Improving Language Access for Limited-English-Proficient, Deaf, and Hard-of-Hearing Patients

By John Palmer

By some estimates, more than 25 million people living in the U.S. are considered limited-English-proficient (LEP) and may face significant language barriers when being treated by medical professionals.

Because of this, the use of medically qualified interpreters is being associated with improved clinical care for LEP patients. The problem is, if an on-site interpreter must be called every time there is a patient-provider language barrier, it can be pricey for providers and might delay care, particularly during emergencies.

With this in mind, several hospital systems and long-term care facilities across the country have started to implement electronic interpreter systems, called video remote interpreting (VRI) devices, in their health centers. This technology improves communication between patients and providers by immediately connecting clinicians with medically qualified interpreters; these interpreters can provide services for more than 200 languages, including American Sign Language (ASL), and they include Certified Deaf Interpreters (CDI). The technology can improve timely access to care for LEP, deaf, and hard-of-hearing patients.

“Using VRI provides tremendous benefits, especially living where we do in a metropolitan area in Illinois where 25% of our patient population is Spanish-speaking,” says Rosalinda Justiniano, patient advocate/language services coordinator for Rush-Copley Medical Center in Aurora, Illinois. “With VRI, we have access to all of our top languages 24 hours a day, seven days a week. The need for language services and the potential to use the service is always there. They are always available. Having a secondary resource available at all times is very helpful.”

Rush-Copley’s setup is rather simple. Equipment is leased for a monthly fee from Washington-based InDemand Interpreting. The system starts with a laptop mounted on a mobile cart and uses the hospital’s WiFi system to connect to the interpreters. Additional laptops can be used, and the service is also available on tablets and cell phones.

Of course, being WiFi-based, there is the question of whether the system can be hacked, if power outages can affect its operation, or if a spotty connection could hamper the service.

“The potential for poor connectivity is minimal with the company that we use, but with some vendors that could be an issue,” says Justiniano. “VRI is not always the best solution for every patient encounter. There are times when an on-site interpreter is preferred.”

As for a power outage, she says most hospitals have backup generators, so that should not be an issue. Also, most hospital systems have very strong firewalls, which helps address the question of cyberattacks.

“The responsibility really falls to each organization to ensure their security system is up and running appropriately,” Justiniano says. “I had to get authorization from our IT executive before we were able to upload onto the iPad. I think it’s definitely safe, but it is each organization’s responsibility to ensure firewalls are doing what they are supposed to be doing. We don’t store any patient information on our VRI devices. Conversations are not stored.”

Other health systems that have installed the VRI systems include Providence Health & Services, Banner Health, and Baylor Scott & White Health. At Nashville General Hospital in Tennessee, the experience has largely been positive.

“Our goal is to better serve our limited English proficient, deaf and hard of hearing patients, which is why we adopted video remote and over-the-phone interpreting services,” said Lilia Medina, manager of case management at Nashville General Hospital, in a published report. “Adoption of this new language access program enables us to continue to fulfill our mission to improve the health and wellness of Nashville by providing equitable access to coordinated patient-centered care and reinforces Nashville General Hospital as a leader in exceptional community healthcare ‘one neighbor at a time.’ ”

VRI in 25 languages is now available inside the emergency department at Baylor University Medical Center in Dallas, according to a report from NBCDFW-TV. Baylor uses portable video kiosks that can be wheeled into patient rooms. Within minutes, an interpreter is on the monitor, much like in a FaceTime call, talking with the patient and relaying his or her communication to the doctor.

“Bringing in an on-site interpreter usually takes two to four hours. Now, we are able to pull in the device in a matter of minutes and in seconds have an interpreter on the line,” said Joe Valenzuela, director of support services at Baylor University Medical Center.

According to the report, about a third of Dallas County residents speak Spanish, which is the most commonly used language for translation services. Valenzuela said growth in North Texas over the last five years has increased the need for more languages. Baylor currently has 30 portable kiosks and plans to add more.

“Two years ago, we had an influx of Burmese that came into the metroplex,” Valenzuela said. “American Sign Language was a little surprising. There’s such a huge need for certified American Sign Language interpreters. By using this device, we know that we are using a Certified Deaf Interpreter.”

Justiniano says her facility uses its VRI service along with an on-site interpreter in some cases, as the service includes ASL and CDI, which she says is a tremendous benefit. She says there have been patient encounters where the services of both a CDI interpreter and a Spanish interpreter were needed.

“There are times when an on-site interpreter is a much more appropriate means of communication,” she says. “For example, for end-of-life discussions or serious health conversations, it may be important to use a live, on-site interpreter.”

Justiniano says VRI is best used in the emergency department, the outpatient area, physical therapy, and most inpatient units, as well as in day surgery, where interpreters may be needed quickly.

“We are also expanding now even further to outpatient areas, and we just started using the application on laptops,” she says. “The demand is so high that we just continue to expand our usage, and we are now using it across the entire medical center.”

Rush-Copley has used VRI for the past two years, and Justiniano says there has been an increase in usage every month since its implementation.

“I do rounds on patients where we are using these services, and the feedback has been incredible,” she says. “When patients are able to not only hear an interpreter that speaks their native language, but also see them as well, you can just see this sigh of relief. Patients can maintain their sense of privacy and they don’t have to involve a friend or family member to interpret for them.”

The impact has been felt immediately, Justiniano says.

“I had an interpreter show up for an appointment who said she was a Spanish interpreter, but we needed an ASL interpreter, so the Spanish interpreter grabbed the VRI device to immediately connect the patient with an ASL interpreter,” she adds. “He almost cried because he was used to using his cell phone to interpret for him. He was so grateful that he was able to use a hands-free method of communication. Clinicians are also free to perform assessments using the VRI device and are not distracted by having to hold something up to interpret for the patient and provider.”

What are the costs associated with using VRI, and how does the service compare to using a human interpreter? Justiniano says with VRI, the hospital pays for the time it is actually using an interpreter. In comparison, the use of staff interpreters might create more opportunity for lost time due to intermittent patient needs.

“For us, we have peace of mind knowing that InDemand has credentialed, medically qualified interpreters that we know are solely focused on the medical industry,” she says. “We don’t have to ensure they have the qualifications because they are vetted, trained, and screened by the company. It is definitely a cost savings not paying for screening and credentialing of all the VRI interpreters we use.”

She notes that hiring contracted on-site vendors can be very costly. Typically, these on-site interpreters will require payment regardless of whether a patient shows up for an appointment; this could mean a minimum of two hours of work plus travel time even when an appointment is delayed or cancelled.

Overall, Justiniano says VRI is best utilized in places like the emergency department because that’s where an interpreter is needed very quickly to assess medical needs.

“The goal is not to delay care,” she says. “I would say it’s probably used differently in busy hospitals. In a long-term nursing facility, you might use it more for family members more than for the patient. In a hospital, it’s real-time usage for the patient, regardless of whether or not their family is present.”

John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at