Every aspect of arranging for patient language support requires technology. The language access program manager must be proficient in database management, in use of the EMR (electronic medical record) program, in pager and smart phone management, and in managing messaging between interpreter schedulers and external agencies. Elements as seemingly trivial as group email accounts for interpreter scheduling, or clinic receptionist logins to external agency websites can make or break the effectiveness of interpreter scheduling.
Effective language support for a healthcare organization requires pro-active planning. What languages will be needed in the next several months? Patient demographics are constantly changing. Is there a new program which will bring new brain cancer patients in, who will need CART services because they are now deaf and do not use ASL? Are there growing referrals from the local community clinic which serves SE Asian immigrants? Which clinical units are experiencing a need for which languages?
Billing documentation, which is retroactive, is insufficient data to understand demand. Billing documentation only shows what services were billed for, it does not show what demand was missed. It is essential to program a daily download of data about upcoming patient appointments and admissions with language need. For organizations with inpatient beds, the interpreter department also needs a daily download of all patients presently in the house who need language support. For organizations with a surgical department, interpreter schedulers need access to the separate surgery scheduling system to see both future scheduled surgeries and the real-time progress of surgical cases today.
The language access manager needs to be able to see past historical patterns of language need as well as upcoming appointments. The language access program needs to maintain its own databases of usage. It also needs to be able to generate its own reports to support hiring, budgeting, and purchasing of remote modality equipment. Databases documenting the specific needs of individual patients, such as patients with overlapping language need and disability accommodation need, are important in order to pro-actively schedule the needed resources.
Effective triage of language support need must be performed by the schedulers in order to put the right level of language support in the right place. Most appointment databases include an interpreter scheduling capability, but these processes are harmful to managing the language program effectively. By having clinic receptionists schedule staff interpreters for future routine appointments, they are locking in resources that will be more needed for urgent encounters at the actual time.
Centralized scheduling allows adjustment of the length of interpreter time needed for each encounter, as well as assignment of staff interpreters to where they are most needed for clinically vulnerable patients. Central interpreter schedulers need access to information about each upcoming encounter, including whether it is a new patient, a procedure visit, etc. Notes from the clinic indicating special needs (gender matching, sensory deficit) or anticipated difficult conversations. The Master scheduling database should include all language need encounters, not just encounters that will have in-person interpreters assigned. Inpatients and surgical patients with language need should be included on the Master. Each line item should show which interpretation or bilingual provider resource was plugged in, be it staff interpreters, agency interpreters, telephonic, or video remote. The Master interpreter schedule thus becomes a complete picture over time showing the totality of interpretation support in the organization.
Staff interpreters must be notified of their schedule for the next day (unless they are permanently assigned to a specific clinical unit). And staff interpreters must have communication devices which allow the Interpreter department to issue changes to their schedule throughout the day. Some departments issue a paper schedule at the beginning of the day, and have interpreters write in changes as they are notified during the day via in-house pagers. Another method of managing staff schedules is to issue staff smartphones and use Outlook calendars to assign interpreters their patients. Interpreters also receive change notifications on Outlook. The phone functions as a way for the interpreter to easily initiate or respond to calls from Base. Using a company phone ensures strict adherence to data privacy protocols such as password-protected screens. Even so, interpreters should promptly delete email traffic related to patients once it is not needed.
Technology protocols for communicating with contracted language agencies are getting clearer. The issues are: maintaining documentation of requests and response to requests, managing after-hours communication at both ends, and documentation of contracted interpreter credentials and compliance. Of course, include iron-clad business agreement language protecting information privacy in the agency contracts.
Fax may be used. Faxes related to requests, confirmations, and inability to fill must be organized and stored at the HC organization and kept for the prescribed number of years, in a way that permits effective retrieval of the needed documentation. Using the encounter date as the filing variable works best, not using the date of the message. Email may be used as long as the emails are saved according to careful filing protocols in a central data repository that can be accessed by the manager later. The emails related to scheduling must be accessible to all schedulers on the team during their daily work, using a group logon, shared inbox, distribution list, or combination thereof. Some agencies provide access to their portal for placing requests, by requiring that timestamped documentation be reproduced via an email or downloadable confirmation will allow the HC organization to maintain evidence of all efforts made. Most scheduling offices use all of these modalities: phone calls combined with documentation by fax, email, and portal.
Messaging between the HC organization and the agencies gets trickier after hours, when the agency may be accepting calls via a staff at home with a pager but no access to agency paper files or fax. It is critical to have the person carrying the pager send a detailed email message related to this call back to both her own agency and to the HC interpreter office for documentation. The person carrying the pager must have access to agency records related to restrictions or bans placed on certain interpreters, so that banned interpreters cannot get assignments just because it is a weekend. At the HC organization end, if the Interpreter office is closed, whoever makes urgent requests to agencies often keeps poor records to hand over to the interpreter schedulers on the next regular work day. For example, if Emergency, Admissions office, and Labor and Delivery are all empowered to call agency on the weekend, there has to be a protocol for staff on these units to document which agencies were called and which agencies responded.
It is increasingly required that the healthcare organization monitor which agency interpreters are on-campus at the time, thus assuring security for patients. Children’s hospitals are quite strict about this. The interpreter scheduling office shares its list for expected agency interpreters with Security each evening, and the following day Security provides a temporary badge for these interpreters when they arrive. As part of the scheduling process for agency interpreters, some hospitals require that the agency fax or email the confirmed interpreter’s compliance documentation at the time that EACH assignment is filled.