The Rise of Video Remote Interpreting in Telehealth
US Cultural and Linguistic Diversity
Language access in healthcare has always played a critical role in healthcare, but during COVID-19, the stakes are even higher.
America is most definitely a home for every language and for every culture. In fact, one of the nation’s most uniquely defining characteristics is its cultural and linguistic diversity. To put this into perspective, as of 2015, the United States Census Bureau reported that approximately 350 languages are spoken in US homes, and, as of 2018, the Bureau estimated that roughly 67 million US residents speak a language other than English (LOTE) at home – a number that “has more than doubled since 1990 and almost tripled since 1980.”1
While the majority of US residents speak English well or very well, a significant percentage of the nation’s population does not. In fact, the most current government data shows that nearly 26 million US residents are limited-English proficient (LEP), an additional 10 million individuals are hard of hearing, and nearly 1 million are functionally deaf, relying heavily on American Sign Language (ASL). In other words, just over 11 percent of the US population requires language support for effective communication. But it isn’t just about those who struggle with the English language. In fact, even those who have a fairly strong command of English as a second language also require linguistic support. Why? The mental dexterity alone that goes into translating everything they hear or read from English to their own language reduces their engagement which can in turn, negatively impact their ability to request appropriate services. Luckily, the federal government has implemented laws to ensure all those who require linguistic support have equal access to necessary government-funded programs such education and healthcare.
Language Services in Healthcare
It goes without saying that effective communication in healthcare not only improves patient outcomes and strengthens patient satisfaction, but it also decreases 30-day readmission numbers, reduces the number of unnecessary testing, and minimizes malpractice risks. Therefore, in a linguistically diverse country such as the United States, language services in healthcare plays a uniquely critical role. In one particular 8-month study conducted in a US academic hospital involving 1,963 LEP patients, there was a nearly 25 percent decrease in 30-day readmissions for patients who received language interpreting services.
Before the outbreak of the coronavirus 2019 (COVID-19), healthcare institutions fluctuated between using bilingual family members and friends* and bilingual staff, as well as professional in-person, over-the-phone, and video remote interpreting (VRI) modalities to facilitate effective communication with their LEP patient population. However, since the outbreak, in-person interpreting in any form has quickly taken a backseat. In fact, the Common Sense Advisory (CSA) “found that interpreters saw a 40 percent decrease in revenue from in-person interpretation due to COVID-19.”2 On the contrary, recent research is finding that over-the-phone interpreting usage has doubled since the outbreak, and VRI has tripled. While both have their strong points,VRI seems to be taking the lead – a lead that will likely remain so for the foreseeable future.
*”In many cases… friends and family members may not have the ability to ensure the LEP person being served fully understands what a health provider is communicating to them. In other cases, a family member or friend may have an interest in misrepresenting what is being said, such as when domestic abuse is the cause of a medical visit…Therefore, when important information is being conveyed… it is the provider’s responsibility to provide competent interpreter services at no cost to the person being served.”3
What Exactly “is” VRI?
Before we can grasp the concept of video remote interpreting, we must first fully understand telehealth. Although this virtual solution to healthcare still seems relatively new to many, it has been around for decades, having first emerged in the 1940s. Modern telehealth solutions however, now offer both video and audio connectivity, facilitating communication between the healthcare provider and the patient. And although this advanced technology is rising in popularity, it is critically important to further provide language-access integration – and that is where VRI technology takes center stage.
VRI technology connects healthcare professionals to their patients and to professional interpreters. And, since the service is online, not only does it provide almost immediate access to interpreters of virtually any language with real-time visibility, it also significantly reduces healthcare interpreter expenses. Perhaps one healthcare system alone best models these advantages.
By investing in VRI, not only did Carolinas Healthcare System (CHS) save USD 1.5 million in one year, but in that same time frame, they were able to increase their patient interpreter minute usage from roughly 370,000 minutes to nearly 915,500 minutes.
The Rise in Popularity of VRI in Telehealth
Besides the obvious benefit of minimizing COVID-19 exposure to patients, frontline healthcare workers, and interpreters, telehealth offers a great many advantages that arguably surpass over-the-phone interpreting options. For one, VRI provides a visual connection, enabling the interpreter to read body language. Interpreters are also able to pay close attention to hand and facial gestures which more closely mimic a face-to-face healthcare interpreting encounter. VRI is also cost effective and relatively easy to implement and use. Two additional advantages that are often overlooked are the conservation of essential personal protective equipment (PPE) as well as the portability of VRI platforms, allowing healthcare professionals to service patients in the hospital or any healthcare facility but from separate rooms.
Federal Government Supports Telehealth but Challenges Language Services
CMS Supports Telehealth Services
In its effort to assist healthcare providers in adopting telehealth solutions, the Centers for Medicare & Medicaid Services (CMS) “has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services…without having to travel to a healthcare facility.”4 Additionally, Medicare will now cover the cost of virtual healthcare visits to doctors’ offices, hospitals, and other medical visits under the new 1135 Waiver. And while this is all very promising, there is one area of concern healthcare providers and patients must be aware of – a growing risk to language access.
Amendments to Section 1557 Affect Language Access
Section 1557 represents the nondiscrimination provision of the Affordable Care Act (ACA). Essentially, it states that all healthcare facilities (including health insurance companies) and all community-based organizations receiving Medicare, Medicaid, or “other” reimbursement from federal health programs must post taglines and notices informing LEP patients of their right to receive language-assistance services. These entities must also ensure that they have taken reasonable steps to provide meaningful access to all LEP recipients.
However, in mid-June of this year, the current administration issued a final rule amending Section 1557, eliminating the requirement to post taglines and notices. Government support for telehealth services is a step in the right direction but it is only as strong as its continued support for language-access services since nearly 9 million “LEP persons [are] enrolled in Medicare, Medicaid, or both programs (Duals).”5 It is imperative that we work together to keep LEP patients informed of their rights to access language services.
Vialink, Vocalink Global’s Advanced VRI Healthcare Solutions
Even before the onset and aggressive spread of COVID-19, technology was rapidly becoming a key differentiating factor in the healthcare interpreting sector. Now, with the unprecedented challenges this pandemic has presented, advancements in language technology solutions have quite literally skyrocketed to meet this growing demand, and Vocalink Global has certainly risen to the occasion. We listen to our clients in the healthcare field and we answer the call each and every time.
So, just how does Vialink work? We’re glad you asked!
Vialink’s On-demand and Pre-scheduled Interpreting
Not only does Vocalink Global support on-demand VRI in top-requested languages (including ASL, Arabic, Chinese Mandarin, Russian, Somali, Spanish, Tagalog, and Vietnamese), but many additional languages are also available on a pre-scheduled basis. And, since we offer pay-by-the-minute services, there are no monthly or minimum fees.
Online Interpreter Records Portal
Our online portal allows healthcare facilities to instantly access our interpreters’ documented proof of competency and training, ensuring our clients remain fully compliant and maintain their accreditation. By allowing Vocalink Global to work within your current internal technology and gain an intimate understanding of your processes, you will have peace of mind during Joint Commission stand audits, knowing that your language access program operates with the highest level of proficiency and efficacy.
Vialink’s Ease of Use
Since Vialink is completely web-based, there is no need for expensive or specialized equipment. In fact, no capital investment is needed at all since our VRI solution works seamlessly on phone, computer, or tablet equipment. All you need is a video and audio-enabled device along with a high-speed internet connection. Once we receive a request for an interpreter, our system automatically broadcasts the appointment to all qualifying interpreters. An interpreter then accepts the appointment, a confirmation is sent to the provider that an interpreter is confirmed, and that’s it! The interpreter is set and ready to join the meeting at the requested time, using the link that was provided.
But we don’t stop there. Not only does Vocalink Global provide highly experienced healthcare interpreters, but we offer exceptional flexibility, with remote interpreting available on either our platform or on our client’s telehealth platform. And, as part of our commitment to taking a leadership position in VRI solutions, we are pleased to offer professional training services for your staff, along with training materials, demos, and VRI test calls.
Partnerships over Transactions
Vocalink Global is honored to be known as a trusted LSP for our clients. We have created an open-feedback channel with each and every client, setting up regular check-ins and will often attend our clients’ monthly or annual meetings. We invest in long-term relationships with our clients, working toward continued optimization in-step with your growth. We choose partnerships over transactions and embed ourselves inside your ecosystem to create a customized process, enhancing your communications in any language.
The time to act is now. Be heard. Be understood. Connect with Vocalink Global today.
REFERENCES
1 Karen Zeigler and Steven A. Camarotaon October 29. “67.3 Million in the United States Spoke a Foreign Language at Home in 2018.” CIS.org, cis.org/Report/673-Million-United-States-Spoke-Foreign-Language-Home-2018.
2 Heilweil, Rebecca. “What It’s like to Interpret for Coronavirus Patients Remotely.” Vox, Vox, 16 May 2020, www.vox.com/recode/2020/5/16/21250477/medical-interpreters-remote-certified-languages-telelanguage-covid-19.
3 (OCR), Office for Civil Rights. “709-May an LEP Person Use a Family Member or Friend as His or Her Interpreter.” HHS.gov, 18 Dec. 2015, www.hhs.gov/civil-rights/for-individuals/faqs/may-an-lep-person-use-a-family-member-as-an-interpreter/709/index.html.
4 “Fact Sheet MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET.” CMS, www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.
5 Proctor, Kimberly, et al. “The Limited English Proficient Population: Describing Medicare, Medicaid, and Dual Beneficiaries.” Health Equity, Mary Ann Liebert, Inc., 1 May 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6071899/.
In addition to:
RE;, Mitchell. “How Many Deaf People Are There in the United States? Estimates from the Survey of Income and Program Participation.” Journal of Deaf Studies and Deaf Education, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/16177267/.
Karliner, Leah S, et al. “Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency.” Medical Care, U.S. National Library of Medicine, Mar. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5309198/.
“History of Telemedicine & Telehealth: When Did It Start.” EVisit, 29 Oct. 2019, evisit.com/resources/history-of-telemedicine/.
TECHNOLOGY: Danilo Formolo, David Fetterolf. “Carolinas Healthcare System Saved $1.5M Annually by Using Remote Interpreter Technology.” Hfma, www.hfma.org/topics/article/57149.html.
“Fact Sheet MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET.” CMS, www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.
Secretary, HHS Office of the, and Office for Civil Rights (OCR). “Section 1557: Frequently Asked Questions.” HHS.gov, US Department of Health and Human Services, 18 May 2017, www.hhs.gov/civil-rights/for-individuals/section-1557/1557faqs/index.html.
