Video remote interpreting: Bridging the communication barrier

With pressure on hospitals to deliver better outcomes and higher patient satisfaction at a lower cost, there is ongoing debate on how to improve the lines of communication between physicians and patients.

Communication can be a challenge when both patient and provider speak the same language, but it's even tougher when they don’t.

"Communication is fundamental to every patient-provider encounter," says James Edwards, CEO of Language Access Network. "Limited English Proficient and deaf and hard of hearing patients simply don't have a level playing field due to language and cultural barriers."

Caring for the increasing diversity of the U.S. population, as well as the rising number of foreign patients seeking care here, is becoming an ever expanding challenge for healthcare providers across the country.

According to 2014 U.S. Census Bureau data, 21.1 percent of people ages 5 and older speak a language other than English at home. And nearly 9 percent of the U.S. population is at risk for an adverse event because of language barriers, according to the Agency for Healthcare Research and Quality.

Therefore, hospitals must work even harder today to be prepared for every patient who walks through the door, says Mark Savage, director of health IT policy and programs at the National Partnership for Women & Families, a nonprofit, nonpartisan advocacy group.

Removing the communication barrier

One way hospitals are working to prepare for patients and improve lines of communication between physician and patient is through video remote interpreting, an on-demand interpreting service that uses web cameras, videophones and other such devices to provide American Sign Language or spoken language interpreting services.  

For instance, Children's Hospital of Orange County in Orange, Calif., recently introduced video remote interpreting for healthcare — to its patients and providers.

"We are always striving to bring innovative solutions to our patients," Melanie Patterson, vice president of patient care services and CNO, said in a statement. "We serve a very diverse population, and video medical interpretation has allowed us to increase access to high quality interpreters in a more timely and cost effective fashion."

The medical center's video remote interpreting system works in real time, with sound and video, and the patients are able to connect with any of CHOC Children's partner's five U.S.- based language centers where interpreters are available every day, 24 hours a day.

Similarly, Royal Oak, Mich.-based Beaumont Health System, which receives about 65 patients each day whose language is not English, unveiled video remote interpreting four years ago to address the new wave of immigrants who are constantly arriving in the area, according to Mr. Edwards.

"Since we began using a video remote interpreting system, we've significantly reduced wait times for patients needing interpreter services," Patricia Avery, nursing administration information systems coordinator at Beaumont Health System, said in a statement. "This helps reduce anxiety for the patient while allowing caregivers to more quickly assess the patient's medical needs and get care underway."

The vendors

An array of vendors are providing these services to the healthcare industry, including Cyracom, LAN, InDemand Interpreting and Stratus Video. 

Some of these vendors started off providing translation services over the phone, such as Cyracom, which is now offering video remote interpretation services as an add-on to their over-the-phone interpretation business. LAN started off purely doing video over their Martti (My Accessible Real-Time Trusted Interpreter) platform.

"We didn't start off looking to augment a business already in existence but instead focused on how to give as many health systems and providers as possible access to certified medical interpreters with a superior level of cultural competence," Mr. Edwards says.

Vendors offer these video remote interpreting services for many reasons. One of those reasons is video remote interpreting saves time, according to Mr. Edwards. LAN has found on its network that an audio interpretation is 50 percent longer in terms of number of minutes used than a video interpretation. "There's simply a lot of clarification on the phone that doesn't need to happen in video," Mr. Edwards says.

He pointed out that an audio interpreter, for instance, can't see somebody clutch their chest when they come to the hospital, discern facial expressions or see what part of the body a provider is pointing to on a clinical model.

The risks

However, there are risks involved in using interpreter services.

LAN Founder Andy Panos says some interpretation companies, in order to reduce costs and drive down per minute pricing, utilize "off-shore" interpreter resources outside of the United States. This involves patient health information going off-shore, which can lead to HIPAA violations and identity theft. In addition, there is a lack of cultural competency of the interpreter who may have little or no understanding of the U.S. healthcare system, Mr. Panos said.

Another risk to be aware of is the use of home based video interpreters, which certain companies use to reduce costs.

Mr. Panos says the audio industry has used this methodology successfully for years, but video brings additional complexities, which make this challenging. These include a lack of quality control of the home environment where a family member or friend may be off-camera, but in the room, the independent contractor status of the home interpreter (restricts the level of training allowed), and the interpreter having little access to proper support.

"Delivering high quality video medical interpretation takes a sophisticated and professional approach," Mr. Panos says, "A good language access plan at a hospital will incorporate video as one part of an integrated plan to extend access to language services for its Limited English Proficient and deaf patients."


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