Case Study: Video Interpreter Services at the Alameda County Medical Center

This article originally appeared in the 2006 Streaming Media Industry Sourcebook. To receive the 2007 edition, subscribe to Streaming Media magazine here

When a patient with limited proficiency in spoken American English is admitted to the Alameda County Medical Center or the San Francisco General Hospital during normal business hours, Cisco and Tandberg listen to the patient every step of the way. An innovative new project now underway allows patients of this non-native-English patient base (estimated to be as high as 40% of all patients at Alameda County Medical Center) to discuss their ailments face-to-face with a remote interpreter who can see their facial expressions and body movements, and can then integrate these important visual cues into their interpretation.

According to Janice Chin, the Interim Director of Interpreter Services at the Alameda County facility (ACMC) in Oakland, there are approximately 300 video interpretations completed each month at ACMC and the San Francisco General Hospital (SFGH).

"The system is still running on a limited scale," says Chin, "and daily statistics are a little more difficult to provide, since they are so varied depending on the number of clinics that operated on any given day. But on average, ACMC and SFGH collectively average about 15 video transmissions a day."

The program was funded by an initial federal grant from the Office of Minority Health, a division of the United States Department of Health and Human Services that works to improve and protect the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities.To minimize expenses, keep costs down, and increase workload efficiencies for the interpreters, a remote interpretation model was created to accommodate the highest number of patients possible. Given the complexity of medical conditions and procedures and the need to use interpreters who weren’t necessarily onsite, ACMC and SFGH evaluated several manufacturers of video conferencing equipment for real-world audio and video clarity and quality. While several systems made the first cut, Chin says a joint Tandberg/Cisco approach was the final choice.

"Tandberg and Cisco were chosen due to the high quality required for interpretation in a medical setting," says Chin, "as well as to the sleek design and easy use of the remote and other features."

The Benefits of Collaboration
Another criterion ACMC and SFGH used for assessing the potential technology partners was the level of collaboration between the two companies.

"A telephony method was the next logical step for the coordination of services as the number of transmissions and implemented sites increased," says Chin. "The collaboration between Cisco and Tandberg was key in the coordination of services as the number of active video and audio units were being deployed."

According to Joe D’lorio, manager of Telehealth for Tandberg, which supplies video communications technology to a growing number of healthcare providers, "Video communication technology can serve as an invaluable solution for linking patients with physicians and medical specialists anywhere, anytime—not to mention facilitate more efficient procedures within other healthcare practices."

Video communications solutions are becoming more and more common in healthcare facilities, D’lorio says. "Gone are the days of primitive video communication technologies featuring low-resolution images and unstable connections. Today’s technology combines high-quality, high-resolution imaging and CD-quality audio with a reliable and secure connection. That’s a significant and valuable tool for medical professionals."

With the success of the initial phase, ACMC and SFGH were awarded two additional grants from the California Endowment, a private health foundation. The grants total $1,542,654 over the course of five years. Those additional grants allowed an expansion of the number of languages interpreted at the remote site. Yet the success of this initial portion of the project proves the need for expanded services.

"This is still operating on a limited scale," says Chin, "so interpreters at this time are available during regular business hours (8:30 a.m.–5 p.m.). "We anticipate an increase in utilization once we expand the system in the next two years, and we specifically hope to expand these hours for the highest-demand languages in the next two years." The highest-demand languages for ACMC include Spanish and the Cantonese and Mandarin Chinese dialects. This is followed by Mien (a hilltribe dialect form the borders of Thailand and Laos), Tigrigna (an Ethiopian dialect), and Vietnamese.

Chin also noted that the collaboration between the hospitals was equally important to the process, to the extent that it is anticipated to expand to cover additional facilities.

"In the next two years, the collaboration between Alameda County Medical Center and San Francisco General Hospital will further expand," says Chin. Expansion will include remote interpreter availability throughout [SFGH’s] ambulatory clinics, including primary care and specialty clinics."

Plans also include expanding video capability to ACMC’s Emergency Department and some inpatient wards, greatly increasing the timeliness and accuracy of patient care for the minority groups that the video system was designed to serve.

Expansion won’t be limited to just the two initial facilities. While an announcement is not immediately forthcoming, Chin did note that the two organizations will also be exploring the possibility of linking an additional partner to the existing network.

In addition, ACMC and SFGH both recognize the potential for increased language access for the deaf community via the VMI project. Unfortunately, at this time, neither organization has a certified American Sign Language interpreter on staff, but both are exploring the possibility of hiring one in the future.