By Sarah Stockler-Rex, Interpreting Quality & Training Manager and Tatiana González-Cestari, PhD, CHITM, Director of Language Service Advocacy.
This piece is the fourth in a series, written by Cloudbreak Health’s quality, training, and advocacy leaders, that discusses medical language access, video remote interpreting, and related topics.
In our last installment, we discussed what interpreters need for general setup and preparation to deliver a quality Video Remote Interpreting (VRI) experience. In this volume, we focus on the implications of providing telehealth and language services in tandem, as well as what telehealth providers and remote interpreters can learn about working together.
At Cloudbreak Health, we have been developing platforms for remote interpreting, telehealth, and their intersection for many years. We were ready to face the challenges of the global shift to telehealth catalyzed by the COVID-19 pandemic. Our experience has also enabled us to help healthcare team members (like interpreters, doctors, nurses, chaplains, technicians and other healthcare staff) that have not previously worked in a remote environment.
In the spirit of serving our community, we are happy to share our experiences providing unified telemedicine with integrated language services. Below we include tips for both healthcare providers and interpreters who may be new to navigating remote interpretation.
Interacting remotely with patients needing health care in a language other than English is only going to become more frequent. The following guidelines for these interactions are based on both our own and others’ experiences with multiple technologies on the market. The technology available will continue to evolve, but there are intrinsic aspects of effective communication that need to be maintained no matter the platform or experience.
Providing telehealth and language services
There are many telehealth solutions on the market; however, many lack language service integration and as such, alienate a large percentage of the patient population. This is a concern across the industry and is one of the many reasons we, as well as others, advocate for the integration of language services in telehealth platforms (DaMassa 2020, Mar 25; Marking 2020, April 3; Found in Translation 2020, Jan 21).
Using telehealth and language service platforms in a way they were not necessarily designed to be used could pose security/exposure risks to users. Improper language service use includes two separate video units in a single patient room or dialing out to an interpreter line from a platform that does not allow language service integrations. These setups are also typically not ideal for effective, accurate interpretation.
Interpreters and providers working together in a telehealth consult
As we mentioned above, having language services as part of a telehealth solution is imperative in order to serve as many patients as possible. How those remote interpreter interactions are conducted, however, is also vital for the success of the session and better outcomes.
There are many best practices resources for performing a telehealth session, but they often don’t include working with an interpreter who is also remote.
Here are some guidelines for interpreters and providers working together in a telehealth consult. These guidelines were developed based on our own interpreters’ experience and feedback from our quality assurance team.
- If working with a team of providers, select one as moderator for the call. This ensures not all participants are speaking/signing at the same time.
- Interoperability of platforms does not mean that each user has the same controls or views of each other. For example, the instructions you give an interpreter to pause video for patient privacy may not apply. The settings/controls could look different on their end.
- Patients may join the session with their device from any place (private or not). Asking them if they can move to a more private area can help in many ways (privacy, audibility, appropriate setting to receive bad news, etc.).
- Interpreters and users that sign need to see each other at all times—this means the videos cannot toggle between active speakers but must remain fixed (gallery view may work based on the number of participants in the interaction. Another consideration to keep in mind “Is the video size adequate for Deaf/Hard of Hearing consumers?”).
- If you would like a spoken language interpreter to disable the video at any time during the session, confirm that they are able to do so before proceeding.
- Patients may need to be guided on navigating the platform (e.g. unmute or mute audio/video feed, reposition themselves within view, etc.).
- Audio issues can happen in telehealth, in remote interpreting, and when these two are combined, and not just because of connection issues. Be patient and take turns.
- It is even more vital to pay attention to your patient’s and interpreter’s tone of voice during remote sessions as you will not have all the visual cues.
- Interpreters may sometimes need something to be repeated or clarified, like any member of your care team.
- Give a pre-session or briefing like you normally would.
- Remind each party to please speak one at a time. Someone from the providers’ side may be moderating the session, ensuring that participants are not speaking at the same time.
- Just like in any VRI session, if you are not be able to see what the patient is doing, request repositioning of the camera or device.
- Interoperability of platforms does not mean that each user has the same controls or views of each other. You may be giving or receiving certain instructions and the settings/controls could look different on the participants’ end.
- You may interpret an informed consent for telehealth services. This may be new to you and it is an important part of the session. We have dedicated the following section to telehealth consent.
Interpreting the telehealth consent
When working in telehealth, you will likely interpret telehealth consent: the patient agreeing to use these services to deliver healthcare while acknowledging possible gaps in the medium. There may be additional implications and explanations needed from the provider when a patient declines video or is only able to join with audio as seen in the example below.
The patient has been advised of the potential risks and limitations of this mode of treatment (including but not limited to the absence of in-person examination) and has agreed to be treated in a remote fashion in spite of them.
Explanation of this consent may be provided verbally but, if for some reason a written consent is required, the American Telemedicine Association (ATA) states that “ […] electronic signatures, assuming these are allowed in the relevant jurisdiction, may be used. The provider shall document the provision of consent in the medical record.”
The following guidelines for video-based online mental services from the ATA, which are applicable to telehealth consents in other medical specialties, state that:
“The consent should include all information contained in the consent process for in-person care including discussion of the structure and timing of services, record keeping, scheduling, privacy, potential risks, confidentiality, mandatory reporting, and billing. In addition, the informed consent process should include information specific to the nature of videoconferencing as described below. The information shall be provided in language that can be easily understood by the patient. This is particularly important when discussing technical issues like encryption or the potential for technical failure.
Key topics that shall be reviewed include: confidentiality and the limits to confidentiality in electronic communication; an agreed upon emergency plan, particularly for patients in settings without clinical staff immediately available; process by which patient information will be documented and stored; the potential for technical failure, procedures for coordination of care with other professionals; a protocol for contact between sessions; and conditions under which telemental health services may be terminated and a referral made to in-person care.”
Solutions like telehealth will continue to grow. Together, we can work to provide telehealth integrated language services in the best way possible.
References and Resources
DaMassa, J. (2020, Mar 25) Telehealth Startup CEO On How COVID-19 Is Changing Telemedicine Use In Hospitals. Retrieved from The Health Care Blog, WTF Health website: https://thehealthcareblog.com/blog/2020/03/25/telehealth-startup-ceo-on-how-covid-19-is-changing-telemedicine-use-in-hospitals-wtf-health/
Marking, M. (2020, April 3). Interpreting Providers React to US Medicare Telehealth Expansion. Retrieved from Slator, Demand Drivers website: https://slator.com/demand-drivers/interpreting-providers-react-to-us-medicare-telehealth-expansion/
Martti’s QA Handout on Interpreting Telehealth Informed Consent.
Found in Translation (2020, Jan 21). Retrieved from StartUp Health website: https://healthtransformer.co/found-in-translation-76283132389f