Building Health Tech Across Borders: Design, AI, and System-Level Change – with Rami Ajjuri

In a new episode of Digital Health Interviews, we sit down with Rami Ajjuri - a founder and long-time operator across venture capital, corporate strategy, innovation, and healthcare - to talk about why so much meaningful technology never reaches real patients, why the U.S. healthcare system feels structurally unsustainable, and what product teams need to understand about incentives, user behavior, and UX before they “layer AI into everything.” Ajjuri’s story moves through medicine, research, policy, Europe’s startup ecosystems, and back to the U.S., but the theme stays consistent: if you don’t understand what drives people and systems, innovation dies early.

A Curious Kid Who Couldn’t Tolerate the System

Ajjuri describes himself as the kid who asked too many questions and often got reprimanded for it - a curiosity shaped by growing up in the South with immigrant parents who steered him toward a narrow set of “acceptable” careers: doctor, engineer, NASA, professor. He initially pursued medicine, but he says he very quickly realized that the American healthcare system wasn’t something his nervous system could tolerate “for many decades.” As both a trainee and a patient, he found the experience increasingly discouraging - less about healing, more about industrialized cost management and optimization.

That realization pushed him toward research. He dropped the MD track and pursued a PhD, working on public policy, innovation, and topics he genuinely cared about. But even there, he ran into another hard truth: academia isn’t exempt from politics or structural dysfunction. In his view, the bigger problem was this: innovation doesn’t travel cleanly from early-stage science into the hands of the people who actually need it. He had seen too many cases where something exceptionally meaningful to patients never makes it all the way through adoption barriers, incentives, and execution gaps.

“The World Doesn’t Need More Good Scientists”

A pivotal moment came when a professor took him aside and offered advice that reframed his path. The world, the professor told him, doesn’t need more good scientists as much as it needs people who can help scientists, doctors, and engineers take early-stage technology and build something that actually matters. That idea stuck.

Ajjuri decided to forgo a postdoc, pursued an MBA, and moved to Barcelona, where he worked in venture capital and deep tech accelerators supporting startup ecosystems across Europe. That European experience exposed him to a very different kind of optimism, one rooted in public-private collaboration, policy access, and more structural thinking about innovation. From there, his career expanded into corporate venture, M&A, corporate strategy, venture studios, and accelerator work, and eventually into founding his own company, motivated by a desire to help more founders “die less.”

The Bay Area Bubble and the “Future That Didn’t Exist Yet”

Having lived and worked across the U.S. and Europe, including New York, the Bay Area, Germany, and now Nashville, Ajjuri offers a sharp observation about innovation culture. The Bay Area, he says, can feel like a vortex: you start living inside a future that doesn’t exist yet, surrounded by companies and people who believe they can force that future onto the rest of the world through willpower. He admires the ambition and the network density, but he calls it disconnected from reality and difficult to scale outside that ecosystem.

In his view, many of the most urgent innovation opportunities in U.S. healthcare won’t be solved solely from Silicon Valley. They’ll come from regions like Nashville, Chicago, Atlanta, New Orleans, and Texas - places closer to operational reality and better aligned with what people actually want and need.

Europe vs. the U.S.: Incentives, Competition, and Adoption Speed

When the conversation turns to Europe’s healthcare systems and innovation environments, Ajjuri focuses on incentives. For him, the central question is always: how do you ask people to change habits they’ve had for years if the system’s incentives don’t support that change or actively prohibit it?

He points to the U.S. “MBAification” of hospital systems, where physicians and teams are often incentivized to do things quicker, faster, cheaper, with less waste. It can create efficiency, but it also shapes innovation through competition. Ajjuri shares an example from New York: a hospital would sign a multi-million-dollar contract for a navigation system and robotics platform only if the vendor promised not to sell to other hospitals within a 20-mile radius, so they could advertise exclusivity on billboards. That type of dynamic, he notes, is not how Europe tends to work.

At the same time, he argues Europe’s lower competition and heavier reliance on grants and single-payer structures can slow innovation adoption. Many European startups, he says, build amazing technology, but their first question is often “How do we break into the US?” because the upside is limited and the adoption cycle can be long. The slower pace of life overseas is a double-edged sword: good for living, but slower for implementing change when there’s no pressure to commercialize.

Learning from Asia and “Skipping Phases” of Innovation

Ajjuri is also interested in what the U.S. and Europe can learn from Asia, and he frames it through a “skipping phases” lens. He references examples like Africa jumping from limited connectivity to widespread mobile use without building landline infrastructure first - an “incredible leap.” Similar dynamics, he suggests, may shape how new healthcare models emerge.

The host adds an example from Thailand: a health system consistently ranked in the top 10 globally, where the appointment starts on the street, someone meets you outside the hospital, collects your data, and routes you into care, paired with surprisingly high-quality professionals. Ajjuri sees these models as evidence that innovation doesn’t always follow the same sequence everywhere, and that necessity plus structural flexibility can create entirely different patient experiences.

Where Would He Prefer Care: Europe or the U.S.?

Asked where he’d prefer to be a patient, Ajjuri avoids a simplistic answer. It depends on what you’re being seen for and where, because quality varies widely within any region. Still, he offers a practical breakdown: as an above-average income household, he appreciated healthcare in Barcelona more than even New York or the Bay Area. As a below-average household, he also believes Europe is a safer bet. People in the middle, he suggests, might choose the U.S., but it’s a broad-brush framework, not a universal rule.

UI/UX in Healthcare: The Incentive Problem No One Wants to Fix

Ajjuri’s product perspective sharpens when the discussion turns to UI/UX, especially in B2B systems like EHRs. He says he’s seen a greater push toward better UX recently because users’ expectations are rising, shaped by banking apps and consumer-grade software. Insurers and others are also thinking more about stickiness and guiding users to the right care.

But he also points out why incumbents often don’t move: where there’s no competition, what’s the incentive to take on the risk of redesign, retraining, and potential workflow disruption? If a massive EHR vendor makes money from upgrades, and hospitals are locked into long contracts, UX becomes optional, even when everyone knows it’s painful.

When asked whether AI-first EHRs could disrupt the market, Ajjuri says the opportunity is massive, but the data lock-in and complexity make it a herculean effort. In healthcare, downtime is unacceptable, so the biggest question is execution.

His more realistic vision is a middle layer: tools built on top of existing systems that improve usability and efficiency without threatening the incumbents’ core revenue. Over time, the EHR may become more like back-office infrastructure, a data warehouse, while new layers shape the front-end experience. Incumbents, he predicts, may eventually acquire those layers rather than losing control of the interface.

AI and “Agentic” UX: Don’t Cram It In

Ajjuri is skeptical of the current trend of “layering AI into everything.” He says the real question is: what would it take for a user to upend the habits they already have, and is AI essential for solving a real human pain point?

He shares a concrete example from his current company: as they discussed building agents and agentic workflows, the team asked what their onboarding would look like if it were fully agentic. That question changed not just the interface but the entire logic of the flow. Instead of linear screens that block progress, an agent could gather missing information, return with what it found, and ask the user to confirm or edit. In healthcare, where users constantly lack time or paperwork, that’s a powerful use of AI because it removes friction without forcing behavior that feels unnatural.

He’s less convinced that voice will dominate everyday interaction in the way people assume, partly because so much tech use happens in public settings. Still, he acknowledges strong voice + vision use cases in clinical environments, like a surgeon asking for prior tumor results and anatomical comparisons in real time, while noting the obvious risk: a room where everyone is talking to agents at once can become chaos.

Ambient Scribes: A Rare Moment of Real Connection

One of the most vivid parts of the interview comes when Ajjuri describes visiting a Stanford satellite clinic. A physician in her 60s or 70s had moved from paper-based records in New York to using Dragon ambient tools. For the first time, he says, he had a real face-to-face conversation with a doctor who wasn’t interrupted by typing pauses or a screen between them. It restored human connection, and it removed the need for an additional person in the room just to take notes.

At the same time, he notes the tradeoffs: post-editing, cleanup, and the challenge for some non-native accents, plus the reality that clinicians sometimes don’t want to say sensitive context out loud. The tool created space for connection, but it didn’t erase workflow complexity.

“Campaign Finance Reform” and Why the System Feels Unsustainable

When asked what should be done to improve U.S. healthcare, Ajjuri’s first answer is not technical: campaign finance reform. He argues money has to be removed from Congress, regulators, and decision-making bodies that benefit from the same system driving costs onto patients. He calls out the revolving door between regulatory agencies and big pharma/medtech, and the conflict of interest created when policymakers profit from stocks in industries they regulate.

He shares a personal example of a family member who switched jobs during a coverage gap, leaving a pregnancy effectively uncovered, forcing tens of thousands of dollars in costs onto a young household already carrying debt. He ties it to a broader moral point: when 40% of bankruptcies are medical-related, and a large portion of medically bankrupt people have insurance, the system is failing in a way that can’t be solved by feature upgrades alone.

Why He “Ran Away” From Healthcare and What He’s Building Instead

Ajjuri says he actively ran away from healthcare, and that was intentional. But the motivation wasn’t burnout, it was a pattern he kept seeing: great innovation dying before it reaches people in need. He argues many technically trained founders, physicians, scientists, and engineers have never been trained or supported to build companies from the ground up. Their networks are deep but shallow: they can find a chief medical officer instantly, but don’t know who to call for a chief revenue officer.

His current company, the.garage, aims to create more of the chance interactions where sparks fly, aligning serious builders with high-quality resources and a curated community across their networks. The goal is to increase the odds that early-stage companies stay alive long enough for innovation to compound into real-world impact.

His Advice to Digital Health Founders: Learn Human Behavior

Ajjuri closes with a simple directive: learn human behavior and psychology, understand what drives people toward or away from something. Tools in negotiation, sales, and user experience research can help refine those skills, but without understanding the core drivers of human interaction, what you build won’t have the impact you want. In his view, doubling down on that knowledge delivers a higher ROI than founders can imagine, because healthcare innovation fails less often for lack of intelligence, and more often for lack of alignment with people and systems.