Language Assistance Technology: Ensuring LEP Patients Are Part of the Care Conversation

It may not be the first thing that comes to mind, but one of the great barriers to outstanding U.S. health care is limited English proficiency.

Studies consistently show that language barriers in U.S. hospitals lead to worse outcomes: miscommunication, medical errors, increased ER visits, longer stays, higher readmissions, higher costs and patient frustration. The result is significant disparities in care for millions of people who speak non-English primary languages.

At Houston Methodist, innovative new technology is breaking down those walls. By integrating advanced language assistance tools throughout the system, the program is bringing interpreters into hospital rooms to help patients participate in their care in their preferred language.

“Every patient needs to know what’s happening with them as they cycle through their journey at Houston Methodist,” says Summer Dajani, vice president for Global & Platinum Patient Services at Houston Methodist. “Language assistance is key to patient safety and compliance — it’s just as important as staff handwashing.”

Houston Methodist is a logical leader in such language assistance, given its status as a magnet for international patients and location in one of the nation’s most diverse cities. It draws international patients from some 80 countries around the world and many of its local patients speak not just Spanish, but Vietnamese, Mandarin and a number of rare languages not easily translated in hospital settings.

Language assistance is required by law of course. The Civil Rights Act of 1964 guaranteed access to free medical translation and the 2010’s Affordable Care Act strengthened the requirement. Still, hospitals struggle to comply — one study found just 13% meet all standards, citing cost and interpreter shortages as barriers.

Houston Methodist’s leadership with non-English-speaking patients traces back to the 1960s, when Dr. Michael DeBakey’s pioneering cardiovascular procedures drew people — including royalty and heads of state — from around the world to Houston Methodist. Sixty years later, international patients still come to Houston Methodist, some 2,300 a year, now more for cancer treatment than heart treatment.

The early demand organically created the early infrastructure of international patient services. Language interpretation was informal in those years — staff members who spoke another language were pulled in when needed — but that approach was unsustainable. In time, the system centralized language assistance under Houston Methodist Global, which came to manage care not just for international patients but for any patients who don’t speak English. A governance council led by nursing and physician leaders supports the effort.

The backbone of the program is a partnership with AMN Healthcare, a Dallas-based hospital staffing provider that ramped up language assistance services during the COVID-19 pandemic. Houston Methodist uses the company’s technology through three main channels:

• Over the Phone Interpretation (OPI): The most widely used option at Houston Methodist, it connects staff to interpreters across more than 200 languages. In practice, nurses and physicians simply place the call, select the language, and put the interpreter on speaker for real time participation. During COVID, Houston Methodist even integrated OPI access into wearable, hands-free communication devices worn by nurses to minimize PPE use.
• Video Remote Interpretation (VRI): Particularly helpful for visual communication and ASL, Houston Methodist has deployed 102 video devices across high foot traffic locations (ED, registration, pre op/post op, high volume nursing units, specialty clinics). VRI has a higher cost profile and device availability can lag — especially in a busy academic medical center surrounded by other institutions drawing on vendor supply — but it remains vital for clinical contexts where seeing the interpreter matters.
• In Person Interpretation (IPI): Less used but essential in specific scenarios. Houston Methodist maintains onsite Spanish and Arabic interpreters to support both international and domestic patients — in cases involving American Sign Language (where patient feedback and nuance are critical) and psychiatric care (often requiring extended presence), in person interpretation is preferred.
  
  

To reduce reliance on dedicated devices, Houston Methodist has embedded interpretation into existing tools. Every inpatient room has an empowerment tablet that can summon an interpreter on demand. Telemedicine visits through MyChart now include language assistance, so virtual care doesn’t leave limited English proficiency patients (LEP) behind.

A simple tool Houston Methodist developed has also made a difference: “I Speak” cards. When a patient arrives at the ED or registration and can’t easily articulate their preferred language, staff present a one-page card with 39 languages (including the 15 required by CMS for Texas), from most to least spoken by Houston Methodist patients. The patient need only point at their language, whereupon staff calls the dedicated AMN line and language-sensitive care can proceed.

Houston Methodist hopes to make language assistance more of an AI technology, which would tremendously reduce the program investment’s cost. But Dajani notes that AI still needs significant improvements in understanding medical terminology, the hardest “foreign” language, the one where complete accuracy is non-negotiable. She says when the technology is almost perfect, if not perfect, Houston Methodist will do a pilot program.

AI assistance will also have to be certified and held to the same standards as certified human interpreters, who remain the standard. To maintain standards, Houston Methodist added a feedback step after each encounter. Patients, families and providers can rate the interpreter, and vendors review calls when issues arise – a loop that’s improved quality and confidence across the system.

Dajani says the program’s uniqueness owes to its thorough integration of the system throughout the system, the buy-in and availability of language-assistance resources should they be needed to help a patient. The system reinforces awareness in new employee orientations, system newsletters and resources available through its general employee digital platform.

“Understanding what's happening with you as a patient is important to the clinical decisions made on your behalf and that you’re expected to follow through on,” says Dajani. “That’s why language-assistance devices are so important to care – they get interpreters in the hospital room without any of my staff having to be there.”