Big data and related technologies have the potential to transform healthcare sectors by facilitating improvements to healthcare planning and delivery. Big data research highlights the importance of aligning big data implementations with business needs to achieve success. In one of the first studies to examine the influence of big data on business-IT alignment in the healthcare sector, this paper addresses the question: how do stakeholders’ perceptions of big data influence alignment between big data technologies and healthcare sector needs across macro, meso, and micro levels in the New Zealand (NZ) healthcare sector? A qualitative inquiry was conducted using semi-structured interviews to understand perceptions of big data across the NZ healthcare sector. An application of a novel theory, Theory of Sociotechnical Representations (TSR), is used to examine people’s perceptions of big data technologies and their applicability in their day-to-day work. These representations are analysed at each level and then across levels to evaluate the degree of alignment. A social dimension lens to alignment was used to explore mutual understanding of big data across the sector. The findings show alignment across the sector through the shared understanding of the importance of data quality, the increasing challenges of privacy and security, and the importance of utilising modern and new data in measuring health outcomes. Areas of misalignment include the differing definitions of big data, as well as perceptions around data ownership, data sharing, use of patient-generated data and interoperability. Both practical and theoretical contributions of the study are discussed
