What Is Healthcare Technology? Applications and Benefits

Healthcare and technology have been inextricably linked throughout history, but perhaps it’s now, in the digital age, where it’s most noticeable. That’s because people are keeping tabs on their health with everyday technologies—smartphones, apps, wearables, and video calls with clinicians—rather than waiting for an infrequent visit to a traditional healthcare facility.

Having such tools in the palm of their hand and attached to their body also makes people more likely to be proactive and preventative with their care, which, ideally, stands to improve population health and reduce the required spend.

More broadly, healthcare technology includes any device or system used to support patients, clinicians, health organizations, and any other body involved in the health and wellbeing of a person or population. This article will delve into the details of what exactly healthcare technology is doing to help these constituents—and where it’s headed.

What Is Healthcare Technology?

Healthcare technology encompasses the applications, systems, and tech infrastructure that supports and enhances almost every element of healthcare, including patient diagnoses and treatment, consultations, scheduling, medical records, medical imaging, surgeries, and clinical research. It also supports back-office functions such as inventory management, accounts receivable, and HR.

Various healthcare technologies are also being improved by developments such as AI, natural language processing, and blockchain.

Key Takeaways

• The intent to empower individuals is playing a huge role in how healthcare technology is advancing.
• Artificial intelligence will support providers, patients, and organizations in myriad ways as it develops.
• Some notions that seem straight out of science fiction—such as nanotechnology and 3D-printed cells and organs—will become accepted parts of our healthcare journeys.
• Efficiency and cost savings are key drivers behind the adoption of health technology, but the needs of patients—in terms of treatment, staying healthy, and engagement with professionals—remain paramount.

Healthcare Technology Explained

Technology is all about helping people, be it patients, care givers, or administrators.

For those receiving care, healthcare technology can be in the palm of their hand in the form of a phone that enables them to schedule appointments or use any number of healthcare apps. It could be the fitness tracker on their wrist that they consult while going for a run or just to count their steps. It could be the laptop where they check their patient portal to securely access test results, prescriptions, and more.

For those providing care, different kinds of IT help ensure that they have the most relevant information at their fingertips. Easily accessible electronic health records (EHRs), for example, inform clinicians of existing patient conditions and meds they need to take into account. And of course there are all kinds of systems for diagnoses, telemedicine, remote patient monitoring, surgeries, and other medical uses, outlined in more detail later in this article.

As with the players in any other major industry, healthcare providers use applications, sometimes augmented by advanced data analytics and natural language user interfaces, to support back-office functions, such as billing, payroll, accounting, recruiting and onboarding, inventory management, and procurement.

There isn’t a single area of healthcare that doesn’t already benefit from technology; the above examples are just the briefest of snippets.

The Evolution of Healthcare Technology

The move from paper to digital records, still ongoing in some parts of the world, has been a major industry breakthrough, helping clinicians, pharmacists, and other allied health professionals treat and coordinate care based on a holistic view of each patient’s medical history. The sharing of information online also means that medical researchers worldwide can work together to drive progress, as seen during the COVID-19 pandemic, when vaccines that could take up to a decade to develop under normal circumstances took just a matter of months.

Such is the degree of connectivity in today’s world that you don’t even need to be in the medical profession to contribute. If you have a smart watch or wearable device that reports your heart rate, blood glucose levels, blood pressure, weight, calories burned, and other variables, you’re adding to the raft of data that can be used to personalize your healthcare as well as be anonymized and contributed to population-level research.

It’s increasingly likely that healthcare providers and researchers won’t carry out these and other analyses themselves. They will instead start using AI, embedded into health systems, applications, and devices, to expedite and improve diagnoses, treatments, and back-office operations. We will cover AI and machine learning in greater depth later in this article.

The Benefits of Technology in Healthcare

There are numerous potential benefits to technology in healthcare. Across all industries, technology is developed mainly to speed up, improve the quality and accuracy, and cut the costs of a variety of processes, while automating mundane tasks to free people to do higher-level work. Where healthcare differs from other industries is these marginal—and not-so-marginal—gains can be the difference between life and death.

• Improved efficiency. Timing is especially crucial in healthcare, so making processes as efficient as possible is an absolute must. This is keenly felt with EHRs, which can be accessed by all the medical providers that need to see them. Say a person is rushed unconscious to the ER: A clinician can check for any preexisting conditions or allergies and begin treatment immediately. Compare this to the previous norm of having to ascertain who held the patient’s paper medical documentation, contacting them, and then getting the information through, all while the person is lying on a gurney awaiting attention.
  
  Improved efficiency is also felt within hospitals relating to staff and equipment. By collecting and analyzing data that suggests when busy periods are likely to occur, for example, weekend evenings for ERs, hospitals can help ensure that they have the appropriate number and type of staff on hand. Similarly, if there are times that are generally less busy, organizations can make sure they don’t overstaff. Also, by monitoring bed occupancy, hospitals will know if they have spare capacity and when they can assign maintenance services to clean a room that’s just been vacated so that it’s readily available for the next occupant.
• Enhanced communication. Enhanced communication isn’t just about having a video consultation with your physician rather than talking on the phone (though we do cover this in more detail in the section on telemedicine). More broadly, it’s about making information from a range of sources available to patients.
  
  Online patient portals let people access their test results and prescriptions anytime they wish, as well as set up notifications about upcoming appointments or payments due. They also give patients another way to contact their medical team if they have questions about tests, prescriptions, appointments, sudden health maladies, or anything else.
  
  These portals give people a greater sense of autonomy, while freeing up admin staff to take urgent calls and freeing doctors to deal with emergencies and spend more face time with patients.
• Advanced diagnostics. Advanced diagnostic systems help clinicians and researchers determine the disease, infection, virus, or other health condition that’s present. Factoring in each patient’s medical history, lifestyle, and in some cases genetics, they correlate the symptoms a patient is displaying with those managed before in other patients to arrive at a treatment plan.
  
  Consider the simple example of a patient complaining of excessive thirst and urination. A clinician would run a blood test to check for glucose levels and factor in the patient’s weight, eating habits, and family medical history to assess whether the patient has prediabetes. They would then decide whether preventative measures, such as reducing carbohydrate intake and exercising more frequently, could forego the onset of Type 2 diabetes. More complex diagnoses require more sophisticated, often genetics-based data analysis.
  
  AI also has a huge role to play in advanced diagnostics, as it can model massive amounts of data that could take human specialists months or years to assemble and analyze.
• Personalized treatment. Traditionally, treatments have had a one-size-fits-all feel to them. But with personalized medicine, clinicians customize their care to each patient’s unique physiology, medical history, and needs.
  
  The most sophisticated form of precision medicine involves sequencing an individual’s genome, now easier and more affordable than ever before. Such analyses could lead a clinician to prescribe drug X instead of drug Y or dosages that are more likely to be effective for that particular patient.
  
  At a presentation at an Oracle conference some years ago, a noted physician told the story of an 18-month-old girl suffering from debilitating neck, leg, and arm weakness who was incorrectly diagnosed to have an autoimmune disease. Her condition (predictably) worsened. Only after the toddler’s blood was drawn and her exome was sequenced was it revealed that she was missing a gene that transports Vitamin B2 (Riboflavin), a lack of which can cause progressive neurological weakness and, eventually, death. Treated with a high dosage of off-the-shelf B2, the girl recovered fully within eight weeks. The outcome would have been very different had it not been for the personalized treatment.
• Patient empowerment. Long gone are the days when patients would just do what clinicians told them to do. Given the health information patients can gather from wearables, access on their care providers’ portals, and consume on authoritative medical websites, apps, podcasts, and other sources, patients are more informed than ever before. Not to self-diagnose, mind you, but to take steps on their own to improve their diets and lifestyles, as well as gather information to ask their clinicians more informed questions.
  
  It’s not only in the management and treatment of conditions where technology has benefited patients. The whole experience—scheduling appointments, accessing test results, getting answers to basic health questions—has become less frustrating thanks to various technologies.
• Reduced likelihood of medical errors. Healthcare involves many moving parts, introducing numerous points at which errors can occur, be it by the provider directly or as a result of an ineffective process. These can lead to patient harm and additional costs, so the advancement of healthcare technology to support healthcare practitioners is a welcome one.
  
  It could be in the form of computerized provider order entry (CPOE), where all treatment instructions are entered into a single system that anyone involved in the process can access, helping them know what actions have been taken—such as drug dispensation—and which are still to take place so that stages aren’t repeated or missed completely. Clinical decision support (CDS) can sit within systems to prompt clinicians if something about their actions appears unusual, such as failing to undertake a part of the diagnostic process. Often, it will be for a specific reason in that scenario—for example, blood samples were taken yesterday, so they don’t need to be taken again—so the alert can be overridden. But it can also act as a checkbox in case a process or order has slipped a clinician’s mind.
  
  Even on the most basic level, healthcare technology advancement can help to reduce the likelihood of medical errors. It has become a joke that doctors have bad handwriting, but when that handwriting means that a pharmacist provides the incorrect dosage or an incorrect treatment is performed, the benefits of having everything rendered electronically cannot be underestimated.
• Medical research and innovation. As mentioned earlier, advances in healthcare technology helped to speed up the process of developing vaccines for COVID-19 by connecting experts and allowing AI to analyze potential combinations that could lead to a product with high efficacy.
  
  Technology platforms let researchers assemble clinical trials more quickly by enabling them to build their own studies when they need them rather than having to rely on third parties. They also let researchers add all the elements they need and make mid-study changes if required.
  
  Once it’s time to involve patients in studies, technology allows for a decentralization of clinical trials in cases where patients and doctors don’t need to meet in person. Data can be collected anytime, and the study will be more reflective of real-life conditions, as participants are monitored during their day-to-day tasks.
• Cost savings. Various healthcare technologies can reduce the cost of care. Here are several examples.
  
  Telemedicine (more on this subject later) lets patients consult with their clinicians without having to take time off work or pay to travel and park at a venue of care, while reducing unnecessary and expensive emergency room visits. Likewise, remote patient monitoring (more later)—whereby glucose and heart rate monitors and other wearables regularly stream patient data to care providers—is known to reduce hospital visits by improving care coordination and making it more likely patients will consistently take their meds and do other preventative measures.
  
  EHRs help medical practices avoid printing, filing, paper storage, and other administrative costs. As with the example of the 18-month-old patient cited earlier in this article, genome sequencing and advanced diagnostic systems remove a degree of costly trial and error when diagnosing and treating patients.
  
  Automating routine administrative tasks (more on this later), such as scheduling appointments, sending reminders, filling out forms, entering patient notes, and billing for services also reduces costs. Data analytics augmented by AI can help hospitals and practices avoid ordering too many or too few supplies by reducing forecasting errors.

Understanding Types of Healthcare Technology

Health organizations are starting to use technologies such as AI, cloud computing, and blockchain that first gained traction in other industries, while adopting technologies more specific to patient care, such as medical wearables.

• Artificial intelligence (AI)
  Healthcare providers are starting to use AI to render a variety of services and perform certain procedures and tasks.
  
  AI is being used in diagnostic systems, whereby AI algorithms analyze medical imaging data—for example, flagging a tumor on a mammogram that’s confirmed by a pathologist, so the next time the program sees that kind of growth it will know it’s more likely to be a tumor, speeding up future diagnoses.
  
  Surgeons use robots augmented by AI to help with various procedures, controlling the robot’s mechanical arms while viewing the surgical site, magnified in 3D, on a computer console next to the operating table.
  
  Another application of the technology is for population health management, whereby AI analyzes vast amounts of data at a community, state, or country level to identify non-obvious patterns. AI is also being used in drug development to predict side effects and identify potentially ideal candidates for clinical trials. Medical researchers use AI to speed up drug discovery by scanning through reams of data on available chemicals and their compatibility.
  
  Hospitals and practices use conversational AI-based chatbots to assist patients faster—for tasks such as scheduling appointments, refilling prescriptions, and providing post-op instructions—while reducing their customer service costs.
• Blockchain
  Blockchain, a digital ledger technology that lets select participants securely share and update important data, has great potential in healthcare. The technology works by anonymizing each data transaction and adding it as a separate, encoded block to the ledger that is available to everyone involved in the process. This structure allows real-time access for authorized users and helps ensure that the information remains tamperproof as any changes need to be approved by those with access permissions.
  
  EHRs can be added to a blockchain and accessed by patients and their care teams. Pharmacists can check the provenance of a medicine by tracking it all the way back to its creation. Medical professionals can be onboarded quickly through an accelerated check of their credentials and qualifications. Life science researchers can collaborate on encrypted genetic information to create new medicines.
• Cloud technology
  Cloud computing is becoming the platform upon which all healthcare technology development is based. Among its many advantages over on-premises applications and systems: It allows for real-time access to information from any location for patients, clinicians, and other relevant healthcare professionals. Cloud services also let health organizations cede system management, maintenance, upgrades, and security—and the scaling of those services—to third-party experts, freeing them to focus more on patient care.
• Telemedicine
  The US Health Resources and Services Administration defines telehealth as “the use of electronic information and telecommunication technologies to support long-distance clinical healthcare, patient and professional health-related education, health administration, and public health.”
  
  Telemedicine benefits healthcare providers in a number of ways. It helps improve efficiency, cut costs, enhance clinician-patient engagement, and improve care decisions, in part by letting patients consult with their doctors, discuss test results, schedule appointments, take training courses, and perform other tasks via video calls and online portals.
• Remote monitoring
  Remote monitoring, or patient monitoring, is a subset of telehealth. With this technology, patients no longer need to go into traditional venues of care to provide their doctor or other clinician with information on their chronic or acute medical conditions. Instead, care providers can capture patients’ heart rate, blood pressure, glucose levels, oxygen saturation, and other information directly from medical devices attached to patients and/or held in their hands. Remote patient monitoring saves time, keeps patients away from other contagious patients, and allows for a more regular flow of information on which to make medical decisions.
  
  Remote monitoring can be carried out using apps on connected consumer devices, such as a smartphone or smart watch, or something more specialized, such as wearable sensors, glucometers, smart inhalers, apnea monitors, and blood pressure cuffs, depending on the information required.
  
  Some monitoring devices require patients to self-test periodically. Others continuously take measurements and send them directly to the patient’s EHR.
• Interoperability
  Interoperability allows health professionals across the continuum of care to access, exchange, and use data in a coordinated way, making the healthcare experience less arduous for both them and their patients. Interoperability can exist across organizations and geographic areas, meaning that healthcare data can be accessed by the relevant people wherever they may be.
  
  The challenge is that healthcare organizations use different systems from different vendors that may not store and share data in the same way, making interoperability harder to achieve. This is why standards such as FHIR (Fast Healthcare Interoperability Resources) are important.

5 Healthcare Technology Applications

We’ve already touched on ways that healthcare technologies can be applied practically, but in this section, we’ll look a little deeper at how they support clinicians, surgeons, administrators, pharmacists, and the population as a whole.

1. Administrative health tech
   A variety of applications, some of them connected to patient EHRs, help health organizations manage administrative processes. Those include scheduling clinicians and patient visits, checking patients in and out, informing staffers when beds have been vacated and scheduling cleanup, billing for services, replenishing inventories, and overseeing outpatient care.
2. Surgical technology
   We’ve already mentioned how surgeons can sit near their patients and manipulate robotic arms to physically carry out an operation. This technology could be a gateway to performing surgeries over far distances. Developments in ever-smaller cameras allow for more laparoscopic (or keyhole) surgeries to be performed, reducing the risk of infection, saving time and resources, and giving the patient a shorter recovery period. Video streaming systems allow for remote observation of surgeries.
   
   3D printing can be used for custom-made implants and replacement joints, reducing the discomfort that can occur from off-the-shelf models. Augmented and virtual reality systems let trainees and surgeons practice in a safe but realistic space. Other surgical technologies include medical imaging systems, sterilization equipment, and lasers and ultrasonic instruments that help surgeons cut and seal tissue.
3. Drug development
   Earlier, we covered how AI-based technology is supporting life scientists in the development of drugs by playing matchmaker among all the available chemicals. This is only going to increase as more data sets get onboarded.
   
   When it’s time to run clinical trials with people, a range of applications help pharmaceutical companies build and refine studies, tap EHR and other data to recruit diverse sets of qualified patients, streamline workflows, harmonize data, manage drug inventories, keep trials within budget, identify safety issues, and, later on, support product commercialization and regulatory compliance.
   
   Meantime, the drug testing process has changed radically—from prospective medicines being tested on animals to testing them in vitro (cells in a dish), ex vivo (whole organs in support systems), and in silico (simulated “digital twins”)—giving more accurate results in a speedier and more ethical way. (More on digital twins below.)
4. Fitness
   Fitness wearables, such as tracking bracelets and feature-rich smart watches, aren’t new, but their applications are developing beyond recording how many steps users have taken in a given day or the times for their most recent 5K runs. They can also collect such data as blood sugar levels, heart rate, and blood pressure, which can be shared with medical professionals to help calibrate personalized treatments or, in extreme cases, recognize symptoms that could lead to critical medical events if not treated promptly.
   
   Other kinds of wearables, such as shoes, socks, and chest bands, can gather more data. Smart screens can act as personalized fitness coaches. Connected bikes and treadmills let people attend fitness classes from their homes, and the whole process can be gamified by taking data and assigning points, benchmarks, and prizes to encourage individuals to keep pushing themselves.
5. Diagnostics and error reduction
   Diagnostic systems connected with other health solutions help reduce medical errors by letting multiple doctors share clinical insights and diagnostic results, so that they can coordinate diagnoses and subsequent care. With machine learning algorithms, error detection can get even smarter and sharper, based on analyses of larger pools of data.

Trends for the Future of Healthcare Technology

Historically, the healthcare sector hasn’t been the quickest at embracing new technologies, given providers’ reliance on old, trusted methods and their concerns about adding costs, including training. However, most health organizations can’t justify putting off adoption of certain advanced technologies for much longer.

• Generative AI
  Generative AI (GenAI) is a subset of machine learning that lets users rapidly create human-like audio, writing, images, video, software code, and other content in response to text prompts. In the healthcare sector, one example of GenAI use is in digital assistants, which let clinicians access patients’ EHR information via simple voice commands, such as “Show me the patient’s latest blood test results.” Likewise, patients can use such assistants to schedule an appointment, pay a bill, and get answers to basic medical questions.
  
  Or consider the example of a physician using a mobile app to record a patient consultation for the purposes of updating the patient’s EHR. GenAI embedded in the app prompts the physician on areas that still need to be completed, which they can do with conversational language, reducing manual and time-consuming note-taking and follow-up administrative work that physicians must complete for every patient visit.
  
  GenAI is also being used in drug development, helping to design and generate molecules with the required properties and forecast possible side effects. Life sciences companies can also use the technology to produce synthetic data samples based on real-life data sets.
• Nanotechnology
  While nanotechnology may sound like science fiction, its application in healthcare is science fact. Defined as the technology that deals with dimensions of less than 100 nanometers—especially the manipulation of atoms and molecules—nanotechnology is used in healthcare for both diagnoses and treatments. For example, clinicians can give patients so-called smart pills—“lab-on-a-chip” vessels with many tiny sensors—to identify cancers. And they can use nanotechnologies carrying microscopic anticancer molecules, customized for the recipient, to target tumor sites.
  
  Nanotechnology can also be used in prevention. Surfaces can be coated in molecules to stop infections from happening, while its usage in the treatment of excess fat, visual rehabilitation, and bone reinforcement can help stop the development of illnesses generally associated with the elderly.
• Digital therapeutics
  The Digital Therapeutics Alliance defines this category as the delivery of “medical interventions directly to patients using evidence-based, clinically evaluated software to treat, manage, and prevent a broad spectrum of diseases and disorders.” Also known as DTx, digital therapeutics can be used on their own or to complement conventional medicines and therapies to help prevent, manage, or treat illnesses and disorders.
  
  Roughly speaking, DTx is a mix of personalized medicine and remote patient monitoring, to the extent that DTx programs take readings from wearables and other connected medical devices and recommend personalized coaching and support. For example, if a diabetic’s glucometer readings indicate the patient isn’t managing their blood sugar levels well, a DTx program might direct that patient to a nutritionist for a diet adjustment and/or to a community support group.
  
  Gamification can also be included, especially if patients agree to healthcare payers and providers being looped into their data, providing a carrot instead of a stick to incentivize healthier lifestyles.
• Chatbots and virtual care
  As discussed earlier in this article, natural language chatbots can be used to book and prepare for appointments, query and populate EHRs, triage patients, and answer basic medical and administrative questions. They can also be used to onboard patients, refill prescriptions, provide education, collect patient feedback, and for a variety of other purposes.
• Digital twins
  Oracle defines digital twins as a “digital proxy of a physical asset or device.” In a healthcare context, it could be a digital representation of a hospital environment, a human physiology, or other sandbox for clinicians to test techniques and treatments without putting people at risk. By using all available data, the twin can be highly personalized to increase the chances that the test results will match those in the human patient.
  
  Cardio digital twins, for example, can produce models that include relevant scarring or abnormalities that could alter the passage of electric pulses through the organ, which could cause an arrythmia, allowing for preventative action. Different treatments can be applied to cancerous tumors in a digital twin before introducing one to the patient.
• Wearable technology
  Of all the seemingly futuristic technologies covered previously in this section, most people already have experience with wearables, whether it’s fitness trackers to monitor heart rate, smart watches to record sleep cycles, or more specialist wearables, such as glucose monitors and smart weigh scales. But what lies ahead?
  
  Expect developments to what we have already. Real-time data can be fed into an algorithm to come up with rapid and personalized preventative advice, whether it’s something as simple as a notification to rehydrate or something more urgent, such as an alert to see a clinician about an unusual heart rhythm.
  
  Beyond that, we may see that smart bandages will monitor how wounds are healing, material in clothes will collect vital signs and help prevent injuries, and augmented reality headsets will allow surgeons to operate with a display of all relevant information and magnified 3D visuals at their disposal.
• Bioprinting
  When you take 3D printing and add biological materials, you get bioprinting. After a suitable scan of the required cells, bioinks—created from natural or synthetic materials, or a mix of both—are used to print the end product, be it a model of organs or tissue for research, or a replacement body part to be grafted onto the recipient.
  
  These applications for bioprinting already exist, as does the practice of creating 3D versions of tumors to see how they respond to treatment. But the future holds many more possibilities as the technology develops.
  
  For instance, compatible patches for skin, bones, and organs could revolutionize treatment, while organ donors may become a thing of the past if the organs produced through bioprinting become of sufficient quality to be used for transplants. One day, people may have a genetically matched set of biological spares kept somewhere, in case they need to replace just about any body part.
• Personalized medicine and precision healthcare
  While having a spare body part in storage is a bit fantastical, personalized medicine and precision healthcare have arrived, thanks to many of the technologies covered in this article.
  
  Continued advancements in genomics, including the falling price of genome sequencing, will make it easier for doctors to diagnose and treat patients on a personal level.
  
  Or consider the example of an electrocardiogram or other wearable alerting a person to a potential issue with their heart. The person could immediately consult a chatbot to rule out certain conditions ahead of contacting a physician. A lab-on-a-chip could be used to gain more specific readings, which help inform the creation of a digital twin to test potential treatments.
  
  Once a suitable digital twin is found, a graft for a new aortic valve could be bioprinted and inserted, with minimal concern about rejection as it has been tailored to meet the patient’s specific genetic makeup. GenAI can be used to devise a recovery plan that suits the patient’s lifestyle. A DTx program can monitor how the patient is progressing and set goals and offer rewards for keeping up with the prescribed treatments and therapies.

Transform Healthcare with Oracle Technology

Oracle Life Sciences and Oracle Health offer the industry’s most comprehensive, open, and interoperable platform for developing drugs, diagnosing and treating patients, and improving healthcare operations and administrative processes, with an emphasis on helping to ensure the privacy and security of patient data.

For years, health organizations have used applications to manage their HR, supply chain, and finance processes, running in parallel with their clinical systems—but never connected to them. Disjointed systems make it difficult for those organizations to provide the best patient care and reduce costs. Oracle is taking on that challenge, combining its Cerner EHRs and other cutting-edge clinical capabilities with its industry-leading back-office applications, all running on Oracle Cloud Infrastructure (OCI) services. Oracle is building AI capabilities into all these services to bring the power of AI directly to users.

Healthcare Technology FAQs

What technology has the greatest impact on healthcare?
Cloud computing underpins almost every healthcare technology development today, whether for medical research, clinical trial management, record-keeping, clinical decision-making, or back-office operations. The cloud also allows for the accumulation of data for myriad AI-based health applications.

What is smart healthcare technology?
Smart healthcare technology applies to any application or device that uses some combination of AI, sensors, data analytics, and networking to monitor patients’ health conditions, inform clinical decisions, improve healthcare provider operations, connect care givers/first responders, and increase patient safety.

What is the difference between medical technology and healthcare technology?
Medical technology includes devices that professionals use to diagnose or treat a patient, while healthcare technology is primarily used to help people stay healthy in the first place.