UNIVERSIDADE FEDERAL DO RIO DE JANEIRO INSTITUTO COPPEAD DE ADMINISTRAÇÃO PAULO ROBERTO PEREIRA PINTO FILHO

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1 UNIVERSIDADE FEDERAL DO RIO DE JANEIRO INSTITUTO COPPEAD DE ADMINISTRAÇÃO PAULO ROBERTO PEREIRA PINTO FILHO MOBILE INNOVATION AND SERVICE DISRUPTION ON HEALTHCARE: THE STARTUP S ENTREPRENEUR PERSPECTIVE RIO DE JANEIRO 2018

2 MOBILE INNOVATION AND SERVICE DISRUPTION ON HEALTHCARE: THE STARTUP S ENTREPRENEUR PERSPECTIVE Paulo Roberto Pereira Pinto Filho Mobile Innovation and Service Disruption on Healthcare: The startup s entrepreneur perspective. Master s dissertation presented to Instituto Coppead de Administração, Universidade Federal do Rio de Janeiro, as part of the mandatory requirements to obtain the degree of Master in Business Administration (M.Sc.). Supervisor: Eduardo Raupp de Vargas, Ph.D. Rio de Janeiro 2018

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4 MOBILE INNOVATION AND SERVICE DISRUPTION ON HEALTHCARE: THE STARTUP S ENTREPRENEUR PERSPECTIVE Paulo Roberto Pereira Pinto Filho Mobile Innovation and Service Disruption on Healthcare: The startup s entrepreneur perspective. Master s thesis presented to Instituto Coppead de Administração, Universidade Federal do Rio de Janeiro, as part of the mandatory requirements to obtain the degree of Master in Business Administration (M.Sc.).

5 5 ACKNOWLEDGEMENT First, I would like to dedicate this work to my wife Amanda, who has always encouraged and supported me to fulfil my dreams, and to my son Felipe, who is still to be born but is already much loved. Second, I would thank my parents for teaching me the importance of always aiming for higher grounds. Third, I would like to thank my Supervisor, Professor Eduardo, for all support and comprehension, accepting to supervise a student who would not be able to stay in Rio de Janeiro along the duration of this work, but understood and provided guidance that allowed me to conclude the Master s. Fourth, I would like to thank all COPPEAD Professors that provided not only knowledge, but also a new way to see the human civilization, and all my colleagues and COPPEAD employees who helped me to get through all difficulties of the classes, group works, essays, exams, administrative issues, and so on. A final and special thanks to my grandma Iolanda, and my grandpa Fu - who had to left us but is certainly watching for us all the time.

6 ABSTRACT FILHO, PAULO ROBERTO PEREIRA PINTO. Mobile Innovation and Service Disruption on Healthcare: The startup s entrepreneur perspective p. Thesis (Master in Business Administration) - Instituto COPPEAD de Administração, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Innovation and healthcare are closely connected as new drug, equipment, disease treatment and service delivery are developed and adopted to bring value to stakeholders. Still, in the last decades, there is a concern about the constant increase of healthcare costs, being one of the main factors the adoption of the same technologies that were supposed to improve patient conditions. Being the innovation inaccessible, it is not bringing real value for patients. On the other hand, mobile technologies are allowing the creation of service platforms that link both technology and service innovation to provide high availability and lower costs in primary care. Can this trend disrupt the health care industry? In order to answer these questions, it was advanced a service innovation definition, which was articulated with disruptive innovation and innovation system insights. Thenceforth, it was made a revision of the literature of the last 10 years on healthcare mobile innovation to identify what the technology tendencies are. Healthcare based startup companies were chosen due to its innovative profile. A structured criterion was used to choose relevant from relevant startups. Their founders were interviewed and the information was submitted to the proposed theoretical framework. It is concluded that health care has the potential to be disrupted by mobile technology innovations, once they bring distinctive characteristics and competences, low costs, high availability, structured business models and immersed into the healthcare innovation ecosystem. The difficulties on determining potentiality to impact are related to the dynamicity of the startup environment, the lack of information sources and level of maturity of these companies are limitation for a more conclusive argument. Keywords: Healthcare, Primary Care, Service Innovation, Disruptive Innovation, ehealth, mhealth, Telehealth, Electronic Health Records, Smartphone, Internet of Things, Mobility.

7 LIST OF ILLUSTRATIONS Figure 1 - Characteristics-based representation of the product (GALLOUJ; SAVONA, 2008) Figure 2 - The Disruptive Innovation Model (CHRISTENSEN; RAYNOR; MCDONALD, 2015) Figure 3 - Visual representation of the Disruptiveness Potential on Service Innovation Framework Figure 4 - Graphical representation of the number of publications per year Figure 5 - Visual representation of the systematic literature review

8 LIST OF TABLES Table 1 - Selected Healthcare Startups from OpenStartup ranking...62

9 LIST OF ABREVIATIONS AHIMA C3N CPOE DSP EHR EMR EPR ESF FAPERJ FP GDP GSM HCAHPS HIS HIV ICT IoT IT MIS OECD PCMH PDA PHI PHR POM PPI PSF R&D RFID American Health Information Management Association Collaborative Chronic Care Network Computerized Provider Order Entry Dried Blood Spot Electronic Health Records Electronic Medical Records Electronic Patient Records Estratégia de Saúde da Família Fundação de Amparo à Pesquisa do Rio de Janeiro Foundational Premises Gross Domestic Product Global System for Mobile Hospital Consumer Assessment of Healthcare Providers and Systems Healthcare Innovation System Human Immunodeficiency Virus Information And Communication Technology Internet of Things Information Technology Management Information Systems Organization for Economic Co-operation and Development Patient-Centered Medical Home Personal Digital assistant Personal Health Information Personal Health Records Production and Operations Management Procurement of Innovation Programa Saúde da Família Research and Development Radio Frequency Identification

10 SDL SEBRAE SENAC SESI-RJ SME SMS SUS UBS VBS WHO Service-Dominant Logic Serviço Brasileiro de Apoio às Micro e Pequenas Empresas Serviço Nacional de Aprendizagem Comercial Serviço Social da Indústria do Rio de Janeiro Small And Medium Enterprises Short Message Service Sistema Único de Saúde Unidade Básica de Saúde Value-Based Purchasing World Health Organization

11 CONTENT 1 Introduction Research Question Objectives Study delimitations Brazilian Health Care Landscape Theoretical Review Service Innovation Disruptive Innovation Healthcare Innovation System Disruptiveness Potential on Service Innovation Framework Systematic Literature Review on Mobile Health Care Innovations e-health Description of Technical and Service Innovations Trends Telehealth Social Networks E-Learning Electronic Health Records Other Health Service Innovations Implementation and Adoption of Technological-Dependent Innovations Patient-value, Experience, and Empowerment Method Startup Companies Presentation Guepardo Sistemas... 76

12 5.1.1 About the company About the Entrepreneurs Describing the innovation Business model Oxiot About the company About the Entrepreneurs Describing the innovation Business model HelpBell About the company About the Entrepreneur Describing the innovation Business model VivaBem About the company About the Entrepreneurs Describing the innovation Business model Theoretical Framework Application Guepardo Sistemas Step 1 Distinct Competences and Characteristics Step 2 Disruptiveness Indicators Step 3 Innovation Ecosystem Oxiot Step 1 Distinct Competences and Characteristics... 93

13 6.2.2 Step 2 Disruptiveness Indicators Step 3 Innovation Ecosystem HelpBell Step 1 Distinct Competences and Characteristics Step 2 Disruptiveness Indicators Step 3 Innovation Ecosystem VivaBem Step 1 Distinct Competences and Characteristics Step 2 Disruptiveness Indicators Step 3 Innovation Ecosystem Theoretical Framework Assessment Conclusion References Appendix A. Interview Script A.1. Script in Portuguese A.2. Script in English

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