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| Bruce Occena at the poster session, APHA in Philadephia 2005 |
More than 8,000 patients have used the "Enhanced Interpreter" Programs at the Alameda County Medical Center and San Francisco General Hospital / Department of Public Health in California to access care since the collaborative project began a little over three years ago. The innovation project has been made possible primarily through funding from the California Endowment and the Federal Office of Minority Health. The program involves connecting patients of Limited English Proficiency (LEP) with trained medical interpreters using "real time" video technology.When a practitioner identifies a patient needing interpreter services, they can access the interpreter by video units that are mounted on mobile carts. A busy clinic might have two or three video units. These units can connect to interpreter stations at the hospital in question, or at the collaborating hospital 50 miles away -- in either case the call can be connected within 30 seconds. The provider, patient and interpreter work together in a "real time" videoconference situation with the benefit of visual "body language" cues similar to having an "in person" interpreter present. The use and set up of the video units is simple, and training practitioners only takes about 15 minutes.
The benefit from patient and practitioners' perspectives is improved quality of service. Both participating medical centers have what are considered "mature" interpreter service departments – offering "in person" interpreter services for over two decades in about 35 languages including Spanish, Chinese dialects, Russian, and Vietnamese. Prior to the technology enhancement project, services were primarily provided "in person," and the average wait time for an interpreter was between 30 to 45 minutes. In addition, at times when the interpreters were late, LEP patients would often loose their turn in queue and be skipped over in favor of an English-speaking patient. Or at such times, practitioners might resort to the use of untrained clerical or janitorial staff with inadequate medical vocabulary.
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| Comparing Quality of Care Performance Indicators |
Preliminary evaluation indicators of the program showed substantial administrative benefits in terms of reduction in "wait time" for LEP patients and increase in productivity of interpreter resources. Prior to the enhanced use of video and phone interpretation, an average "in person" session took approximately 37 minutes (including the time it took for interpreters to travel to the clinic venue and wait for the provider to be ready) – whereas the average videoconference session takes approximately 15 – 17 minutes, completely eliminating non-value added interpreter travel and wait times. From the provider point of view, the wait time for interpreter service has dramatically decreased from between 30 to 45 minutes to approximately 5 minutes. However, the most important service improvement indicator has been that the previous routine practice of skipping over LEP patients while waiting for the arrival of the interpreter has been functionally eliminated – currently the skipping of LEP patients out of queue has become a rare and extraordinary occurrence.The enhanced interpreter services enables practitioners to treat LEP patients with dignity, fairness and respect. More than 46 million people in the United States do not speak English as their primary language, and more than 21 million speak English less than "very well" according to the 2000 Census. Persons who have limited English proficiency are less likely to have a regular source of primary care, and are less likely to receive preventive care. They also are less satisfied with the care that they do receive, are more likely to report overall problems with care, and may be at increased risk of experiencing medical errors.1
The national demographics are changing. Public health centers, in particular, have to meet the needs of increasing number of people with limited English proficiency. Fortunately, at the same time, technology enhancements are getting more affordable. A videoconferencing unit with high quality video images costs about $ 5,000. While traditional interpretative services, where a practitioner, patient and interpreter sit in the same room, are excellent when available – they are often logistically and financially prohibitive. The Enhanced Interpretive program being beta-tested at Alameda Medical Center and San Francisco General Hospital provides encouraging evidence that the need to expand access to trained interpreter services can successfully be met with the application of new video technologies.
Bruce Occena is the Program Coordinator for the Enhanced Interpreter Program and works for the Health Access Foundation. Phone: 510-506-0775. Email: BNOcc@aol.com . Related and Edited by Bruce Occena; Written by Priti Irani.
1 Jacobs E, Shepard D, Suaya J, Stone E. Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services. American Journal of Public Health. 2004;94 (5):866-869