Adaptation of AHRQ patient safety indicators for use in ICD-10 administrative data by an international consortium.

Objective: The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSIs) for use with ICD-9-CM data. Many countries have adopted ICD-10 for coding hospital diagnoses. We conducted this study to develop an internationally harmonized ICD-10 coding algorithm for the AHRQ PSIs. Methods: The AHRQ PSI Version 2.1 has been translated into ICD-10-AM (Australian Modification), and PSI Version 3.0a has been independently translated into ICD-10-GM (German Modification). We converted these two country-specific coding algorithms into ICD-10-WHO (World Health Organization version) and combined them to form one master list. Members of an international expert panel-including physicians, professional medical coders, disease classification specialists, health services researchers, epidemiologists, and users of the PSI-independently evaluated this master list and rated each code as either "include," "exclude," or "uncertain," following the AHRQ PSI definitions. After summarizing the independent rating results, we held a face-to-face meeting to discuss codes for which there was no unanimous consensus and newly proposed codes. A modified Delphi method was employed to generate a final ICD-10 WHO coding list. Results: Of 20 PSIs, 15 that were based mainly on diagnosis codes were selected for translation. At the meeting, panelists discussed 794 codes for which consensus had not been achieved and 2,541 additional codes that were proposed by individual panelists for consideration prior to the meeting. Three documents were generated: a PSI ICD-10-WHO version-coding list, a list of issues for consideration on certain AHRQ PSIs and ICD-9-CM codes, and a recommendation to WHO to improve specification of some disease classifications. Conclusion: An ICD-10-WHO PSI coding list has been developed and structured in a manner similar to the AHRQ manual. Although face validity of the list has been ensured through a rigorous expert panel assessment, its true validity and applicability should be assessed internationally.

Scenarios for the milk production chain in Brazil in 2020

Brazilian milk production has grown steadily and in 2004 the country became self-sufficient in dairy production. This article develops possible scenarios for the milk production chain in Brazil for the year 2020 in order to contribute to decisions that must be made by stakeholders. A literature review on foresight and the use of scenarios was conducted, and a scenario writing approach based on Wright and Spers (2006) was adopted, which includes the use of the Delphi method, Michael Porter's Five Competitive Forces model, Interpretative Structural Modeling (ISM) (WRIGHT, 1991) and quantitative projections. This methodology provided four scenarios, with quantitative and qualitative elements: two exploratory scenarios ("milk, the new agribusiness star" and "a wasted future"), a most probable scenario ("continuous but uneven growth") and a desired scenario ("competitive family agriculture"). Overall, it is possible to note many market opportunities, as well as niche markets and the strengthening of cooperatives. Future prospects are also favorable to the dairy industry in general, but nearly all scenarios point to a concentration in the industrial sphere.

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.

OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. METHODS: We used the GRADE system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost), or clearly do not. Weak recommendations indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. RESULTS: Key recommendations, listed by category, include: early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures prior to antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock (1B) and severe sepsis without septic shock (1D); reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C); a usual 7-10 days of antibiotic therapy guided by clinical response (1D); source control with attention to the balance of risks and benefits of the chosen method (1C); administration of either crystalloid or colloid fluid resuscitation (1B); fluid challenge to restore mean circulating filling pressure (1C); reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion (1D); vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure > or = 65 mm Hg (1C); dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy (1C); stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy (2C); recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death (2B except 2C for post-operative patients). In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7-9 g/dL (1B); a low tidal volume (1B) and limitation of inspiratory plateau pressure strategy (1C) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure in acute lung injury (1C); head of bed elevation in mechanically ventilated patients unless contraindicated (1B); avoiding routine use of pulmonary artery catheters in ALI/ARDS (1A); to decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock (1C); protocols for weaning and sedation/analgesia (1B); using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening (1B); avoidance of neuromuscular blockers, if at all possible (1B); institution of glycemic control (1B) targeting a blood glucose < 150 mg/dL after initial stabilization ( 2C ); equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1A); use of stress ulcer prophylaxis to prevent upper GI bleeding using H2 blockers (1A) or proton pump inhibitors (1B); and consideration of limitation of support where appropriate (1D). Recommendations specific to pediatric severe sepsis include: greater use of physical examination therapeutic end points (2C); dopamine as the first drug of choice for hypotension (2C); steroids only in children with suspected or proven adrenal insufficiency (2C); a recommendation against the use of recombinant activated protein C in children (1B). CONCLUSION: There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improved outcomes for this important group of critically ill patients.

EURECCA colorectal: multidisciplinary mission statement on better care for patients with colon and rectal cancer in Europe

Background: Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012 the first multidisciplinary consensus conference about colon and rectum was held looking for multidisciplinary consensus. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. Methods: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Experts commented and voted on the two web-based online voting rounds before the meeting (between 4th and 25th October and between the 20th November and 3rd December 2012) as well as one online round after the meeting (4th20th March 2013) and were invited to lecture on the subjects during the meeting (13th15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. All sentences that were voted on are available on the EURECCA website www.canceraudit.eu. The consensus document was divided in sections describing evidence based algorithms of diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and stage IV separately. Consensus was achieved using the Delphi method. Results: The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members. Conclusions: It is feasible to achieve European Consensus on key diagnostic and treatment issues using the Delphi method. This consensus embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.

A methodological approach to identify teacher's ICT competencies in online learning environments in Higher Education

Aquest article pretén descriure el procés metodològic d'identificació i mesurament de les competències TIC dels professors i com a formadors en les TIC en un entorn d'aprenentatge en línia en l'Educació Superior portat a terme en el marc del Projecte Europeu Elene-TLC.La revisió de la recerca en les competències en línia del professor demostra que, en primer lloc, el mètode més utilitzat per a identificar aquestes competències és el focus group. En segon lloc, la tècnica Delphi és la tècnica més utilitzada per reunir el consens d'experts sobre quines són les competències principals per al professor en línia entre els que s'indiquen.La proposta metodològica descrita en aquest document consisteix en la creació de 7 grups de discussió en línia, l'objectiu dels quals era identificar les competències formatives dels professors en línia i les dels professos en línia. La llista de competències obtingudes posteriorment es va oferir als experts europeus que participaven en l'aplicació de la tècnica Delphi. A aquests experts se'ls va demanar que ordenessin les competències d'acord amb el seu grau d'importància.Els resultats mostren que els grups de discussió en línia i el mètode Delphi són les metodologies apropiades per a identificar les competències TIC dels professors universitaris en els entorns d'aprenentatge en línia.

Observations on Software Testing Practice

This thesis investigates factors that affect software testing practice. The thesis consists of empirical studies, in which the affecting factors were analyzed and interpreted using quantitative and qualitative methods. First, the Delphi method was used to specify the scope of the thesis. Secondly, for the quantitative analysis 40industry experts from 30 organizational units (OUs) were interviewed. The survey method was used to explore factors that affect software testing practice. Conclusions were derived using correlation and regression analysis. Thirdly, from these 30 OUs, five were further selected for an in-depth case study. The data was collected through 41 semi-structured interviews. The affecting factors and their relationships were interpreted with qualitative analysis using grounded theory as the research method. The practice of software testing was analyzed from the process improvement and knowledge management viewpoints. The qualitative and quantitativeresults were triangulated to increase the validity of the thesis. Results suggested that testing ought to be adjusted according to the business orientation of the OU; the business orientation affects the testing organization and knowledge management strategy, and the business orientation andthe knowledge management strategy affect outsourcing. As a special case, the complex relationship between testing schedules and knowledge transfer is discussed. The results of this thesis can be used in improvingtesting processes and knowledge management in software testing.

Measuring service quality in sport management: an application of the SERVQUAL scale

The aim of this study is to provide an instrument for measuring service quality in sports enterprises from the point of view of the customers. For this purpose we intend to elaborate an enquiry starting out from a more general scale called SERVIQUAL. We have limited our research project to sports enterprises where the customer participates actively, i.e., we have excluded sports clubs and other organizations which offer sport as entertainment. Our choice is mainly due to the fact that few studies have been carried out in this area and that sports has been earning an increasing amount of adepts during the last decades in Spain. The DELPHI method has been applied with the collaboration of a panel of experts in order to evaluate the viability and adequacy of the modified SERVQUAL scale.

Wireless e-Business Applications - Methods for Forecasting the Demand of Wireless Services and Technologies

Tämä tutkimus oli osa sähköistä liiketoimintaa ja langattomia sovelluksia tutkivaa projektia ja tutkimuksen tavoitteena oli selvittää ennustamisen rooli päätöksenteko- ja suunnitteluprosessissa ja määrittää parhaiten soveltuvat ja useimmin käytetyt teknologian ennustusmenetelmät. Ennustusmenetelmiä tarkasteltiin erityisesti uuden teknologian ja pitkän aikavälin ennustamisen näkökulmasta. Tutkimus perustui teknologista ennustamista, pitkän aikavälin suunnittelua ja innovaatioprosesseja käsittelevän kirjallisuuden analysointiin. Materiaalin perusteella kuvataan teknologian ennustamista informaation hankkimisvälineenä organisaatioiden suunnitteluprosessin apuna. Työssä arvioidaan myös seuraavat teknologisen ennustamisen menetelmät: trendianalyysi-, Delfoi-, cross-impact analyysi-, morfologinen analyysi- ja skenaario analyysimenetelmä. Työ tuo esille jokaisen ennustusmenetelmä ominaispiirteet, rajoitukset ja sovellusmahdollisuudet. Käyttäen esiteltyjä menetelmiä, saadaan kerättyä hyödyllistä informaatiota tulevaisuuden näkymistä, joita sitten voidaan käyttää hyväksi organisaatioiden suunnitteluprosesseissa.

EURECCA colorectal: multidisciplinary mission statement on better care for patients with colon and rectal cancer in Europe

Background: Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012 the first multidisciplinary consensus conference about colon and rectum was held looking for multidisciplinary consensus. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. Methods: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Experts commented and voted on the two web-based online voting rounds before the meeting (between 4th and 25th October and between the 20th November and 3rd December 2012) as well as one online round after the meeting (4th-20th March 2013) and were invited to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. All sentences that were voted on are available on the EURECCA website www.canceraudit.eu. The consensus document was divided in sections describing evidence based algorithms of diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and stage IV separately. Consensus was achieved using the Delphi method. Results: The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members. Conclusions: It is feasible to achieve European Consensus on key diagnostic and treatment issues using the Delphi method. This consensus embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.

The Future of Mobile Services and Wireless Applications in the Finnish Healthcare Sector

Työn päätavoitteena oli tutkia mobiilipalveluita ja langattomia sovelluksia Suomen terveydenhuollon sektorilla. Tutkimus havainnollistaa avain-alueita, missä mobiilipalvelut ja langattomat sovellukset voivat antaa lisäarvoa perinteiseen lääketieteen harjoittamiseen, ja selvittää, mitkä ovat tähän kehitykseen liittyvät suurimmat ongelmat ja uhkat sekä tutkimustuloksiin pohjautuvat mahdolliset palvelut ja sovellukset 5-10 vuoden kuluttua. Tutkimus oli luonteeltaan kvalitatiivinen ja tutkimuksen toteuttamiseen valittiin tulevaisuudentutkimus ja erityisesti yksi sen menetelmistä, delfoi-menetelmä. Tutkimuksen aineisto kerättiin kahdelta puolistrukturoidulta haastattelukierrokselta. Työn empiirinen osuus keskittyi kuvailemaan Suomen terveydenhuollon sektoria, siinä meneillään olevia projekteja sekä teknisiä esteitä. Lisäksi pyrittiin vastaamaan tutkimuksen pääkysymykseen. Tutkimustulokset osoittivat, että tärkeät alueet, joihin langaton kommunikaatio tulisi vaikuttamaan merkittävästi, ovat ensiaputoiminta, kroonisten potilaiden etämonitorointi, välineiden kehittäminen langattomaan kommunikaatioon kotihoidon parantamiseksi ja uusien toimintamallien luomiseksi sekä lääketieteellinen yhteistyö jakamalla terveydenhuoltoon liittyvät informaation lähteet. Työn tulosten perusteellavoitiin antaa myös muutamia toimenpide-ehdotuksia jatkotutkimuksia varten.

Transición a la vida adulta de jóvenes con discapacidad intelectual. La opinión de los profesionales de servicios escolares y postescolares = Transition to adulthood of young people with intellectual disabilities. Views of professionals from school and postschool services

La transición a la edad adulta y vida activa es un proceso extremadamente complejo para los jóvenes con discapacidad. Para plantear propuestas de actuación que mejoren sus oportunidades de conseguir objetivos relacionados con la inclusión laboral y social en la vida adulta es imprescindible el diagnóstico en profundidad del contexto en que se construyen y desarrollan los procesos de transición. En este artículo se presenta un estudio en el que se ha aplicado el método Delphi con el propósito de obtener datos sobre la adecuación de los servicios o dispositivos que trabajan con jóvenes con discapacidad a lo largo de su proceso de transición a la edad adulta y vida activa, tanto en el escenario escolar como en el postescolar. Se han constituido dos paneles de expertos, uno con profesionales del ámbito educativo y otro con profesionales que trabajan en servicios postescolares. En ambos casos, los ejes temáticos son: visión del proceso de transición, aspectos curriculares y organizativos de los servicios, existencia de itinerarios de apoyo sistematizados, trabajo colaborativo entre profesionales, acciones de orientación con familias, adecuación de las alternativas postescolares, la formación de los profesionales, y coordinación de servicios. El análisis de los cuestionarios permite constatar las principales dificultades percibidas por los expertos en cada uno de los ámbitos y establece líneas básicas de actuación para mejorar los procesos de tránsito, entre las cuales destaca la necesidad de reforzar el papel de los equipos multiprofesionales en la articulación de redes de trabajo interprofesional

¿Continuidad o fragmentación? Percepción de los profesionales sobre la coordinación entre servicios en los procesos de tránsito a la vida adulta de los jóvenes con discapacidad intelectual

This article is part of a research focusing on the process of transition to adulthood of young people with intellectual disabilities. Specifically, this study analyses transition partnership programs, as the professionals involved in them see them. The information is obtained in two stages: in the first stage 45 interviews to professionals working in this field are conducted. In the second stage we develop a study applying the Delphi method in which two panels of experts, the first one with educational professionals and the second one with professionals working with afters chool services, were asked about several topics. The results show a lack of continuity underlying the actions taken in support of young people with ID during the transition process. Insufficient information and collaboration among services and professionals and a lack of leadership are the main problems perceived by professionals. The study helps to identify problems in the transition partnership programs and establishes actions in order to enhance the transition process

Tulevaisuuden ennakointi liiketoiminnassa: Delfoi- ja skenaariomenetelmät

Tämän kandidaatintyön aiheena on tulevaisuuden ennakointi liiketoiminnassa. Yritysmaailmassa tulevaisuutta ja sen mukanaan tuomia epävarmuustekijöitä ei voida jättää huomioimatta. Tulevaisuutta ei voida tarkkaan ennustaa, sillä liiketoimintaympäristön muutokset tapahtuvat nopeasti ja niitä on paljon. Yritykset voivat kuitenkin varautua tulevaisuuteen tarkkailemalla aktiivisesti toimintaympäristöä. Tulevaisuudessa menestyminen vaatii toiminnan suunnittelua tarpeeksi ajoissa ja muutostekijät on otettava päätöksenteossa huomioon. Muutosten ennakointi ja niihin varautuminen voivat olla tärkeitä menestystekijöitä. Tulevaisuuden ennakointiin on olemassa erilaisia menetelmiä, joita voidaan käyttää muun muassa apuna päätöksenteossa. Tässä työssä keskitytään kahteen keskeiseen menetelmään, Delfoi- ja skenaariomenetelmään ja siihen kuinka niitä voidaan hyödyntää tulevaisuuden ennakoinnissa. Tavoitteena on selvittää myös tulevaisuuden ennakoinnin merkitystä liiketoiminnassa. Aiheeseen liittyen käsitellään heikkoja signaaleja, jotka voivat olla tärkeässä asemassa ennakoinnissa. Trendit, megatrendit ja toimintaympäristön muutosvoimat vaikuttavat myös osaltaan siihen, millaiseksi tulevaisuus voi muuttua. Työssä käydään läpi Delfoi- ja skenaariomenetelmien ominaisuuksia ja tekijöitä, joihin niitä käytettäessä tulee kiinnittää huomiota. Työn empiirisessä osassa arvioidaan Suomen paperiteollisuuden tulevaisuutta. Nykyhetken tilannetta arvioimalla ja tarkkailemalla voidaan havaita monia eri tekijöitä, jotka tulevat vaikuttamaan siihen, millainen tulevaisuus alan yrityksillä voi olla. Työn tuloksena voidaan selkeästi ymmärtää tulevaisuuden ennakoinnin merkitys liiketoiminnassa. Case-esimerkin perusteella voidaan todeta, että jos tulevaisuudessa halutaan menestyä, on sen varalle laadittava toimintasuunnitelmia. Suunnitelmissa on otettava huomioon monipuolisesti toimintaympäristössä tapahtuvia muutostekijöitä. Skenaario- ja Delfoi-menetelmien osoitettiin soveltuvan hyvin tukemaan yritysten tulevaisuuden toiminnan suunnittelua.

Análisis de los apoyos que reciben los jóvenes con discapacidad intelectual en su transición a la vida adulta en España: una investigación a partir de experiencias de profesionales y personas con discapacidad = Analysis of support received by young people with intellectual disabilities in their transition to adulthood in Spain: an investigation based on the experiences of professionals and people with disabilities

The objective of this study is to gather information regarding the adaptation of the range of socio educational projects and services aimed at the transition to an adult life of young persons with intellectual disabilities in Spain. The research of the study has been done in three stages. During each stage, a specific tool has been used. One to one in-depth interviews have been undertaken with 45 professionals and 20 individuals with intellectual disabilities. The Delphi method has been applied to two panels consisting of 20 experts each. Firstly, results focus on the approach to different issues related to the devices. Secondly, the training opportunities that these individuals receive to ease the transition period is addressed. And finally, the study refers to the participation of the individuals themselves and their families in the process. The developed analysis allows us to propose strategies to improve the transition to adult life

Public-Private Partnerships: Managing organizational change for acquiring value creative capabilities

The objective of the dissertation is to examine organizational responses of public actors to customer requirements which drive the transformation of value networks and promote public-private partnership in the electricity distribution industry and elderly care sectors. The research bridges the concept of offering to value networks where capabilities can be acquired for novel product concepts. The research contributes to recent literature, re-examining theories on interactions of customer requirements and supply management. A critical realist case study approach is applied to this abductive the research which directs to describe causalities in the analyzed phenomena. The presented evidence is based on three sources, which are in-depth interviews, archival analysis and the Delphi method. Service provision requires awareness on technology and functionalities of offering. Moreover, service provision includes interactions of multiple partners, which suggests the importance of the co-operative orientation of actors. According to the findings,portfolio management has a key role when intelligent solutions are implemented in public service provision because its concepts involve a variety of resources from multiple suppliers. However, emergent networks are not functional if they lack leaders who have access to the customer interface, have power to steer networks and a capability to build offerings. Public procurement policies were recognized to focus on a narrow scope in which price is a key factor in decisions. In the future, the public sector has to implement technology strategies and portfolio management, which mean longterm platform development and commitment to partnerships. On the other hand, the service providers should also be more aware of offerings into which their products will be integrated in the future. This requires making the customer’s voice in product development and co-operation in order to increase the interconnectivity of products.