Partnering health equity and clinical informatics to close the gaps in multilingual telehealth access

Background The COVID-19 pandemic has driven rapid expansion of telehealth, which is likely to be a keyfeature of the “new normal” even after the pandemic However, the benefits of virtual care are not enjoyedequitably across race/ethnicity, insurance type, and language groups Patients and families with limited Englishproficiency (LEP) are among those least likely to access telehealth due to the challenges of implementingmultilingual video visits Health information technology has tremendous potential for increasing equitablehealth care access We sought to create a process enabling clinical providers, families, and interpreters tointerface during a telemedicine visit We partnered a health equity framework, based in quality improvementscience, with a socio-technical focus on people, process, and technology to target modifiable aspects of ourtelehealth delivery system Methodology We convened a multidisciplinary team including physicians,registration, informatics, and language services Process maps were jointly created to understand therequirements needed for a successful telehealth visit, from initial patient contact to ending the visit (Figure 1) Concurrently, we created process maps to ensure proper scheduling for all patients in need of a multilingualvideo visit (Figure 2) With the requirements understood, the IS team enabled security settings that allowedinstitution-employed interpreters to join a video visit, similar to a multi-party conference call For external,contracted vendors used for less common languages, we designed a parallel audio/video process that still metthe requirements previously outlined We created both written and video training materials that weredisseminated to staff through emails, guided webinars, and the institution's telehealth intranet page Discussion To date, we have successfully conducted multilingual video visits in Spanish, Arabic, and SimplifiedChinese, with nearly 200 visits being completed from April 13, 2020 to April 27, 2020 This is an increase from abaseline of no documented multilingual video visits in the preceding six months The capacity only continuesto increase as the new workflow is integrated into practice We have initiated additional sustaining measures,including training clinicians, schedulers, clinic and information services staff to support telehealth access forLEP patients and families Conclusion Closing gaps in equitable telehealth requires a commitment toinnovation, a strategic allocation of resources, and multidisciplinary champions Successfully implementingmultilingual video visits is an important step to reduce disparities in telehealth access and health morebroadly, especially as we embrace the future of pediatric care