Episode #179. Why Clinical Documentation Has Been Broken For 30 Years, with Dr. James Maisel, CEO and founder of ZyDoc

Summary

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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

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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.

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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)

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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]

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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

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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.

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Transcript

[Dr. James Maisel]

Foreign.

[Ed Gaudet]

Welcome to Risk Never Sleeps, where we meet and get to know the people delivering patient care and protecting patient safety. I'm your host, Ed Gaudet.

[Saul Marquez]

Day three, Aimed San Diego. The Insights podcast series is back on day three. It's sad. And I'm here with my guest host, Saul Marquez, Outcomes Rocket. Saul.

[Ed]

Ed.

[Saul Marquez]

What a three days.

[Ed]

Amazing smokes, right? My mind is blown.

[Saul Marquez]

I know. And we're at it again. This is our first one of the day. The Insights podcast series is brought to you by Outcomes Rocket and Sense in that Risk Never Sleeps podcast series. All of those are on all of the favorite podcasting platforms, Spotify, et cetera, et cetera. Wow. And we are here with the CEO and founder of Zidoc, James Maisel. The marvelous Maisel.

[Ed]

Right?

[Dr. James Maisel]

The marvelous Dr. Maisel.

[Saul Marquez]

Doctor.

[Dr. James Maisel]

I'm a retina surgeon.

[Saul Marquez]

Oh, you're a doctor.

[Ed]

Oh, doctor turned technologist, slash entrepreneur.

[Saul Marquez]

Yeah. The doc ER stands for entrepreneur.

[Ed]

Ready?

[Saul Marquez]

Right.

[Dr. James Maisel]

Thank you for inviting me.

[Saul Marquez]

Yeah.

[Dr. James Maisel]

Nice to talk to you.

[Saul Marquez]

Good to have you.

[Ed]

Have you on the show.

[Saul Marquez]

Now we here all three days.

[Dr. James Maisel]

Yes, I have been.

[Saul Marquez]

You hear anything that really took you back or made you think differently about what you're doing at your current company?

[Dr. James Maisel]

The last keynote was just overwhelming with all the AI technology being introduced from Diagnostic Therapeutic on so many fronts and all the people here were so amazing. I was able to see more value in our services of clinical documentation here and meet some very wonderful people and products and services that we could work with.

[Saul Marquez]

It's an amazing community, isn't it?

[Dr. James Maisel]

It's surprisingly amazing. And the academic background of a lot of these people and the data science is very important to me and resonates.

[Saul Marquez]

Yeah. And have you seen Dr. Daniel Kraft present before?

[Dr. James Maisel]

No, I haven't. Yeah.

[Saul Marquez]

He's incredible, isn't he?

[Dr. James Maisel]

Yes. Yes.

[Saul Marquez]

Putting a slide for every 10 seconds.

[Dr. James Maisel]

Or wrapping your head around all those concepts. You need AI just to keep up now with AI, but in person, if you're an oncologist or something, all the drugs that are coming out.

[Ed]

Incredible even. By the way, like, I literally, on the drive over, because I live here in San Diego, I got this Update for my AirPods, and if you click on both earbuds, it does automated translation. I'm about to try it.

[Dr. James Maisel]

Yes.

[Saul Marquez]

Not now, though.

[Ed]

Not now. No. Okay, good. Yeah.

[Saul Marquez]

Because we're on a podcast.

[Ed]

I get English. Like, I. I'm. It's. I'm not the best at it, but I understand it. You're not the best at English? No. Really? No.

[Saul Marquez]

Oh, okay.

[Ed]

Which Is not good.

[Saul Marquez]

What's your first language?

[Ed]

It's English. Yeah.

[Dr. James Maisel]

Sadly, the translation is very important. We have so much health illiteracy. 30% of people in the US are health illiterate. And then you have all the people hard of hearing, different languages, cultural differences. When you talk to patients about a therapy, culturally, they have different attitudes about switching drugs, getting investigational drugs or newer therapies. And now with COVID attitudes have changed. Also with patients, now with physicians, I'm not quite sure getting them to adopt new technologies. We've worked with doctors for 30 years with innovations. With EHRs, the doctors didn't know how to use a mouse. Yeah. With speech recognition, they have to get the microphone working and navigate around the ehr. And we've had a lot of doctors. The first smartphone application they ever installed was Zidoc.

[Saul Marquez]

Oh, really?

[Dr. James Maisel]

Yeah.

[Saul Marquez]

How long you been around? When did you start the company?

[Dr. James Maisel]

I started the company in 1993.

[Saul Marquez]

Oh, wow. Okay. Yeah.

[Dr. James Maisel]

I was always interested in computers and I thought they might be helpful for physicians and documentation and just speeding up the way doctors work. And I read this book from the Institute of Medicine describing what electronic records should be. Nobody had ever made one.

[Saul Marquez]

Right.

[Dr. James Maisel]

And I created one. And we exhibited in 93 with maybe a dozen companies at a conference like this. Epic was one of them. I didn't have the business experience, but we had a product that did everything the current EHRs did.

[Saul Marquez]

Yeah.

[Dr. James Maisel]

And had references and the like. And we put it out for beta testing. And we identified a problem that it took 15 to 20 minutes to click through the menus. And our 15 beta sites confirmed the product performed fine. But 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. And Phillips approached us at one of the meetings and said, you're one of the few companies that have a Windows based ehr. And we knew we had the data entry problem. We'd been working on it for over a year with everybody we could get had ideas how to do it. And they came to us and said, would you like to incorporate speech recognition? We said, yes, do not leave this booth. We want to work with you. And fortunately, there's development was on Long island where we're based. And we got. There was no remote anything at that time. So physically you had to be there to work with them. And we learned how to make language models with them.

[Saul Marquez]

Interesting.

[Dr. James Maisel]

And we sold the prototype of the ehr. To the Department of Defense. I thought things might be very good. I was on the COVID of magazines and I was involved with this consortium called HOST that subsequently merged with himss. And we were having meetings like this, talking about standards for the industry and performance, and the Department of Defense was there. Government, academia, private companies. And so I've been involved with EHRs for years.

[Saul Marquez]

Same company name, Zidoc.

[Dr. James Maisel]

Yeah, we're just now converting to a C corp, so we can take investment money and we're just starting out on that process. It's. I'm on the learning curve, but we have a lot of interest.

[Ed]

So what is it now then, James? What are you guys focused on?

[Dr. James Maisel]

So we're focused on clinical documentation, the actual AI scribing patient, doctor. So we used to do that with dictation, and we did it with different devices. And we were one of the first companies to do it with recorders. We work with Philips and Olympus primarily to let the doctors dictate everything. And we did a study at Columbia comparing that with keyboard and mouse, and it was 61% more efficient for the doctor to dictate.

[Saul Marquez]

Are you ambient listening?

[Dr. James Maisel]

So we knew that dictation was better and we wanted to improve that. So we used speech recognition for years as the first draft to make the work easier for the transcriptionist. And we built a whole platform designed for taking voice or video and putting it in and having it turned into text and then insert in the ehr. So the problem we have was the speech recognition doesn't do any formatting. It's not so good at fixing grammar or punctuation, and it doesn't categorize the elements of the dictation into sections. So there's a lot of work to get it ready for the ehr. The put it in the right format of chief complaint, past medical history, medications, allergies and the like in those categories. AI came along and we said, my God, this can fix all the problems we have. Taking speech recognition, fixing the grammar, putting punctuation in, and categorizing it there. So we had made language models for the medical industry after Phillips pulled out of the industry for a while. I can't talk about that.

[Ed]

But I have a question, James.

[Dr. James Maisel]

Yes.

[Ed]

What's the biggest risk you've ever taken?

[Dr. James Maisel]

The biggest risk was with Zodiac, actually. My opportunity costs are huge. As a retina specialist, why'd you do it?

[Ed]

Right. Because you had a good life as a doctor.

[Dr. James Maisel]

Yeah, at that time I was trained in retina surgery and I still do that.

[Ed]

Are you still doing It. Are you still practicing?

[Dr. James Maisel]

I'm trying to practice less and hired people to replace me me. But the patients still want me, still want to see me. So I work some and I actually am the alpha tester for the company. We put in new versions of AI. For example, did you know a Dr.

[Saul Marquez]

Suchoff in New York?

[Dr. James Maisel]

No.

[Saul Marquez]

He was an optometrist.

[Ed]

Was he your doctor?

[Saul Marquez]

No, he was pretty well published. He's a friend of mine's father.

[Ed]

Oh, really?

[Saul Marquez]

I didn't know if you know him or not.

[Ed]

Yeah, it's a small enough community.

[Saul Marquez]

It is a small community, I think. Yeah.

[Ed]

Yeah. Just like this community. There's like, wow, man, the brain power here. And then everybody tends to know each other.

[Saul Marquez]

Yeah, exactly. You go back in time and tell your 20 year old self, what would it be?

[Dr. James Maisel]

I've learned a lot of business lessons. I probably should have taken some business courses. Starting up a company is very challenging and as a physician it's totally different and not intuitive. Yeah, what you have to do, how much everything costs and all the skills you need to do that. So 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 and I spoke to a few of them and told them what I would do with that. But just the legal issues and then getting to market and the financial burden is there. And I think the AI community has to have standards now. So I worked in standards for EHR and I think it would be a good time to have them. So all these solutions could be plugged in. So for example, if we have a patient that has an encounter and we document they have breast cancer or lung cancer or rheumatoid arthritis, there's probably great expertise here from physicians that understand how to do that and have made apps for that. So the patient has certain keywords that trigger their app that's plugged in on the platform and it generates all this information the way we do summaries or translate that into the patient's language.

[Saul Marquez]

What was the biggest lesson you learned given your experience?

[Dr. James Maisel]

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. So whenever we can, we try to dual source things. Just because of the rapid fluctuations in medicine. We might get a new drug in your field every year or two or some procedure and. Or outcomes that shifts your thinking and direction. In especially with AI, the exponential rate of change is there. It's going from doing a slow championship chess match to a 30 second move game here where you wake up the next day and all of a sudden there's something that radically off, radically alters your output. For us, it was AI, the generative AI that allowed us to take our transcription work, the speech recognition, and improve it hugely to the fact that we can automate the process and deliver it to the doctor almost instantly in under a minute.

[Ed]

And are you using any AI for like optometry diagnosis? I know there's a lot of applications out there for that.

[Dr. James Maisel]

So we have specialty specific language models for speech recognition that we made decades ago for a dragon 17 medical specialty language models.

[Ed]

So curious about today, like.

[Dr. James Maisel]

Every devices, we're not doing diagnostic devices, but the doctors are dictating the results of those or the automated readings of those. So within a few years we're going to see these equipment that is almost totally automated. Auto focus, auto alignment, you put your head in, takes a picture of the eye with multiple diagnostic images and these are automatically interpreted using AI the way the radiology images are done. And I did this really crazy test.

[Ed]

I was at vive and they scanned my eye and they told me my age, like my physiologic age. Have you heard of that one?

[Dr. James Maisel]

Yeah. So there are a lot of markers in the eye. It's the only place you can actually see blood vessels. So patients come in and they could look at that. That's interesting. And they had hypertension.

[Ed]

Actual blood vessel.

[Dr. James Maisel]

Right, actual blood vessel. So if somebody came into an emergency room, they, they might be anxious and their blood pressure is up. If you look in their eye, you could tell if they had hypertension for a while and other markers for Parkinson's, Alzheimer's, age related things, cardiac problems.

[Ed]

I was floored by this test.

[Dr. James Maisel]

Are there. So this is evolving. It's difficult because 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 and make sure it's reproducible.

[Saul Marquez]

Yeah, yeah, yeah. Dr. James Maizel, thank you from Zidoc. Thank you for joining us. And we're going to put the links for his company.

[Ed]

Best place to get in touch with you.

[Saul Marquez]

Yeah.

[Dr. James Maisel]

Zidoc.com Excell Excellent. Busy. We have an 800 number. We have.

[Ed]

What's the 800 number?

[Dr. James Maisel]

800 546-5633.

[Saul Marquez]

Excellent. Yeah, yeah. Folks, this has been terrific. And we're going to, we're going to see you at next year, 2026. You're going to be in Orlando, right?

[Dr. James Maisel]

This is my first time at the meeting. I'm going to apply as a speaker.

[Saul Marquez]

Oh, nice. Yeah.

[Dr. James Maisel]

Nice to give some of my experiences and hopefully contribute something.

[Saul Marquez]

Yeah. And if we're there and doing this, we'll have you back on. You can tell us about your investment experience.

[Dr. James Maisel]

Okay.

[Saul Marquez]

Because by then you should have.

[Dr. James Maisel]

Yes. We have a lot of opportunities and so many that we need money just to pursue them, to grow this.

[Saul Marquez]

So if you're an investor listening to this program, reach out to Dr. James Maisel Zidoc.

[Dr. James Maisel]

Thank you.

[Ed Gaudet]

Thanks for listening to Risk Never Sleeps. For the show, notes, resources and more information and how to transform the protection of patient safety, Visit [e-mail] that's C-E N S I N E T.com I'm your host, Ed Gaudet. And until next time, stay vigilant because Risk never Sleeps.