Interpreters, Privacy Bolster Virtual Care for Non-English Speakers

Clinicians at Massachusetts General Hospital (MGH) helped address virtual care disparities for patients with limited English proficiency by increasing access to telehealth platforms, ensuring privacy for immigrant patients, and including language interpreters in virtual visits, according to a paper published in the American Journal of Managed Care.

Prior to the COVID-10 pandemic, the Boston-based health system’s Department of Interpreter Services offered interpretations for in-person outpatient visits.  The most popular languages included Spanish, Portuguese, Arabic, Chinese, and Haitian Creole, and most of the interpretations occurred over the phone. 

When the pandemic hit, the hospital transitioned to telehealth for the majority of its ambulatory care services. Following the transition, the number of interpretations over the phone increased by 57 percent, but video interpretations did not follow this trend. Researchers also found that patients with limited English proficiency were less likely to have a video visit.

To address these disparities in accessing telehealth, clinicians implemented three strategies within their virtual care platforms: increase access to technology, ensure privacy for immigrant patients, and include language interpreters in telehealth visits.

“With an increased reliance on virtual care for health care during the pandemic, it’s important to make sure we are not increasing disparities for patients who have language barriers,” Aswita Tan-McGrory, director of the Disparities Solutions Center at MGH and lead author of the study, said in a press release. “Also, addressing challenges with these three strategies will actually increase care and access for all patients.”

For patients to access a video appointment via Zoom, they must enroll in MGH’s patient portal, Patient Gateway. Patient Gateway enrollment is historically low among patients with limited English proficiency, according to the health system.

Clinicians helped increase access to video visits for this patient population by performing targeted outreach that provided patients with information on how to access the portal and its benefits. The clinicians also launched a marketing and education campaign that included resources in multiple languages, such as videos and tip sheets, to help patients navigate the telehealth platform.

In addition, they added more language options to the portal to increase accessibility for patients with limited English proficiency.

To further help facilitate technology access, MGH partnered with a community health center to provide tablets to a handful of behavioral health patients with limited English proficiency. The patients were paired with a bilingual student intern who could help with registering the device, setting up an email account, enrolling in the patient portal, and attending a telehealth visit via videoconferencing.

Clinicians also addressed the matter of privacy when it comes to telehealth, as immigrant patients may be hesitant to use virtual care due to concerns about sharing information.

They developed an easy-to-understand script that informed patients about what types of personal and health information are shared with law enforcement and how the hospital keeps information secure under HIPAA. Additionally, providers should be mindful about asking about patients’ immigration status and should avoid documenting their status in their medical records.

Clinicians also identified the need for a secure virtual platform that patients can access without downloading an application to their phone or computer.

As many patients with limited English proficiency can benefit from interpreters during a medical appointment, the health system sought a way to include interpreters in virtual visits.

MGH utilized Doximity, an application that allowed interpreters to join a telehealth visit and can be accessed by simply clicking on a text message link.

The hospital also customized its EHR system to include an interpreter column to improve communication between the provider and interpreter. Additional updates allowed interpreters to view upcoming visits on the EHR and determine which appointments required interpretation.

“We really had to put ourselves in the patient’s shoes and walk through all workflows to make sure language and health literacy needs were being addressed,” Esteban A. Barreto, PhD, director of Evaluation of Equity and Community Health at MGH and senior author of the study, said in the press release. “Our findings suggest that as health systems continue to address such needs, patients with limited English proficiency should be able to have an active role in managing their own health which, in turn, may positively impact their health.”