Doctor’s startup creates app to help patients understand what they’ll face in surgery

Jonathan Fialkov worked as a urologist for the Iowa Clinic for 14 years. The native of South Africa and son of a physician had watched many presurgery discussions with patients. Often, the interactions weren’t pretty, because it was clear patients struggled to understand what was about to happen.

Fialkov, who now runs a business called Rational Surgical Solutions, was struck by the need for patients to have detailed, understandable information before a procedure so they can ask the doctor specific questions.

That often isn’t the case now, even though federal law requires doctors to explain procedures, risks and benefits as part of the consent process.

“Many times, it’s just, ‘Hey, sign this and we’re going to go ahead and do the procedure,’ ” Fialkov said. “That leads to confusion. It doesn’t manage patients’ expectations about what is going to happen, and ultimately that can lead to bad outcomes and malpractice claims.”
 
His desire to improve the informed consent process led Fialkov to work on what is now called the  Rati-Fi Informed Consent System.

“Over the 14 years, I saw the same situations in practice arise particularly with patients not understanding all of the implications of surgery,” Fialkov said. “I started asking other doctors if they were having the same problem. Is there something I could do when I’m communicating with people to make it easier for them to understand?”

The Rati-Fi app uses high-quality medical animations to help patients understand a coming surgery, test their knowledge through a brief quiz, then record the meeting between the doctor and the patient and the informed consent process. The video and the signed documents are stored available to the patient, family members and caretakers via a password-protected personal portal on a website.

Fialkov, company president and CEO, said multiple studies have shown that patients only remember 20 to 30 percent of what they are told minutes after they give their permission for a surgery.

The software is designed to improve that situation. Some 500 patients have tried the system, and none have filed a malpractice suit. Many praised the computer-aided interactions with the medical team, Fialkov said.

A pilot project at the Iowa Clinic urology department — half of the patients used the system, half didn’t — found that skeptical doctors eventually liked the system, and patients were fans, too, Fialkov said.

“Doctors found that it increased their efficiency so they were able to spend less time just spewing information to patients that the patients couldn’t understand,” Fialkov said. “They were able to focus on really good directed questions. More importantly, the patient satisfaction went up from the 10th percentile in some cases up to the 90th or 100th percentile compared to peers.”

The test run ended in April, and the product is on the market. Quality Consulting Inc. provided the coding for the software, and Boston-based PreOp.com produced the educational materials.

The hope is that buyers will be able to get a discount on malpractice insurance, making the purchase a break-even proposition, or close to it, Fialkov said.

Fialkov also hoped to help doctors in an era of digital records that has encouraged them to be data input specialists rather than physicians.

“The physicians, rather than explaining things to the patients, now are focused on the screen, typing on the keyboard. Also, the records that are generated are supposed to be available to patients but aren’t. They have patient portals, which are federally mandated, but they in many cases are barely functional. There is very low patient adoption and acceptance of them.”

And then there is the medical jargon and unexplained codes.

“The data that they get in many cases is just streams of lab data or stuff that isn’t in any kind of intelligible form,” Fialkov said. “The notes that are created for the patients and other physicians that are important for the care of the patients in many cases are just lines of codes and just computer jargon. They aren’t clinically useful, and there’s no explanation or narrative. It’s basically taking a note that a physician wrote in English and maybe had some medical jargon, and turned really into just reams and reams of medical terms and numbers and old lab values. Now you’ve made this system even worse.”

Fialkov’s product has increased customer satisfaction sharply by providing information that is “straightforward, not razzle-dazzle.” Patients who have taken a quiz after reading some information typically get at least four of five questions right, then can ask more informed questions. On average, they rank their satisfaction 9.21 out of 10.

“This can save lives,” Fialkov said.

Fialkov’s journey to the world of startups

Fialkov moved to the United States as his father pursued a career in medicine and psychiatry. The family lived all over the country, but mostly in Pittsburgh, where Fialkov attended the University of Pittsburgh and Allegheny College. He met his future wife at the University of Iowa, where she worked as a nurse and he was doing a urology residency.

“I had every intention of going back to Pittsburgh to practice,” he said. But an illness in his wife’s family kept the couple in Iowa.

He landed a job at the Iowa Clinic and liked it enough to work there 14 years before he quit to address what he saw as nagging communication problems among doctors and patients.

“It’s a very important idea. It was a big leap to leave my practice,” Fialkov said. “But the potential to improve outcomes is enormous.”