Dr. Rachael Grimaldi, Founder CardMedic

Dr. Rachael Grimaldi is a senior anaesthetic registrar at Great Ormond Street Hospital NHS Foundation Trust and Co-Founder/CEO at CardMedic, a digital health start-up focused on reducing health inequities that result from poor communication.

Rachel initially designed CardMedic at the start of the pandemic when doctors struggled to communicate through cumbersome personal protective equipment (PPE). CardMedic quickly evolved into a flexible tool that helps healthcare professionals communicate in at least 44 languages, including sign language. As of August 2023, over 20 NHS Trusts use the app.

How did you initially gain support for the business?

The business started at the beginning of the COVID-19 pandemic and wasn’t designed to be a business at all. 

The idea was initially to help clinicians communicate [with each other and patients when they wore personal protective equipment (PPE) that covered their face and mouth].

[After the pandemic] we had a significant number of people getting in touch saying we need this to stay as a solution, because there are big gaps in service provision.

The content itself has really come from a group of passionate, enthusiastic healthcare and allied healthcare professionals from all across the UK and internationally – who are determined to reduce health inequalities, improve patient safety and experience, and quality of care.

We’d love to hear more about how it all started

As I mentioned, it started at the beginning of the pandemic and I was on maternity leave at the time in the States but couldn’t get back to work because the borders had closed. I really wanted to do something to help.

I’d read about some patients who’d been to intensive care with COVID-19 and couldn’t understand staff through PPE and felt terrified. 

I’d spoken to friends and colleagues and thought, how are people communicating? Is it with pen and paper? Are they shouting at patients? Or worse, just doing stuff to them without patients understanding or consenting? 

We thought: ‘There’s this acute global crisis in communication and healthcare, and we know that the background to this is long standing barriers to good communication in healthcare.’

I’ve had children and done fellowships and my training has spanned over 13 years now and so I know just from my experience, that there are challenges faced regularly with trying to communicate with patients for lots of different reasons.

We thought, instead of people writing notes on paper, let’s create this library of scripts that replicate what we commonly try to say to patients. Staff can bring up the script and show it to the patient on the screen and it can guide the conversation. 

Within 24 hours we had joined Twitter, which a good friend had advised me to do and I’m really pleased I did. 

Within three weeks, we had 8000 users in 50 countries and then the Department for Business and Trade, formerly the Department for International Trade, got us a media coverage, which went global. 

Within three weeks, we had 8000 users in 50 countries and then the Department for Business and Trade, formerly the Department for International Trade, got us a media coverage, which went global. 

That’s when we had the feedback about big gaps in service provision and long standing issues. 

We’re not here to replace interpreting services, speech language therapists or learning disability nurses at all.  We’re here to complement and be a tool in their pockets. When you can’t get those services at the patient’s bedside in clinical practice or primary care, we’re there to be that additional tool in the pocket of the member of staff to help communicate with that patient.

We’re not here to replace interpreting services, speech language therapists or learning disability nurses at all.  We’re here to complement and be a tool in their pockets.

How did you gain funding for the business?

At the very, very beginning, actually, my anaesthetic department charity was amazing. They donated some money to give us some initial funds, such as to launch the website. 

As I mentioned, it was never intended to be a business, it was just a tool during COVID-19 that grew. 

From there, we applied for Innovate UK grant funding for their de minimis grant, which was during the pandemic. 

We were really lucky to win a pot of money. Then we got a follow-up grant from Innovate UK. And we then received some angel funding in a pre-seed round. 

We’re now looking to close our seed round at the end of September. And moving on to series A next year is the plan. So yeah, it’s a mixture.

We have a lot of angels, many of whom are clinicians, which is always really exciting to be working with someone that really understands the space, and shares the same passion. We have a US investor who’s a VC based in Houston, for this round.

Do you currently work full time with CardMedic?

I practise clinically as well. I try to squeeze a full-time job into three days a week with CardMedic as well. The hours are long especially because we work with hospitals, and teams in the US as well, so evening meetings are common to cover both time zones.

How do you balance this clinician-entrepreneur lifestyle?

Yeah, it’s challenging. It always helps to meet other clinical entrepreneurs. I’m on the Clinical Entrepreneur Programme and the NHS Innovation Accelerator and through that you meet some very like minded people going through the same experience. 

I have a young family as well so it is a lot to juggle. I definitely don’t have the secret sauce to managing it. Trying to build in some time for exercise really helps and trying to eat healthily. Trying to spend some family time at the weekend and save the weekend for time with the children and my husband. 

I run the business with my husband, and we have a team of six full time equivalent people. It’s a small team, but we look after each other.

It always helps to meet other clinical entrepreneurs.

The balance is hard, and I think something always has to give and generally that’s usually sleep and downtime. 

What are your current revenue streams as a business?

We’re a B2B SaaS [business to business, software as service], so we sell straight to healthcare systems. Across the UK, we’ve been selling to ICS’s [Integrated Care Systems] and then directly to some healthcare systems as well. 

We work with an Air Ambulance, which we’re really excited about. 

We essentially are free for the end user, which is the staff and patients, but paid for by the healthcare system as an annual subscription. That’s the primary revenue stream. 

We have some exciting other things up our sleeves too.

What are the future steps for CardMedic?

There’s loads in the pipeline, we will be integrating into EHRs [electronic health records], looking to integrate AI [Artificial Intelligence] solutions as well. The primary focus is growing a content library, we have over 1000 scripts now and growing, and lots of different specialties, and subspecialties. 

Anyone who’s interested in getting involved in content writing, or being a part of a digital innovation that’s focused on reducing health inequalities, we really love them to get in touch, and get involved from the content perspective as well. 

Anyone who’s interested in getting involved in content writing, or being a part of a digital innovation that’s focused on reducing health inequalities, we really love them to get in touch, and get involved from the content perspective as well. 

So that’s our primary focus in the coming months and of course, building the tech alongside of the background and scaling as part of the Innovation Accelerator across the NHS.

What has your experience of integrating with NHS trusts been?

We’ve got 21 hospitals that we work with, but soon to be 29. We’re just planning out the next batch, all parts of ICS’s or in some individual trusts that we’re working with. 

Of course, anytime you introduce a new innovation, there are always challenges involved. We are very much plug and play, so you just pick us up and run with us as we’re very light touch from an IT perspective. This is very attractive, for many reasons, and most importantly for staff as we’re not interrupting workflows, we’re just offering a helpful tool to actually speed things up and become more efficient. 

But as a part of that rollout, and implementation are clinical champions who are dedicated to supporting our initiative at the workforce level. We’ve got some incredible clinical champions across all the NHS trusts that we work with.

Could you touch on some challenges that you experienced when integrating within the NHS?

The challenges when you sell to healthcare are always the long sales cycles. 

Then there are challenges faced from an implementation and user engagement perspective too. As I mentioned, we’ve got fantastic clinical champions that really help with our user engagement and rollout.

We also do site visits, and we floor walk to listen a lot to feedback and that goes into our road map as well. We also do a lot of patient and public engagement to get feedback from our end users. 

The challenges when you sell to healthcare are always the long sales cycles. 

From a procurement perspective, it is really challenging navigating NHS procurement. The sales cycles are long, and it does sometimes rely on specific people being able to attend certain meetings and so on.

It’s a challenge that everyone faces when selling into healthcare and everyone will be familiar with it. 

Again, I don’t have a perfect solution to overcome that, apart from getting as many people involved in the conversations as possible. Very importantly your frontline users, but also the decision makers and the people who are able to access the budgets and make those decisions to spend the money. 

We are a very inexpensive, cost effective solution but we still need the people at the table that make those decisions. 

I think it’s about engaging the right people along the journey of procurement and as early on as possible.

I think it’s about engaging the right people along the journey of procurement and as early on as possible

You’re working with at least one hospital in the United States (US). What are the differences when integrating a startup within the NHS, compared to the US market?

I’ve been on the Texas Medical Centre Innovation Accelerator, and I’ve done two Mass Challenge Accelerators as well. We’ve also done a pilot with Brigham and Women’s Hospital in Boston. 

I think the challenges are really similar. The challenges faced are the same such as pressures on staff. There’s a lot of staff leaving for many reasons.

I think that the challenges are still the long sale cycles and implementation. It hasn’t been hugely different from all of those perspectives. 

It’s more just the structure of their healthcare system is very different to ours. So it’s about understanding market segmentation and where we fit into that. They have IDNs [Integrated Delivery Networks], which are health systems, similar to our ICS’s, which can cover a range of healthcare settings. I think it’s just about really doing a deep dive to understand what their market looks like and where you slot into.

Do you have any tips for startups trying to gain publicity and integrate themselves within the public eye?

I think getting yourself involved with an experienced team is really important. Obviously, in startup land, there is not tons of money to throw at marketing and PR opportunities. It’s just about being creative and getting involved in things.

It might be that you find an agency that does a very bespoke package of low cost, light touch solutions for you every month that you can build upon. It doesn’t have to be super expensive. 

It’s good to pick the channels that you want to communicate through. For us, it’s LinkedIn and Twitter, which we’re active on. These might be relevant for people or they might think that platforms such as Facebook or Instagram are more relevant for their product.

Then there’s also accelerators which are fantastic programmes to be on such as the Clinical Entrepreneur Programme, the NHS Innovation Accelerator, The Hill, which is run out of Oxford. 

All of these, again, will give you opportunities to present your product in a wider, more public space that more opportunities themselves will come out of.

Did you have any previous experience in entrepreneurship before starting Cardmedic?

No, not at all. I run this with my husband and his background is digital technology, E-commerce, and branding. He’s run a global multi-million-pound E-commerce company before, so he’s got a lot of experience in this space of business. It’s very much his bread and butter.

I’ve kind of absorbed some business knowledge from him, I guess, and vice-versa medicine from me to him. There’s so much I have learned through doing the accelerators, and through attending webinars, and training sessions, and so on. 

What would be three tips you would give to other doctors who have a business idea but don’t know where to go from there?

Fall in love with your problem and not your solution.

Fall in love with your problem and not your solution.

That’s one that Tony Young always says, who’s current the National Clinical Director for Innovation. To complement that is to say ‘ensure that your solution is solving a problem’, as well. So you’ve not just invented something that you think is absolutely fantastic, that isn’t actually solving a real problem because it just won’t succeed. 

Another tip is enjoy what you do because it will take up all of your time. 

It’s a juggle, so ensure that it is something that you want to focus on and you want to do. 

What other technologies within the health tech space inspire you?

I love the really simple solutions and the stories behind them. So for example MediShout, which I think a lot of people would have heard of. A really simple idea, you know, trying to streamline issues that delay procedure. It solves an immediate problem, massively improving efficiency and standard of care. 

Who’s another founder who inspires you and why?

Liz Ashall-Payne, the founder of Orcha, was one of my mentors in the NHS Clinical Entrepreneur Programme. There are so many founders who I think are amazing, but I think Liz stands out. She’s a speech and language therapist by background, she also has a young family. 

Tamsin Holland Brown is another one on the Clinical Entrepreneur Programme who again has a young family and has founded Hearglueear. I find them really inspiring because I can relate to them in that they have that background as being practising clinicians, with businesses and young families. 

I find it really inspiring how people can see a problem that either existed or even that they didn’t know existed, but they put a solution in place for it – and are juggling this with life and raising a family.