Rami Alkarmi builds lean startup Ecosystems

Geek. Investor. Growth Strategist.

A proud geek, investor, and widely recognized advisor and expert in strategy, lean startup ecosystems, business models, growth & distribution through big data and viral marketing, and corporate venturing.

In 2013, he founded Arcoten Holdings as his advising/investing vehicle where he partners with corporates, accelerators, and incubators to build lean startup ecosystems, and helps companies through providing expertise in growth, hands-on mentorship, access to capital, and helps companies iterate product and grow fast. From time to time, he also likes to build companies with friends and partners inside Arcoten.

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This last week – the widely read Dr. Rob Lamberts lamented the usability of his Electronic Medical Record (EMR) software for his new primary care practice. It’s worth reading (here) as it highlights the larger systemic problem of EMR software generally and then specifically as EMR software is overlaid onto a new payment model. In Dr. Lamberts case, a software solution – one that was built specifically around billing mechanics (namely ICD-9 and CPT “codes”) – was overlaid onto a new practice model that bills patients a flat monthly fee for “all-they-can eat” primary health care. Almost all EMR/EHR software has been purpose-built to support billing as the primary function. Clinical data capture is the secondary objective – and the EMR/EHR software vendor landscape is 100% reflective of that priority (as is the entire system). At last count, there were over 600 EHR “vendors” and over 300 that had reported at least one doctor or practice that ”attested” to “meaningful use” with their software (a requirement for HITECH Act payment). To date, we’ve spent over $10B on “digitizing” health records. I’m struggling to find the right analogy, but I imagine the effect Dr. Lamberts (and others) are feeling is similar to putting a V-8 engine onto a bicycle. Yes, you could (conceivably) engineer that solution – but why would you – and then why would you expect any kind of usable experience? You simply wouldn’t (unless, perhaps, you were Evel Knievel). Even Felix Baumgarten carefully employed a team of 300 (including 70 engineers and doctors) in his lone (and breathtaking) leap from the edge of space. Forbes colleague David Shaywitz wrote more broadly (and brilliantly) about this in his piece earlier today: Handle With Care: Success of Digital Health Threatened by Power of Its Technology. This too is well worth worth reading as it relates to the “quick-fix” mentality that is pervasive in both our culture and our wheezing health care system. It’s everywhere – and short-sighted. For providers, let’s cram-down EHR solutions so that we can “capture” the downstream data/analytics that we so desperately need to control costs – with little interest, attention or concern to the consequence on the front-end patient dynamics (including both patient AND provider experience). For employers, let’s add “gamification” and “wellness” programs (with “behavioral economics” of course) to the HR/Benefits equation. While we’re at it – let’s automate low-acuity, primary care as much as we possibly can. There – all done. We’ve digitized, gamified and automated the whole mess. The effect – as evidenced by Dr. Lamberts plight (and flight) – is to eject altogether. The fundamental hope (and risk) of this “direct-to-consumer” model is that personal (and fiscal) sanity will return to the private (often solo) practice of primary care. I’m not sure it’s the right hope (or exit), but I do understand the motivation and it is a worthwhile experiment because, more than ever, we need primary care physicians to stay engaged as we work through our health care transformation. I argue that Medscape’s chart on ”average” physician compensation highlights the broader dilemma – namely that primary care (the very entry point for health care) is the lowest paid.


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