Introduction by Tannus Quatre PT, MBA

I am pleased to welcome and introduce Chanin Ballance, CEO of viaLanguage, to The Healthcare Entrepreneur.  A true healthcare entrepreneur, Chanin is a localization and language translation expert.  In 2000, she co-founded viaLanguage, a leading language translation and localization agency that specializes in healthcare.  ViaLanguage works with doctors, hospitals and health plans across the country helping them provide equal access for culturally diverse membership. Chanin speaks at numerous conferences including the TAHIT Symposium on Language Access, SE Medical Region Interpreters Conference, the California Health Plan Association conference, Content Week, as well as many multicultural and marketing webinars.

Please enjoy reading Chanin’s post on enriching patient communication through effective translation.
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Enriching Patient Communication: Tips to effective translation - by Chanin Ballance, CEO of viaLanguage

The core of the doctor-patient relationship is good verbal and written communication. It goes without saying what the consequences would be if there’s a misunderstanding. But when both doctor and patient don’t speak the same language, communicating can be more than a challenge. Sometimes it can be a downright nightmare.

Having interpreter services available is critical. Also having supplemental translated education or instruction information on hand, (in the languages of your community) is key. It aids in greater comprehension of doctor-patient communication, and encourages better follow through of the prescribed advice or regimen.

When it comes to translation it’s crucial that any text or graphics translations be of the highest quality - in wording, connotation and cultural understanding. For example, In the Hmong language, there is no word for cancer or even a concept of it. Inexperienced interpreters have described chemotherapy as “we’re going to put a fire in you” - an obvious deterrent to treatment. And in Spanish, inattention to dialect can designate a baby with the word another dialect uses for “bus,” and a penis as another dialect’s word for “bug.”

So, to keep from eliciting giggles or blank looks from bad or inadequate translations, doctors and other healthcare providers need to pay special attention to the quality of the translation service they use. Yet how can healthcare provider be certain it has received the most accurate translations for its target populations?
 
Factors to consider when selecting a translator or agency include: experience in the source and target languages, special skills relevant to your field, and an established methodology of best practices for getting projects done well, consistently, and on time.

The best and most reliable way to find a good translator is to use the reference of a trusted colleague; someone who has experience with your practice area, and who also has worked with the translator in the past. Since this is not always possible, there are other ways to evaluate prospective agencies or individuals. The approach should be similar to the selection of a valued employee, since the translators can have a big influence on how you are perceived in the target languages. In the U.S., the American Translator’s Association (http://www.atanet.org/) can provide valuable information and references for companies and individuals in your area.

Other factors to consider include:

Go native. Native refers to native of the target language, as that person will have the advantage of linguistic intuition that makes it possible to say things so that they sound right to the target audience. However, the translator’s ability with the source language is important, too (for example, time living in an English-speaking country if the source language is English).

Get references. Much like screening potential employees, it is important to do a professional check on translators to confirm their experience and skill level.

Match skills to topic. In healthcare it is important to find a translator comfortable handling health-related subject matter who is familiar with appropriate terminology and target literacy level. An agency provides this because (a) its translator screening can be more vigorous and it draws from a wider pool of experienced translators, and (b) it is more finely tuned to industry needs.

Project management methodology. Since translation is labor intensive, it is key that translation projects be designed properly, otherwise they can be very expensive to fix. To ensure that your translation agency does a quality job the first time, keep its process in mind and notice whether it uses project managers to track projects, maintain clear communication with all concerned, ensure glossaries are built, and allow for review time while keeping within time and budget.

Translation Memory. If you anticipate a large volume of translations, make sure your “language service provider” builds and maintains a memory of all translated text for you. Over time, much of this text can be recycled lowering your overall costs.

The bottom line is, providing quality translations of vital health information for your limited English proficiency patients means you’ll be helping all people better educate themselves, leading to better health for all.

Credit cards have been around for a long time.  They’re easy to carry, pack a lot of information, and allow you to complete transactions quickly when at a supermarket, bank, or restaurant.  It makes a whole lot of sense, which is why just about all adults (and some children) have more than one.

And what about the kiosks that are now present at most airline ticket counters?  I’d be hard pressed to count the number of times I’ve been “trained” in the last year by ticketing agents on how to use the kiosk to speed up my check in time.  The kiosks work (most of the time) and I actually like the convenience of anonymously speeding through the terminal without having to talk to the ticketing agent.

So why not in healthcare?  I mean, credit cards and kiosks probably aren’t for everyone, but I bet they would work for a lot of people, especially when you’re trying to speed up the amount of time you spend in a place like a hospital or medical clinic.  Imagine a small credit card that stored all of your insurance and general information, and allowed you to check in by simply sliding it through a terminal - no clipboards, no rotten strings holding slightly chewed pens, and no waiting in line twice (once to get the paperwork, an once to turn it in).

Probably has a ways to go, but I bet it’s where we’re all headed.  Check out this Indianapolis-based healthcare system that introduced it’s card and kiosk system this month in an effort to put it’s patients in more control of an efficient and error-free check in process.

The service, unveiled Wednesday, offers a variety of free tech tools to patients who sign up to receive a credit-card-sized “myCommunity” card. The service features express check-in kiosks (similar to those at airports) to be installed at Community North first, then throughout the system eventually. Patients will swipe their myCommunity cards and use touch screens to complete the inpatient and outpatient check-in process.

“It involves the way people are going to interact with health care in the future,” said Daniel Rench, vice president of e-business for Community Health Network, which operates five hospitals and numerous other health facilities in Central Indiana.

As much as electronic medical records (EMR’s) have been the topic of conversation in the healthcare profession over the last 10 years, most of the buzz has been around the “potential” rather than “impact” of the technology. 

One of the main reasons for this is that there exists a lack of standards that allow for the transfer of information between EMR systems.  There are some great EMR systems out there, but for EMR’s to really catch on, they need to be both cost effective and efficient for providers.  For all users of EMR’s to achieve this, one of two things needs to happen: (1) Everyone needs to get on board with the same system, or (2) we agree to, and abide by development “standards” that will allow systems to communicate with each other.  Since getting all providers on board with one EMR platform is unrealistic, the answer to widespread adoption likely lies with the development of standards that will allow systems to integrate together, and that will lower the switching costs associated with moving from one system to the next.

With regard to personal health records (PHR’s), the same is true, and the battle between Microsoft and Google to become the preferred PHR system by consumers and providers has recently brought the issue of “standards” to the forefront.  This article from WashingtonPost.com discusses how Microsoft, Google, and some other PHR developers have agreed to move forward with privacy standards in the development of electronic personal health records - an important step toward widespread adoption by healthcare consumers.

In a move designed to prompt more people to store their medical records online, Microsoft (NSDQ: MSFT), Google (NSDQ: GOOG) and several others have agreed on privacy standards to protect patients’ information. The list includes WebMD (NSDQ: WBMD), MedicAlert, AARP,Consumer Reports publisher Consumers Union, BlueCross BlueShield, and other insurers.

We all know Google, many of us using their search algorithms daily when we “Google” products, services or people online.  For business owners, Google has become a research tool, allowing for “quick and dirty” searches of information about themselves and competitors.

As more people are moving to the web to find information about healthcare providers (read my posts about online physician ratings here and here), it pays for private practice owners to know what is being said about their practice in online news publications and throughout the blogosphere.  With more and more print publications simultaneously funneling their news stories online, web searches now provide a means by which to search local print media who may be publishing information about a practice from recent press releases, sponsorships or other local news stories.

Practice owners and managers don’t have the time to search the Internet daily for news stories or commentary about their practice, but they do have the time to take advantage of Google Alerts in order to have Google scour the web for them.  With Google Alerts, you simply enter the keywords you’d like searched, enter in a frequency of which you’d like the results sent to you by email, and you’re done.  You’ll soon be getting email in your inbox telling you exactly what is being said about your practice online - a great way to keep tabs on your practice’s brand in a way that is efficient, easy and effective.

This article from BizGrowthNews provides some more information about the benefits of this great tool.

I recommend putting in place a once-a-day Google Alert which you can then review at the start of each day.

Items that feature in the news, in blogs or on the web can be included in the alert.

In a big nod to Microsoft HealthVault, the software behemoth’s independent, online personal health record (PHR), Kaiser is rolling out a pilot of the HealthVault system by allowing its 159,000 employees to trial the online PHR.  Employees will be given the option of transferring data between Kaiser’s online PHR and HealthVault.  A successful pilot may mean a roll out to Kaiser members, a member base of 8.7 million insured.

This leap of faith between Kaiser and Microsoft’s HealthVault marks an important acknowledgement of the value of an independent PHR to insurers, providers and patients.  This article from the Mercury News explains.

Launched by Microsoft in October, HealthVault is designed to give people a place to store all of their health information, from prescriptions to X-rays and lab reports. While insurers such as Kaiser, Aetna and WellPoint offer their members access to online databases, HealthVault provides people a way to pull that data together on an independent site.

“Without an independent third party, health records are not portable; they are not owned by the consumers,” Doty said.

On April 23rd I wrote about the benefits of using email in physician-patient communication, and how trends in this area are inevitably going to change the standards of communication in years to come.  I’ve also written about Dr. Jay Parkinson and the company, Myca, who are pushing the use of technology to improve the efficiency and cost effectiveness of the physician-patient relationship through the use of instant messaging, video-conferencing and email.

Email and other efficient modes of communication are undoubtedly in our near future as healthcare providers.  Now if we could just get the payers to notice…

Well, it looks like they are starting to notice.  As part of the medical home model, Capital District Physicians’ Health Plan is entering a 2 year pilot program which will, among other things, pay physicians for using communications such as email to improve the efficiency of interaction with patients.  This article from Times Union explains.

Currently, doctors are paid only for face-to-face visits. There’s little incentive for busy doctors to explore other types of interactions, said Bruce Nash, chief medical officer and senior vice president of medical affairs at CDPHP.

“The rest of the world’s used e-mail for a decade,” he said. “It’s been limited to a physician, because it hasn’t been paid for.”

I’ve had the pleasure to speak with Jay Parkinson, MD about his innovative business model which takes a revolutionary approach to medical communications between physicians and patients through Myca, a company for which he is the Chief Medical Officer.  I’m excited about the concept of “virtualizing” physician communication, and think the 5 minute video below does a great job of speaking to the benefits of such a world.

Last week I spent no less than 20 hours restoring my laptop to its previous working state after a major computer crash.  The problems came on suddenly and caught me off guard; so much so that I didn’t have my backup plan in effect after purchasing the new computer only months ago, and ended up with a lot of rebuild time on my plate that could have easily been avoided.

The critical data that I use for my clients was protected as we keep this type of information redundantly backed up through a system of onsite and offsite storage, however our robust client data backup strategy didn’t help when it came to the simple operations of my computer in the event of a crash such as this, leaving me exposed to significant computer downtime.

Given that it took “only” 20 hours to get back up and running, and the fact that no actual data was lost in the process due to our data backup strategy, this was a relatively inexpensive reminder of the importance of protecting from downtime of this nature.  As I’ve learned a valuable lesson with regard to protecting my computer, I’d like to share with you some of the important elements that I have now put back into place to protect my computer.  These elements will serve users well in the medical practice environment, and I hope readers will follow the recommendations that follow.

1.   Create a working “image” of medical practice computers at regular intervals.  An image is simply a copy of the entire state of a computer’s hard drive at a given point in time.  Software programs are used to create an image, and the image can be used to restore a computer to a previous working state within minutes, rather than days as I recently experienced.  In my most recent rebuild of my computer I’ve taken an image prior to the loading of any significant software or drivers that hold the potential for wreaking havoc on my computer, so in the event that there is a software conflict, I can easily get back to a working state within minutes.  This offers significant protection to medical practice computers as impeding the flow of patients through your practice will likely have a significant impact on quality of care as well as profitability, and it can be easily avoided through the creation of working images of medical practice computers.

2.   Stick with essential software on medical practice computers.  There are a lot of great software utilities, games, and tools on the open market, and due to this there exists a large potential for conflicts between software programs.  These software conflicts increase the likelihood of computer downtime dramatically, and can be avoided by simply keeping the installation of software on medical practice computers to only those programs required in the operation of the medical practice.  In the recent rebuild of my computer I was careful to only include those software programs associated with work productivity so that my chances for software conflict are minimized.

3.   Run only the required computer updates on medical practice computers.  Each software program that is loaded onto the computers in your practice comes with the ability to “update” the software with new features and patches on a regular basis.  This is a great benefit, but one that can come at a cost.  Each time a software update is run, the potential exists for the update to interfere with other software programs on the computer, hence increasing the likelihood of downtime.  Many times software updates will have a beneficial effect though, improving the function of computers in a medical practice.  It is recommended that before running updates, that the medical practice computer administrator read about the actual updates to be performed to ensure that they are required and necessary for the function of the medical practice computers.

4.   Backup data files using a combination of local and offsite storage.  Backup programs can make a copy of your data files onto another location on your medical practice computer for easy retrieval in the event of an accidental deletion or unwanted version change to the file.  Retrieving a working version of a file can take place in seconds if a copy of the file exists locally on the computer.  In the event that a computer is lost, stolen, or rendered unusable however, the local version will be inaccessible, requiring that a copy be stored at an external location in order to be guarantee retrieval.  This redundant backup strategy is extremely important to the preservation of data, and should be performed at frequent intervals on medical practice computers.

5.   Use tested operating systems and configurations.  While a normally working computer is what we should all expect, it should also be considered a blessing to have a computer that is free from performance issues.  To improve the likelihood of this, use only tested operating systems and working configurations that have been proven to work within your medical practice.  If you find that Windows XP with the Windows Office 2003 suite works like a charm and never gives you problems, there’s no sense in changing it when the latest and greatest version comes around.   This is an area that is difficult for me because I really do like the latest feature sets available, but I am learning that the downside to this often manifests as reduced productivity which is harmful to any business.

These are just a few of the lessons I’ve learned over the course of my computer woes last week.  There are more considerations that can and should be made, but these few concepts should provide a level of protection for avoiding unnecessary downtime in the event of computer problems that may strike your medical practice.

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Vantage Clinical Solutions is a private practice consulting, management, and financing firm that specializes in small to medium-sized healthcare practices nationwide.

For many of us, email has become a primary means of building relationships, conducting business, and keeping in touch.  It is very effective in doing so, and while it isn’t a full replacement for phone and face-to-face interaction, it does provide a very efficient means by which to communicate.

In business, email has another important benefit; it provides a document trail that can be used to record activity and conversation, creating a transcript of all that is said (and not said) via electronic format.  Along with other benefits, the efficiency of use and ability to document in real time provides some obvious appeal to those who communicate with clients on a regular basis.

Enter physicians, dentists, physical therapists, and other healthcare providers that interact with clients (i.e., patients) on a daily basis.  While drawbacks exist in the use of email as a means of communicating with patients, we are finding that patients like it and doctors are on the verge of getting reimbursed for it; both important drivers for the regular use of email in the near term.  There will be many pitfalls to avoid for the physician and patient alike, but we will soon be seeing more and more use of email between provider and patients in the years to come.

This article in Modern Medicine explains in detail the key benefits associated with the use of email between physicians and patients, and speaks to the trends that are currently underway in this important area of medical practice.

If you haven’t yet begun using e-mail to communicate with patients, there are plenty of reasons to start. First is the increasingly loud patient clamor for e-mail, as indicated in one survey after another. The latest is a Harris Interactive/Wall Street Journal poll in which three out of four respondents said they should be able to schedule medical appointments via e-mail or the Internet, and e-mail their doctors as part of their overall medical care—at no extra charge.

Ironically, that proviso is precisely what has discouraged many time-pressed doctors from giving their patients e-mail access. But as patient demand rises, the “no extra charge” barrier is slowly but surely coming down.

Late last year, Aetna and Cigna HealthCare announced that they would dramatically expand programs that reimburse physicians for “virtual visits.” Until recently, only a handful of health plans paid doctors for this service, and the news has sparked speculation that other insurers will soon follow. Not surprisingly, the number of physicians who communicate with patients electronically is also on the rise—going from 19 percent in 2003 to 31 percent in 2007, according to a Manhattan Research survey of more than 1,300 doctors. Among physicians who did not yet use a secure online messaging service, one in four said they intended to start in the next 12 months.

It’s an interesting dilemma that we often see new practice owners face.  That is, they want to keep their expenses low and end up tackling every business-related task that there is, and at the same time want to see as many patients as possible to get cash flowing as rapidly as possible.  What usually happens is that the business-related tasks begin to eat away at time that the provider should be in front of patients.  Patient time = cash flow.  Less patient time = less cash flow.  One hour with patient = more money made than it costs to have someone else perform business-related tasks.

A key challenge to handling business growth is whether you are able, and willing, to give up control and delegate certain business tasks to others who are:

• More skilled at the task
• Able to complete the task at a lower hourly rate than you
• Easily trainable to do the jobs that you dislike or are no good at

Here is a quick down-and-dirty to figure out your own “hourly rate”.

Let’s imagine you want your business to gross $300,000 in 2008. And you plan to work a 40-hour week (good luck if you can get away with this!) for 48 weeks in the year.

Your hourly rate is $300,000 ÷ 48 = $6250, and $6250 ÷ 40 = $156.25. In order to make $300,000 in a year, you need to be bringing about $156 an hour in revenue. That means that when you are answering your own emails, you are costing your business roughly $156 an hour to do so.

In her recent post, Kennealy tells us the four tasks that MUST be delegated to someone else, either in-house or to an outsourced company: 1) Housekeeping, 2) Bookkeeping, 3) Administrative support, and 4) Managing technology.  These are tasks that you can find someone that will cost less than your time to do the same job and perhaps a better, more effecient job.

Kennealy goes on to discuss three things that the owning provider MUST hold on to: 1) Strategy development and business planning, 2) Marketing, and 3) Content creation or program development.  These things are critically linked to the owner’s vision, goals and selling efforts.  This doesn’t mean that outside help can not be employed to assist with these things (i.e. consultants, branding companies), but the provider definitely needs to sacrifice some patient time to focus on these elements…these are the elements that get more patients in the door.