RXNT’s CEO and Founder, Randy Boldyga, sat down with Danielle from the Minding My Business Podcast to discuss the history of RXNT and how RXNT is transforming healthcare with its most anticipated product yet—Ambient IQ.
Please note: The following interview has been lightly edited for clarity and brevity.
Over 26 years ago, RXNT’s founder and CEO, Randy Boldyga, transformed prescribing forever. By utilizing digital technology for prescriptions, he made essential care more accurate, secure, and accessible for patients—and it didn’t just end there.
Randy sat down with Danielle Sabrina from the Minding My Business podcast to discuss the history of RXNT and how it’s reshaped healthcare from the beginning days of E-Prescribing to new launches like the AI-powered note scribe, Ambient IQ.
Tune in to the full episode here, or continue reading for a recap of the Q&A segment of the podcast.
Sabrina: Welcome to Minding My Business. I have Randy Boldyga with me, who is the founder and CEO of RXNT. He has grown this incredible healthcare company from scratch. SaaS companies are a beast and you’ve been able to do it without funding and without outside investors. It’s incredible. How long have you been in business now?
Boldyga: We’ve been in business for 26 years.
Sabrina: And how many employees do you have?
Boldyga: Just about 200.
Sabrina: Did you have a healthcare background before?
Boldyga: I had a little bit of healthcare experience. I worked at UAMS Medical Center in Little Rock, Arkansas, for just a short period of time.
Sabrina: How did you end up there? What were you doing?
Boldyga: It’s an interesting story. I was working for the FBI on the Whitewater Investigation. I decided that I wanted to pursue an opportunity at a medical center, so I did. While there, I gained insight into the challenges physicians face in the clinical environment on a day-to-day basis.
Sabrina: That’s a big decision to leave the FBI and go into healthcare.
Boldyga: Yeah, it was a different course of action and pace of life. I liked the Little Rock area and thought it would be something fun and different.
Sabrina: Were you not in Little Rock before? Were you living somewhere else, and then you moved for the job?
Boldyga: Correct. So I lived in the Annapolis, Maryland area and didn’t know where I was going with the FBI, but I was hired as a consultant, and they said, “We can’t tell you where you’re going.” Once I was fully committed and was ready to go, they handed me tickets to Little Rock, Arkansas. Winner, winner, chicken dinner.
Sabrina: What did you learn working in the FBI that helped set you up for success today?
Boldyga: I had worked for several federal agencies, and what I was doing was a lot of setting up and designing the architecture for computer systems. We were doing cloud-based computing before it was called cloud-based computing. The designing and implementation of those systems for those government agencies led me to a strong background, so when I started RXNT, I had a really robust background in the IT infrastructure.
Sabrina: Was it a big decision to leave the FBI? Can you go back to the FBI once you leave?
Boldyga: I think I could go back, but I felt like it was time to move on. I had learned what I needed to learn and was doing what I needed to do there. I felt like I had an entrepreneurial spirit, and a lot of the government agencies don’t lend themselves well to that sort of spirit, so I felt like I needed to do something else.
Sabrina: What were you doing at UAMS Medical Center?
Boldyga: So, at UAMS Medical Center, I oversaw the clinical information systems there. There were about 75 to 100 employees in different clinical environments who reported to me throughout the medical center. I was managing folks who were developing software and supporting infrastructure, new projects, you name it. I learned a lot. I had some insight into the challenges that physicians were having in that environment and firsthand knowledge of what they were doing and why they were struggling, and so, I was solving problems while I was there, but it was off-the-shelf software that was then being customized by our team.
Sabrina: Did you feel like you could solve that when you were there?
Boldyga: I felt like I was certainly making a difference, but there’s nothing like making a difference by owning your own company.
Sabrina: At what point in time did you decide you were going to build your own company and build software for hospitals and doctors?
Boldyga: It all started in May of 1999. I started writing a business plan and went to some friends and family and shared the idea. They invested small amounts of money that totaled about $150,000. Then I went to the local economic development office and told them I raised $150,000, asking if there was some sort of program I could use under the county. They said there’s actually an SBA loan where they’ll match every dollar that you raise up to that $150,000.
So they matched at $150,000 with an SBA loan, which I had to sign my life away for. Then two years later, I did the same thing a second time. Then a year later, we signed a contract with Medco, where they bought 1,000 licenses of our product—and for those who don’t know who Medco is, I think at the time, they were number 43 in the top 50 largest companies in America. So they bought a thousand licenses, and I turned around and took the money that we made and paid those two loans back off, and I was debt-free.
Sabrina: What are your thoughts on raising capital or building with debt? Can you build a company debt-free? Is that even possible?
Boldyga: That’s pretty much what I did. There were two paths. I could either go down the venture capital path or I could do this thing debt-free. I just took the old bricks and mortar debt-free approach.
In the early 2000s, there was the dot-com meltdown. There was no capital to be found. All of my competitors who had raised 20-100 million in capital were going out of business left and right, and all their clients came to my company. We grew very quickly because everybody was just looking for a product that was actually up and running. It was crazy. It was very good timing.
And we were literally running this thing out of the basement of my house. So, fast forward, I had five or six people coming to my house to work in the basement.
Sabrina: Do any of those people still work for you now?
Boldyga: They sure do. I have one gal who has been with the company for 24 years now. And then Thomas, our CTO, has been with the company for 22 years. We have several employees with quite a bit of tenure.
Sabrina: I was reading somewhere that part of the inspiration for creating RXNT was an illegible script. Could you tell me about that?
Boldyga: There was a child in Northern Virginia, and his parents took him to a pediatrician and the pediatrician wrote a script. The parents took the script to the pharmacy. The pharmacy thought they read it accurately, but it was illegible, and so they filled the prescription. The parents gave the child the medication, and he died.
I read that in the paper. It was 1999, and I thought, “How’s this happening?”
I went to my local pediatrician, and I started a conversation with him like, “What do you folks do? How does this work in your office?” He started explaining, “Yeah, we still write everything on a prescription pad.” I started a conversation about what it would look like if we were to build something and asked if he’d be willing to use it, and he said he could definitely see it working.
Sabrina: The first product you created was E-Prescribing, right?
Boldyga: That’s correct. The stepping stone to the adoption of a full electronic medical record was starting with electronic prescribing, because there were a lot of reasons that doctors were going to pick it up. It was just a huge inefficiency in the way they were doing it. We thought that we could just make everything legible and make it super efficient and easy, because all the formularies that doctors have to comply with or the different health plans make it very difficult. There’s also the drug-to-drug interactions and the drug-to-allergy interactions, and getting the script to the right pharmacy so that the patient isn’t having to stand at the pharmacy for 45 minutes waiting for their prescription to be filled.
We built an application that worked on a Palm Pilot. So, that was our first product, and doctors would write scripts for a few patients, and then they would sync their products, and it would send them to the pharmacy by fax at first. And then the network matured. SureScripts was born. SureScripts was our routing network that got us electronically into the pharmacy’s software system.
Sabrina: What were some of the other new products from there that you added?
Boldyga: We just continued to listen to our clients, and I think that that’s a really important thing for any entrepreneur to understand. Just listen to your client and let them tell you the things that you’re doing right and wrong because you’re not going to get it all right. Our clinicians were saying, “this is a great e-prescribing tool. It can do a lot, but I really need to be able to have a full electronic medical record for my patient.”
So we said, “Okay, tell us about that. What does that look like? What are the challenges? What do we need to do?” And so we built an electronic medical records product in 2012.
Sabrina: I am sitting here and wondering how that didn’t dawn on people back then? Like, how is that not an obvious problem to solve? But I think you’re doing it again with this new product that you have coming out, too, which I’m really excited about.
Boldyga: So the new product that we’re about to release is called Ambient IQ, and it’s a native-based product. In a nutshell, we have a mobile application that providers use today for Android and iPhone, but it can also be pulled up on a desktop or PC. They can pull up a patient, select a patient encounter, and then they click a button that says “listen,” and they put that device between them and their patient. Then, they can just have the consultation with the patient. The Ambient IQ product takes all that content and populates their patient encounter so that they’re not having to enter all that information into the system. We’re seeing results already because we introduced this three weeks ago to our existing client base, and we’re showing that there’s a 70% decrease in the time that a doctor has to spend documenting with the patient. There’s also a 95% accuracy rate on the content that’s being picked up during the conversation. It’s pretty amazing.
Sabrina: I’m excited about where AI is headed and especially with your product, capturing what the patient is saying.
Boldyga: Yeah, we also have another AI solution, and that is a clinical summary on a patient. So what clinicians were telling us was: I only have a few minutes between patient visits to review the next patient’s history before walking in the room.
So, they’ll grab that chart, review it, and then walk into the room. You know, how much can you read in a handful of minutes on a patient’s chart when they could have a chronic issue? It’s several pages. So, what we did was create a clinical summary that’s all AI-based, and it gives an overview based on all the content in the patient’s record regarding that particular topic.
If the clinician needs to drill deeper, they obviously can do that, but it helps them get a snapshot so that they’re not going in to talk to the patient and the patient saying, “I’ve told you this multiple times.” They’re reading that [summary] in the chart.
Sabrina: What does being native mean?
Boldgya: So, native means you’re building it within your own platform. It’s not a third-party product. [With a third-party product], you’re basically leveraging their technology within your technology, and there are some advantages to that. We like to think that because we’ve built it and we are managing it, it is going to become a superior product to others on the market.
So it means we can be much more competitive in our pricing, and we can control the data a lot better.
Sabrina: I think a lot of other technology has promised to give doctors back their time, but it hasn’t.
Boldyga: Yeah, we’ve been hearing that for a while. Physician burnout is real. There are lots of physicians who have left medicine because they’re tired of documenting. So I think this is game-changer stuff.
Sabrina: Do you think that another thing that makes it unique is that other EHRs haven’t been building this whole time with AI in mind, but you have?
Boldyga: Yeah, so there are other EHRs that have partnered with some third parties. They’re leveraging the technology of a partner. I think there may be one other vendor who’s created a native-built application, but almost everybody that I’m aware of is partnering with somebody.
So that’s another reason that it’s pretty cool. We like to think that even when we introduce our standalone product, it’s going to be significantly less [cost] than almost everybody on the market, because we built it ourselves.
Sabrina: I feel like something that stands out about your practice management platform for doctors is that it seems you really understand them.
Boldyga: Absolutely. What I learned early on is that every doctor’s office doesn’t run like the next doctor’s office, like the way you walk into a McDonald’s and that McDonald’s is run just like the McDonald’s in the next city over. It makes it very difficult for software vendors like myself to create software for them because what works in doctor office A doesn’t necessarily work in doctor office B because they do things differently than the other doctor might do.
We had to make the software so it was customizable or flexible enough to work in these different sorts of office environments. We’ve listened to our client base. I think that that’s one of the key reasons why we’ve been so successful over 26 years and have grown by 30% every year because we’re just sitting and listening.
Sabrina: So now that you’re growing this company and you have almost 200 employees, I want to talk to you about this concept of cycle thinking or cycling your time and energy into different problems or people or just areas that need your attention. Can you talk to me about that process a little bit?
Boldyga: Annually, we go through a budgeting process. I take that time to do my own sort of year-in-review, and I look at what we did right and wrong. What are the areas that we feel like we need to concentrate on this next year? Obviously, that all goes into budgeting.
For example, I will say to myself, I need to not only put more money into the marketing department, but I need to put time and energy into that department and spend more time with our Chief Marketing Officer.
So, every year I go through this. There are years when it’s the Sales area, and another year where it may be Engineering. A few years ago, it was AI, right? We’ve spent the last couple of years building an AI team so that we could release AI products this year.
Sabrina: What would you say are the three biggest lessons that you have learned in business?
Boldyga: Top of the list is to listen to your clients.
Then, always use the old bricks and mortar business model as much as you can. What I mean by that is don’t spend more money than you’re generating in revenue.
Lastly, I could go back a my story about the IRS to say, “Don’t mess with the IRS.” Back in the second year of owning RXNT, I was doing payroll manually and not paying the payroll taxes, and I learned a lesson. They were sending letters, and then they just seized the money out of our bank accounts. I would say just make sure you’re staying in good graces with all the government agencies, and you’ll be good.
Sabrina: What do you think about the saying “fire fast, hire slow?”
Boldyga: Make sure you have a really solid team around you. Hire people who are smarter than you and are really dedicated. I know it’s not easy when you’re an entrepreneur and you’re looking for your first hires. It’s really hard sometimes to read people and properly interview people, but finding good people is really important. And so to your point, take your time hiring. We do that at RXNT. We’ve been really thoughtful about the people we’ve hired. I like to think we have a really good team now. It’s taken years to get there, but all of our executive team members do a wonderful job in that area. You can tell just by the tenure of the employees.
As I had mentioned, we have two employees who have been there for more than 20 years, but we have quite a few employees who’ve been there more than 10 years. It speaks volumes about the kind of company we have and the culture of the company.
Sabrina: What would you say if someone comes to you on your team and they’re having a problem with someone or having to pull the weight of this person?
Boldyga: What we’ve been training our executives to do is put them through a performance improvement plan. If you feel that this individual is a C player, but they have potential to be an A player, how you get them from a C player to an A player? Sometimes it’s just putting them on a performance improvement plan.
Sabrina: So you believe you can turn C players into A players?
Boldyga: If they’re willing to, 100%.
Sabrina: You’ve grown this incredible company, and you’re impacting healthcare and ultimately our lives. I hope that more practices implement your software, and especially Ambient IQ because I think it’s going to really transform the way that we receive care, the accuracy of our care, and ultimately extend our own lifespans as well.
Boldyga: Thank you for your time, Danielle. I appreciate you speaking with me about this!
We’d like to extend a big “thank you” to Danielle Sabrina and the Minding My Business podcast for hosting Randy. You can listen to the full episode here.
