When telehealth visits increased exponentially throughout the pandemic, patients at Mount Sinai Health System with limited English proficiency, or LEP, were in a great disadvantage to receive equal access to services due to the language barrier.
Telehealth programs weren’t originally installed with LEP patients in mind. And Mount Sinai’s patient population at New York City is quite varied — the health system has to be prepared to deliver health care in more than 200 languages.
“Our pool of in-house interpreters is limited; it only covers a few languages,” said Silvina de la Iglesia, associate manager of language support at The Mount Sinai Hospital. “As a health system, we rely primarily on phone and video interpreter vendors to cover the demand.
“One of the most challenging problems we faced was not needing translation solutions incorporated into the various telehealth platforms that were being used,” she continued.
“Each stage offered distinct capabilities for three-way communication, and we had to research that which would work better for our patients. We chose to tackle Epic/MyChart at the first place and operate in partnership with all our terminology vendor, Language Line Solutions.”
On this platform, an invitation to join the encounter could only be pushed via email or text message in real time. This was possible when aligning the encounter with a staff interpreter, but not with the organization’s phone or video vendors, as those interpreters operate in an enclosed environment on an on-demand basis.
“Providers were originally calling Language Line and putting the interpreter on speakerphone or holding mobile phones in their hands and trusting that the movie platform could pick up the sound,” de la Iglesia recalled. “This was a really frustrating experience for providers and patients as the audio quality was poor, with lots of residual sound and echo on the line.”
“And as with all engineering and use-cases, rarely is there a one-size-fits-all solution. It’s crucial, whether interpreters or caregivers, to get as many options as possible for technology that is flexible to allow another party to join.”
Natalya Sholomyansky, Mount Sinai Health System
Video visits are heavily utilized at Mount Sinai and a great option for patients who do not want to come into the office; they can be accessed via a mobile app or on a computer with a webcam. Neither needed the ability for the patient or other individuals joining the video visit to be called via phone number since this was accessed via login credentials.
“Our in-house interpreters may be invited to and combine a video interaction with our patients utilizing the present platform,” said Natalya Sholomyansky, director, IT digital health, at Mount Sinai.
“However, external vendors that supplement cannot leverage this workflow or combine video visits. Providers may only access those outside Language Line spouses by dialing out to a 800 amount, a capability that did not exist in the movie visit platform. This left just the in-house language interpreters capable to encourage patients who desired them throughout the movie visit.”
Mount Sinai turned to health IT vendor Caregility for help. Caregility offered the option for the provider to dial a phone number to Language Line and have the external vendor join the video visit with audio.
“Our providers and non-English-speaking patients desired instant, seamless access to language interpreters to communicate effectively,” de la Iglesia said. “Language Line has a pool of 14,000 interpreters in more than 200 languages running 24/7. Caregility offered the choice for the supplier initiating the encounter on the telehealth platform to dial out to a toll-free amount to connect with Language Line within seconds.”
Mount Sinai leveraged this capability by building a call-routing architecture behind the scenes. With the help of Language Line, the provider organization created dedicated toll-free telephone lines for the top five languages — Spanish, Mandarin, Cantonese, Russian and Bengali — and another one for the remaining languages. The dedicated telephone lines are answered directly by interpreters, reducing the connectivity time to less than 10 seconds.
MEETING THE CHALLENGE
This new solution went live on October 26, 2020, with the more robust integration features. Mount Sinai expanded utilization 100-fold in three days.
“When the supplier is about to begin a video trip, they can have an external interpreter join,” Sholomyansky explained. “They do this by choosing one of our language outlines and also the language that’s needed. Th