The Affordable Care Act: Say ‘Hola’ to your patients.

NEW YORK - Sept. 24, 2013 - PRLog -- Open enrollment for the Affordable Care Act, or ‘Obamacare’, starts in October 2013. While political squabbling and financial projections have dominated the airwaves, there has been near radio silence about the new law’s impact on quality of care when 30 million newly insured patients flood an already overburdened healthcare system. Most importantly, these newcomers are more diverse than the current average insured American, and many will speak a primary language other than English. It has been shown that language barriers are associated with poor health outcomes, so what is being done to support these particularly vulnerable individuals? While millions of dollars are spent on multilingual marketing campaigns to enroll this population in health plans in accordance with the law, little is being done to ensure that these traditionally underserved groups are supported once they actually get in front of a healthcare provider.

Today, healthcare providers are already encountering a rising number of patients who speak English less than well or not at all. This includes 26 million Americans, a number that is growing rapidly—it increased by 30% in the past decade, more than triple the growth rate of the overall US population.  A full 9 million of the 30 million soon to be newly insured patients do not speak English as their primary language. To understand how to help this tremendous influx of patients with limited English proficiency (LEP) navigate the complex American healthcare system—some for the first time—it is important to understand the current language assistance solutions in healthcare.  Right now, hospitals employ networks of in-person or telephone interpreters to communicate with LEP patients. These services are extremely costly; in fact, the average US hospital spends nearly $1 million a year on language services. And although these services are available, they are often underutilized because they are difficult to access, leading providers to sometimes reluctantly struggle through interactions with LEP patients using methods like hand signals and informal interpreters like patients’ family members.

"Challenges in accessing interpreters include scarcity of in-person interpreters and logistics involved in using telephone interpretation in busy, hectic clinical settings. There is an important utility for more user friendly translation technologies to bridge gaps between patients and providers."said Dr. Adam Castano, MD, a physician at New York Presbyterian Hospital in New York City.

While inadequate use of language assistance has been shown to lead to poor health outcomes for patients and increased financial risks for providers, it takes sensational stories like the following to really bring the point across.  In one horrifying case, a Spanish-speaking boy was misunderstood by a paramedic as saying he was intoxicated, instead of nauseated. The boy was treated for drug abuse instead of his actual health issue, suffered a ruptured brain aneurysm, and subsequently became a quadriplegic. After winning a malpractice case, this patient was awarded $71 million—unarguably more expensive than the cost of a few minutes with an interpreter.  While this is a sensational case, similar stories repeat themselves everyday in our healthcare system with financial implications for all Americans, and irreparable human costs. In a recent study, 2.5 percent of a malpractice insurance company’s lawsuits could be blamed on lack of use of interpreters, at a cost of approximately $5 million to the company that year.  These costs are passed down to healthcare providers, and shouldered by all Americans.  In those malpractice cases, two children and three adults died. In one case, the deceased child’s 16-year-old sibling was used as the interpreter, one patient was rendered comatose, one underwent a leg amputation, and another child suffered major organ damage. Even with obvious human and financial implications on the line, proper language assistance continues to be underused.

The numbers and stories make it clear that the current paradigm isn’t working. A problem this big, with such high stakes, with not be resolved with incremental improvement, and instead needs a complete reimagining. As with many industries, entrepreneurs are seeing opportunities to solve the language barrier in healthcare. One such company is Canopy Apps (http://www.canopyapps.com), a company supported by the National Institutes of Health’s Small Business Innovation Research program. As CEO Jerrit Tan explains, “We took a look at the entire industry, saw the huge amount of money spent on interpreters, and yet we know that they are still being underused, costing even more money and lives. It just didn’t make sense. So we asked ourselves a set of questions: since providers forgo the use of medical interpreters because they are hard to access, how can we make them available at the push of a button? To reduce the cost of and increase the availability of language assistance, how can routine interactions that do not require interpreters be supported by technology—ideally one that is scalable to cover 150+ languages? And in the long run, how can we enable healthcare personnel to gradually acquire skills in another language?”

Based on these requirements, the company developed its proprietary language assistance “canopy” that covers clinical communication for non-English speaking patients and their providers. The ecosystem of apps that make up Canopy include CanopyTranslator, a mobile app for providers to access a library of routine medical phrases that are pre-translated into 150 languages, connected to a one-touch button to call live telephone interpreters for more complex conversations, all from the provider’s smartphone.  CanopyLearn is a mobile and online medical language-learning program, for languages like medical Spanish, that helps providers learn the medical phrases they use most.  Finally, CanopyTest powers the National Certification for Bilingual Healthcare Providers (NCBHP), the first national exam to assess healthcare providers’ abilities to work with non-English speaking patients without the presence of medical interpreters. Institutions such as Duke University Medical System and the Hospice Foundation of America had deployed Canopy to cover their language assistance needs.

As we head into the second half of this decade, disparities based on race, ethnicity, income, and language will become more pronounced, with negative implications for all Americans—that is, unless we take a proactive approach to mitigating these problems.  Low hanging fruit to narrow healthcare disparities for the most vulnerable patients can be adequately addressed with better technology.  Now is the time to act, and not stand by as another patient goes through our healthcare system without understanding their care.