As our country’s diverse populations grow, the variety in the numbers of spoken languages and dialects is also on the rise. In 2013, approximately 25.1 million individuals were considered Limited English Proficiency (LEP), which is a term that refers to individuals ages 5 and older who report speaking English less than very well as per Census Bureau’s classification.
About 80% of the LEPs speak one of the 5 languages with Spanish being the predominant non-English language spoken among LEPs (by about 64%) followed by Chinese, Vietnamese, Korean and Tagalog. However, in states with large immigrant populations such as CA or TX, there are about 30 different languages spoken by LEPs according to the Migration Policy Institute [1]. Further, as depicted in a KQED radio broadcast on migrant farm workers in California, different dialects used by immigrants from different regions of the same country can pose additional challenges to finding accurate medical translation. Many studies conclude unequivocally that the language divide prevents LEP patients from seeking and receiving quality medical care.
These barriers to communication or miscommunicated medical instructions can have dire consequences for LEP patients. There is a federal law (title VI) that requires all health care organizations that receive federal funding to provide appropriate services of bilingual staff or interpreters free of charge to LEP patients. The diversity of languages and a chronic shortage of qualified interpreters makes this requirement difficult to implement for many healthcare organizations–in practice many resort to relying on ad-hoc translators, such as family members.
There are also quality concerns about how interpreter mode (in-person, over telephone or video conferencing) and role (person related, independent consultant, from an agency or hospital staff) affect communication quality. A recent study explores the relationship between interpretation modalities (in-person, video conferencing and ad-hoc interpreter) and the outcomes in terms of accuracy of interpretations and clinical significance of inaccurate interpretations. This study was conducted in a northern CA urban health center included encounters with 32 Spanish speaking patients and 14 clinicians and used transcribed audio taped primary care visits. 70% of the coded text units (TUs) were deemed accurate. Inaccurate interpretations occurred at twice the rate for ad-hoc interpreters (54% of the time) compared to professional in-person (24%) or professional video conferencing (23%). Most of the errors were errors of omission or errors due to interpreters answering for patients or clinicians.
While these data are from 2005 and a number of changes have occurred in technology since then, these results indicate video conferencing to be a valuable tool for healthcare organizations. This result along with future studies to delineate differences between modalities can help move the field technologically forward toward better patient outcomes.
Bureau of Labor Statistics data indicate that medical interpretation is a high growth field with a projected job growth of 52% in the healthcare industry between 2012 and 2022. Specifically, the highest growth is projected in the home healthcare sector, outpatient centers, ancillary healthcare services such as physical and occupational therapy centers and other ambulatory healthcare services. The growth in inpatient services such as hospitals is projected to be smaller. These numbers indicate that current services are concentrated in hospital settings and there is a growing need for these services in other areas of healthcare.
Many community colleges and some universities and medical schools provide training and certification in this area. Most of the certificate programs are accredited by the National Board of Certification for Medical Interpreters. The primary new direction in this area, of course, is the development of apps to translate. One such app that is gaining traction among medical professionals is called Canopy and was developed with funding from NIH. Another is MediBabble, developed by UCSF researchers. These apps have been used by clinicians with Canopy being the most popular currently. While these apps can do some of the work of translators as they try to interpret natural language (think of Siri!), they have a lot to catch up in terms of replacing actual translators. However, these apps use combinations of pictures, images and voice translations to facilitate communication which can get complicated and time consuming, potentially decreasing their usefulness.
Future research should examine the effectiveness of health apps by comparing them with other interpretation modalities in influencing patient outcomes. While technological advance can help with the shortage, we still need more qualified interpreters in the workforce. Future research should also examine reimbursement models for interpreters and education programs to understand why this potentially lucrative career option is being left on the table by our diverse and younger entrants to the healthcare workforce.
Lisa M. Lines