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Translation technology fills important niche
Computers supplement interpreters, phone lines
Emergency health care experts agree that the ideal way to enhance treatment of patients who do not speak English or who are hearing impaired is a live interpreter, and indeed, many EDs do offer such a service. However, these individuals, and even telephonic translation services, are not always available immediately in an emergent situation, when time is of the essence.
A growing number of EDs have found they can make translation services immediately available to these patients through technology. Several vendors now provide software systems that can be accessed via a laptop, and they provide two-way interpretation between the provider and the patient.
One such vendor is Medbridge Systems, which has offices in Boston and Canada. Medbridge, whose system has been in use in hospitals since 2002, now is in 26 EDs, according to Beth Webster, vice president of business development. A newer entrant in the market, Denver-based VoiceBot, is just beginning to market its product.
Another recent entry is Language Line HealthPort, designed by principals of Polyglot Systems, a Morrisville, NC-based firm that has been in this market for several years, and released with Monterey, CA-based Language Line Services.
How systems work
The Medbridge and Polyglot software enable several kinds of communication: text, audio and video. The VoiceBot system uses text and audio.
"When the patient comes into the ED at triage, first thing you do is identify their language, by asking the patient or showing them phrases in different languages," explains Webster. "Once you've done that, you can immediately go through quick registration and then triage." Through a series of questions and responses, the provider can determine the patient's main complaint, explain the treatment, and so forth.
To serve the hearing-impaired, the Medbridge system employs videos, with an interpreter signing the questions and answers. (Editor's note: You can view a demonstration of VoiceBot by going to www.univg.com/demo. A Medbridge demo is available by contacting Webster.
"You are able to immediately interact with the patient," says Webster. "Just knowing they can hear that voice in their language is calming to the patient, and releases stress for the health professional as well."
Since it is important these messages be delivered correctly, VoiceBot uses only native-language speakers, says president Bob Priddy. "We can do it in any dialect," he says. While at present the system only employs Spanish; by July, it will have the most common six non-English languages; in addition to Spanish, they are Mandarin, Cantonese, Vietnamese, Arabic, and Russian. Priddy says his firm has trademarked the term "e-terpretation" to identify its technology.
These systems are of greatest value on nights and weekends, when the availability of an interpreter is not as great, Webster says. Debbie Fleischmann, MPA, RN, CNAA, BC, administrative director of emergency services at Howard County General Hospital in Columbia, MD, agrees. "While we are part of the Johns Hopkins Medicine system and do have access to contracted services — with one call to a central number we can request an interpreter to come on site — we also use AT&T's Language Line as another means of providing services. Both of those can take a little bit time to put together," says Fleischmann, explaining why her department is starting to pilot the Medbridge system. "We felt strongly that in order to improve care, we wanted to be able to help patients immediately. "The AT&T Language Line is a joint venture with Language Line Services. It involves dialing (800) 528-5888, asking for the language you want, and having a live translator come on the line to speak one of 70 languages."
Costs can vary
Depending on the type of system you want, the investment can be significant. For example, Medbridge will let you purchase a one-time license for unlimited use, or pay on a monthly basis for 36 months. The unlimited use arrangement costs $48,675 for a facility of fewer than 200 beds; $98,675 for a facility of more than 200 beds but fewer than 400; and $135,675 if your facility has more than 500 beds. However, says Webster, the monthly fee for a midsized facility would be about $3,741.
Priddy says his system "maxes out" at $4,000 for a hospital with 1,251 FTEs or more, with a small hospital paying as little as $1,000. "We would prorate the cost to a single department," adds Priddy, asserting that "the system will pay for itself in a matter of hours." An ED, he says, can calculate return on investment based primarily on three factors:
These costs do not have to come out of your department's pocket, notes Fleishmann. "We got a grant from a local foundation whose goals are to improve quality of life and access to health care," she says. "They do a needs assessment in our community and set strategic goals each year; this year it was improving health care access information for non-English speakers."
Underscoring the basis of her decision, Fleischmann says, "We were really intrigued by the possibilities it could offer us for the immediacy of need that occurs in the ED. What does that nurse do out in triage that has a patient arrive who has limited English proficiency, and needs to find out information right now?"
For more information on translation technology, contact:
For additional information on translation technology, contact: