1. Use of VRI at Swedish Health Services Kathleen To Manager, Linguistic Services WASCLA May 3, 2013

2. Rationale for Addition of VRI Technology Delay of care for patients due to lack of timely agency interpretation, decreased availability of interpreters, late arrival due to traffic/parking issues, etc. Escalating costs for agency in-person interpretation for a non-reimbursable expense Increased costs for cancellation and no-show appointments (averaging <$5,000/month) Campus locations: difficult to get interpreters to agree to go to some locations (need for remote solution) Emergent nature of interpreter needs for specific units/departments Need to link remote providers to campus services

3. Addition of VRI Technology, 2009 Leveraged the organization’s expansion of wireless technology due to EPIC/EHR implementation Aligned with organization’s “culture of business expansion & opportunity” Aligned with the rise of Telehealth technology in organization Became an answer to provider & patient dissatisfaction with quality and reliability of vendor in person interpretation Aligned with department’s strategic planning goals of cost efficiency and standardization of service delivery Initial Foundation grant for equipment agreements

4. Where was VRI implemented? Initial pilot (2009/2010) covered most emergent and highest users of interpreter services  Emergency Rooms, medical imaging, perinatal services, breast imaging, OB services After initial pilot showed fiscal and quality opportunities, second phase expansion (2010/2011) included both outpatient and inpatient locations  NICU, ISCU, OTPT Rehab, Family Medicine, WIC, ICU’s, etc.  “Roaming” carts at each campus material service center for check-out. Third phase (2012)– Internal VRI Call Center installed  8 stations, two campus locations  Staff interpreters trained  Second Foundation grant received for VRI Call Center build Fourth phase, TBD: Expansion to Swedish Medical Group clinics for continuity of care for patients

5. Internal VRI Call Centers All calls stay on video – no rollover to phone interpreting SMC interpreters can work on VRI between onsite appointments Calls are monitored for quality Calls Initiated from 62 VRI Devices Calls Routed to Swedish VRI Interpreters, if Available Calls Then Routed to Vendor VRI Interpreters

6. Current Service Level: HMC & SMC Harborview Medical Center Swedish Medical Center Hospital Size: Level 1 adult & pediatric trauma center for WA, AK, MT & ID Five hospitals in 3 cities and two Free- standing Emergency Rooms/primary clinics in 2 additional cities Number of in patient beds 4131637 licensed beds VRI implementation began 20082009 Departments served 2 out-patient, 1 inpatient 55 departments at 5 hospitals Inpatient and outpatient 5 ‘roaming’ available MSC for check-out Equipment used Polycom V700 for customers and HDX4000 for interpreter operators Lenovo laptops w/speakers & cameras Ergotron wheeled carts Number of call center stations 58 (@ two campuses) Languages served Spanish & Somali Spanish, Somali, Vietnamese, Arabic, Cantonese, Mandarin, Toisanese, Chau Jo, French (Vendor also adds: ASL & Polish) Average monthly volume 64 video encounters (Staff handles telephone calls as well) 10,000-12,000 average minutes per month, including current vendor plan

7. Lessons Learned: Each clinic location is unique – a “cookie cutter approach” does not work! Implementation requires individualized initial assessment of patient workflow, standardization of process, customized acuity chart designed, translation of patient materials and much stakeholder input VRI must be offered as part of the “menu of choices” for most flexibility and staff acceptance Assessment must include solutions for all communication needs for diverse patient population: patients with hearing/vision loss & patients with low/no English, and include both telephonic, video & in-person support – get creative! Stakeholders must help design the acuity chart, but then be accountable for implementing it. Follow up with good data to show impact, + or – Be flexible & prepared to move VRI carts if needed VRI needs technical support person – is not “stand alone” Staff education & encouragement is an on-going process!

8. Interpretation “Acuity” Guidelines

9. Other “ah ha’s”…. Some of the reluctance was “generational” and some was due to technology “overload” If VRI proves to be a solution that makes provider’s work easier – it will be adapted Busy clinicians don’t have time for “issues”! Marketing is everything! (have to do it vs. if accepted) Use of VRI caused other economies of scale to naturally occur; <telephonic use VRI implementation unearthed a wealth of bad and out of scope practices! (be careful what you wish for!) No excuse anymore to fall back on using patient family members and friends -

10. Successes: Getting the VRI Call Center created (OMG! Facilities, Space, Engineering, IT – never the ‘twain shall meet!) All staff interpreters trained and actively staffing the internal VRI Call Center Family Medicine clinics whole-heartedly embracing VRI Entire new Issaquah campus completely staffed with VRI carts – culture changed Inpatient units fighting over the VRI carts In 2012 we decreased purchased services’ costs by <$300,000

11. Some unfilled needs…. LEP patients who also have hearing loss – need for amplification that is confidential…(headphones???) Wireless headphones that could allow registration/front desk staff to converse with patients confidentially VRI installed on organization’s EPIC carts (not allowed) More VRI languages