228136 Best practices in collecting and using data for quality improvement in language services: Implementing clinician documentation in the electronic medical record of how patient language needs were met

Wednesday, November 10, 2010 : 8:45 AM - 9:00 AM

Yoon Susan Choi, MA , Department of Community Affairs/Institute for Community Health, Cambridge Health Alliance, Cambridge, MA
Ffyona Patel, BA , Institute for Community Health, Cambridge Health Alliance, Cambridge, MA
Helena Santos-Martins, MD , Department of Medicine, Cambridge Health Alliance, Cambridge, MA
Izabel Arocha, MEd , Department of Multilingual Services, Cambridge Health Alliance, Cambridge, MA
Mursal Khaliif, BSN, MA , Department of Multilingual Services, Cambridge Health Alliance, Somerville, MA
Laura Nevill, APRN , Departments of Information Technology and Nursing, Cambridge Health Alliance, Somerville, MA
Hilary Worthen, MD , Departments of Information Technology and Medicine, Cambridge Health Alliance, Somerville, MA
Linda Cundiff, RN, MSN , Department of Community Affairs, Cambridge Health Alliance, Somerville, MA
Robert P. Marlin, MD, PhD , Department of Medicine, Cambridge Health Alliance, Cambridge, MA
Elisa Friedman, MS , Department of Community Affairs/Institute for Community Health, Cambridge Health Alliance, Cambridge, MA
           
This presentation describes how a large safety net hospital system capitalized on the strengths of the electronic medical record (EMR) to better capture and make use of data to improve the care provided to limited English proficient (LEP) patients and ultimately reduce health disparities.

Quality improvement efforts for language services in healthcare organizations require accurate and comprehensive data on patients' language needs and the provision of all forms of language assistance. This means tracking not only professional interpreter services, but also assistance provided by clinicians or ad hoc (untrained) interpreters. By documenting how patient language needs are met in each clinical encounter, organizations are able to better identify and address gaps in language services.

At the Cambridge Health Alliance (CHA), a system for clinician documentation in the EMR of how LEP patient language needs were met was instituted organization-wide. The “Quick Questions” system was developed, piloted, and institutionalized with support from the Robert Wood Johnson Foundation's Speaking Together National Language Services Network. With the Quick Questions, clinicians in primary care and all specialties are required to complete documentation for every encounter with an LEP patient. Because clinicians are able to select from both appropriate and less ideal options, the Quick Questions data provide guidance on areas for improvement. For example, this documentation showed that, for November 2009, clinicians met LEP patients' language needs for 21% of encounters, while 7% of encounters involved either bilingual employees, family/friends, or no language services.

Implementation of the Quick Questions has achieved four key innovations: 1) Documentation through the EMR is quick and user-friendly. 2) Standardized response options increases accuracy of documentation. 3) Required CHA-wide documentation allows comprehensive collection of this information on an unprecedented scale. 4) Creation of electronically generated, regular reports provides a complete picture of language services at CHA and enables tracking of the effects of quality improvement initiatives.

In response to data showing that clinicians regularly provide language assistance to their LEP patients, CHA has worked towards institutionalizing clinician language proficiency testing. Initiatives have included raising clinician awareness of the risks associated with miscommunication, identification of an appropriate language proficiency test, and laying groundwork for policies that would require testing.

Use of the Quick Questions allows a healthcare system to ensure compliance with Joint Commission standards and optimize interpreter services. Further, reports from such documentation may prompt quality improvement initiatives to improve language access and ensure the safety of patient-clinician communication.

Learning Areas:
Communication and informatics
Diversity and culture
Provision of health care to the public

Learning Objectives:
1) Explain how improved documentation systems in the electronic medical record (EMR) can help to achieve social justice in health care for limited English proficient (LEP) by better meeting their language needs. 2) Articulate rationale for documenting how LEP patients’ language needs were met in each clinical encounter. 3) Describe approaches for engaging diverse stakeholders in interdepartmental partnerships that are necessary to implement a documentation system like the Quick Questions. 4) Identify ways in which data from the Quick Questions system could be used for quality improvement in language services.

Keywords: Health Information Systems, Interpreters

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: At the Cambridge Health Alliance (CHA), I am responsible for managing language service quality improvement initiatives focused on enhancing patient language need documentation and ensuring that those needs are met safely. I also manage the Zero Disparities Committee, a cross-departmental working group of the Quality Management, Community Affairs and Multilingual Services Departments that seeks to reduce disparities in service utilization and health outcomes among populations served by CHA. In this capacity, I have spearheaded efforts in improving processes for collecting and using race/ethnicity/language patient data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5063.0: Quality Improvement: Patient Safety & Organizational Practices