By Sarah Stockler-Rex, Interpreting Quality & Training Manager and Tatiana González-Cestari, PhD, CHITM, Director of Language Service Advocacy.

This piece is the fifth in a series, written by Cloudbreak Health’s quality, training and advocacy leaders, that discusses medical language access and related topics.

In our last installment, we discussed implications of providing telehealth and remote language services in tandem, as well as what telehealth providers and remote interpreters can learn about working together.

In this volume, we focus on what goes on behind-the-scenes to make a video remote interpreting (VRI) session possible.

The Tip of the VRI Iceberg

In a VRI session there are typically three main participants: the patient, the healthcare provider and the interpreter (Figure 1). These individuals are the key visible players, however there many more parties involved behind-the-scenes. In this volume, we will discuss what other essential elements support VRI and their importance.

Figure 1. 

Why is this important?

When a consultation is seamless, you don’t notice the time, effort, creativity and resources that go into a video remote interpretation. What you don’t see is a critical part of what makes an experience work. The VRI support system is vast. It’s important to recognize the innovative professionals who make remote interpretation possible. Additionally, all of these components offer many career path opportunities in the remote healthcare communication industry.

VRI may seem simple, but you need more than an interpreter and a camera to ensure quality, compliance, and effective language access.  For example, imagine you want to make a movie and all you have is a smart phone to record and your neighbor to act. You could certainly make a movie with these two components alone, but a professional crew, trained cast, high tech equipment, and professional lighting make a huge difference in quality.

Let’s look at what the equivalent elements are for VRI…

Below the Surface of VRI

There are a variety of moving pieces behind the VRI interaction. Below, we review the support systems for the interpreter, the healthcare organization, and the patients.

Interpreter support system

If a remote interpreter works for a language service organization (as an employee or contractor), they may have a support network (see Figure 2) composed of teams in charge of:

    1. Development, implementation and management of technology. This team makes a remote interaction possible, from managing a reliable HIPAA-compliant network, developing user-friendly interfaces to handling millions of pieces of data securely.
    2. Leadership, mentoring, and support of interpreters.
    3. Acquiring and managing accounts to engage true partnerships with customers, provide customer analytics and support (identifying needs, providing solutions and education while being transparent).
    4. Forecasting language needs based on patient population and ensuring adequate coverage while incorporating needed rest time for the remote interpreters.
    5. Monitoring, coaching, tracking, and reporting quality metrics based on remote interpreting best practices.
    6. Sharing compliments as well as investigating and resolving grievances related to the service.
    7. Training interpretersand other professionals to provide timely, high quality, and effective communication services. Education approaches should include initial and ongoing training.
    8. Promoting peer interaction for learning and support.
    9. Management and coordination of timely completion of all projects that support the service, from coordinating meetings and shipping equipment to fully activating services for thousands of users in multiple locations.

All other aspects of being an organization: accounting, human resources, communications, marketing, etc.

Figure 2.

It is important to note that if VRI services are provided by hospital staff or self-employed interpreters under a direct contract with the healthcare organization, all aspects mentioned in this section should be provided by the healthcare organization.

Healthcare organization support system

Figure 3 illustrates how healthcare organizations support VRI. Some of theaspects identified are:

  1. A language service department that manages, organizes, provides and evaluates language access solutions in all interpreting modalities; that safeguards language access compliance; that educates hospital staff on the importance of working with interpreters, how to work with them, and best practices on working with patients with limited English proficiency (in the case of the United States).
  2. An information technology department that develops, implements and manages the access and structure needed at the healthcare system level for remote interpreting services. This team is key in opening the “network gates” so to speak and adapting to the remote interpreting technology making communication between the organization and the remote interpreter possible.
  3. Healthcare personnel who complement the work done by the language service department in many aspects. For example, supporting effective communication through interpreters, learning and following best practices in language access, coordinating implementation or expansion of VRI services.
  4. Healthcare administrators and leaders who develop Language Access Plans which include VRI solutions, taking into consideration different clinical and operational needs of varying departments. This group allocates resources to support appropriate language access among other programs.

Figure 3.

Patient support system

Last but certainly not least, patients, relatives and caregivers need a support system in order to have access to VRI (see Figure 4). In the past, patients accessed VRI onsite in the healthcare facility with the interpreter connected via video. This still can be the case, of course, but we’re also seeing entirely remote telehealth encounters become more common. The patient support system may need to include a personal mobile device, tablet, or computer and an internet connection.

Figure 4.

Many people now own a smart telephone; however, in some instances, patients rely on relatives, friends or acquaintances to have access to VRI. In this case, these individuals are part of the patient’s support system. The equipment and internet connection needed are further supported by the companies that provide them.

Many individuals in the U.S. don’t have access to the technology needed due to various constraints, including socioeconomic, linguistic or other barriers. Everyday organizations, providers and patients present new innovations and solutions to address these obstacles.

Collaboration between support systems

It is common to see these support systems working separately but the best outcomes in VRI have been obtained when they interact with one another for effective communication (Figure 5).

Figure 5.

Some examples of having these teams collaborating successfully are:

    • the IT team of a language service organization setting up and problem solving with the IT team of a hospital
    • language access experts from hospitals and language access companies discussing or auditing the hospital’s language access plans
    • Users of the service communicating feedback to the language service’s Quality Assurance/Training teams to identify strengths and areas for development.
    • The healthcare organization’s development team working with the language service development team as well as other software developers to integrate patient care platforms (for telehealth as well as medical charting tools).
    • Healthcare providers engaging patient populations for training to overcome barriers to remote technologies and new remote processes.

As we have identified in this article, there are real people behind the scenes making real things happen and true partnership goes a long way when providing quality of care in multiple languages.