Patient Safety in Any Language - Volume II

Second in a series of educational forums hosted by Language Line^® University and the International Medical Interpreters Association, or IMIA

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Welcome to the second in a series of educational forums hosted by Language Line^® University and the International Medical Interpreters Association, or IMIA.


Today’s program is entitled


I’m Christine Barney and I will be moderating this discussion. Last time we reviewed the preventable, but all too frequent, medical errors and misdiagnoses that occur in our nation’s hospitals when a qualified interpreter is not made available to limited English speaking patients.

Today we’re going to take a deeper look at the medical interpreting profession itself, the importance of these professionals to the delivery of quality health care, the current need for a national certification standard for medical interpreters, and the steps being taken to accomplish this.

With me today to discuss this issue and their new collaboration to launch a joint National Medical Interpreter Certification are:

• Izabel Arocha, the President of IMIA, the oldest and largest professional association of medical interpreters worldwide, and

• Louis Provenzano, the President & Chief Operating Officer of Language Line Services, the leading language services company.

Izabel, Louis, and their organizations are long-time advocates of medical interpreting certification as a means to ensure patients have qualified language services for safe communication with their providers. And both organizations have led a national consensus building process to speed the creation of higher industry standards through medical certification and have been instrumental in heightening the overall profile of the interpreting and translation industry.

In addition to remarks from Izabel and Louis, later in the program we’re going to hear from several medical interpreters currently working on the field about their experiences as professional interpreters, what national medical certification means to them, and answer their questions about the national certification process.

Thank you all for being here. Before we begin reviewing the details of the National Medical Interpreter Certification program, I’d like to first get some feedback from both Louis and Izabel about the need for such a program.

Louis, let me begin with you.

(Louis Provenzano):  Christine thanks very much. One recent news even that really hit home with me and underscored just how important it is to have a real expert on the job when things get tough was the almost fairytale story of US Airways Flight 1549 in New York City that ended up in the Hudson River. If not for the experience and expertise of that pilot, Captain Sullenberger, and the crew, that day might have ended in absolute tragedy. Given how important it is to have trained, skilled, and experienced people on hand in situations where our safety and security are at stake its still shocking to me and many others that there is one critical job, a job that involves life and death situations, that is completely devoid of any kind of federal oversight, regulation, or recognized national standard.

The title of job in question is medical interpreter. And the responsibility of the interpreter is to allow the millions of people in the U.S. with limited English skills to communicate with their doctors, nurses and other medical staff.

In effect, the medical interpreter is that missing link in the highly regulated medical field of medicine. When a patient arrives at a hospital, for instance, he or she is assessed by a trained and licensed nurse or medical assistant and ultimately sees a physician who is tested, licensed, and subject to specific continuing education requirements. The technicians who run and service the medical equipment are certified. Medical professionals are assessed, tested and retested throughout their careers. Even the individuals who sell health insurance to patients must also abide by regulations and standards of certification.

So understanding that important role of the medical interpreter, for the last dozen years Language Line University, along with industry partners, has worked to develop a medical training and certification program for interpreters working in the health care field. And at the beginning of this year, our effort came full circle through a great new collaboration with IMIA.

(Christine Barney):  Thank you Louis. Izabel, please give us your thoughts.

(Izabel Arocha):  Thank you Christine. The interpreter is truly the one who holds the key to effective communication between a patient and a medical caregiver who do not speak the same language. This makes professional medical interpreters invaluable and essential to the delivery of life saving care. And while there are thousands of highly trained interpreters who have special knowledge of medical terminology and processes, the unfortunate fact is that there is still no national procedure in place to ensure every interpreter on the job is actually competent. It’s imperative for medical interpreters to have access to a professional designation indicative of the role they play.

Our members have been asking for leadership to make this happen. That said, I’m very optimistic with the new developments that will allow us to have national medical interpreter certification in 2009. Our certification program incorporates principals of inclusiveness, transparency, credibility and multi-organizational collaboration. This process includes partnership with a testing company to proctor and administer the exams. Most importantly, the launch of national certification is a historic time for medical interpreters. They will be able to join their Court Interpreter and ASL sister professions which have had certification available to them for decades.

(Christine Barney):  Thank you Izabel. Now let’s address how and why this collaboration came to be. Izabel, would you like to start?

(Izabel Arocha):  Sure. First of all, we’ve definitely wanted to consolidate resources and avoid duplication—in the field there had been a lot of duplication and reinventing of the wheel, if you will—to respect and protect each organization’s copyrights and patents from other organizations who are considering developing certification instruments, and also to coalesce existing efforts into a single national certification program.

(Louis Provenzano):  To add to Izabel’s comments, you know, we also wanted to accelerate the availability of certification to the largest number of interpreters. We want to plan a program that recognizes other national testing companies for the minority languages, and we want to be able to model a multi-organizational collaboration towards a common vision. National certification will be overseen by the National Board of Certification for Medical Interpreters.

(Christine Barney):  So let’s talk about how this certification process will work.

(Izabel Arocha):  Well a candidate registers for certification, that’s the first step. And that means simply that they are proving that they meet the prerequisites of certification. Their second step is to take the National Board written exams, which test the knowledge areas. Those who pass that test are eligible to take the National Board performance exams. Candidates have to recertify every five years after providing proof of having undergone three continuing education credits and there will be no retesting required.

Now an important note is that the National Board written and performance exams are proctored and administered by a third party entity, PSI, which is a testing company with over 60 years of experience.

(Christine Barney):  Thank you, Izabel. Louis, how many languages will be covered under the new national medical certification?

(Louis Provenzano):  Under this new collaboration, the skills component of certification will be available in the current 22 languages, with expansion into 30 in the year 2010 and others in succeeding years. The program will consist of a single certification process for these languages, and to support this development and a future single-level reimbursement structure, LLU will eventually phase out over a period of time its Interpreter Skills test in Medical.

(Izabel Arocha):  And to add to Lou’s overview, there’s also an incorporated qualifying process for all the languages for which a certification exam is not in place, and by which candidates take other national tests. This multi-testing organization collaborative process will bestow another credential; the Qualified Medical Interpreter credential, or QMI. And for the languages in a third tier, what we call the new emerging languages for which there is no national testing available, there will be a Portfolio Process similar to those in Canada and Australia. So those who pass the Portfolio Skills Process will be bestowed the Screened Medical Interpreter credential, or SMI.

So the qualified and screened medical interpreter credentials are part of the national certification umbrella process. And this ensures that all language interpreters are given access to the certification process, and also that all hospitals are able to assess the qualifications of interpreters in all languages.

(Christine Barney):  Thank you both. The process you outlined is very thorough. How will professional interpreters interested in obtaining national medical certification be able to enroll in the program?

(Louis Provenzano):  For information on the process we intend to have a very robust website; it’s www.certifiedmedicalinterpreters.org. That’s www.certifiedmedicalinterpreters.org. We want to provide a certification process that is accessible to the largest possible number of interpreters across the country. And it is the intent that the administration of the exams will be administered by the 600 plus proctored sites of PSI Services. And for those locations we’re asking our interpreters to go to www.psionline.com. There’s a solid commitment to ensure a process that will not stifle the access, ability and opportunity for interpreters to begin and undergo the three simple steps of the certification process.

(Christine Barney):  Thank you Louis and Izabel for walking us through what will be a revolutionary opportunity for the medical interpreting industry. Now I’d like to open up the floor for questions from medical interpreters currently working in the field.

Let’s start with Max, a Spanish language interpreter with more than ten years experience in the medical interpreting field. Max?

(Max - interpreter):  Thank you Christine. You know I am curious about who owns the National Certification process.

(Louis Provenzano):  Max I’m glad you brought up this point as I’m sure it’s a concern for many, which is why we have made this an open process with certification open to all with oversight from the National Board of Certification for Medical Interpreters. We’re taking input from all who want to participate in this effort so that, in effect, medical interpreters own the process. And we’ve been very pleased by the number of individuals from across the industry that have already gotten involved.

We had an overwhelming response to our National Job Analysis Survey amongst interpreters and are already receiving RSVPs to the Third Annual National Medical Interpreter Certification Forum, which is open to all and takes place May 1, 2009 in Denver, Colorado. And for those that, you know, can’t make this year, stay tuned for the announcement of the next May 1 event and information on all of the May 1 events is available, again, at www.certifiedmedicalinterpreters.org.

(Max - interpreter):  Thank you Louis. This is all very exciting, but will I need to become a member of IMIA or be employed by Language Line Services in order to receive the National Medical Interpreter Certification?

(Louis Provenzano):  Max, neither IMIA membership nor LLS employment are required to achieve certification. To see the list of prerequisites to this process, again, we encourage you to go to www.certifiedmedicalinterpreters.org.

(Christine Barney):  Thank you Louis. Next up we have Irina, a professional interpreter who’s worked in the medical industry for many years. Irina?

(Irina - interpreter):  Thank you very much. Here’s my question. I understand that those IMIA and Language Line University are investing a lot of dollars into the creation of this program and hope to make profit back from this, but will you consider pricing of certification and keep costs in check so that certification is accessible to all interpreters who want it?

(Izabel Arocha): Thank you for your question Irina. First let me address the issue of the cost to the interpreter to obtain certification, because making the National Medical Interpreter Certification as readily available as possible is at the very center of this effort.  Affordable pricing will be a significant factor in the development of the certification. It’s likely that due to the pooling of efforts and resources of the private/public collaboration we can provide the best options and a more affordable and accessible process for interpreters.

And in order to fulfill the goal of making certification process as widely available as possible, it has required an enormous investment of resources by both organizations. In fact, we anticipate that it will take over a decade for each organization to recover the investments made.

(Christine Barney):  Thanks Izabel. Now I’d like to give the floor to Muriel, a French and Haitian Creole interpreter who’s been in the medical interpreting field for four years. Muriel?

(Muriel - interpreter):  Thank you. Louis and Izabel, I am curious to know whether or not you think National Medical Interpreter Certification will make a difference in terms of reimbursement for language services.

(Izabel Arocha): Yes Muriel, that’s a great question. Many reimbursement processes in existence require some form of qualifier or smaller certification programs that are built usually by entities that are not testing organizations or not experts in medical interpreting. Our organizations have started advocating for reimbursement of medical interpreter services on a national/federal level. We call on other organizations and the many interpreter trade and advocacy associations around the country to do the same with a unified voice. In the current economy hospitals cannot continue to pay out of pocket for professional services that should be reimbursed by insurance companies. Also with national health reforms taking place in 2009 this is the time to tackle this issue.

(Christine Barney):  Thanks Izabel. Finally we have a question from Maria, a Polish language interpreter with more than 15 years in the field. Maria?

(Maria - interpreter):  Yes thank you Christine. I’ve been frustrated with how long it’s taking the industry to achieve a national certification, but I am excited about the momentum over the last two years. How can I endorse this process and contribute to its success?

(Louis Provenzano):  Maria, there is no question that most interpreters wish the certification was already a reality. Over the last two years there has been a national consensus building process that confirmed the readiness of the field, and this is one of the primary reasons for Language Line University and IMIA to join forces to economize our resources towards a common goal. We’re following all the steps required to have this process recognized by the National Organization for Competency Assurance, also known as NOCA, and it’s really important to note that NOCA is the only organization that can accredit national certification programs.

We’re also working in a transparent manner with all relevant bodies—be they federal, state, government, accrediting bodies, hospital associations or associations representing the medical interpreter profession, or patients that utilize these services—join us. We welcome you to join us. We welcome any and all support that will enable us to advocate for certification and reimbursement in Washington D.C. Join us by telling your colleagues to send letters of endorsement for this collaborative process that can be sent via email to info@certifiedmedicalinterpreters.org.

(Christine Barney):  Thanks Louis and thank you Maria, Muriel, Irina and Max for your thoughtful questions. Before we end today’s session, I’d like to turn the floor back over to Louis and Izabel for some final thoughts. Izabel.

(Izabel Arocha): We’re very excited about the recent breakthroughs that have enabled National Medical Interpreter Certification to become a reality for the public at large. This is a great achievement and it will ensure meaningful access to healthcare for a large group of underserved population. And in order to achieve this we will continue to work with other organizations and coalitions and government  entities to promote national certification for medical interpreters. We will apply for NOCA accreditation. And third, we will continue advocating for the reimbursement of medical interpreters.

Certification is what is going to formalize this new specialization in the interpreting field. It’s a high-growth profession. The demand has outweighed supply for many years. It’s perfect for the retraining of unemployed bilingual individuals. It will increase our nation’s language capacity. And it’s also important to note that it’s an unfunded mandate; Title VI, ADA, the Executive Order 13166 and state laws require hospitals to provide interpreting services, but hospitals are capped by administrative budgets. So reimbursement is a real need to ensure that patients receive the services that they need.

A joint commission study shows that patient/provider communication is at the root cause of many adverse effects. And the unfortunate truth is that linguistically diverse patients are seen often without qualified professionals. And the cost of interpreter services is minimal compared to the cost of delays or additional tests and visits or hospitalizations; not to mention the horrible adverse effects that can occur when an unqualified individual is used to interpret.

(Christine Barney):  Thank you Izabel. Louis, any closing comments to add?

(Louis Provenzano):  Thank you Christine. To add to Izabel’s summary of our next steps in this process, I also wanted to once again extend an open initiation to our Third Annual National Medical Interpreter Certification Forum on May 1 in Denver, Colorado. The Third Annual National Medical Interpreter Certification will go from 9 am to 5 pm local time, and it really is, in essence, a meeting to convene to discuss the important topic of national medical certification. We want to be able to share and hear from national and international speakers, subject matter experts sharing all the important updates and relevant information.

The forum also consists of round table sessions and an expert panel. Past speakers and sessions can be visited at www.languageline.com/llu. In the past, attendees have included interpreters, providers, associations, state officials, advocates, policy makers, language service providers, educators, trainers and international representatives. This is an open collaboration that crosses state lines and industry sectors to enable a broader perspective, so all are welcome to participate. There’s no registration fee and this is an annual event.

(Christine Barney):  Thank you Louis. We’ve been talking today about the importance of the medical interpreting profession to the delivery of quality healthcare, the current national certification standard for medical interpreters, and how it will benefit the profession.

This conversation is part of an ongoing national dialogue looking at patient safety in any language. If you’d like a transcript of this cast, a copy of the presentation or would like more information about the certification, please visit www.certifiedmedicalinterpreters.org.

Thank you.

Recorded on March 10, 2009.