THE LAB

The Rise of OPI, VRI,
and Interpretation Management Systems in Healthcare

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Mark Shriner is the strategic sales director for memoQ, leading the company’s market growth in the regulated industries. He has previously worked in several leadership roles in the localization industry including CEO Asia Pacific for CLS Communication.

terena-bell

Mark Shriner is the Strategic Sales Director for memoQ, leading the company’s market growth in the regulated industries. He has previously worked in several leadership roles in the localization industry including CEO Asia Pacific for CLS Communication.

Welcome back to The Lab, where we take a look at what’s cooking in life sciences localization. This month, we are going to jump tracks a bit and look at some of the trends in the delivery of interpretation services in healthcare. Specifically, we will discuss drivers of the growth in this space and a few of the key attributes of the technology that supports the delivery of interpretation services. We will also cover some trends for providers and consumers of these services.

One macro trend that has been greatly accelerated by the pandemic is the shift towards telemedicine and telehealth. These terms refer to the delivery of healthcare services from a remote location by the use of electronic information and technology including computers, databases, video conference equipment, and the internet.

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According to a report published by Grandview Research, the telemedicine market was valued at $70.4 billion in 2021 and is estimated to grow at a compound annual growth rate (CAGR) of 19.5% until 2030. The main drivers, aside from the pandemic, have been the increased focus on reducing the cost of care, industry consolidation, and the improvement in monitoring device and other technologies that facilitate remote monitoring and assessments.

In the US, the widespread adoption of telemedicine has resulted in a greater demand for remote interpretation services to deliver healthcare services to people with Limited English Proficiency (LEP). According to the 2020 census, over 8% of Americans have LEP, and that number is expected to reach 19% by 2050. This can lead to problems, as language barriers have been shown to result in a poor understanding of diagnosis, treatment, and an increased chance of a serious medical event.

In a paper published by the NIH titled, “Use of Communication Technologies to Cost-Effectively Increase the Availability of Interpretation Services in Healthcare Settings”, the authors stated that remote interpretation services provided an affordable option for patients that have LEP, and the development of video conference technology and call center interpretation services have facilitated the adoption of video remote interpretation (VRI). The authors also claim that VRI is more effective than over-the-phone (OTP) interpretation services in many scenarios.

The paper cites an example of the Healthcare Interpreter Network, a cooperative of nine hospitals in California that utilizes video VoiP call center technology to automatically route interpretation requests in 15 languages to a pool of 35 full-time interpreters and bilingual staff. It takes an average of 12 seconds to reach a trained interpreter using this platform, and if none of the pool interpreters are available, the request is routed to an interpretation service vendor that provides services 24/7. The system is now handling over 10,000 requests for interpretation per month.

LSPs are also adopting newer technology to support the delivery of both OTP and VRI services. For example, according to Lena Petrova-Toosie, founder and CEO of Ad Astra, “While we have been providing both face-to-face and OTP interpretation services for years, the pandemic and the development of improved technologies were catalysts for us to greatly accelerate our movement towards, and expansion of, our OTP and VRI services.”

The question many organizations have is how to choose the best platform to offer OTP and VRI services. Interpretation platforms are comprised of two components: the Interpretation Management System (IMS) and the Interpretation Delivery Platform (IDP). And while most platforms include an integrated IMS and IDP, it’s worth looking at the function and features of each.

An IMS is primarily responsible for supporting the business side of delivering interpretation services and has features for booking and automatic scheduling of services. It should also include tools for account management, vendor management, service rate management, billing, and invoicing. The vendor management tool should allow for the uploading of interpreter credentials, resumes, background checks, and more. Business reporting tools that provide insights on activity, costs, and margins, and also support data exporting or integration with the most popular bookkeeping applications such as QuickBooks, NetSuite, and others, are becoming an essential component of an IMS.

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IDPs should support on-demand OPI and VRI services and handle requests in a fast and seamless manner. The key metric for OPIs is average response times (ARTs) and access to a qualified interpreter who meets all the language, experience, and specialization requirements of a specific request. IDPs should be platform agnostic — that is, they can work with all commonly used browsers, be mobile friendly, and support the full range of communication devices from analog phone lines to smartphones and laptop and desktop systems, as well as commonly used collaboration platforms such as Zoom and Microsoft Teams.

According to Dieter Runge, global chief strategy officer at Boostlingo: “While most IDPs are fully integrated with an IMS, proper IDP functionality should include a tool for Quality of Service (QOS) detection, and give insights regarding the number of interpreters online, connection times, the number of dropped or abandoned calls, and other key information that helps operators understand how to improve the QOS.”

Adam Hodgson, CEO at Interpreter.io, agrees about IMS and IDP integration and stated, “The distinction between an IMS and an IDP is academic as leading solutions meet both IMD and IDP business requirements.” He continued by stressing the importance of scalability, “A critical question is whether the system can meet your current and future needs.”

One added advantage of VRI systems is that they more effectively support American Sign Language (ASL) interpretation services. According to the previously cited paper published by the NIH, “Exchange of visual information makes video interpretation especially useful for ASL and mental health interpretation which can be very costly.”

The authors cited examples of the savings from using VRI for ASL interpretation that, by themselves, have more than paid for the installation of video interpretation network systems in some hospital facilities.

Pure play interpretation platform and interpretation service providers are not the only ones providing interpretation services in the healthcare space. Many traditional LSPs and hybrid organizations have noticed the opportunity and are adopting various strategies for going after this growing business. Some are developing their own proprietary systems, while others that have a need to scale or want a more robust platform are buying third-party options suitable to their needs.

For example, according to James Dodson, executive vice president of interpretation at United Language Group (ULG): “Our team currently uses a proprietary platform for the delivery of both OPI and VRI service. However, to maintain our velocity of growth and enhance our ability to scale, we are migrating to a world-class third-party platform in Q1 2023.”

James further explained that the key reasons for going in that direction included ULG’s need for updated phone technology to deliver a stronger connection and clearer calls, more flexible customer data collection, multiple third-party dial outs with a single interpreter, enhanced IVR technology with dynamic data collection options, interpreter skill-based routing, and a FEDRAMP certification.

One decision that service providers must make is whether or not they want to use a platform that also sells interpretation services and could possibly end up in a competitive situation with its customers. Interpreter.io’s Adam Hodgson gives the following advice: “It is very important to ensure that the provider of your IMS system is not a competitor.”

This scenario is not a new dilemma to companies in the language services space who have used or are using Trados technologies or from other companies that sell both technology and services. Many are OK with this arrangement, but others balk at the idea of buying a tool from a potential competitor. While the competitive threat may or may not be real, white labeling an IMS from a provider that has their own pool of interpreters or call center that can be leveraged when needed could also be a significant advantage. This is demonstrated by the earlier example of the group of hospitals in California that automatically route interpretation requests to an external call center when they can be fulfilled by their staff interpreters.

Going forward, there is a strong consensus that to be competitive in the healthcare interpretation space platform, providers will need to provide data protection that aligns with regional and global standards such as GDPR, HIPAA, ISO 27001, SOC2, and others. Automation and the ability to integrate with a variety of telehealth platforms is also high on most lists.

“In the healthcare sector, we see IMS and IDP vendors integrating with telehealth platforms and healthcare record systems,” said Dieter Runge of Boostlingo. “Support for electronic health record (EHR) and electronic medical record (EMR) interoperability is also something telehealth IT system admins and manager are beginning to require.”

The global pandemic kicked off a massive need for OPI and VRI services. At the same time the development and adoption of new telehealth services and technologies, the pressure to reduce the costs of care, and a growing LEP population in the US all point to a significant growth in the demand for OPI and VRI services and the platforms that support their delivery over the next decade.

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