Table 1.

Potential stakeholder biases and conflicts of interest

Stakeholder	Potential biases and manifestations of such biases
Hospitals	The needs of the hospital, such as remaining financially viable, are more important than the needs of individual patients. This can manifest via prioritization of meeting quality benchmarks (eg, reduction in readmissions or reduced length of stay) over specific patient health needs, such as by indirectly suggesting that a different diagnosis be used for a readmission
Pharmaceutical, Medical Device, or Diagnostic Companies	Selling products is paramount, as in the Practice Fusion, Inc. case,2 and advisories are created that may result in over prescription or overuse of medical services or devices
Physicians	Physicians’ power and authority must be preserved, which may manifest by advising that a certain type of specialist must been seen (or be recommended) or services be provided only by an M.D. (eg, not an advance practice provider) for the benefit of physicians as a whole or a particular specialty rather than for the patient
Algorithms	Algorithms may be biased toward optimization of “rewards” (eg, prevention of high volumes of care), rather than optimization of patient health outcomes or experiences5