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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 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 more than 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 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 Telephonic Interpreting Benefits experienced Concerns 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 Grand Total: All Interpreted Encounters by fiscal year 125,000 120,000 115,000 110,000 105,000 100,000 95,000 90,000 85,000 80,000 75,000 70,000 65,000 60,000 55,000 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 115,441 117,587 121,000 107,660 93,921 FY05/06 97,854 FY06/07 FY07/08 FY08/09 FY09/10 FY10/11 Total of all Interpreted Encounters: by modality 65,000 FY05/06 FY06/07 58,238 59,450 60,000 FY07/08 FY08/09 FY09/10 FY10/11 59,938 58,150 58,096 54,113 55,000 50,000 45,290 45,000 40,000 38,026 35,000 29,876 30,000 26,064 25,000 22,317 20,000 18,138 16,842 15,432 15,000 16,528 12,827 7,509 2,634 1,314 8,174 2,763 Ag e ncy Age ncy Age ncy Te le VM I- S pan VM I-S o ma HM CS t aff FY11 - 1,095 Si gn Ag e ncy Age n cy Age ncy Te le VM I- S pan VM I-S o ma HM CS t aff FY09 - Si gn - 2,376 9,983 Ag e ncy Age ncy Age ncy Te le VM I- S pan VM I-S o ma HM CS t aff FY10 1,775 Age ncy Age ncy Te le STE L HM CS t aff FY07 Age ncy Age ncy Te le STE L HM CS t aff FY06 - 6,790 5,308 3,260 3,409 Age ncy Age ncy Te le STE L HM CS t aff FY08 5,000 8,385 Si gn 10,000 Agency Sign Language Agency STEL VMI-Spanish Agency TEL HMC Staff (HMC Spanish telephonic) VMI-Somali 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 realtime 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 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 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 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 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… 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 inhouse or outsourced Pros and Cons exist with both approaches depending upon the size, location and affiliation of the institution in question 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? 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 Two Spanish and One Somali interpreter on each shift