On Creating A Health Care Website Used In 190 Countries

Published: January 10th, 2020
Gerald Diaz MD
Founder, GrepMed
from Sacramento, California, USA
started May 2018
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Hi! My name is Gerald Diaz. I’m a physician and co-founder of GrepMed.com. GrepMed is an image-based medical reference platform that leverages images as an alternative to traditional text-based medical resources.


We’re trying to make it easier for doctors and other clinicians to find the information they need to make better decisions at the bedside. Traditional medical reference platforms are heavily text-based which is overwhelming during the middle of a busy shift. We are leveraging images to shortcut the information retrieval process through algorithms, checklists, decision aids, guidelines, pharmacology reference tables and much more.

We are a crowd-sourced platform that gives medical educators an evergreen platform to share high yield medical infographics with clinicians across the globe. We are being used in over 190 different countries, and recently crossed over 300 thousand image impressions per day.

GrepMed has the largest searchable online collection of Point of Care Ultrasound (POCUS) and physical exam video clips, making it easier for clinicians to teach the lost art of bedside diagnosis.

What's your backstory and how did you get into entrepreneurship?

Before medicine, I was a software engineer for four years. I think I always had an entrepreneurial bug deep inside but perhaps needed a little more courage to pursue my ideas more seriously. In college, long before Gmail and yahoo mail was mainstream, my roommate and I created a web interface that allowed college students to access their POP email accounts before it was shut down for security concerns. We still like to reminisce about how we invented visual voicemail as part of our senior class project years before Apple did.

Be prepared for the extreme emotional highs and lows that come with being an entrepreneur, that only others who have put themselves out there in a similar fashion will understand.

Health issues within my family eventually inspired me to switch careers and apply to medical school. During medical school, I had a failed attempt at a startup where we tried to automate the process of taking a patient’s medical history. Ultimately things got too busy with board exams and clinical rotations and I had to shelf the project.

After finishing up 9 years of medical training I decided I wanted to leverage my background in technology and do something creative again. Although I love reading about venture-backed startups, as a newly minted attending physician heavily burdened with loans, I knew it was most prudent to go the Indiehacker route. This meant bootstrapping a company on the side and avoiding choosing an idea that avoids patient data and long sales cycles that often bankrupt medical startups.

I loved working with medical students and residents, but I didn’t like the publish or perish nature of academic medicine, particularly when most research is of such small impact and readership. When I saw the need for GrepMed, I knew it was a unique opportunity to blend my background in technology with my passion for medical education to have an impact on clinicians and patients at scale.

Take us through your entrepreneurial journey. How did you go from day 1 to today?

The idea for GrepMed started as a personal itch that I had as a clinician. Traditional medical reference sources are heavily text-based and can be overwhelming as a busy clinician. You simply don’t have the time to look things up when you have to see 20-30 patients a day. I found myself constantly turning to google image search to find visual algorithms and diagrams to shortcut the information process of parsing through walls of text.

Unfortunately google image search results are too often filled with content hidden behind paywalls, patient-oriented information, or simply irrelevant content. Images I saved onto my phone were quickly buried beneath mountains of food and vacation pictures. The medical photo albums on my phone quickly became unwieldy to manage. I found that many of my colleagues had the same problem. Why were we still carrying around pocket reference cards and taping protocols to our office walls?

I met my eventual cofounder Keyan Kousha at a local meetup event for entrepreneurs. Although I initially set out to develop GrepMed on my own, I learned from my previous startup failure that I would find much more success in partnering with someone who could complement my skills as a clinician. Keyan is a brilliant software developer who had thought about medical school and was interested in projects with a positive social impact. We got along very well and batted around many potential projects to work on together before settling upon GrepMed.

As Keyan developed our MVP, I began the process of manually curating hundreds of high yield infographics into a google spreadsheet in order to seed our image database with some initial content. After releasing our MVP came the arduous task of marketing our platform to gain traction. As a brand new website, we had zero domain authority with Google. We also did not want to buy traffic so decided to try our hand at leveraging established social media channels to bootstrap our own platform and brand.

We discovered a vibrant community of physicians promoting Free Open Access Medical Education (#FOAMed) and began sharing some of our best infographics, first on twitter and later on Instagram. Both platforms have their own relative strengths and weaknesses for us. Twitter is the platform of choice for academic physicians on social media, and also makes it easier to drive traffic externally. Even after unlocking up swipe on Instagram, it’s relatively difficult to drive traffic off of the platform. But growth on Instagram has been far more explosive, with over 15 thousand followers in less than a year. There are far younger physicians on Instagram, and we’re also exposing our brand to a wider audience of potential users in pharmacists, nurses, physician assistants, nurse practitioners, EMTs and more.

Now that we’ve built up large followings on social media, we’ve been using these platforms to highlight the work of contributors to our platform and incentivize those who are looking to build their own social media followings. In the meantime, we have slowly been developing trust and domain authority with Google. We’re the number 1 search result for many medical queries on google, and organic search traffic is now by far our biggest source of traffic.

How are you doing today and what does the future look like?

Things have been growing steadily recently, with about 10% monthly growth in traffic, but we are still far from where we want to be. Although we’ve just crossed over 300,000 image impressions per day, most of our traffic comes directly from google image search. While this is largely beneficial to us, it also means we are dependent upon google’s search engine for traffic and subject to the whims of any algorithm updates- a painful lesson we experienced after suddenly losing a quarter of our traffic in May.

It also means we haven’t yet reached product-market fit with enough returning users. Although we now have well over 6000 images uploaded by our community, given the breadth and depth of medicine we probably still need to 5x our database in order to be a more reliable resource for medical reference information. In order to drive more stickiness with some of our users, we’ve decided to double-down on a few subject matter areas where we can provide a 10x better experience for clinician users. We’ve latched onto the growing Point of Care Ultrasound movement that is poised to replace the role of the stethoscope in modern medicine. GrepMed now has the largest searchable online collection of POCUS and echocardiogram clips that can be used by clinicians to improve their bedside ultrasound skills. We have worked to curate a similarly comprehensive library of physical examination clips. This is the only library of its kind for medical educators to use in teaching medical students and other learners both rare and common physical exam signs.

As we grow in traffic we’re hoping to attract more and more medical educators to contribute to our platform. If you’re a medical educator, unless you have a large social media following or a very popular blog, it’s otherwise difficult to share your content online with other clinicians and learners. You can share a table at a conference and get a few dozen views, post onto twitter and maybe get a few thousand impressions. But we have hundreds of images that have over 100k impressions on our site because our content remains evergreen and exposed to the greater audience on google.

We’ve decided to hold off on any attempts to monetize the platform for the time being. A perk of YC’s startup school were AWS credits that have gone a long way in subsidizing our bandwidth costs. With our current traffic levels, in theory, we could flip a switch to turn on significant ad revenue, however, our current main focus is on growth and finding better product-market fit. We know that the target audience is valuable- Medscape reported $400 million in ad-supported annual revenue. But for now, we’re focused on creating an indispensable tool for clinicians.

Through starting the business, have you learned anything particularly helpful or advantageous?

Like many entrepreneurs, I think we realized that it’s never as simple as building a better mousetrap. It takes a long time to build SEO and domain authority with search engines and even longer to brand awareness. There are so many apps competing for attention, and most users don’t know they have the problem you’re trying to address. Doctors especially are very busy people who are reluctant to change their established workflows unless you have a very compelling solution.

One often-repeated bit of advice I learned is to constantly be talking to users, and not to be afraid to ask them for advice. Reaching out to influential members of the medical community has led not only to valuable product feedback but valuable features in blog posts, podcasts, and social media shares.

What platform/tools do you use for your business?

We use multiple trello boards to organize our product road map, bugs, feature requests, marketing, content planning, social media and much more.

We use Slack and UberConference for internal communications and meetings.

We use Buffer to schedule social media posts, and twitter and instagram extensively for social media marketing and interacting with our target audience of clinicians.

What have been the most influential books, podcasts, or other resources?

YCombinator’s Online Startup School was an awesome free online program and resource. The lectures were terrific of course, but the most valuable experience was the weekly video conferencing sessions that were scheduled with other founders. Its great practice in pitching your startup, but also just nice to commiserate and brainstorm with other founders.

My favorite podcasts are IndieHackers, How I Built This, and Startups for the Rest of Us. As every business is so different, more than anything they serve as inspiration and motivation along this difficult path as an entrepreneur.

For books, I really liked the War of Art by Steven Pressfield as a reminder to keep moving forward every day. I recently also enjoyed Traction by Gabriel Weinberg.

Advice for other entrepreneurs who want to get started or are just starting out?

Just get started! There is so much wantrepreneur porn out there it is so easy to get distracted by all of the blogs, podcasts, and videos- even if you are just learning to code you really have to just throw yourself in and learn through experience.

If this is a side hustle then have a goal to make a little bit of progress every day. Be prepared for the extreme emotional highs and lows that come with being an entrepreneur, that only others who have put themselves out there in a similar fashion will understand.

Probably the best way to stay motivated is to find an idea or business that scratches your own itch. For me, it’s motivating to build a tool that I use at work every day to help make decisions for patients. By making it easier for doctors to find the information they need, I also feel like I’m doing a small part towards fighting the epidemic levels of physician depression and burnout.

Where can we go to learn more?

If you’re a medical educator, please reach out. We’d love to hear your feedback and would appreciate it if you shared our tool with your learners.