The Med
When inventing communication tools, technological solutions are generally perceived as very expensive and as infrastructure altering. However, Hablamos Juntos grantee sites are proving that technological solutions do not necessarily need to be costly; they simply need to be innovative.

The Regional Medical Center at Memphis, Tennessee known as the Med has developed three “low-tech” tools to help patients and physicians interact easier. They have created a communication passport that allows patients to better navigate through the complex campus of hospital and health services. A staff member puts useful information about the patient and the hospital in both English and Spanish on the passport. This information includes the patient's reason for being in the facility, the department or building the patient needs to go to, and that department's contact number. In the event a patient gets confused about where he needs to go, he can simply present the card to any staff member who can help direct him to the right location.

In addition, the Med has created language access cards with all the available options for language services in that hospital. In fact, physicians are advised to carry this card so they also know the available options, which include instructions on reaching in-person interpreter or for help from interpreters on the telephone. This simple tool increases awareness and access to interpreting services.

Finally, the Med has developed a "Quick Tool" document with simple, common phrases in Spanish to help clinical and non-clinical staff communicate with LEP patients upon first meeting them. For example, the card has the Spanish phrase for, “One moment, please. I will call an interpreter.” Overall, the staff has indicated satisfaction with the new tools at their disposal.

Central Nebraska
Although not as “low-tech” as the Med’s innovations, the Central Nebraska Area Health Education Center is in the process of developing tablet computers designed for interpreters called “virtual portfolios.” The tablets have a database of medical terminology, audio files, and graphics to assist in interpreting. These electronic notebooks can be updated and individualized based on the medical settings served by the interpreter. The organization plans on testing the tablets and training individuals with the tablets soon this year.

En Español
On the high end of the technology spectrum, En Español, which serves the Greater Birmingham area in Alabama, is considering a touch screen communication tool with over 6,700 phrases commonly used in emergency department care to support communication between patients and health care staff. The health care worker selects the topic on the screen (contents are displayed in English) and the software plays a digitally recorded version of the phrases, questions, or instructions on the target language. With this program front line staff, for example, can ask for basic information in a patient’s language such as name and address, and doctors and nurses can query for a medical history.

The software, called ProLingua ED, developed by Dr. Charles Lee from Polyglot Systems Inc. for Emergency Department interactions is being considered for use by the Copper Green Hospital. Front desk settings already equipped with computers provide the best implementation environment, while examination and treatment areas present the biggest challenge. The Alabama Department of Public Health Area V, one of En Español’s partners, is also looking at how a kiosk version of the software may be able to help with communication around the Medicaid application process.

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Creating solutions to overcome language barriers is a team effort. Two grantee sites have “teamed up” with local institutions in their areas to coordinate local efforts to provide quality interpreting services for multiple health organizations. Their approaches build on local opportunities to create different and effective solutions, and show models of how community collaborative efforts are means to addressing the issue of language services.

Nebraska Statewide Telehealth Network

The Nebraska Statewide Telehealth Network is a project to create an inter-connected system that can provide patient clinical consultation, give health care providers continuing access to education and professional development, and improve administrative connections in eventually 80 hospitals. Due to the rural locations of many hospitals in Nebraska, connectivity would provide greater access to other health care providers and reduce extensive travel for both patients and providers.

In terms of interpreting services, this connectivity will include video conferencing capabilities. Interpreters can stay at one station in one location yet be able to interpret for patients in any member hospital or health facility.

The Central Nebraska Area Health Education Center Inc. along with other key organizations within the state have worked with state agencies in order to secure subsidies for installing and maintaining a robust IP network in the rural hospitals. Tapping into state universal service funds, the Nebraska Public Service Commission has made it possible for hospitals joining the network to add video conferencing capabilities for the low fee of $100 per month. Overall, it is estimated that the telecommunication providers serving these hospitals will invest nearly $1 million to provide service support for the network.

Security precautions taken to protect sensitive information include using a private network with no commercial Internet access and AES encrypted software for all equipment purchased.

Status

• Six hospitals targeting for first phase of implementation
• Five hospitals have T-1 connections and video conferencing equipment installed
• Video medical interpreting system will be used in emergency rooms and delivery rooms from 6 pm to 6 am
• Video medical interpreting system will eventually phased in to cover departments 24/7 at hospitals that do not currently have qualified interpreters
• CN-AHEC is recruiting and training more interpreters

MedVerse Language Service Agency

In South Carolina, another type of statewide interpreting service agency has stemmed from multiple hospitals need for quality interpreters. Instead of each hospital recruiting and training and competing for local interpreters, they joined forces to create MedVerse, a language service agency that recruits, trains, and assigns interpreters to the partner hospitals and others around the state.

Status

• Initially, MedVerse provided services to four sponsoring organizations
• Now, MedVerse serves 11 hospitals, clinics, and private practices in Upstate South Carolina
• MedVerse employs 35 interpreters that have logged more than 2,250 interpretation encounters per month

MedVerse, charging $25 per hour, provides local health organizations a more affordable alternative to private interpreting agencies that charged upwards of $60 per hour. The agency uses full time and part time employees offering round-the-clock interpreting. Each interpreter hired is assessed for language proficiency in English and Spanish and undergoes multiple stages of on going training and coaching.

In addition to offering trained interpreters, MedVerse offers all clients contracting for interpreting services two In-Service trainings, which includes a two-hour session on cultural competency and a one-hour session on how to use interpreters. Upon completing the training the staff is then tested using the Provider-Staff Knowledge Measurement Tool developed by MedVerse in order to assess content retention.

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Hablamos Juntos has selected the health facilities and the fabricators to participate in pilot testing of a newly designed symbol-based signage system. This project will produce a set of tested symbols for common health signage terminology with guidelines and standards for using the new system in health facilities. The following four health facilities have volunteered to pilot test this new system and the following fabricators have volunteered to construct and deliver temporary signs with the symbols set to be tested are needed at each pilot site.

Cambridge Health Alliance, Boston, Massachusetts
The Cambridge Health Alliance is an academic public health care system in the Boston metropolitan area that includes three community teaching hospitals and over 25 primary care sites. The HJ symbol-based signage system will be pilot-tested at Somerville Hospital, a 193,000 square-foot multi-floor facility located in Somerville, a mid-sized suburb of Boston. The top four languages spoken by patients at Somerville are Spanish, Portuguese, Haitian-Creole, and Hindi.
Fabricator: Design Communications Ltd.

Grady Health System, Atlanta, Georgia
Grady is one of the largest public hospitals in the United States and covers 1,800,000 square feet in the main hospital. In 2004, Grady Health System served patients who spoke 66 different languages. Over 90 percent of the Limited English Proficiency (LEP) patients coming to GHS speak Spanish. Since 2000, Atlanta has the fastest growing immigrant population in the nation, and Georgia experienced a 360 percent increase in its immigrant population in the 1990s.
Fabricator: APCO

St. Francis Medical Center, Grand Island, Nebraska
Located in Grand Island, Nebraska, Saint Francis Medical Center is a Catholic Health Initiatives hospital and a partner of one of the ten Hablamos Juntos grantee sites, the Central Nebraska Area Health Education Center. The medical center serves approximately 187,000 patients annually. The languages spoken by the medical center’s patients are Spanish by majority, and very small numbers of individuals speak Nuer, Vietnamese, and Laotian.
Fabricator: Poblocki Sign Company

Kaiser Permanente San Francisco Medical Center, San Francisco, California
Kaiser Permanente’s San Francisco Medical Center is a microcosm of the diversity represented throughout the organization and local communities. The Medical Center is a multi-floor, 237-bed, 366,194 square feet facility that offers a wide range of care, and serves approximately 178,000 health plan members. The top four languages spoken by the facility’s members are Cantonese, Spanish, Mandarin, and Vietnamese.
Fabricator: ASI-Modulex

The four fabricators, located near the pilot sites have agreed to construct and deliver as many as 30-40 signs made out of black and white foam core. The signs developed will be specific to each pilot site. The signs will be both overhead identity elements and wall-mounted elements. The sign elements will be provided by JRC Design in Illustrator using scaled and camera ready art. Alcan Composites USA Inc, the maker of Foam Core has agreed to contribute all the materials needed to make the foam core signs, except banner signs.

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Hablamos Juntos is proud to support this important, nationwide effort and we urge all of our health care professionals to become involved as well. During the week of May 1-8, a variety of events will be held in communities across the country, including health and enrollment fairs for uninsured Americans, and health care coverage seminars for small business owners. Last year there were more than 2,700 events involving more than 2,750 organizations across the country. Log on to www.CoverTheUninsuredWeek.org to see a complete list of events, order free planning materials in English and Spanish, and learn more about solutions.

A few specific ways you can get involved include:

1) Help Plan or Participate in Cover the Uninsured Week Health Fairs
Cover the Uninsured Week health and enrollment fairs will provide medical screenings for uninsured residents and others, and provide volunteer opportunities for organizations and individuals. Promote and participate in health fairs taking place near you. Check the events listing on www.CoverTheUninsuredWeek.org or contact Alison Gould, Cover the Uninsured Week Organizational Outreach Coordinator at (202) 572-2978 or alison.gould@gmmb.com to find out how you can get involved.

2) Help Identify Potential Uninsured Spokespersons
One of the best ways to highlight the issue of America’s uninsured is through the compelling stories of uninsured individuals and the providers who care for them. You can help by identifying individuals who are willing to share their experience and be available for interviews with the media. Stories of uninsured individuals and providers may also appear on the Cover the Uninsured Week Web site and in campaign materials. A document outlining uninsured spokesperson criteria and instructions on how to submit a story is attached.

Guidelines for Identifying Uninsured Spokespersons

Thank you for your commitment to this effort. Let’s help the nearly 44 million uninsured Americans get the coverage they need!

A married woman in her middle thirties from the Dominican Republic was at the hospital for pre admission testing before surgery. Her husband, who usually accompanied her for medical visits and served as her interpreter, accompanied her on this day. The interpreter happened to go by and heard commotion. The patient was yelling in Spanish that she was having chest pains. The interpreter stopped in to see if she could be of assistance hearing the women screaming in Spanish. When the husband stepped out of the room she held the interpreter’s hands and told her that she had a hysterectomy when she went back to the Dominican Republic, and that her husband did not know. The women had pretended that she was having chest pains because she did not want her husband to know about her hysterectomy. Her husband had told her that a woman who had a hysterectomy is not a women and she feared that her husband would not want anything to do with her. She was also scared because she did not want to go through with surgery without letting the doctor know all of her health information, but she couldn’t because her husband was interpreting for her. After the interpreter was involved she escorted her husband out, and interpreted for her to complete the pre surgery interview.

Family Values: Interpreters cross cultural divides

When called to the Breast Imaging Center to interpret for a young female patient accompanied by her husband, the interpreter noticed the patient was pale and nervous. In an effort to acquaint herself with the patient, the interpreter introduced herself and asked why the patient was there. This interpreter likes to take a few minutes to learn a little bit about the patient’s history in order to learn about the patient’s perceptions and medical understanding.

The patient was there for an ultrasound as a result of a biopsy and finding a lump on both her left and right breasts. When the doctor arrived, only the patient and the interpreter were allowed to go into the room. As soon as the patient realized her husband was left behind, she started crying. The interpreter held her hand and told her, “Let’s see what the doctor has to say. Everything will be alright.” The patient was having difficulty breathing, and said, “My mom and grandmother died of breast cancer…not too long ago.” The patient continued, “I was living with my only sister and suddenly she became very ill. When we went to the doctor, it was already too late. She died ten months later of breast cancer.”

The interpreter was silent. The patient looked at the interpreter and asked for a hug. The interpreter explained to the doctor and technician what was going on. The patient desperately needed her husband to be there. The room was small and the doctor was becoming impatient.

The interpreter explained to the doctor the importance of the presence and opinion of family members in the Latino community, especially during a critical medical situation. The doctor relaxed almost immediately and was very understanding. She hugged the interpreter as well and after a big smile, let her husband come in.

It made a huge difference that was sensed right away. When the procedure was over the patient asked when her results would be ready. The reply was four days later. Four days later, the interpreter was there to give help give the results. It was good news, and the patient started crying with happiness and thanked God. After a few seconds, she thanked the interpreter then the doctor. The doctor also thanked the interpreter for helping her understand better a little part of the Latino culture. “It was such a beautiful experience,” the interpreter wrote.

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Hablamos Juntos (Spanish for "We Speak Together") is a unique project designed to forge connections between health care providers and the rapidly growing Latino health market. As a national program of the Robert Wood Johnson Foundation, Hablamos Juntos is investing $10 million in ten demonstration sites around the country. These sites, ranging from health plans and large hospital systems to small nonprofit community organizations, will work to improve communication between health care providers and patients and eliminate language barriers that can lead to medical errors and compromise the quality of care.

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