Working With Video Working With Video Remote InterpretersRemote Interpreters

Best PracticesBest Practices

Video Remote EquipmentVideo Remote Equipment

Equipment and installation requirementsEquipment and installation requirements

Steps of the VRI SystemSteps of the VRI SystemStep 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

Situations where the VRI is Situations where the VRI is appropriateappropriate

Emergency Room-admissions information for triage to Emergency Room-admissions information for triage to formulate treatment planformulate treatment plan

Pre-OP, to explain procedure and to fill out hospital Pre-OP, to explain procedure and to fill out hospital questionnaire, consent form etcquestionnaire, consent form etc

Prior to a routine procedure i.e. x-ray, MRI,CATSCAN, Prior to a routine procedure i.e. x-ray, MRI,CATSCAN, Physical Therapy etcPhysical Therapy etc

Short routine office visit (less than ½ hr)Short routine office visit (less than ½ hr) Doctor’s roundsDoctor’s rounds When medical staff needs to talk to a patient who is When medical staff needs to talk to a patient who is

hospitalized for an update on patient’s status hospitalized for an update on patient’s status Discharge planningDischarge planning

Situations where VRI Situations where VRI should not be usedshould not be used

Post operationPost operation Equipment barriers (lead shielded rooms etc)Equipment barriers (lead shielded rooms etc) Patient is not coherentPatient is not coherent Patient’s ability to use the VRI or patient’s Patient’s ability to use the VRI or patient’s

personal preference to have on site interpreterpersonal preference to have on site interpreter Emotionally Sensitive informationEmotionally Sensitive information Complicated and Risky ProceduresComplicated and Risky Procedures Certain Mental Health situations i.e. patient is in Certain Mental Health situations i.e. patient is in

restraints etc.restraints etc.

Mental Health Mental Health

If the patient is comfortable with using the VRI If the patient is comfortable with using the VRI for mental health status, one on one counseling for mental health status, one on one counseling etcetc

In groups, you have to consider the hearing In groups, you have to consider the hearing participants. This is probably not a good venue participants. This is probably not a good venue for the VRI. The other issue is the ability to hear for the VRI. The other issue is the ability to hear who is speaking and this could pose a problemwho is speaking and this could pose a problem

If patient is in restraints or out of control, then If patient is in restraints or out of control, then the VRI is not appropriatethe VRI is not appropriate

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

the VRIthe VRI

~Always direct your comments to the deaf ~Always direct your comments to the deaf

patient DIRECTLYpatient DIRECTLY

~~Be aware that everything that is Be aware that everything that is

heard or seen by the interpreter will be interpretedheard or seen by the interpreter will be interpreted

~Give the Interpreter time to explain what is going to ~Give the Interpreter time to explain what is going to occur before you proceed with an action (i.e. insert occur before you proceed with an action (i.e. insert the needle into the patient’s arm)the needle into the patient’s arm)

What you need to knowWhat you need to know

Remember not to block the patient’s view Remember not to block the patient’s view of the interpreter and vice versaof the interpreter and vice versa

If you leave the room and plan on not If you leave the room and plan on not returning for a while, inform the VRI returning for a while, inform the VRI interpreter so they can disconnect and interpreter so they can disconnect and make arrangements for a reconnection at make arrangements for a reconnection at the appropriate timethe appropriate time

Privacy GuidelinesPrivacy GuidelinesIf the patient is If the patient is notnot in a private room the in a private room the

following steps will need to be taken:following steps will need to be taken:

1. Make sure the volume on the VRI unit is turned 1. Make sure the volume on the VRI unit is turned down so other people not associated with the down so other people not associated with the patient cannot hear what is being saidpatient cannot hear what is being said

2. Make sure the VRI unit is not visible to others not 2. Make sure the VRI unit is not visible to others not associated with the patientassociated with the patient

3. Limit the amount of information that needs to be 3. Limit the amount of information that needs to be stated at that point in time, until patient can be stated at that point in time, until patient can be moved to a more private locationmoved to a more private location

Advantages of VRIAdvantages of VRI

Interpreters on DemandInterpreters on Demand Access to important information immediately for quick Access to important information immediately for quick

responseresponse Better use of resources (a VRI interpreter can cover Better use of resources (a VRI interpreter can cover

more assignments in one day than an interpreter who more assignments in one day than an interpreter who drives from assignment to assignment)drives from assignment to assignment)

Pay for only the real interpreting time not the driving or Pay for only the real interpreting time not the driving or down timedown time

Interpreter is not exposed to hazardous conditionsInterpreter is not exposed to hazardous conditions Can be a cost savings if used efficientlyCan be a cost savings if used efficiently Complies with the ADA legislationComplies with the ADA legislation

Resistance to VRIResistance to VRI

Some people have a fear of high tech equipment, but the Some people have a fear of high tech equipment, but the VRI is actually quite simple to use, equivalent to turning VRI is actually quite simple to use, equivalent to turning on and off your TV seton and off your TV set

Some people don’t like change and may feel it is too Some people don’t like change and may feel it is too impersonalimpersonal

There are legitimate reasons with certain situations when There are legitimate reasons with certain situations when the VRI shouldn’t be usedthe VRI shouldn’t be used

The VRI equipment is usually housed in the IT dept and The VRI equipment is usually housed in the IT dept and if they don’t keep track of where it is, it can be frustrating if they don’t keep track of where it is, it can be frustrating to try to find the equipment when neededto try to find the equipment when needed

Sometimes there are technical difficulties and this could Sometimes there are technical difficulties and this could cause some resistance to using the equipmentcause some resistance to using the equipment

The Difference between The Difference between VRS & VRIVRS & VRI

VRSVRSPhone Relay ServicePhone Relay Service

Controlled by FCCControlled by FCC

Can only be located in Can only be located in approved Centersapproved Centers

VRIVRIVideo to Video ServiceVideo to Video Service

No Controls, just No Controls, just partnership agreementpartnership agreement

Can be located in Can be located in Interpreter’s home and Interpreter’s home and follows HIPPA/RID follows HIPPA/RID confidentiality confidentiality guidelinesguidelines

The Difference between The Difference between VRS & VRI VRS & VRI (continued)(continued)

VRSVRS

Variety of TopicsVariety of Topics

Qualified Interpreters, Qualified Interpreters, does not mean certified does not mean certified or trained to cover all or trained to cover all topic matterstopic matters

VRIVRI

Specialized TopicsSpecialized Topics

Interpreters should be Interpreters should be RID Certified and had RID Certified and had specialized training i.e. specialized training i.e. MedicalMedical

VRI Teaming with CDIVRI Teaming with CDI

Certain patients have a compromised Certain patients have a compromised communication issue and will need a deaf communication issue and will need a deaf interpreter along with the hearing interpreter along with the hearing interpreterinterpreter

A CDI will be on site and will use the VRI A CDI will be on site and will use the VRI Interpreter to relay the message to the Interpreter to relay the message to the patientpatient

VRI Teaming with CDIVRI Teaming with CDI

The VRI Interpreter along with the CDI The VRI Interpreter along with the CDI interpreter will control the communication interpreter will control the communication traffic to make sure the CDI has plenty of traffic to make sure the CDI has plenty of time to convey the messagetime to convey the message

The patient will not be viewing the VRI The patient will not be viewing the VRI Screen, only the deaf interpreter will be Screen, only the deaf interpreter will be viewing the screenviewing the screen

VRI Teaming with CDIVRI Teaming with CDI

The patient will be in direct communication The patient will be in direct communication line with the CDIline with the CDI

Medical staff has to be aware not to block Medical staff has to be aware not to block visual communication either by standing or visual communication either by standing or putting equipment in front of the sightlines putting equipment in front of the sightlines of the interpreters and the deaf patientof the interpreters and the deaf patient

VRI Teaming with CDIVRI Teaming with CDI

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

CDI ResponsibilitiesCDI Responsibilities

CDI needs to be aware of environmental CDI needs to be aware of environmental information that needs to be passed onto the information that needs to be passed onto the VRI InterpreterVRI Interpreter

CDI needs to be aware to pass on visual cues in CDI needs to be aware to pass on visual cues in a subtle way as to not offend the deaf patienta subtle way as to not offend the deaf patient

When the VRI is turned off, the CDI should leave When the VRI is turned off, the CDI should leave the room and establish a way for the medical the room and establish a way for the medical staff to alert the CDI when interpreting needs staff to alert the CDI when interpreting needs arisearise

CDICDI

CDI in a mental health setting need to be CDI in a mental health setting need to be aware of their signing affect so as not to aware of their signing affect so as not to increase the patient’s anxiety or emotional increase the patient’s anxiety or emotional statestate

CDI can determine if an onsite hearing CDI can determine if an onsite hearing interpreter would be better suited for the interpreter would be better suited for the situation at handsituation at hand

CDICDI

CDI and VRI interpreters don’t have a way CDI and VRI interpreters don’t have a way at the end of the session to talk about the at the end of the session to talk about the teaming aspect of their work, so another teaming aspect of their work, so another method has to be utilizedmethod has to be utilized

CDI have to understand how CDI have to understand how

to work in a 2 dimensional to work in a 2 dimensional frameworkframework

The Interpreting ChallengeThe Interpreting Challenge

Medical Terminology Interpretation Medical Terminology Interpretation Language Equivalents (expansions) Language Equivalents (expansions) Working in 2 dimensional environment has an impact on Working in 2 dimensional environment has an impact on

certain visual cuescertain visual cues TeamingTeaming The interpreter has to make sure the lighting, contrast The interpreter has to make sure the lighting, contrast

and visibility is clear enough on both endsand visibility is clear enough on both ends The interpreter has to be aware and notify if picture The interpreter has to be aware and notify if picture

quality starts to disintegratequality starts to disintegrate The interpreter has to be aware and notify if audio levels The interpreter has to be aware and notify if audio levels

are compromisedare compromised

Clear CommunicationClear Communication

Roles clearly definedRoles clearly defined RespectRespect Effective Teaming (medical staff, VRI, CDI Effective Teaming (medical staff, VRI, CDI

and patientand patient Eliminating barriersEliminating barriers VRI should never be forced upon a deaf VRI should never be forced upon a deaf

patient even though it is stated that it patient even though it is stated that it complies with ADA (lawsuits have been complies with ADA (lawsuits have been filed in this arena)filed in this arena)

Questions and Answer PeriodQuestions and Answer Period

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