Sink or Swim: Connected Health Software

Grasping the Innovation Opportunities by Mitigating Risk

Ita Richardson

, Ahmed AbuBaker

, Patrick O’Connor

, Jerry O’Mahony

and Pádraig O’Leary

Lero the Irish Software Research Centre, University of Limerick, Limerick, Ireland

ADA-Security Ltd., Rockchapel, Co Cork, Ireland

Emergent Research Ltd., Hillcrest, Dromhale, Killarney, Co Kerry, Ireland

Keywords: Connected Health, Innovation, Risks, Mitigation, Malnutrition, Software System.

Abstract: Connected Health innovation can be an opportunity for companies to develop and grow, if they take

opportunity to develop solutions for healthcare. In this paper, we discuss a case study where a very small

company in Ireland developed a connected health solution, but in doing this, discovered a number of risks

which they faced. Working with a research from the University of Limerick (author 1), they developed

mitigation strategies to avoid these risks, and subsequently developed an updated version of their initial

connected health solution. This software, Global-MN, has been implemented by a charity in India, Varanasi

Children’s Hospital. We present information about both the initial and updated product, illustrating how

overcoming the risks has resulted in the company redesigning their product for a global market. Data entered

via this software is now providing Varanasi Children’s Hospital with information and analysis, which, in turn,

is allowing them to provide a better service and improve the nourishment of children in India.

1 INTRODUCTION

The term “Connected Health” describes a new form

of healthcare service that depends on technology

innovation to deliver healthcare. This is defined by

Richardson (2015) as:

Connected Health is where patient-centred care

results from process-driven health care delivery

undertaken by healthcare professionals, patients

and/or carers who are supported by the use of

technology (software and/or hardware).

The development and implementation of

connected health solutions cannot be undertaken by

technologists alone – it must be carried out hand-in-

hand with patients and healthcare professionals

(HCP). For any connected health solution to work

efficiently and effectively, the processes through

which they work must also be developed. Therefore,

while connected health products include software, e-

health (electronic health) and m-health (mobile

health), connected health must be recognised as a

much wider concept.

Furthermore, for companies to move into the

Connected Health market, they need to develop their

products with healthcare in mind. Many innovative

ideas have been proposed. With the global older

population growing dramatically, and the costs of

healthcare rising, connected health is an innovative

marketing opportunity. To support this growth, the

first author is on a Science Foundation Ireland (SFI)

Industry Fellowship, where she has worked for the

past 2 years (part-time) to carry out research within

ADA-Security. She has developed insights into how

connected health innovations should be structured so

that both the healthcare consumer and the company

can benefit. In this research (Richardson et al.,

2016a), we are also interested in understanding how

companies make the transition from one product to

the next. Through the case study presented in this

paper, we have been enabled to investigate how a very

small company can shift extensively to a different

product line through mitigating risk. This paper

discusses these mitigations which ensure that the

company could complete product development. Our

research question is:

What mitigations should a very small enterprise

implement to ensure success in the growing

Connected Health market place?

The remainder of this paper discusses how the

innovation process works for very small enterprises,

presents a case study, outlines the company

products, presents the research method used and

Richardson I., AbuBaker A., O’Connor P., O’Mahony J. and O’Leary P.

Sink or Swim: Connected Health Software - Grasping the Innovation Opportunities by Mitigating Risk.

DOI: 10.5220/0006104102130221

In Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2017), pages 213-221

ISBN: 978-989-758-213-4

213

discusses the risks faced and mitigations

implemented.

2 BACKGROUND

In Ireland, small-to-medium sized enterprises (SMEs)

account for 97% of all enterprises and the most

important contributors to the economy (Forfás, 2007).

The need for SMEs to become more innovative has

probably never been greater given the new

economies, new technologies, and hyper competition

with which they are challenged (Drejer, 2002).

Rogers (2004) regards innovation “as a key

ingredient in business success”.

Foster (1986) advocated that the diffusion of

innovation over time follows an S-Curve (Figure 1).

Under the S-Curve paradigm, firms go through

various stages in the diffusion of innovation (Silveria,

2001), namely start-up, scale, maturation (compete)

and decline (transition). Small to medium sized

enterprises (SMEs) experience different market

challenges at each stage ranging from survival and

market validation, transitioning to challenges in

increasing market share, and entering and expanding

into the new markets.

Figure 1: Double S-Curve Model (Squarespace, 2016).

SMEs need to recognise how to operate in markets

with constraints, e.g. regulatory challenges, so as to

retain their competitive advantage as they climb the

S-Curve. Coupled with the diffusion of innovation is

market adaptation, with particular attention being

given to the stage and the focus of the market at each

stage of the S-Curve. Credence must be given to the

market forces at play given the very strong influence

they may assert on the success of innovations in new

targeted markets (Bolton and Thompson, 2013).

3 RESEARCH PROJECT

In her role as an SFI Fellow, the first author of this

paper has spent 2 years part-time as a participant

observer within ADA-Security, a very small

enterprise in rural Ireland. Working closely with the

managing directors (authors 3 and 4), she studied

their connected health software development and

innovation processes. She carried out interviews,

attended meetings, discussed strategy, analysed the

existing product, Local-Health and was involved in

the development of their new product Global-MN.

4 CASE STUDY

ADA-Security is a company, whose focus has been

on installing security systems within homes and

companies nationally. It is a very small enterprise

located in rural Ireland, over 50 miles from the

nearest city. The local area has intermittent access to

broadband, which is not uncommon in rural Ireland

[Irish Farmers’ Association, 2015].

The directors noted an opening in the market for

the installation of home care systems, such as panic

buttons and home monitoring. Innovatively,

company has developed a number of services through

which people can feel more secure and cared for in

their homes. For example, they have developed

activity monitors which can detect inactivity – if an

older person has not risen by a certain time during the

morning, and alarm can be activated. Their service

also includes a friendly-call system which would have

someone ring the older person during the day,

reducing their feeling of social isolation. They now

provide a combination of security, social and

healthcare requirements.

Maintaining the security business and expanding

into home care systems have ensured that the

company has continued to be successful for over 2

decades. Examining the S-Curve in Figure 1, it is

obvious that the company have shifted from one ‘S’

to another – from security to home care systems.

However, as innovators, and to ensure

sustainability and continued growth of the business,

the directors were soon looking at other business

opportunities. They worked with the local

community, investigated requirements from older

persons and established that there is a need for further

healthcare support within their homes, which could

not be provided through hardware products –

software was needed for this purpose. In rural areas,

there is a growing trend towards home monitoring,

HEALTHINF 2017 - 10th International Conference on Health Informatics

214

with many ratified medical devices available for use,

by the older person in the home.

Home monitoring, then, brings with it another

need – that of transmitting biometric data such as

blood pressure measurement and blood sugar levels

to the patient’s health professional. General Practice

has the potential to change – at times, there may not

be a need for the patient, in this case the older person,

to travel to the practice to have these measurements

taken on a sporadic basis. Alternatively, they can take

their own measures and transmit these to medical

care. Consequently, ADA-Security directors, in

conjunction with another company, developed Local-

Health, a prototype for initial testing, with a view to

supplying the connected health market.

4.1 Local-Health: Biometric

Measurement System

Local-Health (described in Richardson et al., 2016b)

allows individuals to text their biometrics from their

mobile phone to the local General Practice. The

information is coded for reading by the bespoke

software where the text is received.

Figure 2: Blood pressure reading text message.

As an example, in Figure 2, the text message

shows a Blood Pressure (BP) reading of 70/120,

which was taken by the patient using a home blood

pressure monitor. The receiving system recognises

the mobile number from whom the text came, and the

data is collected within the General Practice.

The data is compared against an expected reading

for the particular patient. If the actual reading is

abnormal, an alert is sent to that user, asking them to

follow the suggested preventative advice, for example

to seek medical advice. An alert can also be sent to

individual users if they have not sent their results at

the time expected. The General Practitioner can

monitor each patient’s readings on a regular basis,

receive alerts if someone’s readings go out of control,

and conduct up a follow-up if they deem it to be

needed.

Through modifying their healthcare process, the

implementation of this simple connected health

solution has introduced technology for use within the

General Practice,. The patient no longer has to attend

the practice on a regular basis, for example, weekly,

and yet the Doctor and Nurse can effectively monitor

the patient. The consequence of this is that the patient

can be monitored without having to leave their own

home, while the queues and load for the medics in this

rural practice has been alleviated. The General

Practitioner can view their patient’s data as a line

graph e.g. blood pressure over a period of time.

Therefore, a trend is illustrated and support making

medical interventions in a convenient fashion.

4.2 Local-Health: Potential Business

Risks

As time progressed, the company directors

recognised a number of potential business risks which

arose with Local-Health system:

 Aimed towards individuals and small healthcare

practices;

 Market for Local-Health is national;

 ADA-Security expertise is in hardware;

 System developed on a known platform;

 Regulation required for the system.

Aimed towards individuals and small

healthcare practices: Once patients have mobile-

phone text available they can submit readings, and

they are not required to buy Local-Health software.

Software cost, therefore, is totally borne by the

healthcare practice. The expectation is that this will

become a high-volume, low-cost product. Due to

high software development costs, the business model

is not very cost-efficient.

Market for Local-Health is national: Due to

the nature of its hardware products, which includes

physical installation of security and social systems,

the company has dealt mainly locally and nationally.

The market needs to become international.

However, going global with a low-cost product can

be an expensive undertaking.

Company expertise is in hardware: Those

working in the company have a background and

experience in hardware installation and hardware

attributes. The nature of the new product requires

software engineering expertise. This has not been

readily available, and development to-date has been

sub-contracted. However, without in-house

expertise, other business requirements take priority.

System developed on a known platform:

Local-Health was to be used by older persons within

the local community and it was considered best to

develop the product as a mobile-phone text-based

system integrating with healthcare practice software.

While this works effectively, there is no income due

to selling product to individual patients.

Regulation required for the system: Within

their hardware business in the security industry, ADA

regularly implement regulations. Under European

Council (2007) directive, a medical device means

–

70-120

Sink or Swim: Connected Health Software - Grasping the Innovation Opportunities by Mitigating Risk

215

(amongst other things) “software… intended by the

manufacturer to be used for human beings for the

purpose of diagnosis”, and “software … is a medical

device”. As Local-Health is dealing with the

transmission, collection and diagnosis involving

patient data and HCPs, it is a medical device.

Regulations need to be integrated into the software

which is time-consuming and expensive, thus

pushing up the cost of production.

5 MAKING THE TRANSITION

Reflecting on the S-Curve (Figure 1), the Transition

required for ADA-Security to move from their main

businesses of security and home care systems to

Local-Health is substantial, and the company needs to

find a way to overcome the problems identified. They

had put many resources into the development of

Local-Health to both fulfil a social need and be

profitable. This was an opportunity for them to move

across to yet another ‘S’ curve which is vital for the

survival of any small company - it is the innovative

companies who survive. The leap from security

systems to homecare systems was achievable for the

company. The leap from their current offerings to the

Local-Health software system was difficult.

So how could the company get over this chasm?

How could they mitigate the risks they had identified?

Considering their options, the directors with the first

author of this paper made strategic decisions to

change the direction of the product, allowing the

company to develop a new innovation, while also

presenting opportunities to consider other markets

with which they could be involved. The following

modifications were made to mitigate the difficulties

identified above:

 Seek global market opportunities

 Develop solution for an organisation

 Acquire software engineering skills

 Investigate non-regulated possibilities

 Investigate mobile solutions

Seek global market opportunities: Global

opportunities present much larger markets than local,

and companies have the ability to expand beyond

their local area. For ADA-Security, the installation of

hardware systems provided the natural consideration

of national solutions. However, moving to a

software-based product provides the potential to

exploit global expanding markets. In particular, the

company recognised that developing countries can

offer large populations, therefore much greater sales

potential.

According to World Food Programme (WFP)

“there are around 800 million people in the world who

are malnourished” (WFP, 2016). This includes 200

million children under the age of five suffering from

undernutrition (USAID, 2016). A quarter of the

world’s malnourished children live in India (WFP,

2016), and there are 473,000 malnourished children

in Kenya (UNICEF, 2016). Charities and Non-

Government Organisations (NGOs) provide health

check-ups to diagnose malnourished children and

nutrition programmes to resolve the problem.

The development of a system, Global-MN, to

support nourishment programs globally has the

potential to provide a large market to ADA-Security’s

software solution.

Develop solution for an organisation: Local-

Health was developed for individual use, but, selling

to an organisation would be more profitable.

Therefore, charities in developing countries were an

opportunity that should be explored further, and the

development of Global-MN was undertaken. This is

an innovative mobile health software application that

can store, track and monitor details of malnourished

children.

NGOs hire Community Health Workers and

health clinics to reach children, test and diagnose

them, enrol them into nutrition programmes, and

schedule further visits to monitor their progress. The

test process normally includes taking the child’s

height, weight, middle-upper arm circumference

(MUAC) and age. To ensure user input to the

product, at development stage, ADA-Security teamed

with an Indian based charity, Varanasi Children’s

Hospital, whose work with these children has been

hampered by the following problems:

 The manual process currently used to document

children’s readings is time consuming, thus

decreasing productivity of Community Health

Workers;

 Retrieval of paper files when a child returns to

the nutrition clinic is cumbersome and difficult;

 Paper-based process does not support efficient

monitoring of children’s progress;

 Community Health Workers are unable to

identify previously registered children

As a result, Varanasi were not able to reach and help

as many children as they would like. Additionally,

there are difficulties in developing reasonable

statistics to show how effective the work of the

charity is. Varanasi were unable track how well

individual children are progressing, nor could they

see the success they are having in the field. Having

HEALTHINF 2017 - 10th International Conference on Health Informatics

216

matched this situation with Local-Health, a decision

was made within ADA-Security that Global-MN,

would initially support the nutrition program within

Varanasi Children’s Hospital.

The identified end users are Community Health

Workers, as Global-MN software will be downloaded

into their phones, allowing them to register and

perform screenings on malnourished children. The

second end user group are charity and NGO

management who ensure that their nourishment

programme is effective. Also, to obtain investment

from donors, they must demonstrate the effectiveness

of their program. Therefore, Global-MN will follow

a Business to Business (B2B) commerce model rather

than Business to Consumer (B2C) commerce model.

In the first instance, ADA-Security has developed

the product for Varanasi Children’s Hospital, with

plans to expand in the future to other charities

internationally.

Acquire software engineering skills: This

software-based innovation has potential to open

doors to a global market. While, through their

business and initial software development, they were

in a position to identify the innovation, ADA-

Security directors have recognised that they need to

acquire software engineering skills and make this

product a priority. The skills will ensure that the

product they develop is marketable, secure and

profitable. Therefore, to bring software engineering

to the development process, ADA-Security have

partnered with Emergent Research Ltd. (author 5), a

high performance start-up software company

headquartered locally.

Investigate non-regulated possibilities: While

Global-MN must be secure and private, it is not a

product that needs to be regulated. It is used to input,

track and analyse food-related information – for

example, information regarding children who are

malnourished and amounts of food. Therefore, it is

not a Medical Device and there are no regulations that

need to be considered during its development.

Investigate mobile solutions: Local-Health was

developed as a text-based system for the reasons

stated earlier. However, within the global market for

organisations within which Global-MN is being

targeted, a text-based system would have many

limitations, and a mobile internet-based product is the

better option. We have undertaken research which

demonstrates that there is internet coverage

throughout both India and Kenya, countries where

malnourishment programs with children are being

undertaken, demonstrating sales’ potential.

Additionally, the company needed to understand the

cheapest and most convenient method by which the

data could be transmitted. In rural Ireland, given that

there is often limited and sporadic internet access, the

solution for Local-Health was to text data via mobile

phone. In rural India, internet access is relatively

stable, and cheaper than using a mobile phone.

Therefore, Global-MH used the internet as its

platform. Entering data in this manner means that

once a child is registered with Varanasi Children’s

Hospital, their information is immediately available

to the central office. The effectiveness of the

program can be monitored on a regular basis.

Children who are not progressing as expected can

have their food source changed early on in the

program, and interventions by the central office can

happen quickly. Therefore, infant mortality rates are

affected positively in the long-term.

5.1 Global-MN: A Software Solution

Global-MN system is a web-based system with data

stored on a secure system in Ireland. This research

project was carried out as one action research cycle,

allowing the researchers to understand the difference

that the implementation of the software made in the

field and how the processes could be changed to make

a difference. The charity director was trained in

system use by author 3. He then travelled to India

where he trained the Community Health Workers.

They enter data to the system using software running

on a smart phone. This data can be aggregated and

analysed for Varanasi Children’s Hospital allowing

management to make informed decisions regarding

their malnourishment program..

6 Global-MN: MANAGING

MALNOURISHMENT

Using Global-MN, Community Health Workers add

children’s identification data and a photograph to the

system in the rural villages and collect measures to

determine malnourishment: MUAC, weight, height

and age. Malnourished children are started on a

special food program. They return to the clinic every

two weeks where their signs are re-measured, further

food provided, and updates added to the Global-MN

system. Figure 3 shows relevant screen shots from

the system. Once data is uploaded, management are

provided with data analysis, allowing them to observe

progress of children who are on the food program.

Sink or Swim: Connected Health Software - Grasping the Innovation Opportunities by Mitigating Risk

217

6.1 Data Analysis - Individual

Data illustrated is not real data to maintain

confidentiality. However, it illustrates how the

system can be used for the benefit of tracking the food

program for malnourished children.

In Global-MN, data is stored about individual

children, including: child ID, which is created by the

system when child is first entered, child name,

packets given to child per week, start weight, MUAC

and height, weight, MUAC and height at each clinic

visit, healthcare clinic to which the child is registered,

and status, which can be active or discharged. Thus,

the system allows the charity to visualise trends for

individual children.

As an example, Figure 4 shows the percentage

weight gained by individual children based on their

start weight. We have highlighted the data for one

child whose start weight was 3kg – this child gained

50% of start weight while on the program. Two

children weighing over 15kg at the start of the

program gained approximately 5% of start weight.

Most children gained between 10-25% of their start

weight, which is what would be expected from the

food program. Figure 5 shows the weight and

MUAC gain for a single child during 6 visits to the

healthcare clinic. As weight increases, so does the

size of the MUAC. This demonstrates that, for this

child, the malnutrition program is having a positive

effect.

Once a child attends the healthcare clinic, a target

weight gain is determined for him / her depending on

starting weight, MUAC and height. For the child

illustrated in Figure 6, it was expected the child would

gain over 4kg in the course of the program. However,

it can be seen here that actual weight gain is much

lower. With access to on-line real-time data, they can

make decisions about this child. It could be, for

example, that the child has an underlying condition,

in which case she / he can now be sent for medical

attention. Prior to Global-MN, this information was

not available, further diagnosis was missing, thus

perpetuating their problem.

Figure 3: (a) Top level menu (b) Adding child’s details (c)

Adding information for a child, including number of food

packets for that child (d) Information about existing patient

including photograph.

Figure 4: % weight gained based on start weight.

Figure 5: Weight (kg) / MUAC (cm) gained by child over 6

clinic visits.

HEALTHINF 2017 - 10th International Conference on Health Informatics

218

Figure 6: Actual weight gain mapped against Target weight

for a child.

Figure 7: Average MUAC gain per day during program.

Figure 8: Weight gain per packet.

Figure 9: Weight increases mapped against starting

weights.

6.2 Data Analysis - Collective

Data can also be aggregated to determine how well

the food program is working. This information is used

to ensure that children who can benefit are receiving

food and that the investment in food is having the

maximum required effect. In figure 7, the average

MUAC gain per day illustrates that MUAC is

increasing through the food program. Thirty-five

children (out of 56), 62%, gain between 0.11 and

0.20mm per day. Figure 8 illustrates children’s

weight gain per food packet distributed. Sixty-five

percent of children gained between 25-35g in weight

per packet of food. However, six percent of children

gained less than 15g per packet distributed. The

charity can now further investigate as to why

distributed food is not being effective.

Figure 9 shows data for discharged children

categorised by starting weight. The expectation is

that children’s weight would increase by 15-20% of

their starting weight. As can be seen in the graph,

48% of children who start at 6kg or less gain this

amount of weight. Sixty-two percent of children who

are in the 6.1-9kg category gain between 15-20%,

while 51% of those whose starting weight is greater

than 9kg gain similar amounts. Such aggregated data

allows the charity to delve deeper into the success and

difficulties within the program.

6.3 Case Study - Summary

To implement Global-MN within Varanasi

Children’s hospital, Community Care Workers had to

be trained in system usage to ensure that data was

being entered correctly. Initially, all records were

also held on paper, requiring extra work for everyone

involved. Trust in the system needed to be developed.

At this point, we, the researchers, have been enabled

to provide them with both individual and collective

data, allowing them to make changes within the

charity. For example, if a child is observed as not

gaining the expected weight within the program they

can be checked for other health issues. The analysis

regarding weight per packet mapped against start

weight is allowing the charity to consider whether

they give different amounts of food to children who

start with higher weights. They are collating data

which can be used to support arguments for further

funding for the charity.

Following the case study, the software is being

updated to make it more user-friendly and to provide

more on-line and visual reporting that currently exists

within the system. Both Varanasi Children’s Hospital

Sink or Swim: Connected Health Software - Grasping the Innovation Opportunities by Mitigating Risk

219

and ADA-Security are benefitting from the

implementation and analysis of this case study.

7 CONCLUSION

In Ireland and globally, it is recognised that

healthcare is a serious problem that needs fixing -

“healthcare is the greatest immediate threat to the

country” [USA]” (Chase, 2016). Many innovators

see connected health in a variety of forms as a means

to solving that problem. Innovators must decide the

best way to mitigate risks that arise, ensuring that the

return on investment is as expected. For the small to

medium sized enterprise, and certainly for the very

small enterprise, taking risks has a far-reaching effect.

Within ADA-Security, the directors recognised

and mitigated the risks being faced by the company.

Understanding that their business could grow

significantly they sought global market opportunities,

identifying that there was a need for data analysis and

tracking in programs in developing countries. Their

product needed to shift from supporting small to

supporting large and from solutions for individuals to

solutions for organisation. There are many NGOs

working with malnourished children in developing

countries, and, supported by a business plan, ADA-

Security are now marketing internationally. They

recognised that they needed to extend their skill set.

Rather than take on new employees, they have

partnered with Emergent Research to provide

software skills. A further risk was entering the

Medical Device software market which is heavily

regulated. While being cognisant of regulation, they

are developing software without having to obtain

European Union or similar certification. In bringing

in an established software partner, there are

documented software development processes in

place. From a technical perspective, the greatest

change was that of the platform upon which the

product would run - Global-MN is very different to

Local-Health.

Throughout their 25 year history, ADA security

have been an innovative company, expanding their

product base, growing and providing employment in

the local community. They recognised an

opportunity for innovation, and, in exploiting this,

have considered how to overcome the initial risks. In

conclusion, Global-MN has given ADA-Security a

further innovation opportunity. Considering the five

risks and developing mitigation strategies has

allowed them to leap the larger chasm between S-

curves. As they move forward on their innovative

journey, they can take the learnings from Global-MN

development to ensure that they can continue to

innovate and grow.

ACKNOWLEDGEMENTS

This work was supported by Science Foundation

Ireland (SFI) Industry Fellowship Grant Number

14/IF/2530. We would like to thank Pat McMahon,

Varanasi Children’s Hospital for invaluable

discussion.

REFERENCES

Chase, Dave, Why 98% of Digital Health Startups are

Zombies and What They Can Do About it,

http://www.forbes.com/sites/davechase/2016/05/18/w

hy-98-of-digital-health-startups-are-zombies-and-

what-they-can-do-about-it/#1f0ed5bf68f3, Forbes,

22th September, 2016.

Bolton, B., and Thompson, J., (2013) Entrepreneurs Talent,

Temperament and Opportunity, Routledge 3rd Ed.

Drejer, A.(2002) ‘Situations for innovation management:

towards a contingency model’, European Journal of

Innovation Management, 5(1), 4-17.

European Union Council, 2007, EU directive 2007/47/EC.

Irish Farmers Association, Supporting Farms and

Businesses in the Irish Countryside, 2015.

https://www.ifa.ie/wp-

content/uploads/2015/08/150805-IFA-Countyside-

Policy-Document-Final.pdf

Forfás (2007) “Towards developing a policy for

Entrepreneurship in Ireland”, Dublin.

Foster, R.J., (1986) Innovation: The Attackers Advantage.

New York: Summit Books.

Richardson I. (2015). Connected Health: People,

Technology and Processes, Lero-TR-2015-03, Lero

Technical Report Series. University of Limerick.

Richardson, Ita, O’Mahony, Jerry, Howarth, Paul,

O’Connor, Patrick, Glenny, Liam (2016b), Connected

Health: From Rural Ireland to Rural India, Software

Quality in Healthcare Systems, co-located with IEEE

International Conference on Software Engineering,

Austin Texas, May 2016, pp 39-42.

Richardson, Ita, Costin, Yvonne, O’Connor, Patrick,

O’Mahony, Jerry, Glenny, Liam (2016a) Connected

Health Innovation within SMEs: Understanding the

Marketplace, 4th International Conference on

Innovation and Entrepreneurship, Toronto, Canada, 28-

29th April, 2016, pp 63-71.

Rogers, M. (2004), ‘Networks, firm size and innovation’,

Small Business Economics, 22, 141-153

Silveira, G.(2001), ‘Innovation Diffusion: research agenda

for developing economies’, Technovation, 21, 767-773.

HEALTHINF 2017 - 10th International Conference on Health Informatics

220

Squarespace (accessed September 2016) http://static1

.squarespace.com/static/55d244b8e4b0f26e56cd2b32/t

/55e51df8e4b09f6b9550a6d9/1441078778831

WFP (accessed September 2016). World Food Program:

Hunger Statistics. https://www.wfp.org/hunger/stats.

UNICEF (accessed September 2016). UNICEF: Kenya.

http://www.unicef.org/appeals/kenya.html.

USAID, (accessed September 2016). Home: GLOBAL

NUTRITION. https://www.usaid.gov/what-we-do/

agriculture-and-food-security/supporting-global-

nutrition.

Sink or Swim: Connected Health Software - Grasping the Innovation Opportunities by Mitigating Risk

221