Last year, OSF HealthCare in Peoria, Ill., launched a mission: to standardize its approach to treating patients with limited English proficiency.
That not only included a focus on setting consistent processes across the system’s 13 hospitals and dozens of ambulatory sites but also on standardizing the types of interpretation and translation solutions available to the system’s staff—including an innovative use of video-based telehealth.
In Illinois, an estimated 4.6% of households speak limited English, according to the U.S. Census Bureau. For years, each OSF HealthCare facility or department determined how to best offer assistive services to these patients, whether that meant connecting staff and patients with on-site interpreters or by using newer tech-based practices.
“Historically and prior to implementation of ACA 1557, we had evidence of either a lack of availability of tools to assist (with language interpretation), or utilization of processes that we as an organization didn’t support,” such as allowing employees who weren’t part of the patient’s care team to interpret for the patient, said Brandy Fisher, vice president of clinical support services at OSF.
Section 1557 of the Affordable Care Act prohibits racial, gender, age or disability discrimination in health programs, and includes requirements for healthcare organizations to provide access to language assistance for individuals with limited English proficiency.
OSF now uses tablets and other devices across its facilities that enable care teams to connect almost immediately with remote interpreters who can speak at least one of 35 different languages.
The video service, offered by a company called Stratus InDemand, is OSF’s primary method for offering interpreting services—though the decision to use remote or on-site interpreters is also dependent on factors like the patient’s comfort. Stratus charges by the minute for the video interpreting services.
The service has helped to reduce the need for staff and patients to wait for a contracted interpreter to travel to a facility.
“We’re definitely trying to provide that immediacy of care and communication,” said Patty McMahill, OSF’s program manager for assistive services who was hired in 2018 as part of the system’s effort to standardize its processes for patients who need interpreters.
Video interpreting has proved particularly helpful during emergency care because, as Fisher noted, it’s not always logistically possible to get a person in the ER, especially when every second counts.
Since rolling out the video service systemwide, OSF is now homing in on the next step: analyzing the interpretation services and practices deployed at the system today to assess their use against patient language needs and solution spend. That’s one of the system’s key strategic goals for fiscal 2020.
Video interpreting services typically provide cost savings by cutting down the need to have interpreters on staff at each facility—a significant challenge for health systems with a number of different sites, said Susan Irby, managing director for business intelligence and analytics at Maestro Strategies.
“It’s difficult to: A) find interpretive talent and B) be able to station them at every single site,” she said. “It becomes both cost-prohibitive and logistically very difficult” to have interpreters on site.
Accurate interpretation and translation isn’t just important for those who speak limited or no English, said Dr. Donald Goldmann, chief scientific officer emeritus and senior fellow at the Institute for Healthcare Improvement. Even those who learned English as a second language and speak it often might have trouble with the jargon that’s often used in healthcare settings.
“It’s not just an English language problem; it’s a health literacy problem,” he said. “I think we do a mediocre job as physicians—and other healthcare providers—in meeting patients at the level that their health literacy would require. By and large, we tend to use language that’s obscure, intimidating.”
Some companies are starting to address that problem on a consumer level, too. This summer, Medici, an app that connects physicians to their patients outside of visits via text messages, audio calls and video chats, launched a translating feature within its messaging service. Users can select their preferred language, and the app will automatically translate incoming messages.
The Austin, Texas-based startup integrated translation services from three companies to provide a total of 30 languages in its translation feature, said Clinton Phillips, Medici’s CEO.