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Deaf Service Center Association of Florida, Inc.
Position Paper
Video Remote Interpreting (VRI) in a Medical Setting
OUR POSITION: We, the membership of the Deaf Service Center Association of Florida, Inc. , feel that when appropriately used, video remote interpreting (VRI) can be a valuable tool in the provision of “effective communication”. However, we view VRI as compliment to and not a replacement for standard on-site interpreting services. We believe VRI should be limited to: emergency situations when an on-site interpreter can not be provided on a timely basis and used only as a stop-gap until that interpreter can be provided; for rural areas where on-site interpreting services are not readily available; and for non-complex interactive situations. Medical providers should: carefully select their VRI provider to insure that the interpreters are qualified; provide a dedicated technical package insuring quality video imaging and transmission; and have a continual training program for staff on equipment operation.
BACKGROUND:
The Americans with Disabilities Act became law on July 26, 1990. Title III of that act specifies the requirement for a place of public accommodation to provide for “effective communication” for individuals who are deaf or hard of hearing.
Title III: PUBLIC ACCOMMODATIONS AND SERVICES OPERATED BY PRIVATE ENTITIES: Sec.36.201 states that no individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any private entity who owns, leases (or leases to), or operates a place of public accommodation.
Doctor’s offices and medical facilities in general are places of “public accommodation”. Therefore, medical professionals must provide effective means of communication for patients and family members who are deaf and hard of hearing. Wherever patients, their family members, companions, or members of the public are interacting with medical staff, there is an obligation to provide effective communication.

Determining which service or which aid is most appropriate is a daunting task and requires careful consideration of the answers to the following four questions:

• What is the purpose of the communication?
• What is the length of the communication?
• How many people are involved?
• What is the depth or complexity of the exchange of information?

One means of providing effective communication in some situations is Video Remote Interpreting, commonly referred to as VRI.

TECHNOLOGY SUMMARY:

VRI is an internet based service which uses video conferencing technology to provide access to sign language interpreting services 24 hours a day, seven days a week. By using a computer equipped with a webcam and an audio feed, a deaf individual can be provided the services of a sign language interpreter operating from a remote location. The service is usually fee based as opposed to an hourly rate charged by on site interpreter services.

BENEFITS:

Two major benefits are inherent in using VRI. The first is financial. Interpreting costs may be reduced through the fee based system and the accompanying lack of travel / mileage costs. The second is access both with respect to speed and 24/7 availability. Immediate access is extremely beneficial in an emergency situation when communication is essential.

LIMITATIONS AND CONCERNS:

Interpreter Qualifications: The US Department of Justice considers an interpreter as being “qualified” if he or she can interpret competently, accurately, and impartially. In the medical setting, the interpreter must be familiar with any specialized vocabulary used and must be able to interpret medical terms and concepts. The only way of insuring that the remote interpreter is qualified is for the medical facility to require the VRI provider to use nationally certified interpreters with specialized training in medical terminology.

Technical Quality and Preparation:

• Video Quality – The system should have a dedicated high-speed internet connection, sufficiently sized screen, adjustable camera angle and video screen angle to accommodate various patient positioning scenarios and clear audio quality. If the system being used does not satisfy any one of these requirements the medical facility may not be deemed as satisfying its requirement for “effective communication”. In addition, blurred or disjointed video, inability to fully view the screen or misinterpretation due to poor audio quality may in fact put the facility at the risk of liability because of miscommunication.
• Preparation – Staff must be thoroughly trained in the set-up and operation of the system. Since this is a stop-gap system in emergency situations, it is essential for staff to be well versed in this area. We are finding hospitals subscribing to a VRI service, but only have one or two staff members familiar with the operation of the system.
• Privacy: When possible VRI should be used in a private room to reduce distractions.

Inappropriate Situations for Using VRI: We are in agreement the following situations as outlined in the “VRI Standard Practice Paper” published and approved by the membership of the Registry of Interpreters for the Deaf (RID).

• “Situations involving high interactivity, such as multiple participants with less structured turn-taking protocols;
• Situations with complex dialogic exchange, such as abstract philosophical interchange or dialogue with veiled intentions and double meanings;
• Situations involving communications of a sensitive nature;
• Situations involving individuals with a secondary disability (e.g. low vision) that impedes their ability to utilize the technology.”

SUMMARY:

Video Remote Interpreting is a useful tool in the provision of effective communication. However, the patient should always be consulted and their communication preference should always be accommodated if possible. Being aware of the limitations of this technology and not exceeding those limitations will insure that the patients communication needs will be met.

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