Harborview Medical Center

1. Harborview Medical Center Video Remote Interpreting Call Center What we have learned in our first few years of operation Eliana Lobo – Trainer & Supervisor, Interpreter Services Harborview Medical Center

2. 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

3. 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

4. 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 Telephonic Interpreting Benefits experienced Concerns

5. Grand Total: All Interpreted Encounters by fiscal year

6. Agency Sign Language Agency STEL VMI-Spanish Agency TEL HMC Staff (HMC Spanish telephonic) VMI-Somali Total of all Interpreted Encounters: by modality FY05/06 FY06/07 FY07/08 FY08/09 FY09/10 FY10/11

7. VMI/VRI Video Medical Interpretation or Video Remote Interpretation is referred to by different acronyms. Basically, what is it? • 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

8. 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 • Susquehanna Health System, PA • Temple University Health System, PA • UC-Davis Medical Center, CA • UCSF Medical Center, CA

9. 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

10. 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

11. 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…

12. VMI rollout is a strategic planning issue • The centerpiece being, how to secure the core asset (trained interpreters) over time • The keystone being, 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

13. 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?

14. 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

16. Two Spanish and One Somali interpreter on each shift