A Review of Data Engineering in United States Healthcare Infrastructure

With the rapid advancements in artificial intelligence (AI) and machine learning (ML), the role of data engineering has become increasingly critical due to the growing demands for high-quality, large-scale, and well-structured datasets required to train reliable predictive models. Healthcare is one of the most data-intensive industries and has demonstrated strong potential for AI-driven automation in clinical decision support, diagnostics, and operational efficiency. However, healthcare data is often fragmented across multiple systems, inconsistently formatted, and constrained by privacy and regulatory requirements, creating significant barriers to scalable AI adoption. In this review, we examine recent research on healthcare data engineering and AI applications, focusing on how data pipelines, interoperability, and governance frameworks support or limit real-world deployment. This review examined 68 peer-reviewed studies published between 2018 and 2026 across multiple clinical domains, including oncology, cardiovascular disease, infectious disease, neurological disorders, medical imaging, and algorithmic frameworks for explainability and fairness. The reviewed literature shows that while AI models achieve promising performance across these domains, the lack of standardized data architectures and interoperable infrastructure remains a primary bottleneck. The purpose of this study is to highlight key challenges and emerging solutions in healthcare data engineering and outline the future directions needed to support safe, scalable, and trustworthy AI integration in the United States healthcare system. The intended core contributions of this article are to: (i) identify the need for reliable AI systems for healthcare, (ii) explore challenges associated with implementing AI systems in healthcare from a data engineer's perspective, and (iii) analyze key limitations of data engineering as it applies to the implementation of AI systems in healthcare. It must be noted that one of the key limitations of this narrative review is that the authors mostly used citations from MDPI journals.