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What is the current state of meeting the needs of patients with limited proficiency in a country’s dominant language?

Posted: 14 Nov, 2016   Recommendation: 1   Replies: 13

What are the impacts of regulatory agencies recent efforts to enhance language services?



Eugenia Smither Replied at 8:52 AM, 14 Nov 2016

Section 1557 of the ACA had lots of requirements for language, proficiency and impairments such as hearing and visual
The work is never ending for us on this topic and interested in how others have accomplished
Since we have a focus to electrify all of our records ( post- acute care- no meaningful use standards for us) it is taking a lot of energy to identify those things that need modification
there was no mention of using apps - what are other's thoughts on that

Eben Afarikumah Replied at 9:04 AM, 14 Nov 2016

In America, some state employ the services of Certified Medical
Interpreters (CMI). States such as Massachusetts, New York, California and
Oregon use the services of CMI's a lot.

Kathleen Addison Panelist Replied at 10:47 AM, 14 Nov 2016

Eugenia - If I understand your question correctly, you are interested in hearing recommendations for electronically tracking changes to records and other printed information, in target languages.... Is that correct? Or if not, would you mind clarifying?

Eugenia Smither Replied at 11:05 AM, 14 Nov 2016

I am interested in whether or not apps can be used as a suitable trans. and/or text enhancer, etc
Paying for a service just in case gets costly and when you provide care in people's homes its not as helpful

Kathleen Addison Panelist Replied at 11:11 AM, 14 Nov 2016

In general, in the US, there is a fair amount of legislation that has been and is being passed, to ensure LEP patients can take a proactive part in their healthcare, participate in dialogue over their care and treatment, and play an integrated role in the decision making process. The two primary mechanisms for this are via the regulatory environment and healthcare reform; (Attached is Language Challenges for Healthcare Providers Slide, that we often use when trying to qualify this conversation with our clients.)

The regulatory environment includes:
• Title VI of the Civil Rights Act
• Executive Order 13166
• ADA (Americans with Disabilities Act)
• HIPAA (Health Insurance Portability / Accountability Act)
• ACA (Affordable Care Act)
• CMS (Centers for Medicare/ Medicaid)
• FWA (Fraud, Waste and Abuse)
• The Joint Commission
• 1557/ First Rule regulations

Conversely, Healthcare Reform pertains to:
• HCAHPS: Patients Perspectives of Care Survey
• CMS: Readmissions Reduction Program
• Hospital Value Based Purchasing

What is particular relevant to healthcare providers at the moment are the 1557/ First Rule Regulations, the nondiscrimination provision of the Affordable Care Act, which were only recently passed, and implemented to go live October 2016. Rather than being a new set of rules, 1557 more or less serves to further codify existing regulations. Section 1557 requires covered entities, (Medicare/Medicaid participating hospitals, pharmacies, and health plans, etc.) to adhere to specific interpretation and translation requirements,and encourages them to develop a Language Access Plan. Non-compliance can include suspension or termination of federal funding, and individuals can sue in federal court and receive damages.

(LanguageLine's marketing department developed a one-pager cut sheet to try and simplify the requirements of the First Rule, and what can be done to meet those requirements. This has been attached for everyone’s reference and review, in addition to the full regulation document.)

Attached resources:

Manuel Lluberas Replied at 11:12 AM, 14 Nov 2016

No current automatic translator can replace good interpreter. What is needed in medicine is not a translation, but an interpreter.

Thomas Bauer Replied at 11:32 AM, 14 Nov 2016

As we move to all forms of meeting the needs of patients with limited proficiency in a country’s dominant language... how are meeting meeting their written education needs in just in time education. For example a discharge summary from the hospital?

Kathleen Addison Panelist Replied at 11:40 AM, 14 Nov 2016

Eugenia - thanks for clarifying!

Regarding interpretation and translation applications, I can tell you that while the solution is compelling, when it comes to providing medical care, the technology is not yetclose to being sophisticated enough.... It may be more easily justified to enhance non-medical conversations, the main arguments against using applications to facilitate medical conversations are:
1. Medical terminology alone is so utterly vast, there is not an app to date that offers a large enough medical vocabulary to support a comprehensive medical conversation in any one of the hundreds of medical specialties.
2. Context and nuance play such an important role in language, human touch is absolutely necessary to navigate the differences and limitations between languages.
3. Particularly in the case of providing healthcare services, a simple miscommunication can be life threatening....

If it helps to illustrate, I've attached a slide illustrating famous mis-translations that occurred because qualified professionals were not used. These are fairly humorous examples, but it is important to remember that in a healthcare setting, there is far more at stake, including a patients life.

Attached resource:

A/Prof. Terry HANNAN Replied at 2:53 PM, 14 Nov 2016

Here is an App that attempts to address poly lingual literacy in care. I has been posted on GHDonline previously but has expanded its functionality significantly.
Canopy Speak:

Kathleen Addison Panelist Replied at 3:21 PM, 14 Nov 2016

Tom - The best way to meet the written needs for patients is to engage a professional translator, or translation company, to translate the documents from the target language to English or vice-versa.

Discharges in particular tend to be one the more challenging obstacles to overcome for several reasons, since they are typically needed within a very short timeline. One suggestion is to have the most common discharge templates translated in one's top languages. In a majority of cases, about 80% of the information sent home with patients is standard and so can be pre-translated into a template, while only about 15-20% needs to be customized, which could be sent to a professional translator or vendor. This is certainly not set in stone, as much is still left up to circumstance and dependant on a myriad of factors. In this case as well, lead time would still be needed; it would be difficult to turn this kind of request around in say, 2 hours.

Alternatively, the next best suggestion is to utilize an onsite interpreters since he/ she can be in person to physically view the discharge instructions and work the provider to make sure everything is communicated properly. Even in this case however, it is recommended to have basic information which can be sent home with the patient.

Please let me know if this fully answers your question or if you'd like me to make any further commentary!

Thomas Bauer Replied at 3:26 PM, 14 Nov 2016

The average healthcare professional learns approximately 24,000 new words when entering our profession. Consequently, medical terminology can be considered a foreign language. Consequently, I always think of interpretation as the transfer of information across three languages as opposed to two. Given this complexity I think of interpreting not only as a skill but also an art.

Kathleen Addison Panelist Replied at 10:58 AM, 18 Nov 2016

Prof. Terry - I am actually quite familiar with Canopy and think it is a wonderfully interesting niche they are exploring at the moment! It's important to keep our ears to the ground on new technology as it develops, while keeping in mind that there are few things as complex, fluid and dynamic as language.... at this juncture, an app of that nature could be a tool if an interpreter is not available, but is extremely limited. The website itself suggests having live interpreter options available when the conversation supercedes the abilitiies of the app.

A/Prof. Terry HANNAN Replied at 2:46 PM, 18 Nov 2016

Kathleen, "niche" is the correct description. This discussion has lighted the complexity-technically and inter personal-of language interactions and interpretations. Thanks for the feedback

This Expert Panel is Archived.

This Expert Panel is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.