To prioritize language services, medical IT professionals must understand federal, state and accreditation compliance requirements for delivering effective language access to Limited English Proficient (LEP) and Deaf patients, and to family members. In addition to legal mandates and regulations, not providing qualified medical language interpreting exposes hospitals and clinics to legal risks, longer visits and stays, readmissions, and to reduced quality of care and negative clinical outcomes.

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Language Services as a Risk
Reduction Strategy––What IT Needs
to Know
Presented by Elizabeth Swan & Eliana Lobo
Sponsored by InDemand Interpreting

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+ OBJECTIVES
UNDERSTANDING THE COMPLIANCE
REQUIREMENTS FOR LANGUAGE ACCESS
AND LEGAL RISKS CREATED BY NOT USING
QUALIFIED INTERPRETERS
Sponsored by InDemand Interpreting

3. 3
Eliana Lobo
MA, BA
SPEAKERS
Elizabeth Swan
RN, BSN, MBA, CPHRM
BANNER HEALTH
RN Risk Management Consultant
INDEMAND INTERPRETING
National Director of Interpreter Quality

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+ OBJECTIVES
UNDERSTANDING THE LEP CHALLENGE,
WHERE IT STANDS AND HOW IT WILL GROW
LEP: Limited English Proficiency
Sponsored by InDemand Interpreting

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INTRODUCING
Eliana Lobo, MA, BA
INDEMAND INTERPRETING National Director of Interpreter Quality
Bio
Eliana is a certified Trainer of Medical Interpreters
who studied at CultureSmart in Boston, MA. She
recently joined InDemand Interpreting to oversee
quality and train the language interpreters. Eliana led
interpreter training and quality at Seattle's
Harborview Medical Center for 6 years and was the
Portuguese Division Chair for the International
Medical Interpreters Association. Currently Eliana
serves as the Chair of the Trainers Division at I.M.I.A.
After completing her master's degree in Bilingual
Education at Brown University she received a
Fulbright Grant to conduct research in Brazil.

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UNDERSTANDING THE LEP CHALLENGE
People Speaking a Language
Other Than English
23.1 M
31.8 M
55.4 M
61.6 M
47 M
1980 1990 2000 2007 2013
GROWTH FROM 1980 - 2013
Source: US Census Bureau
267%

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WHY LANGUAGE ACCESS IS IMPORTANT
LEP Patients in the United States
61.6 Million people (1 in 5)
Speak a Language Other than English in the Home
25.2 Million
Are considered Limited English Proficiency (LEP)
300 Languages
Spoken in the United States
Sponsored by InDemand Interpreting

8. LEP Patients are almost twice as likely to suffer adverse events in
8
U.S. hospitals resulting in temporary harm or death.
WHY LANGUAGE ACCESS IS IMPORTANT
Sponsored by InDemand Interpreting
Other common adverse events for LEP include:
• Medication errors
• Longer LOS (length of stay) in hospital as an in-patient for LEP
– Costs more for hospital to provide basic care
• Increased readmission rates
– Negatively impacts reimbursement rates to the hospital for Medicare and
Medicaid patients
– Negatively impacts patient’s experience
• Overuse of the Emergency Room as a way to access primary care
– Literally, the most expensive way to treat a bad flu or cough
– Leads to lack of primary care physician for patient

9. ABOUT
9 Harborview Medical
Center
Licensed beds: >400
Employees: 4,700
Admissions: 18,00
Emergency Department Visits:
66,000
Clinic Visits: 246,000

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UNDERSTANDING THE LEP CHALLENGE: The Growth is Real
Harborview Medical Center
Total Number of LEP Encounters
FY
05-06
FY
10-11
134,757
FY
12-13
FY
06-07
FY
07-08
FY
08-09
FY
11-12
FY
09-10
93,921
97,854
107,660
115,441
117,587
121,637
126,596
102,569
Jan-June 2014
FY
13-14

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UNDERSTANDING THE LEP CHALLENGE
Partner with IT Upfront!
• At Registration, ask patient for their preferred language
• Do NOT ask, “Do you speak English?”
• Ask instead, “What language would you prefer to use when discussing your medical concerns?”
• Make sure the preferred language is a stop field!
• Track your interpreter requests and compare them to the Registration numbers
• Discrepancies often mean inappropriate use of friends and family members
• Discrepancies can point to patients going without language access
• Know the number of requests for your top languages and track daily/monthly
• Facilitate the documentation on the EMR (electronic medical record) so providers can
accurately document the language and the fact that an interpreter was used!
Sponsored by InDemand Interpreting

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+ OBJECTIVES
UNDERSTANDING THE COMPLIANCE
REQUIREMENTS FOR LANGUAGE ACCESS
AND LEGAL RISKS CREATED BY NOT USING
QUALIFIED INTERPRETERS
Sponsored by InDemand Interpreting

13. 13
Elizabeth Swan RN, MBA, CPHRM
BANNER HEALTH RN Risk Management Consultant
Bio
Liz Swan is a RN Risk Management Consultant for Banner
Health, a role she has held since 2005. As part of her loss
prevention and claims management efforts she serves as
the consultant to the Banner System Interpreter
Program. She develops policy guidance on the provision
of interpretation services and the implementation of
Video Remote Interpreting, and supervises the System
Interpreter Educator and System Translation coordinator.
Still active, Liz Swan served as a Registered Nurse for 25
years, much of it specializing in hospice and home care.
INTRODUCING

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ABOUT
Banner Health
25 Acute-Care Hospitals and Medical Centers in 7 States
with 39,000 Employees

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WHY LANGUAGE ACCESS IS IMPORTANT
A WORD IS WORTH
A MILLION DOLLARS
“Misinterpretation of a single Spanish word (intoxicado)
led to a $71 million dollar malpractice settlement
associated with a potentially preventable case of
quadriplegia”
Harsham P. A misinterpreted word worth $71 million. Med Econ. June 1984;61:289-292
Sponsored by InDemand Interpreting

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LEGAL IMPLICATIONS FOR HEALTHCARE PROVIDERS
Sponsored by InDemand Interpreting

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Compliance: Federal Regulations
Sponsored by InDemand Interpreting

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+ COMPLIANCE: Federal
Regulat ions
TITLE VI OF
THE CIVIL
RIGHTS ACT
OF 1964
"Health care organizations
that receive Federal
financial assistance have
an obligation to help
people who are unable to
speak, read, write, or
understand English well.
These patients are called
Limited English Proficient
(LEP)”.

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"Health care
organizations that
receive Federal
financial assistance
have an obligation
to help people who
are unable to speak,
read, write, or
understand English
well…”
COMPLIANCE: Federal Regulations
Title VI Also Says
"No person in the United States shall, on
the ground of race, color, or national
origin, be excluded from participation in,
be denied the benefits of, or be
subjected to discrimination under any
program or activity receiving Federal
financial assistance."
42 U.S.C. § 2000d
"National origin" includes individuals with
Limited English Proficiency (LEP)

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COMPLIANCE: Federal Regulations
CLAS Standards
Department of Health and Human Services Office
of Minority Health
Provide language services at no cost, at all points of contact, in a timely
manner during all hours of operation
Provide verbal and written notices informing patients of their right to receive
language services
Assure competence of language services, family & friends should not be used
to interpret
Signage and patient-related materials in languages of commonly encountered
patients
Sponsored by InDemand Interpreting

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COMPLIANCE: Federal
Regulat ions
THE IMPACT
OF THE
AFFORDABLE
CARE ACT
Obama administration is giving more attention to potential
National Origin Discrimination.
CLAS standards were updated

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Compliance: Accreditations
Sponsored by InDemand Interpreting

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+ COMPLIANCE: Accredi tat ions
THE JOINT
COMMISSION
RI.01.01.01 –
The hospital prohibits
discrimination based on
age, race, ethnicity,
religion, culture, language,
physical or mental
disability . . .

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prohibits
discrimination
based on age,
race, ethnicity,
religion, culture,
language,
physical or mental
disability
COMPLIANCE: Accreditation
The Joint Commission
RI.01.01.03 – The hospital provides language
interpreting and translation services.
PC.02.01.21 – The hospital identifies the patient’s
oral and written communication needs, including
the patient’s preferred language for discussing
health care.
HR.01.02.01 - The hospital defines staff
qualifications for those who provide interpretation
and translation.
RC.02.01.01 – The medical record contains the
patient’s communication needs, including
preferred language for discussing health care.

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Risk Management
Sponsored by InDemand Interpreting

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RISK MANAGEMENT
Clinical Risk of Not
Providing Language
Services
Incorrect diagnosis when the history and
symptoms are conveyed to the clinician
incorrectly
Patient making the wrong decision when
the risks and benefits are misunderstood
Unnecessary return visit to the emergency
department when the patient does not
understand the discharge instructions
Potential HIPAA violation when a family
member is used to interpret

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RISK MANAGEMENT
Clinical Risk: Medical Malpractice
Standard of Care: adequate steps to be certain that the
clinician fully understands the patient’s complaints and the
patient understands the clinician’s instructions.
Potential Issues:
– Decreased access
– Delay in care
– Misdiagnosis
– Lack of informed consent
– More complications
Sponsored by InDemand Interpreting

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BANNER HEALTH & LANGUAGE ACCESS
Can Technology Provide Effective Language Access
Quickly And Economically?
Sponsored by InDemand Interpreting

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LANGUAGE ACCESS
Challenges Banner Faced
• Budget Constraints
• Standardizing Language Services
• Clinical Risks
• Compliance Issues
• Legal Risks
• Accreditations Risks
• Educating Staff to
– Recognize the Safety Issues
– Identify LEP Patients / ASL

31. LANGUAGE ACCESS
31 Banner’s Solution
What Choices Did Banner
Make and Why?
• Bilingual Staff
• Bedside Interpreters
• Language Assistants
• Video Remote Interpreting (VRI)
• Over-the-Phone Interpreting (OPI)
• Translation services

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Reduced risk of
miscommunication
with patients and
family
LANGUAGE ACCESS
HOW HAS VRI HELPED?
• Qualified interpreters being used more
frequently through OPI, VRI and trained
staff
• Decreased expenses
• Improved satisfaction among patients,
staff and physicians
• Reduced risk of miscommunication with
patients and family
• Meeting Federal and Joint Commission
requirements

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LANGUAGE ACCESS
Video Remote
Interpreting Benefits
• Works for ASL & LEP
• Effective Access
• Fast
• Economical
• Secure

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LANGUAGE ACCESS
The Importance of IT as a Partner
• Understand the importance of
Language Access for compliance
• Critical that you are engaged early
• Important that IT vet the vendor

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Q & A
Sponsored by InDemand Interpreting

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LANGUAGE SERVICES AS A RISK REDUCTION STRATEGY––What IT Needs to Know
Thank You.
Sponsored by InDemand Interpreting