1. Customer Service in a Health Care Environment HCIN/CHIA Conference March 18 – 20, 2010 Healthcare Interpreting: From Face-to-Face to Cyberspace Tim Moriarty, MPA President Forum on the Coordination of Interpreter Services (FOCIS) Baystate Health Springfield, MA Tim.moriarty@bhs.org

2. Basic Assumption You have Interpreter Capacity to Meet Demand/Need (Don’t Laugh too Hard!)

3. The Problem... Doctor: What’s wrong with your baby? Mom:?????????????????????????

4. Providers Belief/Philosophy: Interpreters are Like Cans of Coke: Push a Button and Out We Come! =

5. California Challenge Some of You Actually Do Have Providers Push a Button and You Are Instantaneously There to Interpret via Video Phone! Instant Is Not Always Possible.

6. What is a Manager’s or Interpreter’s Scope of Responsibility for Ensuring Access? Where or When Are Patients Impacted by the Lack of an Interpreter? Where or When Are Patients Impacted by the Lack of an Interpreter? Any Time They Are in Contact with Us! Primary Care, Specialty, Emergency Room, Etc.

7. What Didn’t Happen In this Pediatric Encounter? Outpatient Booking Failed to Detect or Document Need for Interpreter and Provider Failed to React. Why? Is patient Booking Centralized (Access)? Is patient Booking Centralized (Access)? Was Language Question Asked? Was Language Question Asked? Does Software Collect Language Preferred for discussing health care? Does Software Collect Language Preferred for discussing health care? Does “Yes” to that Question Trigger an Interpreter Request? (Automatic or In Scheduler’s head?) Does “Yes” to that Question Trigger an Interpreter Request? (Automatic or In Scheduler’s head?) If Not, Why Not? If Not, How Can It? If Not, Why Not? If Not, How Can It?

8. Not Collecting Language Data? YOU MUST! Federal Law, California Law and Joint Commission Require You to Provide Interpreters and Collect Data. Federal Law, California Law and Joint Commission Require You to Provide Interpreters and Collect Data. How Can You Provide an Interpreter if You Don’t Document the Need? (Risk Management, IS, etc.) How Can You Provide an Interpreter if You Don’t Document the Need? (Risk Management, IS, etc.) Fixed Fields with Language Options Are Better than Banner or Text Field. Fixed Fields with Language Options Are Better than Banner or Text Field. Must Be Able to Add Languages as Needed (Data Set Huge, Enter New Languages as New Groups Arrive.) Must Be Able to Add Languages as Needed (Data Set Huge, Enter New Languages as New Groups Arrive.)

9. If Your System Does Collect Preferred Language, Where Does Language Get Documented? Is It Buried or Obvious? Is It Buried or Obvious? Does It Trigger Anything? Does It Trigger Anything? Is Software Unidirectional or Bidirectional? Is Software Unidirectional or Bidirectional? -Feeds into One Software Only -Feeds into One Software Only -Feeds into Others and Receives from Others -Feeds into Others and Receives from Others At Baystate: Centricity (IDX), CIS (EMR), SMS, ORSOS, and Lantis Patient Software Used. Important to Know How They Work. At Baystate: Centricity (IDX), CIS (EMR), SMS, ORSOS, and Lantis Patient Software Used. Important to Know How They Work.

10. Make Friends with Information Services Staff Meet with Analyst to Determine Your Needs. Meet with Analyst to Determine Your Needs. Work with Analyst to Determine if What You Need Can Be Done or Is Already Done in Some Fashion/By Someone Else in Current System. Work with Analyst to Determine if What You Need Can Be Done or Is Already Done in Some Fashion/By Someone Else in Current System. If Not Currently Done or Not Easy, Work with Analyst to Figure Best Ways to Implement, Establish Priority Level, and Determine Timeline for Implementation. If Not Currently Done or Not Easy, Work with Analyst to Figure Best Ways to Implement, Establish Priority Level, and Determine Timeline for Implementation.

11. Make Friends with Access Services Staff Even if Not Centralized, Work to Have Access Services Support You by Having Them Book the Interpreter at the Same Time They Book the Main Medical Appointment.

12. Example of Fail Proof System New Staff Training re: Interpreter Services at Hospital Orientation. New Staff Training re: Interpreter Services at Hospital Orientation. At Least A Question re: Language “Preferred” Should Be Asked and Documented on Registration or Pre-registration. At Least A Question re: Language “Preferred” Should Be Asked and Documented on Registration or Pre-registration. Interpreter Services Notified Each Time Patient Has Appointment or ED/In-Patient (fax, e-mail, within software). Interpreter Services Notified Each Time Patient Has Appointment or ED/In-Patient (fax, e-mail, within software). “Interpreter Needed?” Question Asked at Registration and/or Nursing Assessment for Inpatients with Info Sent to Interpreter Services. “Interpreter Needed?” Question Asked at Registration and/or Nursing Assessment for Inpatients with Info Sent to Interpreter Services. Language Question Tailored for Minors/Family Members. Language Question Tailored for Minors/Family Members. Interpreter Services Able to Change Language when Language Listed Is Incorrect or Interpreter Needed Is Not Indicated. Interpreter Services Able to Change Language when Language Listed Is Incorrect or Interpreter Needed Is Not Indicated. Interpreters Round to Hospital Floors and Outpatient Offices. Interpreters Round to Hospital Floors and Outpatient Offices. Direct Outreach to Patient via Signage and/or Hospital TV System Indicating Legal Right to Interpreter with Number to Call. Direct Outreach to Patient via Signage and/or Hospital TV System Indicating Legal Right to Interpreter with Number to Call.

13. Health System Staff Training Training re: Laws Changes to Systems/Process Changes to Software Training re: Laws Changes to Systems/Process Changes to Software In-Person Best, But Web Based Training Helpful. (You Can Create Computer-Based or Web-Based Training in PowerPoint.) In-Person Best, But Web Based Training Helpful. (You Can Create Computer-Based or Web-Based Training in PowerPoint.)

14. Outreach to System-Affiliated Offices (Primary Care & Specialty) Meet with Practice Managers to Discuss Laws, Risk, Quality Improvement. Meet with Practice Managers to Discuss Laws, Risk, Quality Improvement. Discuss Their Options – Your Department or Outside Agencies, Phone, etc. Discuss Their Options – Your Department or Outside Agencies, Phone, etc. Determine with Practice Manager Best System for Particular Office. Determine with Practice Manager Best System for Particular Office. Ensure Office Informs Hospital of Need for Interpreter when Referring. Ensure Office Informs Hospital of Need for Interpreter when Referring.

15. Non-Affiliated Physician Offices Biggest Challenge Biggest Challenge Brochures or Letters re: Legal Requirements and Services Offered in System Brochures or Letters re: Legal Requirements and Services Offered in System Importance of Informing of Need for Interpreter when Booking Appointments In-System. Importance of Informing of Need for Interpreter when Booking Appointments In-System. Follow Up Phone Calls when They Fail to Request Interpreter Follow Up Phone Calls when They Fail to Request Interpreter Letters Stating Obligation of Providers to Offer and/or Provide Interpreter Free of Charge Letters Stating Obligation of Providers to Offer and/or Provide Interpreter Free of Charge Local DPH Sending Letters or Inviting to Training Breakfast to Discuss Interpreter Laws Local DPH Sending Letters or Inviting to Training Breakfast to Discuss Interpreter Laws

16. When Out of System Providers Fail to Provide Interpreters Clarify with Patient that You Cannot Provide Interpreters Out of Network (Cost, Liability). Clarify with Patient that You Cannot Provide Interpreters Out of Network (Cost, Liability). Assure You Will Follow-Up with Non-Affiliated Practice, and Do Follow-Up. Assure You Will Follow-Up with Non-Affiliated Practice, and Do Follow-Up. Provide Contact Information for Complaints: Provide Contact Information for Complaints: Refugee Health Program, CADPH CA Department of Health Care Services Office for Civil Rights U.S. Department of Health and Human Services http://www.hhs.gov/ocr/discrimhowtofile.html

17. Thanks for Your Attention! Tim Moriarty President of FOCIS Manager Interpreter & Translation Services Baystate Health Springfield, MA 01199 (413) 794-2502 Tim.moriarty@bhs.org