This Community is Archived.

While this community is no longer active, we invite you to review and recommend past posts and resources. Membership for this community is closed, but we hope you'll join us in one of the many other communities on GHDonline.

Moderators of Technology for Patient Engagement and GHDonline staff

Idea Using the diverse healthcare workforce in US to tackle the healthcare disparity in US and beyond!

By Soojin Jun | 03 Dec, 2014

The US is like a microcosm of the wider world with so many ethnic and cultural diversity; more than 50 million US population speak languages other than English and more than 22.3 million people believe they have limited English proficiency.

We have so many highly qualified healthcare professionals who are bilingual and are trained extensively to provide quality healthcare but they are not always at the right places for the patients in need and underutilized in our current system. Minorities and the populations with English as their second language have a wider disparity in overall health and access to healthcare than English speaking patients.

Through a web community of diverse bilingual healthcare professionals by languages and virtual training programs for native languages for these bilingual healthcare professionals, and letting them allow to see patients virtually when possible, we can break down communication barriers and connect to the patients through methods such as video conferencing.

Notice that this should not be limited to just doctors because the issue isn't just limited to what doctors can provide; all qualified healthcare professionals are needed just as much for these patients, just like English speaking patients. If this can be successfully implemented in the United States, it can serve as a model for wider application around the world.

Keywords:
 

David Eisenberg Replied at 8:29 PM, 4 Dec 2014

I think that the idea of adding telemedicine that puts language at the forefront of the patient's choice of healthcare professional is an excellent idea. Like you mentioned, it could be done for a range of healthcare professionals. It could apply for languages as well as communities like the deaf and hard of hearing culture as well. It is very difficult, especially in underserved areas to find people with these niche skills. I am a student at The Commonwealth Medical College, and I know that something like this would be great to offer to patients in the area since we suffer from a lack of diversity amongst medical professionals with reference to language in our area.

A/Prof. Terry HANNAN Advisor Replied at 8:38 PM, 4 Dec 2014

David, you have struck a loud personal note with me with this posting. My eldest son is profoundly hearing impaired and he is a 1st Class Honours Graduate in Mechanical Engineering. He manages amazingly in the corporate world and often helps me with the technical side of my informatics. He and I used to manage a health informatics blog site.
It has been a fascinating experience to watch him use the emerging technologies over the last 30-40 years of his life (he is 41 years) and made it adapt to his needs.
Your posting reminded me when he migrated form pagers to mobile phones. It was like leaping a giant chasm. Terry

David Eisenberg Replied at 8:49 PM, 4 Dec 2014

Hi Terry,

Wow, thank you for sharing your personal story! It seems like your son is not only using the emerging technologies but has been creating them as well! I really admire people who find solutions to things that other people would view as a set back. I think that there are certain individuals who use all of their unique talents in incredible ways, and it is very inspiring.

I think that as the world of medicine grows we are starting to become more aware of the people that surround us, and not just the physical body that we are treating. I hope to be able to collaborate with people on working to expand care in unique ways in a compassionate and patient centered manner.

Thank you again for taking the time to respond with a personal and inspiring story! I am sure that we will be connecting more.

David

Soojin Jun Replied at 12:50 AM, 5 Dec 2014

Thank you David and Terry for your comments. This idea is inspired by my personal story as well; my father passed away partially because of the problem that this idea is trying to tackle. It is a long story how I have realized the importance of this idea but I have realized this area is well recognized but hardly anything is done about it. It is a hard problem that will be more and more prevalent as global population migrate/immigrate to almost anywhere in the world these days. I also realized fluency in everyday English wasn't enough to explain my symptoms and what I like to express in my native language. And yes, it is important to recognize a sign language as a language and hearing difficulties to be inclusive in this idea. I recently encountered a good IT solution for patients with language barriers; check out pgsi.com and their products. However, this problem needs multidimensional solution just like the tools available in English for English speaking patients.

Soojin

Attached resource:

A/Prof. Terry HANNAN Advisor Replied at 1:01 AM, 5 Dec 2014

Soojin, my son was "gifted" with not having to use "sign language" which is the normal language of the deaf. We used "cued speech" which was formulated at Gauladett University in Washington DC and provide the English language to my son 'before the age of 5 years'-critical in language acquisition. Once he began to read he did not and has not required the "cues" of cued speech. So everything he did from there was acquired by reading. He manages corporate group workshops these days-an amazing journey.
I have learnt so much about language acquisition and communication that is NOT taught in medical school or informatics but is so essential. I hope this is a nice story and does not distract from our discussions. Anyhow I will end this discussion here and concentrate on the other postings.

Nancy Street Advisor Replied at 11:05 AM, 5 Dec 2014

Hello Soojin-

I concur with the noted disparity in access to quality healthcare, driven by a multitude of factors. Technology provides unlimited opportunity to expand the outreach and sharing of healthcare knowledge to many under-served populations, including those with disabilities as well as language barriers as Terry and David have noted.

In my experience as a nurse practitioner over the past thirty years, I have witnessed amazing progress on the availability of technologies, yet note resistance among some healthcare providers (mostly older experienced professionals) to adopt the use of new modes for delivering care. Some may be based in lack of familiarity with technology, while others are resistant to change in delivery of care preferring face to face, hands on contact with patients. We need to partner our colleagues who are skilled with the use of technology with those who may lack skills or confidence with technology, yet have expertise drawn from years of experience, in order to share the highest quality of knowledge to all patients, regardless of language, location or ability. These partnerships will benefit all parties: health care providers both young and old, tech savvy or not and patients from all walks of life.

Communication is complex, most notably when dealing with sensitive or complicated material. The use of translators in the delivery of health care requires careful training and most importantly a strong mutual respect between provider and translator, and importantly with patients.

Ideally, I believe we need to invest in training, support and the development of best practices to expand the use of a web community for providing healthcare. We have come so far with certain technologies and I am confident that we will move forward in this area. I can only imagine the world of healthcare delivery over the next fifty years and beyond. It is exciting to envision these changes. Thanks for starting this interesting conversation. I look forward to continued dialogues with all of you.

Soojin Jun Replied at 1:15 AM, 7 Dec 2014

Terry, thank you for the clarification on your son's story. Nancy, thank you for your comment as well. The adoption of new technology is always a challenge and collaboration between early adopters and future adopters is essential. However, space and time are not often permitted. The idea I suggest will allow both of them by providing a space online and allowing users to learn and contribute when they can be available.

I challenge ghdonline community about the problem my suggestion is trying to solve. I will be very honest that I have been very disappointed with answers I have received from so called innovators in healthcare in healthcare conferences. All they could come up we're google translators and interpreters. Not only did they not care to listen to the problem but also they could not see the seriousness of the problem. Imagine you are sick in a foreign country where they all speak gibberish to you...or you receive a prescription bottle that says nothing you can understand...or you are given a choice of a surgery or a chemotherapy without a full explanation of the consequences in a language you can understand...or you are told to give an injection of insulin to yourself without a full explanation if what diabetes is and you have a disease you cannot swallow food. Some of these were what my father had to go through and it is partly why I have become a healthcare professional.

There has been progress in solution and recognition about the problem but it is very far from being available to everyone. I'm the meantime, I hear the suffering of the voiceless patients and caregivers. I want my healthcare professionals to see who I am and recognize the problems and be willing to help me truly. In order to do that, all people in healthcare need to open their eyes and see patients with hearts. But the truth is that they resist to open them or they resist to do anything about them even when they see them.

Soo

Nancy Street Advisor Replied at 10:39 AM, 7 Dec 2014

Soo- You rightfully advocate and call for empathy in all health care delivery, notably with patients who may lack language skills or have disabilities. I endorse your challenge and encourage others to as well.

I am currently a professor of nursing and see the role of education in promoting the provision of quality care to all persons. I would encourage educators of health professionals (nurses, doctors, pharmacists, social workers, physical therapists, etc.) to incorporate disability and language barriers into their patient simulations and case-based presentations. Further, I suggest adding web technology into these scenarios, incorporating the use of translators or devices in delivering this care. Central to the teaching within these scenarios is a patient-centered approach to health care, respecting the patient's capacity while providing the highest quality care. We as educators can lay the ground work for the delivery of quality health care that is based on respect for all.

Soojin Jun Replied at 11:22 PM, 8 Dec 2014

Thank you, Nancy, for kind words. I noticed some of my typing a were auto-corrected and now look like typos (this is a technology driven error--imagine this happening in healthcare, which it does very often...); I apologize. I agree with education being as a leading resource for this topic. What is hard, though, how what is being taught at schools get translated into practice. Schools usually teach academically driven ways and practice such ways; however, I feel those ways are not often practical. I feel more challenging and practical scenarios should be used in educational immersion.

For example, maybe students can have immersion of handicap by pretending a patient and adding a handicap one at a time. How will each handicap affect patients and what accommodations would the patients need? As patients, what would you wish your provider did for you? Would you be able to provide this accommodation? Why or why not? What are the barriers and how do we overcome them? What could you do now differently as a student? Healthcare provider?

I feel this way of teaching will bring more constructive discussion and possibly embed empathy in discussions. I hope this helps and you may already know this, Nancy; you are at a position that is so important for future students and I am eager to share other ideas if you like...thanks!

Andrey Ostrovsky Advisor Replied at 8:03 PM, 11 Dec 2014

Hi Soojin - Using alternative workforce to tackle the issues of disparities is a great idea. Here is a recent video from a congressional briefing I was a part of that highlights how the existing non-clinical workforce can be tapped into to prevent admissions in the least expensive transitions program available in the marketplace: http://blog.careathand.com/2014/12/video-congressional-briefing.html

Additionally, there is a great program call Project Starfish which helps to place persons with visual and other disabilities into employment using their unique highly qualified skill sets: http://www.pstarfish.org/

Attached resource:

Soojin Jun Replied at 12:56 AM, 13 Dec 2014

Hi Andrey,
thanks for sharing the links. I appreciate them. I also checked your company website; I participated in student startup competitions, including SXSW, with a similar idea as yours in preventing hospital admissions, not with nurses but with pharmacists. Many models uses nurses as alternative workforce but pharmacists can be another good resource and since I am a pharmacist, it is sad that pharmacists are overlooked. Pharmacists already practice such ways through something called medication therapy management (MTM) and is happening all over the US; however, because we are not considered as providers in Medicare act, getting paid is a barrier for many states (this will hopefully change in near future as pharmacy organization is pushing for a change). My idea was to connect patients and caregivers to pharmacists through mobile apps and enroll high risk patients for 30 days after hospital discharges for MTM service and build habits to take care of them the right way; the features of the app would have video conferencing ability, ability to record sessions with pharmacists, medication reminders, medical records, etc. I did not have an actual app but it was an idea that was inspired through my experience while taking care of my dad with stage 3 esophageal cancer with complication of diabetes before I went to pharmacy school. I wanted all those features as a caregiver and if they were there, I thought, his death might have been prevented. I am including the google doc of the presentation to this post.

However, on my way of promoting this idea, it really hit me big when I realized there was no innovation for population with LEP! Even when the innovations of the startups I see that are promising flourish, population with LEP, again, is left out when they are the ones who can truly use innovations! There were similar ideas to my idea in one way or another out there, like yours, but almost none for population with LEP. That is when I have changed the idea to my current one.

Andrey, since you already have a business of yours, I like you to think about my idea when you are developing models and business practice. How would population with LEP be served? Is translator in the middle of care sufficient? My answer is absolutely not! They also need interventions just like English speaking patients get. I have suggested the same to Ron Gutman of HealthTap after I have met him at SXSW. I challenge entrepreneurs like you to try to solve this disparity. Thanks for your comment!

Attached resource:

Joaquin Blaya, PhD Advisor Replied at 8:19 AM, 13 Dec 2014

The idea in your presentation looks good, especially the risk sharing with hospital for readmission rates. Have you been able to talk to hospitals directly about this? and if so, what's been their feedback? I have a feeling that the main problem might be that if they are implementing other methods of reducing readmissions that it'll be hard to separate out which part was due to your app versus the other methods they are implementing.

Also, designing the app so that your target population will use it and managing the amount of calls you'll get will be challenges. Does the team have experience in that? Because one thing missing from your powerpoint was the description of the team.

Soojin Jun Replied at 9:50 PM, 17 Dec 2014

Joaquin,
Thank you for looking into the presentation. My intention was to share the idea and not to pitch in. I took out the team info because of that; besides, we didn't have a cto to develop the app at the time and as you had mentioned, we would have needed someone with a depth of experience.

To be back to the focus of the discussion, a recent study points to the underutilization of the language skill set of doctors, which I will include in this post. I strongly feel bulinguality of healthcare professionals have to be encouraged and utilized as much as possible. And I fewl technology is the key to make this possible.

Attached resource:

Sandeep Saluja Replied at 2:56 AM, 18 Dec 2014

I have been keenly interested in this topic.Is there a portal where doctor and patient can maintain one to one interaction?Suppose every patient who visits me can have a page opened for him to interact with me.All the patient's data can be kept on that for both the doctor and patient to see together.As more reports come,both the doctor and the patient can have the opportunity to upload it on the page.The current prescription can be there for both to see and patient may have the liberty to put in additional notes about himself on regular basis with possible response from the doctor.Additionally,there may be a section where doctor can put notes of a technical nature which need not be shared with the patient(to avoid generating unnecessary panic)
I am not aware of such a portal but would look forward to one and would be happy to be associated with the development of something like this.

This Community is Archived.

While this community is no longer active, we invite you to review and recommend past posts and resources. Membership for this community is closed, but we hope you'll join us in one of the many other communities on GHDonline.

Moderators of Technology for Patient Engagement and GHDonline staff