“ARTIFICIAL INTELLIGENCE IN HEALTH CARE ”

MINI PROJECT 2
Submitted To

Dr A P J Abdul Kalam Technical University, Lucknow

In partial fulfillment of the requirements of the degree

Master of Business Administration

Prepared by Under the Guidance of

Aditya Pandey Dr. Neetu singh

MBA 2nd sem. Associate Professor & Head

Roll number: Dept. of Business Administration

2022-23

Department of Business Administration

Technical Education & Research Institute

Post-Graduate College, Ghazipur – 233001 (U.P.)
 Certificate

This is certify that Aditya Pandey, pursuing MBA 1st semester from this

institute, has prepared research report entitled “ARTIFICIAL

INTELLIGENCE IN HEALTH CARE ” in partial fulfillment of the

requirements of the degree of Master of Business Administration from

Dr A.P.J. Abdul Kalam Technical University,Lucknow,for the session

2022-23.

This project report is undertaken by Aditya Pandey under the guidance

of

Dr. Neetu Singh during the course of MBA-1st Semester and fulfills the

requirements of regulations relating to the nature and standard of

MBA course of Dr. A.P.J.Abdul Kalam Technical University, Lucknow

I recommend that this project report may be sent for evaluation.

Dr. Neetu Singh

Associate Professor & Head

Dept. of Business Administration

 Declaration

I, Aditya Pandey, hereby declare that the project report entitled

“ARTIFICIAL INTELLIGENCE IN HEALTH CARE” has been prepared by

me during the course of MBA-1 st semester, under the guidance of
Dr.Neetu Singh.

This project report is my bona fide work and has not been
submitted in any form to any University or Institute for the award of
any degree or diploma prior to the under mentioned date. I bear the
entire responsibility of submission of this project report.

It tragically effects many victims and their families annually.

Aditya Pandey
MBA -1st Semester

Department of Business Administration

Technical Education & Research Institute

P.G. College, Ghazipur

 Table of Content

1. Problem Identification
2. The job the user wants to be done
3. System Analysis
4. Interaction Matrix
5. Pictorial presentation
6. Deep Dive How
7. How might we solve the problem
8. Material Required
9. Conversion Thinking
9. Diversion thinking
10. Idea Ranking
11. Hypothesis- Assumption identification
12. Assumption mapper
13. Design the experiment
14. My Idea
15. Material Required
 Acknowledgement

I would like to express my special thanks of gratitude to Dr. Neetu

Singh, who gave me the golden opportunity to do this wonderful
project on the topic “ARTIFICIAL INTELLIGENCE IN HEALTH CARE”
which also helped me in doing a lot of research and I come to know
about so many new things.

I new really thankful to them.

Lastly, I would like to thank almighty and my parents for their moral
support and my friends with whom I shared my day-to-day
experience and received lots of suggestions that improved my quality
of work.
 Aditya Pandey

INTRODUCTION

When the concept of the amphibious car was announced a little over half a century
ago, it was met with incredible delight, and there was much enthusiasm for the
product. The idea of a car with the viability to ply roads and navigate water bodies
was something to behold. Although this piece of ingenuity briefly grabbed traction,
the amphibious car failed to grab market share sizeable enough to justify its
existence. Eventually, the amphibious car fizzled into oblivion and into the dustbins
of history. Since then, humanity has taken giant strides in technological
advancements and although there are no flying cars in the 21st century, there has
been a concerted effort to use technology to enhance everyday life. Reducing costly
human errors has become essential in ensuring safety, efficiency, and productivity.

For instance, 94% of motor vehicular accidents (MVA) are a result of human error
(National Highway Traffic Safety Administration [NHTSA], 2015). Hence, billions of
dollars have been poured into the development of enhanced motor vehicular safety
features that aid in mitigating the senseless loss of life from MVA. The solution is
automation and technology companies in Silicon Valley such as Tesla, Waymo and
Embark are working on producing fully autonomous vehicles equipped with autopilot
features that include active and passive safety systems. The NHTSA acknowledges
the benefits of automation and its potential to “remove human error from the crash
equation” (U.S. Department of Transportation, 2019). The benefits remain enormous
and the large-scale adaptation to automated vehicles has a lot of economic benefits.
According to an NHTSA study in 2010, MVA crashes cost $242 billion in economic
activity (National Highway Traffic Safety Administration, 2010). This includes a loss
of $57.6 billion in productivity and an estimated $594 billion related to loss of human
life and the associated decrease in quality of life (National Highway Traffic Safety
Administration, 2010). The money and resources saved can certainly be channeled
towards more productive endeavors.

Similarly, the cost of human-induced errors and waste in the U.S medical system
cannot be ignored. According to research funded by the Agency for Healthcare
Research and Quality (AHRQ, 2014), approximately 12 million people are affected
by diagnostic errors annually. Additionally, the cost of healthcare related waste in
the U.S amounts to approximately $960 billion.

Decades ago, the Institute of Medicine (IOM) released a groundbreaking report that
shed light on human-inspired medical errors in the American healthcare system. Its
report entitled “To Err is Human: Building a Safer Health System,” identified the
limitations of the U.S healthcare system and opened the door for improvements.
According to the IOM report, “an estimated 44,000 to 98,000 people die annually
from medical errors” (Wakefield, 2000, p. 233). These numbers are astonishing and
indicate the need for intervention in an ever-changing healthcare system.

To put things in perspective, “more people die in a given year as a result of medical
errors than motor vehicle accidents, breast cancer or AIDS” (Wakefield, 2000, p.
233). Since then, policies have been instituted and there has been a concerted effort
from stakeholders, including the government and private entities, to remedy the
situation. Nevertheless, medical errors continue to be the third leading cause of
death in the United States and accounts for ten percent of all mortalities in the
country.

Additionally, the cost of healthcare remains high and 28.5 million Americans do not
have access to healthcare (United States Census Bureau, 2018). Furthermore,
attention needs to be steered away from merely treating acute illnesses and focused
on preventative medicine that improves quality of life and keeps individuals and
families out of the hospital. Solutions are plentiful and the recent global health crisis
has shed light on the importance of investing heavily in technology.
Telehealth has emerged as an essential tool in remotely diagnosing, monitoring, and
triaging patients for COVID-19 at a fraction of what an emergency room visit may
cost. And this can be done conveniently from the confines of the home environment
without

making the dreaded visit to the hospital. According to Goldman Sachs, Telehealth
and other related digital healt.

technology has the capacity to save approximately $300 billion in costs related to
the management of certain chronic conditions (Stern, 2015). This innovation is
inspired by Artificial Intelligence and in the era of Alexa and Google Home, it is
refreshing to envision what the future has in store for healthcare. But what is
Artificial intelligence?

HISTORY

Research in the 1960s and 1970s produced the first problem-solving program,

or expert system, known as Dendron. While it was designed for applications in organic
chemistry, it provided the basis for a subsequent system MYCIN, considered one of

the most significant early uses of artificial intelligence in medicine. MYCIN and other
systems such as INTERNIST-1 and CASNET did not achieve routine use by

practitioners, however.
The 1980s and 1990s brought the proliferation of the microcomputer and new levels

of network connectivity. During this time, there was a recognition by researchers and
developers that AI systems in healthcare must be designed to accommodate the

absence of perfect data and build on the expertise of physicians Approaches

involving fuzzy set theory, Bayesian networks, and artificial neural networks, have been

applied to intelligent computing systems in healthcare.

Medical and technological advancements occurring over this half-century period

that have enabled the growth of healthcare-related applications of AI to include:

 Improvements in computing power resulting in faster data collection and data

processing

 Growth of genomic sequencing databases

 Widespread implementation of electronic health record systems
 Improvements in natural language processing and computer vision, enabling machines
to replicate human perceptual processes
 Enhanced the precision of robot-assisted surgery
 Improvements in deep learning techniques and data logs in rare diseases

AI algorithms can also be used to analyze large amounts of data through electronic
health records for disease prevention and diagnosis. Medical institutions such as The

Mayo Clinic, Memorial Sloan Kettering Cancer Center, and the British National Health

Service, have developed AI algorithms for their departments. Large technology

companies such as IBM and Google, have also developed AI algorithms for

healthcare. Additionally, hospitals are looking to AI software to support operational

initiatives that increase cost saving, improve patient satisfaction, and satisfy their
staffing and workforce needs.[23] Currently, the United States government is

investing billions of dollars to progress the development of AI in

healthcare Companies are developing technologies that help healthcare
managers improve business operations through increasing utilization, decreasing

patient boarding, reducing length of stay and optimizing staffing levels.

What is Artificial Intelligence?

Artificial intelligence (AI) refers to “a wide-ranging branch of computer science
concerned with building smart machines capable of performing tasks that typically
require human intelligence” (Christopher, 2020, p. 1). We are in the era of the
Internet of things (IoT) and Artificial intelligence may define this century. The term
Artificial intelligence was first coined in the 1940’s and represents a broad term that
includes

machine learning, natural language processing, rule based expert systems, physical
robots and robotic automation.

Machine learning which is a subset of artificial intelligence refers “to a process in

which computers use algorithms to analyze large data sets in non-linear ways,
identify patterns, and make predictions that can be tested and confirmed” (General
Electric, 2016, p. 1). This form of technology is what makes it possible to stream TV
shows on Netflix while commanding Siri to provide you with the most current
weather report. This process focuses on building computer algorithms that can
methodically learn, improve, and make decisions through experience without
necessarily being programmed.

Furthermore, machine learning has key elements which include deep learning. Deep
learning utilizes networks that are built on the premise of the neural network and
neural activities in the brain. In 1943, McCulloch and Pitts took the initiative and
began the early stages of the development of the perceptron, which represents the
most fundamental unit of deep neural networks (Kawaguchi, 2017). The perceptron
in its formative stages was reported in the New York Times in 1958 as “the embryo”
of the electronic computer and a device that “will be able to walk, talk, see, write,
reproduce itself and be conscious of its existence” (New York Times, 1958, p. 25).
By imitating the functioning capacity of the human brain, it utilizes artificial neural
networks to learn and develop solutions to complex and challenging problems that
are beyond the limitations of the human brain. In brief, “Artificial intelligence is a set
of algorithms and intelligence to try to mimic human intelligence. Machine learning is
one of them, and deep learning is one of those machine learning techniques”
(Christopher, 2020, p. 1). This piece of ingenuity is present in various forms of
technology and brings into reality ideas such as robotic surgery.

Artificial Intelligence in Healthcare

There is a plethora of instances of this level of technology in healthcare. An example

is the federally funded Undiagnosed Disease Network, that operates with private
medical universities like Harvard and Stanford University to diagnose and treat rare
diseases. Using data analysis, deep learning and genetic sequencing, the program
has successfully diagnosed 25% of cases and provided a lifeline for many patients.
At Stanford University, an algorithm was developed to accurately predict the
prognoses of cancer patients that researchers suggest “could provide rapid and
objective survival prediction for numerous patients” (Koontz, 2017). Developers at
Google Health utilized deep learning to create a model capable of diagnosing breast
cancer after analyzing an enormous amount of data from the United States and the
United Kingdom. This study involved information gathered from over 28,000 women
across both countries. Surprisingly, the system was able to learn and detect breast
cancer with 5.7% less false-positives and 9.4% less false-negatives than board-
certified radiologists (Abbasi, 2020). Based on the outcomes indicated, fully
integrating this system into clinical practice has enormous potential in reducing
misdiagnosis and medical errors as most of the breast cancers identified by the
Artificial intelligence model in the Stanford University study were invasive. In areas
with poorly equipped health care systems, AI can play an important role in bringing
affordable healthcare to the doorsteps of individuals. Today, smart phones have the
capacity to be equipped with electrocardiogram and ultrasound functionalities that
can be utilized in impoverished areas for diagnostic purposes. However, what are
the implications for medical providers?
 Why Does AI in Healthcare Matter?

Healthcare is one of the most critical sectors in the broader landscape of big
data because of its fundamental role in a productive, thriving society. The
application of AI to healthcare data can literally be a matter of life and death. AI
can assist doctors, nurses, and other healthcare workers in their daily work. AI
in healthcare can enhance preventive care and quality of life, produce more
accurate diagnoses and treatment plans, and lead to better patient outcomes
overall. AI can also predict and track the spread of infectious diseases by
analyzing data from a government, healthcare, and other sources. As a result, AI
can play a crucial role in global public health as a tool for combatting epidemics
and pandemics.

The role of artificial intelligence in healthcare: a

structured literature review

Background/Introduction
Artificial intelligence (AI) in the healthcare sector is receiving attention from
researchers and health professionals. Few previous studies have investigated this
topic from a multi-disciplinary perspective, including accounting, business and
management, decision sciences and health professions.
 Methods
The structured literature review with its reliable and replicable research protocol
allowed the researchers to extract 288 peer-reviewed papers from Scopus. The
authors used qualitative and quantitative variables to analyse authors, journals,
keywords, and collaboration networks among researchers. Additionally, the paper
benefited from the Bibliometrix R software package.

Results
The investigation showed that the literature in this field is emerging. It focuses on
health services management, predictive medicine, patient data and diagnostics, and
clinical decision-making. The United States, China, and the United Kingdom
contributed the highest number of studies. Keyword analysis revealed that AI can
support physicians in making a diagnosis, predicting the spread of diseases and
customising treatment paths.

Background

Artificial intelligence (AI) generally applies to computational technologies that

emulate mechanisms assisted by human intelligence, such as thought, deep learning,
adaptation, engagement, and sensory understanding [1, 2]. Some devices can
execute a role that typically involves human interpretation and decision-making
[3, 4]. These techniques have an interdisciplinary approach and can be applied to
different fields, such as medicine and health. AI has been involved in medicine since
as early as the 1950s, when physicians made the first attempts to improve their
diagnoses using computer-aided programs. Interest and advances in medical AI
applications have surged in recent years due to the substantially enhanced
computing power of modern computers and the vast amount of digital data available
for collection and utilisation .AI is gradually changing medical practice. There are
several AI applications in medicine that can be used in a variety of medical fields,
such as clinical, diagnostic, rehabilitative, surgical, and predictive practices. Another
critical area of medicine where AI is making an impact is clinical decision-making
and disease diagnosis. AI technologies can ingest, analyse, and report large volumes
of data across different modalities to detect disease and guide clinical decisions
[3, 8]. AI applications can deal with the vast amount of data produced in medicine
and find new information that would otherwise remain hidden in the mass of
medical big data [9,10,11]. These technologies can also identify new drugs for health
services management and patient care treatments.

Courage in the application of AI is visible through a search in the primary research

databases. However, as Meskò et al. find, the technology will potentially reduce care
costs and repetitive operations by focusing the medical profession on critical
thinking and clinical creativity. As Cho et al. and Doyle et al. add, the AI perspective
is exciting; however, new studies will be needed to establish the efficacy and
applications of AI in the medical field.

Our paper will also concentrate on AI strategies for healthcare from the accounting,
business, and management perspectives. The authors used the structured literature
review (SLR) method for its reliable and replicable research protocol and selected
bibliometric variables as sources of investigation. Bibliometric usage enables the
recognition of the main quantitative variables of the study stream. This method
facilitates the detection of the required details of a particular research subject,
including field authors, number of publications, keywords for interaction between
variables (policies, properties and governance) and country data. It also allows the
application of the science mapping techniqu. Our paper adopted the Bibliometrix R
package and the biblioshiny web interface as tools of analysis.

The investigation offers the following insights for future researchers and
practitioners:

1. (a)

bibliometric information on 288 peer-reviewed English papers from the

Scopus collection.
 2. (b)

Identification of leading journals in this field, such as Journal of Medical

Systems, Studies in Health Technology and Informatics, IEEE Journal of
Biomedical and Health Informatics, and Decision Support Systems.

3. (c)

Qualitative and quantitative information on authors’ Lotka’s law, h-index, g-

index, m-index, keyword, and citation data.

4. (d)

Research on specific countries to assess AI in the delivery and effectiveness of

healthcare, quotes, and networks within each region.

5. (e)

A topic dendrogram study that identifies five research clusters: health services
management, predictive medicine, patient data, diagnostics, and finally,
clinical decision-making.

6. (f)

An in-depth discussion that develops theoretical and practical implications for

future studies.
The paper is organised as follows. Section 2 lists the main bibliometric articles in
this field. Section 3 elaborates on the methodology. Section 4 presents the findings
of the bibliometric analysis. Section 5 discusses the main elements of AI in
healthcare based on the study results. Section 6 concludes the article with future
implications for research.

Related works and originality

As suggested by Zupic and Čater , a research stream can be evaluated with
bibliometric methods that can introduce objectivity and mitigate researcher bias.
For this reason, bibliometric methods are attracting increasing interest among
researchers as a reliable and impersonal research analytical approach. Recently,
bibliometrics has been an essential method for analysing and predicting research
trends []. Table 1 lists other research that has used a similar approach in the
research stream investigated.

References Field

Huang et al. 1 Rehabilitation medicine

Hao et al. 2 Text mining in medical research

  Medical big data

Liao et al. 3 Global evolution of research on AI in health and medicine

dos Santos et al. 4 Data mining and machine learning techniques applied to public health problems

Connelly et al. 5 Robotic surgery

Guo et al.6 AI-related research conducted in the field of health problems

Choudhury et al. 7 Machine learning in geriatric clinical

Choudhury and Asan AI in patient safety outcomes

8

This paper AI techniques for clinical decision-making and data management quality in
healthcare
The scientific articles reported show substantial differences in keywords and
research topics that have been previously studied. The bibliometric analysis of
Huang et al. describes rehabilitative medicine using virtual reality technology.
According to the authors, the primary goal of rehabilitation is to enhance and restore
functional ability and quality of life for patients with physical impairments or
disabilities. In recent years, many healthcare disciplines have been privileged to
access various technologies that provide tools for both research and clinical
intervention.

Hao et al. focus on text mining in medical research. As reported, text mining reveals
new, previously unknown information by using a computer to automatically extract
information from different text resources. Text mining methods can be regarded as
an extension of data mining to text data. Text mining is playing an increasingly
significant role in processing medical information. Similarly, the studies by dos
Santos et al. focus on applying data mining and machine learning (ML) techniques
to public health problems. As stated in this research, public health may be defined as
the art and science of preventing diseases, promoting health, and prolonging life.
Using data mining and ML techniques, it is possible to discover new information
that otherwise would be hidden. These two studies are related to another topic:
medical big data. According to Liao et al. , big data is a typical “buzzword” in the
business and research community, referring to a great mass of digital data collected
from various sources. In the medical field, we can obtain a vast amount of data (i.e.,
medical big data). Data mining and ML techniques can help deal with this
information and provide helpful insights for physicians and patients. More recently,
Choudhury et al. provide a systematic review on the use of ML to improve the care of
elderly patients, demonstrating eligible studies primarily in psychological disorders
and eye diseases.
Tran et al.focus on the global evolution of AI research in medicine. Their
bibliometric analysis highlights trends and topics related to AI applications and
techniques. As stated in Connelly et al.’s [24] study, robot-assisted surgeries have
rapidly increased in recent years. Their bibliometric analysis demonstrates how
robotic-assisted surgery has gained acceptance in different medical fields, such as
urological, colorectal, cardiothoracic, orthopaedic, maxillofacial and neurosurgery
applications. Additionally, the bibliometric analysis of Guo et al.provides an in-
depth study of AI publications through December 2019. The paper focuses on
tangible AI health applications, giving researchers an idea of how algorithms can
help doctors and nurses. A new stream of research related to AI is also emerging. In
this sense, Choudhury and Asan’sscientific contribution provides a systematic
review of the AI literature to identify health risks for patients. They report on 53
studies involving technology for clinical alerts, clinical reports, and drug safety.
Considering the considerable interest within this research stream, this analysis
differs from the current literature for several reasons. It aims to provide in-depth
discussion, considering mainly the business, management, and accounting fields
and not dealing only with medical and health profession publications.

Additionally, our analysis aims to provide a bibliometric analysis of

variables such as authors, countries, citations and keywords to guide
future research perspectives for researchers and practitioners, as
similar analyses have done for several publications in other research
streams. In doing so, we use a different database, Scopus, that is
typically adopted in social sciences fields. Finally, our analysis will
propose and discuss a dominant framework of variables in this field,
and our analysis will not be limited to AI application descriptions.

Methodology
This paper evaluated AI in healthcare research streams using the SLR method. As
suggested by Massaro et al. an SLR enables the study of the scientific corpus of a
research field, including the scientific rigour, reliability and replicability of
operations carried out by researchers. As suggested by many scholars, the
methodology allows qualitative and quantitative variables to highlight the best
authors, journals and keywords and combine a systematic literature review and
bibliometric analysis Despite its widespread use in business and management the
SLR is also used in the health sector based on the same philosophy through which it
was originally conceive. A methodological analysis of previously published articles
reveals that the most frequently used steps are as follows

1. 1.

defining research questions;

2. 2.

writing the research protocol;

3. 3.

defining the research sample to be analysed;

4. 4.

developing codes for analysis; and

5. 5.

critically analysing, discussing, and identifying a future research agenda.

Considering the above premises, the authors believe that an SLR is the best method
because it combines scientific validity, replicability of the research protocol and
connection between multiple inputs.

As stated by the methodological paper, the first step is research question

identification. For this purpose, we benefit from the analysis of Zupic and Čater who
provide several research questions for future researchers to link the study of authors,
journals, keywords and citations. Therefore, RQ1 is “What are the most prominent
authors, journal keywords and citations in the field of the research study?”
Additionally, as suggested by Haleem et al., new technologies, including AI, are
changing the medical field in unexpected timeframes, requiring studies in multiple
areas. Therefore, RQ2 is “How does artificial intelligence relate to healthcare, and
what is the focus of the literature?” Then, as discussed by Massaro et al. RQ3 is
“What are the research applications of artificial intelligence for healthcare?”.

The first research question aims to define the qualitative and quantitative variables
of the knowledge flow under investigation. The second research question seeks to
determine the state of the art and applications of AI in healthcare. Finally, the third
research question aims to help researchers identify practical and theoretical
implications and future research ideas in this field.

The second fundamental step of the SLR is writing the research

protocol.Table 2 indicates the currently known literature elements,
uniquely identifying the research focus, motivations and research
strategy adopted and the results providing a link with the following
points. Additionally, to strengthen the analysis, our investigation
benefits from the PRISMA statement methodological article. Although
the SLR is a validated method for systematic reviews and meta-
analyses, we believe that the workflow provided may benefit the
replicability of the results. Figure 1 summarises the researchers’
research steps, indicating that there are no results that can be referred
to as a meta-analysis.
 The third step is to specify the search strategy and search database. Our analysis is
based on the search string “Artificial Intelligence” OR “AI” AND “Healthcare” with a
focus on “Business, Management, and Accounting”, “Decision Sciences”, and
“Health professions”. As suggested by and motivated by keywords can be selected
through a top-down approach by identifying a large search field and then focusing
on particular sub-topics. The paper uses data retrieved from the Scopus database, a
multi-disciplinary database, which allowed the researchers to identify critical articles
for scientific analysi. Additionally, Scopus was selected based on Guo et al.’s
limitations, which suggest that “future studies will apply other databases, such as
Scopus, to explore more potential papers”. The research focuses on articles and
reviews published in peer-reviewed journals for their scientific relevance and does
not include the grey literature, conference proceedings or books/book chapters.
Articles written in any language other than English were exclude. For transparency
and replicability, the analysis was conducted on 11 January 2021. Using this research
strategy, the authors retrieved 288 articles. To strengthen the study's reliability, we
publicly provide the full bibliometric extract on the Zenodo repository.

The fourth research phase is defining the code framework that initiates the analysis
of the variables. The study will identify the following:

1. (1)

descriptive information of the research area;

2. (2)

source analysis

3. (3)

author and citation analysis

 4. (4)

keywords and network analysis ; and

5. (5)

geographic distribution of the papers

The final research phase is the article’s discussion and conclusion, where
implications and future research trends will be identified.

At the research team level, the information is analysed with the statistical software
R-Studio and the Bibliometrix package which allows scientific analysis of the results
obtained through the multi-disciplinary database.

Results

The analysis of bibliometric results starts with a description of the main bibliometric
statistics with the aim of answering RQ1, What are the most prominent authors,
journal keywords and citations in the field of the research study?, and RQ2, How
does artificial intelligence relate to healthcare, and what is the focus of the
literature? Therefore, the following elements were thoroughly analysed: (1) type of
document; (2) annual scientific production; (3) scientific sources; (4) source growth;
(5) number of articles per author; (6) author’s dominance ranking; (7) author’s h-
index, g-index, and m-index; (8) author’s productivity; (9) author’s keywords; (10)
topic dendrogram; (11) a factorial map of the document with the highest
contributions; (12) article citations; (13) country production; (14) country citations;
(15) country collaboration map; and (16) country collaboration network.
 Main information

Table 3 shows the information on 288 peer-reviewed articles published between

1992 and January 2021 extracted from the Scopus database. The number of
keywords is 946 from 136 sources, and the number of keywords plus, referring to the
number of keywords that frequently appear in an article’s title, was 2329. The
analysis period covered 28 years and 1 month of scientific production and included
an annual growth rate of 5.12%. However, the most significant increase in published
articles occurred in the past three years (please see Fig. 2). On average, each article
was written by three authors (3.56). Finally, the collaboration index (CI), which was
calculated as the total number of authors of multi-authored articles/total number of
multi-authored articles, was 3.97 [46].
Main information Explanation No

Documents Total number of scientific papers and review 288

Sources The frequency distribution of sources as journals 136

Author’s keywords Total number of keywords 946

Keywords plus (ID) Total number of phrases that frequently appear in the title 2329
of an article's references

Period Years of publication 1992–

2021

Authors Total number of authors 1025

Authors appearances The authors’ frequency distribution 1059

Authors of single-authored The number of single authors per articles 36

documents

Authors of multi-authored The number of authors of multi-authored articles 989

documents

Authors per document The average number of authors in each document 3.56

Co-authors per documents The average number of co-authors in each document 3.68

Average citations per article The average number of quotes in each article 12.68

Collaboration index (CI)   3.97

 Table 4 shows the top 20 sources related to the topic. The Journal of Medical
Systems is the most relevant source, with twenty-one of the published articles. This
journal's main issues are the foundations, functionality, interfaces,
implementation, impacts, and evaluation of medical technologies. Another relevant
source is Studies in Health Technology and Informatics, with eleven articles. This
journal aims to extend scientific knowledge related to biomedical technologies and
medical informatics research. Both journals deal with cloud computing, machine
learning, and AI as a disruptive healthcare paradigm based on recent publications.
The IEEE Journal of Biomedical and Health Informatics investigates technologies
in health care, life sciences, and biomedicine applications from a broad perspective.
The next journal, Decision Support Systems, aims to analyse how these
technologies support decision-making from a multi-disciplinary view, considering
business and management. Therefore, the analysis of the journals revealed that we
are dealing with an interdisciplinary research field. This conclusion is confirmed,
for example, by the presence of purely medical journals, journals dedicated to the
technological growth of healthcare, and journals with a long-term perspective such
as futures.
Top 20 sources No of articles

Journal of Medical Systems 21

Studies in Health Technology and Informatics 18

IEEE Journal of Biomedical and Health Informatics 17

Decision Support Systems 11

Healthcare Informatics Research 11

International Journal of Scientific and Technology Research 8

International Journal of Recent Technology and Engineering 7

Journal of Digital Imaging 7

NPJ Digital Medicine 5

Physiotherapy Theory and Practice 5

Telemedicine and E-Health 5

Biomedical Engineering Online 4

Information Sciences 4

International Journal of Healthcare Information Systems and Informatics 4

BMJ Health and Care Informatics 3

Futures 3

International Journal on Emerging Technologies 3

Journal of the Operational Research Society 3

Judgement and Decision Making 3

Medical Image Analysis 3

The distribution frequency of the articles (Fig. 3) indicates the journals dealing with
the topic and related issues. Between 2008 and 2012, a significant growth in the
number of publications on the subject is noticeable. However, the graph shows the
results of the Loess regression, which includes the quantity and publication time of
the journal under analysis as variables. This method allows the function to assume
an unlimited distribution; that is, feature can consider values below zero if the data
are close to zero. It contributes to a better visual result and highlights the
discontinuity in the publication periods.

Finally, Fig. 4 provides an analytical perspective on factor analysis for the most cited
papers. As indicated in the literature, using factor analysis to discover the most cited
papers allows for a better understanding of the scientific world’s intellectual structure.
For example, our research makes it possible to consider certain publications that
effectively analyse subject specialisation. For instance, Santosh’sarticle addresses the
new paradigm of AI with ML algorithms for data analysis and decision support in the
COVID-19 period, setting a benchmark in terms of citations by researchers. Moving on
to the application, an article by Shickel et al.begins with the belief that the healthcare
world currently has much health and administrative data. In this context, AI and deep
learning will support medical and administrative staff in extracting data, predicting
outcomes, and learning medical representations. Finally, in the same line of research,
Baig et al.with a focus on wearable patient monitoring systems (WPMs), conclude that
AI and deep learning may be landmarks for continuous patient monitoring and support
for healthcare delivery.
 Authors
This section identifies the most cited authors of articles on AI in healthcare. It also identifies the
authors’ keywords, dominance factor (DF) ranking, h-index, productivity, and total number of
citations. Table 5 identifies the authors and their publications in the top 20 rankings. As the table
shows, Bushko R.G. has the highest number of publications: four papers. He is the editor-in-chief
of Future of Health Technology, a scientific journal that aims to develop a clear vision of the future
of health technology. Then, several authors each wrote three papers. For instance, Liu C. is a
researcher active in the topic of ML and computer vision, and Sharma A. from Emory University
Atlanta in the USA is a researcher with a clear focus on imaging and translational informatics.
Some other authors have two publications each. While some authors have published as primary
authors, most have published as co-authors. Hence, in the next section, we measure the
contributory power of each author by investigating the DF ranking through the number of
elements.

Authors’ dominance ranking

The dominance factor (DF) is a ratio measuring the fraction of multi-authored articles in which an
author acts as the first author. Several bibliometric studies use the DF in their analysesThe DF
ranking calculates an author’s dominance in producing articles. The DF is calculated by dividing
the number of an author’s multi-authored papers as the first author (Nmf) by the author's total
number of multi-authored papers (Nmt). This is omitted in the single-author case due to the
constant value of 1 for single-authored articles. This formulation could lead to some distortions in
the results, especially in fields where the first author is entered by surname alphabetical order.

The mathematical equation for the DF is shown as:

DF=NmfNmtDF=NmfNmt
Table 6 lists the top 20 DF rankings. The data in the table show a low level of articles per author,
either for first-authored or multi-authored articles. The results demonstrate that we are dealing
with an emerging topic in the literature. Additionally, as shown in the table, Fox J. and Longoni C.
are the most dominant authors in the field.

Authors’ impact
Table 7 shows the impact of authors in terms of the h-index(i.e., the productivity and impact of
citations of a researcher), g-index (i.e., the distribution of citations received by a researcher's
publications), m-index (i.e., the h-index value per year), total citations, total paper and years of
scientific publication. The H-index was introduced in the literature as a metric for the objective
comparison of scientific results and depended on the number of publications and their impact .
The results show that the 20 most relevant authors have an h-index between 2 and 1. For the
practical interpretation of the data, the authors considered data published by the London School of
Economics. In the social sciences, the analysis shows values of 7.6 for economic publications by
professors and researchers who had been active for several years. Therefore, the youthfulness of
the research area has attracted young researchers and professors. At the same time, new indicators
have emerged over the years to diversify the logic of the h-index. For example, the g-index
indicates an author's impact on citations, considering that a single article can generate these. The
m-index, on the other hand, shows the cumulative value over the years.

Author h-index g-index m-index Total citations Total papers Year Start

Bushko RG 1 2 0.050 4 4 2002

Liu C 2 3 0.500 10 3 2018

Sharma A 1 1 0.167 1 3 2016

Attia S 2 2 0.333 7 2 2016

Beckstead JW 1 1 0.500 2 2 2020

Bonezzi A 2 2 0.667 46 2 2019

Boubetra A 2 2 0.333 7 2 2016

Chang H 1 2 0.200 8 2 2017

Chang V 1 2 0.250 14 2 2018

Clifton DA 1 2 0.111 20 2 2013

Das S 1 1 0.333 3 2 2019

Fan W 2 2 1.000 20 2 2020

Fox J 1 1 0.500 2 2 2020

Kalhori SRN 2 2 0.400 13 2 2017

Khan O 1 1 0.500 2 2 2020

Liu J 1 2 0.250 11 2 2018

Longoni C 2 2 0.667 46 2 2019

Luo G 2 2 0.200 20 2 2012

 Author h-index g-index m-index Total citations Total papers Year Start

Michalowski W 2 2 0.154 14 2 2009

Morewedge CK 2 2 0.667 46 2 2019

The role of artificial intelligence in healthcare: a

structured literature review

Abstract
Background/Introduction
Artificial intelligence (AI) in the healthcare sector is receiving attention from researchers and health
professionals. Few previous studies have investigated this topic from a multi-disciplinary perspective,
including accounting, business and management, decision sciences and health professions.

Methods
The structured literature review with its reliable and replicable research protocol allowed the researchers to
extract 288 peer-reviewed papers from Scopus. The authors used qualitative and quantitative variables to
analyse authors, journals, keywords, and collaboration networks among researchers. Additionally, the paper
benefited from the Bibliometrix R software package.

Results
The investigation showed that the literature in this field is emerging. It focuses on health services
management, predictive medicine, patient data and diagnostics, and clinical decision-making. The United
States, China, and the United Kingdom contributed the highest number of studies. Keyword analysis
revealed that AI can support physicians in making a diagnosis, predicting the spread of diseases and
customising treatment paths.

Conclusions
The literature reveals several AI applications for health services and a stream of research that has not fully
been covered. For instance, AI projects require skills and data quality awareness for data-intensive analysis
and knowledge-based management. Insights can help researchers and health professionals understand and
address future research on AI in the healthcare field.
 Background
Artificial intelligence (AI) generally applies to computational technologies that emulate mechanisms
assisted by human intelligence, such as thought, deep learning, adaptation, engagement, and sensory
understanding [1, 2]. Some devices can execute a role that typically involves human interpretation and
decision-making [3, 4]. These techniques have an interdisciplinary approach and can be applied to different
fields, such as medicine and health. AI has been involved in medicine since as early as the 1950s, when
physicians made the first attempts to improve their diagnoses using computer-aided programs [5, 6]. Interest
and advances in medical AI applications have surged in recent years due to the substantially enhanced
computing power of modern computers and the vast amount of digital data available for collection and
utilisation [7]. AI is gradually changing medical practice. There are several AI applications in medicine that
can be used in a variety of medical fields, such as clinical, diagnostic, rehabilitative, surgical, and predictive
practices. Another critical area of medicine where AI is making an impact is clinical decision-making and
disease diagnosis. AI technologies can ingest, analyse, and report large volumes of data across different
modalities to detect disease and guide clinical decisions. AI applications can deal with the vast amount of
data produced in medicine and find new information that would otherwise remain hidden in the mass of
medical big data. These technologies can also identify new drugs for health services management and
patient care treatments.

Courage in the application of AI is visible through a search in the primary research databases. However, as
Meskò et al.find, the technology will potentially reduce care costs and repetitive operations by focusing the
medical profession on critical thinking and clinical creativity. As Cho et al. and Doyle et al. add, the AI
perspective is exciting; however, new studies will be needed to establish the efficacy and applications of AI
in the medical field

Our paper will also concentrate on AI strategies for healthcare from the accounting, business, and
management perspectives. The authors used the structured literature review (SLR) method for its reliable
and replicable research protocol and selected bibliometric variables as sources of investigation. Bibliometric
usage enables the recognition of the main quantitative variables of the study stream .This method facilitates
the detection of the required details of a particular research subject, including field authors, number of
publications, keywords for interaction between variables (policies, properties and governance) and country
data . It also allows the application of the science mapping technique. Our paper adopted the Bibliometrix R
package and the biblioshiny web interface as tools of analysis

The investigation offers the following insights for future researchers and practitioners:

1. (a)

bibliometric information on 288 peer-reviewed English papers from the Scopus collection.

2. (b)

Identification of leading journals in this field, such as Journal of Medical Systems, Studies in Health
Technology and Informatics, IEEE Journal of Biomedical and Health Informatics, and Decision
Support Systems.

3. (c)

Qualitative and quantitative information on authors’ Lotka’s law, h-index, g-index, m-index,
keyword, and citation data.

4. (d)
 Research on specific countries to assess AI in the delivery and effectiveness of healthcare, quotes,
and networks within each region.

5. (e)

A topic dendrogram study that identifies five research clusters: health services management,
predictive medicine, patient data, diagnostics, and finally, clinical decision-making.

6. (f)

An in-depth discussion that develops theoretical and practical implications for future studies.
The paper is organised as follows. Section 2 lists the main bibliometric articles in this field.
Section 3 elaborates on the methodology. Section 4 presents the findings of the bibliometric analysis.
Section 5 discusses the main elements of AI in healthcare based on the study results. Section 6 concludes the
article with future implications for research.
Related works and originality
As suggested by Zupic and Čater a research stream can be evaluated with bibliometric methods that can
introduce objectivity and mitigate researcher bias. For this reason, bibliometric methods are attracting
increasing interest among researchers as a reliable and impersonal research analytical approach Recently,
bibliometrics has been an essential method for analysing and predicting research trends [Table 1 lists other
research that has used a similar approach in the research stream investigated.

The scientific articles reported show substantial differences in keywords and research topics that have been
previously studied. The bibliometric analysis of Huang et al. ] describes rehabilitative medicine using virtual reality
technology. According to the authors, the primary goal of rehabilitation is to enhance and restore functional ability
and quality of life for patients with physical impairments or disabilities. In recent years, many healthcare disciplines
have been privileged to access various technologies that provide tools for both research and clinical intervention.

Hao et al. focus on text mining in medical research. As reported, text mining reveals new, previously
unknown information by using a computer to automatically extract information from different text
resources. Text mining methods can be regarded as an extension of data mining to text data. Text mining is
playing an increasingly significant role in processing medical information. Similarly, the studies by dos
Santos et al.focus on applying data mining and machine learning (ML) techniques to public health problems.
As stated in this research, public health may be defined as the art and science of preventing diseases,
promoting health, and prolonging life. Using data mining and ML techniques, it is possible to discover new
information that otherwise would be hidden. These two studies are related to another topic: medical big data.
According to Liao et al.big data is a typical “buzzword” in the business and research community, referring
to a great mass of digital data collected from various sources. In the medical field, we can obtain a vast
amount of data (i.e., medical big data). Data mining and ML techniques can help deal with this information
and provide helpful insights for physicians and patients. More recently, Choudhury et al. provide a
systematic review on the use of ML to improve the care of elderly patients, demonstrating eligible studies
primarily in psychological disorders and eye diseases.

Tran et al. focus on the global evolution of AI research in medicine. Their bibliometric analysis highlights
trends and topics related to AI applications and techniques. As stated in Connelly et al.’sstudy, robot-
assisted surgeries have rapidly increased in recent years. Their bibliometric analysis demonstrates how
robotic-assisted surgery has gained acceptance in different medical fields, such as urological, colorectal,
cardiothoracic, orthopaedic, maxillofacial and neurosurgery applications. Additionally, the bibliometric
analysis of Guo et al.provides an in-depth study of AI publications through December 2019. The paper
focuses on tangible AI health applications, giving researchers an idea of how algorithms can help doctors
and nurses. A new stream of research related to AI is also emerging. In this sense, Choudhury and Asan’s ]
scientific contribution provides a systematic review of the AI literature to identify health risks for patients.
They report on 53 studies involving technology for clinical alerts, clinical reports, and drug safety.
Considering the considerable interest within this research stream, this analysis differs from the current
literature for several reasons. It aims to provide in-depth discussion, considering mainly the business,
management, and accounting fields and not dealing only with medical and health profession publications.

Additionally, our analysis aims to provide a bibliometric analysis of variables such as authors, countries,
citations and keywords to guide future research perspectives for researchers and practitioners, as similar
analyses have done for several publications in other research streams . In doing so, we use a different
database, Scopus, that is typically adopted in social sciences fields. Finally, our analysis will propose and
discuss a dominant framework of variables in this field, and our analysis will not be limited to AI
application descriptions.
Methodology
This paper evaluated AI in healthcare research streams using the SLR method. As suggested by Massaro et
al. an SLR enables the study of the scientific corpus of a research field, including the scientific rigour,
reliability and replicability of operations carried out by researchers. As suggested by many scholars, the
methodology allows qualitative and quantitative variables to highlight the best authors, journals and
keywords and combine a systematic literature review and bibliometric analysis. Despite its widespread use
in business and management, the SLR is also used in the health sector based on the same philosophy through
which it was originally conceived. A methodological analysis of previously published articles reveals that
the most frequently used steps are as follows

1. 1.

defining research questions;

2. 2.

writing the research protocol;

3. 3.

defining the research sample to be analysed;

4. 4.

developing codes for analysis; and

5. 5.

critically analysing, discussing, and identifying a future research agenda.

Considering the above premises, the authors believe that an SLR is the best method because it combines
scientific validity, replicability of the research protocol and connection between multiple inputs.

As stated by the methodological paper, the first step is research question identification. For this purpose, we
benefit from the analysis of Zupic and Čater who provide several research questions for future researchers to
link the study of authors, journals, keywords and citations. Therefore, RQ1 is “What are the most prominent
authors, journal keywords and citations in the field of the research study?” Additionally, as suggested by
Haleem et al. new technologies, including AI, are changing the medical field in unexpected timeframes,
requiring studies in multiple areas. Therefore, RQ2 is “How does artificial intelligence relate to healthcare,
and what is the focus of the literature?” Then, as discussed by Massaro et al. RQ3 is “What are the research
applications of artificial intelligence for healthcare?”.

The first research question aims to define the qualitative and quantitative variables of the knowledge flow
under investigation. The second research question seeks to determine the state of the art and applications of
AI in healthcare. Finally, the third research question aims to help researchers identify practical and
theoretical implications and future research ideas in this field.

The second fundamental step of the SLR is writing the research protocol . Table 2 indicates the currently
known literature elements, uniquely identifying the research focus, motivations and research strategy
adopted and the results providing a link with the following points. Additionally, to strengthen the analysis,
our investigation benefits from the PRISMA statement methodological article. Although the SLR is a
validated method for systematic reviews and meta-analyses, we believe that the workflow provided may
benefit the replicability of the results

Figure 1 summarises the researchers’ research steps, indicating that there are no results that can be referred
to as a meta-analysis.

Table 2 SLR protocol and results obtained from Scopus.

Full size table

Fig. 1

Source: Authors’ elaboration on Liberati et al. [37]

PRISMA workflow.
Full size image

The third step is to specify the search strategy and search database. Our analysis is based on the search string
“Artificial Intelligence” OR “AI” AND “Healthcare” with a focus on “Business, Management, and
Accounting”, “Decision Sciences”, and “Health professions”. As suggested by [11, 41] and motivated by
[42], keywords can be selected through a top-down approach by identifying a large search field and then
focusing on particular sub-topics. The paper uses data retrieved from the Scopus database, a multi-
disciplinary database, which allowed the researchers to identify critical articles for scientific analysis [43].
Additionally, Scopus was selected based on Guo et al.’s [25] limitations, which suggest that “future studies
will apply other databases, such as Scopus, to explore more potential papers”. The research focuses on
articles and reviews published in peer-reviewed journals for their scientific relevance [11, 16, 17, 29] and
does not include the grey literature, conference proceedings or books/book chapters. Articles written in any
language other than English were excluded [2]. For transparency and replicability, the analysis was
conducted on 11 January 2021. Using this research strategy, the authors retrieved 288 articles. To strengthen
the study's reliability, we publicly provide the full bibliometric extract on the Zenodo repository [44, 45].

The fourth research phase is defining the code framework that initiates the analysis of the variables. The
study will identify the following:

1. (1)

descriptive information of the research area;

2. (2)

source analysis [16];

3. (3)
 author and citation analysis [28];

4. (4)

keywords and network analysis [14]; and

5. (5)

geographic distribution of the papers [14].

The final research phase is the article’s discussion and conclusion, where implications and future research
trends will be identified.

At the research team level, the information is analysed with the statistical software R-Studio and the
Bibliometrix package [15], which allows scientific analysis of the results obtained through the multi-
disciplinary database.
Results
The analysis of bibliometric results starts with a description of the main bibliometric statistics with the aim
of answering RQ1, What are the most prominent authors, journal keywords and citations in the field of the
research study?, and RQ2, How does artificial intelligence relate to healthcare, and what is the focus of the
literature? Therefore, the following elements were thoroughly analysed: (1) type of document; (2) annual
scientific production; (3) scientific sources; (4) source growth; (5) number of articles per author; (6) author’s
dominance ranking; (7) author’s h-index, g-index, and m-index; (8) author’s productivity; (9) author’s
keywords; (10) topic dendrogram; (11) a factorial map of the document with the highest contributions; (12)
article citations; (13) country production; (14) country citations; (15) country collaboration map; and (16)
country collaboration network.

Main information
Table 3 shows the information on 288 peer-reviewed articles published between 1992 and January 2021
extracted from the Scopus database. The number of keywords is 946 from 136 sources, and the number of
keywords plus, referring to the number of keywords that frequently appear in an article’s title, was 2329.
The analysis period covered 28 years and 1 month of scientific production and included an annual growth
rate of 5.12%. However, the most significant increase in published articles occurred in the past three years
(please see Fig. 2). On average, each article was written by three authors (3.56). Finally, the collaboration
index (CI), which was calculated as the total number of authors of multi-authored articles/total number of
multi-authored articles, was 3.97 [46].

Table 3 Main information.

Full size table

Fig. 2

Source: Authors’ elaboration

Annual scientific production.
Full size image

Table 4 shows the top 20 sources related to the topic. The Journal of Medical Systems is the most relevant
source, with twenty-one of the published articles. This journal's main issues are the foundations,
functionality, interfaces, implementation, impacts, and evaluation of medical technologies. Another relevant
source is Studies in Health Technology and Informatics, with eleven articles. This journal aims to extend
scientific knowledge related to biomedical technologies and medical informatics research. Both journals
deal with cloud computing, machine learning, and AI as a disruptive healthcare paradigm based on recent
publications. The IEEE Journal of Biomedical and Health Informatics investigates technologies in health
care, life sciences, and biomedicine applications from a broad perspective. The next journal, Decision
Support Systems, aims to analyse how these technologies support decision-making from a multi-disciplinary
view, considering business and management. Therefore, the analysis of the journals revealed that we are
dealing with an interdisciplinary research field. This conclusion is confirmed, for example, by the presence
of purely medical journals, journals dedicated to the technological growth of healthcare, and journals with a
long-term perspective such as futures.

Table 4 Main twenty sources.

Full size table

The distribution frequency of the articles (Fig. 3) indicates the journals dealing with the topic and related
issues. Between 2008 and 2012, a significant growth in the number of publications on the subject is
noticeable. However, the graph shows the results of the Loess regression, which includes the quantity and
publication time of the journal under analysis as variables. This method allows the function to assume an
unlimited distribution; that is, feature can consider values below zero if the data are close to zero. It
contributes to a better visual result and highlights the discontinuity in the publication periods [47].

Fig. 3

Source growth. Source: Authors’ elaboration

Full size image

Finally, Fig. 4 provides an analytical perspective on factor analysis for the most cited papers. As indicated in
the literature [48, 49], using factor analysis to discover the most cited papers allows for a better
understanding of the scientific world’s intellectual structure. For example, our research makes it possible to
consider certain publications that effectively analyse subject specialisation. For instance, Santosh’s [50]
article addresses the new paradigm of AI with ML algorithms for data analysis and decision support in the
COVID-19 period, setting a benchmark in terms of citations by researchers. Moving on to the application,
an article by Shickel et al. [51] begins with the belief that the healthcare world currently has much health
and administrative data. In this context, AI and deep learning will support medical and administrative staff
in extracting data, predicting outcomes, and learning medical representations. Finally, in the same line of
research, Baig et al. [52], with a focus on wearable patient monitoring systems (WPMs), conclude that AI
and deep learning may be landmarks for continuous patient monitoring and support for healthcare delivery.

Fig. 4

Source: Authors’ elaboration

Factorial map of the most cited documents.
Full size image
 Authors
This section identifies the most cited authors of articles on AI in healthcare. It also identifies the authors’
keywords, dominance factor (DF) ranking, h-index, productivity, and total number of citations.
Table 5 identifies the authors and their publications in the top 20 rankings. As the table shows, Bushko R.G.
has the highest number of publications: four papers. He is the editor-in-chief of Future of Health
Technology, a scientific journal that aims to develop a clear vision of the future of health technology. Then,
several authors each wrote three papers. For instance, Liu C. is a researcher active in the topic of ML and
computer vision, and Sharma A. from Emory University Atlanta in the USA is a researcher with a clear
focus on imaging and translational informatics. Some other authors have two publications each. While some
authors have published as primary authors, most have published as co-authors. Hence, in the next section,
we measure the contributory power of each author by investigating the DF ranking through the number of
elements.

Table 5 Most cited authors.

Full size table

Authors’ dominance ranking

The dominance factor (DF) is a ratio measuring the fraction of multi-authored articles in which an author
acts as the first author [53]. Several bibliometric studies use the DF in their analyses [46, 54]. The DF
ranking calculates an author’s dominance in producing articles. The DF is calculated by dividing the number
of an author’s multi-authored papers as the first author (Nmf) by the author's total number of multi-authored
papers (Nmt). This is omitted in the single-author case due to the constant value of 1 for single-authored
articles. This formulation could lead to some distortions in the results, especially in fields where the first
author is entered by surname alphabetical order [55].

The mathematical equation for the DF is shown as:

DF=NmfNmtDF=NmfNmt
Table 6 lists the top 20 DF rankings. The data in the table show a low level of articles per author, either for
first-authored or multi-authored articles. The results demonstrate that we are dealing with an emerging topic
in the literature. Additionally, as shown in the table, Fox J. and Longoni C. are the most dominant authors in
the field.

Table 6 Authors dominance factor.

Authors’ impact
Table 7 shows the impact of authors in terms of the h-index [56] (i.e., the productivity and impact of
citations of a researcher), g-index [57] (i.e., the distribution of citations received by a researcher's
publications), m-index [58] (i.e., the h-index value per year), total citations, total paper and years of
scientific publication. The H-index was introduced in the literature as a metric for the objective comparison
of scientific results and depended on the number of publications and their impact [59]. The results show that
the 20 most relevant authors have an h-index between 2 and 1. For the practical interpretation of the data,
the authors considered data published by the London School of Economics [60]. In the social sciences, the
analysis shows values of 7.6 for economic publications by professors and researchers who had been active
for several years. Therefore, the youthfulness of the research area has attracted young researchers and
professors. At the same time, new indicators have emerged over the years to diversify the logic of the h-
index. For example, the g-index indicates an author's impact on citations, considering that a single article
can generate these. The m-index, on the other hand, shows the cumulative value over theThe analysis, also
considering the total number of citations, the number of papers published and the year of starting to publish,
thus confirms that we are facing an expanding research flow.

Authors’ productivity
Figure 5 shows Lotka’s law. This mathematical formulation originated in 1926 to describe the publication
frequency by authors in a specific research field [61]. In practice, the law states that the number of authors
contributing to research in a given period is a fraction of the number who make up a single contribution.

The mathematical relationship is expressed in reverse in the following way:

xn∗yx=Cxn∗yx=C
where yx is equal to the number of authors producing x articles in each research field. Therefore, C
and n are constants that can be estimated in the calculation.

The figure's results are in line with Lotka's results, with an average of two publications per author
in a given research field. In addition, the figure shows the percentage of authors. Our results lead
us to state that we are dealing with a young and growing research field, even with this analysis.
Approximately 70% of the authors had published only their first research article. Only
approximately 20% had published two scientific papers.
Authors’ keywords
This section provides information on the relationship between the keywords artificial
intelligence and healthcare. This analysis is essential to determine the research trend, identify
gaps in the discussion on AI in healthcare, and identify the fields that can be interesting as
research areas [42, 62].

Table 8 highlights the total number of keywords per author in the top 20 positions. The ranking is
based on the following elements: healthcare, artificial intelligence, and clinical decision support
system. Keyword analysis confirms the scientific area of reference. In particular, we deduce the
definition as “Artificial intelligence is the theory and development of computer systems able to
perform tasks normally requiring human intelligence, such as visual perception, speech
recognition, decision-making, and translation between languages” [2, 63]. Panch et al. [4] find that
these technologies can be used in different business and management areas. After the first
keyword, the analysis reveals AI applications and related research such as machine learning and
deep learning.

Author keywords (top 20) Occurrences

Artificial intelligence 64

Machine learning 34

Healthcare 31

Deep learning 19

Data mining 10

Big data 9

Decision support system 9

Natural language processing 9

Data analytics 7

Decision support systems 7

Author keywords (top 20) Occurrences

Classification 6

COVID-19 6

Predictive analysis 6

Telemedicine 6

AI 5

Clinical decision support system 5

Descriptive analysis 5

Internet of things 5

Medical informatics 5

mHealth 5

Additionally, data mining and big data are a step forward in implementing exciting AI
applications. According to our specific interest, if we applied AI in healthcare, we would achieve
technological applications to help and support doctors and medical researchers in decision-
making. The link between AI and decision-making is the reason why we find, in the seventh
position, the keyword clinical decision support system. AI techniques can unlock clinically
relevant information hidden in the massive amount of data that can assist clinical decision-making
[64]. If we analyse the following keywords, we find other elements related to decision-making and
support systems.
The TreeMap below (Fig. 6) highlights the combination of possible keywords representing AI and
healthcare.

The topic dendrogram in Fig. 7 represents the hierarchical order and the relationship
between the keywords generated by hierarchical clustering [42]. The cut in the figure
and the vertical lines facilitate an investigation and interpretation of the different
clusters. As stated by Andrews [48], the figure is not intended to find the perfect level
of associations between clusters. However, it aims to estimate the approximate number
of clusters to facilitate further discussion.
The research stream of AI in healthcare is divided into two main strands. The blue strand focuses
on medical information systems and the internet. Some papers are related to healthcare
organisations, such as the Internet of Things, meaning that healthcare organisations use AI to
support health services management and data analysis. AI applications are also used to improve
diagnostic and therapeutic accuracy and the overall clinical treatment process [2]. If we consider
the second block, the red one, three different clusters highlight separate aspects of the topic. The
first could be explained as AI and ML predictive algorithms. Through AI applications, it is possible
to obtain a predictive approach that can ensure that patients are better monitored. This also allows
a better understanding of risk perception for doctors and medical researchers. In the second
cluster, the most frequent words are decisions, information system, and support system. This
means that AI applications can support doctors and medical researchers in decision-making.
Information coming from AI technologies can be used to consider difficult problems and support a
more straightforward and rapid decision-making process. In the third cluster, it is vital to highlight
that the ML model can deal with vast amounts of data. From those inputs, it can return outcomes
that can optimise the work of healthcare organisations and scheduling of medical activities.

Furthermore, the word cloud in Fig. 8 highlights aspects of AI in healthcare, such as decision

support systems, decision-making, health services management, learning systems, ML techniques
and diseases. The figure depicts how AI is linked to healthcare and how it is used in

Figure 9 represents the search trends based on the keywords analysed. The research
started in 2012. First, it identified research topics related to clinical decision support
systems. This topic was recurrent during the following years. Interestingly, in 2018,
studies investigated AI and natural language processes as possible tools to manage
patients and administrative elements. Finally, a new research stream considers AI's role
in fighting COVID-19 [65, 66].
represents the number of citations from other articles within the top 20 rankings. The
analysis allows the benchmark studies in the field to be identified [48]. For instance,
Burke et al. [67] writes the most cited paper and analyses efficient nurse rostering
methodologies. The paper critically evaluates tangible interdisciplinary solutions that
also include AI. Immediately thereafter, Ahmed M.A.'s article proposes a data-driven
optimisation methodology to determine the optimal number of healthcare staff to
optimise patients' productivity [68]. Finally, the third most cited article lays the
groundwork for developing deep learning by considering diverse health and
administrative information [51].

Ranking Authors and their sources (top 20) Total citations (number of Total citation
no citations received) per year

1 Burke EK., 2014, J Scheduling 604 33.556

2 Ahmed MA., 2009, Eur J Oper Res 215 16.538

3 Shickel B., 2018, IEEE J Biomedical 212 53,000

Health Informat

4 Liao Y., 2011, Morb Mortal Wkly Rep 149 13.544

5 Fusco C., 2011, Physiother Theory Pract 78 7.090

6 Baig MM., 2017, J Med Syst 76 15.200

7 Yeh JY., 2011, Decision Support Syst 76 6.909

8 Santosh KC., 2020, J Med Syst 72 36.000

9 Classen DC., 1992, Hosp Pharm 60 2.000

10 Mozaffari-Kermani M., 2015, IEEE J 58 8.286

Biomedical Health Informat
 Ranking Authors and their sources (top 20) Total citations (number of Total citation
no citations received) per year

11 Yan H., 2015, J Manag Anal 55 7.857

12 Longoni C., 2019, J Consum Res 44 14.667

13 Isern D., 2016, J Med Syst 44 7.333

14 Gayathri KS., 2015, Pers Ubiquitous 44 6.286

Comp

15 Ben Ayed M., 2010, Decision Support 44 3.667

Syst

16 Reiner B., 2010, J Digit Imaging 44 3.667

17 Li Y., 2016, Inf Sci 43 7.167

18 Rahulamathavan Y., 2014, IEEE J 41 5.125

Biomedical Health Informat

19 Johnson MP., 2014, Decision Support 37 4.625

System

20 Gmez-Vallejo HJ., 2016, Decision 36 6.000

Support Syst

Country
This section analyses the diffusion of AI in healthcare around the world. It highlights countries to
show the geographies of this research. It includes all published articles, the total number of
citations, and the collaboration network. The following sub-sections start with an analysis of the
total number of published articles.

Country total articles

Figure 9 and Table 10 display the countries where AI in healthcare has been considered. The USA
tops the list of countries with the maximum number of articles on the topic (215). It is followed by
China (83), the UK (54), India (51), Australia (54), and Canada (32). It is immediately evident that
the theme has developed on different continents, highlighting a growing interest in AI in
healthcare. The figure shows that many areas, such as Russia, Eastern Europe and Africa except
for Algeria, Egypt, and Morocco, have still not engaged in this scientific debate.

Country Total number of articles

USA 215

China 83

UK 54

India 51

Australia 34

Canada 32

South Korea 28

Spain 21

Italy 20

Germany 13

France 11

Iran 11

Turkey 11

Finland 9

Greece 9

Portugal 9

Netherlands 8

Norway 7
Country publications and collaboration map
This section discusses articles on AI in healthcare in terms of single or multiple publications in
each country. It also aims to observe collaboration and networking between countries. Table 11 and
Fig. 10 highlight the average citations by state and show that the UK, the USA, and Kuwait have a
higher average number of citations than other countries. Italy, Spain and New Zealand have the
most significant number of citations.

Country Total citations Average article citations

UK 680 97.14

USA 545 17.58

Kuwait 215 215.00

Italy 161 17.89

Spain 122 20.33

New Zealand 112 56.00

China 107 10.70

Korea 51 5.10

Tunisia 48 24.00

Australia 36 18.00

Canada 35 5.00

Hong Kong 31 7.75

Country Total citations Average article citations

Greece 30 30.00

Japan 29 29.00

depicts global collaborations. The blue colour on the map represents research
cooperation among nations. Additionally, the pink border linking states indicates the
extent of collaboration between authors. The primary cooperation between nations is
between the USA and China, with two collaborative articles. Other collaborations
among nations are limited to a few papers.
 Artificial intelligence for healthcare: applications
This section aims to strengthen the research scope by answering RQ3: What are the research
applications of artificial intelligence for healthcare?

Benefiting from the topical dendrogram, researchers will provide a development model based on
four relevant variables [69, 70]. AI has been a disruptive innovation in healthcare [4]. With its
sophisticated algorithms and several applications, AI has assisted doctors and medical
professionals in the domains of health information systems, geocoding health data, epidemic and
syndromic surveillance, predictive modelling and decision support, and medical imaging
[2, 9, 10, 64]. Furthermore, the researchers considered the bibliometric analysis to identify four
macro-variables dominant in the field and used them as authors' keywords. Therefore, the
following sub-sections aim to explain the debate on applications in healthcare for AI techniques.
These elements are shown
Health services management
One of the notable aspects of AI techniques is potential support for comprehensive health services
management. These applications can support doctors, nurses and administrators in their work.
For instance, an AI system can provide health professionals with constant, possibly real-time
medical information updates from various sources, including journals, textbooks, and clinical
practices These applications' strength is becoming even more critical in the COVID-19 period,
during which information exchange is continually needed to properly manage the pandemic
worldwide. Other applications involve coordinating information tools for patients and enabling
appropriate inferences for health risk alerts and health outcome prediction. AI applications allow,
for example, hospitals and all health services to work more efficiently for the following reasons:
  Clinicians can access data immediately when they need it.
 Nurses can ensure better patient safety while administering medication.
 Patients can stay informed and engaged in their care by communicating with
their medical teams during hospital stays.
Additionally, AI can contribute to optimising logistics processes, for instance, realising drugs and
equipment in a just-in-time supply system based totally on predictive algorithms. Interesting
applications can also support the training of personnel working in health services. This evidence
could be helpful in bridging the gap between urban and rural health services. Finally, health
services management could benefit from AI to leverage the multiplicity of data in electronic health
records by predicting data heterogeneity across hospitals and outpatient clinics, checking for
outliers, performing clinical tests on the data, unifying patient representation, improving future
models that can predict diagnostic tests and analyses, and creating transparency with benchmark
data for analysing services delivered

Predictive medicine
Another relevant topic is AI applications for disease prediction and diagnosis treatment, outcome
prediction and prognosis evaluation. Because AI can identify meaningful relationships in raw data,
it can support diagnostic, treatment and prediction outcomes in many medical situations. It allows
medical professionals to embrace the proactive management of disease onset. Additionally,
predictions are possible for identifying risk factors and drivers for each patient to help target
healthcare interventions for better outcomes. AI techniques can also help design and develop new
drugs, monitor patients and personalise patient treatment plans Doctors benefit from having more
time and concise data to make better patient decisions. Automatic learning through AI could
disrupt medicine, allowing prediction models to be created for drugs and exams that monitor
patients over their whole lives

Clinical decision-making
One of the keyword analysis main topics is that AI applications could support doctors and medical
researchers in the clinical decision-making process. According to Jiang et al. AI can help
physicians make better clinical decisions or even replace human judgement in healthcare-specific
functional areas. According to Bennett and Hauser , algorithms can benefit clinical decisions by
accelerating the process and the amount of care provided, positively impacting the cost of health
services. Therefore, AI technologies can support medical professionals in their activities and
simplify their jobs. Finally, as Redondo and Sandoval find, algorithmic platforms can provide
virtual assistance to help doctors understand the semantics of language and learning to solve
business process queries as a human being would.

Patient data and diagnostics

Another challenging topic related to AI applications is patient data and diagnostics. AI techniques
can help medical researchers deal with the vast amount of data from patients (i.e., medical big
data). AI systems can manage data generated from clinical activities, such as screening, diagnosis,
and treatment assignment. In this way, health personnel can learn similar subjects and
associations between subject features and outcomes of interest.

These technologies can analyse raw data and provide helpful insights that can be used in patient
treatments. They can help doctors in the diagnostic process; for example, to realise a high-speed
body scan, it will be simpler to have an overall patient condition image. Then, AI technology can
recreate a 3D mapping solution of a patient’s body.
In terms of data, interesting research perspectives are emerging. For instance, we observed the
emergence of a stream of research on patient data management and protection related to AI
applications.

For diagnostics, AI techniques can make a difference in rehabilitation therapy and surgery.
Numerous robots have been designed to support and manage such tasks. Rehabilitation robots
physically support and guide, for example, a patient’s limb during motor therapy ]. For surgery, AI
has a vast opportunity to transform surgical robotics through devices that can perform semi-
automated surgical tasks with increasing efficiency. The final aim of this technology is to automate
procedures to negate human error while maintaining a high level of accuracy and precision Finally,
the -19 period has led to increased remote patient diagnostics through telemedicine that enables
remote observation of patients and provides physicians and nurses with support tools

Limitations
Like any other, our study has some limitations that could be addressed by more in-depth future
studies. For example, using only one research database, such as Scopus, could be limiting. Further
analysis could also investigate the PubMed, IEEE, and Web of Science databases individually and
holistically, especially the health parts. Then, the use of search terms such as "Artificial
Intelligence" OR "AI" AND "Healthcare" could be too general and exclude interesting studies.
Moreover, although we analysed 288 peer-reviewed scientific papers, because the new research
topic is new, the analysis of conference papers could return interesting results for future
researchers. Additionally, as this is a young research area, the analysis will be subject to recurrent
obsolescence as multiple new research investigations are published. Finally, although bibliometric
analysis has limited the subjectivity of the analysis the verification of recurring themes could lead
to different results by indicating areas of significant interest not listed here.

Future research avenues

Concerning future research perspectives, researchers believe that an analysis of the overall amount
that a healthcare organisation should pay for AI technologies could be helpful. If these
technologies are essential for health services management and patient treatment, governments
should invest and contribute to healthcare organisations' modernisation. New investment funds
could be made available in the healthcare world, as in the European case with the Next Generation
EU programme or national investment programmes. Additionally, this should happen especially in
the poorest countries around the world, where there is a lack of infrastructure and services related
to health and medicine. On the other hand, it might be interesting to evaluate additional profits
generated by healthcare organisations with AI technologies compared to those that do not use such
technologies.

Further analysis could also identify why some parts of the world have not conducted studies in this
area. It would be helpful to carry out a comparative analysis between countries active in this
research field and countries that are not currently involved. It would make it possible to identify
variables affecting AI technologies' presence or absence in healthcare organisations. The results of
collaboration between countries also present future researchers with the challenge of greater
exchanges between researchers and professionals. Therefore, further research could investigate the
difference in vision between professionals and academics.

In the accounting, business, and management research area, there is currently a lack of
quantitative analysis of the costs and profits generated by healthcare organisations that use AI
technologies. Therefore, research in this direction could further increase our understanding of the
topic and the number of healthcare organisations that can access technologies based on AI. Finally,
as suggested in the discussion section, more interdisciplinary studies are needed to strengthen AI
links with data quality management and AI and ethics considerations in healthcare.

Conclusion
In pursuing the philosophy of Massaro et al.’s methodological article, we have climbed
on the shoulders of giants, hoping to provide a bird's-eye view of the AI literature in
healthcare. We performed this study with a bibliometric analysis aimed at discovering
authors, countries of publication and collaboration, and keywords and themes. We
found a fast-growing, multi-disciplinary stream of research that is attracting an
increasing number of authors.

The research, therefore, adopts a quantitative approach to the analysis of bibliometric

variables and a qualitative approach to the study of recurring keywords, which has
allowed us to demonstrate strands of literature that are not purely positive. There are
currently some limitations that will affect future research potential, especially in ethics,
data governance and the competencies of the health workforce.