Risk Never Sleeps Podcast – Episode #160

Title: The Hidden Cost Of Siloed Data And How AI Finally Breaks It Open
Host: Ed Gaudet (with Saul Marquez, Outcomes Rocket)
Guest: Dr. Doug Fridsma, CMIO at Health Universe
Date: December 11, 2025

Episode Overview

In this engaging episode, Ed Gaudet and Saul Marquez sit down with Dr. Doug Fridsma—an accomplished physician, computer scientist, and digital health thought leader—to discuss how siloed healthcare data stifles innovation and the pivotal role of AI-powered platforms in transforming patient safety. Doug shares lessons from his influential tenure in government and the private sector, offering insight into building the technical and cultural bridges necessary for real data interoperability.

Key Discussion Points and Insights

1. Doug Fridsma’s Background and Legacy

• Internal medicine doctor and PhD in computer science.

• Chief Science Officer at the Office of the National Coordinator (ONC) during the Obama administration, instrumental in deploying electronic health records (EHRs) across the U.S.

• Former CEO of the American Medical Informatics Association, updated board certifications for clinical informatics.

  "When we started at ONC, 20% of all the doctors had electronic health records. When we ended...80%." (Doug, 02:29)

  “Our hope when I was in the government is that we would have all of this data that would drive innovation. We never really anticipated that we'd have three or four vendors that would really have a lock on the data.” (Doug, 03:25)

2. Evolution of Health Data Infrastructure

• Movement from paper-based to digital health records—unmatched scale and speed over five years.

• The current issue: major vendors “lock” the data, restraining the vibrant ecosystem of apps and tools once envisioned.

  “We hate lazy data. Data that just sits there.” (Doug, 03:54)

3. The Next Layer: How AI Unlocks Data

• The future of healthcare is “agentic and AI-driven”—enabling smarter, more flexible, and efficient systems.

• Doug draws parallels to the 1950s mainframe era: just like computers evolved from mainframes to smartphones, health data must move beyond siloed EHRs to flexible, app-based platforms.

  “We’ve got to move out of these mainframes in the sky...make it easy to deploy these things and actually start to use them in real life.” (Doug, 05:02)

• Health Universe aims to serve as the “operating system for AI in healthcare”, facilitating integration, normalization, and real-time utility of disparate healthcare data.

  “Health Universe in large part is intended to be an operating system...it helps to coordinate agents, does data normalization, makes it really easy...plug[s] into EHRs and HIEs.” (Doug, 05:03)

4. Platform Design and Innovation Enablement

• Health Universe is built on Python and leverages agentic AI, using orchestration to sync data and tools contextually (06:16-06:45).

• Capabilities include scanning and unlocking data even from unstructured sources (PDFs, images) using OCR (Optical Character Recognition).

  “We do things like customize summarizations for cancer. And we can pull out everything from scanned images. We have our own pipeline for OCR because data matters. It’s garbage in, garbage out.” (Doug, 06:49)

• The platform serves both large institutions and entrepreneurial developers: “horizontal,” not “vertical,” so one integration supports many solutions.

• Co-development partnerships help innovators focus on expertise while Health Universe provides infrastructure.

  “So many of these AI solutions are vertically integrated...it becomes overwhelming. So our platform is a horizontal one that allows you to integrate once and deploy many.” (Doug, 08:00)

5. Breaking Open the Silos Through Standards and APIs

• Doug wrote and implemented critical standards (e.g., Consolidated CDA, SMART on FHIR) underpinning modern health information exchanges and interoperability.

  "A lot of those standards I actually developed when I was at ONC...We use that in the HIEs...to pull [data] out." (Doug, 10:51)

• Emphasizes the difference smarter interfaces and APIs make in bypassing vendor “locks.”

  “Well, all the problems associated with...data in healthcare—Doug’s fault.” (Ed, joking, 11:33)

6. Patient-Centered Perspective & History Analogy

• Identifies the lack of patient representation in health AI forums.

• Shares a compelling analogy: early medical use of automobiles was focused on doctor benefit, but ultimately became transformative for patients, enabling them to access care differently.

  "I think we spend a lot of time with technology to try to make patients better, but I think we're going to end up making better patients." (Doug, 14:48)

Notable Quotes & Memorable Moments

• On the changing landscape of EHRs:

  “We’ve got like seven EHRs. And you know what happened after [the mainframe era]? We had personal computers and now everything runs on my iPhone and it’s all a bunch of apps.” (Doug, 04:12)

• On innovation bottlenecks:

  “[Institutions] have to wait two, two and a half years for good ideas to get through the gauntlet...the CIO says, if you can’t give me a seven figure return, we aren’t going to take a look at it...there’s a tremendous amount of bottom up innovation waiting to be released.” (Doug, 05:47)

• On the purpose of Health Universe:

  “We named our platform Health Universe because Health Solar System seemed a little small in terms of our aspirations.” (Doug, 10:31)

• Historical parallel:

  “Between 1905 and 1912...doctors were adopting this new technology...the automobile...to improve and transform healthcare. Actually [it] became a patient’s tool...doctors could have offices and patients could come to them...I think we're going to end up making better patients.” (Doug, 13:00–14:48)

Memorable Moments & Banter

• Playful callbacks to classic computer history and standards, e.g., reference to CORBA, Linux (08:53–09:03).

• Doug’s comedic timing:

  “My flight just got canceled.” (Doug, 10:03)

• Closing “lightning round” with personal and humorous responses:

  • Riskiest thing Doug has ever done?
    “Starting a company.” (Doug, 15:36)
  • Advice to his 20-year-old self?
    “Buy Amazon.” (Doug, 15:58)
  • Desert island albums might include: Lady Gaga, EDM, the Beatles. (Doug, 16:50)

Timestamps for Important Segments

| Timestamp | Topic / Segment Description | |-------------|----------------------------------------------------------------------| | 01:14 | Doug’s intro: medical/technical background & EHR federal rollout | | 02:29 | National shift to EHR adoption—impact during ONC tenure | | 03:54 | “Lazy data”—current problems with data silos and vendor lock-in | | 05:03 | Future vision: agentic, AI-driven healthcare platforms | | 06:49 | How AI + OCR extracts value from structured and unstructured data | | 08:00 | Platform approach: horizontal vs. vertical integration | | 10:31 | Why “Health Universe” and ambitions for broad impact | | 10:51 | The standards behind breaking silos (CDA, SMART on FHIR) | | 13:00–14:48 | Historical analogy: the car, patient empowerment, better patients | | 15:36–16:50 | Lightning round: risk, advice to young self, desert island albums |

How to Learn More or Connect

• Explore Health Universe:
  healthuniverse.com – Free accounts available for app deployment and experimentation

• Contact Doug Fridsma:
  Email: [first initial][last name]@healthuniverse.com

Tone & Style

The conversation is fast-paced, technical yet approachable, and peppered with humor and camaraderie. Doug is insightful, candid, and self-deprecating, while Ed and Saul keep the discussion lively and accessible, unafraid to poke fun at jargon and the quirks of health tech industry history.

Summary prepared for listeners and readers seeking an actionable, engaging distillation of this Risk Never Sleeps podcast episode.