Telehealth visits increased dramatically at Mount Sinai Health System during the pandemic. Patients with limited English proficiency (LEP) found themselves at a disadvantage when it came to receiving equal access to services because of the language barrier, according to a report in Healthcare IT News.
As we have previously reported, telehealth platforms were not originally set up with limited-English speakers in mind. Mount Sinai's patient population in New York City is perhaps the most diverse in the nation, serving more than 200 languages.
"Our pool of in-house interpreters is limited; it only covers a few languages," Silvina de la Iglesia, associate director of language assistance at Mount Sinai Hospital, told Healthcare IT News. "As a health system, we rely primarily on phone and video interpreter vendors to cover the demand.
"One of the most challenging problems we faced was not having interpretation services integrated into the different telehealth platforms that were being used. Each platform offered different capabilities for three-way communication, and we needed to explore which one would work best for our patients. We chose to tackle Epic/MyChart in the first place and work in partnership with our language vendor, LanguageLine Solutions(R)."
On the platform, an invitation to join an appointment could only be pushed via email or text message in real time. This was possible when arranging the meeting with a staff interpreter, but not with LanguageLine’s phone or video interpreters, as those linguists operate on an on-demand basis.
"Providers were initially calling LanguageLine and placing the interpreter on speakerphone or holding cell phones in their hands and hoping that the video platform would pick up the sound," de la Iglesia said. "This was a very frustrating experience for providers and patients as the audio quality was poor, with lots of residual noise and echo on the line."
According to Healthcare IT, LanguageLine video visits are heavily utilized at Mount Sinai and are a great option for patients who do not want to come into the office. Video interpreters can be accessed via a mobile app or on a computer with a webcam.
"Our in-house interpreters could be invited to and join a video interaction with our patients using the existing platform," said Natalya Sholomyansky, IT Director for Digital Health at Mount Sinai. "However, external vendors that supplement could not leverage this workflow or join video visits. Providers could only access those external LanguageLine interpreters by dialing out to an 800 number, a capability that did not exist in the video visit platform. This left only the in-house language interpreters able to support patients who needed them during the video visit."
Mount Sinai turned to Caregility for help. Caregility offered the option for the provider to dial a phone number to LanguageLine and have the external vendor join the video visit with audio.
"Our providers and non-English-speaking patients needed instant, seamless access to language interpreters to communicate effectively," de la Iglesia said. "LanguageLine has a pool of more than 20,000 interpreters in more than 240 languages operating 24-7. Caregility offered the option for the provider initiating the encounter on the telehealth platform to dial out to a toll-free number to connect with LanguageLine within seconds."
Mount Sinai leveraged this capability by building a call-routing architecture behind the scenes. With the help of LanguageLine, the provider organization created dedicated toll-free telephone lines for the top five languages – Spanish, Mandarin, Cantonese, Russian and Bengali – and another one for the remaining languages. The dedicated telephone lines are answered directly by interpreters, reducing the connectivity time to less than 10 seconds.
This new solution went live on October 26, 2020, with the more robust integration features. Mount Sinai expanded utilization 100-fold in three days.
The IT teams from Mount Sinai, Language Line, and Caregility worked together to place the patient at the center of this initiative and find solutions to address the language and technology barriers, de la Iglesia said. The focus was to find a solution for Epic/MyChart, the telehealth platform most widely used by the health system for ambulatory services.
"We achieved integration of interpretation service into the platform via audio in a very short period of time and with minimal testing," she said. "The sound quality has greatly improved as it comes from a single source.
"The most important feature to highlight is that it is provider- and patient-friendly. The provider simply clicks on the ‘Add Interpreter’ button and selects a desired language. The patient can receive the link on any mobile device and simply click on ‘Begin Encounter’ to join. Once on the encounter, the patient can see the provider on the screen but only hear the interpreter, which fosters a more direct patient-provider rapport supported by the invisibility of the interpreter."
According to Healthcare IT, from the time Mount Sinai implemented the solution through early June, more than 600 telemedicine encounters took place using the ‘Add Interpreter’ button. To ensure the health system was going in the right direction, it surveyed non-English-speaking patients and obtained feedback from providers using the service.
"Some quality metrics that indicated success were connectivity time, audio quality, ability to understand the interpreter and availability of interpreters," de la Iglesia said.
"We also identified some opportunities for improvement, like educating providers to add the interpreter before the patient joins an encounter. Patients reported they feel more welcome when they are greeted in their preferred language. A total of 88 percent of surveyed patients would recommend telehealth services to family and friends."
Advice for Others
The ability to have a third party join a telehealth session in general is an important one, Sholomyansky said.
"And as with all technology and use-cases, rarely is there a one-size-fits-all solution," she noted. "It is important, whether interpreters or caregivers, to have as many options as possible for flexible technology to allow another party to join."
From the language access and patient experience perspective, de la Iglesia would encourage stakeholders to work together, in a creative and agile manner, and explore all possibilities the telehealth platform offers. Oftentimes, it does not require a lot of financial investment or bringing a completely new vendor into the picture, she said.
"Knowing the different communication needs of the patient population your hospital or health system serves also will provide great guidance to build a roadmap," she said. "When we first launched this technology solution as audio, we assumed our patients expected to see the interpreters on video; however, 86% of the surveyed patients indicated satisfaction with audio interpreting as it is.
"Providers also reported that seeing an interpreter on the screen could be very distracting," she said. "Video is imperative for patients who are deaf and/or hard of hearing, but not for spoken languages. Patients are driving the way we deliver healthcare, and we need to keep them engaged when implementing solutions."
This case study was first reported by Healthcare IT News.