Running head: INTERPRETERS ON WHEELS 1

Interpreters on Wheels

Charlene Dover

Delaware Technical and Community College

NUR 410 Nursing Informatics

INTERPRETERS ON WHEELS 2

According to a 2018 study, a language, other than English is spoken at home in one of

five households, the highest level since World War I (Squires, 2018). Patients with limited

English proficiency have difficulty accessing managed care and utilize fewer preventative care

services (Massland, Lou & Snowden, 2010). This is changing how nursing is done to meet

healthcare communication needs. Due to Title VI of the U.S. Civil Rights Act passed in 1964,

healthcare organizations are required to provide interpreter services and regulations have been

implemented by the Affordable Care Act placing restrictions on using family members as an

interpreter (Squires, 2018). Utilizing a family member is discouraged due to poor translation,

patient privacy, or ethical considerations (Massland, Lou & Sweden, 2010). So, in comes the

question, how do we provide validated interpreters for all these patients?

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Solution

With the increased focus on technology and telemedicine new opportunities for

interpretation services have been provided (Mottelson, Sodemann & Nielsen, 2017). Video

interpretation services is an online technology that utilizes a computer with a camera and

microphone. This service creates a forum where the patient, nurse, and interpreter can see and

hear each other, but with the interpreter not having to physically being present (Mottelson,

Sodemann & Nielsen, 2017). Mobile video interpreters improve access and quality of care to

LEP patients. Utilizing the more accessible interpreters can mean an increase in understanding

diagnosis, treatment, medication instructions, increase understanding of compliance, and

increase patient satisfaction (Masland, Lou & Snowden, 2010). There are many benefits to

interpreters on wheels: it provides access to interpreters in seconds, avoids the cost of bringing in

on-site interpreters with two-hour billing minimums for a five-minute patient conversation.

Access to interpreters also improves the patient experience for LEP patients. Studies have

shown that patients are more satisfied with trained interpreters than they would be using friends

and family to communicate, and that interpreter modality -phone vs. video vs. on-site does not

appear to impact patient satisfaction in a measurable way (interpretersunlimited.com). This

leaves language service leaders in a position to advocate for the use of professional interpreters,

and to utilize the interpreter modality which best fits each individual situation. Unlike on-site

and telephone interpretation, video remote interpreting (VRI) provides on-demand interpreting

services with the push of a button. Rates for video interpretation have been quoted by the minute

versus the hour and can start at $1.95/ minute for any language. Interpreters on wheels have the

benefit of 24/7/365 on-demand interpreters; nationwide coverage; no mileage fees,

no scheduling, no risk of privacy issues, and are HIPAA Compliant.

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Ethical & Legal Considerations

An ethical concern with the utilization of interpreters on wheels is patient confidentiality.

To help assure each patients confidentiality, the utilized devices should be encrypted and none of

the conversations should be recorded. Commercial telephone interpreters are bound by their

business agreements with the healthcare providers to abide by the Health Insurance Portability

and Accountability Act standards and implement safeguards to protect the patient’s information

(Massland, Lou & Snowden, 2010).

Current Method

Once a patient with limited English proficiency is identified, the current workflow

process for face-to-face interpreters would be: make a call for an interpreter; wait for an

interpreter to arrive; once they arrive, identify interpreter and the credentials, identify the patient;

speak to the patient through the interpreter; then chart the interpretation. Just one of the issues

with the current process is time, another is cost. According to interpretersonline.com in-person

hospital rate appointments have a required three-hour minimum and are quoted at a higher rate.

There is a required hourly minimum that must be met for each appointment and after the

minimum, are billed in half hour increments. And then what happens in an emergency room,

where there is no way to set up appointment times for interpreters.

New Method

With the new method, the workflow of the new process after the patient with LEP is

identified would be push the interpreter on wheels into the room; identify the patient and dial

interpreter; speak to the patient through the interpreter; and chart the interpretation.
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Benefits and Challenges of Interpreters on Wheels

Mobile video interpreters improve access and quality of care to LEP patients. Utilizing

the more accessible interpreters can mean an increase in understanding diagnosis, treatment,

medication instructions, increase understanding of compliance, and increase patient satisfaction

(Masland, Lou & Snowden, 2010). There are many benefits to interpreters on wheels: it

provides access to interpreters in seconds, avoids the cost of bringing in on-site interpreters with

two-hour billing minimums for a five-minute patient conversation. Access to interpreters also

improves the patient experience for LEP patients. Studies have shown that patients are more

satisfied with trained interpreters than they would be using friends and family to communicate,

and that interpreter modality -phone vs. video vs. on-site does not appear to impact patient

satisfaction in a measurable way (interpretersunlimited.com). This leaves language service

leaders in a position to advocate for the use of professional interpreters, and to utilize the

interpreter modality which best fits each individual situation. Unlike on-site and telephone

interpretation, video remote interpreting (VRI) provides on-demand interpreting services with

the push of a button. Rates for video interpretation have been quoted by the minute versus the

hour and can start at $1.95/ minute for any language. Interpreters on wheels have the benefit of

24/7/365 on-demand interpreters; nationwide coverage; no mileage fees, no scheduling, no risk

of privacy issues, and are HIPAA Compliant.

Conclusion

In some cases, LEP patients that have gone without proper interpretation, have pretended

they could understand the practitioner simply because they did not have time to wait for an

interpreter. Due to the amount of time and resources utilized to find an appropriate interpreter,

family members and friends are frequently utilized. The practice of using family and friends for
INTERPRETERS ON WHEELS 6

interpreting can lead to poor translation quality, patient privacy, or ethical considerations,

especially when minor children interpret for a parent or if abuse or domestic violence is

suspected (Massland, Lou & Snowden, 2010). Often even other staff members: housekeeping,

dietary, transport, etc., that are not properly certified, are utilized for interpreters. These staff

members may not have the medical vocabulary that is needed for accuracy.

Video interpretation services is an online technology that creates a forum where the

patient, nurse, and interpreter can see and hear each other, but with the interpreter not having to

physically being present (Massland, Lou & Snowden, 2010). Mobile video interpreters improve

access and quality of care to LEP patients. Utilizing the more accessible interpreters can mean an

increase in understanding diagnosis, treatment, medication instructions, increase understanding

of compliance, and increase patient satisfaction (Massland, Lou & Snowden, 2010).
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Current Method New Method

Staff Identify Limited Staff Identify Limited

English Proficiency Patient English Proficiency Patient

Push Interpreter on
Call for Interpreter Wheels Machine
in to Room

Wait for Interpreter to Identify Patient, Dial in to

Arrive Video Interpreter

Speak to
Identify Interpreter and Patient
Credentials, Identify Through
Patient Interpreter

Speak to Patient
Through
Interpreter Chart Video
Interpretation

Chart
Interpretation
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Policy for Interpreters on Wheels

Interpreters on Wheels Policy No. 0002

Effective Date of Policy September 30, 2019

Education Required Skill Validation

Purpose/Statement: Provide timely and efficient access of interpretation services to limited

English proficiency patients.

Procedure:

 Identify LEP patient

 Obtain Interpreter on Wheels, take to patient

 Identify patient, dial in to interpreter

 Speak to patient through interpreter

 Chart video interpretation

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References

Ehaidukova. (2019, March 26). Why Workflow Process Mapping is So Important. Retrieved

from https://www.comindware.com/blog-why-workflow-process-mapping-is-so-

important/

In-person Interpreting Services: Hourly Pricing. (n.d.). Retrieved from

https://interpretersunlimited.com/pricing/interpretation/per-hour/

Masland, M. C., Lou, C., & Snowden, L. (2010). Use of communication technologies to cost-

effectively increase the availability of interpretation services in healthcare settings.

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992399/

Mottelson, I. N., Sodemann, M., & Nielsen, D. S. (n.d.). Attitudes to and implementation of

video interpretation in a Danish hospital: A cross-sectional study - Ida Nygaard

Mottelson, Morten Sodemann, Dorthe Susanne Nielsen, 2018. Retrieved from

https://journals.sagepub.com/doi/10.1177/1403494817706200

Squires, A. (2018). Strategies for overcoming language barriers in healthcare. Nursing

Management (Springhouse), 49(4), 20–27. doi: 10.1097/01.numa.0000531166.24481.15