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Listen Please: A Clinical Translation System
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Listen Please: A Clinical Translation System



Presented by Janet Liang

Presented by Janet Liang
Specialist Intensivist and Anaesthetist, North Shore Hospital



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Listen Please: A Clinical Translation System Listen Please: A Clinical Translation System Presentation Transcript

  • Listen Please A clinical translation system
  • My talk  The demand for clinical translation  The case for electronic clinical translation  Listen Please  Alternatives  What more would I like  Questions 2
  • The demand for translation  NZ is an increasingly multicultural society, e.g. Asians represent ~22% of total regional Auckland popn  Proportion of non English speakers within Asian groups is (Statistics NZ)  17.9% for Chinese  29.6% for Korean  5.3% for Indian  Proportion of non English speakers within Pacifc Islanders is 13% (Statistics NZ) 3
  • The demand for translation (cont).  Being able to explain what is happening and what will happen to the patient makes care easier (Gadon et al 2007)  It certainly can improve patient satisfaction (Jacobs et al 2007)  Clinicians find language barriers impede the delivery of quality care and are a source of workplace stress (Bernard et al 2006); more stressful for nurses Gadon M et a. Caring for patients with limited English proficiency: the perspectives of small group practitioners. J Gen Intern Med (2007); 22(S2): 341-6 Jacobs EA, Sadowski LS, Rathouz PJ. The impact of an enhanced interpreter service intervention on hospital costs and patient Satisfaction. J Gen Intern Med (2007);22(S2):306-11 Bernard et al. Impact of language barrier on acute care medical professionals is dependent upon role. J Prof Nurs (2006); 22: 355-8 4
  • The case for electronic translation  Trained interpreters still have their limits  availability : at NSH, 10 min by phone, 30 min + to arrive at scene  cost: at NSH ~$70/hr  accuracy: may still have errors but less likely to be of clinical significance cf family (Flores et al 2003)  Doctors still tend to use a patient’s family & friends to interpret because of perceived cost, inaccessibility and inconvenience of trained interpreters (Gadon et al 2007) but may not be as effective (Flores et al 2003) & can be inappropriate Flores G et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics (2003) 111;6-14 Gadon M et al. Caring for patients with limited English proficiency: the perspectives of small group practitioners. J Gen Intern 5 Med (2007); 22(S2): 341-6
  • The case for electronic clinical translation (cont.) -Bilingual clinicians ? Absolutely but -you can’t assume that well naturalised immigrants will remember their language of birth -they may know the language of everyday life, but not that associated with clinical management -Pacific people many may respond best to spoken words and diagrams, rather than the written word (Buetow et al 2002) Buetow S, Adair V, Coster G, Hight M, Gribben B, Mitchell E. Reasons for poor understanding of when and how to access GP care for childhood asthma in Auckland, New Zealand. Family Practice (2002); 19(4): 319-325
  • Listen Please  A clinical translation app which works on iPads. For those who can’t speak English, or can’t speak at all  Mainly for seriously ill patients but adaptable to other contexts. Aims at  Urgent questions that can’t wait for an interpreter  Mundane questions that you wouldn’t keep an interpreter around for 24/7  Has printed statements, audio, pictures/ photos  Stand alone, does not need WiFi
  • How it started  I won the Health Informatics NZ Clinicians’ Challenge in 2011  I used the $10000 prize to fund :  Printed language/ audio translation of ~ 400 sentences/ questions into Mandarin & Cantonese Chinese, Korean, Samoan, Tongan (WDHB Asian and Pacific Health Services)  High quality audio recording of above  Illustrations/ photos to go with above  By Guy Body www.gbstudioart.co.nz  Photos by Scotty and Sonya English
  • Who and How to program  Therefore, to use the translations & pictures  I got $20000 from WDHB Asian Health Services grant (via Sue Lim) to pay for MEA Mobile to produce my design of Listen Please  Early assistance with project management by Annie Ualesi  Rod Mac Farlane and Mike Aston (MEA Mobile) have worked long and hard  Dr Johan van Schwalkyk is producing web based app – but not finished & requires wifi access
  • ‘Listen Please’ !
  • Choices
  • Examples of ‘Patient talks’  Patient statements/ questions – some of list
  • Examples of ‘Patient Talks’
  • Examples of ‘Clinician Asks’
  • Examples of Clinician Asks
  • Examples of ‘Clinician Explains’
  • Examples of Clinician Explains
  • Overall Listen Please is…  Well yes it is a sort of fancy electronic phrasebook  But my design intentions were:     Speed Usability Several modes of conveying ideas with patient Design for contexts where most likely to be useful  Few other electronic translators & of these, they use translation software = more complex & expensive
  • Alternatives: Google Translate  It can work well and it’s free…  But:  Accuracy not that good, especially for Asian languages (Nguyen-Lu et al 2010)  Doesn’t handle colloquialisms well  Needs web connection  Doesn’t do graphics Nguyen-Lu N, Reide P., Yentis S.M. ‘Do you have a stick in your mouth?’ –use of Google Translate as an aid to anaesthetic pre-assessment. Anaesthesia (2010); 65:94-113
  • Alternatives: other iOS  SmallTalk Intensive Care  only English, for those who can’t speak at all  simple graphics and audio  www.aphasia.com/products/apps/smalltalk  ThumbsUp  doesn’t translate Asian or Pacific languages other than Mandarin Chinese  simple graphics and audio  much more about patient communicating with clinician than vice versa  www.thumbsup.ch 20
  • What more would I like ?  Does it work ???!!!! i.e. will patients and clinicians use it in practice ?  Having versions on other platforms, i.e. Android and Windows tablets. iPhone ???  Having my original idea of allowing family (if they wish) to record their version of translation of statements/questions  I’m open to including other statement/ question lists and other languages  But for all this I need more $$$. App pricing ??
  • Acknowledgements I would also like to acknowledge the help of others at NSH and University of Auckland who have helped me to get Listen Please developed. 22