Description
The challenges of how to manage healthcare and achieve clinical integration in todays payment setting has become a national concern.
Interdisciplinary Journal of Information, Knowledge, and Management Volume 9, 2014
Cite as: Ashrafi, N., Kelleher, L., & Kuilboer, J-P. (2014). The impact of business intelligence on healthcare delivery in
the USA. Interdisciplinary Journal of Information, Knowledge, and Management, 9, 117-130. Retrieved from
http://www.ijikm.org/Volume9/IJIKMv9p117-130Ashrafi0761.pdf
Editor: Shane Tomblin
The Impact of Business Intelligence on Healthcare
Delivery in the USA
Noushin Ashrafi, Lori Kelleher, and Jean-Pierre Kuilboer
University of Massachusetts Boston, Boston, MA, USA
[email protected] [email protected]
[email protected]
Abstract
The challenges of how to manage healthcare and achieve clinical integration in today's payment
setting has become a national concern. The use of technology to help ensure healthcare quality
and control cost is an ongoing research subject. Business intelligence solutions are used in many
industries to garner insight from financial and operational data to make more informed decisions
towards the ultimate goal of achieving efficiency and effectiveness.
This paper aims to bring the reader up-to-date with the current literature on two basic topics;
business intelligence and healthcare delivery and form the basis for the justification of research
on the impact of business intelligence on healthcare delivery in the U.S.A. To achieve that goal
we examine BI deployment in the healthcare industry, address relevant issues and challenges, and
explore the role of BI to foster certain organizational capabilities. Examples of how BI capabili-
ties have supported organizational capabilities impacting the problems of accessibility, cost, and
quality of healthcare are presented. Scholars and professionals, alike, could benefit from this
study where BI is presented as a mechanism to ensure a robust and systematic approach to health-
care management with an ultimate goal of enduring impact on quality improvement and cost con-
trol.
Keywords: Healthcare, Business Intelligence, Quality, Cost, Capabilities, Sustainability.
Introduction
To improve healthcare quality, safety, and efficiency is an economic and national necessity. The
role of technology to ensure healthcare quality and control cost is an ongoing debate within the
industry and a subject of interest to researchers. Delivering quality healthcare requires the inte-
gration of patient health information from many different sources and availing a diverse set of
users; health providers must be able to readily access and use the right information at the right
time and patients should be able to access their health information in order to be able to self-
manage their conditions. Supporters of
the adoption of advanced technology in
healthcare consider it as an opportunity
not only to enhance the quality of health
services, but also transparency of eco-
nomic activities and the availability of
information in real time (Mettler, 2009).
As technology has enhanced diagnosis
and treatment options and since lifesav-
ing medicines are entering the market at
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The Impact of Business Intelligence on Healthcare Delivery in the USA
an increasing rate, life expectancy is on the rise. Healthcare organizations are investing millions
in computer systems, diagnostic technology, and preventive care programs in an attempt to meet
healthcare quality goals. These developments, however, come with a huge price tag. Health care
costs now consume nearly 18 percent of the U.S. GDP (Ramsey, Ganz, Shankaran, Peppercorn, &
Emanuel, 2013). Payers face difficulties compensating providers for high-cost treatments made
possible by advances in technology. Claims that are inflated as well as outright fraudulent are
intensifying the problem. The payers and providers in the healthcare industry, public and private,
are looking into technology to reduce costs, while keeping the quality care intact.
The predicament doesn’t end with the notion of quality versus cost; the healthcare industry is ex-
periencing more scrutiny and complexity than any other single industry in modern history. Health
providers and the affiliates have to understand and respond to privacy laws and information secu-
rity. In addition, a vast range of factors such as health care practice regulations, patient records
and requirements, practice and staff management, training, financial stability, facilities and
equipment management influence the holistic view of quality healthcare. Another force altering
the current condition of healthcare in the United States is the passing of the Patient Protection and
Affordable Care Act (PPACA). Healthcare industry is under pressure to reduce costs and better
manage care. Burke and Ingraham (2008) note that healthcare in the U.S. is at the point of colos-
sal change. The entire industry is struggling with the notion of management of quality and cost
metrics. Intensified focus on compliance with evidence-based care protocols and, a staggering
number of reimbursement programs affect revenue and the ability to compete. Healthcare indus-
try executives must evaluate an increasing amount of information to best assess their organiza-
tion’s wellbeing and future. Furthermore, data overload is a common problem for many care pro-
viders and executive teams, who are grappling with too much information and looking to find
ways to simplify acquiring knowledge from raw data (Byrnes, 2012). Coddington (2012) argues
that decision-support capabilities allow collecting data from multiple sources, such as cost ac-
counting systems, electronic health records and other sources, and make them available to physi-
cians and other users. He suggests that a balance between cost control and the other priorities of
healthcare organizations is necessary to provide quality care. The most important issue surround-
ing quality healthcare is the development of measurement goals to find validated metrics. Since
usually high quality is perceived to be correlated with high cost, a statement such as “reduce
costs, while keeping the quality care intact,” sounds paradoxical. However, Process improvement
initiatives facilitated by business intelligence solutions constitute a cost-effective option. Business
intelligence solutions allow garnering insight from financial and operational data to make more
informed decisions towards the ultimate goal of achieving efficiency and effectiveness so badly
needed in healthcare industry. In order to be able to affect financial, operations, and care man-
agement, there is a need to transform data into actionable insight, which starts with understanding
that, “having ready access to timely, complete, accurate, legible, and relevant information is criti-
cal to health care organizations (Wagner, Lee & Glaser, 2009).”
Ferrand (2010) suggests the use of business intelligence tools for the analysis and reporting of
quality measures. He further argues that their goal-oriented approach, facilitated by business in-
telligence tools, allows objectivity and diversity across clinical specialties and regions when goals
differ from one scenario to the next. Frye (2010) reminds us that successful companies use busi-
ness intelligence for their competitive advantage. They understand that the process of transform-
ing data into information and then to knowledge provides answers to not only the question
“what?” but also “why?”
The healthcare industry is now realizing that business intelligence framework, using root-cause
analysis, yields meaningful and actionable knowledge about opportunities for improvement. Or-
ganizations are recognizing the importance of using a rigorous and systematic approach to im-
prove return on their investment. A recent study by KLAS, a research firm specializing in moni-
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Ashrafi, Kelleher, & Kuilboer
toring and reporting the performance of healthcare vendors, revealed that the top five healthcare-
specific functions sought by organizations from their BI products are the following: (1) enterprise
analytics; (2) predictive analytics; (3) ACO analytics; (4) healthcare data integration/data ware-
housing; and (5) population health. Currently, a third of healthcare organizations have no BI
tools, according to the KLAS study, while half are using a single BI vendor or product, and 17%
have multiple BI products or vendors. Clarke (2012, p. 120) in his “rethinking business intelli-
gence” lists four areas where the leaders of healthcare industry should build organizational capa-
bilities by “[1]Creating a culture that advocates value, collaboration, and accountability, [2] De-
veloping robust business intelligence systems that integrate clinical and financial data, [3] Driv-
ing performance improvement throughout the organization to improve safety, reduce variation,
and eliminate waste, [4] Building risk and contract management capabilities that create, manage,
and mitigate actuarial risk of provider networks of care.” This paper focuses on the second area;
the role of business intelligence in building organization capabilities.
While decision makers in the healthcare sector are facing the multifaceted challenges of quality,
cost and compliance with regulations and patient-specific requirements, based on both clinical
and administrative data, a holistic view of BI solutions can help address these challenges. Sab-
herwal and Becerra-Fernandez (2011) offer such holistic views of business intelligence capabili-
ties. We build our argument upon their views and explore how business intelligence capabilities
can facilitate organizational capabilities. We focus on deployment of BI capabilities in healthcare
industry, address relevant issues and challenges and offer examples of how BI technology has
impacted the problems of accessibility, cost, and quality of healthcare delivery.
Scholars interested in BI research should be interested in learning about BI as a mechanism to
ensure a robust and systematic approach to healthcare management. Health industry professionals
should benefit from this study that justifies investment in BI with an ultimate goal of enduring
impact on quality improvement and cost control.
The organization of the paper is as follows: Section II describes the methodology used for litera-
ture review. Section III lays the background of the study by describing the healthcare condition in
the United States. Section IV provides a description of BI benefits in health industry and ad-
dresses the (why?) question. Section V addresses the (how?) question by relating the four capa-
bilities of BI to Healthcare Industry. Section VI offers examples of successful BI implementation
in the healthcare industry. Section VII addresses the complications of BI deployment in health-
care industry. Section VIII, the final section is the conclusion and future research.
Methodology
Google scholar and other academic databases such as EBSCO Business Source Complete were
used in an iterative manner between April-August 2013 to retrieve articles related to concepts
addressed in this paper. The literature search started using search terms on the two basic topics:
business intelligence and healthcare in the U.S.A. and broadened to include application of busi-
ness intelligence to healthcare, business intelligence capability, organizational capabilities, and
capabilities of BI in the healthcare industry. The authors of this paper independently read the
sum of fifty articles and a number of federal documents, evaluated the relevance of the articles,
studied the main findings, and decided for “inclusion” or “exclusion” of the articles. The criteria
for inclusion were obviously the relevance of the articles to the research interest; the application
of business intelligence in general and business intelligence capabilities in particular to healthcare
industry. We further searched for examples of BI applications in health industry in real world set-
tings to support the paper objectives.
Understanding organizational capability, which is the mediator between BI capabilities and
healthcare delivery was an important part of this research. Organizational capability is a well-
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The Impact of Business Intelligence on Healthcare Delivery in the USA
researched topic and there are research experts with landmark articles published throughout the
years. We focused on resource-based theory of organizational capabilities and emphasized the
role of BI in empowering the users and elevating knowledge-based decision making. Since the
use of BI in healthcare also encompasses creating a new IT infrastructure, another component of
resource-based organization capability, a number of landmark articles on the topic were included.
Electronic health record, a good example of the use of technology to improve healthcare delivery
and related articles, were examined and included in this study. However, the notion of application
of BI capabilities to improve the delivery of healthcare is quite new and not too many major arti-
cles could be found to address these issues in a comprehensive manner. The search for scholarly
publications on support of organizational capabilities via BI solutions was even more limited.
Hence we relied on the real work examples to support this aspect of our research.
Our goal was to bring the reader up-to-date with current literature on two basic topics; business
intelligence and healthcare and form the basis for the justification of the research on the impact of
business intelligence, via improvement of organizational capabilities, on healthcare delivery in
the U.S.A.
Healthcare in the United States
Due to the passing of the Patient Protection and Affordable Care Act in 2010 (PPACA), the U.S.
healthcare system has dramatically changed. This act is an attempt to reform the current health-
care industry through making healthcare more accessible and affordable to a greater range of pa-
tients. The PPACA has many components including incorporating technology as well as coordi-
nating healthcare within a group of providers. Within the PPACA there is a mandate requiring
healthcare practices and facilities to incorporate Electronic Medical Records (EMR). EMR’s are
technology based systems that are believed to have the ability to lead to major savings in health-
care costs, reduced medical errors and improved health (Hillestad et al., 2005; Meinert, 2005).
The EMR mandate is set to take effect in 2014, and by this time, all healthcare facilities and prac-
tices will have some form of a technology based system in place to promote increased efficien-
cies.
Interoperability is needed to make it possible to share electronic health records with physicians,
pharmacists and hospitals. Interoperability can even integrate individual records with evidence-
based clinical decision support that provides reminders and best-practices for treatment (Hillestad
et al., 2005). Through mandating that EMRs become part of healthcare delivery, PPACA pro-
vides a technology based foundation to ensure coordination of care, better quality outcomes and
lower costs.
Coordination of care within a group of healthcare providers is another feature of the PPACA. Ac-
countable Care Organizations (ACOs) are the vehicles that have been developed to deliver
healthcare to populations through coordinating efforts of all the members of a patients’ care team
(Walker & McKethan, 2012). Since patient care involves multiple facets, it is necessary to have a
system in place to plan, transition, and execute treatments. Care delivery in this system requires
collecting all relevant external and internal data, then extracting and transforming this informa-
tion in order to guide patients’ care. The ACO model also relies on providing evidence based care
that takes into consideration specific patient circumstances as well as affordability. Through this
system, ACOs provide incentives for healthcare providers to work together to treat an individual
patient across care settings. ACOs’ focus on affordability, access and coordination is a shift from
the current US healthcare system, and therefore requires the development and use of healthcare
specific business process management systems and software to support the care of individual pa-
tients and entire populations (Walker & McKethan, 2012). ACOs have the potential to become
successful delivery outlets as long as community wide care processes are designed so that they
embody a patient centered vision of optimal care and all users that contribute to patient care are
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Ashrafi, Kelleher, & Kuilboer
capable of utilizing new healthcare delivery tools (Walker & McKethan, 2012). In order to coor-
dinate care and make decisions that result in the delivery of high quality, low cost healthcare, it is
essential to incorporate and utilize EMR’s and shift to ACOs. Ghosh and Scott (2011, p. 396)
look at quality and cost issues in healthcare and argue that “an analytic capability is especially
critical in healthcare because lives are at stake and there is intense pressure to reduce costs and
improve efficiency.” They further argue that “the rapid growth in clinical data repositories from
increased use of EMR (Electronic Medical Record) systems in patient care facilities has moti-
vated Business Intelligence (BI) in healthcare to facilitate decision-making and improve health-
care processes” (p. 396).
The debate on use of BI in healthcare “to guide more informed decisions on financial, administra-
tive, and clinical questions” (Hennen, 2009, p. 92) has gained general support, however the ques-
tion remains as how to capture the benefits of BI in a systematic and robust manner to justify the
initial investment of BI. Before addressing this question, we need to review what are the benefits
and challenges of BI in the healthcare industry in the USA and the possible differences from other
industries when it comes to deploying BI.
BI Benefits and Challenges in the Healthcare Industry
Deployment of business intelligence, like any other technology-based approach, to solve business
problems not only brings about benefits, but also challenges to overcome. As regulations change
and the amount of data increases, health organizations are turning to business intelligence
(BI) solutions to harness data for precise decision-making to help improve patient outcomes, re-
duce costs, and ensure the future of healthcare industry. Access to timely, relevant, and accurate
healthcare information is the first step. An effective healthcare practice relies not only on the
availability of public health data sources, but also assessment tools to communicate information
to investigators, practitioners, policy makers and the general public (Jinpon, Jaroensutansinee, &
Jaroensutansinee, 2011). Incorporating business intelligence tools into healthcare practice has the
ability to streamline available data and improve population health. Sabherwal and Becerra-
Fernandez (2011, p. 6) view business intelligence as a system, “providing decision makers with
valuable information and knowledge by leveraging a variety of sources of data as well as struc-
tured and unstructured information.” Generally, there are two different perspectives of the BI sys-
tems: data centric and process centric. The data-centric view deploys BI systems to understand
the capabilities within organization by collecting, transforming, and integrating data to present
complex and competitive information to planners and decision makers. The objective is to im-
prove the timeliness and quality of inputs to decision making. The process-centric perspective
views an organization as a set of well-integrated processes (Hammer & Champy, 2001), where BI
is to be deployed to assimilate the information into processes.
Information is the key to a successful business. The health industry is no different from any other
business where the simple model of Plan, Do, Check, and Act is the key to successful processing
of data into useful and actionable information. To make appropriate operational judgment, each
of these steps must be completed using accurate data. The health industry has similarities and dif-
ferences with other industries. Like other industries, healthcare focuses on revenue, expenses,
utilization, and quality, but it differs, as it should, on using information to influence the behavior
of a more diverse set of constituencies such as physicians, patients, government, insurance com-
panies, hospital administrators, pharmacies, and more. Similarly, BI operations can be a challenge
for any company, but when it comes to the healthcare industry there are added layers of complex-
ity such as privacy issues (Cucoranu et al., 2013). Healthcare organizations collect and analyze
sensitive data about patients that is governed by privacy rules.
In today's healthcare environment, there is no shortage of data, in fact; organizations are reeling
in an ever-deeper pool of data. The challenge is how to convert the vast amount of available
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The Impact of Business Intelligence on Healthcare Delivery in the USA
data to valuable information and knowledge. Emerging business intelligence tools are capable of
delivering all components of the “who, what, when and where” quartet more quickly than ever,
with a potentially higher level of quality and assurance, and using new analysis and visualization
tools (Yi et al. 2008).
Through business intelligence capabilities, healthcare providers have immediate access to knowl-
edge that allows them to provide quality care at a low cost (Hsia, Lin, Wu, & Tsai, 2006). Mettler
(2009) views BI solutions as triggers for information and data collection, processing, and distri-
bution. Sabherwal and Becerra-Fernandez (2011) introduce four synergistic capabilities of BI –
organizational memory, information integration, insight creation, and presentation, which make
BI essential for every industry and specifically healthcare organization. To appreciate how BI, as
a tool and a facilitator, can weave the four capabilities into the fabrics of the organization, we
need an understanding of BI and its capabilities.
Capabilities of BI in Healthcare Industry
The amount of data generated by and for the healthcare industry is overwhelming and it is busi-
ness intelligence capabilities that deliver value by pulling data from various sources and bringing
them into a common repository, enabling a thorough analysis of data, and creating insights into
routine operations while providing decision support mechanism. Whether data collection, trans-
formation, and analysis of data triggered by the processes or routinely deployed to support deci-
sion making process, BI capabilities improve and fosters organizational capabilities by empower-
ing the users, facilitate the IT structure, and enhance the use of structured and unstructured data.
Four key capabilities of business intelligence addressed in this study are (1) organizational mem-
ory capability, (2) information integration capability, (3) Insight creation capability, and (4) pres-
entation and communication capabilities.
Organizational Memory Capability
To start, historical data has to be captured and stored to establish the foundation of organizational
memory, which is one of most important capabilities required in the healthcare industry. Organ-
izational memory is usually acquired over the years, passed on to the newcomers through per-
sonal contacts, meetings, training courses, and mentor-protégé relationships and if not stored
safely, is destroyed through downsizing, frequent layoffs, unmanaged employee attrition, and/or
disasters.
Patient data comes from a variety of sources and providers, which makes it difficult to track his-
tory or manage a specific population’s health without this information being readily available.
According to Figlioli (2011) data are neither the problem nor the solution. The issue is the lack of
ability to manage these data in a meaningful way. He asserts that a person's medical history in-
cludes data on previous medical procedures and tests, medication allergies, and prescription dos-
age. While this information is needed to ensure the best possible care, a physician may have ac-
cess to only 10 or 20 of these critical pieces. As a result, individuals are often treated episodically
by providers who have access only to a limited amount of necessary clinical information.
Health care involves a diverse set of public and private data collection systems, including health
surveys, administrative enrollment and billing records, and medical records, used by various enti-
ties, including hospitals, CHCs, physicians, and health plans. None of these entities has the capa-
bilities to collect all data for entire population of patients. Nor does any single entity currently
collect all health data on individual patients.
Organization memory capability of business intelligence facilitated by data warehousing is the
first step for a systematic and robust approach to capturing, structuring, and conceptualizing of
knowledge assets across a range of healthcare environment. Electronic medical records systems
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(EMR’s) provide important input into the data warehouse, where population health information is
stored and transformed. These systems make it possible to access individual records online from
many separate, interoperable automated systems within an electronic network (Hillestad et al.,
2005). The wealth of information on care accessibility, ambulatory services, emergency visits,
patient health, insurance, healthcare disparities, healthcare quality, healthcare spending, health-
care use, hospitalization, payer information, state information on healthcare, as well as Medicare
and Medicaid are staggering. Clinicians, purchasers, policy makers, researchers, and patients are
the creators and consumers of the data. Organizational memory capability represents an organiza-
tion’s accumulated history reflecting past experiences, insights, and knowledge. Extraction, trans-
formation (making data consistent) and loading this humongous amount of data collected over the
years is the responsibility of data warehousing, a component of business intelligence. According
to Sabherwal and Becerra-Fernandez (2011) organizational memory enabled by data warehouse
helps organizations by enabling creation of new knowledge based information about the past.
Information Integration Capability
There is a need for better integration and sharing of data within and across health care entities and
even within a single entity. According to National Research Council (2009), one way to increase
the usefulness of data is to further integrate them with data from external sources. Stefanelli
(2001) points out that improving the quality of shared care between a professional team “depends
critically on the ability to share patient-specific information and medical knowledge easily among
care providers”.
Organizational memory focuses on historical data, information integration; another organizational
capability supported by BI, integrates and links past data from a variety of sources that encom-
pass organizational memory with the new, real-time content. It links structured and unstructured
data from a variety of sources, such as internal databases and knowledge repositories. BI integra-
tion capability significantly reduces the time it would take a human to catalogue these data and it
is intended to solve cost and quality problem in healthcare. Peter Osborne (2013) argues that an
integrated approach to data could deliver efficiency and lower cost. He provides an example of a
patient arriving at a primary care facility; a doctor examines him and, if required, sends him to a
secondary care facility where he is re-examined and provided specific treatment if needed. The
patient is then discharged, but if repeat visit is needed, the whole process is replicated with all the
associated costs. BI integration technology such as text mining that allows automatic reading of
large documents of text written in natural language is probably the most useful in healthcare envi-
ronment where large and diverse set of documents containing all sorts of information about pa-
tients (clinical, personal, and financial) has to be integrated to provide a comprehensive view of a
patient to be used by care providers and payer no matter where, when, and who.
Insight Creation Capability
This capability enables the organization to understand past events and make predictions about the
future and perhaps is the most talked about contribution of business intelligence to health organi-
zations. The first two capabilities, organizational memory and integration provide input to insight
creation. In complex domains such as healthcare, when quick reflexes requires quick decisions
based on information from diverse sources, a mechanism to provide reliable and quick answers is
badly needed. Technologies enabling insight creation include data mining and real-time decision
support systems. According to Koh and Tan (2011), data mining tools are becoming very popular
in healthcare industry, where they provide an in-depth analysis of data with the purpose of build-
ing predictive models and answering questions. The authors cite examples such as helping payer,
e.g., insurance companies to detect fraud and abuse, care providers to improve patient relation-
ship management, and clinicians to identify treatments and best practices, and patients to receive
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The Impact of Business Intelligence on Healthcare Delivery in the USA
improved and better services. They continue that “The huge amounts of data generated by health-
care transactions are too complex and voluminous to be processed and analyzed by traditional
methods. Data mining provides the methodology and technology to transform these mounds of
data into useful information for decision making (p. 64).” Benko and Wilson (2003) argue data
can be a great asset to healthcare organizations, but they have to be first transformed into infor-
mation.
Presentation/Communication Capabilities
It is generally agreed that ineffective communication among medical teams is a leading cause of
preventable patient harm throughout the health care system. The presentation capability of BI
fosters effective and quick communication and is the capability that displays generated insights in
different ways to make them easy to grasp and to utilize. Online analytical processing, for exam-
ple, supports multidimensional data views and allows users to aggregate, filter, drill down, and
pivot the data. Dashboards allow users to customize the information they would like to monitor
and facilitate display.
Business Intelligence not only provides the detailed data for analysts, but also allows for monitor-
ing performance. In the past, BI was used only by IT specialists who had been trained to query
and format data. Today, however, BI provides workers with easy access to relevant, actionable
information, when they need it. BI can be used in Organizational level to achieve larger strategic
initiatives, such as operating margin, return on investment on strategic investments, and quality of
care goals. At the Departmental level, BI helps employees work more effectively as a team, en-
suring the goals of the department are met. Personal BI helps workers in tasks they do every day.
In summary, the four main capabilities of business intelligence, build upon each other and are
significant contributors to organizational capabilities. According to Bharadwaj (2000) organiza-
tional capabilities refer to “organization’s ability to assemble, integrate, and deploy resources,
usually in combination or co-presence.” In modern business where the concept of “big data” is
integral to the operation of any business, the most valued resource consists of data, information,
and knowledge. As Dinesh Kumar (2009) indicates, the role of the IT industry is transitioning
from a limited capability of individual/functional reporting and analysis to one that is defined by
a connected, collaborative, and contextual world of BI. As the need for real-time data gathering,
analysis, and decision making increases, business intelligence capabilities to assembles, inte-
grates, and deploys data to help strategize the future path of an organization becomes more rele-
vant.
Furthermore, one important aspect of BI is empowerment of the user to manipulate the data and
ask “what if” questions. In a world of constant change, enabling employees to take responsibility
for their own work situation is becoming increasingly important for organizations. According to
business experts “implementing BI solutions for quick access of company resources and tools
empower employees to become more adept in handling daily responsibilities with quick, positive
ramifications (Blatche, 2012). Empowering the employees as the users of BI, the company adopts
a more efficient use of resources in term of people, IT infrastructure, and IT deployment; the nec-
essary components of organization resources.
Examples of Business Intelligence Capabilities
in Healthcare
Business intelligence tools make the healthcare industry’s shift to a technology driven, patient-
centric system possible. The advantage of correlating technology and healthcare is the ability to
manage various forms of data within user-friendly systems that help drive decision making. Busi-
ness intelligence produces contributions, which, in turn, produces a variety of benefits in terms of
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organizational performance. In what follows, we provide examples to demonstrate these capabili-
ties in the context of the healthcare industry.
The first example illustrates how organizational memory captured in data warehouse helps pro-
vide accurate data. Business intelligence systems have several advantages, yet these systems are
only effective if they have accurate data. In healthcare, data is obtained from a variety of sources,
including patients, hospitals and physicians. Business intelligence tools are then able to leverage
data obtained from these structured and unstructured resources to produce information of value.
Data serves as the foundation for business intelligence, it is therefore essential to enhance the
quality of data before embarking on business intelligence solutions. In fact, data quality is consid-
ered to be the most important technical factor for successful business intelligence, which ampli-
fies the need for using data with strong integrity (Howson, 2008). In healthcare, determining how
to best obtain and manage data is a difficult endeavor.
Cardinal Health, a global provider of integrated solutions for the healthcare industry, focused on
first creating a solid data warehouse so they were capable of implementing a strong and reliable
business intelligence system (Carte, Schwarzkopf, Shaft, & Zmud, 2005). Management at Cardi-
nal Health understood how an effective business intelligence system could benefit their organiza-
tion, and also recognized the need to first enhance the quality of the data in their data warehouse
before embarking upon business intelligence solutions (Sabherwal & Becerra-Fernandez, 2011).
This strategy of ensuring quality data was being incorporated into their business intelligence solu-
tions and allowed Cardinal Health to develop a software system capable of assisting with making
the best quality decisions for the organization.
The second example shows how integration capability helps identify patients at risk for disease.
One of the greatest features of business intelligence, affecting health management, is that it has
the ability to identify patients at risk for disease. This allows medical personnel to reduce risk,
eliminate unnecessary tests and save patient lives. The NorthShore University Health System is
an example of a healthcare organization that used business intelligence tools to tackle a specific
disease state. Identifying and treating hypertension is an elusive goal that exposes millions of
people in the country to the risk of heart attack and stroke. So to combat this epidemic, North-
Shore University Health System took steps to control this disease (Degaspari, 2013). North-
Shore’s aim was to develop a way to better link practicing physicians with research and quality
improvements, in order to eliminate undiagnosed hypertension within their network (Degaspari,
2013). Through the use of EMR, the team at NorthShore was able to better identify hypertensive
patients who were undiagnosed or at risk, then created algorithms to determine which patients
should be flagged for additional follow-up. Since the new program went live, the system has been
used to identify, test and diagnose more than 500 patients with previously undiagnosed hyperten-
sion (Degaspari, 2013). Program’s like NorthShore’s can be implemented all over the country for
a variety of disease states, which will assist with identifying patients at risk for disease and less-
ens the number of people who slip through the cracks of the healthcare system.
Third example indicates how insight creation capability helps discover complications from pro-
cedures. Business intelligence solutions also assist medical facilities determine potential compli-
cations resulting from procedures. At Sahlgrenska University Hospital in Gothenburg, Sweden,
business intelligence was used to provide doctors with a simple, easy and fast way to sift through
test results and evaluate whether a patient recovering from brain surgery had meningitis and how
it should be treated (Sabherwal & Becerra-Fernandez, 2011). The hospital implemented a busi-
ness intelligence tool that was able to provide a real-time decision support system that doctors
could use to see the most recent test results compared with patient records over time (QlikTech
International, 2007). Without a business intelligence solution in place, the physician would be
tasked with manually sifting through vast amounts of data to hopefully make an accurate diagno-
sis. In this instance, business intelligence software helped address complications arising from cra-
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The Impact of Business Intelligence on Healthcare Delivery in the USA
nial surgery, and was able to make the hospital more efficient and improve the treatment of criti-
cally ill patients (QlickTech international, 2007).
The last example is to portray how presentation capability of BI helps improve care communica-
tion. Communication is a key area improved through business intelligence. With the addition of
multiple practitioners, various facilities to obtain services and involvement of insurers, it is neces-
sary to have efficient means of communication to ensure best patient outcomes. Colorado Beacon
Consortium is an example of how a regional health information exchange, a large independent
physician association, the largest hospital in the area, and the regional health plan, came together
to share data so that they could improve care management and care communications across a vast
patient region (Hagland, 2013). Although these four Colorado care groups ran on different EMR
systems, the CBC’s goal was to implement their business intelligence solution into the existing
EMR based practice workflows. This integration allowed all areas essential to patient health in
this region to share data and information, and enabled better decision making related to patient
care.
Table one illustrates business intelligence area in healthcare.
Table 1: BI Deployment in Healthcare
ORGANIZATION NAME INDUSTRY BI TOOL BENEFIT
Cardinal Health Healthcare Data Warehouse Quality Data
Northshore University
Health System
Healthcare Integration Ability To Identify At Risk
Patients
Sahlgrenska University
Hospital
Healthcare Insight Creation Discover Procedure
Complications
Colorado Beacon
Consortium
Healthcare Presentation Electronic Communica?
tion Between Multiple
Care Sites
Complications
While the benefits of using business intelligence for health management are recognized by the
industry, there are still a variety of factors that have prohibited new systems from transforming
the healthcare industry. One of the major obstacles is the difficulty in implementing technology
into current practice. Researchers from RAND Corporation suggest that the adoption of health-
care technologies could, on the average, save more than $77 billion (Hillestad et al., 2005). Yet
despite the savings and efficiency, technology based systems have not been embraced by all
healthcare providers. Some experts note that high initial costs for BI technology implementation
deter providers, especially those in small group practices, from adopting new technologies (Tak-
vorian, 2007).
Even with the government mandate for healthcare providers to put EMR into action, as well as
providing incentive programs and assistance with implementation, broad adoption has been slow.
In fact, even for those providers who have some form of EMR, it is rare that they are using a fully
operational system capable of collecting patient information, displaying test results, allowing
providers to enter medical orders and prescriptions and helping doctors make treatment decisions
(Takvorian, 2007). For population health to be managed successfully, technology based systems
must be fully operational and incorporate all areas of patient health.
Privacy and security are also concerns when technology systems are involved with patient care.
While the Health Insurance Portability and Accountability Act, more commonly referred to as
126
Ashrafi, Kelleher, & Kuilboer
HIPPA, protects patients’ personal health information, it does not alleviate anxieties related to
electronically storing healthcare data. Polls show that Americans remain deeply concerned about
the privacy and security of electronically stored health information (Blumenthal, 2011). In order
to better protect patients’ personal data, stronger security solutions for technology systems must
be developed, as well as implementing safeguards to limit issues arising from human error related
to using healthcare technology. Developing tools that not only give patients the confidence that
their private health data is protected, but also defends against potential security breaches is an
essential part of incorporating business intelligence into population health management.
Finally, in order for business intelligence tools to be utilized at their full extent, they must possess
strong usability and presentation abilities. While some systems offer many technological ad-
vances and have the ability to generate vast amounts of data, the end users are not always capable
of interpreting this information, determining what is relevant and avoiding mistakes. Poor usabil-
ity can result in errors that threaten patient safety, loss of productivity and the failure to realize
the quality and efficiency benefits of health information technology (Blumenthal, 2011). The
main advantage of incorporating business intelligence into business operations is producing use-
ful data. Therefore, it is essential that systems are simple to both integrate and navigate in order to
provide information leading to better decision making. Additionally, the information generated
via business intelligence tools should produce valuable results that are easily interpreted by the
end-users. These presentation capabilities are especially significant because organization mem-
bers need technologies to support tactical and strategic decision making (Ward, 2012) but the in-
formation produced is only valuable if the end results are easy to comprehend and put into prac-
tice (Sabherwal & Becerra-Fernandez, 2011). If a business intelligence tool is implemented and it
lacks usability or does not present data that assists with strategic decision making, the final result
is an expensive undertaking that generates information of little value.
Conclusions
The best approach to managing population health has become an increasingly discussed topic. As
changes are made to the healthcare system, and cost and quality have become frequent concerns,
the current approach to healthcare delivery is evolving. One of the biggest challenges in respond-
ing to this change is how to coordinate patient healthcare needs. If the healthcare system can ef-
fectively coordinate healthcare between patients, providers and facilities, it will contribute to bet-
ter management of entire communities’ health. Business intelligence tools provide solutions that
help healthcare providers effectively manage population health. Since technology has now be-
come an integral part of the healthcare industry, it is essential that healthcare organizations inte-
grate appropriate business intelligence systems into their operations.
To survive in a competitive market, healthcare providers need a strong BI foundation to correlate,
analyze, and glean insight from financial and operational data. Providers are hoping BI tools can
accomplish an assortment of functionality, including analysis of financial and departmental data,
including emergency, surgical, and pharmacy analytics, as well as insight into physician quality,
performance improvement, and patient outcomes. The insights garnered from these tools can also
help leaders better understand accountable care organization (ACO) activities, especially as new
ACOs and reimbursement change emerge under healthcare reform.
The contribution of this research is to show how the four capabilities of BI, in combination, use
data and information to generate knowledge that serves as input for decision making in health
care industry. How these capabilities are realized in different contexts is a valid research question
and requires an understanding of the context and the idiosyncrasy of the industry. Based on this
argument, we have relied on existing literature to show how BI capabilities support organizational
capabilities in healthcare industry and provided examples of their effectiveness to improve quality
care and reduce cost.
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The Impact of Business Intelligence on Healthcare Delivery in the USA
Overall, the literature search concentrated on the existing knowledge on basic concepts such as
BI, BI capabilities, healthcare in the United States, organization capabilities, and use of technol-
ogy in healthcare. We then built upon those existing knowledge to show how in combination they
further the efforts to improve healthcare delivery in the United States.
Future studies could generalize these concepts by collecting data from care providers to find out
the extent to which these BI capabilities are implemented and measure their impact on the effec-
tiveness and efficiency of healthcare delivery. Questions such as which capability is the most
crucial, which is the most costly, and which is the best in terms of cost-benefit analysis could be
examined. The authors of this paper are investigating the possibility of conducting this line of
research through a case study.
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Biographies
Noushin Ashrafi is a professor of Management Information Systems
at the University of Massachusetts-Boston. Her areas of expertise are
in Business Intelligence, Object-Oriented System Analysis and Desig
and health informatics. She has numerous journal publications and is
the author of “Object Oriented System Analysis and Design”, 2009.
She has conducted seminars in organizational agility/business intelli-
gence in the U.S.A and abroad. She was Fulbright Scholar in 2010-
2011 and has been granted another Fulbright Scholar award for Spring
2015. She was the recipient of IBM 2010-2011 Healthcare Industry
Skills Innovation award and Watson cognitive technological capabili-
ties award 2012-2013. Dr. Ashrafi received her Ph.D. and M.B.A. Degrees from the University of
Texas and her B.A. from SUNY.
Lori Kelleher is a 2013 graduate of MBA program, specializing in
Healthcare Administration, from the University of Massachusetts Bos-
ton. Lori’s studies and research focused on population health and
healthcare management strategies. Her work experience encompasses a
blend of professional and personal interests, including working in sales
within the pharmaceutical industry, as well as in sports serving as the
Manager of Youth Hockey Development for the Boston Bruins Ice
Hockey Organization. Currently, she works for Medtronic in the medi-
cal device field, focusing on pain management therapies.
Jean-Pierre Kuilboer is an associate professor in the Management
Science and Information Systems Department at the University of
Massachusetts Boston. Dr. Kuilboer’s current research interests are in
the area of business Intelligence, computer forensics, information secu-
rity and privacy, database management. Dr. Kuilboer is an active
member of a research group that aims at informing academia and i
dustry through extended understanding of virtualization, enterprise
document management, cloud computing, computer forensics, and in
formation security. He is also involved in a number of initiatives such
as strategic planning, academic computing advisory, and the Massa-
chusetts advanced cyber secur
doc_148219534.pdf
The challenges of how to manage healthcare and achieve clinical integration in todays payment setting has become a national concern.
Interdisciplinary Journal of Information, Knowledge, and Management Volume 9, 2014
Cite as: Ashrafi, N., Kelleher, L., & Kuilboer, J-P. (2014). The impact of business intelligence on healthcare delivery in
the USA. Interdisciplinary Journal of Information, Knowledge, and Management, 9, 117-130. Retrieved from
http://www.ijikm.org/Volume9/IJIKMv9p117-130Ashrafi0761.pdf
Editor: Shane Tomblin
The Impact of Business Intelligence on Healthcare
Delivery in the USA
Noushin Ashrafi, Lori Kelleher, and Jean-Pierre Kuilboer
University of Massachusetts Boston, Boston, MA, USA
[email protected] [email protected]
[email protected]
Abstract
The challenges of how to manage healthcare and achieve clinical integration in today's payment
setting has become a national concern. The use of technology to help ensure healthcare quality
and control cost is an ongoing research subject. Business intelligence solutions are used in many
industries to garner insight from financial and operational data to make more informed decisions
towards the ultimate goal of achieving efficiency and effectiveness.
This paper aims to bring the reader up-to-date with the current literature on two basic topics;
business intelligence and healthcare delivery and form the basis for the justification of research
on the impact of business intelligence on healthcare delivery in the U.S.A. To achieve that goal
we examine BI deployment in the healthcare industry, address relevant issues and challenges, and
explore the role of BI to foster certain organizational capabilities. Examples of how BI capabili-
ties have supported organizational capabilities impacting the problems of accessibility, cost, and
quality of healthcare are presented. Scholars and professionals, alike, could benefit from this
study where BI is presented as a mechanism to ensure a robust and systematic approach to health-
care management with an ultimate goal of enduring impact on quality improvement and cost con-
trol.
Keywords: Healthcare, Business Intelligence, Quality, Cost, Capabilities, Sustainability.
Introduction
To improve healthcare quality, safety, and efficiency is an economic and national necessity. The
role of technology to ensure healthcare quality and control cost is an ongoing debate within the
industry and a subject of interest to researchers. Delivering quality healthcare requires the inte-
gration of patient health information from many different sources and availing a diverse set of
users; health providers must be able to readily access and use the right information at the right
time and patients should be able to access their health information in order to be able to self-
manage their conditions. Supporters of
the adoption of advanced technology in
healthcare consider it as an opportunity
not only to enhance the quality of health
services, but also transparency of eco-
nomic activities and the availability of
information in real time (Mettler, 2009).
As technology has enhanced diagnosis
and treatment options and since lifesav-
ing medicines are entering the market at
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The Impact of Business Intelligence on Healthcare Delivery in the USA
an increasing rate, life expectancy is on the rise. Healthcare organizations are investing millions
in computer systems, diagnostic technology, and preventive care programs in an attempt to meet
healthcare quality goals. These developments, however, come with a huge price tag. Health care
costs now consume nearly 18 percent of the U.S. GDP (Ramsey, Ganz, Shankaran, Peppercorn, &
Emanuel, 2013). Payers face difficulties compensating providers for high-cost treatments made
possible by advances in technology. Claims that are inflated as well as outright fraudulent are
intensifying the problem. The payers and providers in the healthcare industry, public and private,
are looking into technology to reduce costs, while keeping the quality care intact.
The predicament doesn’t end with the notion of quality versus cost; the healthcare industry is ex-
periencing more scrutiny and complexity than any other single industry in modern history. Health
providers and the affiliates have to understand and respond to privacy laws and information secu-
rity. In addition, a vast range of factors such as health care practice regulations, patient records
and requirements, practice and staff management, training, financial stability, facilities and
equipment management influence the holistic view of quality healthcare. Another force altering
the current condition of healthcare in the United States is the passing of the Patient Protection and
Affordable Care Act (PPACA). Healthcare industry is under pressure to reduce costs and better
manage care. Burke and Ingraham (2008) note that healthcare in the U.S. is at the point of colos-
sal change. The entire industry is struggling with the notion of management of quality and cost
metrics. Intensified focus on compliance with evidence-based care protocols and, a staggering
number of reimbursement programs affect revenue and the ability to compete. Healthcare indus-
try executives must evaluate an increasing amount of information to best assess their organiza-
tion’s wellbeing and future. Furthermore, data overload is a common problem for many care pro-
viders and executive teams, who are grappling with too much information and looking to find
ways to simplify acquiring knowledge from raw data (Byrnes, 2012). Coddington (2012) argues
that decision-support capabilities allow collecting data from multiple sources, such as cost ac-
counting systems, electronic health records and other sources, and make them available to physi-
cians and other users. He suggests that a balance between cost control and the other priorities of
healthcare organizations is necessary to provide quality care. The most important issue surround-
ing quality healthcare is the development of measurement goals to find validated metrics. Since
usually high quality is perceived to be correlated with high cost, a statement such as “reduce
costs, while keeping the quality care intact,” sounds paradoxical. However, Process improvement
initiatives facilitated by business intelligence solutions constitute a cost-effective option. Business
intelligence solutions allow garnering insight from financial and operational data to make more
informed decisions towards the ultimate goal of achieving efficiency and effectiveness so badly
needed in healthcare industry. In order to be able to affect financial, operations, and care man-
agement, there is a need to transform data into actionable insight, which starts with understanding
that, “having ready access to timely, complete, accurate, legible, and relevant information is criti-
cal to health care organizations (Wagner, Lee & Glaser, 2009).”
Ferrand (2010) suggests the use of business intelligence tools for the analysis and reporting of
quality measures. He further argues that their goal-oriented approach, facilitated by business in-
telligence tools, allows objectivity and diversity across clinical specialties and regions when goals
differ from one scenario to the next. Frye (2010) reminds us that successful companies use busi-
ness intelligence for their competitive advantage. They understand that the process of transform-
ing data into information and then to knowledge provides answers to not only the question
“what?” but also “why?”
The healthcare industry is now realizing that business intelligence framework, using root-cause
analysis, yields meaningful and actionable knowledge about opportunities for improvement. Or-
ganizations are recognizing the importance of using a rigorous and systematic approach to im-
prove return on their investment. A recent study by KLAS, a research firm specializing in moni-
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Ashrafi, Kelleher, & Kuilboer
toring and reporting the performance of healthcare vendors, revealed that the top five healthcare-
specific functions sought by organizations from their BI products are the following: (1) enterprise
analytics; (2) predictive analytics; (3) ACO analytics; (4) healthcare data integration/data ware-
housing; and (5) population health. Currently, a third of healthcare organizations have no BI
tools, according to the KLAS study, while half are using a single BI vendor or product, and 17%
have multiple BI products or vendors. Clarke (2012, p. 120) in his “rethinking business intelli-
gence” lists four areas where the leaders of healthcare industry should build organizational capa-
bilities by “[1]Creating a culture that advocates value, collaboration, and accountability, [2] De-
veloping robust business intelligence systems that integrate clinical and financial data, [3] Driv-
ing performance improvement throughout the organization to improve safety, reduce variation,
and eliminate waste, [4] Building risk and contract management capabilities that create, manage,
and mitigate actuarial risk of provider networks of care.” This paper focuses on the second area;
the role of business intelligence in building organization capabilities.
While decision makers in the healthcare sector are facing the multifaceted challenges of quality,
cost and compliance with regulations and patient-specific requirements, based on both clinical
and administrative data, a holistic view of BI solutions can help address these challenges. Sab-
herwal and Becerra-Fernandez (2011) offer such holistic views of business intelligence capabili-
ties. We build our argument upon their views and explore how business intelligence capabilities
can facilitate organizational capabilities. We focus on deployment of BI capabilities in healthcare
industry, address relevant issues and challenges and offer examples of how BI technology has
impacted the problems of accessibility, cost, and quality of healthcare delivery.
Scholars interested in BI research should be interested in learning about BI as a mechanism to
ensure a robust and systematic approach to healthcare management. Health industry professionals
should benefit from this study that justifies investment in BI with an ultimate goal of enduring
impact on quality improvement and cost control.
The organization of the paper is as follows: Section II describes the methodology used for litera-
ture review. Section III lays the background of the study by describing the healthcare condition in
the United States. Section IV provides a description of BI benefits in health industry and ad-
dresses the (why?) question. Section V addresses the (how?) question by relating the four capa-
bilities of BI to Healthcare Industry. Section VI offers examples of successful BI implementation
in the healthcare industry. Section VII addresses the complications of BI deployment in health-
care industry. Section VIII, the final section is the conclusion and future research.
Methodology
Google scholar and other academic databases such as EBSCO Business Source Complete were
used in an iterative manner between April-August 2013 to retrieve articles related to concepts
addressed in this paper. The literature search started using search terms on the two basic topics:
business intelligence and healthcare in the U.S.A. and broadened to include application of busi-
ness intelligence to healthcare, business intelligence capability, organizational capabilities, and
capabilities of BI in the healthcare industry. The authors of this paper independently read the
sum of fifty articles and a number of federal documents, evaluated the relevance of the articles,
studied the main findings, and decided for “inclusion” or “exclusion” of the articles. The criteria
for inclusion were obviously the relevance of the articles to the research interest; the application
of business intelligence in general and business intelligence capabilities in particular to healthcare
industry. We further searched for examples of BI applications in health industry in real world set-
tings to support the paper objectives.
Understanding organizational capability, which is the mediator between BI capabilities and
healthcare delivery was an important part of this research. Organizational capability is a well-
119
The Impact of Business Intelligence on Healthcare Delivery in the USA
researched topic and there are research experts with landmark articles published throughout the
years. We focused on resource-based theory of organizational capabilities and emphasized the
role of BI in empowering the users and elevating knowledge-based decision making. Since the
use of BI in healthcare also encompasses creating a new IT infrastructure, another component of
resource-based organization capability, a number of landmark articles on the topic were included.
Electronic health record, a good example of the use of technology to improve healthcare delivery
and related articles, were examined and included in this study. However, the notion of application
of BI capabilities to improve the delivery of healthcare is quite new and not too many major arti-
cles could be found to address these issues in a comprehensive manner. The search for scholarly
publications on support of organizational capabilities via BI solutions was even more limited.
Hence we relied on the real work examples to support this aspect of our research.
Our goal was to bring the reader up-to-date with current literature on two basic topics; business
intelligence and healthcare and form the basis for the justification of the research on the impact of
business intelligence, via improvement of organizational capabilities, on healthcare delivery in
the U.S.A.
Healthcare in the United States
Due to the passing of the Patient Protection and Affordable Care Act in 2010 (PPACA), the U.S.
healthcare system has dramatically changed. This act is an attempt to reform the current health-
care industry through making healthcare more accessible and affordable to a greater range of pa-
tients. The PPACA has many components including incorporating technology as well as coordi-
nating healthcare within a group of providers. Within the PPACA there is a mandate requiring
healthcare practices and facilities to incorporate Electronic Medical Records (EMR). EMR’s are
technology based systems that are believed to have the ability to lead to major savings in health-
care costs, reduced medical errors and improved health (Hillestad et al., 2005; Meinert, 2005).
The EMR mandate is set to take effect in 2014, and by this time, all healthcare facilities and prac-
tices will have some form of a technology based system in place to promote increased efficien-
cies.
Interoperability is needed to make it possible to share electronic health records with physicians,
pharmacists and hospitals. Interoperability can even integrate individual records with evidence-
based clinical decision support that provides reminders and best-practices for treatment (Hillestad
et al., 2005). Through mandating that EMRs become part of healthcare delivery, PPACA pro-
vides a technology based foundation to ensure coordination of care, better quality outcomes and
lower costs.
Coordination of care within a group of healthcare providers is another feature of the PPACA. Ac-
countable Care Organizations (ACOs) are the vehicles that have been developed to deliver
healthcare to populations through coordinating efforts of all the members of a patients’ care team
(Walker & McKethan, 2012). Since patient care involves multiple facets, it is necessary to have a
system in place to plan, transition, and execute treatments. Care delivery in this system requires
collecting all relevant external and internal data, then extracting and transforming this informa-
tion in order to guide patients’ care. The ACO model also relies on providing evidence based care
that takes into consideration specific patient circumstances as well as affordability. Through this
system, ACOs provide incentives for healthcare providers to work together to treat an individual
patient across care settings. ACOs’ focus on affordability, access and coordination is a shift from
the current US healthcare system, and therefore requires the development and use of healthcare
specific business process management systems and software to support the care of individual pa-
tients and entire populations (Walker & McKethan, 2012). ACOs have the potential to become
successful delivery outlets as long as community wide care processes are designed so that they
embody a patient centered vision of optimal care and all users that contribute to patient care are
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capable of utilizing new healthcare delivery tools (Walker & McKethan, 2012). In order to coor-
dinate care and make decisions that result in the delivery of high quality, low cost healthcare, it is
essential to incorporate and utilize EMR’s and shift to ACOs. Ghosh and Scott (2011, p. 396)
look at quality and cost issues in healthcare and argue that “an analytic capability is especially
critical in healthcare because lives are at stake and there is intense pressure to reduce costs and
improve efficiency.” They further argue that “the rapid growth in clinical data repositories from
increased use of EMR (Electronic Medical Record) systems in patient care facilities has moti-
vated Business Intelligence (BI) in healthcare to facilitate decision-making and improve health-
care processes” (p. 396).
The debate on use of BI in healthcare “to guide more informed decisions on financial, administra-
tive, and clinical questions” (Hennen, 2009, p. 92) has gained general support, however the ques-
tion remains as how to capture the benefits of BI in a systematic and robust manner to justify the
initial investment of BI. Before addressing this question, we need to review what are the benefits
and challenges of BI in the healthcare industry in the USA and the possible differences from other
industries when it comes to deploying BI.
BI Benefits and Challenges in the Healthcare Industry
Deployment of business intelligence, like any other technology-based approach, to solve business
problems not only brings about benefits, but also challenges to overcome. As regulations change
and the amount of data increases, health organizations are turning to business intelligence
(BI) solutions to harness data for precise decision-making to help improve patient outcomes, re-
duce costs, and ensure the future of healthcare industry. Access to timely, relevant, and accurate
healthcare information is the first step. An effective healthcare practice relies not only on the
availability of public health data sources, but also assessment tools to communicate information
to investigators, practitioners, policy makers and the general public (Jinpon, Jaroensutansinee, &
Jaroensutansinee, 2011). Incorporating business intelligence tools into healthcare practice has the
ability to streamline available data and improve population health. Sabherwal and Becerra-
Fernandez (2011, p. 6) view business intelligence as a system, “providing decision makers with
valuable information and knowledge by leveraging a variety of sources of data as well as struc-
tured and unstructured information.” Generally, there are two different perspectives of the BI sys-
tems: data centric and process centric. The data-centric view deploys BI systems to understand
the capabilities within organization by collecting, transforming, and integrating data to present
complex and competitive information to planners and decision makers. The objective is to im-
prove the timeliness and quality of inputs to decision making. The process-centric perspective
views an organization as a set of well-integrated processes (Hammer & Champy, 2001), where BI
is to be deployed to assimilate the information into processes.
Information is the key to a successful business. The health industry is no different from any other
business where the simple model of Plan, Do, Check, and Act is the key to successful processing
of data into useful and actionable information. To make appropriate operational judgment, each
of these steps must be completed using accurate data. The health industry has similarities and dif-
ferences with other industries. Like other industries, healthcare focuses on revenue, expenses,
utilization, and quality, but it differs, as it should, on using information to influence the behavior
of a more diverse set of constituencies such as physicians, patients, government, insurance com-
panies, hospital administrators, pharmacies, and more. Similarly, BI operations can be a challenge
for any company, but when it comes to the healthcare industry there are added layers of complex-
ity such as privacy issues (Cucoranu et al., 2013). Healthcare organizations collect and analyze
sensitive data about patients that is governed by privacy rules.
In today's healthcare environment, there is no shortage of data, in fact; organizations are reeling
in an ever-deeper pool of data. The challenge is how to convert the vast amount of available
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data to valuable information and knowledge. Emerging business intelligence tools are capable of
delivering all components of the “who, what, when and where” quartet more quickly than ever,
with a potentially higher level of quality and assurance, and using new analysis and visualization
tools (Yi et al. 2008).
Through business intelligence capabilities, healthcare providers have immediate access to knowl-
edge that allows them to provide quality care at a low cost (Hsia, Lin, Wu, & Tsai, 2006). Mettler
(2009) views BI solutions as triggers for information and data collection, processing, and distri-
bution. Sabherwal and Becerra-Fernandez (2011) introduce four synergistic capabilities of BI –
organizational memory, information integration, insight creation, and presentation, which make
BI essential for every industry and specifically healthcare organization. To appreciate how BI, as
a tool and a facilitator, can weave the four capabilities into the fabrics of the organization, we
need an understanding of BI and its capabilities.
Capabilities of BI in Healthcare Industry
The amount of data generated by and for the healthcare industry is overwhelming and it is busi-
ness intelligence capabilities that deliver value by pulling data from various sources and bringing
them into a common repository, enabling a thorough analysis of data, and creating insights into
routine operations while providing decision support mechanism. Whether data collection, trans-
formation, and analysis of data triggered by the processes or routinely deployed to support deci-
sion making process, BI capabilities improve and fosters organizational capabilities by empower-
ing the users, facilitate the IT structure, and enhance the use of structured and unstructured data.
Four key capabilities of business intelligence addressed in this study are (1) organizational mem-
ory capability, (2) information integration capability, (3) Insight creation capability, and (4) pres-
entation and communication capabilities.
Organizational Memory Capability
To start, historical data has to be captured and stored to establish the foundation of organizational
memory, which is one of most important capabilities required in the healthcare industry. Organ-
izational memory is usually acquired over the years, passed on to the newcomers through per-
sonal contacts, meetings, training courses, and mentor-protégé relationships and if not stored
safely, is destroyed through downsizing, frequent layoffs, unmanaged employee attrition, and/or
disasters.
Patient data comes from a variety of sources and providers, which makes it difficult to track his-
tory or manage a specific population’s health without this information being readily available.
According to Figlioli (2011) data are neither the problem nor the solution. The issue is the lack of
ability to manage these data in a meaningful way. He asserts that a person's medical history in-
cludes data on previous medical procedures and tests, medication allergies, and prescription dos-
age. While this information is needed to ensure the best possible care, a physician may have ac-
cess to only 10 or 20 of these critical pieces. As a result, individuals are often treated episodically
by providers who have access only to a limited amount of necessary clinical information.
Health care involves a diverse set of public and private data collection systems, including health
surveys, administrative enrollment and billing records, and medical records, used by various enti-
ties, including hospitals, CHCs, physicians, and health plans. None of these entities has the capa-
bilities to collect all data for entire population of patients. Nor does any single entity currently
collect all health data on individual patients.
Organization memory capability of business intelligence facilitated by data warehousing is the
first step for a systematic and robust approach to capturing, structuring, and conceptualizing of
knowledge assets across a range of healthcare environment. Electronic medical records systems
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(EMR’s) provide important input into the data warehouse, where population health information is
stored and transformed. These systems make it possible to access individual records online from
many separate, interoperable automated systems within an electronic network (Hillestad et al.,
2005). The wealth of information on care accessibility, ambulatory services, emergency visits,
patient health, insurance, healthcare disparities, healthcare quality, healthcare spending, health-
care use, hospitalization, payer information, state information on healthcare, as well as Medicare
and Medicaid are staggering. Clinicians, purchasers, policy makers, researchers, and patients are
the creators and consumers of the data. Organizational memory capability represents an organiza-
tion’s accumulated history reflecting past experiences, insights, and knowledge. Extraction, trans-
formation (making data consistent) and loading this humongous amount of data collected over the
years is the responsibility of data warehousing, a component of business intelligence. According
to Sabherwal and Becerra-Fernandez (2011) organizational memory enabled by data warehouse
helps organizations by enabling creation of new knowledge based information about the past.
Information Integration Capability
There is a need for better integration and sharing of data within and across health care entities and
even within a single entity. According to National Research Council (2009), one way to increase
the usefulness of data is to further integrate them with data from external sources. Stefanelli
(2001) points out that improving the quality of shared care between a professional team “depends
critically on the ability to share patient-specific information and medical knowledge easily among
care providers”.
Organizational memory focuses on historical data, information integration; another organizational
capability supported by BI, integrates and links past data from a variety of sources that encom-
pass organizational memory with the new, real-time content. It links structured and unstructured
data from a variety of sources, such as internal databases and knowledge repositories. BI integra-
tion capability significantly reduces the time it would take a human to catalogue these data and it
is intended to solve cost and quality problem in healthcare. Peter Osborne (2013) argues that an
integrated approach to data could deliver efficiency and lower cost. He provides an example of a
patient arriving at a primary care facility; a doctor examines him and, if required, sends him to a
secondary care facility where he is re-examined and provided specific treatment if needed. The
patient is then discharged, but if repeat visit is needed, the whole process is replicated with all the
associated costs. BI integration technology such as text mining that allows automatic reading of
large documents of text written in natural language is probably the most useful in healthcare envi-
ronment where large and diverse set of documents containing all sorts of information about pa-
tients (clinical, personal, and financial) has to be integrated to provide a comprehensive view of a
patient to be used by care providers and payer no matter where, when, and who.
Insight Creation Capability
This capability enables the organization to understand past events and make predictions about the
future and perhaps is the most talked about contribution of business intelligence to health organi-
zations. The first two capabilities, organizational memory and integration provide input to insight
creation. In complex domains such as healthcare, when quick reflexes requires quick decisions
based on information from diverse sources, a mechanism to provide reliable and quick answers is
badly needed. Technologies enabling insight creation include data mining and real-time decision
support systems. According to Koh and Tan (2011), data mining tools are becoming very popular
in healthcare industry, where they provide an in-depth analysis of data with the purpose of build-
ing predictive models and answering questions. The authors cite examples such as helping payer,
e.g., insurance companies to detect fraud and abuse, care providers to improve patient relation-
ship management, and clinicians to identify treatments and best practices, and patients to receive
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The Impact of Business Intelligence on Healthcare Delivery in the USA
improved and better services. They continue that “The huge amounts of data generated by health-
care transactions are too complex and voluminous to be processed and analyzed by traditional
methods. Data mining provides the methodology and technology to transform these mounds of
data into useful information for decision making (p. 64).” Benko and Wilson (2003) argue data
can be a great asset to healthcare organizations, but they have to be first transformed into infor-
mation.
Presentation/Communication Capabilities
It is generally agreed that ineffective communication among medical teams is a leading cause of
preventable patient harm throughout the health care system. The presentation capability of BI
fosters effective and quick communication and is the capability that displays generated insights in
different ways to make them easy to grasp and to utilize. Online analytical processing, for exam-
ple, supports multidimensional data views and allows users to aggregate, filter, drill down, and
pivot the data. Dashboards allow users to customize the information they would like to monitor
and facilitate display.
Business Intelligence not only provides the detailed data for analysts, but also allows for monitor-
ing performance. In the past, BI was used only by IT specialists who had been trained to query
and format data. Today, however, BI provides workers with easy access to relevant, actionable
information, when they need it. BI can be used in Organizational level to achieve larger strategic
initiatives, such as operating margin, return on investment on strategic investments, and quality of
care goals. At the Departmental level, BI helps employees work more effectively as a team, en-
suring the goals of the department are met. Personal BI helps workers in tasks they do every day.
In summary, the four main capabilities of business intelligence, build upon each other and are
significant contributors to organizational capabilities. According to Bharadwaj (2000) organiza-
tional capabilities refer to “organization’s ability to assemble, integrate, and deploy resources,
usually in combination or co-presence.” In modern business where the concept of “big data” is
integral to the operation of any business, the most valued resource consists of data, information,
and knowledge. As Dinesh Kumar (2009) indicates, the role of the IT industry is transitioning
from a limited capability of individual/functional reporting and analysis to one that is defined by
a connected, collaborative, and contextual world of BI. As the need for real-time data gathering,
analysis, and decision making increases, business intelligence capabilities to assembles, inte-
grates, and deploys data to help strategize the future path of an organization becomes more rele-
vant.
Furthermore, one important aspect of BI is empowerment of the user to manipulate the data and
ask “what if” questions. In a world of constant change, enabling employees to take responsibility
for their own work situation is becoming increasingly important for organizations. According to
business experts “implementing BI solutions for quick access of company resources and tools
empower employees to become more adept in handling daily responsibilities with quick, positive
ramifications (Blatche, 2012). Empowering the employees as the users of BI, the company adopts
a more efficient use of resources in term of people, IT infrastructure, and IT deployment; the nec-
essary components of organization resources.
Examples of Business Intelligence Capabilities
in Healthcare
Business intelligence tools make the healthcare industry’s shift to a technology driven, patient-
centric system possible. The advantage of correlating technology and healthcare is the ability to
manage various forms of data within user-friendly systems that help drive decision making. Busi-
ness intelligence produces contributions, which, in turn, produces a variety of benefits in terms of
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organizational performance. In what follows, we provide examples to demonstrate these capabili-
ties in the context of the healthcare industry.
The first example illustrates how organizational memory captured in data warehouse helps pro-
vide accurate data. Business intelligence systems have several advantages, yet these systems are
only effective if they have accurate data. In healthcare, data is obtained from a variety of sources,
including patients, hospitals and physicians. Business intelligence tools are then able to leverage
data obtained from these structured and unstructured resources to produce information of value.
Data serves as the foundation for business intelligence, it is therefore essential to enhance the
quality of data before embarking on business intelligence solutions. In fact, data quality is consid-
ered to be the most important technical factor for successful business intelligence, which ampli-
fies the need for using data with strong integrity (Howson, 2008). In healthcare, determining how
to best obtain and manage data is a difficult endeavor.
Cardinal Health, a global provider of integrated solutions for the healthcare industry, focused on
first creating a solid data warehouse so they were capable of implementing a strong and reliable
business intelligence system (Carte, Schwarzkopf, Shaft, & Zmud, 2005). Management at Cardi-
nal Health understood how an effective business intelligence system could benefit their organiza-
tion, and also recognized the need to first enhance the quality of the data in their data warehouse
before embarking upon business intelligence solutions (Sabherwal & Becerra-Fernandez, 2011).
This strategy of ensuring quality data was being incorporated into their business intelligence solu-
tions and allowed Cardinal Health to develop a software system capable of assisting with making
the best quality decisions for the organization.
The second example shows how integration capability helps identify patients at risk for disease.
One of the greatest features of business intelligence, affecting health management, is that it has
the ability to identify patients at risk for disease. This allows medical personnel to reduce risk,
eliminate unnecessary tests and save patient lives. The NorthShore University Health System is
an example of a healthcare organization that used business intelligence tools to tackle a specific
disease state. Identifying and treating hypertension is an elusive goal that exposes millions of
people in the country to the risk of heart attack and stroke. So to combat this epidemic, North-
Shore University Health System took steps to control this disease (Degaspari, 2013). North-
Shore’s aim was to develop a way to better link practicing physicians with research and quality
improvements, in order to eliminate undiagnosed hypertension within their network (Degaspari,
2013). Through the use of EMR, the team at NorthShore was able to better identify hypertensive
patients who were undiagnosed or at risk, then created algorithms to determine which patients
should be flagged for additional follow-up. Since the new program went live, the system has been
used to identify, test and diagnose more than 500 patients with previously undiagnosed hyperten-
sion (Degaspari, 2013). Program’s like NorthShore’s can be implemented all over the country for
a variety of disease states, which will assist with identifying patients at risk for disease and less-
ens the number of people who slip through the cracks of the healthcare system.
Third example indicates how insight creation capability helps discover complications from pro-
cedures. Business intelligence solutions also assist medical facilities determine potential compli-
cations resulting from procedures. At Sahlgrenska University Hospital in Gothenburg, Sweden,
business intelligence was used to provide doctors with a simple, easy and fast way to sift through
test results and evaluate whether a patient recovering from brain surgery had meningitis and how
it should be treated (Sabherwal & Becerra-Fernandez, 2011). The hospital implemented a busi-
ness intelligence tool that was able to provide a real-time decision support system that doctors
could use to see the most recent test results compared with patient records over time (QlikTech
International, 2007). Without a business intelligence solution in place, the physician would be
tasked with manually sifting through vast amounts of data to hopefully make an accurate diagno-
sis. In this instance, business intelligence software helped address complications arising from cra-
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The Impact of Business Intelligence on Healthcare Delivery in the USA
nial surgery, and was able to make the hospital more efficient and improve the treatment of criti-
cally ill patients (QlickTech international, 2007).
The last example is to portray how presentation capability of BI helps improve care communica-
tion. Communication is a key area improved through business intelligence. With the addition of
multiple practitioners, various facilities to obtain services and involvement of insurers, it is neces-
sary to have efficient means of communication to ensure best patient outcomes. Colorado Beacon
Consortium is an example of how a regional health information exchange, a large independent
physician association, the largest hospital in the area, and the regional health plan, came together
to share data so that they could improve care management and care communications across a vast
patient region (Hagland, 2013). Although these four Colorado care groups ran on different EMR
systems, the CBC’s goal was to implement their business intelligence solution into the existing
EMR based practice workflows. This integration allowed all areas essential to patient health in
this region to share data and information, and enabled better decision making related to patient
care.
Table one illustrates business intelligence area in healthcare.
Table 1: BI Deployment in Healthcare
ORGANIZATION NAME INDUSTRY BI TOOL BENEFIT
Cardinal Health Healthcare Data Warehouse Quality Data
Northshore University
Health System
Healthcare Integration Ability To Identify At Risk
Patients
Sahlgrenska University
Hospital
Healthcare Insight Creation Discover Procedure
Complications
Colorado Beacon
Consortium
Healthcare Presentation Electronic Communica?
tion Between Multiple
Care Sites
Complications
While the benefits of using business intelligence for health management are recognized by the
industry, there are still a variety of factors that have prohibited new systems from transforming
the healthcare industry. One of the major obstacles is the difficulty in implementing technology
into current practice. Researchers from RAND Corporation suggest that the adoption of health-
care technologies could, on the average, save more than $77 billion (Hillestad et al., 2005). Yet
despite the savings and efficiency, technology based systems have not been embraced by all
healthcare providers. Some experts note that high initial costs for BI technology implementation
deter providers, especially those in small group practices, from adopting new technologies (Tak-
vorian, 2007).
Even with the government mandate for healthcare providers to put EMR into action, as well as
providing incentive programs and assistance with implementation, broad adoption has been slow.
In fact, even for those providers who have some form of EMR, it is rare that they are using a fully
operational system capable of collecting patient information, displaying test results, allowing
providers to enter medical orders and prescriptions and helping doctors make treatment decisions
(Takvorian, 2007). For population health to be managed successfully, technology based systems
must be fully operational and incorporate all areas of patient health.
Privacy and security are also concerns when technology systems are involved with patient care.
While the Health Insurance Portability and Accountability Act, more commonly referred to as
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Ashrafi, Kelleher, & Kuilboer
HIPPA, protects patients’ personal health information, it does not alleviate anxieties related to
electronically storing healthcare data. Polls show that Americans remain deeply concerned about
the privacy and security of electronically stored health information (Blumenthal, 2011). In order
to better protect patients’ personal data, stronger security solutions for technology systems must
be developed, as well as implementing safeguards to limit issues arising from human error related
to using healthcare technology. Developing tools that not only give patients the confidence that
their private health data is protected, but also defends against potential security breaches is an
essential part of incorporating business intelligence into population health management.
Finally, in order for business intelligence tools to be utilized at their full extent, they must possess
strong usability and presentation abilities. While some systems offer many technological ad-
vances and have the ability to generate vast amounts of data, the end users are not always capable
of interpreting this information, determining what is relevant and avoiding mistakes. Poor usabil-
ity can result in errors that threaten patient safety, loss of productivity and the failure to realize
the quality and efficiency benefits of health information technology (Blumenthal, 2011). The
main advantage of incorporating business intelligence into business operations is producing use-
ful data. Therefore, it is essential that systems are simple to both integrate and navigate in order to
provide information leading to better decision making. Additionally, the information generated
via business intelligence tools should produce valuable results that are easily interpreted by the
end-users. These presentation capabilities are especially significant because organization mem-
bers need technologies to support tactical and strategic decision making (Ward, 2012) but the in-
formation produced is only valuable if the end results are easy to comprehend and put into prac-
tice (Sabherwal & Becerra-Fernandez, 2011). If a business intelligence tool is implemented and it
lacks usability or does not present data that assists with strategic decision making, the final result
is an expensive undertaking that generates information of little value.
Conclusions
The best approach to managing population health has become an increasingly discussed topic. As
changes are made to the healthcare system, and cost and quality have become frequent concerns,
the current approach to healthcare delivery is evolving. One of the biggest challenges in respond-
ing to this change is how to coordinate patient healthcare needs. If the healthcare system can ef-
fectively coordinate healthcare between patients, providers and facilities, it will contribute to bet-
ter management of entire communities’ health. Business intelligence tools provide solutions that
help healthcare providers effectively manage population health. Since technology has now be-
come an integral part of the healthcare industry, it is essential that healthcare organizations inte-
grate appropriate business intelligence systems into their operations.
To survive in a competitive market, healthcare providers need a strong BI foundation to correlate,
analyze, and glean insight from financial and operational data. Providers are hoping BI tools can
accomplish an assortment of functionality, including analysis of financial and departmental data,
including emergency, surgical, and pharmacy analytics, as well as insight into physician quality,
performance improvement, and patient outcomes. The insights garnered from these tools can also
help leaders better understand accountable care organization (ACO) activities, especially as new
ACOs and reimbursement change emerge under healthcare reform.
The contribution of this research is to show how the four capabilities of BI, in combination, use
data and information to generate knowledge that serves as input for decision making in health
care industry. How these capabilities are realized in different contexts is a valid research question
and requires an understanding of the context and the idiosyncrasy of the industry. Based on this
argument, we have relied on existing literature to show how BI capabilities support organizational
capabilities in healthcare industry and provided examples of their effectiveness to improve quality
care and reduce cost.
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The Impact of Business Intelligence on Healthcare Delivery in the USA
Overall, the literature search concentrated on the existing knowledge on basic concepts such as
BI, BI capabilities, healthcare in the United States, organization capabilities, and use of technol-
ogy in healthcare. We then built upon those existing knowledge to show how in combination they
further the efforts to improve healthcare delivery in the United States.
Future studies could generalize these concepts by collecting data from care providers to find out
the extent to which these BI capabilities are implemented and measure their impact on the effec-
tiveness and efficiency of healthcare delivery. Questions such as which capability is the most
crucial, which is the most costly, and which is the best in terms of cost-benefit analysis could be
examined. The authors of this paper are investigating the possibility of conducting this line of
research through a case study.
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Biographies
Noushin Ashrafi is a professor of Management Information Systems
at the University of Massachusetts-Boston. Her areas of expertise are
in Business Intelligence, Object-Oriented System Analysis and Desig
and health informatics. She has numerous journal publications and is
the author of “Object Oriented System Analysis and Design”, 2009.
She has conducted seminars in organizational agility/business intelli-
gence in the U.S.A and abroad. She was Fulbright Scholar in 2010-
2011 and has been granted another Fulbright Scholar award for Spring
2015. She was the recipient of IBM 2010-2011 Healthcare Industry
Skills Innovation award and Watson cognitive technological capabili-
ties award 2012-2013. Dr. Ashrafi received her Ph.D. and M.B.A. Degrees from the University of
Texas and her B.A. from SUNY.
Lori Kelleher is a 2013 graduate of MBA program, specializing in
Healthcare Administration, from the University of Massachusetts Bos-
ton. Lori’s studies and research focused on population health and
healthcare management strategies. Her work experience encompasses a
blend of professional and personal interests, including working in sales
within the pharmaceutical industry, as well as in sports serving as the
Manager of Youth Hockey Development for the Boston Bruins Ice
Hockey Organization. Currently, she works for Medtronic in the medi-
cal device field, focusing on pain management therapies.
Jean-Pierre Kuilboer is an associate professor in the Management
Science and Information Systems Department at the University of
Massachusetts Boston. Dr. Kuilboer’s current research interests are in
the area of business Intelligence, computer forensics, information secu-
rity and privacy, database management. Dr. Kuilboer is an active
member of a research group that aims at informing academia and i
dustry through extended understanding of virtualization, enterprise
document management, cloud computing, computer forensics, and in
formation security. He is also involved in a number of initiatives such
as strategic planning, academic computing advisory, and the Massa-
chusetts advanced cyber secur
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