Welcome to The Health Tech VC. I'm Dr. Fiona Pathiraja, a former NHS physician turned VC investor. I invest millions into health tech across Europe and the US. In this podcast, I'll be spotlighting startups, leaders, and operators who are truly pushing forward the boundaries of healthcare. Dr Rachel Grimaldi is an anaesthetist in the NHS who founded CardMedic at the beginning of the pandemic.
Rachel noticed that the PPE, personal protective equipment used to shield all healthcare workers during COVID, brought massive communication barriers with it. With doctors and nurses gowned up, masked, and covered head to toe, patients struggle to see, hear, and understand them. Cardmedic is a digital tool developed to close the gap in communication in healthcare.
Its success during the pandemic ensured its post-pandemic success in a variety of healthcare settings including hospitals, ambulances and more. Hospitals are unique places which bring anxiety and stress to patients and their relatives, where good communication is imperative.
Communication in healthcare is much more than just translation services for patients who don't speak the primary language of the health system. It also encompasses patients with cognitive impairment, sight loss, hearing loss, autism, and other barriers to communication. We also touch on communication in the context of health literacy, its impact on healthcare outcomes and the social mission of CardMedic who are developing technology for good.
Award-winning Card Medic success has been covered internationally, including on the BBC and in The Guardian. They've also done three accelerators in the US and the UK, The Hill, Mass Challenge, and the Texas Medical Center's Accelerator. Rachel gives her perspectives of these accelerators coming from the background of a non-business founder.
We touched on whether clinical founders can work effectively in a startup while still maintaining some clinical work and how Rachel effectively manages a portfolio career in the NHS. I really hope you enjoy this conversation.
Rachel, welcome to the HealthTech VC podcast. I'm really grateful that you're here today. Thank you so much for having me. I've really been looking forward to chatting. To start off with, I'd like to hear a bit about how you've ended up in HealthTech and starting your own business. My background is in clinical medicine. I'm an anesthetist, currently in my last year of training and working at Great Ormond Street Hospital.
and ended up co-founding a digital health startup at the start of the pandemic, which is a communication app that helps healthcare staff and patients communicate across different barriers like language, deafness, blindness. cognitive problems and literacy issues. But it was very much almost an accidental journey into entrepreneurship. It was a solution that was answering an acute crisis in communication and healthcare that...
had immediate traction and a huge amount of interest from staff and patients and members of the public and carers from all across the UK and internationally within a very short space of time, within literally three weeks. Then there was a sudden... demand for it to remain after the pandemic and I found myself in the scenario of being a practicing clinician albeit on maternity leave at the time that had come up with this really unique idea that was
not just solving a problem in the pandemic, but actually solving a really long-term problem of communication barriers in healthcare and the challenges around not being able to support patients 24-7 with translators and signers and speakers. language therapists learning disability nurses and there's this huge gap in service provision that's very much where the idea came from and then I within that very short space of time found myself in a scenario of
And realizing that I needed to very quickly acquire some skill sets around how are we going to turn this into something sustainable whilst maintaining a social impact at the heart of it. So that's very much where it all started. And then very quickly. became a huge amount of networking, whether that was on LinkedIn and Twitter, and then attending accelerator programs, both in the UK initially, and then in the US, and growing the team around us from there. It was a 72.
two hour from concept to launch of the product journey into entrepreneurship and then a very quick learning from there. For people who are not familiar with Cardmedic, what does it actually do? What was the specific challenges of the pandemic that led you to think about this? Cardmedic is an app and a website that has a library of pre-written scripts.
that replicate common clinical conversations that staff can bring up on a device, whether that's a mobile phone, a tablet or a desktop, and they can then change those scripts into different languages, sign language videos. Easy read with pictures or read aloud so patients can listen to it and they can show it to them on that device to guide the interaction. At the beginning of the pandemic, whilst I was abroad visiting family and the borders shut, I couldn't get back to work.
As an anaesthetist with critical care skills, I really wanted to do something to help in the pandemic. I'd read about a patient who'd been to intensive care with COVID and couldn't understand staff through PPE. So I thought, how's he coping? looked like he was probably in his 30s no underlying communication problems but was
clearly finding it challenging and terrifying. So I thought, well, if he's struggling, what's everybody else doing that does have a communication barrier and how are staff coping? So I spoke to friends who were working on the front line and they said, it is really difficult. We're either shouting at people or just doing stuff to them without being able to really explain it or occasionally writing notes on paper. So we thought none of those solutions are scalable for a pandemic. How about...
Instead of people writing notes on paper, we just make those digital because we do find ourselves. saying the same things to patients frequently, whether it's taking a history, whether it's examining them, explaining an investigation, for example, or a procedure. So we felt Because there is that relative standardization, if we just create this A to Z library of pre-written scripts, it will allow for those conversations to take place between staff and patients when it's...
difficult to get a translator present or a sign language interpreter or speech and language or learning disability support. That was the initial idea for it. What we're not there to do is replace any of those services. We're just there to bridge massive gaps. service provision when they can't be there we launched within 72 hours my husband's background's not medicine he's e-commerce branding and technology and he built the website he saw how we could create something that was intuitive
scalable, simple to use. Within 24 hours, we're encouraged to join Twitter. I wasn't quite sure what a tweet was, but we got involved and within three weeks, we'd had 8,000. people using the website from 50 countries the enthusiasm from healthcare staff all across twitter was immense actually the feedback that we kept getting was
Why hasn't anyone thought about this before? Because this is a really long standing problem in health care, not being able to communicate with patients when you can't get a translator, for example.
In medicine, you're so used to doing things to people, whether it's an intervention, procedure, you sometimes forget that actually it's really scary for the patients. Their first time, perhaps in hospital, in a room like this. And it's very nerve wracking. So being dressed head to toe in PPE where the patient can't even read.
see your face it's pretty challenging yeah absolutely like you said for us it's bread and butter the ppe aspect wasn't but being in hospital being on in a clinical environment is very much our comfort zone it's normal for us but for patients at the best of times they come in they're having something done to them it might be invasive it might be painful or it might be a clinic appointment for example but there's definite baseline level of anxiety for patients
they go into that fight or flight mode where it's hard to take information on board, even when you don't have PPE in the mix. But suddenly you have almost faceless staff who... are essentially doing things to you without really explaining it. You have no idea what's coming next. You haven't got that rapport you're relying on.
essentially people's facial expressions that you can just tell through their eyes or their sort of body language that non-verbal communication to try and reassure you when you're really at your most vulnerable and especially in covid where people are needing to go from potentially awake to being asleep on a ventilator in a very short space of time. which we have to do not infrequently outside of pandemic times when people come into A&E, for example, very sick, but we at least...
have been able to build a little bit of rapport using facial expressions and they can hear us, understand what we're saying. But as soon as PPE was thrown into the mix, people have no idea what's happening. And especially if they've been attached to breathing support machines like. CPAP people might have heard of it's really noisy too it's trying to blow oxygen into their face with a mask on and it's
Really difficult, even without PPE, for a patient to hear what you're trying to say when they have that equipment attached. So these poor patients are absolutely terrified. For many of them in the pandemic, that might have been the last time they were awake, which is awful and really scary experience for them. So anything that we could do in that scenario to try and alleviate that fear for patients and support health care staff.
to do their job as best as they could because of course it's really distressing for staff as well not being able to talk to patients and reassure them as they normally would. Communication, I'm thinking of people who maybe don't speak the same language, people who are deaf, people who are blind, but actually it's a much broader spectrum than that. Absolutely. Communication barriers impact nearly 50% of the population. Language barriers is...
definitely a big one that's one of the biggest use cases we've had a huge amount of feedback from patients who are deaf as well as health care staff who are deaf but it goes beyond that visual impairment but then cognitive impairment patients who have learning disabilities or stroke
dementia, autism, and so on, or aphasia where they can't talk, including patients with literacy issues as well. So the average reading age in the UK is between about nine and 11. When you look at the type of information that the population can absorb of that reading age you're just thinking about banking information or going to the supermarket or paying your bills and that's
challenging enough for many people, but then you throw in healthcare information on top of that. Health literacy levels are really low. The fallout for these groups of people, which is a huge number of patients in our population, is massive. inequalities they suffer from are absolutely huge and morbidity is higher, mortality, mental health issues, they're less compliant with medication.
They're more likely to be readmitted to hospital quickly. They have longer lengths of stay. Imagine if someone's in hospital a few days, weeks or potentially even months and they have a communication barrier. They're, of course, going to be requiring.
24-7 care or input or whether it's a ward round or nursing care or physio or nutrition dietitians etc if they haven't got 24-7 communication support from a translator for example but they really struggle so what ends up happening in reality is staff just trying to do what they can and doing their best will end up relying on other friends and family to try and communicate with patients or
pull in other staff members who might be on shift that happen to speak that person's language or otherwise just turn to machine translation. And that's what with CardMedic we are trying to prevent is that aspect of patient care because it massively compromises their safety as well.
Their quality of care, their experience goes way above and beyond just a language barrier or someone who might be deaf or blind. And in terms of the types of organisations who are now using the Cardmedic solution, can you tell us a little bit about them? Across the UK, we have a number of NHS trusts who are using it and also ICSs. So these new integrated care systems, which have been formed as of April this year officially. And we are.
We're currently launching with implementing as well, rolling out at the moment with Mid and South Essex, which is going really well. And also with Norfolk and Waveney ICS. And we're just in the final stages of procurement. We've had a huge amount of interest from maternity as well. Lewisham and Greenwich.
going to be working with their maternity teams and then we have our beacon site university hospital sussex that we have a five-year contract with so it's a range primarily secondary care settings at the moment but because of our ics We are building out the primary care content as well. We're also working with Kent, Surrey and Sussex Air Ambulance and we have content relevant for ambulance services. So it really can be used in any health care setting where.
healthcare or allied healthcare professional is trying to communicate with a patient and doesn't have formal communication support with them so it's been a real combination and then in the US we had a huge amount of interest in thousands of people using the website from the US when we first launched so we thought that will be a next sensible place to go but it's actually just naturally and organically happened earlier than we'd anticipated.
through a combination of the accelerator programs we've been on, working with Scale Health, which is a team based in LA, which act as innovation partners for hospitals, and then also with our work with the Department of International Trade. So we have our beacon site for...
hospitals in the US, which is based in New Mexico, called Norley Hospital District. They're a 25-bed hospital, but most of their population, or a significant number of their population, don't speak English as a first language. And they don't have the resources and the funding to have 24-7 translators, especially being a rural hospital. We're also currently piloting with Brigham and Women's Hospital in Boston. We have a pilot.
plan with Penn State Health. And we've just been accepted onto the Texas Medical Center Accelerator, which is a brilliant opportunity. It's a six-month program based in Houston.
Texas Medical Center being the largest medical center in the world. We're working with Texas Children's Hospital to build out our Easy Read content. They have a particular use case that they're really interested in for their group of patients, particularly with autism, actually. You've also done the Hill and the Mass Challenge.
two different accelerators, a part of the NHS Clinical Entrepreneurship Programme. There's a lot of stuff that you're doing here in terms of acceleration. Why did you decide to do these accelerators? What's your experience of them? And what are the skills that you've gained here? I understand that you're a non... business background founders what is the purpose of doing all of this stuff yeah that's a great question so for me as I mentioned in the beginning when I started this it very much came
Out of nowhere is an idea and wasn't set up initially to be a business. So I found myself in a scenario of. not having a business background at all tim has been in business for many years very much has that skill set but i thought if i'm going to be in the scenario i need to be equipped And what is going to be the most efficient, effective and focused way of doing that?
quickly the hill was recommended to me at three weeks in we had some media coverage which was on the bbc and the guardian it went all around the world and had lots and lots of feedback and one of them was a social worker who said i've got some thoughts and that was fantastic and interesting
me to her son who was a medical student at Oxford who I chatted with and he said there's this program called The Hill. I'd only been doing car medics about a month by that point but was absolutely thrilled when a week later I was
offered an interview and then subsequently a place on it. It was completely invaluable because it was specifically designed to help innovative ideas get to the front line of the NHS, but also taking... it could be clinical or non-clinical founders, through the understanding of the structure of the NHS, procurement, which is obviously very complex and changes everywhere you go, and then thinking more about business skills.
thinking about how to create a business plan or a financial model or an executive summary, and also went on to do their open API. intraoperability boot camp which brought in cerner into the mix and that was a six-week program so through those two programs at the hill the mentorship was fantastic the team there were really supportive and it was a very rounded experience as well we
had kind of groups with other founders that we were put in to support each other through just the founder journey, sharing ideas. It was very holistic. Off the back of that, we applied for Mass Challenge, which was... a US accelerator, which is essentially designed to solve the biggest challenges facing humanity all across the world.
Whilst they take companies internationally, it was primarily focused on US companies that were the main kind of crux of the cohort. But there were a couple of hundred of us on that programme. It was equipping us with... the business skills and knowledge but also focused with more of a US nuance to it. We also won a prize, which was amazing. We then applied for the Health Tech Accelerator. That was very focused. And that's been the last six months with Maths Challenge.
Off of that, we work with the City of Boston and also with Brigham and Women's Hospital, where we're now piloting, and they'd selected us to work with them. It's become more focused now, less on the... kind of equipping us with the business skills but more what's the outcome of this are you working towards a pilot or are you working towards improving your product rather than then yes having the kind of regular mentorship around
growing a business etc it's more focused on getting the product into the hands of clinical people and trialing it we've had quite a few of our founders going through both the angel stage and within our fund going through the texas one so i think it's some accelerators Oh, I think really useful. If you had any tips for people thinking about doing one, what would you say?
I think they're phenomenal opportunities. So I would say definitely research it and see, does it suit what you're looking for? One of the great things about the Texas one is it's a real combination of the two, actually. Part of it is working directly with healthcare settings from the get-go, but the other part of it's also focused on...
ensuring what do you need out of it. For example, for us, one of the big things or a couple of big things we're really getting out of it is honing our value proposition for the US market, making sure that we've got that go-to-market strategy more watertight. specifically for that US market. The NHS Clinical Entrepreneur Programme is also a phenomenal programme. Again, it depends what stage you're at. If you're at an earlier stage and you're thinking,
Like I was in the beginning, I don't know where to start. I don't have the skill set. I need mentorship. I need advice. I need... tutorial programs ranging from accountants to lawyers to IP to financial business model whatever it might be it's looking at what does that program offer you
What do you want and need to get out of it? What can you offer it? Because a lot of it as well is about that community of founders and being able to support each other and collaborate as well. Some of them ask for equity as well. It's just thinking about how does that...
fit in where you are currently and what your future plans are? Is it something you're comfortable with? It's a variety of decisions to weigh up and think about but I wouldn't just do them for the sake of doing them. Every one we've done has added a lot of value. and knowledge and network to what we're doing. One that's very much on my radar for next year is the NHS National Innovation Accelerator, who we've spoken to in the past. I think we'd be a really good fit now we're in a position of...
potentially scaling up across the NHS. So it's about finding what's the right programme at the right time for you. I'm always mentioning to people who pitch me, who are medical founders, that actually it's difficult for me to justify an investment from our fund.
They are only part-time in a startup. Now you're part-time in a startup. I want to hear the other side of this. How do you mitigate this? Who else is on the Cardmedic team that can help and support you? And how can you be a founder if you're actually also still doing clinical work? From the clinical side, I keep it very structured. So although on paper it's part time and that I'm two days a week clinical and three days a week card medic, actually what happens is my two days a week clinical.
I'm commuting for four hours a day those days. So I'm doing carb medic work in that time. And my three days a week that I'm not clinical, I'm still working long days those days as well. So it essentially is.
pretty much full-time car medic and two days a week clinical which is not an easy juggle admittedly but being clinical I think is really important important depending on what your startup is how necessary it is but i think for doing card medic it's really important because it's provided a huge amount of the network festivals really important so In the beginning and still now we have everyone come to us. We haven't cold called anybody. And a lot of that's come through.
networking initially and then word of mouth from there. When I speak to hospitals and I'm visiting hospitals on site or meeting clinicians online, and if I'm able to say, I'm currently practicing. I worked yesterday to give an example of using CardMedic on a shift, for example, or a challenge that I might have faced with a patient who had a communication barrier and their translator didn't show up. Having those real time.
current lived experiences brings with it a lot of gravitas and weight when you're speaking to fellow clinicians because it means that You're one of them. You're speaking their language. You understand their pain points. You're not coming in salesy, if you like. If I'd have left medicine potentially a few years ago and I'm not current and can't.
fully understand the pain points that people are experiencing so there's a huge amount of relevance that comes with current clinical practice from that perspective but also maintaining clinical knowledge being up to date with actual shop floor practice is very relevant for the content of CardMedic and allows me to maintain that thought leadership position as well and really focus on the clinical side. So the juggle, the yes, is not.
straightforward but anyone who's running a startup business will know that it's not a nine-to-five it's a 24-7 endeavor growing the team in a very focused way bringing on the right people at the right time Everyone has their different skill sets that are all complementary and we all support each other. So Tim is the COO of the business. Jim is now our full-time CCO. We've got Mirella, who's head of projects.
We all have and Dave, our CTO, we all have different skill sets that come together to complement each other to the running of the business. As we scale, of course, we do need to grow the team.
at the right time. So talking about it from, I guess, from the medical point of view, many medics would love to be doing what you're doing and running a portfolio career. In fact, it's something that I thought about when I became a consultant radiologist. Could I move into something where I'm doing a bit of both?
And actually, I tried that for a while and it just didn't work for me. I can't manage to do two things at once. I don't know what that says about me, but you are doing it. How did you negotiate this with your workplace? How do your colleagues view you? nuances around running a portfolio career. I hadn't even thought about it or planned it or it just fell into it. My workplaces have been phenomenally supportive. When I first started this and was based at my previous hospital.
My department for anesthetics, at the very beginning, when I started CardMedic, had a charity fund and they gave us some money to help cover our startup costs. He was really supportive. My subsequent hospital, when they knew I had... For example, if I needed to swap a shift to attend a certain meeting or whatever it might be, they were really flexible with accommodating that. And where I currently am at Great Ormond Street.
They're absolutely brilliant. For example, needing to swap shifts or going out to Texas, for example. I could not speak more highly of how supportive they've been around us doing this. They're so excited about Cardminic. They asked me to present to the department.
the response from colleagues has been overwhelmingly really positive people keep saying like you said i wish i could do something like this i don't know how you juggle it it's so interesting people's horizons have expanded now like when i started medicine i didn't even know what a portfolio career was it wasn't something i'd ever really
I just thought I'll always be an anesthetist and that will be that and continue to obviously work hard and do my projects and audits, teaching, training, all the stuff that you do. Now I'm doing this. It's opened my eyes to an entirely new world of what's out there. And I think for people who.
are potentially interested in it one of the things just to think about is how if it's something you're interested in doing how in what structure in what format is it something where you think right like someone I know who works for Pfizer
Is a consultant anaesthetist one day a week and the rest of the time works for Pfizer? It might be that's what you want to do. You don't want to have a startup. You want to work in industry, but you still want to keep a foot in the clinical door. Or is it something that you want to do four days?
a week clinical and one day a week so we have a consultant anaesthetist who's a good friend of mine who's planning on joining us a day a week from to be a senior review of our content get involved in the texas medical center accelerator so his portfolio career is four days a week clinical, one day a week doing something external that he's really passionate about and interested in, but isn't.
his a full-time career it's about understanding what do you want out of it do you want to be involved with a startup but not running it and you just want to dip in a day a week or do you want it to be the opposite from a perspective of thinking early on about it There are now programmes at university that you can do whilst you're not just medical school.
taught on a program earlier this week called Learn to Innovate from Cardiff University and it's a whole range of healthcare and non-healthcare students and it's all about innovating in whatever your industry is and they've set a project and they're pitching it was a session all about pitching um and i think there is that support now i know We've had an intern from Liverpool join us for the summer where they've worked with Santander Bank to fund an eight-week programme of a medical student.
joining you're having a placement in industry for example so there are those opportunities for people at very much early stage now when they're at university to start thinking about these things whereas I, first of all, didn't know about that. Second of all, I don't think that was an opportunity 20 years ago when I was at uni. I think it's just about doing a bit of research.
If you're thinking I'm a medical student and really interested in this, you can still apply for the NHS Clinical Entrepreneur Programme. We have medical students on that. So it's about starting early or it doesn't really matter when you start.
There's no wrong time to start. I don't think there's any wrong time to start. I think the world has changed, certainly when I finished medical school in 2006. So I think just go out there and start doing things. I wanted to end by asking you about your vision for CardMedic because it is... Thank you so much. It really means a huge amount to hear you say that.
over the moon that you're one of our angel investors and just thrilled to have you as part of our team on CardMedic everyone who's got involved from an investment perspective share our vision for CardMedic which is to ensure that this is tech for good and makes a positive social impact globally. But of course does take the investment because it costs a lot to do these things. It's a balance for us between growing.
a profitable and successful company to ensure that our investors be well out of that because you've taken a leap of faith with us and you're working with us but as as well to ensure that Part of our vision is to make sure with a carb medic foundation that we are also able to subsidize carb medics use for humanitarian crises, which we've already had a team that have gone out to Ukraine, a pediatric critical care retrieval team who have. used it and found it.
phenomenally helpful. We've worked with refugees already to do some translation work. We want to be able to fund training programs for community health workers for refugee camps, provide grants for female entrepreneurs and healthcare entrepreneurs in developing.
countries, as well as subsidise its use in developing countries. So that's very much at the heart of what we're doing is that global reach to reduce health inequalities all across the world that arise because of communication barriers in healthcare. Our vision for the next... few years is to continue expanding across the NHS.
and in the US, which really excitingly has already started. And then we have a roadmap of other countries to go to. In many ways, it's almost endless where CardMedic can go, not just within healthcare, but within different industries as well. But healthcare is our focus for the... next few years it's just about scaling up but maintaining that vision at the heart of it and ensuring that our team which is really a family we have a really warm
friendly inclusive culture of it feels a family culture of car medic and we want our investors to feel part of that as well making sure that anyone who's a part of that just shares that big vision with us And we do. Oh, thank you. On that note, I want to say thank you very much, Rachel, for joining the HealthTech VC today. I really appreciate your time. Oh, thank you so much for having me. I really love chatting about it.
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