Competing interests: Kushal Kadakia reports previous employment at Cleveland Clinic London, Google Health (via Adecco), and the US Food and Drug Administration (FDA), and has received consulting fees from the National Academy of Medicine, all unrelated to this manuscript. Sanket Dhruva is supported by the Department of Veterans Affairs Health Services Research and Development (1IK2HX003357). He also receives research funding from Arnold Ventures, the National Evaluation System for Health Technology Coordinating Center (NESTcc), and the National Institute for Health Care Management. Joseph Ross reports receiving grants from the FDA, Johnson and Johnson, Medical Devices Innovation Consortium, Association for Healthcare Research and Quality, the National Institutes of Health National Heart, Lung, and Blood Institute, and the Laura and John Arnold Foundation, as well as expenses and/or personal fees from the Green Law Firm (expert testimony on behalf of relator) outside the submitted work. In the past three years, Harlan Krumholz received expenses and/or personal fees, outside the submitted work, from UnitedHealth, Element Science, Aetna, Reality Laboratories, Tesseract/4Catalyst, F-Prime, and the Martin/Baughman Law Firm; is a co-founder of Refactor Health and HugoHealth; and is associated with contracts from the Centers for Medicare and Medicaid Services through Yale New Haven Hospital, and from Johnson and Johnson, Google, and Pfizer through Yale University.