Working With Video Remote Interpreters

1
Working With Video Remote Interpreters

• Best Practices

2
Video Remote Equipment

• Equipment and installation requirements

3
Steps of the VRI System
Step One The hospital personnel phones the VRI
agency to request the VRI service
Step Two The agency then contacts the VRI
interpreter with the request
Step Three The VRI interpreter places the call
to the hospital contact person to ensure the
equipment is in place and is ready to be used
Step Four The Interpreter then initiates the VRI
connection
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Situations where the VRI is appropriate

• Emergency Room-admissions information for triage
  to formulate treatment plan
• Pre-OP, to explain procedure and to fill out
  hospital questionnaire, consent form etc
• Prior to a routine procedure i.e. x-ray,
  MRI,CATSCAN, Physical Therapy etc
• Short routine office visit (less than ½ hr)
• Doctors rounds
• When medical staff needs to talk to a patient who
  is hospitalized for an update on patients status
  
• Discharge planning

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Situations where VRI should not be used

• Post operation
• Equipment barriers (lead shielded rooms etc)
• Patient is not coherent
• Patients ability to use the VRI or patients
  personal preference to have on site interpreter
• Emotionally Sensitive information
• Complicated and Risky Procedures
• Certain Mental Health situations i.e. patient is
  in restraints etc.

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Mental Health

• If the patient is comfortable with using the VRI
  for mental health status, one on one counseling
  etc
• In groups, you have to consider the hearing
  participants. This is probably not a good venue
  for the VRI. The other issue is the ability to
  hear who is speaking and this could pose a
  problem
• If patient is in restraints or out of control,
  then the VRI is not appropriate

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What the medical staff needs to know in order to
facilitate communication through the VRI

• Always direct your comments to the
  deaf
• patient DIRECTLY
• Be aware that everything that is
• heard or seen by the interpreter will be
  interpreted
• Give the Interpreter time to explain what is
  going to occur before you proceed with an action
  (i.e. insert the needle into the patients arm)

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What you need to know

• Remember not to block the patients view of the
  interpreter and vice versa
• If you leave the room and plan on not returning
  for a while, inform the VRI interpreter so they
  can disconnect and make arrangements for a
  reconnection at the appropriate time

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Privacy Guidelines

• If the patient is not in a private room the
  following steps will need to be taken
• 1. Make sure the volume on the VRI unit is
  turned down so other people not associated with
  the patient cannot hear what is being said
• 2. Make sure the VRI unit is not visible to
  others not associated with the patient
• 3. Limit the amount of information that needs
  to be stated at that point in time, until patient
  can be moved to a more private location

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Advantages of VRI

• Interpreters on Demand
• Access to important information immediately for
  quick response
• Better use of resources (a VRI interpreter can
  cover more assignments in one day than an
  interpreter who drives from assignment to
  assignment)
• Pay for only the real interpreting time not the
  driving or down time
• Interpreter is not exposed to hazardous
  conditions
• Can be a cost savings if used efficiently
• Complies with the ADA legislation

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Resistance to VRI

• Some people have a fear of high tech equipment,
  but the VRI is actually quite simple to use,
  equivalent to turning on and off your TV set
• Some people dont like change and may feel it is
  too impersonal
• There are legitimate reasons with certain
  situations when the VRI shouldnt be used
• The VRI equipment is usually housed in the IT
  dept and if they dont keep track of where it is,
  it can be frustrating to try to find the
  equipment when needed
• Sometimes there are technical difficulties and
  this could cause some resistance to using the
  equipment

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The Difference between VRS VRI

• VRS
• Phone Relay Service
• Controlled by FCC
• Can only be located in approved Centers

• VRI
• Video to Video Service
• No Controls, just partnership agreement
• Can be located in Interpreters home and follows
  HIPPA/RID confidentiality guidelines

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The Difference between VRS VRI (continued)

• VRS
• Variety of Topics
• Qualified Interpreters, does not mean certified
  or trained to cover all topic matters

• VRI
• Specialized Topics
• Interpreters should be RID Certified and had
  specialized training i.e. Medical

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VRI Teaming with CDI

• Certain patients have a compromised communication
  issue and will need a deaf interpreter along with
  the hearing interpreter
• A CDI will be on site and will use the VRI
  Interpreter to relay the message to the patient

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VRI Teaming with CDI

• The VRI Interpreter along with the CDI
  interpreter will control the communication
  traffic to make sure the CDI has plenty of time
  to convey the message
• The patient will not be viewing the VRI Screen,
  only the deaf interpreter will be viewing the
  screen

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VRI Teaming with CDI

• The patient will be in direct communication line
  with the CDI
• Medical staff has to be aware not to block visual
  communication either by standing or putting
  equipment in front of the sightlines of the
  interpreters and the deaf patient

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VRI Teaming with CDI

• Technology is also available where both the CDI
  and the hearing interpreter will be on the VRI
  screen, in that case, the VRI screen will be
  facing the deaf patient and all other information
  listed above will still hold

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CDI Responsibilities

• CDI needs to be aware of environmental
  information that needs to be passed onto the VRI
  Interpreter
• CDI needs to be aware to pass on visual cues in a
  subtle way as to not offend the deaf patient
• When the VRI is turned off, the CDI should leave
  the room and establish a way for the medical
  staff to alert the CDI when interpreting needs
  arise

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CDI

• CDI in a mental health setting need to be aware
  of their signing affect so as not to increase the
  patients anxiety or emotional state
• CDI can determine if an onsite hearing
  interpreter would be better suited for the
  situation at hand

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CDI

• CDI and VRI interpreters dont have a way at the
  end of the session to talk about the teaming
  aspect of their work, so another method has to be
  utilized
• CDI have to understand how
• to work in a 2 dimensional
  framework

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The Interpreting Challenge

• Medical Terminology Interpretation
• Language Equivalents (expansions)
• Working in 2 dimensional environment has an
  impact on certain visual cues
• Teaming
• The interpreter has to make sure the lighting,
  contrast and visibility is clear enough on both
  ends
• The interpreter has to be aware and notify if
  picture quality starts to disintegrate
• The interpreter has to be aware and notify if
  audio levels are compromised

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Clear Communication

• Roles clearly defined
• Respect
• Effective Teaming (medical staff, VRI, CDI and
  patient
• Eliminating barriers
• VRI should never be forced upon a deaf patient
  even though it is stated that it complies with
  ADA (lawsuits have been filed in this arena)

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Questions and Answer Period

• Thank you for attending our Workshop and we look
  forward to possibly working with you in a Video
  Remote Venue