Electronic Health Records

Interoperability continues to improve among U.S. hospitals, but there’s still a ways to go, according to new government data.

More than six in 10 hospitals electronically shared health information and integrated it into their electronic health records in 2021, up 51% since 2017, the Office of the National Coordinator released in a Thursday data brief.

The availability and usage of electronic data received from outside sources at the point of care has also increased over the last four years, reaching 62% and 71% respectively in 2021.

The brief illustrates the progress that’s been made in hospitals using electronic data to provide care, and sharing it with other providers outside of their networks, as facilties adopt government-certified EHRs and pivot to comply with interoperability regulations stemming from the 21st Century Cures Act. However, discrepancies among providers indicate ongoing challenges.

For example, rural and small hospitals saw rates of available electronic information at the point of care increase by more than 26%, to reach 48% in 2021. In addition, rural and small hospitals’ use of information received electronically from outside facilities grew twice as fast as all hospitals nationally over the four years studied.

But these smaller hospitals, which generally have fewer resources than their larger counterparts, aren’t on par with larger peers in terms of having full access to electronic information from external sources, the report said.

Other barriers to information exchange also remain sticky. For example, 48% of hospitals said they shared patient data with other providers who don’t share patient information with them.

The ONC also found that roughly four in 10 hospitals participate in multiple health information exchanges, or data-sharing networks. The agency said the findings reinforce the need to have multiple networks at play, and the importance of policies that facilitate cross-network exchange, such as the Trusted Exchange Framework and Common Agreement launched last year.

TEFCA’s goal is to create a framework for nationwide data exchange, though its voluntary nature has raised concerns about industry buy-in. However, a number of entities have applied or said they plan to apply to be certified as qualified health information networks in TEFCA, including EHR giant Epic and existing HIEs like Carequality and eHealth Exchange.

Regulators are still working to implement provisions of 21st Century Cures, including potential punishments for providers and vendors found information blocking. 

The government is authorized by statute to issue up to $1 million in civil monetary penalties against health IT vendors found guilty of information blocking. However, regulators have yet to finalize a rule proposed in 2020 outlining how their investigations will be performed and the size of penalties. In addition, the HHS has yet to define penalties for providers found blocking the free flow of information due to enforcement complexity, ONC head Micky Tripathi has told Healthcare Dive in December.

Artificial intelligence is already used widely in healthcare, but generative AI is a big — and somewhat risky — step forward due to rapid deployment of the technology paired with a lack of regulation and oversight, industry experts said at the HIMSS conference in Chicago this week.

As a result, tough ethical questions are dogging generative AI like GPT-4, OpenAI’s latest large language model that backs the premium version of the wildly popular chatbot ChatGPT. Still, generative AI has huge potential to help improve U.S. medical care, proponents say.

One of the biggest companies in the space, Microsoft, has been working with GPT-4 developer OpenAI over the last eight months to understand the technology’s implications for healthcare. Generative AI is showing early success in a number of use cases, including simplifying explanation of benefits notices and writing prior authorization request forms, Peter Lee, corporate vice president of Microsoft Healthcare, said in a keynote panel on Tuesday.

Physicians can give the AI prompts to help them interpret novel medical cases or rewrite a patient conversation in a standardized format, Lee said.

Microsoft recently unveiled plans to embed generative AI into clinical software from Epic, the biggest hospital EHR vendor in the U.S.

Last week, Microsoft and Epic went live with the first sites integrating GPT into EHR workflows to automatically draft replies to patient messages. The companies also are bringing generative AI tools to Epic’s hospital database, allowing laypeople to ask the AI general questions instead of needing a data scientist to query specific data.

Epic is investing a significant amount of R&D resources into generative AI, Seth Howard, Epic’s vice president of R&D, said in an interview.

The health IT company also is researching the use of generative AI to summarize a patient’s medical history, and translate patient-facing materials between different languages and reading levels, to improve health literacy.

“That’s kind of a big category of work,” Howard said. “There are many use cases we’ll put out over the next year.”

Google also is making its own large language model, called Med-PaLM 2, available to a select group of customers to explore use cases. Med-PaLM was specifically trained on medical data, allowing it to sift through and make sense of massive amounts of healthcare information. Still, it has room for improvement in the complexity of queries it can perform and meeting product excellence, according to Google’s AI team.

Med-PaLM won’t be used in patient-facing settings, Google Cloud head Aashima Gupta said in an interview. Instead, hospitals could use the AI to analyze data to help diagnose complex diseases, fill out records or as a concierge for patient portals.

One notable use case for generative AI is streamlining medical notetaking, experts say. Physicians can spend up to six hours a day logging notes in their EHR, which can result in cutting back on time with patients and contribute to burnout.

Leading clinical documentation companies are integrating generative AI technology that they say improve their products’ accuracy and speed.

Nuance, a documentation company owned by Microsoft, said last month that it had integrated GPT-4 into its clinical notetaking software. This summer, providers using existing Nuance documentation products can apply to beta test the application, called DAX Express.

Ten to 15 clients summing 300 to 500 physicians will test the product in private preview in mid-June, before it’s generally available in early fall, said Diana Nole, general manager at Nuance.

Suki, a documentation company that’s partnered with Google, launched its generative AI-powered “Gen 2” voice assistant earlier this month.

Now, Suki can generate a clinical note ambiently from a conversation and fill in the note automatically, CEO Punit Soni told Healthcare Dive. Closer to the end of the year, doctors will also be able ask the AI questions and give it commands, such as plotting a patient’s A1C levels over the last three months, Soni said.

Gen 2 currently is being piloted with “very few” customers, according to the CEO. Suki plans to make it generally available later this year.

”The interest is unbelievable,” Soni said. “If you could have somebody to just do all your notes for you — wouldn’t that be awesome?”

Weighty risks

To be sure, generative AI makes mistakes, raising pernicious ethical questions around accuracy, equity and accountability. That means the medical community needs to have a robust ongoing role in deciding whether, when and how this type of AI is used, experts said at HIMSS.

One issue with AI is the black box problem: How can a result be trusted if it’s unclear how the AI got there?

It’s easy to be fooled into thinking that this type of technology is able to reason, but users have to remember generative AI doesn’t engage in deliberation — just predicts the next set of words that makes the most sense, said medical ethicist Reid Blackman.

“Maybe we’re okay with magic that works. That’s one option. The other option is to say okay, if you’re making a cancer diagnosis, I need to absolutely understand the reasons why you’re making that diagnosis… The problem is that GPT doesn’t give reasons. It gives what looks like reasons,” Blackman said on a Tuesday panel.

Generative AI also has issues with accuracy. Large language models are known to hallucinate, or provide answers that are factually incorrect or irrelevant. GPT-4 “still has many known limitations that we are working to address, such as social biases, hallucinations, and adversarial prompts,” OpenAI’s website reads.

Bias is another key worry with AI, especially in healthcare. If an algorithm is trained on biased data, or its results are applied in biased ways, it will reflect and perpetuate those biases, experts said.

Accountability also remains a concern. Since generative AI is such a new field, it’s unclear which stakeholder — the owner? the user? the developer? — is at fault for any negative consequences stemming from its use, according to Kay Firth-Butterfield, CEO of the Centre for Trustworthy Technology.

“Who do you sue when something goes wrong? Is there somebody to sue?” Firth-Butterfield asked during the Tuesday keynote panel.

More than 27,000 stakeholders have signed an open letter asking AI labs to immediately pause training AI systems more powerful than GPT-4 for at least six months. The letter argues that industry should use the moratorium to develop shared safety protocols and work with policymakers to develop AI governance systems.

“You shouldn’t be exploring, engaging in artificial intelligence, without having some understanding of responsible AI issues,” said Firth-Butterfield, who signed the letter. “We are hurtling into the future without actually taking a step back and designing it for ourselves.”

‘Mysterious,’ ‘awe-inspiring,’ ‘frustrating’

AI companies argue many of these problems can be ameliorated with careful human oversight. Organizations should be explicitly aware of the dataset a model was trained on and when precisely it should be used, experts said.

Microsoft’s Lee said while questions about generative AI are important, especially those around accountability, the black box problem might not be as troubling as some say.

“We’ve been unable to provide its incapable [of reason],” Lee said. ”It’s a mysterious and awe-inspiring and frustrating research roadblock that we’ve been unable to prove that. I have to admit, as a scientist, that this black box issue, at some point of development starting with GPT-4, actually might not really exist.”

And there are techniques to ensure generative AI gives a reliable output — a field called prompt engineering, where scientists figure out how to query the AI in a way that produces trustworthy results, Epic’s Howard said.

Both Suki and Nuance declined to share the accuracy rates of their generative AI-based notetakers, but said accuracy was high enough that they’re comfortable instituting them in a real-world setting.

Soni said Suki could publish its Gen 2 accuracy rates in a few months. And Nuance has been working with AI for years, Nole said.

“The level of accuracy we were already producing is advanced. We know how it works. We know how it acts. Now, we’re just utilizing GPT to kind of raise the level,” Nole said.

As AI has advanced, some models have outperformed doctors on diagnostic tasks, creating concerns that machines could one day replace clinicians. Experts at HIMSS agreed that day is nowhere close, even with generative AI.

Med-PaLM’s ability to pass a medical exam is “in no way indicative of medical knowledge or competence,” Alan Karthikesalingam, Google’s health AI research lead, said in an interview.

“There are a lot of material safety, bias and ethical concerns that need to be attended to very carefully,”  Karthikesalingam said. But replacement? “I think by and large that on its own is hopefully not a huge concern to us physicians. The positioning of these systems is very much as tools.”

Suki and Nuance stressed that their AI-created notes allow clinicians to edit and approve what is finalized in the EHR. Generative AI is an instrument for doctors, not a substitute for them, AI executives said.

Still, “anyone who can make predictions on what this epoch will bring is a fool,” Soni said. “What I can tell you is that in the foreseeable future, I see AI being a very strong and serious assistant that makes a lot of our lives better.”

Dive Brief:

• Electronic health record vendor NextGen Healthcare announced on Wednesday it agreed to be acquired in a take-private deal by private equity firm Thoma Bravo.
• Thoma Bravo will buy NextGen for $23.95 per share, which represents a 46% premium on NextGen’s closing price on Aug. 22, according to a press release. The acquisition is expected to close in the fourth quarter this year.
• The deal comes days after Bloomberg reported the private equity firm was in advanced discussions to acquire NextGen. In August, Reuters reported that NextGen had tapped investment bank Morgan Stanley to explore a sale.

Dive Insight:

NextGen, which has over 100,000 provider clients across the U.S., will become a private company upon the deal’s completion. The company’s provider clients include accountable care organizations, independent physician associates and managed service organizations. Medicare and Medicaid cover approximately one-third of the company’s covered lives, according to NextGen’s most recent 10-K filing. NextGen’s competitors include Epic, Athenahealth, Oracle and Veradigm.

The Thoma Bravo acquisition comes after NextGen agreed earlier this summer to pay $31 million to settle allegations that it violated the False Claims Act by misrepresenting versions of its product and providing illegal incentives to induce referrals for its software. 

Healthcare investment is a “relatively uncommon play” for Thoma Bravo, comprising roughly 9% of its total investments, according to a July report from research firm Pitchbook. Information technology investments make up about 76% of Thoma Bravo’s investments.

The private equity firm’s portfolio of healthcare companies include Bluesight, a software supply chain company focusing on pharmacies and hospitals.

Thoma Bravo bills itself as “one of the largest software investors in the world,” with more than $130 billion in assets under management as of June this year. Most recently, the firm acquired identity and access management company ForgeRock in a deal valued at approximately $2.3 billion, and it completed its acquisition of business spend management company Coupa Software.

Dive Brief:

• The Department of Veterans Affairs announced this week it had renegotiated its contract with Oracle Cerner to overhaul its electronic health record after a series of implementation missteps, including patient safety concerns.
• The agency promised the updated contract “dramatically increases” its ability to hold the technology giant accountable for outages, responsiveness to clinician requests and interoperability with other health systems and applications.
• The deal includes stronger performance expectations and larger financial credits to the VA if Oracle Cerner doesn't meet requirements, according to a statement from Neil Evans, acting program executive director of the EHR Modernization project.

Dive Insight:

The VA first signed a contact with EHR vendor Cerner — later acquired by Oracle — in 2018 to migrate from its customized VistA medical records system.

But the Cerner rollout has been slow and more expensive than planned. The first VA hospital to use the new EHR went live in 2020, and four sites deployed the system last year.

The VA Office of the Inspector General found “high-risk” patient safety issues at Mann-Grandstaff VA Medical Center attributed to the EHR. A report published in July described one error where orders for labs, imaging or specialty care were sent to an undetectable location, causing harm to multiple patients.

In April, the VA said it would put future deployments on hold to focus on improvements at sites already using the new EHR.

Despite delays, Mike Sicilia, executive vice president of Oracle Global Industries, said in a statement to Healthcare Dive that the new agreement reflects the company's "complete confidence" in its technology and partnership with the VA.

The new deal will also shift from a five-year term to five one-year terms, so the VA can renegotiate the contract again if necessary, according to the department.

“The system has not delivered for veterans or VA clinicians to date, but we are stopping at nothing to get this right — and we will deliver the efficient, well-functioning system that veterans and clinicians deserve,” Evans said in a statement.

Dive Brief:

• The average length of clinical notes increased 8.1% from May 2020 to April 2023, according to a report published last week by Epic Research, the largest EHR provider and medical software vendor in the U.S.
• However, 40% of providers reduced their average note length and nearly 90% spent less time writing notes.
• The data showing increased note length comes more than two years after the CMS overhauled evaluation and management billing codes in an attempt to reduce “note bloat” and associated documentation burden on providers.

Dive Insight:

Clerical documentation burdens for physicians expanded during the past decade in part due to increased regulatory requirements and the corresponding proliferation of EHRs — one 2017 study found providers spend more than half their workday on documentation tasks.

In 2019, the CMS introduced changes to evaluation and management services reporting, including eliminating some elements for code selection and allowing physicians to choose whether their documentation is based on medical decision making or total time, which captures face-to-face and non face-to-face time spent caring for a patient.

Longer notes are associated with increased redundancies and can cause “information overload,” hindering clinicians’ ability to effectively utilize the patient record to direct care, according to a study published in JAMA last year. Documentation burden is also associated with increased provider burnout, a problem that’s taken center stage since burnout soared during the COVID-19 pandemic.

The Epic report evaluated 1.7 billion clinical notes written by outpatient providers from May 2020 to April 2023 to determine whether the CMS revisions, which went into effect in January 2021, led to reduced note length.

Though the Epic study found that, on average, providers spent 11.1% less time writing notes in 2023, average note length increased from 4,628 characters in 2020 to 5,002 characters. Paradoxically, the providers who composed the longest notes spent the least amount of time on documentation. Providers who averaged notes of 5,314.5 characters spent 5.7 minutes composing notes, while providers who averaged 3,601.2 characters spent 6.9 minutes. 

Clinicians were more likely to compose longer notes at organizations that had increased their use of copy/paste functions and Epic-owned “SmartTools,” which allow clinicians to auto-populate fields in a patient record with links, text, phrases or lists found elsewhere in the patient’s chart. This finding is consistent with past studies which demonstrated SmartTools contribute to note bloat.

It is possible to reduce note length, researchers noted. Forty percent of providers decreased their average note length over the study period, and the providers that most significantly cut note length came from across multiple specialties.

Dive Brief:

• Oracle joined a slew of healthcare technology companies offering generative artificial intelligence tools on Monday, announcing capabilities that will be integrated into the software giant’s recently acquired health records system.
• Its clinical digital assistant, which will be available in the next year, will automatically take notes during visits with patients and can propose next steps for providers, like ordering medications or scheduling labs, according to a press release.
• Oracle also announced patient-facing tools, available now, which include the option to receive generative AI answers to medical questions and use voice commands to schedule appointments or pay bills. Clinicians will be able to send information to patients through a chat in their patient portal, like reminding them to bring lab results.

Dive Insight: 

Generative AI, which can create new content like text or images, has become an increasingly hot topic for healthcare industry players, with a number of large technology companies launching tools they argue will cut down on providers’ administrative tasks.

Earlier this summer, Amazon unveiled its own clinical documentation service called HealthScribe, while Google said it would broaden access to its large language model that’s trained on medical information to more healthcare and life science customers. 

Last month, Microsoft and Epic, the country’s largest EHR vendor, announced they would expand their partnership on generative AI tools and work to “deploy dozens” of technologies like clinical note summarization, medical coding suggestions and data exploration tools.

Notetaking is one major focus for generative AI in healthcare, as many providers report spending large amounts of time on EHR tasks like documenting patient visits, entering patient orders, and billing and coding. 

Though relatively few healthcare executives currently have a strategy for generative AI, around half say they’re developing one or planning to do so soon, according to a survey from consultancies Bain and Klas Research. 

But some experts are concerned by the rapid deployment of generative AI in healthcare, noting some models have offered incorrect information. They also question who should be held accountable for potential mistakes, and whether AI will inadvertently perpetuate biases and deepen existing healthcare inequities.

Oracle boosted its healthcare presence last year with the more than $28 billion acquisition of EHR company Cerner. But the business arm is facing “near-term headwinds” to its growth rate as Oracle transitions its customers from licensed purchases to cloud subscriptions, which means less upfront revenue, executives said on an earnings call last week.

Still, Cerner also expects new contracts worth a total of over $1 billion, executives said.

Dive Brief:

• Electronic health record purchasing last year featured a “significant uptick” in migrations and small organization purchasing decisions, according to a new report by Klas Research.
• Epic continues to be the EHR market leader, covering 36% of acute care hospitals in the U.S. and 48% of beds. It was the only vendor to have positive net change in both hospital market share and number of beds in 2022.
• Oracle Health, which acquired Cerner in June 2022, saw its first double-digit net gain in hospitals since 2018, driven largely by small acute-care hospitals choosing its CommunityWorks platform. The loss of large hospitals, however, led to an overall decline in beds.

Dive Insight:

Last year, 313 hospitals made an EHR purchase decision, down slightly from 2021.

Larger customers are leaving Oracle Health “due to ongoing revenue cycle challenges,” according to the report. But 2022 was the fifth year in a row that Oracle signed the most hospitals with fewer than 200 beds.

Oracle was recently pushed to renegotiate its contract with the U.S. Department of Veterans Affairs after a series of implementation missteps including patient safety concerns.

Epic continues to dominate the market, with only one loss last year. Its customers “include most of the largest, well-resourced academic medical centers in the US,” according to the report.

The vendor has rolled out partnerships recently with big names like Google and Microsoft, and just announced that Suki will integrate a generative AI assistant in its software.

Meditech saw the most hospitals wins of any vendor in 2022. However, it had a net decrease in hospitals and beds, in part because of M&A and standardization activity by larger customers.

Dive Brief:

• Microsoft and major electronic health vendor Epic announced Monday that the two companies are expanding their partnership and integrating Microsoft’s Azure OpenAI Service into Epic’s EHR software.
• The integration hinges on generative AI-powered tools, according to the announcement, to increase productivity and enhance patient care. One of the integration’s tools, which helps automatically draft message responses, is being implemented at UC San Diego Health, UW Health and Stanford Health Care, according to the companies.
• Microsoft has been focused on enhancing its medical AI capabilities recently, with the company announcing last month that Microsoft-owned Nuance was integrating GPT-4, OpenAI’s latest large language model technology, into its clinical notetaking software. 

Dive Insight:

In addition to tools aimed at automatically drafting message responses, the partnership aims to bring interactive data analysis and natural language query capabilities to Epic’s self-reporting tool, SlicerDicer.

“Our exploration of OpenAI’s GPT-4 has shown the potential to increase the power and accessibility of self-service reporting through SlicerDicer, making it easier for healthcare organizations to identify operational improvements, including ways to reduce costs and to find answers to questions locally and in a broader context,” said Seth Hain, senior vice president of research and development at Epic, in a statement.

The two companies have partnered before, with an existing partnership allowing Epic environments to run on the Azure cloud platform. During the COVID-19 pandemic, in September 2020, Epic and Microsoft announced they were partnering to integrate Microsoft-owned messaging app, Teams, directly with health records to allow clinicians to launch virtual visits from their EHR.

Technology companies have been focusing on AI healthcare integrations this year as hospital systems report depressed financial margins and labor woes exacerbated by the pandemic. Technology integrations like EHRs have promised to help ease documentation burden, and burnout, but can sometimes create “information overload” for clinicians. 

AI integrations promise to alleviate burnout by automating certain tasks, but integration in the sector has been slow moving so far. 

However, tech companies have been ramping up their healthcare AI integration efforts this year. Stat News reported last week that Google was releasing a version of its generative language model to healthcare customers to test task abilities in certain research and medical settings, setting up a rivalry with GPT-4. Also last week, EHR company Cerner announced that it and another company were developing AI tools to help the FDA extract information from clinical notes in health records to better understand the effects of medicines on large populations.

The Biden administration has released a sweeping new rule touching on multiple aspects of health information technology in the U.S., including proposals meant to create more transparency and trust in clinical decision support software.

The rule proposed Tuesday would give providers more information in their electronic health record system to assess clinical decision support algorithms and their results.

The changes would promote greater trust in predictive decision support interventions, and help providers assess their applicability for a particular patient population or circumstance, the Office of the National Coordinator for Health IT said.

Artificial intelligence has a potential to cut costs and improve care delivery in healthcare, including in the area of clinical decision support. AIs are trained on datasets to find patterns and make recommendations to clinicians, like alerts for adverse medication interactions or potential cases of sepsis.

Demand for clinical decision support is rising as physicians try to keep up with rapidly shifting medical knowledge and recommendations. In addition, mounting data suggests tools can help fend off adverse outcomes for patients.

However, regulating algorithms has historically been a gray area, until Food and Drug Administration guidance last year broadened the agency’s oversight of clinical decision support software, including those that provide a specific diagnostic or treatment suggestion.

Now, the ONC — which regulates health IT systems that can include the AI tools — is proposing new regulations meant to make more information about the algorithms available in the EHR for providers, ONC head Micky Tripathi said on a Tuesday call with reporters.

The rule proposes a new certification criteria for clinical decision support algorithms, to keep pace with advances in decision-making software.

Along with defining algorithm-based, predictive decision support interventions, the rule requires certified EHRs that enable or interface with the software to allow users to review information about additional source attributes, including around health equity. The rule also requires developers of certified health IT modules to undergo intervention risk management practices for all the predictive decision support interventions they interface with.

Together, the proposals should improve transparency and promote trustworthiness of clinical decision support tools by enabling users, like providers, to better scrutinize them, the ONC said.

New info blocking condition for TEFCA

The rule is also proposing to add new information blocking flexibilities for organizations that participate in the Trusted Exchange Framework and Common Agreement, the government’s nascent framework for nationwide health information exchange.

Since participation is TEFCA is voluntary, there have been questions around industry buy-in since it was finalized over a year ago. Some stakeholders have argued that regulators should exempt organizations that participate in TEFCA from information blocking stipulations, to incentivize companies to join by reducing their compliance burden.

Now, the ONC is proposing a new information blocking condition for parties that participate in TEFCA.

If a TEFCA participant offers to fulfill a data-sharing request from another TEFCA participant through the framework, they wouldn’t be required to offer that data in any alternative manner — even when the data might exceed the minimum data classes and elements required in the Common Agreement.

The proposed manner exception says it’s reasonable for an information blocking actor to prioritize using TEFCA means to send data over other feasible ways.

This approach furthers both the goals of TEFCA adoption and interoperability, according to the final rule.

Other changes

The proposed rule would discontinue year-themed editions of ONC certification criteria for health IT. Instead, it would establish a single set of criteria that would be updated incrementally, with the goal of aligning with standard development cycles and making it easier for health IT developers to maintain their product certificates over time.

The rule also includes provisions meant to help individuals and providers, including those engaged in public health, to securely access electronic health information through broader adoption of standardized application programming interfaces.

It would also standardize electronic case reporting, with the goal of facilitating faster disease tracking and case management, after the lack of a nationwide reporting infrastructure hamstrung the public health response during COVID-19.

Regulators are also proposing that developers adopt the third iteration of the U.S. Core Data for Interoperability dataset by 2025. The dataset would be expanded to include additional data elements related to public health, sexual orientation and social determinants of health.

The proposed rule would also clarify the infeasibility exception to the information blocking rules.

The ONC has yet to finalize a long-awaited regulation creating appropriate disincentives for providers found information blocking. That regulation now has a tentative release date of September.

Regulators also expect to release new standards for EHRs, including expanded uses of APIs around electronic prior authorization and patient engagement, in November.

Seema Verma, the former CMS administrator for the Trump administration, is joining Oracle, Oracle Chairman David Feinberg told Healthcare Dive on Tuesday.

Verma will be senior VP and general manager of Oracle Life Sciences, the company’s clinical trials business. Oracle plans to officially announce the news on Thursday.

Oracle Life Sciences helps pharmaceutical companies conduct clinical trials to bring new drugs to market. A company spokesperson did not respond to a question on why Verma, whose background is overwhelmingly in the payer space, is a good fit for the division. Verma did enact a number of interoperability measures while at the CMS, experience that could be valuable as Oracle, which is currently integrating EHR vendor Cerner that it bought for $28 billion last year, steps further into healthcare.

While at the CMS, Verma oversaw a number of controversial policies, including expanding short-term limited duration health insurance plans and work requirements and block grants for Medicaid programs. She also championed then-President Donald Trump’s effort to repeal and replace the Affordable Care Act, and promulgated policies that critics said destabilized the federal ACA exchanges.

While in office, Verma also faced ethical and legal controversies over her use of taxpayer funds. Reports found the administrator spent millions in taxpayer dollars on communications consultants to polish her public image, in violation of federal regulations.

Prior to being nominated by Trump to lead the CMS, Verma was a healthcare consultant who worked with several state governments on Medicaid reform and expansion.

Since leaving the government in 2021, Verma has worked as a consultant, including as a senior adviser to private equity firms TPG and Cressey. She currently serves on the board of directors for health tech companies Lumeris, Monogram, Wellsky and Lifestance.