UAB eMedicine has been using telehealth technology to connect patients with UAB Medicine providers since 2014. The COVID-19 pandemic prompted a major increase in the use of telehealth, but it also required rapid advancements to make telehealth participation more equitable.
UAB’s eMedicine telehealth service continually expands its capabilities and availability to provide greater access to care. UAB eMedicine reached a milestone in May 2021, when it used its Video Remote Interpreting (VRI) system to connect a hearing-impaired patient with a provider and an American Sign Language (ASL) interpreter.
Telehealth creates a virtual doctor visit, allowing providers to remotely perform basic physical exams and diagnose and treat medical conditions. UAB eMedicine Medical Director Eric Wallace, MD, says improving the service has been a matter of filling gaps.
“Prior to the COVID-19 pandemic, most telehealth was performed with patients in a remote medical facility, not in their home” Dr. Wallace says. “When we first started doing telehealth in patient homes, the service worked well. There were still some gaps in whom we could serve, such as patients who didn’t have Internet, didn’t have smart phones, or had them but didn’t know how to use them. We are always working toward 100% inclusion. Other areas we needed to address were patients who needed interpretative languages and sign language.”
Today, UAB eMedicine provides technology aids and services to deaf and hearing-impaired patients, including on-site live interpreters, as well as the VRI system, which brings ASL-certified interpreters to the bedside via videoconferencing. On-site interpreters for outpatient clinic visits can be scheduled when making an appointment. In unexpected cases, it’s sometimes possible to quickly bring in on-site interpreters, depending on their availability.
Fine-Tuning the Process
Dr. Wallace says adapting VRI for the hearing-impaired required some innovation and fine-tuning.
“The issue with sign language is that it can’t be audio-only,” Dr. Wallace says. “The ASL interpreter has to be visible, which requires three-way video conferencing. In a video conference, the screen size changes depending on who is speaking the loudest in the conversation, but we didn’t want that to happen in this case, because the image of the ASL interpreter would always remain small. Our technology allows us to pin the interpreter screen so that everyone can see them. Patients sign in to the conference link and see their provider on the screen, whether that’s via desktop or mobile device. The ASL interpreter will log on, and as soon as we pin them, the interpreter will be the large screen image. When the provider needs to see the patient on a larger screen to do an exam, they can un-pin the interpreter and pin the patient.”
Dr. Wallace says controlling the size of screen images is less of an issue with larger mobile devices and desktop computers. One of the advantages of setting up telehealth visits in advance is that patients can inform the eMedicine coordinating center if they prefer a link to the conference via email. That makes it easier for some patients to join from a desktop computer instead of their phone, so that images are much larger.
Bridging Other Digital Divides
The practical details of telehealth are worked out in advance, so that remote visits function seamlessly and don’t create technical burdens for providers and patients.
“As an industry, medicine is constantly asking providers to learn and master more and more technology,” Dr. Wallace says. “But in this case, we have to start pushing what I call the ‘easy button,’ so that doctors can think about diagnosis, treatments, and patient needs instead of technology. That’s why our coordinating center handles the mechanics of the videoconference, that’s why we put this workflow in place, and that’s why our team saw success the first time we had a patient being consulted through the ASL interpreter.”
Now that UAB Medicine has a successful workflow in place for all patients who wish to use telehealth, the goal is to bridge certain other digital divides. eMedicine now uses patient educators, who proactively call patients who need assistance with the technology or who may not know, for example, that they can go to a public Wi-Fi spot to get Internet access. Patient educators can explain various digital options, such as visiting county health departments in Alabama, all of which are now wired for telehealth.
Dr. Wallace says UAB Medicine is well-positioned to advance telehealth services for all scenarios.
“It’s satisfying to see that telehealth is successful and is advancing now, considering all the operational and planning components involved,” Dr. Wallace says. “In one respect, it’s good that most people think of it as ‘FaceTime with a doctor’, because you want patients to see it as simple and easy. But there are many employees involved in setting up and operating our system, especially since the goal is for every visit to work seamlessly for patients and providers. UAB Medicine is ahead of the game in that respect.”
To request an interpreter or learn more, please contact UAB Medicine Guest Services at interpreterrequest@uabmc.edu or by calling 205-934-CARE (or dial *55 from any hospital phone).
Receive care remotely and learn more about UAB eMedicine at UABeMedicine.com.