Harborview Medical Center

Video Remote Interpreting Call CenterWhat we have learned in our first few years of operation

Eliana Lobo – Trainer & Supervisor, Interpreter ServicesHarborview Medical Center

Harborview Medical Center

1 in 6 patients are limited English proficient (LEP) or deaf – Nearly 7,000 patients every month

LEP patients/family members communicate in morethan 90 languages and dialects, including ASL

47 Employee interpreters for 25 languages Employee interpreters for both onsite and remote

(telephonic and video) 6 agencies give us access to over 100 languages 91% LEP patients reached 430-450 encounters/day

41% interpreting by telephone/video

On-site interpreting is prioritized for:

Sharing bad news / worsening health condition

Family conferences Speech therapy / neuropsych testing Conscious sedation procedures Hands on teaching Situations requiring delicate or complex

cultural brokering

Telephonic Interpreting

Easy to access

Timely (no need to pre-schedule)

Less invasive = more privacy for patients

Wider range of languages available (especially rare languages and dialects)

In-person interpretation puts patients more at ease

Loss of non-verbal/subtle communication

Discussing difficult topics: end of life, organ donation

More challenging to check for understanding

Benefits experienced Concerns

Grand Total: All Interpreted Encounters by fiscal year*

*fiscal year 12/13 reflects data for July through December 2013 only

Total of all Interpreted Encounters: by modality

Total of all Interpreted Encounters: by modality

Total of all Interpreted Encounters: by modality

VMI/VRI

Interpretation that takes place using a video monitor unit or computer with an attached video camera

Technology that gives the patient and provider real-time visual presence of a medical interpreter who in turn, can also see and hear both patient and provider

Transmissions can take place on private networks, shared private network or on the public internet

Video Medical Interpretation or Video Remote Interpretation is referred to by different acronyms.

Basically, what is it?

Partial List of Health Care Institutions Utilizing VMI Alameda County Medical Center, CA Baystate Medical Center, MA Cambridge Health Alliance, MA Central DuPage Hospital, IL Grady Health Systems, GA Harborview Medical Center, WA HCIN – Health Care Interpreter Network, CA Holy Name Hospital, NJ Massachusetts General Medical Center, MA New York City Medical Center, NY San Francisco Department of Public Health, CA Swedish Medical Center, WA Susquehanna Health System, PA Temple University Health System, PA UC-Davis Medical Center, CA UCSF Medical Center, CA

VMI Technology = efficiency and quality

Remote video interpretation eliminates both the travel and waiting times associated with in person interpretation. From an average of 1 service unit/hour

(for in-person) to between 2–4 service units/hour (for VMI)

Real Time video maintains the visual body language cues that are key to quality interpretation

Practice Improvements Associated with VMI

Quick and easy access encourages interpreter use by providers

Dramatic reduction in average wait times for interpreters

Elimination of the practice of skipping

LEP patients in queue due to long waits for interpreters

Common Pitfalls when rolling out VMI

Introducing video units will not, in and of itself, result in increased understanding of the importance of interpreters or optimum utilization of this service

The technology is essentially “architectural”, meaning that the units do not interpret—the core asset question remains: How to secure trained medical interpreters?

Resistance to change…

VMI rollout is a strategic planning issue

The centerpiece: how to secure the core asset (trained interpreters) over time

The keystone: how to partner with IT and Telecommunications before you begin Whether the call routing infrastructure is

in-house or outsourced Pros and Cons exist with both approaches

depending upon the size, location and affiliation of the institution in question

General Approach:BEFORE hardware purchase / installation

Partner with I.T. and Telecommunications Ask for demo units from vendors and TEST them onsite! Assess your I.T. infrastructure (see handout )

Have blueprints available for sites where VMI will be implemented

You will have to map the location of ports and electrical outlets in order to place units effectively

OR You will have to map the location of electrical outlets

in order to INSTALL ports convenient to said outlets

Assess the phones currently in use by your providers Only digital, multi-directional phones will work

with this technology Most of the phone sets in out-patient clinics are

inexpensive, analog and unidirectional—This will NOT work!

Do the provider phones have conference capability?

General Approach:AFTER hardware purchase / installation

AVOID sub-optimal adoptions and utilization Train your providers rigorously! Have super-users identified from both groups

(provider and interpreter) to help champion use Be willing to park someone on site the first week of

implementation to hand hold providers/users

Have a strategic, enterprise level plan Stay focused on dramatic improvements in clinical

practice

Two Spanish and One Somali interpreter on each shift