Doug Fridsma, MD, President & CEO, AMIA, Chapter 3

We all know that interoperability must be solved, but what’s the first step we need to take? Doug Fridsma believes it’s in changing the definition. “We need to stop thinking of it as a ‘utopian place’ where data can freely flow.” Rather, it should be viewed in a much simpler and more practical way — as “incremental added functionality.” In this interview, the CEO and president of AMIA talks about why interoperability wasn’t baked into Meaningful Use, why he thinks FHIR has great potential, and why patient access has become such a big priority for his organization.

Fridsma also reflects on his time with ONC, discussing some of the difficult decisions that had to be made and why he believes a “front-loaded incentive program” made sense when it came to Meaningful Use, and talks about the work AMIA is doing to advance the field of informatics.

Chapter 1

Chapter 2

Chapter 3



* 5 years with ONC

* Taking “the path of least regret”

* ONC’s approach to standards: “Hedge your bets”

* HITECH as the infrastructure for EHRs

* “You can’t develop interoperability in a committee.”

* More city planning, less architecture

* AMIA: “We’re representing patients.”



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Bold Statements

One of my mottos at ONC was, ‘we want to take a path of least regret,’ because we had to adopt certain things. There were regulatory mandates and timelines we had to follow, but at the same time we knew that there could be better solutions, and we didn’t want to box ourselves in.

The way you manage your retirement portfolio is you hedge your bets; you make sure you’ve got a balanced portfolio of different things. What we tried to do is to create a portfolio of standards that we knew we could rebalance in the future if we needed to.

We knew that you couldn’t develop interoperability in a committee. You had to do in the real world. We also knew it was going to be messy after we adopted all these records, because it would be challenging to get them to talk with one another.

There’s an implicit evolution that has to happen with the technology that we use, and the smart CIOs and others will build into their technology and processes ways that will allow these things to change.

I think sometimes we mischaracterize the problem. The problem isn’t one of architecture. The problem is one of city planning. It’s different than designing a building. It’s about creating the incentives and the structures that allow robust cities to grow and thrive.

Gamble:  You’ve been with AMIA for about three years, correct?

Fridsma:  Yes. This November will be my three-year anniversary. I’ve been with AMIA since the fall of 2014, and I was with ONC from 2009 through 2014, so about five years.

Gamble:  I can imagine there were a lot of learnings from that experience that have helped shaped the role you have now.

Fridsma:  When I was at ONC, I was the director of the Office of Standards and Interoperability, and then later the chief science officer for ONC. My job was understanding and conveying some of the hard technical details so that as we tried to turn Meaningful Use into policies and regulations, we’d have a good understanding of what the pros and cons of different technology solutions applied to those different policy options might be. There was a lot we learned.

Early on, we had to adopt standards that existed because we simply didn’t have time to create ones that would be better than what we had.