Telehealth adoption has expanded rapidly in the last year, and with it, more and more organizations are building long-term digital strategies to better serve their populations. But instead of accessibility being included in initial strategies, it is often an afterthought or an add on. The reality is that while digital solutions can help overcome barriers to care, they can also stand in the way. Poor planning leads to poor results, and poorly considered accommodations do not appropriately span gaps in care. So how do we make the new normal of healthcare better serve all patients? Easy: put accessibility at the forefront of hospitals’ digital strategies, beginning with language access.
Video Remote Interpretation (VRI), or teleinterpretation, is often considered a separate service from telehealth. But VRI is telehealth. It is one of the foundational inventions of telehealth technology and a key component of any digital care strategy. Here’s why you should consider VRI as the cornerstone of any comprehensive digital healthcare strategy.
Language Access is the Law
The law requires language access as a reasonable accommodation in healthcare. Healthcare systems are to provide medical interpretation for any Limited English Proficient (LEP), Deaf, or hard of hearing patient who needs it, no matter how minor the interaction.
Languages access laws include:
- The Americans with Disabilities Act
- Executive Order 13166: Improving Access to Services for Persons with Limited English Proficiency
- Title VI, Civil Rights Act of 1964
- Department of Health and Human Services Regulations (45 CFR § 80.1, et seq.)
- Medicaid Managed Care Requirements (42 CFR § 438.10)
- Medicare Regulations for Medicare Advantage Program (42 CFR § 422.2264 & § 422.112)
In addition, several federal departments are dedicated to protecting accessibility and individual rights including the U.S. Department of Justice, Civil Rights Division, the Department of Health and Human Services, and the Office of Minority Health Directives.
Integration Requires Forethought
When implementing new technology, plan how it supports language access and other accessibility accommodations. Closed telehealth platforms that do not allow a third party to join a session make it nearly impossible for interpreters to be present digitally. Without reasonable interpretation access, these platforms aren’t compliant and don’t appropriately meet the needs of patients or providers. Failure to provide interpretation can result in poor patient outcomes, as well as penalties and fines for healthcare organizations. Telehealth regulation has already begun. We can expect that, post-pandemic, the standard HIPAA restrictions and accessibility requirements will likely apply to virtual care.
There’s no excuse for a platform’s failure to integrate with language access options. Video Remote Interpreting has existed for more than a decade and easily integrates with existing solutions. Telehealth platforms that don’t already include a language access option are likely incompatible with other accommodations as well, making digital solutions a hindrance rather than a help.
Communication is Key
Communication is the number one diagnostic tool for providers. Clear communication empowers patients to properly advocate for themselves. Additionally, patients who are invested in their own care are happier with their experience and more likely to experience better outcomes.
Karliner et al demonstrated that language access availability decreases readmission rates and hospital cost in the treatment of limited English proficiency (LEP) individuals. They note that “[c]omprehensive language access for Patients with LEP represents an important service that all medical centers should provide in order to achieve equitable, high quality healthcare for vulnerable LEP populations.”
And, 80% of HCAHPS scores are based on communication, demeanor, and understanding. Quality HCAHPS scores depend on consistent and clear communication. Language access ensures proper communication for LEP, Deaf, and hard of hearing patients.
Barriers to Care Cost Lives
18 months into this pandemic, I was the first person to explain to my patient who is deaf and experiencing homelessness what coronavirus is using an ASL interpreter. He agreed to get vaccinated immediately.
— Abhi Kole, MD, PhD (@DrDrAbhiKole) August 25, 2021
The COVID-19 pandemic further highlights pre-existing inequities in our healthcare system. COVID-19 disproportionately impacts minority communities both economically and in their health, resulting in preventable death. The pandemic has proven again and again that communities with less economic power are more likely to be impacted, that LEP communities tend to be less informed about the virus, and that BIPOC communities are disproportionately impacted with illness and death compared to the larger population. It is the healthcare industry’s responsibility to provide the most accessible care possible and providing language access is the bare minimum.
Similarly, information and education are only meaningful if they’re accessible to their audience. Most public health information disseminated about the pandemic is provided digitally, in English. Many communities struggle to access this information – either because they cannot read English or they lack digital literacy (or both). As important as digital solutions are, care and information need to be made accessible in various ways, like visiting community centers and places of worship that serve as gathering places for impacted communities. Community outreach can easily include Virtual Remote Interpretation to assist with educational efforts, via mobile apps and portable devices.
“Patients don’t have the information they need to take preventative measures and protect themselves from infection. They don’t know what the symptoms of COVID-19 are, where to go for testing or how to access the health care system when they need it. Without interpreters, they can’t understand what their doctors and nurses are telling them, and they can’t make informed decisions about their own medical care.”Dr. Margarita Alegria, Language barriers can mean life or death in fight against coronavirus
Interpretation is Already Digital
The new shift in healthcare centers around one core idea: delivering care to the patient where they are. And that care should be as comprehensive, compassionate, and accessible as care provided onsite. Language access is thriving in the digital space, with Video Remote Interpretation (VRI) that easily integrates with existing telehealth, electronic health record, and patient experience platforms. Now, we must make sure it’s built into healthcare providers’ digital strategy, ensuring
42 CFR part 438 — managed care. 42 CFR Part 438 — Managed Care. (n.d.). Retrieved October 1, 2021, from https://www.ecfr.gov/cgi-bin/text-idx?SID=36300623aa362eae90c0a7d206c0140d&mc=true&node=pt42.4.438&rgn=div5#se42.4.438_1100.
Executive order 13166. The United States Department of Justice. (2021, August 31). Retrieved October 1, 2021, from https://www.justice.gov/crt/executive-order-13166.
Jain, P. (2021, May 28). Council post: How digital technology can increase diversity, equity and inclusion in Medical Research. Forbes. Retrieved October 1, 2021, from https://www.forbes.com/sites/forbestechcouncil/2021/05/12/how-digital-technology-can-increase-diversity-equity-and-inclusion-in-medical-research/?sh=3794dd6d2f7a.
Legal Information Institute. (n.d.). 42 CFR § 422.112 – access to services. Legal Information Institute. Retrieved October 1, 2021, from https://www.law.cornell.edu/cfr/text/42/422.112.
Simon, M. (2020, April 23). Language barriers can mean life or death in fight against coronavirus. The Hill. Retrieved October 1, 2021, from https://thehill.com/changing-america/opinion/494284-isolated-with-no-family-members-for-non-english-speakers-with.
Title VI, Civil Rights Act of 1964. United States Department of Labor. (n.d.). Retrieved October 1, 2021, from https://www.dol.gov/agencies/oasam/regulatory/statutes/title-vi-civil-rights-act-of-1964#:~:text=No%20person%20in%20the%20United,activity%20receiving%20Federal%20financial%20assistance.