AxessPointe. Community Health Centers CASE STUDY

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1 CASE STUDY AxessPointe Community Health Centers The Case for Video Remote Interpreting and Improved Access to Medically Qualified Interpreters in Community Health Clinical Environments to Improve Compliance and Patient-Provider Satisfaction

2 Table of Contents Executive Summary Introduction Study Methodology Results Conclusion References page 2

3 CASE STUDY Executive Summary This study examined the adoption of video remote interpreting (VRI) at AxessPointe Community Health Centers, Inc. in Akron, Kent and Barberton, Ohio, to better meet the needs of its limited English proficient (LEP), Deaf and hard of hearing patients. Partnering with InDemand Interpreting, a technology-enabled medical interpreting company, AxessPointe gained access to medically qualified interpreters in 28 languages over video, including American Sign Language (ASL) and Certified Deaf Interpreters, in addition to 200 languages via voice interpreting through the VRI application. Prior to the use of VRI, AxessPointe used employees, phone interpreters, other community organizations and family members where requested and appropriate to meet their interpreting needs. This study examined 12 months of historical language access data prior to the VRI implementation (August 2016 August 2017) and language access data compiled from August 2017 March 2018 following the VRI implementation. The goal of the study was to evaluate the total number of interpreter encounters, the length of those encounters, the top languages served and whether or not providers were satisfied with VRI. Following the VRI implementation at AxessPointe, nearly three and a half times the number of interpreter encounters per month were reported using VRI compared to the pre-vri study period. Further, the use of near instant, on-demand access to medically qualified interpreters using InDemand VRI, resulted in staff and clinicians ranking their satisfaction with the InDemand service 4.2 out of 5 stars. Finally, the risk of miscommunication between clinicians, patients and their family members was reduced. VRI reduced the average length of encounters with LEP patients by 26.8% compared to previous interpreting methods, improving efficiency and patient-provider communication. Additionally, interpreting encounters were 26.8% shorter with LEP patients using VRI. page 3

4 CASE STUDY Introduction One in five people in the United States speaks a language other than English at home and 41 percent of these individuals, or 25.1 million people, are considered LEP. 1 The growing limited English proficient population across the nation is creating an increased demand for language access. Healthcare providers are feeling the impact of the increasing LEP population and are seeking effective solutions to provide interpreting services to these patient populations. AxessPointe provides affordable, high-quality and compassionate healthcare to families and individuals in Summit and Portage counties in Ohio. The name AxessPointe stands for the point where community and care meet and strives to provide access to healthcare for all patients. AxessPointe has six clinics within five locations, in Northeast Ohio, and is committed to serving its communities, including three in Akron, one in Kent and one in Barberton. As a Federally Qualified Health Center (FQHC), the health center delivers primary medical and dental care in medically underserved areas. AxessPointe also provides behavioral health, women s health and pharmacy services. AxessPointe employs more than 100 care providers throughout its locations. While AxessPointe had solutions in place, it was facing several challenges in fully meeting the language needs of its LEP and Deaf patient populations. The health center was using two Spanish speaking employees who were regularly being pulled away from their full-time positions to interpret for patients. Many patients requested to use family members to interpret for them, but clinicians were concerned about whether or not the information was accurately being relayed to patients. The health center also used over-the-phone interpreters, however, the phone lines would often drop during the conversation or clinicians could not find the cordless phone as there was only one available phone per facility. When there was a need for an American Sign Language (ASL) interpreter, AxessPointe partnered with community organizations but struggled to effectively coordinate patient and provider schedules in order to utilize an on-site interpreter. These challenges led site managers to approach senior leadership about the problem and proposed a potential solution to increase compliance and improve the patient/provider experience. The site managers recommended the implementation of VRI to better meet the needs of its LEP, Deaf and hard of hearing patients. AxessPointe partnered with InDemand Interpreting to provide immediate access to medically qualified interpreters through VRI. It started with a shared vision: to ensure every patient has access to high quality healthcare regardless of language, cultural background or disability. Today VRI devices are in use throughout eight AxessPointe clinics, immediately connecting patients and providers to medically qualified interpreters. This study examines 12 months of language access data prior to the VRI implementation and language access data compiled from August 2017 March 2018 following the VRI implementation. page 4

5 The Case for Video Remote Interpreting and Improved Access to Medically Qualified Interpreters Patient Safety as Priority It s not uncommon for health care providers to use an untrained bilingual employee or a family member of the patient who speaks the patient s language. However, in addition to an increased liability for the health care organization and potential HIPAA violations, this can also create a challenge in accurately communicating important information to patients. As providers, it is essential that patients clearly understand such things as their condition, treatment plan, medication needs and discharge instructions. A study by the Health Research and Educational Trust 2, Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency, examine whether or not professional medical interpreters have a positive impact on clinical care for LEP patients. According to the research, in all four areas examined, the use of professional interpreters is associated with improved clinical care more than the use of ad hoc interpreters and professional interpreters appear to raise the quality of clinical care for LEP patients to approach or equal that for patients without language barriers. The findings report that the benefits of using professional interpreters for communication includes (errors on comprehension), utilization, clinical outcomes and satisfaction with care. Another study published by The Joint Commission 3, Language proficiency and adverse events in U.S. hospitals: a pilot study, examined the differences in the characteristics of adverse events between English speaking patients and LEP patients in U.S. hospitals. According to the study results, nearly 50% of LEP patient adverse events involved some physical harm whereas only 24.4% of adverse events for patients who speak English resulted in physical harm. Of those adverse events resulting in physical harm, 46.8% of the LEP patient adverse events had a level of harm ranging from moderate temporary harm to death, compared with 24.4% of English speaking patient adverse events. The adverse events that occurred to LEP patients were also more likely to be the result of communication errors (52.4%) than adverse events for English speaking patients (35.9%). The study concluded that language barriers do, in fact, increase the risk to patient safety, recommending patients with language barriers have immediate access to competent language services. The study also recommends that providers collect reliable language data at the point of care and document those services provided during a patientprovider encounter. page 5

6 CASE STUDY It s the Law Health care organizations are legally required to provide access to healthcare in a patient s preferred language. If a healthcare organization receives Medicare, Medicaid or reimbursement from Federal health programs, they have a legal obligation to provide language access services to LEP, Deaf or hard of hearing patients. In addition, healthcare organizations that receive Medicare, Medicaid or other sources of Federal funds have an obligation to provide oral interpreters and written translated documents 4. In fact, failing to provide language access services to LEP patients is a form of national origin discrimination. There is case law going all the way up to the United States Supreme Court (Lau v. Nichols. 1974) 5 that establishes that basic principle. This regulation requires covered entities to take reasonable steps to provide meaningful access to each individual with limited English proficiency eligible to be served or likely to be encountered. Federal law, state law in all 50 states, as well as multiple judicial decisions, make reference to the need for health care organizations to provide language access services. Additionally, the major language access provisions of Section 1557 of the ACA require the use of qualified interpreters and significantly restricts the use of untrained family members and friends, minor children and untrained bilingual staff as medical interpreters. 4 page 6

The Case for Video Remote Interpreting and Improved Access to Medically Qualified Interpreters Video Remote Interpreting as a Language Access Solution It is nearly impossible to have a staff

7 The Case for Video Remote Interpreting and Improved Access to Medically Qualified Interpreters Video Remote Interpreting as a Language Access Solution It is nearly impossible to have a staff interpreter, or even a third party onsite interpreter, available for every unique language request. On-site agency interpreters can be costly, requiring payment regardless of whether or not a patient appears for an appointment, and this could mean a minimum of two hours of work plus travel time even when an appointment is delayed or cancelled. Over-the-phone interpretation is another option, though studies indicate between 55-93% of all communication is non-verbal. Dr. Albert Mehrabian, author of Silent Messages, conducted several studies on nonverbal communication. Through his research, he discovered that just 7% of any message is conveyed through words, 38% through certain vocal elements and 55% through nonverbal elements (facial expressions, gestures, posture, etc.). 6 VRI provides both verbal and non-verbal means of communication at a fraction of the cost of on-site interpretation. VRI is a viable alternative to on-site and over the phone interpreting. Partnering with InDemand, AxessPointe gained access to 28 languages over video, including American Sign Language (ASL) and Certified Deaf Interpreters. For more diffuse languages, InDemand provides more than 200 languages via voice interpreting through the VRI application. The immediacy of VRI improved the provider s ability to immediately reach a medically qualified interpreter at any time while remaining compliant with federal and state regulations. And, by providing a more provider and patientcentric interpreting capability, staff and clinicians ranked their satisfaction very high, posting an average satisfaction 4.2 out of 5 stars. Staff and clinicians concluded that VRI reduced the risk of miscommunication between clinicians, patients and their family members and proved to fit better in the clinical workflow. From August 2017 March 2018, approximately 95% of AxessPointe encounters were met through VRI. The remaining 5% were met using the use of voice interpreters through the VRI application. page 7

8 CASE STUDY The Study Prior to the use of VRI, AxessPointe used family members, employees and phone interpreters to meet their interpreting needs. The only change they made to their interpreting services program was adopting InDemand as their main language services provider. This study examined the interpreting services program at AxessPointe Community Health, both prior to the use of video remote interpreting (VRI), and after the VRI program was implemented. The study examines these questions: Does VRI support increased access to medically qualified interpreters and increased compliance at AxessPointe? Does VRI improve communication between patients and providers? Does VRI improve the patient and provider experience? Baseline data on the number of encounters and minutes per encounter prior to InDemand VRI was provided by AxessPointe. The post data VRI/voice interpreters minutes per month, number of encounters, minutes by language, encounters by language and Star-Ratings, was provided via the InDemand Clarity platform over an eight-month period (August 1, 2017-March 31, 2018). Study Methodology This study explored historical data, the number of encounters and minutes per encounter both prior to VRI usage and following the VRI implementation. This included exploring the number of encounters, the length of those encounters and top languages served. page 8

9 The Case for Video Remote Interpreting and Improved Access to Medically Qualified Interpreters Results Increase in the Number of LEP Encounters Number of Encounters Through the use of VRI, the total number of LEP encounters increased nearly three and a half times the previous number of monthly encounters. AxessPointe data indicated approximately 47 patient encounters each month were facilitated by overthe-phone interpreters. Once the health center implemented VRI, AxessPointe was able to facilitate LEP encounters on average each month, an increase of interpreter encounters notwithstanding AxessPointe seeing fewer LEP patients during the study period. According to Census data from , the non-english speaking populations in Summit and Portage Counties increased to 6.2% from , but leveled off in With the adoption of InDemand interpreting services, AxessPointe has been able to deliver interpreting services to patients on average every month, support all of its most requested languages with VRI and serve 95% of all encounters using VRI versus other interpreting modalities from August 2017 March page 9

CASE STUDY Results, Continued Reduction in Length of Interpreter Encounters Minutes Prior to VRI usage at AxessPointe, over-the-phone LEP encounters averaged 19 minutes in length.

10 CASE STUDY Results, Continued Reduction in Length of Interpreter Encounters Minutes Prior to VRI usage at AxessPointe, over-the-phone LEP encounters averaged 19 minutes in length. Following the introduction of VRI, the average encounter for LEP patients dropped 26.8% to an average of 13.9 minutes for combined VRI and voice interpreter encounters, an average reduction of 5.1 minutes per encounter. AxessPointe believes that a reduction in interpreter encounter times may enable the health center to increase the number of patients a clinician can see each day. Satisfaction with VRI has been evaluated through a Star Rating system delivered by InDemand Interpreting through its VRI application. At the conclusion of each video call, clinicians receive a prompt to rate the session on a scale of 1-5 stars (1 star = poor to 5 stars = excellent experience). During the months of August 2017 March 2018, the average star rating was 4.2 out of 5 stars. Adoption of InDemand interpreting services has given our clinicians peace of mind in knowing they are able to accurately understand our patients and provide the best possible care right when it is needed, said Sarah Genet, the Dental Office Manager for AxessPointe Community Health Centers. With VRI, we have the ability to immediately access medically qualified interpreters, things are not getting missed when we are gathering a patient s history, and clinicians are able to establish a bond with the patient by understanding their needs and having a real conversation. We know InDemand interpreters are fluent not only in a patient s language, but they are also culturally competent and understand how to bridge any cultural nuances that may exist with ease. page 10

11 The Case for Video Remote Interpreting and Improved Access to Medically Qualified Interpreters Conclusion This study evaluated whether VRI supported increased access to medically qualified interpreters at AxessPointe without any other change to its language services policy. Following the VRI implementation at AxessPointe, nearly three and a half times the number of interpreter encounters per month were supported by VRI compared to the pre-vri study period despite AxessPointe seeing fewer patients during the study period compared the pre-study time period. AxessPointe reduced the length of encounters with LEP patients by 26.8%. As such, it was concluded that the significant increase in LEP patients being provided access to effective communication and medically qualified interpreters was attributed to VRI. The study further demonstrated high provider satisfaction with an average 5-Star rating of 4.2. page 11

12 REFERENCES 1 Detailed Languages Spoken at Home and Ability to Speak English for the Population 5 Years and Over (U.S. Census Bureau) 2 Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? (Karliner, LS., Jacobs, EA., Chen, AH, Mutha, S.) 3 Language proficiency and adverse events in U.S. hospitals: a pilot study examined (Divi C., Koss RG, Schmaltz SP, Leb JM) Interntaional Journal Quality Health Care Apr;19(2):60-7. Epub 2007 Feb Section 1557 of the Patient Protection and Affordable Care Act (ACA) 5 (Lau v. Nichols. 414 U.S ) 6 Silent Messages (Mehrabian, A.) 7 Non-English speaking population in Summit and Portage Counties, OH (American Census Bureau) Website InDemandInterpreting.com Phone 1 (877) Info@InDemandInterpreting.com

Language Access Plan Basics

Language Access Plan Basics What you need to know to build a compliant and effective program InDemand Interpreting 01 Compliance HOW TO COMPLY WITH UPDATED LANGUAGE ACCESS STANDARDS Federal mandates require