Telehealth and Language Access

What is required when providing health care services to patients/clients who have Limited English Proficiency?  Title VI of the Civil Rights Act prohibits discrimination on the basis of national origin. Title VI and Department of Health and Human Services regulations, 45 C.F.R. Section 80.3(b)(2), require recipients of Federal financial assistance from HHS to take reasonable steps to provide meaningful access to Limited English Proficient (LEP) persons. See A Practice Guide to Implementing the National CLAS Standards for more information and resources.  Additionally, federal disability discrimination laws mandate equal access to and an equal opportunity to participate in and benefit from health care services, and effective communication with individuals who are deaf or hard of hearing.  These laws include:

• Section 504 of the Rehabilitation Act of 1973 – applies to federal health care services and facilities; and health care providers who are also recipients of federal financial assistance, usually provided by direct funding (such as federal Medicaid funds) or by grants (such as a federal research grant).
• Title II of the Americans with Disabilities Act – applies to all public (state and local) health care providers.
• Title III of the Americans with Disabilities Act – applies to all private health care providers.

Additionally, the U.S. Department of Health & Human Services Office for Civil Rights (OCR) and the U.S. Department of Justice Civil Rights Division recently issued Guidance on Nondiscrimination in Telehealth: Federal Protections to Ensure Accessibility to People with Disabilities and Limited English Proficient Persons.

Many practices have developed ways to provide these services during an office or hospital visit, but what happens when you are providing care by telehealth?  Below are several options for addressing this need.

• Things to consider when weighing your options:
  • Video interpretation, when possible, will be a better option than audio only because the majority of communication is done nonverbally!
  • A trained healthcare interpreter will almost always be better than using staff, family or friends.  Some patients will insist on using family members or friends. Don't be afraid to offer an alternative if you have one.
  • Here are a few resources you may want to review:
    • A Guide to Understanding Interpreting and Translation in Health Care 
    • State Law Requirements Addressing Language Needs in Health Care

• If you have access to a trained healthcare interpreter:
  • There are many videoconference platforms that allow for multi-point videoconferencing. There is no reason not to continue to use your interpreter remotely by video.
    • As an example, Zoom for Healthcare has a built-in feature that allows you to add an interpreter as well as a closed captioning and live transcription.  While Zoom has a pilot integration with otter.ai for artificial intelligence driven transcription, it is not recommended for important healthcare communications due to the often technical vocabulary being used.  If you do use this feature, please monitor and correct errors continuously and carefully.  To find a Communication Access Realtime Translation (CART) provider (real-time captioning or live-event captioning), please visit the National Court Reporter's Association PROLink Professional Directory and search for CART Captioner or CART Captioning under Professional Type.

• If you don't have access to a trained healthcare interpreter: 
  • The National Board of Certification for Medical Interpreters has a searchable registry of interpreter training programs.  These programs may be able to direct you to certified medical interpreters in your state.  These individuals may or may not have had training in video/remote interpretation.
  • There are some telehealth platforms that have integration of healthcare interpreter services (both language and AS:L) as part of their license agreement with end-users.
  • There are remote interpretation companies that provide interpretation by video.  Make sure you ask for someone who is trained in healthcare interpretation.
  • Do not use Google Translate for important healthcare communications.  Google Translate has only 57.7% accuracy when used for medical phrase translation!

• If you are an interpreter or know one that has never done interpretation by video before:  The National Council on Interpreting in Health Care has many helpful resources.

• Finally, the Northeast Telehealth Resource Center has developed a nice overview video on  the Telemedicine Physical Exams that has a small segment on integrating an interpreter into a visit that we think might be helpful: