Background: Despite the high potential of big data, its applications in healthcare face manifold organizational, social, financial, and regulatory challenges. Big data embedment in the societal dimensions of healthcare systems is underrepresented in medical research. Little is known about integrating big data applications in the corporate routines of hospitals and other care providers. Equally little is understood about embedding big data applications in daily work practices and how they lead to actual improvements for healthcare actors, such as patients, care professionals, care providers, IT companies, payers and society
Objective: This planned study aims to provide an integrated analysis of big data applications, focusing on the interrelations between concrete big data experiments, organizational routines and relevant systemic and societal dimensions. To understand the similarities and differences between interactions in various contexts, the study covers 12 big data pilot projects in eight European countries, each with its own healthcare system. Workshops will be held with stakeholders to discuss the findings, our recommendations, and their implementation. Dissemination is supported by visual representations developed to share the knowledge gained
Methods: This study will utilize a mixed-methods approach that combines performance measurements, interviews, document analysis and co-creation workshops. Analysis will be structured around four key dimensions: ‘performance’, ‘embedding’, ‘legitimation’ and ‘value creation’. Data and their interrelations across the dimensions will be synthesized per application and per country
Results: The multidisciplinary focus of this study enables us to combine insights from several social sciences (health policy analysis, business administration, innovation studies, organization studies, ethics and health services research) to advance a holistic understanding of big data value realization. The multinational character enables comparative analysis across eight European countries: Austria, France, Germany, Ireland, the Netherlands, Spain, Sweden, and the United Kingdom. Given that national and organizational contexts change over time, note that it will not be possible to isolate the factors and actors that explain the implementation of the big data applications. The visual representations developed for dissemination purposes will help to reduce complexity and clarify the relations between the various dimensions
Conclusions: This study will develop an integrated approach to big data applications that considers the interrelations between concrete big data experiments, organizational routines and relevant systemic and societal dimensions

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Journal JMIR Research Protocols
Wehrens, R.L.E, Sihag, V, van Elten, H.J, Sülz, S, van Raaij, E.M, de Bont, A.A, & Weggelaar, A.M. (2019). Understanding the Uptake of Big Data in Healthcare. JMIR Research Protocols, preprint. doi:10.2196/preprints.16779