Healthcare providers are relying more and more on digital health tools to communicate with their patients. That’s especially true when the patient doesn’t understand English.
At Chicago’s Advocate Health Care, five of the health system’s 10 hospitals have interpreters on-site, and those interpreters are trained in the most prevalent languages: Spanish, Arabic and – this being Chicago – Polish. But what of those patients who might speak Russian, Mandarin, Cantonese, Nepali or Korean?
Easy. The clinician on duty simply grabs an iPad or smartphone, accesses an app for video remote interpreting, and there’s a video feed with someone within minutes, usually seconds.
“It’s amazing, seeing their eyes light up when you have an interpreter right there (on the mobile device) that they can talk to face-to-face,” says Carolyn Hager, MBA, JD, CPHRM, Advocate Health’s director of language services, who uses two different video remote interpreting platforms to provide services in 24 different languages. “Sometimes people don’t understand how important that can be.”
Indeed, patient engagement is one of the trendiest topics in healthcare these days, and it goes far beyond boosting patient satisfaction rates or getting someone to buy into medication adherence. If patient and provider can’t even get past “hello,” it stands to reason that a clinician won’t be able to provide proper care and a patient won’t be able to react accordingly.
Challenges in dealing with patients who aren’t fluent in English are well-documented in healthcare circles, and sometimes prove to be fatal (imagine a patient misinterpreting a doctor’s instructions for post-discharge care). Furthermore, the U.S. Census Bureau estimates that more than 21 percent of the nation’s residents speak a language other than English at home, and that percentage is only expected to grow.
In recent years, researchers have sought to study whether language barriers affect hospital care outcomes, whether professional interpreters (as opposed to, say, family members) can affect clinical outcomes, and whether non-English-proficient patients have longer hospital stays.
Among the results, a 2010 study published in the Journal of Hospital Medicine found that non-English-speaking Latino and Chinese patients in the San Francisco area do have a higher risk for readmission. And in a 2012 study conducted by the University of Massachusetts Medical School, the length of stay for limited-English-proficiency (LEP) patients was “significantly longer when professional interpreters were not used at admission or both admission (and) discharge.”
Those numbers and the advent of video-on-demand platforms make for a strong market for mHealth companies like Stratus, Cyracom, InDemand Interpreting and LanguageLine.
Dave Fetterolf, president and CEO of Stratus Video, says roughly $2 billion is spent each year on interpreting services in healthcare, ranging from on-site interpreters (very expensive) to phone-based services to video services. Carolinas Healthcare had averaged $3 million a year to provide each of its 40 hospitals with on-site interpreters, he says, and has since cut that bill in half with an mHealth-based platform.
And healthcare providers can’t use just anyone with a proficiency for another language – they need certified medical interpreters, capable to understanding medical terminology and relaying that information to a patient. “We’re not talking someone’s grandson or the janitor,” says Fetterolf. “You need someone who knows the language.”
Some health systems are developing their own services. In California – where roughly 40 percent speak a language other than English, according to census estimates – San Joaquin General Hospital partnered with the Health Access Foundation and Cisco to create The Health Care Interpreter Network of Northern California, a system of shared remote interpreter services for the region’s hospitals. The system boasts access via video or phone to an interpreter within three minutes 24 hours a day.
“Good healthcare requires good communication between the patient and the healthcare provider, and this technology proves that we can cost-effectively provide such access to good care for all Californians, regardless of what language they speak,” Anthony Wright, executive director of the statewide consumer advocacy coalition Health Access, says in a case study presented by Cisco. “With an innovative technology solution, health insurers and providers will no longer have an excuse to rely on children or random passersby for interpreters, or to not have these essential services provided.”
At Seattle’s Providence Health & Services, patients can access video interpreters through touch-screen computers. West Chester Hospital in Ohio, meanwhile, uses iPads affixed to three-foot-tall wheeled stands that can be moved from room to room, offering patients access to LanguageLine Solutions’ video interpreters. And the Kettering Health Network uses an Internet-based video system called My Accessible Real Time Trusted Interpreter, or MARTTI.
While accommodating the world’s vast array of languages, as well as sign language, video remote interpreting platforms are being adopted for other uses as well. A Florida health system is using the Stratus platform to search for and connect to stroke specialists in emergencies, Fetterolf says, and others are using the service for diabetes or medication adherence education.
Stratus, meanwhile, is working on a consumer-facing ‘Stratus in Person’ – “an Uber for interpreting,” says Fetterolf, that enables users to search for interpreters in the neighborhood.
Advocate Health Care is also experimenting, says Hager. The health system’s two children’s hospitals have added iPads to their patient transport vehicles, giving clinicians a real-time communication tool with children and their families as they’re being ferried from another hospital into Advocate. And doctors aren’t just using the app at admission or in the ER – they’re using it whenever and wherever they need to communicate with a patient.
“We’re finding that we’re using it in more conversations,” says Hager.