Harborview Medical Center
Video Remote Interpreting Call Center
What we have learned in our first few years of operation
Eliana Lobo – Trainer & Supervisor, Interpreter Services
Harborview Medical Center
Harborview Medical Center

1 in 6 patients are limited English proficient (LEP)
or deaf – Nearly 7,000 patients every month
LEP patients/family members communicate in more
than 90 languages and dialects, including ASL
47 Employee interpreters for 25 languages
 Employee interpreters for both onsite and remote
(telephonic and video)
6 agencies give us access to over 100 languages
91% LEP patients reached
430-450 encounters/day

41% interpreting by telephone/video





On-site interpreting is prioritized for:

Sharing bad news / worsening health condition

Family conferences

Speech therapy / neuropsych testing

Conscious sedation procedures

Hands on teaching

Situations requiring delicate or complex
cultural brokering
Telephonic Interpreting
Benefits experienced




Concerns
Easy to access

Timely
(no need to pre-schedule)

Less invasive = more
privacy for patients

Wider range of languages
available (especially rare
languages and dialects)

In-person interpretation
puts patients more at ease
Loss of non-verbal/subtle
communication
Discussing difficult topics:
end of life, organ donation
More challenging to check
for understanding
Grand Total: All Interpreted Encounters
by fiscal year
125,000
120,000
115,000
110,000
105,000
100,000
95,000
90,000
85,000
80,000
75,000
70,000
65,000
60,000
55,000
50,000
45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
115,441
117,587
121,000
107,660
93,921
FY05/06
97,854
FY06/07
FY07/08
FY08/09
FY09/10
FY10/11
Total of all Interpreted Encounters:
by modality
65,000
FY05/06
FY06/07
58,238
59,450
60,000
FY07/08
FY08/09
FY09/10
FY10/11
59,938
58,150
58,096
54,113
55,000
50,000
45,290
45,000
40,000
38,026
35,000
29,876
30,000
26,064
25,000
22,317
20,000
18,138
16,842
15,432
15,000
16,528
12,827
7,509
2,634
1,314
8,174
2,763
Ag e
ncy
Age
ncy
Age
ncy
Te le
VM
I- S
pan
VM
I-S o
ma
HM
CS
t aff
FY11
-
1,095
Si gn
Ag e
ncy
Age
n
cy
Age
ncy
Te le
VM
I- S
pan
VM
I-S o
ma
HM
CS
t aff
FY09
-
Si gn
-
2,376
9,983
Ag e
ncy
Age
ncy
Age
ncy
Te le
VM
I- S
pan
VM
I-S o
ma
HM
CS
t aff
FY10
1,775
Age
ncy
Age
ncy
Te le
STE
L
HM
CS
t aff
FY07
Age
ncy
Age
ncy
Te le
STE
L
HM
CS
t aff
FY06
-
6,790
5,308
3,260
3,409
Age
ncy
Age
ncy
Te le
STE
L
HM
CS
t aff
FY08
5,000
8,385
Si gn
10,000
Agency
Sign Language Agency
STEL
VMI-Spanish
Agency TEL
HMC Staff
(HMC Spanish telephonic)
VMI-Somali
VMI/VRI
Video Medical Interpretation or Video Remote
Interpretation is referred to by different acronyms.
Basically, what is it?



Interpretation that takes place using a video monitor
unit or computer with an attached video camera
Technology that gives the patient and provider realtime visual presence of a medical interpreter who in
turn, can also see and hear both patient and provider
Transmissions can take place on private networks,
shared private network or on the public internet
Partial List of Health Care Institutions Utilizing VMI















Alameda County Medical Center, CA
Baystate Medical Center, MA
Cambridge Health Alliance, MA
Central DuPage Hospital, IL
Grady Health Systems, GA
Harborview Medical Center, WA
HCIN – Health Care Interpreter Network, CA
Holy Name Hospital, NJ
Massachusetts General Medical Center, MA
New York City Medical Center, NY
San Francisco Department of Public Health, CA
Susquehanna Health System, PA
Temple University Health System, PA
UC-Davis Medical Center, CA
UCSF Medical Center, CA
VMI Technology = efficiency and quality

Remote video interpretation eliminates both
the travel and waiting times associated with
in person interpretation.


From an average of 1 service unit/hour
(for in-person) to between 2–4 service
units/hour (for VMI)
Real Time video maintains the visual body
language cues that are key to quality
interpretation
Practice Improvements Associated with VMI



Quick and easy access encourages
interpreter use by providers
Dramatic reduction in average wait times
for interpreters
Elimination of the practice of skipping
LEP patients in queue due to long waits
for interpreters
Common Pitfalls when rolling out VMI



Introducing video units will not, in and of
itself, result in increased understanding of
the importance of interpreters or optimum
utilization of this service
The technology is essentially “architectural”,
meaning that the units do not interpret—the
core asset question remains: How to secure
trained medical interpreters?
Resistance to change…
VMI rollout is a strategic planning issue


The centerpiece being, how to secure the
core asset (trained interpreters) over time
The keystone being, how to partner with IT
and Telecommunications before you begin

Whether the call routing infrastructure is inhouse or outsourced

Pros and Cons exist with both approaches
depending upon the size, location and affiliation
of the institution in question
General Approach:
BEFORE hardware purchase / installation

Partner with I.T. and Telecommunications


Ask for demo units from vendors and TEST them onsite!
Assess your I.T. infrastructure (see handout )
 Have blueprints available for sites where VMI will be
implemented

You will have to map the location of ports and electrical
outlets in order to place units effectively
OR


You will have to map the location of electrical outlets in
order to INSTALL ports convenient to said outlets
Assess the phones currently in use by your providers
 Only digital, multi-directional phones will work with this
technology


Most of the phone sets in out-patient clinics are inexpensive,
analog and unidirectional—This will NOT work!
Do the provider phones have conference capability?
General Approach:
AFTER hardware purchase / installation

AVOID sub-optimal adoptions and utilization


Train your providers rigorously!
Have super-users identified from both groups
(provider and interpreter) to help champion use


Be willing to park someone on site the first week of
implementation to hand hold providers/users
Have a strategic, enterprise level plan

Stay focused on dramatic improvements in clinical
practice
Two Spanish and One Somali interpreter on each shift
Descargar

Slide 1