Hospitals are rethinking how they invest in AI as the Trump administration moves to consolidate AI oversight — a shift that’s already affecting vendor selection and governance frameworks, according to conversations with four chief medical information officers.
A Dec. 11 executive order signed by President Donald Trump blocks states from creating new AI regulations outside federal frameworks and directs agencies to challenge existing state AI laws, tying future federal funding eligibility to compliance with national policy.
That federal reset is now showing up in how CMIOS evaluate AI vendors. Four themes emerged from those discussions with leaders:
1. CMIOs are shifting from hype to governance.
For many clinical IT leaders, federal guidance has accelerated a move away from flashy product demonstrations toward deeper scrutiny of how AI is governed. AI tools are being evaluated less like innovation pilots and more like clinical infrastructure.
“Emerging federal AI guidance has pushed me to evaluate vendors less on hype and more on governance, transparency and clinical risk management,” said Jason La Marca, MD, CMIO at Los Angeles-based Mission Community Hospital. “I expect clear explainability, strong data controls, bias mitigation and post-deployment monitoring as minimums. If a vendor cannot support auditability and responsible clinical use at scale, we will not move forward.”
2. Transparency, bias testing and monitoring are becoming table stakes.
At Virginia Hospital Center in Arlington, federal guidance has translated into tougher requirements for vendors.
CMIO Usman Akhtar, MD, said new national AI policy frameworks, “unbiased AI” principles and contractor disclosure rules have raised expectations for documentation and accountability.
“Our procedures will mandate comprehensive model transparency, localized validation and bias testing, safeguards for protected health information, and a definitive plan for ongoing monitoring, auditability and incident response prior to vendor approval,” Dr. Akhtar said.
That level of scrutiny pushes AI out of the experimental category and into something closer to regulated clinical systems.
3. Regulatory uncertainty is now part of vendor risk.
The evolving relationship between federal and state governments over AI oversight is also changing how some CMIOs think about vendor risk. Vendors now have to demonstrate not just technical sophistication, but regulatory fluency — and the ability to adapt as policy evolves.
“The growing tension between federal and state governments regarding AI oversight does make me more cautious when evaluating AI vendors,” said Matthew Anderson, MD, CMIO at HonorHealth in Scottsdale, Ariz. “It is another variable that adds to the complexity of the decision. We need partners that are knowledgeable on all regulatory sides, in addition to the technical components.”
4. For some systems, federal guidance is confirming existing strategies.
Not every organization is changing course because of federal shifts. In some cases, the new national policy aligns with existing internal standards around governance, transparency and risk management.
“At this point, we are reading and keeping up to date, but so far it is more confirming our pathway rather than changing our direction,” said Neal Chawla, MD, CMIO at WakeMed in Raleigh, N.C.
Nonetheless, the CMIOs point to the same shift: AI purchasing is becoming less about speed to deploy and more about safety, accountability and long-term compliance. As oversight tightens, vendors that cannot demonstrate transparency, auditability and regulatory readiness may struggle to get traction — no matter how powerful their technology looks.
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