Modernizing U.S. Healthcare Financial Systems: A Unified HIGLAS Data Lakehouse for National Efficiency and Accountability
DOI:
https://doi.org/10.47941/ijce.2976Keywords:
Healthcare Financial Management, Data Lakehouse Architecture, HIGLAS Modernization, Fraud Detection Analytics, Regulatory Compliance AutomationAbstract
The modernization of healthcare financial management systems represents a critical transformation in addressing escalating costs and administrative inefficiencies within the United States healthcare sector. The HealthCare Integrated General Ledger Accounting System (HIGLAS) emerges as a pivotal solution through implementation of unified data lakehouse architecture that consolidates fragmented financial platforms into cohesive, high-performance systems. Traditional healthcare financial infrastructures demonstrate significant limitations through siloed data management, delayed analytics capabilities, and complex regulatory compliance requirements that impede operational effectiveness and increase administrative burden. The proposed lakehouse architecture combines scalability advantages of data lakes with performance characteristics of traditional data warehouses, enabling comprehensive integration of financial transactions, clinical information, and operational metrics within secure, compliant environments. Implementation demonstrates substantial improvements in operational efficiency through automated data integration processes, real-time analytics capabilities, and enhanced fraud detection mechanisms that significantly reduce manual reconciliation requirements while improving accuracy and transparency. The system addresses critical challenges including data fragmentation across multiple platforms, real-time processing limitations, and evolving regulatory compliance demands through cloud-native technologies that support elastic scaling and automated quality monitoring. Enhanced fraud detection capabilities leverage machine learning algorithms and cross-system correlation to identify sophisticated schemes while comprehensive audit trails support regulatory compliance and forensic investigations. The transformation establishes foundations for industry-wide adoption of similar architectures, driving standardization efforts and collaborative initiatives that benefit the entire healthcare ecosystem through improved interoperability and reduced integration costs.
Downloads
References
Centers for Medicare & Medicaid Services, "National Health Expenditure Data: Historical," 2024. [Online]. Available: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical
David U Himmelstein et al., "Health Care Administrative Costs in the United States and Canada, 2017," Annals of Internal Medicine, 2020. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/31905376/
Aleh Yafimau, “Healthcare data integration: connecting the dots of patient care," InnoWise, 2024. [Online]. Available: https://innowise.com/blog/healthcare-data-integration/
Centers for Medicare & Medicaid Services, "State Program Integrity Reviews." [Online]. Available: https://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/fraudabuseforprofs/stateprogramintegrityreviews
Michael Armbrust, "Lakehouse: A New Generation of Open Platforms that Unify Data Warehousing and Advanced Analytics," DataBricks, 2021. [Online]. Available: https://www.databricks.com/sites/default/files/2020/12/cidr_lakehouse.pdf
ISO, "Software engineering — Software product Quality Requirements and Evaluation (SQuaRE) — Data quality model," 2008. [Online]. Available: https://www.iso.org/obp/ui/#iso:std:iso-iec:25012:ed-1:v1:en
Rand Al-Dmour,et al., "Impact of AI and big data analytics on healthcare outcomes: An empirical study in Jordanian healthcare institutions," Digit Health, 2025. [Online]. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC11705344/
Meredith Freed, et al., "Medicare Program Integrity and Efforts to Root Out Improper Payments, Fraud, Waste and Abuse," KFF, 2025. [Online]. Available: https://www.kff.org/medicare/issue-brief/medicare-program-integrity-and-efforts-to-root-out-improper-payments-fraud-waste-and-abuse/
Markets and Markets, "Edge Computing in Healthcare Market by Component (Hardware, Software, Services), Application (Diagnostics, Robotic Surgery, Telehealth, RPM, and Ambulances), End User (Hospitals, Clinics, Ambulatory Care Center), & Region - Global Forecast to 2028," 2023. [Online]. Available: https://www.marketsandmarkets.com/Market-Reports/edge-computing-in-healthcare-market-133588379.html
Riddhi Agrahari, "Fraud, Waste and Abuse Detection in Health Insurance Claims: Leveraging AI," DronaPay, 2024. [Online]. Available: https://www.dronapay.com/post/fraud-waste-and-abuse-detection-in-health-insurance-claims-leveraging-ai
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Surender Kusumba

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.