Faced with a surge in virtual visits and a growing population of limited English proficiency (LEP) patients, clinicians at Massachusetts General Hospital developed a three-pronged approach to tackling the language barrier and improving access to care for underserved populations.
Healthcare organizations may see virtual care as the key to helping underserved populations access care, but things don’t work so well if those patients have problems understanding English.
With a surge in virtual care caused by the pandemic and a growing population of limited English proficiency (LEP) patients, clinicians at Massachusetts General Hospital launched new protocols to make sure the Boston-based health center was reaching people who needed to be reached. The developed three specific strategies aimed at tackling what could be a considerable barrier to care.
“With an increased reliance on virtual care for health care during the pandemic, it’s important to make sure we are not increasing disparities for patients who have language barriers,” Aswita Tan-McGrory, MBA, MSPH, director of the Disparities Solutions Center and administrative director of the Mongan Institute at MGH, said in a press release. “Also, addressing challenges with these three strategies will actually increase care and access for all patients.”
“We really had to put ourselves in the patient’s shoes and walk through all workflows to make sure language and health literacy needs were being addressed,” added Esteban A. Barreto, PhD, MA, director of Evaluation of Equity and Community Health at MGH. “Our findings suggest that as health systems continue to address such needs, patients with limited English proficiency should be able to have an active role in managing their own health which, in turn, may positively impact their health.”
Tan-McGrory and her colleagues outlined those strategies in a recent article in the American Journal of Managed Care.
First, the team identified the five top languages spoken by MGH’s patient population and launched a targeted campaign in multiple languages aimed at reaching people with limited technology and health literacy. The campaign was designed to extol the benefits of MGH’s digital health channels and giving them an easy pathway to enrollment.
In addition, the health system made 43 Amazon Fire tablets available through an affiliated community health center to patients with LEP and technology barriers, and paired participants with a bilingual students intern to learn how to use the tablet to access healthcare resources.
“We have successfully enrolled our first cohort of patients, and the pilot is still ongoing and will provide insights and recommendations for engaging patients with LEP in accessing virtual visits,” Tan-McGrory and her colleagues said in the article. “Our feasibility pilot highlighted that creative solutions may need to include a partnership with payers, community-based organizations, and faith-based organizations to provide broadband hotspots that patients can use to access virtual care.”
Second, to address privacy concerns from patients, MGH created a script that described how the health system protects information through the Health Insurance Portability and Accountability Act (HIPAA), and under what circumstances patient information can be shared. They also created cards in multiple languages outlining he rights and protection of immigrants under the US Constitution. Finally, the team identified a need to educate clinicians about whether and how to ask patients and family members about their immigration status.
“They also should avoid documentation of such status on a patient’s medical record to reduce stigma or unnecessary risk should immigration enforcement officers obtain access to the medical record,” Tan-McGrory and her team pointed out.
Third, MGH partnered with Doximity to develop a browser-based platform, one that doesn’t require the user to download an app, that can be used to create customized text messages in different languages and initiate a video visit. That platform can also be used to link in medical interpreters, either in advance or on demand. Finally, the health system customized its EHR platform to allow virtual visits that include interpreters, including third-party interpreters if none are available in-house.
“Healthcare organizations will undoubtedly rely heavily on virtual visits to provide patient care in the future,” the team concluded in its article. “As such, they will need to take all these challenges into consideration if they are to provide high-quality care and address disparities for patients with LEP.”
“Unfortunately, virtual visit platforms and systems are by default built for the technology-literate, English-speaking patient who has a smartphone, tablet, and/or computer,” they added. “Given the likelihood that payment reimbursement for audio-only visits will be reduced or discontinued after the public health emergency ends, healthcare organizations and policy makers should consider the impact on access to virtual care for those without broadband or technology. Ideally, systems, workflows, and platforms must be reviewed by staff who have the lived experience of low digital literacy, language barriers, and lack of access to technology or broadband. We have recently partnered with CRICO, our medical malpractice insurer, to develop best practices for the conduct of virtual visits.”
Along with Tan-McGrory, the lead author for the report, and Barreto, the senior author, the team included Lee H. Schwamm, MD, Christopher Kirwan, PhD, and Joseph R. Betancourt, MD, MPH.
Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.