Earlier this year I wrote about how language barriers are creating a new digital health divide and I suggested that the single biggest barrier to successfully connecting patients online internationally is language. On the one hand, the Internet has broken down many boundaries and has changed the geography of healthcare, uniting patients and healthcare stakeholders all over the world so that people are not constrained by information available in their own country alone. Yet on the other hand, language has become an even greater barrier as it separates people into groups – the advantaged or the disadvantaged – based on the information they can access.
I concluded that innovation is required, and offered some ideas about how to tackle language barriers in healthcare engagement. Now, in this report, I explore some of the innovative solutions being developed that are transforming healthcare engagement, improving access to healthcare, and literally saving lives by breaking down language barriers.
Solving patient-clinician language barriers
In the United States, over 34 million people speak Spanish as their primary language at home. When it comes to providing effective and reliable healthcare to this Spanish-speaking population, it is in the face to face encounter between physician and patient that any language barrier becomes critical.
I spoke with Dr Martha Bernadett, Executive Vice President at Molina Healthcare, a leading national healthcare provider in the United States, about the challenges of ensuring effective healthcare communication amongst non-English speaking communities in the US.
“It’s in the patient-clinician face-to-face encounter that patients gain the most important information and have the most important interaction,” says Dr Bernadett. “All other non-face-to-face interactions are trusted in a secondary manner, compared with the face to face encounter with a nurse or physician. After that is any written communication that the patient might take home, that they use to convey to family members what happened at that encounter. Those are the two critical elements in healthcare delivery where you don’t have as much margin for error.”
Molina Healthcare focuses on enhancing the relationship between patients and physicians, enabling them to communicate effectively with each other. Dr Bernadett told me that matching physician and patient language is an important aspect of the work they do. Where language matches or bilingual healthcare professionals are not available, interpreters are used for face-to-face encounters. Pre-translated documents also play an important role in efficient and accurate cross-language interactions.
Automating patient-physician interaction
Meanwhile, new technologies for automating translation are emerging and have been used successfully in healthcare. Staff at Bayshore Community Hospital in Holmdal, NJ, communicate with Spanish-speaking patients using an automated spoken translation tool that listens to a sentence in English, translates it to Spanish and speaks the Spanish sentence to the patient.
I spoke to Dr Mark Seligman, President and Founder of Spoken Translation whose product, Converser for Healthcare, is the innovative tool used by the hospital to engage patients in their own language and I asked him what makes the product reliable enough for use in a medical environment.
One of the keys to the product’s effectiveness, as Dr Seligman demonstrated to me, is ‘back-translation’ which confirms to the original speaker in text, what the translated text looks like when translated back into its original language. Through this innovation, it is easy to identify whether the context of an English word with multiple possible meanings has been correctly understood. If not, the correct meaning or inference can be specified by the user before the correct translation is spoken by the tool.
In the example below, the ambiguous meaning of the word ‘right’ in “Your right knee is broken” is clarified by selecting the correct meaning:
This is certainly an effective tool for reliable, context-sensitive translation that is making a real difference to areas including patient safety and compliance. The tool includes pre-translated compliance tools such as an informed consent form.
“Consent becomes a stronger thing when you can know and prove what you have said in a foreign language”, says Dr Seligman. The tool retains a transcript of conversations so it is possible to review exactly what was said. This opens another possibility for the future – the integration of transcripts with electronic medical records. Dr Seligman hopes this will be achieved next year.
“The challenge [of integrating with electronic medical records] is organisational rather than technological”, says Dr Seligman.
If this is starting to sound a little too much like a move towards fully-automated medical interactions, Dr Seligman is quick to reassure that Converser is not trying to replace human interpreters.
“Human minds, human hearts, human cultural understanding is irreplaceable.” says Seligman. “We’re not trying to replace humans. Converser will always work along with human interpreters.”