By Paloma Peña, Director of Quality and Customer Experience; Sarah Stockler-Rex, Quality Assurance Supervisor; and Tatiana González-Cestari, PhD, CHITM, Director of Language Service Advocacy.
This piece is the first in a new series, written by Cloudbreak Health’s quality and training leaders, that discusses medical language access, VRI, and related topics.
Chances are if you work in healthcare you have seen or even worked with an interpreter. If not, it is likely that you will in the near future.
The population of Limited English Proficient (LEP) patients is rapidly increasing; there is a growing need for access to quality interpretation. The unfortunate reality is that it is nearly impossible for healthcare systems to meet these around-the-clock needs through on-site interpretation only. Video Remote Interpretation (VRI) services can provide on-demand access to interpretation services 24/7/365 when on-site interpreters may not be readily available (Burkle et al. 2017; Marshall et al, 2019).
Nowadays, VRI is likely to be part of any solid holistic Language Access Plan which helps health systems care for patients as soon as needed and remain compliant with language access regulations. While becoming increasingly popular as a solution to interpreting demands and hospital compliance needs, it’s important to note that research is still relatively limited surrounding VRI standards and best practices for spoken language interpretation.
The purpose of this series is to provide guidance on best practices in VRI based on our experience and data, national standards, and any research available. In addition, we aim to open a discussion on what research has taught us and what needs to be implemented in VRI.
Through this series, our goal is to communicate with interpreters, language service providers, VRI users, and hospital administrators about VRI practices to further advance the healthcare interpreting profession and serve our patients.
THE BASICS:
What is Video Remote Interpretation?
Video Remote Interpreting (VRI) is a video telecommunication service to access real-time sign or spoken language interpretation through interpreters who are located in a satellite call center or remotely. While VRI is most commonly used within medical settings, it can also be an effective communication tool in a variety of settings such as educational, legal, business, etc.
When referring to video communication services, VRI is occasionally confused with Video Relay Service (VRS), which is a separate service for Deaf/Hard of Hearing individuals that is governed by the Federal Communications Commission (FCC). This service “enables persons with hearing disabilities who use American Sign Language to communicate with voice telephone users through video equipment” (https://www.fcc.gov/consumers/guides/video-relay-services).
What about Over the Phone Interpretation (OPI)?
In addition to on-site and video remote interpretation, telephonic interpreting services, also called Over the Phone Interpretation (OPI), is a popular solution used by healthcare teams to help meet the increasing demand for interpreting services.
While OPI is a commonly used and essential component of an effective Language Access Plan, OPI is limited to providing spoken language interpretation only and does not give interpreters access to non-verbal cues or the human connection of working with someone face-to-face.
The addition of video capabilities makes VRI accessible to be used for sign language interpretation needs and provides all language interpreters access to non-verbal language which is unseen through OPI solutions.
Additionally, VRI can provide a better human connection between provider, patient, and interpreter (Marshall et al. 2019), which reduces communication errors, interpretation time, readmission, and improves overall patient satisfaction.
Providing VRI services: What do I need to know?
Short answer: a little bit about a lot!
To provide effective VRI services, healthcare systems must follow Language Access Plans, compliance requirements, and VRI best practices. We will delve into these topics later in this series but for now, we will outline the basic foundation for providing effective VRI services:
- Review national compliance requirements and guidelines in Language Access
- Title VI of the Civil Rights Act of 1964
- The Affordable Care Act (ACA), including Section 1557
- The Americans with Disabilities Act (ADA)
- The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards)
- The Joint Commission publications
- The National Health Law Program publications
- Any additional national, state, and local requirements
- Implement or revise a Language Access Plan
- Plan VRI deployment and implementation
- Train hospital staff on the use of VRI and best practices
- Develop a decision-making tree tailored to your Language Access Plan
- Track VRI utilization and performance
- Understand protocols regarding
- working with the interpreter
- staff training requirements
- technical requirements
- environmental control
- quality control
- Work with highly qualified interpreters who have proven
- language proficiency and interpreting skills
- an understanding of the code of ethics or professional conduct and standards of practice
- knowledge of specialized vocabulary, terminology, and phraseology
- completion of national certification requirements
- ability to navigate cultural sensitivities
Establishing the basics is critical for effective communication when providing care to Deaf/Hard of Hearing and LEP patients. Equally important is knowledge and frequent review of your organization’s Language Access Plan, specific policies/procedures, and designated contact for language services matters.
Armed with this knowledge you are well on your way to improving patient outcomes through effective communication. Support by your language service provider(s) will be key in the implementation and success of this process as it requires ongoing collaboration and education.
Whether you are new to the discussion of VRI or are a seasoned expert, we welcome you to follow our series which will provide a glimpse into VRI-centered topics including best practices, scripting, common challenges, their solutions, and more.
Resources:
(ADA – https://www.ada.gov/effective-comm.htm)
(RID VRI SOP – https://drive.google.com/file/d/0B3DKvZMflFLdTkk4QnM3T1JRR1U/view)
(NAD Position Statement –https://www.nad.org/about-us/position-statements/minimum-standards-for-video-remote-interpreting-services-in-medical-settings/)
(ACA, Section 1557) – https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html
References:
- Burkle CM, Anderson KA, Xiong Y, Guerra AE, Tschida-Reuter DA. Assessment of the efficiency of language interpreter services in a busy surgical and procedural practice. BMC Health Serv Res. 2017 Jul;17(1):456.
- Marshall LC, Zaki A, Duarte M, Nicolas A, Roan J, Colby AF, Noyes AL, Flores G. Promoting Effective Communication with Limited English Proficient Families: Implementation of Video Remote Interpreting as Part of a Comprehensive Language Services Program in a Children’s Hospital. Jt Comm J Qual Patient Saf. 2019 Jul;45(7):509.
