Better patient care through video interpretation: a New Jersey hospital uses teleconferencing tools and interpreters to break down patient language and hearing barriers.

Clear verbal and visual communications between physician and patient is the first step in compassionate and effective healthcare. With the ever-increasing percentage of non-English speaking patients as well as patients who are deaf or hard of hearing, video-based technology may be a single effective solution to a broad-based challenge.

This communication challenge came to the forefront for us at Holy Name Hospital in Teaneck, N. J., where we treat a high percentage of non-English speaking as well as deaf and hard of hearing patients. While interpreters have been extensively used in the past, the hospital's healthcare professionals required interpretation services for 46 different languages as well as American Sign Language (ASL) interpreters in one 2-year period.

Challenges in Past Communication Methods

Historically, a family member or an available staff member served as interpreter between a patient and staff. In most cases, however, family members are not medically trained and they don't always comprehend the magnitude of the patient's medical complaints. The obvious challenges were an inaccurate interpretation from the transposition of words, misinterpretations or even harm to the patient due to the interpreter's feelings toward the patient.

Serving as an interpreter also disrupts a family member's life since he or she must be present much of the time to make the patient feel comfortable about care and personal needs. Patient confidentiality becomes an issue when a family member is directly involved with the interpretation process while using a non-clinical staff member can produce similar concerns.

In the early 1980s, a new method of interpretation emerged that uses a centralized group of interpreters accessed by a telephone. This remains the mainstay of nearly all interpretations handled today in the United States. When an interpreter is needed, the hospital brings a telephone with two receivers to the patient. The patient takes one receiver, the clinician takes the other, and a call is then placed to the off-site interpreter.

While this proved a major breakthrough at the time, interpretation concepts have not kept up with the profound advances in medicine, thereby triggering a wider gap in patient communication. The amount of information given to or requested by a patient also has increased. Interpreters often wondered if the patient on the other phone receiver shaking his or her head up and down during the interpretation really understood what was being said to them.

During the past quarter century, deaf or hard of hearing patients have relied on trained sign language interpreters who work onsite. However, ASL interpreters are seldom available in the hospital when needed, and the 2-hour minimums, mileage and high fees make it prohibitive for hospitals to use them as frequently as the need arises.

Delays in service occurred while waiting to find interpreters for these patients, many of whom had to wait for assistance and frequently became confused by not being able to see the interpreter and express understanding. This often resulted in a frustrating game of charades between hospital personnel and patients in what often can be an emotional situation. Holy Name Hospital needed to find a better solution for patients, visitors and staff that would free everyone from language barriers in the most effective and expeditious manner.

Better Interpretation Through Video

Through analysis of current and cutting-edge technology, Holy Name Hospital made the commitment to be pioneers in the field of interpretation services through video communications. Commonly referred to as videoconferencing, the application brings live video-based non-English and ASL interpretations into the hospital, thereby raising the quality and quantity of interpretations.

To succeed, the video system had to be reliable, secure and available when needed. The hospital envisioned a one-stop interpretation solution that was accessible, simple to use and so popular with patients and staff that it would be used extensively. To accomplish this, the solution had to offer:

* On-demand non-English and ASL interpretation;

* One device to handle all interpretations;

* High-quality picture and sound for the patient and the interpreter at the other end;

* Encrypted transmission for HIPAA compliance;

* Ease of use;

* Accessibility;

* Interpretation by "medically trained" interpreters;

* Cost effectiveness;

* Staff training.

In late 2003, the hospital began its search for an interpretation system by exploring several language vendors and many interpretation solutions that met our criteria. Several of these systems were tested live in our facility and then analyzed for effectiveness before deciding to partner with an interpreter-services company and a technology vendor.

Ultimately, Holy Name Hospital chose Language Line Services of Monterey, Calif. to provide interpretation services due to its experience in the field, medically trained interpreters in more than 150 different languages and around-the-clock service from call centers throughout the U.S. For the video communication system, the hospital chose the TANDBERG 1000 MXP system, based on the company's reputation, the system's ease of use and its flexibility.

Criteria for Effective Video Interpretation

To bring the power of visual cues to the interpretation, it is critical that the technology be accessible anywhere, simple to use and easily manageable. To achieve this, Holy Name Hospital established the following criteria for the video solution:

* A minimum of a 12.1-inch liquid crystal display (LCD) screen to provide

a large-enough display to see the interpreter clearly;

* Integrated speakers, microphone, camera and screen with minimal wires to keep it simple for front-line users such as nurses, physicians and clinical staff;

* The ability to connect to other devices at 768 kilobits-per-second for smoother picture and enhanced audio, which is especially important for sign-language interpretations;

* Wireless capabilities would be needed for flexibility and the ability to leverage existing wireless networks;

* Built-in AES/DES secret-key encryption to meet HIPAA privacy requirements.

* An H.264 video compression standard for broadcast quality video;

* High-resolution video to ensure that all facial, lip and hand movement is seen in order to provide an accurate interpretation. By reading a patient's movements, an interpreter can determine if the message was understood and doesn't have to rely solely on a "yes" or "no" response;

* An auto-answer functionality to make the device as easy to use as possible by giving it a plug-and-play experience.

In addition to facilitating better care, the visual cues and lower cost of video interpretation have a huge financial impact. Video interpretation costs average about $3 per-minute while current telephone-interpretation charges range from $2.20 to $3.00 per-minute. However, it was clear to us that a well-informed patient is more likely to cooperate with treatment and get dismissed more quickly because they recover faster.

Results for Holy Name and Other Providers

By instituting the video interpretation system, Holy Name Hospital is able to guarantee a rapid response to every call for a skilled and "medically" trained interpreter. The typical 5-minute to 10-minute length of an interpretation helped realize large financial savings by not employing live interpreters with huge financial guarantees. This ultimately raised our level of patient care by freeing staff to concentrate on patient care rather than interpretations.

Ultimately, the most important benefit from video interpretation has been the welcome responses from patients and family members who use the technology. Instead of being delayed due to a language barrier, our patients feel that the hospital has a sense of urgency in meeting their language needs. Patients feel at ease with the interpreter on the screen and easily communicate to hospital healthcare professionals. They no longer have to search for words and can also point to areas that hurt without having to give verbal explanations.

Since the wireless video system is very transportable, other institutions can follow Holy Name Hospital's model and easily effect positive patient-care changes. Most institutions already have in place in-house networks, as well as the wireless resources needed for the transmissions, so the video interpretation system can be easily implemented by closely working with IT staff.

The Future of Interpretation

Video interpretation on demand at the bedside in every patient room is the next step for Holy Name Hospital. This can be accomplished by integrating it with the hospital's in-room monitors, which are already being used for Internet, e-mail, TV, Movies on Demand, games and accessing clinical data. Additionally, Holy Name is beginning to work on using the video technology in the field so that paramedics and EMTs have the same ability to use video interpretation at the scene of an accident or disaster.

For more information on TANDBERG, www.rsleads.com/703ht-2004

Jonathan Hirsch (left) is director of guest services and patient advocate, and Frank Marano is system administrator, information systems at Holy Name Hospital in Teaneck, N.J. Contact them at [e-mail] and [e-mail].