For years, providers have utilized translation service technology with the aim of increasing patient trust and complying with federal regulations.
While digital health companies offer potential avenues in this area, experts say a business plan and technology won’t create the inroads required to build trust with non-English speakers.
“There is a lot that technology is going to be able to do,” said Dr. Casey Lion, associate professor of pediatrics at the University of Washington School of Medicine. “But I don’t think that technology will ever replace humans in bridging the language divide.”
Health systems have long touted the ability to translate for non-English speakers, but the pandemic showed how ill prepared many were to use technology for this service. In April 2020, when most appointments transitioned to telehealth, non-English speakers’ patient-provider relationships suffered, experts said.
Dr. Robert Bart, chief medical information officer at the University of Pittsburgh Medical Center said the health system faced challenges integrating translation services into telehealth platforms.
“We worked so hard to decrease in-person barriers to care, we didn’t want to recreate those in virtual care,” Bart said. He said it took around six months for virtual care platforms to integrate with translators without significant interruption.
Bart said there were few, reliable technological solutions for virtual care that didn’t subject patients and their providers to delays. He said many telehealth platforms were not programmed to support translation services.
“There was never a question of whether we were going to spend the money or not,” Bart said. “It broadens the opportunities for true access to care. You have to engage patients and families.”
Now that the technology has caught up, Bart said it is a relatively simple plug and play solution for providers. As the space becomes more saturated, companies will look for competitive advantages to stand out.
Last month, Jeenie, a virtual translation service company, said it was partnering with Zoom, the popular videoconferencing app, to allow providers and patients to install an app connecting translators to an existing call.
“This decentralizing of medical [care] that we’re seeing right now, the push towards more ambulatory services, all of that is going to require more interpreting in the field,” said Kirsten Brecht Baker, CEO and co-founder of Jeenie.
Barriers still remain
Most experts agree the technological barriers are largely removed, but the problems that remain could be more difficult to solve. Dr. Jason Espinoza, an associate professor of clinical pediatrics at Riley Hospital Children in Indianapolis said translation and communication platforms can be great tools, but providers should be better trained on how to use them.
“I think there needs to be appropriate trainings,” said Espinoza, who identifies as Mexican American and speaks Spanish. “I don’t want to just sit this iPad in front of you and have this [other] person communicate. I want to be able to look my patients in the eye, have a face-to-face conversation and utilize the interpreter in that way.”
While the overall ease of access has improved, health systems and other organizations must get buy-in both from individual physicians and leadership.
Despite the fact the Affordable Care Act and Civil Rights Act of 1964 require that providers offer translation services, barriers persist at the institutional level. Lion cited clinician wait times, knowledge and access to equipment all play a role. She and Espinoza agree most providers prefer in-person interpreters.
However, they’re not always available in emergent situations or for less common languages. In those situations, video is preferred and offers a potential path forward.
Patients prefer in-person interpreters as well, according to a study from researchers at Boston University School of Medicine. Patients who had telehealth interpretation services reported significantly lower satisfaction scores than those who used in-person services or family members.
Lion’s research focuses on how to leverage existing technologies for patients speaking a language other than English. She’s found easing access and encouraging individual providers to leverage the technology helps, but it’s also important to rethink who initiates the conversation.
“Currently most interpreter use is clinician driven, so we enter the room, and we decide whether we're going to access the interpreter or not,” Lion said. “There's a lot of opportunity to find ways to empower patients to actually initiate the interpreter connection themselves.”