice, central to marketing activities? Words count: 1621 words Marketing is the analyzing, organizing, planning, and controlling of the firms customer-impinging resources, policies, and activities with a view to satisfying the needs and wants of chosen customer groups at a profit. (Kotler and Keller, 1967) [1] The main purpose of any business is to make profit. To do so, their customers are necessary. The role of marketing is to anticipate and identify consumers needs and wants, in order to satisfy them efficiently and profitably.2 In view of the dynamic nature of the marketing environment, to what extent are consumers, in practice, central to marketing activities? First of all, it is necessary to define what characterizes the marketing environment, and in what way this environment is dynamic. Secondly, we will see how the consumer is central to marketing activities. Finally, we will discuss about the relative importance of the consumers in these activities and the other factors that can also influence them. The marketing environment consists of external factors that affect the companies and their ability to satisfy customers.[2] There are two aspects to this marketing environment: the macro-environment, and the micro-environment. The PESTEL factors are the factors found in the macro-environment: political, environmental, social/cultural, technological, economical and legal.[3] They are societal factors, thus not controllable; and the companies need to adapt to these factors. In the macro-environment is included the demographical factor. The study of the demographic environment can help predict the size of the market of a certain product. For example if the number of elderly people is going to rise, the potential market for retirement homes will grow. The same goes for a change in the number of children, which could impact the number of schools and teachers needed.[4] Companies need to adapt to changes in the micro-environment as well. The factors in the micro-environment are the ones close to the company, making them easier to control: customers, competitors, distributors, suppliers, and other departments within the company.For example, if a company has competitors satisfying the same needs with a similar product but at a lower price, it wont be able to sell its product and make profit out of it. Companies make use of marketing research and marketing intelligence to collect information about the marketing environment in order to adapt their marketing strategies. Marketing takes place in a dynamic environment: these external factors change constantly, and companies need to be aware of these changes taking place in the marketing environment in order to adapt themselves efficiently and effectively, and be able to keep on answering consumers needs and wants.[5] To satisfy their target consumers, marketers need to understand them. They need to study the existing and potential markets. Resources need to be efficiently managed in order to meet the identified needs in these markets.2 Marketing orientation is important because different customers have different needs. In order to meet the specific needs of each customer, firms have to adapt. Answering everyones needs is not a realistic thing, which is why segmentation is used. Segmentation is the method used to separate the population into specific segments, which contains customers with similar needs. Understanding the needs of these segments of population will allow the determination of the marketing strategy that will be used in a specific business plan.[6] The marketing strategy determines the actions that will be taken over time to achieve the objectives of the company. Marketing decisions are based on the 4Ps, also called marketing mix: Product, Price, Place and Promotion. The four components of this marketing mix are determined by the target consumers.[7] As said before, the purpose of any business is to make profit, and it needs to satisfy the consumers for that to happen. The product needs to fulfil the customers need of course, but not only. The product also has to be at an acceptable price in the eyes of the consumers for them to buy it. The price is what makes money for the company, it is determined by the production costs and the competition, as well as by how much the customers are willing to pay for the product. On the one hand, if the price is too high, consumers wont buy, which means the company wont achieve its sales target. On the other hand, if it is too low, the target will be achieved but there will be no profit made out of it. 4 Price has to be chosen accordingly as well as place. Different types of consumers will need the product to be available at specific places. A very expensive product, such as a luxury item, will not necessarily be available at the local supermarket for example, but most certainly in a specific shop or place. Consumers also prefer to buy products when they are located close to their homes and workplaces.[8] In order to answer consumers needs profitably, marketers have to use segmentation to target their market, and match their marketing strategy to their target consumers needs.4 Thus making the consumers central to the companys marketing activities. Lets take Microsoft as an evolutionary example of changes in the marketing environment with the technological factor (macro-environment) and the companys competition (micro-environment).9 Recently, Microsoft has struggled to find its place in a fast changing digital and technological environment. Microsoft was and still is in consumers mind the leader in Personal Computers. They are now lagging behind competitors like Apple or Samsung, and are trying to develop other devices like tablets, smartphones, consoles, etc. They even acquired Nokias smartphone business in order to do so. They developed a new version of their operating system that works on every platform, including their console Xbox; which provides a cloud based connectivity that consumers are looking for. Their change in strategy to provide consumers what they need in this era of technological improvements has paid off: Microsofts sales are trending upward since the past few years.[9] In order to keep his place in the market, Microsoft had to change its strategy to improve its solutions to satisfy todays consumers after being left behind by competitors and technological advances. To this point, we can affirm that consumers are indeed essential and central to marketing activities. Marketing is all about satisfying consumers profitably, and marketing research and marketing strategies are calculated around them. Despite their importance, consumers are only one of the forces in the marketing environment. Changes in the marketing landscape are so fast that it is now more and more difficult for companies to adapt. One of the most influential factors of marketing activities is technology: 40% of the worlds population now has access to the Internet, compared to 1% in 1995.[10] The vast majority owns a smartphone that also has access to the Internet. The Internet and social media are thus also used for marketing purposes as well[11]: websites, adverts, e-mails, videos, etc. Influencers on the Internet are also important for marketing research; they can be people who have blogs and websites for example, and are useful to marketers for them to better understand current trends and interests.[12] Companies can also sponsor people such as bloggers and video makers (YouTube in particular) by making them review products and/or services online.[13] Globalization is another factor that influences marketing activities. Lots of companies now face global competition. Also, when a company decides to sell its products abroad, it has to take into account the tastes and habits of the selected country. For example, for the French market, Nutella is manufactured to be more spreadable, due to the fact that French people mostly eat it on baguettes, making it more difficult to spread.[14] Nowadays, companies also need to take into account the environmental aspect for their marketing activities. They have to be environmentally responsible, to be more sustainable in their practices than in the past. These are a few other examples of factors, apart from the consumers, that can have an influence on the marketing activities of businesses. To conclude, consumers are indeed central to marketing activities, but are only one of the many factors that have an influence on them: notably changes in the marketing environments factors; the technological factor in particular, which is probably the fastest changing factor as of now. References Berthon, P., Pitt, L., Plangger, K. and Shapiro, D. (2012). 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