Raghupathi and Raghupathi Health Information Science and Systems 2014, 2:3

http://www.hissjournal.com/content/2/1/3

REVIEW

Open Access

Big data analytics in healthcare: promise and

potential
Wullianallur Raghupathi1* and Viju Raghupathi2

Abstract
Objective: To describe the promise and potential of big data analytics in healthcare.
Methods: The paper describes the nascent field of big data analytics in healthcare, discusses the benefits, outlines
an architectural framework and methodology, describes examples reported in the literature, briefly discusses the
challenges, and offers conclusions.
Results: The paper provides a broad overview of big data analytics for healthcare researchers and practitioners.
Conclusions: Big data analytics in healthcare is evolving into a promising field for providing insight from very large
data sets and improving outcomes while reducing costs. Its potential is great; however there remain challenges to
overcome.
Keywords: Big data, Analytics, Hadoop, Healthcare, Framework, Methodology

Introduction
The healthcare industry historically has generated large
amounts of data, driven by record keeping, compliance
& regulatory requirements, and patient care [1]. While
most data is stored in hard copy form, the current trend is
toward rapid digitization of these large amounts of data.
Driven by mandatory requirements and the potential to
improve the quality of healthcare delivery meanwhile reducing the costs, these massive quantities of data (known
as big data) hold the promise of supporting a wide range
of medical and healthcare functions, including among
others clinical decision support, disease surveillance,
and population health management [2-5]. Reports say
data from the U.S. healthcare system alone reached, in
2011, 150 exabytes. At this rate of growth, big data for U.S.
healthcare will soon reach the zettabyte (1021 gigabytes)
scale and, not long after, the yottabyte (1024 gigabytes) [6].
Kaiser Permanente, the California-based health network,
which has more than 9 million members, is believed to
have between 26.5 and 44 petabytes of potentially rich
data from EHRs, including images and annotations [6].
By definition, big data in healthcare refers to electronic
health data sets so large and complex that they are difficult
* Correspondence: [email protected]
1
Graduate School of Business, Fordham University, 113 W. 60th Street, 10023
New York, NY, USA
Full list of author information is available at the end of the article

(or impossible) to manage with traditional software and/

or hardware; nor can they be easily managed with traditional or common data management tools and methods
[7]. Big data in healthcare is overwhelming not only because of its volume but also because of the diversity of
data types and the speed at which it must be managed [7].
The totality of data related to patient healthcare and wellbeing make up big data in the healthcare industry. It
includes clinical data from CPOE and clinical decision
support systems (physicians written notes and prescriptions, medical imaging, laboratory, pharmacy, insurance,
and other administrative data); patient data in electronic
patient records (EPRs); machine generated/sensor data,
such as from monitoring vital signs; social media posts, including Twitter feeds (so-called tweets) [8], blogs [9], status
updates on Facebook and other platforms, and web pages;
and less patient-specific information, including emergency
care data, news feeds, and articles in medical journals.
For the big data scientist, there is, amongst this vast
amount and array of data, opportunity. By discovering
associations and understanding patterns and trends
within the data, big data analytics has the potential to
improve care, save lives and lower costs. Thus, big data
analytics applications in healthcare take advantage of the
explosion in data to extract insights for making better
informed decisions [10-12], and as a research category

2014 Raghupathi and Raghupathi; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of
the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly credited.

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are referred to as, no surprise here, big data analytics in

healthcare [13-15]. When big data is synthesized and analyzedand those aforementioned associations, patterns
and trends revealedhealthcare providers and other
stakeholders in the healthcare delivery system can develop more thorough and insightful diagnoses and treatments, resulting, one would expect, in higher quality
care at lower costs and in better outcomes overall [12].
The potential for big data analytics in healthcare to lead
to better outcomes exists across many scenarios, for example: by analyzing patient characteristics and the cost
and outcomes of care to identify the most clinically and
cost effective treatments and offer analysis and tools,
thereby influencing provider behavior; applying advanced analytics to patient profiles (e.g., segmentation
and predictive modeling) to proactively identify individuals who would benefit from preventative care or lifestyle changes; broad scale disease profiling to identify
predictive events and support prevention initiatives; collecting and publishing data on medical procedures, thus
assisting patients in determining the care protocols or
regimens that offer the best value; identifying, predicting
and minimizing fraud by implementing advanced analytic systems for fraud detection and checking the accuracy and consistency of claims; and, implementing much
nearer to real-time, claim authorization; creating new
revenue streams by aggregating and synthesizing patient
clinical records and claims data sets to provide data and
services to third parties, for example, licensing data to
assist pharmaceutical companies in identifying patients
for inclusion in clinical trials. Many payers are developing and deploying mobile apps that help patients manage
their care, locate providers and improve their health. Via
analytics, payers are able to monitor adherence to drug
and treatment regimens and detect trends that lead to
individual and population wellness benefits [12,16-18].
This article provides an overview of big data analytics
in healthcare as it is emerging as a discipline. First, we
define and discuss the various advantages and characteristics of big data analytics in healthcare. Then we describe the architectural framework of big data analytics
in healthcare. Third, the big data analytics application
development methodology is described. Fourth, we provide examples of big data analytics in healthcare reported
in the literature. Fifth, the challenges are identified. Lastly,
we offer conclusions and future directions.
Big data analytics in healthcare

Health data volume is expected to grow dramatically in

the years ahead [6]. In addition, healthcare reimbursement models are changing; meaningful use and pay for
performance are emerging as critical new factors in todays healthcare environment. Although profit is not and
should not be a primary motivator, it is vitally important

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for healthcare organizations to acquire the available

tools, infrastructure, and techniques to leverage big data
effectively or else risk losing potentially millions of dollars in revenue and profits [19].
What exactly is big data? A report delivered to the U.S.
Congress in August 2012 defines big data as large volumes of high velocity, complex, and variable data that require advanced techniques and technologies to enable the
capture, storage, distribution, management and analysis of
the information [6]. Big data encompasses such characteristics as variety, velocity and, with respect specifically to
healthcare, veracity [20-23]. Existing analytical techniques
can be applied to the vast amount of existing (but currently unanalyzed) patient-related health and medical data
to reach a deeper understanding of outcomes, which then
can be applied at the point of care. Ideally, individual and
population data would inform each physician and her
patient during the decision-making process and help determine the most appropriate treatment option for that
particular patient.
Advantages to healthcare

By digitizing, combining and effectively using big data,

healthcare organizations ranging from single-physician
offices and multi-provider groups to large hospital networks and accountable care organizations stand to
realize significant benefits [2]. Potential benefits include
detecting diseases at earlier stages when they can be
treated more easily and effectively; managing specific individual and population health and detecting health care
fraud more quickly and efficiently. Numerous questions
can be addressed with big data analytics. Certain developments or outcomes may be predicted and/or estimated based on vast amounts of historical data, such as
length of stay (LOS); patients who will choose elective
surgery; patients who likely will not benefit from surgery;
complications; patients at risk for medical complications;
patients at risk for sepsis, MRSA, C. difficile, or other
hospital-acquired illness; illness/disease progression; patients at risk for advancement in disease states; causal
factors of illness/disease progression; and possible comorbid conditions (EMC Consulting). McKinsey estimates that big data analytics can enable more than $300
billion in savings per year in U.S. healthcare, two thirds
of that through reductions of approximately 8% in national healthcare expenditures. Clinical operations and R
& D are two of the largest areas for potential savings
with $165 billion and $108 billion in waste respectively
[24]. McKinsey believes big data could help reduce waste
and inefficiency in the following three areas:
Clinical operations: Comparative effectiveness
research to determine more clinically relevant and
cost-effective ways to diagnose and treat patients.

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Research & development: 1) predictive modeling to

lower attrition and produce a leaner, faster, more
targeted R & D pipeline in drugs and devices;
2) statistical tools and algorithms to improve clinical
trial design and patient recruitment to better match
treatments to individual patients, thus reducing trial
failures and speeding new treatments to market; and
3) analyzing clinical trials and patient records to identify
follow-on indications and discover adverse effects before
products reach the market.
Public health: 1) analyzing disease patterns and
tracking disease outbreaks and transmission to improve
public health surveillance and speed response; 2) faster
development of more accurately targeted vaccines, e.g.,
choosing the annual influenza strains; and, 3) turning
large amounts of data into actionable information that
can be used to identify needs, provide services, and
predict and prevent crises, especially for the benefit of
populations [24].
In addition, [14] suggests big data analytics in
healthcare can contribute to
Evidence-based medicine: Combine and analyze a
variety of structured and unstructured data-EMRs,
financial and operational data, clinical data, and genomic
data to match treatments with outcomes, predict patients
at risk for disease or readmission and provide more
efficient care;
Genomic analytics: Execute gene sequencing more
efficiently and cost effectively and make genomic
analysis a part of the regular medical care decision
process and the growing patient medical record [25];
Pre-adjudication fraud analysis: Rapidly analyze
large numbers of claim requests to reduce fraud, waste
and abuse;
Device/remote monitoring: Capture and analyze in
real-time large volumes of fast-moving data from
in-hospital and in-home devices, for safety monitoring
and adverse event prediction;
Patient profile analytics: Apply advanced analytics
to patient profiles (e.g., segmentation and predictive
modeling) to identify individuals who would benefit
from proactive care or lifestyle changes, for example,
those patients at risk of developing a specific disease
(e.g., diabetes) who would benefit from preventive
care [14].
According to [16], areas in which enhanced data and
analytics yield the greatest results include: pinpointing
patients who are the greatest consumers of health resources or at the greatest risk for adverse outcomes; providing individuals with the information they need to
make informed decisions and more effectively manage
their own health as well as more easily adopt and track
healthier behaviors; identifying treatments, programs

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and processes that do not deliver demonstrable benefits

or cost too much; reducing readmissions by identifying
environmental or lifestyle factors that increase risk or trigger adverse events [26] and adjusting treatment plans accordingly; improving outcomes by examining vitals from
at-home health monitors; managing population health by
detecting vulnerabilities within patient populations during
disease outbreaks or disasters; and bringing clinical, financial and operational data together to analyze resource
utilization productively and in real time [16].

The 4 Vs of big data analytics in healthcare

Like big data in healthcare, the analytics associated with

big data is described by three primary characteristics:
volume, velocity and variety (http://www-01.ibm.com/soft
ware/data/bigdata/). Over time, health-related data will be
created and accumulated continuously, resulting in an incredible volume of data. The already daunting volume of
existing healthcare data includes personal medical records,
radiology images, clinical trial data FDA submissions, human genetics and population data genomic sequences, etc.
Newer forms of big data, such as 3D imaging, genomics
and biometric sensor readings, are also fueling this exponential growth.
Fortunately, advances in data management, particularly virtualization and cloud computing, are facilitating
the development of platforms for more effective capture,
storage and manipulation of large volumes of data [4].
Data is accumulated in real-time and at a rapid pace, or
velocity. The constant flow of new data accumulating at
unprecedented rates presents new challenges. Just as the
volume and variety of data that is collected and stored
has changed, so too has the velocity at which it is generated and that is necessary for retrieving, analyzing, comparing and making decisions based on the output.
Most healthcare data has been traditionally staticpaper
files, x-ray films, and scripts. Velocity of mounting data increases with data that represents regular monitoring, such
as multiple daily diabetic glucose measurements (or more
continuous control by insulin pumps), blood pressure
readings, and EKGs. Meanwhile, in many medical situations, constant real-time data (trauma monitoring for
blood pressure, operating room monitors for anesthesia,
bedside heart monitors, etc.) can mean the difference between life and death.
Future applications of real-time data, such as detecting
infections as early as possible, identifying them swiftly
and applying the right treatments (not just broad-spectrum
antibiotics) could reduce patient morbidity and mortality
and even prevent hospital outbreaks. Already, real-time
streaming data monitors neonates in the ICU, catching
life-threatening infections sooner [6]. The ability to perform real-time analytics against such high-volume data in

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motion and across all specialties would revolutionize

healthcare [4]. Therein lies variety.
As the nature of health data has evolved, so too have
analytics techniques scaled up to the complex and sophisticated analytics necessary to accommodate volume,
velocity and variety. Gone are the days of data collected
exclusively in electronic health records and other structured formats. Increasingly, the data is in multimedia
format and unstructured. The enormous variety of data
structured, unstructured and semi-structuredis a dimension that makes healthcare data both interesting
and challenging.
Structured data is data that can be easily stored, queried, recalled, analyzed and manipulated by machine. Historically, in healthcare, structured and semi-structured
data includes instrument readings and data generated by
the ongoing conversion of paper records to electronic
health and medical records. Historically, the point of
care generated unstructured data: office medical records,
handwritten nurse and doctor notes, hospital admission
and discharge records, paper prescriptions, radiograph
films, MRI, CT and other images.
Already, new data streamsstructured and unstructuredare cascading into the healthcare realm from fitness devices, genetics and genomics, social media
research and other sources. But relatively little of this
data can presently be captured, stored and organized so
that it can be manipulated by computers and analyzed
for useful information. Healthcare applications in particular need more efficient ways to combine and convert
varieties of data including automating conversion from
structured to unstructured data.
The structured data in EMRs and EHRs include familiar input record fields such as patient name, data of
birth, address, physicians name, hospital name and address, treatment reimbursement codes, and other information easily coded into and handled by automated
databases. The need to field-code data at the point of
care for electronic handling is a major barrier to acceptance of EMRs by physicians and nurses, who lose the
natural language ease of entry and understanding that
handwritten notes provide. On the other hand, most
providers agree that an easy way to reduce prescription
errors is to use digital entries rather than handwritten
scripts.
The potential of big data in healthcare lies in combining traditional data with new forms of data, both individually and on a population level. We are already seeing
data sets from a multitude of sources support faster and
more reliable research and discovery. If, for example,
pharmaceutical developers could integrate population
clinical data sets with genomics data, this development
could facilitate those developers gaining approvals on
more and better drug therapies more quickly than in the

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past and, more importantly, expedite distribution to the

right patients [4]. The prospects for all areas of healthcare are infinite.
Some practitioners and researchers have introduced a
fourth characteristic, veracity, or data assurance. That
is, the big data, analytics and outcomes are error-free
and credible. Of course, veracity is the goal, not (yet) the
reality. Data quality issues are of acute concern in
healthcare for two reasons: life or death decisions depend on having the accurate information, and the quality
of healthcare data, especially unstructured data, is highly
variable and all too often incorrect. (Inaccurate translations of poor handwriting on prescriptions are perhaps
the most infamous example).
Veracity assumes the simultaneous scaling up in granularity and performance of the architectures and platforms, algorithms, methodologies and tools to match
the demands of big data. The analytics architectures
and tools for structured and unstructured big data are
very different from traditional business intelligence (BI)
tools. They are necessarily of industrial strength. For example, big data analytics in healthcare would be executed in distributed processing across several servers
(nodes), utilizing the paradigm of parallel computing
and divide and process approach. Likewise, models and
techniquessuch as data mining and statistical approaches,
algorithms, visualization techniquesneed to take into account the characteristics of big data analytics. Traditional
data management assumes that the warehoused data is
certain, clean, and precise.
Veracity in healthcare data faces many of the same issues as in financial data, especially on the payer side: Is
this the correct patient/hospital/payer/reimbursement
code/dollar amount? Other veracity issues are unique to
healthcare: Are diagnoses/treatments/prescriptions/procedures/outcomes captured correctly?
Improving coordination of care, avoiding errors and
reducing costs depend on high-quality data, as do advances in drug safety and efficacy, diagnostic accuracy
and more precise targeting of disease processes by treatments. But increased variety and high velocity hinder
the ability to cleanse data before analyzing it and making
decisions, magnifying the issue of data trust [4].
The 4Vs are an appropriate starting point for a
discussion about big data analytics in healthcare. But
there are other issues to consider, such as the number of architectures and platforms, and the dominance of the open source paradigm in the availability
of tools. Consider, too, the challenge of developing
methodologies and the need for user-friendly interfaces. While the overall cost of hardware and software
is declining, these issues have to be addressed to harness and maximize the potential of big data analytics
in healthcare.

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Architectural framework

The conceptual framework for a big data analytics project in healthcare is similar to that of a traditional health
informatics or analytics project. The key difference lies
in how processing is executed. In a regular health analytics project, the analysis can be performed with a business intelligence tool installed on a stand-alone system,
such as a desktop or laptop. Because big data is by definition large, processing is broken down and executed
across multiple nodes. The concept of distributed processing has existed for decades. What is relatively new is
its use in analyzing very large data sets as healthcare
providers start to tap into their large data repositories to
gain insight for making better-informed health-related
decisions. Furthermore, open source platforms such as
Hadoop/MapReduce, available on the cloud, have encouraged the application of big data analytics in healthcare.
While the algorithms and models are similar, the user
interfaces of traditional analytics tools and those used
for big data are entirely different; traditional health analytics tools have become very user friendly and transparent. Big data analytics tools, on the other hand, are
extremely complex, programming intensive, and require
the application of a variety of skills. They have emerged
in an ad hoc fashion mostly as open-source development
tools and platforms, and therefore they lack the support
and user-friendliness that vendor-driven proprietary
tools possess. As Figure 1 indicates, the complexity begins with the data itself.
Big data in healthcare can come from internal (e.g., electronic health records, clinical decision support systems,
CPOE, etc.) and external sources (government sources, laboratories, pharmacies, insurance companies & HMOs,
etc.), often in multiple formats (flat files, .csv, relational

Figure 1 An applied conceptual architecture of big data analytics.

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tables, ASCII/text, etc.) and residing at multiple locations

(geographic as well as in different healthcare providers
sites) in numerous legacy and other applications (transaction processing applications, databases, etc.). Sources and
data types include:
1. Web and social media data: Clickstream and
interaction data from Facebook, Twitter, LinkedIn,
blogs, and the like. It can also include health plan
websites, smartphone apps, etc. [6].
2. Machine to machine data: readings from remote
sensors, meters, and other vital sign devices [6].
3. Big transaction data: health care claims and other
billing records increasingly available in semi-structured
and unstructured formats [6].
4. Biometric data: finger prints, genetics, handwriting,
retinal scans, x-ray and other medical images, blood
pressure, pulse and pulse-oximetry readings, and
other similar types of data [6].
5. Human-generated data: unstructured and
semi-structured data such as EMRs, physicians
notes, email, and paper documents [6].
For the purpose of big data analytics, this data has to
be pooled. In the second component the data is in a
raw state and needs to be processed or transformed, at
which point several options are available. A serviceoriented architectural approach combined with web services (middleware) is one possibility [27]. The data stays
raw and services are used to call, retrieve and process
the data. Another approach is data warehousing wherein
data from various sources is aggregated and made ready
for processing, although the data is not available in realtime. Via the steps of extract, transform, and load (ETL),

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data from diverse sources is cleansed and readied. Depending on whether the data is structured or unstructured, several data formats can be input to the big data
analytics platform.
In this next component in the conceptual framework,
several decisions are made regarding the data input approach, distributed design, tool selection and analytics
models. Finally, on the far right, the four typical applications of big data analytics in healthcare are shown.
These include queries, reports, OLAP, and data mining.
Visualization is an overarching theme across the four applications. Drawing from such fields as statistics, computer science, applied mathematics and economics, a
wide variety of techniques and technologies has been developed and adapted to aggregate, manipulate, analyze,
and visualize big data in healthcare.
The most significant platform for big data analytics is
the open-source distributed data processing platform
Hadoop (Apache platform), initially developed for such
routine functions as aggregating web search indexes. It
belongs to the class NoSQL technologiesothers include CouchDB and MongoDBthat evolved to aggregate data in unique ways. Hadoop has the potential to
process extremely large amounts of data mainly by allocating partitioned data sets to numerous servers (nodes),
each of which solves different parts of the larger problem and then integrates them for the final result [28-31].
Hadoop can serve the twin roles of data organizer and
analytics tool. It offers a great deal of potential in enabling enterprises to harness the data that has been, until
now, difficult to manage and analyze. Specifically, Hadoop
makes it possible to process extremely large volumes of
data with various structures or no structure at all. But
Hadoop can be challenging to install, configure and administer, and individuals with Hadoop skills are not easily
found. Furthermore, for these reasons, it appears organizations are not quite ready to embrace Hadoop completely.
The surrounding ecosystem of additional platforms and
tools supports the Hadoop distributed platform [30,31].
These are summarized in Table 1.
Numerous vendorsincluding AWS, Cloudera,
Hortonworks, and MapR Technologiesdistribute opensource Hadoop platforms [29]. Many proprietary options
are also available, such as IBMs BigInsights. Further,
many of these platforms are cloud versions, making them
widely available. Cassandra, HBase, and MongoDB, described above, are used widely for the database component. While the available frameworks and tools are mostly
open source and wrapped around Hadoop and related
platforms, there are numerous trade-offs that developers and users of big data analytics in healthcare must
consider. While the development costs may be lower
since these tools are open source and free of charge, the
downsides are the lack of technical support and minimal

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Table 1 Platforms & tools for big data analytics in

healthcare
Platform/Tool

Description

The Hadoop Distributed

File System (HDFS)

HDFS enables the underlying storage for

the Hadoop cluster. It divides the data into
smaller parts and distributes it across the
various servers/nodes.

MapReduce

MapReduce provides the interface for the

distribution of sub-tasks and the gathering
of outputs. When tasks are executed,
MapReduce tracks the processing of each
server/node.

PIG and PIG Latin

(Pig and PigLatin)

Pig programming language is configured

to assimilate all types of data (structured/
unstructured, etc.). It is comprised of two
key modules: the language itself, called
PigLatin, and the runtime version in which
the PigLatin code is executed.

Hive

Hive is a runtime Hadoop support

architecture that leverages Structure Query
Language (SQL) with the Hadoop platform.
It permits SQL programmers to develop
Hive Query Language (HQL) statements
akin to typical SQL statements.

Jaql

Jaql is a functional, declarative query

language designed to process large data
sets. To facilitate parallel processing, Jaql
converts high-level queries into low-level
queries consisting of MapReduce tasks.

Zookeeper

Zookeeper allows a centralized

infrastructure with various services,
providing synchronization across a cluster
of servers. Big data analytics applications
utilize these services to coordinate parallel
processing across big clusters.

HBase

HBase is a column-oriented database management system that sits on top of HDFS. It

uses a non-SQL approach.

Cassandra

Cassandra is also a distributed database

system. It is designated as a top-level project modeled to handle big data distributed
across many utility servers. It also provides
reliable service with no particular point of
failure (http://en.wikipedia.org/wiki/Apache_
Cassandra) and it is a NoSQL system.

Oozie

Oozie, an open source project, streamlines

the workflow and coordination among the
tasks.

Lucene

The Lucene project is used widely for text

analytics/searches and has been
incorporated into several open source
projects. Its scope includes full text indexing
and library search for use within a Java
application.

Avro

Avro facilitates data serialization services.

Versioning and version control are
additional useful features.

Mahout

Mahout is yet another Apache project

whose goal is to generate free applications
of distributed and scalable machine
learning algorithms that support big data
analytics on the Hadoop platform.

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security. In the healthcare industry, these are, of course,

significant drawbacks, and therefore the trade-offs must be
addressed. Additionally, these platforms/tools require a
great deal of programming, skills the typical end-user in
healthcare may not possess. Furthermore, considering the
only recent emergence of big data analytics in healthcare,
governance issues including ownership, privacy, security,
and standards have yet to be addressed. In the next section
we offer an applied big data analytics in healthcare methodology to develop and implement a big data project for
healthcare providers.
Methodology

While several different methodologies are being developed

in this rapidly emerging discipline, here we outline one
that is practical and hands-on. Table 2 shows the main
stages of the methodology. In Step 1, the interdisciplinary
big data analytics in healthcare team develops a concept
statement. This is a first cut at establishing the need for
such a project. The concept statement is followed by a description of the projects significance. The healthcare
organization will note that there are trade-offs in terms of
alternative options, cost, scalability, etc. Once the concept
statement is approved, the team can proceed to Step 2, the
proposal development stage. Here, more details are filled
in. Based on the concept statement, several questions are
Table 2 Outline of big data analytics in healthcare
methodology
Step 1

Concept statement
Establish need for big data analytics project in healthcare
based on the 4Vs.

Step 2

Proposal
What is the problem being addressed?
Why is it important and interesting?
Why big data analytics approach?
Background material

Step 3

Methodology

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addressed: What problem is being addressed? Why is it

important and interesting to the healthcare provider?
What is the case for a big data analytics approach?
(Because the complexity and cost of big data analytics
are significantly higher compared to traditional analytics
approaches, it is important to justify their use). The project team also should provide background information on
the problem domain as well as prior projects and research
done in this domain.
Next, in Step 3, the steps in the methodology are fleshed
out and implemented. The concept statement is broken
down into a series of propositions. (Note these are not
rigorous as they would be in the case of statistical approaches. Rather, they are developed to help guide the big
data analytics process). Simultaneously, the independent
and dependent variables or indicators are identified. The
data sources, as outlined in Figure 1, are also identified;
the data is collected, described, and transformed in preparation for for analytics. A very important step at this
point is platform/tool evaluation and selection. There are
several options available, as indicated previously, including
AWS Hadoop, Cloudera, and IBM BigInsights. The next
step is to apply the various big data analytics techniques
to the data. This process differs from routine analytics
only in that the techniques are scaled up to large data sets.
Through a series of iterations and what-if analyses, insight
is gained from the big data analytics. From the insight, informed decisions can be made. In Step 4, the models and
their findings are tested and validated and presented to
stakeholders for action. Implementation is a staged approach with feedback loops built in at each stage to
minimize risk of failure.
The next section describes several reported big data
analytics applications in healthcare. We draw on publicly
available material from numerous sources, including
vendor sites. In this emerging discipline, there is little independent research to cite. These examples are from
secondary sources. Nevertheless, they are illustrative of
the potential of big data analytics in healthcare.

Propositions
Variable selection
Data collection
ETL and data transformation
Platform/tool selection
Conceptual model
Analytic techniques
-Association, clustering, classification, etc.
Results & insight
Step 4

Deployment
Evaluation & validation
Testing

Source: Adapted from [Raghupathi & Raghupathi, [9]].

Examples

Premier, the U.S. healthcare alliance network, has more

than 2,700 members, hospitals and health systems,
90,000 non-acute facilities and 400,000 physicians and is
reported to have data on approximately one in four patients discharged from hospitals. Naturally, the network
has assembled a large database of clinical, financial, patient, and supply chain data, with which the network has
generated comprehensive and comparable clinical outcome measures, resource utilization reports and transaction level cost data. These outputs have informed
decision-making and improved the healthcare processes
at approximately 330 hospitals, saving an estimated
29,000 lives and reducing healthcare spending by nearly

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$7 billion [16]. North York General Hospital, a 450-bed

community teaching hospital in Toronto, Canada, reports
using real-time analytics to improve patient outcomes and
gain greater insight into the operations of healthcare delivery. North York is reported to have implemented a scalable real-time analytics application to provide multiple
perspectives, including clinical, administrative, and financial [16]. Another example, reported by IBM, is that of the
large, unnamed healthcare provider that is analyzing data
in the electronic medical record (EMR) system with the
goal of reducing costs and improving patient care. (Data
in the EMR include the unstructured data from physician
notes, pathology reports and other sources). Big data analytics is used to develop care protocols and case pathways
and to assist caregivers in performing customized queries
[16]. Another example of big data analytics in healthcare
is Columbia University Medical Centers analysis of complex correlations of streams of physiological data related
to patients with brain injuries. The goal is to provide medical professionals with critical and timely information to
aggressively treat complications. The advanced analytics is
reported to diagnose serious complications as much as 48
hours sooner than previously in patients who have suffered a bleeding stroke from a ruptured brain aneurysm
[16]. The Rizzoli Orthopedic Institute in Bologna, Italy, is
reportedly using advanced analytics to gain a more
granular understanding of the clinical variations within
families whereby individual patients display extreme differences in the severity of their symptoms. This insight is
reported to have reduced annual hospitalizations by 30%
and the number of imaging tests by 60%. In the longterm, the Institute expects to gain insight into the role of
genetic factors to develop treatments [16]. The Hospital
for Sick Children (Sick Kids) in Toronto is using analytics
to improve the outcomes for infants prone to lifethreatening nosocomial infections. It is reported that
Sick Kids applies advanced analytics to vital-sign data
gathered from bedside monitoring devices to identify potential signs infection as early as 24 hours prior to previous
methods [6,16]. Additional examples are reported below.
A recent New Yorker magazine article by Atul Gawande,
MD described how orthopedic surgeons at Brigham and
Womens Hospital in Boston relied on personal experience along with insight extracted from research on data
based on a host of factors critical to the success of jointreplacement surgery to systematically standardize knee
joint-replacement surgery. The result: improved outcomes
at lower costs. The University of Michigan Health System
standardized the administration of blood transfusions
using analytics in a similar fashion, combining experience
with big data analytics research. This resulted in a 31% reduction in transfusions and $200,000 reduction in expenses per month (reported in [6]). Another example is
The National Institute for Health and Clinical Excellence

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(NICE) of the U.K.s National Health Service. NICE is reportedly a leader in the analytics of large clinical datasets
for exploring the effectiveness of clinical and cost factors
in the use of new drugs and/or clinical treatments. The
Italian Medicines Agency is also reported to collect and
analyze clinical data on the use of expensive new drugs as
one goal in a country-level cost-effectiveness program [6].
Another leading example of big data analytics in healthcare is the Department of Veterans Affairs (VA) use of applications on its very large data set in an effort to comply
with performance-based accountability framework and
disease management practice [6]. In one very famous example, California-based Kaiser Permanente associated
clinical data with cost data to generate a key data set, the
analytics of which led to the discovery of adverse drug effects and subsequent withdrawal of Vioxx from the market [6]. Researchers at the Johns Hopkins School of
Medicine discovered they could use data from Google Flu
Trends to predict sudden increases in flu-related emergency room visits at least a week before warnings from
the CDC. Likewise, the analysis of Twitter updates was as
accurate as (and two weeks ahead of) official reports at
tracking the spread of cholera in Haiti after the January
2010 earthquake [6]. Also reported is an application developed by IBM that predicts the likely outcomes of diabetes
patients using patients panel data linked to physicians,
management protocols, and the overall relationship to
population health management averages [6]. In another diabetes application, physicians at Harvard Medical School
and Harvard Pilgrim Health Care recently demonstrated
the potential of analytics applications to EHR data to identify and group patients with diabetes for public health surveillance. Four years worth of data based on numerous
indicators from multiple sources was utilized. The analytics application also differentiated between Type 1 and
Type II diabetes [6,26]. Finally, at Blue Cross Blue Shield
of Massachusetts (BCBSMA) there was a need to embed
analytics into business processes to help decision-makers
across the business gain insight into financial and medical
data and become more proactive. Several benefits were
reported. First, the analytics enabled medical directors to
identify high-risk disease groups and act to minimize risk
and improve patient outcomes. For example, new preventive treatment protocols could be introduced among
patient groups with high cholesterol, thereby fending off
heart problems. Also, complex health informatics reports were generated 300% faster than previously, helping BCBSMA service clients more effectively [6].
The next section briefly identifies some of the key
challenges in big data analytics in healthcare.
Challenges

At minimum, a big data analytics platform in healthcare

must support the key functions necessary for processing

Raghupathi and Raghupathi Health Information Science and Systems 2014, 2:3
http://www.hissjournal.com/content/2/1/3

the data. The criteria for platform evaluation may include

availability, continuity, ease of use, scalability, ability to
manipulate at different levels of granularity, privacy and
security enablement, and quality assurance [6,29,32]. In
addition, while most platforms currently available are
open source, the typical advantages and limitations of
open source platforms apply. To succeed, big data analytics in healthcare needs to be packaged so it is menudriven, user-friendly and transparent. Real-time big data
analytics is a key requirement in healthcare. The lag between data collection and processing has to be addressed.
The dynamic availability of numerous analytics algorithms, models and methods in a pull-down type of menu
is also necessary for large-scale adoption. The important
managerial issues of ownership, governance and standards
have to be considered. And woven through these issues
are those of continuous data acquisition and data cleansing. Health care data is rarely standardized, often fragmented, or generated in legacy IT systems with incompatible
formats [6]. This great challenge needs to be addressed
as well.

Conclusions
Big data analytics has the potential to transform the way
healthcare providers use sophisticated technologies to
gain insight from their clinical and other data repositories and make informed decisions. In the future well see
the rapid, widespread implementation and use of big
data analytics across the healthcare organization and the
healthcare industry. To that end, the several challenges
highlighted above, must be addressed. As big data analytics becomes more mainstream, issues such as guaranteeing privacy, safeguarding security, establishing standards
and governance, and continually improving the tools and
technologies will garner attention. Big data analytics and
applications in healthcare are at a nascent stage of development, but rapid advances in platforms and tools can accelerate their maturing process.
Competing interests
We, the authors declare we have no competing interests.
Authors contributions
Both WR and VR contributed equally. Both authors read and approved the
final manuscript.

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Author details
1
Graduate School of Business, Fordham University, 113 W. 60th Street, 10023
New York, NY, USA. 2Brooklyn College, City University of New York, Brooklyn,
NY, USA.

25.

Received: 27 August 2013 Accepted: 5 January 2014

Published: 7 February 2014

27.

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doi:10.1186/2047-2501-2-3
Cite this article as: Raghupathi and Raghupathi: Big data analytics in
healthcare: promise and potential. Health Information Science and Systems
2014 2:3.

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