Documenting How Patients' Language Needs Are Met

Intervention Title:
Documenting How Patients’ Language Needs Are Met

Cambridge Health Alliance (CHA); Cambridge, Massachusetts

To create systems that ensure documentation of how the hospital is meeting the language needs of its limited English proficient (LEP) patients.

Developed an electronic system in which providers document how a patient’s language needs are met during a clinical encounter using “quick questions” built into the existing electronic medical record (EMR) system.

Clinical providers at East Cambridge Health Center now document how language needs were met during a patient’s visit, allowing for periodic, systematic evaluations of language services.

Cambridge Health Alliance’s East Cambridge Health Center
163 Gore Street
Cambridge, M.A. 02141

From the Leadership:
“In order to ensure our patients are receiving the best care possible, it is vital that we have the appropriate information needed to evaluate the language services we are providing. The “quick questions” give us data that is easily available and quantifiable on the clinical experience and has allowed us to move from the question of ‘Was an interpreter used?’ to the more critical question of ‘How was the language need met?”

Helena Santos-Martins MD
Medical Director

A Harvard-affiliated health system that provides care in Cambridge, Somerville, and Boston's metro-north communities. It includes three hospital campuses, more than 20 primary care and specialty practices, the Cambridge Public Health Department, and the Network Health plan.

Clinical areas affected:
East Cambridge Health Center primary care clinic

Staff involved:

  • Information technology (IT) specialists
  • Multilingual Services Department staff
  • Nurses
  • Physicians

It took approximately two months to create an initial pilot program, which launched in July of 2007. The full system was implemented for continued piloting and refinement at East Cambridge Health Center in January of 2008. Anticipated rollout to the entire CHA system is scheduled for November 2009.

Yoon Susan Choi, M.A.
Research Associate II
P: (617) 499-6618

Innovation implementation:
It is important for hospitals and health systems to be able to accurately track and evaluate the language services they provide. It is also critical for information collected to be easily available for review.

To meet this need, the Cambridge Health Alliance’s Speaking Together team created a system in which providers electronically answer “quick questions” about how language needs were met during clinical encounters. The answers to the questions are recorded in CHA’s existing Epic EMR. During clinical visits providers now record the following in the EMR:

  • “Language needs met by" followed by a dropdown menu that includes the following options: 1.)English Used Effectively by Patient, 2) Provider Proficient (Tested) in Patient’s Language (Not English), 3) Face to Face Interpreter, 4) Phone Interpreter, 5) Videoconference Interpreter, 6) Bilingual Employee - Tested and Trained, 7) No Interpreter Services Used (Use Interpreter Services Waiver). 8) Family or Friend Preferred by Patient (Use Interpreter Services Waiver), 9) Other (Please Add Comments)
  • “Language of this encounter" followed by a drop down menu including a list of languages from which the provider may choose.

Prior to implementing the system, it was difficult to evaluate how patient’s language needs were met, as it was unclear that all language service use was being documented consistently. In order to determine whether this had been documented or to review the services provided, the language services staff would have to conduct a labor-intensive chart review. The documentation of language services is now easily pulled electronically through the EMR and reports can be regularly generated and quickly evaluated.

Advice and lessons learned:

  1. Keep it simple. Adoption of the new system was facilitated by keeping the burden on the provider to a minimum. It takes only an average of 7 seconds or less for the provider to fill in the quick questions.
  2. Use existing screens. The CHA team was able to increase provider buy-in by using existing screens within the EMR and adding the questions and drop-down menus. Providers do not have to go to another screen to collect the information.
  3. Take your time and pilot extensively. The initial pilot testing of the questions began in July of 2007 at East Cambridge Health Center to not only ensure that they would fit into the existing provider work flow, but to also obtain provider feedback and buy-in. Changes were made based on the feedback we received and the full system was implemented in January 2008. Piloting, however, has continued through August 2009, as the team continues to refine the wording of the fields to promote clarity and consistency of usage. Feedback from key providers at other CHA sites have been invaluable in this process, as they have helped to ensure that the fields more completely reflect all the situations that may arise in clinical encounters. We are still in the process of considering other changes before the large-scale rollout to sites throughout CHA.

Cost/benefit estimate:
Costs to implementing the “quick questions” systems included a small amount of IT time to design the quick questions and drop-down screens within the EMR, the time of a coordinator to manage the process, the time of a physician champion to promote the new system for other providers, and the time to secure buy-in from providers at various sites. The success of the new system is still being evaluated, but provider adoption at the pilot site has been substantial. Despite the questions being optional, 5670 questionnaires (44% of visits) were completed for the “quick questions” between January 2009 and June 2009.