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Fialkov Shares a Startup Story and a Learning Curve as Doctor Turns Businessman

Des Moines Startups Rational Surgical Solutions Path to

"It's an interesting journey that led me to being an entrepreneur. I really didn't understand how the process worked," confessed Dr. Jonathan Fialkov, President and Founder of Rational Surgical Solutions LLC, and guest at the October rendition of Square One DSM's Startup Stories hosted by Mike Colwell. The practicing urologist knew what he wanted in the form of a software application, but was woefully unaware of the path from idea to product.

An Innovative Idea

"I thought if I just patented this idea, someone would come along and buy the patent and develop the software with me on the development team," he said reflecting back on his own awakening. As it happened, even though he was not familiar with the process, the good doctor did, in fact, have a very good idea.

"Over the course of my 14 years of practice I saw inefficiencies, not specific to my clinic, but to medicine in general. And I heard the same stories over and over from my colleagues around the country," he explained. One of the most commonly cited issues was time ineffectively spent educating patients in counseling sessions, where true communication was often not taking place. The patient would walk away still unaware of all the issues surrounding their condition or procedure. 

With considerable deliberation, Fialkov devised what would prove to be a tenable solution to this common challenge in the form of a software package now called the Rati-Fi® Informed Consent System. The Rati-Fi app uses high-quality medical animations to educate and engage patients, evaluate patients' comprehension using a brief quiz, and then record the doctor-patient consult and the informed consent process. A copy of the video and a PDF of the signed file is stored securely in the cloud. The product provides unique value to medical professionals and patients alike. On the patient side, it reduces patient anxiety and confusion while lowering patient readmission. For medical professionals, it reduces the burden on the physician to explain and educate as well as lowers the incidence of malpractice litigation.

The Startup Learning Curve

Working with local vendor QCI, Fialkov forged a prototype, which he then presumed would be snatched up by a big vendor wanting to purchase his intellectual property. Another lesson in the process awaited him, as he soon was informed no one would be interested until the product was in the field and had proven itself with a large number of users.

At that point, Fialkov was introduced to Colwell, Executive Director of Square One DSM, who helped him formulate a business plan. Fialkov quickly realized his personal savings would no longer suffice to sustain his business and that a fund raising round was in order.

"The whole thing started escalating," he said. Now, two years out from the founding of the company and only one year out from his meeting with Colwell, he has a product. He has also grown to a staff of five full-time employees including sales staff, closed a successful funding round of $1.4 million, and has enlisted the assistance of such local notables as Tej Dhawan, Sheldon Ohringer and JD Geneser to serve as fractional officers and board members.

Noting that medicine is becoming more and more like a business, in that a surgeon needs to know how to manage people as well as time and other resources, Fialkov confessed that business planning and sales were simply outside his skill-set. He knew that this was the place where he should seek advice and assistance, strongly encouraging other entrepreneurs to know where their own skills need supplementing. "I could manage my own personal finances, but when you are talking about a startup and you are raising funds, it has got to be done right," he emphasized. Here, both Fialkov and Colwell spoke to the concept of fractional professionals, one who serves a critical function, but does not need to be full-time. "CFO for instance is critical, particularly for dealing with investors, but when you are first starting out you don't need one full time and you certainly couldn't afford the one you need. So, employing one for a few hours a week or month might be just what you need," shared Colwell of what Fialkov was doing with Geneser and Dhawan.

"One thing we have learned in this process is that the sales cycle, particularly in healthcare, is long and arduous," Fialkov noted, echoing more than a few entrepreneurs who have shared the same insight at previous Startup Stories. The process, especially when working with large complex clients like clinics and hospitals, involves a seemingly endless cycle of hurdles and roadblocks, seeking approvals from one individual or committee after another, until the green light is finally given for purchase and implementation. "What I would do differently would be to hire professional full time sales people earlier in the process, even before software was ready, even before a pilot was done," he offered. "The surgeon in me wanted to wait and see the data before pitching it to clients, but having those extra months to close some of the contracts we are working on currently would have been helpful."

In a press release announcing his appearance, Fialkov stated that he wanted to shatter the misconception that startups were just for people fresh out of college. Those in attendance at the October luncheon would concur strongly that he did just that.