As more hos­pi­tals use med­i­cal trans­la­tors, re­mote ser­vices raise con­cerns

Some crit­i­cize re­mote in­ter­pre­ta­tion ser­vices

Modern Healthcare - - NEWS - Mau­reen McKinney

Fac­ing ramped-up fed­eral re­quire­ments and new ac­cred­i­ta­tion stan­dards, hos­pi­tals are tak­ing a closer look at how to best use in­ter­preters to meet the needs of pa­tients with lim­ited English pro­fi­ciency. Pa­tients hin­dered by lan­guage bar­ri­ers with clin­i­cians are more likely to be the vic­tims of med­i­cal er­ror and more likely to suf­fer re­lated harm, said Dr. Alexan­der Green, as­so­ciate di­rec­tor of the Dis­par­i­ties So­lu­tions Cen­ter at 945bed Mas­sachusetts Gen­eral Hospi­tal, Bos­ton.

Re­search has re­peat­edly demon­strated the ben­e­fits of pro­fes­sional in­ter­preter ser­vices for lim­ited English-pro­fi­cient pa­tients, or LEPs, as they are com­monly known. A May 2012 study in the An­nals of Emer­gency Medicine, for in­stance, found that hos­pi­tals’ use of well­trained med­i­cal in­ter­preters can re­duce the risk of er­rors and im­prove pa­tient out­comes.

In­creas­ingly, many hos­pi­tals are choos­ing to con­tract with com­pa­nies that of­fer re­mote med­i­cal in­ter­pre­ta­tion ser­vices, usu­ally pro­vided by tele­phone. Th­ese ser­vices, which typ­i­cally cover more than 200 lan­guages, are of­ten more cost­ef­fec­tive for bud­get-strapped hos­pi­tals. But ques­tions per­sist about whether tele­phone in­ter­preters are as ef­fec­tive as on-site em­ploy­ees and how out­sourc­ing such ser­vices af­fects pa­tient care.

On Jan. 7, Monterey, Calif.-based Lan­guage Line Ser­vices, an in­ter­pre­ta­tion ser­vices com­pany that cov­ers a num­ber of in­dus­tries, in­clud­ing health­care, government and man­u­fac­tur­ing, an­nounced it had ac­quired ri­val Pa­cific In­ter­preters, Dal­las, from Ster­ling Cap­i­tal, a North­brook, Ill.-based pri­vate eq­uity firm, for an undis­closed sum. The two com­pa­nies, whose com­bined an­nual rev­enue to­tals nearly $300 mil­lion, are lead­ers in the med­i­cal in­ter­pre­ta­tion mar­ket, a sec­tor that is ex­pected to ex­pand rapidly in coming years. Ac­cord­ing to U.S. Cen­sus Bureau data, LEPs ac­counted for more than 25 mil­lion peo­ple in 2010, or roughly 9% of the na­tion’s pop­u­la­tion over age 5.

“It’s a fast-grow­ing area,” said Scott Klein, Lan­guage Line Ser­vices’ CEO, adding that hos­pi­tals face mount­ing pres­sure to en­sure in­ter­pre­ta­tion ser­vices are ad­e­quate.

In Jan­uary 2010, the Joint Com­mis­sion is­sued new and re­vised stan­dards for ef­fec­tive pa­tient­cen­tered com­mu­ni­ca­tion, in­clud­ing more spe­cific pro­vi­sions for hospi­tal in­ter­pre­ta­tion ser­vices. They re­quire that hos­pi­tals doc­u­ment pa­tients’ lan­guage needs in their med­i­cal records and en­sure in­ter­preters’ qual­i­fi­ca­tions and pro­fi­ciency through train­ing and ed­u­ca­tion. The stan­dards were pi­loted through 2011, and as of Jan­uary 2012 are con­sid­ered as part of the Joint Com­mis­sion’s hospi­tal ac­cred­i­ta­tion process.

“The Joint Com­mis­sion usu­ally puts a toe in the water first, but when they do get in­volved, it raises a lot of in­ter­est among hos­pi­tals, to say the least,” said Green, of the Dis­par­i­ties So­lu­tions Cen­ter. The Pa­tient Pro­tec­tion and Af­ford­able Care Act also put greater em­pha­sis on care for LEPs, in­clud­ing pro­vi­sions that re­quire hos­pi­tals to col­lect data on pa­tients’ race, eth­nic­ity and lan­guage, he added.

Green said tele­phone in­ter­preters can serve an im­por­tant role, par­tic­u­larly when it comes to serv­ing pa­tient pop­u­la­tions that are not well- rep­re­sented in a hospi­tal’s com­mu­nity. Ide­ally, though, hos­pi­tals should have some on-site staff who main­tain ser­vices for the racial and eth­nic groups that con­sti­tute the largest per­cent­ages of their pa­tient pop­u­la­tion, he said.

“Tele­phone in­ter­pre­ta­tion is best as a backup for less-rep­re­sented groups,” Green said. “There is such an im­por­tant role for live in­ter­preters be­cause they can carry out cer­tain func­tions that phone in­ter­preters can­not, like work­ing as part of the care team.”

Stan­ford Hospi­tal and Clin­ics, Palo Alto, Calif., re­lies on a com­bi­na­tion of on-site and re­mote ser­vices. The 477-bed hospi­tal’s in­ter­preter ser­vices de­part­ment, re­garded as a model for other health­care fa­cil­i­ties, has a staff of 37 who are tested for lan­guage com­pe­tency and fa­mil­iar­ity with med­i­cal ter­mi­nol­ogy, said Luis Alberto Molina, Stan­ford’s as­sis­tant di­rec­tor of in­ter­preter ser­vices. Molina called phone in­ter­pre­ta­tion “com­ple­men­tary and an es­sen­tial part” of Stan­ford’s pro­gram. But he cau­tioned that tele­phone in­ter­preters can miss im­por­tant body lan­guage cues and fa­cial ex­pres­sions.

“Some­one who is really trained in the field needs in­ter­me­di­ate or ad­vanced knowl­edge of anatomy and phys­i­ol­ogy, di­ag­noses, ther­a­pies, pro­ce­dures, names of med­i­cal equip­ment—all of th­ese come into play in th­ese con­ver­sa­tions,” he said. “The chal­lenge is know­ing how th­ese com­pa­nies are train­ing their in­ter­preters. Are they se­lect­ing the best ones or are they hir­ing just to meet the in­creases in mar­ket de­mand?”

But Klein, Lan­guage Line Ser­vices’ CEO, de­fended his com­pany’s prac­tices, say­ing LLS re­quired in­ter­preters to be fully trained in med­i­cal is­sues and ter­mi­nol­ogy.

Tele­phone in­ter­preter ser­vices are at­trac­tive to hos­pi­tals be­cause the price is low, com­par­a­tively, said Teresa Reyna, Stan­ford’s di­rec­tor of op­er­a­tions for guest ser­vices.

Brunilda Tor­res, former di­rec­tor of the Of­fice of Mul­ti­cul­tural Health at the Mas­sachusetts De­part­ment of Pub­lic Health, ac­knowl­edged that cost pres­sures are in­creas­ingly push­ing hos­pi­tals to­ward re­motely pro­vided op­tions, though she called face-to-face in­ter­pre­ta­tion “the gold stan­dard.”

Like Green, she said the best ar­range­ment is one in which hos­pi­tals meet their pri­mary lan­guage needs with staff in­ter­preters and use tele­phone ser­vices as a backup. “Fi­nan­cially speak­ing, tele­phone in­ter­preters have made it much more fea­si­ble for hos­pi­tals to pro­vide th­ese ser­vices,” said Tor­res, who is now re­tired. “But we have to be clear about what we’re trad­ing for those sav­ings.”

Johanna Parker of Stan­ford Hospi­tal and Clin­ics demon­strates a video ser­vice that lets in­ter­preters work with pa­tients re­motely.

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