VRI Whiteboard and Best Practices in Healthcare

July 13, 2020 •

BY CLOUDBREAK HEALTH Darcy Meade

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By Tatiana González-Cestari, PhD, CHI^TM,Director of Language Service Advocacy.

What is a whiteboard in this context?

In the digital world, a whiteboard is an area on a display screen common to several users, on which they can write and draw. It is not closed captioning, CART (Communication Access Realtime Translation) services or a tool for real time translations, transcriptions, etc.

Why have a whiteboard in a video remote healthcare interpreting platform?

Many video remote interpreting companies have now added a whiteboard feature to their platforms. The reasons for it seem to vary. Based on our review of marketing information whiteboards are often added as a new gadget or as a marketing tool. In other cases, whiteboards are intended for further written clarification of medical jargon or prescription instructions. Whiteboards have also been used to clarify non-medical terms when the language organization provides interpreting services in other specializations (financial, customer service, etc.).

Cloudbreak Health recently added a whiteboard feature to our Martti Next app solution. The market guided us to make this update as more and more platforms featured the tool, but it isn’t an empty marketing effort. We recognize the benefits of this tool when drawings or schematics are needed to deepen understanding in a consultation. This, in turn, helps interpreters follow along, ensuring they deliver the most accurate interpretation. Whiteboard usage may also reduce the need for clarification.

With no industry standards for the whiteboard feature widely available, we found it necessary to create best practices for the use of this tool. Below, we share these best practices, why they are necessary, and the benefits of the whiteboard feature.

Benefits

This is a portable tool, to which providers have quick access to use as a visual aid. For example, a provider can draw a heart or a thyroid gland to help explain a procedure.

Additional applications of the whiteboard include asking patients to write as part of an exercise (but not as a tool to evaluate skills). Also, patients may need to draw as part of an explanation to the provider. For example, to explain to a physical therapist how their home is set up, which is relevant information when assessing what kind of equipment is needed at home.

Why are best practices for the use of a whiteboard feature in VRI platforms needed?

Interpreters may attract attention to themselves and break communicative autonomy during the session. This means that they may violate NCIHC’s standards of practice number 12, “The interpreter promotes direct communication among all parties in the encounter”, or standard number 13, “The interpreter promotes patient autonomy.”
Translating is a separate skill set from interpreting, and interpreters should not be put into a position where they are expected to translate.
Most likely, there is no way to record the information added to the whiteboard, which may increase risk and prevent companies from ensuring quality of what is being shared.
Interpreters are typically tested for fluency, interpreting skills and protocols in oral or visual form (signing), not in written.
Multiple visual interactions at the same time can be distracting for signed language interpreters and patients as they may try to read while someone is speaking, and the interpreter is trying to interpret. This can cause confusion, and information may get lost.
Hearing individuals may promote communication in written English with patients who are Deaf. It is incorrect to assume Deaf or Hard of Hearing patients know written English or that it is their preferred method of communication. This can be frustrating for patients and can set a bad precedent, set the wrong expectations, or can even compromise the reputation of language service organizations. Of course, many patients who are Deaf do communicate in written English, but patients should have agency in deciding the most effective method of communication for their visit.
Additionally, there is risk of confusion with:
- Handwritten notes. Think about this: how well do you write with your fingertips or a stylus pen on a screen? Do all letters and numbers look the way they should to ensure understanding? How does this affect written characters in languages that don’t use the Roman/Latin alphabet?
- Misspelled words in any of the working languages. This happens in any field, but it is a particularly sensitive matter in healthcare; it can cause confusion and even life-threatening problems. For example, when words like “cord”, “chord”, “cor” (heart) and “core” get mixed up. Also, “scarring” versus “scaring”, “valacyclovir” versus “valganciclovir”, “Tdap” versus “DTaP”, “Bidex” versus “Videx”, “Cedax” versus “Cidex”, “cycloserine” versus “cyclosporine”, “Diovan” versus “Dioval” … and many more!
- Words that have the same spelling but different meaning in multiple languages (false cognates). For example, the word “once” exists in English and in Spanish; however, it has meanings such as “on one occasion”, “for one time only”, “as soon as” or “when” in English but it means “eleven” in Spanish. Think about treatment compliance or medication toxicity when a patient associates that word (and remembers seeing it written) with “eleven” instead of “once” -a day, for example-.

Best Practices

Based on the information collected, the nature of the remote healthcare interpreting profession, the National Council on Interpreting in Health Care’s code of ethics and standards of practice, our quality standards, and to reduce risks, we formulated the following best practices for the use of whiteboard features in video medical platforms.

Remote healthcare interpreters should only interpret what is spoken or signed in the room during a consultation.
The whiteboard should not be used:
- As the primary form of communication for the consultation.
  - Avoid extensively communicating in writing (text) with participants.
- For sight translations.
- To assess patient’s skills when writing (such as in certain speech or occupational therapy sessions).
- To type prescriptions.

What should interpreters do if a provider/patient is asking them to write or draw on the whiteboard?

Assess the situation. Using the guidelines above, determine if this is an appropriate use of the whiteboard. Ask yourself if these are special circumstances and the whiteboard is the only option for communication. Use the whiteboard sparingly and as a last resort. Document the reason for the request if it falls outside of these guidelines. You may have to refer providers to their internal language service department.

The author would like to thank Sarah Stockler-Rex, Manager of Quality Assurance at Cloudbreak Health, for providing valuable input on best practices in remote healthcare interpreting.