O0661 Oct.4: 5:23pm - 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 key feature of the “new normal” even after the pandemic. However, the benefits of virtual care are not enjoyed equitably across race/ethnicity, insurance type, and language groups. Patients and families with limited English proficiency (LEP) are among those least likely to access telehealth due to the challenges of implementing multilingual video visits. Health information technology has tremendous potential for increasing equitable health care access. We sought to create a process enabling clinical providers, families, and interpreters to interface during a telemedicine visit. We partnered a health equity framework, based in quality improvement science, with a socio-technical focus on people, process, and technology to target modifiable aspects of our telehealth delivery system.

Methodology
We convened a multidisciplinary team including physicians, registration, informatics, and language services. Process maps were jointly created to understand the requirements 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 multilingual video visit (Figure 2). With the requirements understood, the IS team enabled security settings that allowed institution-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 met the requirements previously outlined. We created both written and video training materials that were disseminated 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 Simplified Chinese, with nearly 200 visits being completed from April 13, 2020 to April 27, 2020. This is an increase from a baseline of no documented multilingual video visits in the preceding six months. The capacity only continues to 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 for LEP patients and families.

Conclusion
Closing gaps in equitable telehealth requires a commitment to innovation, a strategic allocation of resources, and multidisciplinary champions. Successfully implementing multilingual video visits is an important step to reduce disparities in telehealth access and health more broadly, especially as we embrace the future of pediatric care.