Treatment's Not Lost in Translation

With a rising number of people in the United States who do not speak English, it is not always feasible or cost-effective for hospitals to provide live interpreters for everyone. Many hospitals, like Children’s Medical Center Dallas, a private, not-for-profit pediatric hospital that treated more than 340,000 children and teens in northern Texas last year, are turning to speech-based technologies to facilitate communication with non-English-speaking patients and their families.

The 411-bed hospital deployed a two-way, Internet telephony-based videoconferencing system throughout its emergency and first-care departments in late April and early May. The system, known as MARTTI (My Accessible Real-Time Trusted Interpreter), is provided by the Language Access Network, based in Columbus, Ohio.

Children’s Medical Center Dallas currently has two portable MARTTI units—one for its emergency room and one for its first-care area, and two desktop units in its triage area. When someone who does not speak English comes into the hospital, caregivers can call for the MARTTI units to be brought to them. MARTTI is tied into the hospital’s wireless network, and with the press of a button, connects via the Internet to a live operator in Language Access Network’s central facility in Ohio. Once the language is selected, the proper interpreter is brought on the line. Through integrated video cameras on both ends of the conversation, the entire session is totally interactive. The caregiver speaks to the live interpreter via MARTTI and that person, who is trained in many languages and in medical terminology, will speak to the patient families via real-time video conferencing. The patient can then ask questions in return, which will be interpreted back to the caregiver. In this way, clinicians and family alike can ask questions and receive answers in their native languages.

“It’s never a question as to whether families can better understand and question the care they are receiving when they can communicate with the physicians, nurses, and other caregivers here in the hospital,” says Edgardo Garcia, director of translation services at Children’s Medical Center Dallas. “This technology will support the existing group of staff interpreters, and will allow us to serve more families in real time.”

In addition to extensive training in medical terminology, Language Access Network’s team of interpreters complete constant continuing education courses in areas such as medical ethics, general vocabulary, technology usage, privacy laws, and cultural competency.

Typical conversations over the system involve getting a patient’s medical history, and discussing current medical conditions and treatment options. Most sessions are between seven and 12 minutes in length. MARTTI can be used 24 hours a day, 365 days a year. The hospital is billed on a usage fee of between $1.75 and $2.95 per minute. Last year the medical center had 110,000 patient encounters for interpretation.

The hospital has a translation services office, with 22 full-time interpreters, in place, but the number of requests for interpreters last year was so large that “there were many instances when our in-house interpreters could not get to them all in time,” Garcia says.

“Having live interpreters there is not always practical because you can’t always plan for what will be needed. People miss their appointments; people come late or early for their appointments, and in the emergency room you can never predict who will be coming in,” he says.

Last year, the hospital was able to provide translation services for about 92 percent of the people who requested them. With MARTTI, it hopes not only to be able to meet the needs of the other 8 percent, but also to relieve the workload of the over-taxed in-house interpreters. “It’s a very portable piece of equipment, with just a monitor and computer terminal. We can take it all over the hospital if we need to,” Garcia says.

Language Access Network offers interpreters for 150 languages, including American Sign Language. “It doesn’t happen very frequently that we get requests for sign language, but if it does, we have to be ready to provide the service,” Garcia says.

Spanish is obviously the most-requested language, but others have included Vietnamese, Arabic, Japanese, and even Swahili. The system ranks the top-five requested languages and prioritizes the level of service to the hospital in those languages based on those rankings. It tracks usage and can revise the rankings as needs dictate.

“MARTTI allows us to provide equal access to services to limited-English-proficient people coming to the hospital,” Garcia says. “The main benefit is quick access to services. With our fast access to the service, a patient does not have to wait for translation services,” he says.

Prior to signing on with Language Access Network, Children’s Medical Center Dallas also looked at a few telephone-based translation services, but quickly dismissed the idea. “Telephone service is good, but the audio/visual service is better because you can get the body language element too. The interpreter can see it in the eyes if a person does not understand something, and that’s not something you can get over the phone,” Garcia says.

Garcia and other hospital administrators first came across Language Access Network and the MARTTI system at a medical trade show about a year ago, and followed up with the company three or four times before deploying the system. Language Access Network is one of only about three companies to offer this type of equipment.

“MARTTI is very easy to use, and it’s been very dependable for us,” Garcia says. “It’s very effective under controlled circumstances.”

Though the system has only been in place for a few months, it has already been heavily used throughout the emergency room. “Even though it’s fairly new even for us, there are a number of other departments at the hospital that are looking at it,” Garcia says.

In addition to basic care, the hospital offers specialized care for heart disease, hematology, and cystic fibrosis, and is also a major pediatric kidney, liver, intestine, heart, and bone marrow transplant center. To serve the growing population in the Dallas area, it will open another 72-bed facility in Plano, Texas, next year. It also is the primary pediatric teaching facility for the University of Texas Southwest Medical Center in Dallas and a research facility for developing treatment and understanding of childhood diseases.

“I know it will be beneficial for something like the ambulatory surgery department, to help get and give information before and after surgery,” he says.

Besides Children’s Medical Center Dallas, MARTTI systems are also being used at Ohio State University Medical Center; Mercy Hospital in Miami; Corona Hospital and Olympia Medical Center, both in Los Angeles; and Indian River Medical Center in Vero Beach, Fla., to name a few. Other installations are taking place at Boston Medical Center and Marion General Hospital in Ohio.

A number of pharmacies, including those operated by Cincinnati-based supermarket giant The Kroger Cos., have also started deploying MARTTI. Using the system, pharmacists will be able to  talk with customers, providing drug counseling and answering questions about their medications in their preferred language during normal pharmacy hours.