Translation web site aids broad patient population

Site includes forms, educational material

Responding to the growing cultural diversity of Missouri’s hospital patients, the Missouri Hospital Association (MHA), based in Jefferson City, has launched a new web site,

The site offers admission agreements, privacy notices, and consent forms, among other documents. Users also can search for consumer health information in more than 30 languages, including Armenian, Cambodian, Haitian, Creole, Korean, Romanian, Somali, and Thai. Future plans for the site include translated educational materials based on commonly diagnosed conditions, and an on-line picture gallery showing medical items and their proper translation.

"This became an issue about three years ago," recalls Leslie Porth, RN, MPH, MHA’s vice president of health improvement. "At that time in St. Louis, there were more than 90 different languages and dialects spoken, including Bosnian and other Eastern European languages. The hospitals asked us to work with them to help them figure out what to do to provide better care."

St. Louis, at that time, had one or two translation services, but they were so backlogged they had become overwhelmed. "What came out of that was the development of the web site," she says.

Several issues raised

The lack of translation services can raise several different quality-related issues, Porth points out.

"First and foremost, at least in the Midwest, there are a limited number of people who are competent to provide medical interpretation and translation," she notes. "While it is not an ideal situation, what occasionally happens is that family members or hospital support staff are used. That brings up a host of ethical issues, quality issues, and even potential legal issues, but at that time, the hospitals had no other choice."

Potential legal and ethical issues often present themselves together, Porth explains. "As a hypothetical example, let’s say you ask a child to step in as translator, because quite often the children are the ones who learned English. What happens is the child is providing interpretation for a parent who may be receiving or needing medical attention, even though they are not competent in medical interpretation, and you are asking them to address sensitive issues, so from a legal perspective you have a minor providing services, which is a potential conflict of interest." Another hypothetical could involve a patient presenting in the emergency department needing a diagnostic work-up, or perhaps immediate surgery. "They are not proficient in English, so you can’t get a basic consent from them or explain appropriately the type of service or diagnostic you want to perform," she notes.

In such instances, does patient satisfaction become an issue as well quality of care?

"Absolutely," Porth says.

While the awareness of the problem originated in St. Louis, "it made sense to expand beyond the area," she says. A statewide advisory committee was established, and the site was developed with a grant from Tenet Healthcare Foundation and Tenet St. Louis.

Why a web site? "We wanted ready access to all hospitals within Missouri and the ability to provide those hospitals with the most current documents available, so a web site seemed the logical choice," Porth explains.

In terms of the types of documents to be made available, two general needs were identified. "One was the hospital administrative form: consent for treatment, admission, advance directives, and so on," she says. "The second type involved patient education. Because the lack of hospital administrative documents made care so difficult, we made the decision to provide those first; now we’re expanding into patient education."

In terms of the languages to make available, the advisory committee chose those of greatest volume and requests, using the census and other demographic resources. "We have currently translated in six languages: Bosnian, Arabic, Vietnamese, Mandarin Chinese, Spanish, and Russian," says Porth, noting that this always can be expanded. "For example, there now seems to be an influx of North Koreans," she observes.

A St. Louis-based translation service is used. "Sometimes, it is easy to make misinterpretations when translating medical documents, so we back-translate — first to the native language, and then a different person translates it back," says Porth, noting that this redundancy helps ensure the quality of the translation. Instructions for downloading Bosnian, Chinese, and Vietnamese fonts, which are necessary to view and print certain documents, are posted on the site. The site also enables users to search for information about specific health topics, including heart disease, infectious diseases, and maternal/child care.

Currently, the site is designed with only providers in mind. "We hope that once we expand into education, anyone who wants to get on the site can use it," says Porth.

At present, there is a small user fee for any hospital or health care provider organization. "The start-up cost is from $250 to $1,000, and the annual fee per organization ranges from $100 to $750," she explains.

While the site was formally launched on Oct. 28, 2003, it was piloted for several months prior to that. "The pilot group said they liked the site — that it was user-friendly, easy to locate and access," Porth notes.

Could other hospital associations or organizations do the same thing? "They could, or they could access ours," she says. "The model we developed demonstrates the efficiency and effectiveness of doing this as a collective body, rather than as an individual hospital or system."

Future site enhancements include patient education materials based on hospitals’ most frequently diagnosed conditions, and translated discharge and medication instructions, Porth says. An on-line picture gallery will show images of various medical items, such as a wheelchair, crutches, or medicine, and the translated word for the object. Another benefit of the site to health providers is the regular dissemination of changes on forms when state and federal regulations are revised.

Need More Information?

For more information, contact:

• Leslie Porth, RN, MPH, Vice President of Health Improvement, Missouri Hospital Association, Jefferson City, MO. E-mail: