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International Journal of Computer Systems (ISSN: 2394-1065), Volume 03 Issue 03, March, 2016

Available at http://www.ijcsonline.com/

Using Big Data and Business Intelligence in Health care Management

P. Prathyusha, Y. Annie Jerusha
Department of Computer Science and Engineering,
JNTUA CEP, Pulivendula,
Andhra Pradesh, India

Evidence primarily based medication (EBM) is that the conscientious, explicit, and even handed use of current best proof
in creating and concerning care of individual patients. Each year, a big range of research studies (potentially serving as
evidence) area unit reported within the literature at associate degree ever-increasing rate outpacing the interpretation of
analysis findings into practice. Including the proliferation of electronic health records, and client health info,
researchers and practitioners area unit challenged to leverage the complete potential of EBM. During this paper we
have a tendency to present a search agenda for investing business intelligence and large information analytics
conspicuous primarily based medicine, and illustrate however analytics is accustomed support EBM.
Keywords: Big data, business intelligence, Health care management.



The United States (US) spends quite $2.3 trillion per

year in help & support and its a second largest nation(just
below Marshall Island) in aid disbursement as a share of
GDP [1]. However, such disbursement has not translated
into quality of care. As several as 98,000 people die
annually in hospital as a result of medical errors [2].
Moreover, there's a major gap between the aid we tend to
may have and therefore the health care that's currently
obtainable within the US [3, 4]. In response to the current
state of affairs, The Institute of drugs proposes many
recommendations to extend the quality of care. One in all
the extremely wanted areas is that the usage of business
intelligence and large information analytics (BI & A)
techniques to gather, analyse, curate, and present proof at
the purpose of care, i.e., the apply of proof primarily based
medication (EBM). For the aim of this study, EBM is
considered because the conscientious ,explicit, and its use
of current best proof in making selections regarding the
care of individual patient[5]. EBM suggests that affirming
the individual clinical expertise with the simplest
obtainable external clinical evidence and this clinical proof
may be drawn from the literature, and/or through the apply
based Information. Each year, a major range of research
studies (potentially serving as evidence) square measure
reported within the literature at Associate in nursing everincreasing rate outpacing the interpretation of those
analysis findings into practice. Including the proliferation
electronic health records, client health info, researchers and
practitioners square measure challenged to gain full
potential of EBM. The proliferation of potential proof,
patient information, and health client info represent
opportunities for the innovative applications of analytics
techniques to help with the interpretation of data (in a range
of format counting on the source) to consumable
information. During this study, confined with analytics, the
systematic usage of knowledge and connected business
insights developed through the applied analytical
disciplines (statistical, contextual, quantitative, predictive,

and cognitive) to deliver the fact-based deciding for

management, measurement, learning and designing.
Analytics may be predictive, descriptive, or prescriptive
The objective of this study is to explore the
opportunities for leverage business intelligence and big
information analytics for evidence-based medication. The
paper is organized as follows: consequent section further
describes business intelligence and large information
analytics within the context of this study. Next, we
illustrate the method of proof primarily based drugs,
followed by a groundwork agenda for leverage business
intelligence and large information analytics in EBM. The
paper concludes with a group of samples of analysis come
semanating from the analysis agenda and a quick
discussion of challenges and prospects of BI&A in


Evidence based mostly drugs (EBM) is conscientious,

explicit, and considered use of current best proof in
creating choices regarding the care of individual patients
[5]. It is the intersection of individual clinical experience,
external proof, and value to the patient. proof generates
from both existent medical literature and practice-based
evidence. Literature sources embrace randomized
controlled trials (RCT), systematic reviews, clinical
guidelines, cohort studies, Quasi-Experimental studies,
descriptive studies, and professional opinions [7]. The
practice-based evidences square measure generated from
the day-after-day information is collected within the
hospital through treating the patients (electronic health
record).Additional sources of practice-based proof embrace
claims information, insurance, and different body hospital
A. Evidence Based Medicine Health Care Expenditures
According to Bloomberg, Among advanced
economies, U.S. spends the foremost on health care on a

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P. Prathyusha et al

Using Big Data and Business Intelligence in Health care Management

relative value basis with the worst outcome, ranking46th

among Bloomberg list of the foremost economical
healthcare countries, with Associate in Nursing potency
score of thirty [8].This is way behind the comparable
developed countries like port (efficiency= 92.6) and
Singapore(efficiency= 82) [8]. Moreover, the National
Health Expenditures (NHE) reality sheet comes the
condition to persistently degrade within the future [9]. Over
2011-2021 NHE projected (a) health care value is expected
to grow a median of 5.7% per annum (b) health share of
GDP to accrued from 18 % to 19.6% (c) health care
Spending to grow in average of 6% per annum (d)Medicaid
defrayal is calculable to grow a median of8.2 % per annum.
most significantly, in 2007, 62.1% of bankruptcies filers
claimed high medical expenses; and a study exhausted
2013 showed that twenty fifth of old person who filed
bankruptcy indicates the health care value as primary
reason [10]. In essence, health care value is real problem in
US and if one thing isn't done, healthcare is probably going
to hamper the countrys economy and therefore the quality
of lifetime of its voters. In this regard, there's a big interest
in EBM by varied stakeholders (e.g. federal organizations,
researchers and practitioners) as a mechanism to cut back
value and improve quality of care. In principal, EBM can
assist in characteristic what works for individual patients
and in characteristic the foremost suitable intervention.
Moreover, there are evidence that the observe of EBM can
ends up in value saving. as an example, Neubauer et al.
showed that use of EBM for patients with non-small-cell
carcinoma(NSCLC) resulted in value saving of thirty fifth
over twelvemonths [11]. Kolodziej [12] additional
demonstrates various ways that for a way EBM may result
in reduced healthcare value including: 1) EBM ends up in a
decrease in overall medical aid. That is, Dr. will with
confidence recommend the foremost effective medical aid
because the 1st line of treatment, that eliminates several
poor or detrimental interventions; 2) EBM will cut back the
value by prescribing less costly medication or/and
Intervention. as an example, if proof points to 2probable
therapies with similar advantages and risks, but largely
varies in cost; than, Dr. recommends less expensive
therapies; 3) EBM will cut back the amount of hospital
visit by permitting physicians to reduce the adverse facet
result of medication or therapies. Other important value
saving through the EBM includes: value saving by
preventing or predicting the diseases condition, economical
chronic care, and cost reducing of adverse drug effects etc.
B. The Evidence Based Medicine Process
Generally, proof primarily based medication consists of
seven steps as represented below [4, 13].
Step 1Identifying the Patient Condition: The first
step in EBM is to adequately perceive patients clinical
downside. associate degree example of patients condition
may be 48 years recent, 200 pounds, white male, with high
vital sign (BP), A1C=7% that's fresh diagnosed with Type2 polygenic disorder. Alternative relevant information
includes: hypersensitivity reaction condition; urinary organ,
foot and eye health; cardio-vascular diseases etc. The
patients condition is understood by the past and present
designation, laboratory, and body knowledge.
Step 2Formulating EBM Question: once the patients
condition is known, this step taking with synthesizing that

condition into clinical queries. An example of a clinical

question could be: Is biological process therapy as
affectional as Oral Medication to the forty eight years old
T2 polygenic disorder patients with overweight, and high
BP? Then, clinical queries ar born-again into EBM
question. One amongst the ways that to structure the EBM
question is thru the Population-Intervention ComparisonOutcome(PICO) criteria. PICO is a method to check the
economic, social and clinical outcome of various
intervention alternatives [14, 15]. Population refers to the
demographic and clinical info of patient; intervention refers
to the potential course of action; while comparison refers to
scrutiny between Alternative interventions, or between
intervention and no intervention; finally, outcome
suggests that output which we wish to access (clinical,
economic or social).
Step 3Evidence Gathering: This step focuses on
extracting the data associated with the EBM question. This
step conjointly includes preliminary analysis of relevant
data (individual article, or individual piece of knowledge
from electronic health record) before it's used for additional
analysis. as an example, if an article doesn't satisfy the
minimum criteria, then it should be discarded. the data is
analyzed, synthesized, and translated into expendable
module that solve the EBM question. The sources of proof
could be electronic health record (Practice-Based
Evidence) and/or analysis studies (Literature-Based
Step 4Evidence Evaluation: The observe guidelines
that are generated in previous step are further curated
during this step. Medical field is data critical domain
correct data assist to form correct call and save life; but,
faulty information might invite death or complicates the
patients condition. As a result, clinicians are reluctant to
trust a computer virus that show proof without clear data
regarding dependability and provenance of the data [3, 17,
18]. Researcher and practitioners should adequately judge
the evidence and maintain confidence {in proof
conspicuous |obvious}. Evidence analysis will be tired 3
steps: grade the individual articles, or individual piece of
information; grade the proof (after aggregating the
individual piece of information); and calculate the applied
mathematics significance of overall information. The
output of proof analysis is that the grade (A-D or similar)
and applied mathematics significance (pvalue) of proof.
Step 5Convert the Critically Appraised Evidence
into a practicable to use at the point of care: Here, the main
focus is on changing critically appraised proof into
Guidelines ideally in code format, e.g., evidence coded
into the UMLS, or proof coded in the Asbru language [19].
Step 6Evidence Presentation and Use: Regarding the
proof presentation, literature points four key factors [20,
21]: gift the EBM at the purpose of care; gift a minimum of
two alternatives course of actions; show dependability and
citation alongside the proof, fit data in an exceedingly
single screen of a laptop.
Step 7Evaluate the results of putt proof into practice:
This step assesses if stakeholders are literally getting profit
by active EBM. Not solely this, it also helps to grasp that
proof is functioning, and what are the enhancements

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P. Prathyusha et al

Using Big Data and Business Intelligence in Health care Management

required within the information base of EBM. Once

technology is employed to deliver EBM; this step becomes
easier by automating the evaluation task.


With the growth of knowledge, business intelligence

and big knowledge analytics has emerged as a very
important study for each practitioners and researchers,
regardless of domain. Chen et al. [22] defines BI&A
because the techniques, technologies, systems, practices,
methodologies, and applications that analyse important
business knowledge to assist associate enterprise higher
perceive its business and market and create timely business
decisions. samples of rising problems in BI&A
include huge knowledge Analytics, Text Analytics, Web
Analytics, Network Analytics, and Mobile Analytics[22]. a
number of the vital applications of analytics in the literature
within the context of proof primarily based medication are
(a) article procedures are changed based on systematic
reviews [23, 24] (b) mechanically structure the abstract of
article in PICO (population, intervention, comparison and
outcome) criteria [25] (c)mine the free-text document of
practicing notes [26] (d)mine the electronic health record
and establish the patients condition [27, 28] (e) convert the
clinical guidelines into pc practicable format [29-31]
(f)grade the proof and calculate the applied mathematics
significance[32, 33] (g) Mine the health records and
identify the optimum follow pointers [34] (h) and, identify
the association rules within the electronic health records
[35]. These applications of knowledge mining whereas
valuable, still lags behind alternative domains, like
ecommerce. This may be attributed to the notion that
healthcare researchers area unit comparatively new the
sector orhas seldom taken advantage of climbable
procedure platform or analytical strategies [36]. During this
study, we demonstrate that the potential exist for
researchers and practitioners to use BI&A in attention,
specifically the follow of EBM and as a mechanism to
provide a brand new venue to scale back the price and
improve the quality of attention.


Extant literature suggests that EBM ought to be absolutely
integrated with electronic health record (EHR) systems[21,
37]. Currently, only, categorization and matching of
keywords of EHR with pertinent literature is finished (for
example, matching diseases condition with Metathesaurus
of article) [28]. as an example, Demner Fushmanet al. [27]
developed a image system that explores the chance to
mechanically extract patients issues from the teams notes
and question evidence resources on the market in
literature. They used the National Library of drugs (NLM)
MetaMap service to spot relevant Unified Medical
Language System (UMLS) Metathesaurus ideas within the
patients electronic medical history (EMR); then, used
those terms to question resources. the matter with their
system isidentifying solely the UMLS terms within the
patients EMR doesn't give a whole image of patients
condition, e.g., demographic info, duration of issues, etc.
Indeed, if a research worker desires to realize importance

of EBM, a lot of work need to be doneEBM systems

should mechanically go through patients past and gift
health record and assist in identifying the general clinical
condition. Examples include demographics, allergies,
symptoms, diagnosis, tests, economic standing, past
condition and family history for hereditary). In essence,
there's a restricted capability for mechanically extracting
patients information from EHR for distinguishing a
patients condition [27, 28].
In order to mechanically establish patients condition,
a system ought to use a mixture of analytics techniques.
Applying information analytics are going to be facilitated
if the electronic health record is during a standardized
format, e.g., CDA, SNOMED, and LONIC. Otherwise, adhoc processes is also needed. Data mining and Text
analytics techniques like information retrieval {and info|
and knowledge| and data} extraction may be applied to
EHR. Ad-hoc techniques to mine the unstructured medical
man notes can even use. Currently, clinicians have to be
compelled to manually translate patients condition into
associate EBM question following the PopulationIntervention-Comparison-Outcome
However, this can be terribly time intense and inefficient.
as an example, the typical hospital visit in United States in
medical aid setting takes twenty 8minutes; with but ten
minutes for quite 2 hundredth of the patients [38].
Throughout a visit, it's nearly not possible for the medical
man to conduct the extra work required to adequately
formulate the clinical question, to get the search question,
and to execute those queries against associate evidencebase. There should be a better way!luckily, with recent
developments in technology, patients condition may be
mechanically changed into PICO criteria. one amongst the
key techniques in synthesizing clinical question into PICO
criteria is Topic Modelingit uncovers the hidden the
matic structure in document assortment. Topic modeling
assist in making new strategies to browse, search and
summarize giant archives of text into structured format
(based on topic) [39].After the clinical queries are
structured into the PICO criteria, it's doable to
mechanically produce the search query; furthermore,
search question should be slightly customized supported
the underlying technology(Vendor of EMR system,
information system, analytics tools and other) used. The
system conjointly permits practician to alter the clinical
queries, or generate the clinical question manually.



There is a requirement for having the ability to get

usable information from existing literature in addition
because the ever increasing repository of knowledge in
electronic health records. For instance, as of could 2013,
over 145 thousand clinical trials square measure registered
inclinicaltrial.gov alone; furthermore, there's a large
number of clinical pointers, cohort studies, expert
opinions, and alternative proof sources. On the opposite
hand, because the aid is getting in electronic format, giant
amounts of knowledge is being created and stored in EHR
systems on a day to day. Therein regard, IBM Watson [40]
use proprietary DeepQA technology to generate proof by

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P. Prathyusha et al

Using Big Data and Business Intelligence in Health care Management

retrospective analysis of existing knowledge in addition as

knowledge from perspective studies. IBM partnered with
tube and Memorial Sloan Kettering Cancer Center
(MSKCC) to make commercial applications for Watson in
aid. At MSKCC, Watson is going to be trained regarding
the medical specialty so that it will facilitate with
diagnostic and choices in cancer. IBM Watson is
unbelievable example of application of BI&A for
EBM; but, it's still in the analysis part, and plenty of a lot
of analysis and business problems ought to be figure it out
before its delivered into the market. Another example
from literature is study by Cohen et al [41]. They projected
text mining primarily based pipelining framework that
supports the creation and change of proof reports that
provide help for the literature assortment, collation, and
sorting steps of the systematic review process. The system
has four components: (a) meta search engine; (b)
classifierclassifies article primarily based in RCT,
cohort studies etc. (c) collector, that teams the articles
publications connexion (d) the fourth component ranks
the classified and sorted articles based on chance of
inclusion in systematic review.
The projected approach automates some aspects of the
systematic review method. Alternative examples embody
[18, 42-46]; notwithstanding, these studies don't however
realize the total potential enabled by Associate in Nursing
ever-increasing evidence base...Big knowledge analytics
permits all the info (medical literature, electronic health
record, clinical notes, x-ray and alternative imaging
knowledge, insurance and claims knowledge, and more) to
be leveraged to supply translate knowledge to relevant
info for EBM support [47]. A meta search Engine provides
the mechanism to look all the available resources (e.g.,
PubMed and Cochrane) by translating user queries into the
individual question languages of every computer program
[48]. Also, Enterprise Search System provides the
capabilities for looking and retrieving any range of
unstructured and structured knowledge sources at intervals
and organization by single query [49]. The info analysis
will then proceed with the application of varied analytics
technologies semantic internet technology, text
analytics, applied mathematics machine learning et al...
linguistics internet technology is especially vital in EBM
as a result of it bridge the vocabularies gap between the
various ontology, and facilitate to deal with the variability
aspects of medical literature, clinical notes, and electronic
health records [50]. Text analytics technologies that square
measure particularly vital for EBM knowledge analytics
square measure [22,47] (a) conception Linking: finding
connected document based on shared conception (b) Entity
Extraction: extracting the name, location, diagnosis,
allergy, dates, medication, and alternative (c) Topic
Tracking: chase the interested info in data (d) Document
Categorization: Categorizing documents supported prespecified criteria (e) Clustering: Grouping documents into
clusters (f) Question Answering: finding the answer
specific queries. There are varied alternative business
intelligence and large knowledge analytics techniques that
square measure helpful for the EBM knowledge analysis.
Examples of on however these techniques are often
helpful to investigate the EBM knowledge embody the

utilization of document categorization to mechanically

classify RCT as relevant or not-relevant throughout
systematic review [51]. Entity extraction will then be
accustomed extract the criteria for the EBM question [52]
(population, intervention, comparison, outcome) Another
examples the use of entity extraction to extract vital
concepts in an exceedingly RCT (demographic,
intervention, outcomes, conclusion, funding supply) and
grade the trials supported the Agency for aid analysis and
Quality (AHRQ) criteria mistreatment regression or
applied mathematics machine learning [52, 53]. Topic
linking are often used to link all the patients in Associate
in Nursing EHR World Health Organization have a
selected combination of connected conditions, e.g.,
urarthritis and have allergy of NSAIDs. Despite of robust
pointers and recommendation, there is no adequate
mechanism for evaluating the evidence. for instance, West
at al. [7] projected 3criteria for rating evidence: (a)
qualityaggregate rating of individual studies (b)
quantitynumber of studies, sample size, and impact
magnitude (c)consistencyfor any topic, the extent to that
different studies according similar findings. While the
study demonstrates the viability of the standards in
evaluating relevant proof, it's not ascendible given the
sheer volume of medical knowledge/evidence. There is a
requirement to change the applying of those criteria to the
literature and apply primarily based information. BI&
A techniques could also be accustomed rate the individual
articles in addition because the overall proof. The
individual piece of knowledge are often rated supported
the study question, population, randomisation, blinding,
intervention, and a lot of [33]. For instance, are searcher
will use text analytics and language processing to spot if
the articles satisfy the standards given by AHRQ and rate
the individual articles accordingly [7].


The final task of EBM systems, namely EBM

presentation, is to make sure that the correct data gets to
the correct person, at the correct place, at the correct time,
and within the right format [18]. Any data delivered
should have information associated with birthplace,
dependableness, and quality of the delivered data. It is also
important that the data given ought to be concise, and if
attainable, ought to slot in one screen [20, 21]. However,
majority of the EBM systems within the literature haven't
thought of these factors. EBM knowledge visual image
techniques gift the economic, clinical, and social outcome
of various treatment alternatives within the type of text.
Physicians do not have time to browse in depth
documentation. Better way should be found! Thinking out
of the box, and moving afar from the standard aid
knowledge visualization; it's time for researchers and
practitioners to adopt recent developments in areas like
visual analytics, e.g., SAS Visual Analytics [57]. Visual
Analytics gift massive knowledge in AN interactive graph
and chart in an exceedingly approach that's not
overwhelming. For an example, in spite of presenting the
economic, clinical, and diseases progression of various
treatment alternatives within the type of text in 3 totally
different screens; visual analytics will gift all the detain

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Using Big Data and Business Intelligence in Health care Management

single screen within the type of chart, or graph [57].

Virtually each literature suggests evaluation of putting
proof into practice could be a crucial step of evidencebased drugs. However, existing literature have performed
solely restricted task of analysis. For example, Bigus et al.
[18] explicit that EBM for internal organ condition
(Cardiac call Support) optimize the physician time for
obtaining relevant data. They have not done the microlevel analysis. Different studies have conjointly done
similar sorts of analysis. However, the potential is there
for applying analytics to trace the outcome (success or
failure) of specific proof, and update the arrogance of the
proof consequently. System unceasingly tracks whether or
not the utilization of EBM is providing any profit to
patients. The key ideawhen practicing follows the proof
urged by EBM system, and also the outcome is obviously
or better than expected; then, applied mathematics
important or rating of proof will increase. Consequently, if
the outcome is worse than the expected, than applied
mathematics significant or rating of proof decreases.
The study explores opportunities for investing business
intelligence and large information analytics conspicuous
based medication. The study initial describes the steps
involved conspicuous primarily based medication and so
yield to identify current wants and discusses the potential
for business intelligence and large information analytics in
addressing these gaps. The study presents a number of the
emerging analysis areas regarding the utilization of huge
information Analytics for EBM. In therefore doing, this
study provides research agenda for health scientific
discipline analyzers and data scientists to handle problems
with pressing wants, namely, reducing the price and up the
price of healthcare by broadening the follow of proof based
medication through the applications of business
intelligence massive information analytics.

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199 | International Journal of Computer Systems, ISSN-(2394-1065), Vol. 03, Issue 03, March, 2016