Improving the Language Screening Process: Verifying Patients' Language Needs at the Point of Service

Intervention Title:
Improving the Language Screening Process: Verifying Patients’ Language Needs at the Point of Service

Cambridge Health Alliance (CHA); Cambridge, Massachusetts

To ensure that the patient’s preferred language of care recorded at registration/scheduling is accurate.

Developed a system to ensure the accuracy of the patient’s “language of care” in the electronic medical record (EMR).

Interpreters, front desk staff, and providers help to ensure that the language of care preference previously screened and recorded at registration/scheduling is accurate. The system has corrected errors in the documentation of language of care, which is crucial for the efficient and appropriate deployment of interpreter services.

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

From the Leadership:
“It is critical that we meet our patient’s language needs appropriately, and that starts with asking the right questions. Even with an established language screening system, the preferred language of care may be incorrectly recorded, and that can cause unneeded delays to both our patient and provider. This system ensures that from the beginning of each clinical visit, patients are receiving the care they need in their preferred language.”

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
  • Registration/scheduling staff

It took approximately one month to establish the work flow for providers to verify and request corrections for preferred language of care at the point of service. Within three months, the team inserted a banner in the EMR that prominently displayed the patient’s language of care. Efforts to improve the quality of language data and the language screening process have been ongoing, however, as we continue to discover areas for improvement. For example, a report was recently created to document patients for whom the language of care and the interpreter request language did not match. A staff member in Multilingual Services was designated to monitor trends and pass this report to registration staff for correction. In addition, we have recently changed the front desk screen to show language of care, instead of primary language.

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

Innovation implementation:
CHA’s registration/scheduling staff records three language preferences from each patient: primary language; preferred language of care; and language in which they receive written instructions. Even in hospitals and health systems with a well-established language screening system, a patient’s preferred language of care may be incorrectly recorded or not recorded at all. Not having a patient’s preferred language for communicating about their health can lead to delays for both the patient and provider, as well as inefficient use of interpreter resources. CHA therefore implemented several initiatives to ensure that patients’ language of care was accurately documented.

First, the CHA team added a language banner to the provider’s EMR screen to prominently display the patient’s preferred language of care and more recently changed the screen seen by front desk staff to display language of care, instead of primary language. Prior to CHA’s involvement in Speaking Together, only the primary language was displayed in the patient’s EMR. However, displaying the primary language did not take into consideration cases where the primary language may not be the language in which the patient prefers to receive care. For example, a patient may speak Portuguese at home with family members but may be able to effectively communicate in English with his/her provider.

In addition, clinical providers, front desk staff, and interpreters work together to ensure that the language preference is screened and recorded at registration/scheduling. If a change in preferred language is discovered, providers, front desk staff, and interpreters send the information to approved members of the registration team who make the change in the patient’s EMR.

The point-of-service language preference verification and the language banner together serve as effective tools to ensure that patients are treated in their preferred language of care.

Advice and lessons learned:

  1. Implement quick QI studies to assess the problem. The CHA team began by conducting a rapid cycle test of their language screening system which revealed an error rate of 16 percent in the language recorded at registration/scheduling.
  2. Start low and go slow. CHA found that starting with a small clinic of just a handful of providers smoothed the implementation of the new work flow and helped with physician buy-in.
  3. Identify a physician champion. When making any changes to provider’s work flow, it is critical to identify a physician to help “champion" the new system and gather feedback from affected providers. It also helps implementation to begin the new system as voluntary instead of starting with a mandate.

Cost/benefit estimate:
There were only minimal costs to implement the new system, including a small amount of IT time to design and add the new language banner to the EMR, as well as generate regular reports of patients whose language of care information needs to corrected. The new system is still being evaluated, but the team has anecdotal evidence that it has created a more patient-centered approach to language service and has increased the awareness of the value of interpreter services among providers.