Risk Never Sleeps Podcast - Episode #179

Why Clinical Documentation Has Been Broken For 30 Years

Guest: Dr. James Maisel, CEO and founder of ZyDoc
Host: Ed Gaudet
Guest Host: Saul Marquez
Date: December 30, 2025

Episode Overview

This engaging episode features an insightful conversation with Dr. James Maisel, a retina surgeon turned entrepreneur, who founded ZyDoc to tackle the persistent challenges in clinical documentation. Dr. Maisel reflects on the evolution of digital health records, the cumbersome nature of traditional documentation methods, and the revolutionary impact artificial intelligence is starting to have on streamlining and improving physician workflows. The discussion also touches on the broader healthcare technology landscape, the risks and lessons learned from decades in the field, and forward-thinking approaches to both patient care and business development.

Key Discussion Points & Insights

1. The Landscape of Healthcare Innovation

• The Power and Pace of AI:
  Dr. Maisel discusses how AI's rapid development in diagnostics and therapeutics was highlighted at the recent conference. This explosion of technology has reinforced the value of ZyDoc’s clinical documentation solutions and opened doors to new collaborations.

  “The last keynote was just overwhelming with all the AI technology being introduced from Diagnostic Therapeutic on so many fronts…” (03:30)

• The Value of Data Science:
  Highlighting the surprising academic depth of conference attendees, Dr. Maisel notes the increasing importance of data science in healthcare innovation.

  "The academic background of a lot of these people and the data science is very important to me and resonates." (01:59)

2. The Clinical Documentation Problem

• Origins of ZyDoc:
  Dr. Maisel founded ZyDoc in 1993, driven by the belief that computers could boost physician efficiency. He recounts being among the first to build an electronic health record (EHR) system, only to discover that existing workflows were too slow and burdensome for everyday clinical use.

  “We identified a problem that it took 15 to 20 minutes to click through the menus... they saw patients every 10 minutes or something, so it wasn’t going to work. And I’ve spent the last 30 years trying to solve that problem. Remove clicks to make it easier and faster.” (04:51)

• Speech Recognition & AI Integration:

  • Early on, ZyDoc partnered with Philips to take advantage of speech recognition in EHRs, streamlining data entry and making clinical documentation more efficient.
  • Dr. Maisel explains that while speech recognition was an improvement, it struggled with formatting and structuring patient notes for the EHR.

  “The problem we have was the speech recognition doesn’t do any formatting…AI came along and we said, my God, this can fix all the problems we have.” (07:29)

3. Physician Adoption & Health Literacy Challenges

• Resistance to New Technology:
  Dr. Maisel recalls the long path to getting doctors to embrace digital tools, from EHRs to smartphones.

  “With EHRs, the doctors didn’t know how to use a mouse...The first smartphone application they ever installed was Zidoc.” (03:02)

• Health Literacy & Translation:
  He notes the importance of addressing health illiteracy, language, and cultural barriers—further underscoring the need for smarter documentation tools and patient education.

  “We have so much health illiteracy. 30% of people in the US are health illiterate...culturally, they have different attitudes about switching drugs, getting investigational drugs or newer therapies.” (03:02)

4. Lessons Learned: Risk, Resilience, and Business

• Risk and Opportunity Cost:
  Dr. Maisel shares how founding ZyDoc was the biggest risk in his career, given the lucrative potential of staying solely in retina surgery. Nevertheless, he continues practicing part-time and serves as ZyDoc’s primary product tester.

  "The biggest risk was with Zidoc, actually. My opportunity costs are huge. As a retina specialist..." (08:49)

• Advice for Medical Entrepreneurs:
  On transitioning from medicine to business, Dr. Maisel emphasizes how difficult and non-intuitive the business side is for most physicians:

  “Starting up a company is very challenging and as a physician it’s totally different and not intuitive...I see all the doctors here with amazing ideas and they can’t really...I see that they’re going to have a hard time turning it into a business model...” (09:51)

• Importance of Standards and Partnerships:

  • He advocates for industry standards in AI and healthcare, enabling interoperability and plug-and-play solutions.
  • He warns of the risk in depending on single partners, sharing a lesson:

  “Always dual source whenever you can. Because we’ve had partnerships with large companies that just arbitrarily decide to change their focus and market...” (11:27)

5. Future of Clinical AI and Device Automation

• AI in Diagnostics:

  • Dr. Maisel predicts a near future of fully automated diagnostic devices powered by specialty-specific AI models, drawing parallels to radiology image analysis.
  • He shares examples, including AI-driven eye scans that can now estimate physiological age and detect hypertension, Parkinson’s, Alzheimer’s, and cardiac issues by examining the eye’s blood vessels.

  “Within a few years we’re going to see these equipment that is almost totally automated...automatically interpreted using AI the way the radiology images are done.” (13:04)

• Challenges in Medical AI Validation:

  • The regulatory landscape requires extensive validation of device-AI outcomes, making progress expensive and complex.

  “The FDA links the device to the outcomes of any program that’s working there. So it’s device specific and it’s very expensive. You need to get thousands of images, for example, to test your hypothesis.” (14:21)

Notable Quotes & Memorable Moments

• On the Persistence of the Documentation Problem:

  “I’ve spent the last 30 years trying to solve that problem. Remove clicks, to make it easier and faster.”
  — Dr. James Maisel [04:51]

• On Recognizing AI's Game-Changing Potential for Documentation:

  “AI came along, and we said, my God, this can fix all the problems we have.”
  — Dr. James Maisel [07:29]

• On Health Literacy Challenges:

  “30% of people in the US are health illiterate...health illiteracy...you have all the people hard of hearing, different languages, cultural differences...”
  — Dr. James Maisel [03:02]

• On Business Risk and Resilience:

  “Always dual source whenever you can. Because we’ve had partnerships with large companies that just arbitrarily decide to change their focus and market. It doesn’t matter how much time you’ve put in.”
  — Dr. James Maisel [11:27]

• On the Surge of Diagnostic AI Devices:

  “Within a few years we’re going to see these equipment that is almost totally automated...AI the way the radiology images are done.”
  — Dr. James Maisel [13:04]

Timestamps for Key Segments

• [01:00] Intro to Dr. James Maisel and ZyDoc
• [03:02] Health literacy and the challenge of patient engagement
• [04:08] ZyDoc’s founding and first attempts at EHR innovation
• [07:29] Integrating speech recognition and the impact of AI
• [08:49] Dr. Maisel’s greatest professional risk
• [09:51] The business side: Lessons and advice for clinicians
• [11:27] On partnerships, dual sourcing, and industry volatility
• [13:04] The future: AI in diagnostics and automated devices
• [14:21] Regulatory challenges for diagnostic AI

Final Thoughts

Dr. James Maisel’s journey underscores both the complexity and necessity of solving the clinical documentation puzzle—one that, despite decades of progress, remains a major contributor to physician burnout and inefficiency. With AI’s rise, he is cautiously optimistic, recognizing both the transformative potential and challenges that lie in validating and integrating these technologies at scale. Clinicians and innovators alike will appreciate his hard-won perspective on innovation, standards, and the need for resilience in healthcare technology.

For more about ZyDoc, visit ZyDoc.com or call 800-546-5633.