Rural-Hospital

Adventures in Remote Interpreting at a Rural Hospital

Barton Health’s goal for 2016: to provide interpreting services for its monthly support groups and community wellness lectures. The solution: remote interpreting.

Since 1963, Barton Health, a community health system in California, has been committed to delivering exception health care. In an effort to adapt to the changing needs of patients, the hospital recently implemented a remote conference interpreting system, allowing experienced conference interpreters to interpret remotely for on-site meetings with non-English-speaking patients, for staff meetings with hospital leadership, and for other events. Patients listen through either their cell phones or wireless receivers that Barton Health makes available to them. What follows is the story of how the project came about, told from the perspectives of Barton’s language access coordinator and one of the interpreters working remotely.

The Client’s Perspective: (Tracy Young, Language Access Coordinator at Barton Health)

Barton Health is a rural health system consisting of a 63-bed hospital, 20 outpatient offices, a skilled nursing facility, a surgery center, and an urgent care facility based in South Lake Tahoe, California. While Lake Tahoe (skiing, anyone?) is a world-class destination, South Lake Tahoe is essentially a small town of 25,000 that swells to over 100,000 on holiday weekends. We run our language access department with 30 dual-role Spanish and Russian interpreters who have gone through rigorous training and testing. We have 30 video remote interpreting (VRI) units, and, if needed, utilize over-the-phone interpreting. In both my role as a language access coordinator and as a certified medical interpreter, I’m always looking for new and innovative ways to provide language access to the Spanish speakers in our community, which is 31.1% Hispanic.

The Challenge

We had a goal for 2016: to provide interpreting services for our monthly support groups and community wellness lectures. However, after careful analysis, I determined that our department didn’t have the interpreter skill level needed for this type of conference interpreting. Our dual-role medical interpreters work mainly in the consecutive mode and don’t have the simultaneous interpreting experience necessary. In fact, as far as I know, there are only two nationally certified medical interpreters within hundreds of miles of Lake Tahoe, and I’m one of them.

Tracy Young and Eder Vazquez, part of the language access services team at Barton Health, connect the listeners to the speakers during live events.

Tracy Young and Eder Vazquez, part of the language access services team at Barton Health, connect the listeners to the speakers during live events.

We needed highly skilled, trained, and certified conference-level interpreters to interpret for our doctors during their lectures. However, these interpreters don’t live within driving distance. I had identified the interpreters I wanted to retain for this project, most of whom I already knew professionally. However, it would be just too expensive to fly them out for our frequent meetings.

The Solution

In 2015, I attended the California Healthcare Interpreting Association’s conference in Monterey, California, and learned about a new system designed to deliver remote simultaneous interpreting via the web and over the phone called ZipDX. As I took copious notes, I asked myself: how does this all work? Can we use this at Barton Health? I was determined to find out. I immediately contacted Barry Slaughter Olsen, the general manager of multilingual operations at ZipDX, to start this journey.

The Preparatory Phase

After spending some time learning about the software and talking to my team and director, I decided that ZipDX could work for us. The software had been designed for multilingual conference calls and remote participation in interpreted meetings only, so we were going to have to adapt it. At Barton, our meetings happen in person, so only the interpreters would be remote. Even though that isn’t the traditional ZipDX setup, I collaborated with Barry and his team to figure out a way to adapt the system to our needs. To get approval for this project, I had to go through my very supportive director, Amber Tanaka, the contracts department, the IT department, and public relations—and they all gave me the go-ahead. (One of the great benefits of working for a small hospital is that I face relatively little red tape.)

I am a big proponent of the fact that our profession needs to catch up with technology, and at Barton I’ve helped implement some fantastic new technologies, such as VRI. However, I felt a bit out of my league with this new adventure. Eder Vazquez from the language access services team served as cheerleader and core support person along the way as we tried to troubleshoot, test, restart, and set everything up correctly on our end. It took us a few months to get everything done. The to-do list included contracts for all new interpreting teams, working with IT to open data ports that were secure, and purchasing minor equipment.

The specific challenges we face would most likely not happen in a large city, but then again, where this technology is needed is in small rural communities like ours, which come with some spotty cell phone and wireless coverage. (We also have to contend with the Sierra Nevada Mountains.)

I recruited six interpreters to make three teams of two interpreters each. We set up various online meetings and trainings for them to make sure they were familiar with the equipment and that they had everything they needed to interpret remotely (e.g., an appropriate space, microphones, etc.). We paid them to train on the equipment and an appropriate hourly fee for the interpreting services, comparable to conference interpreting rates. Some interpreters had to upgrade their headsets, others had to set up soundproof spaces from which to interpret, and others were 100% ready.

The Equipment

The way the ZipDX system was adapted for our purposes called for attendees to listen to the interpreted rendition through their cell phones using a special call-in number. However, as a community-oriented hospital, we wanted to remove any language access barrier and didn’t want patients and community members to use their cell phone minutes. We devised a plan to use our wireless interpreting equipment as receivers, which attendees could use comfortably with disposable headsets.

How does it all work exactly? Here’s the set-up. The speaker calls in from a phone (land line, cell, or web connection) while wearing a Bluetooth earpiece. Wearing the Bluetooth allows the speaker to remain wireless so they are free to walk around the room. The hosts (in this case, Eder and I) call in on behalf of the listeners and connect the transceiver to the cell phone. Finally, the participants listen with the individual receivers and disposable headsets.

The Maiden Voyage

Our first live event was extremely stressful for us. Barton’s new chief executive officer and new chief marketing officer wanted to make a presentation to each department. Two of these departments have quite a few non-native English speakers where ZipDX was a perfect fit. We had the PowerPoint presentation translated so the interpreters would have copies to prepare for the assignment. We also distributed the presentation to the listeners so they could follow along. We encountered a few minor challenges, but were able to solve them during the presentation. We collected participant feedback via a survey on our department’s iPads.

We debriefed with the interpreters shortly after the presentation. Around 50% of the attendees took advantage of the interpreting services. We are fortunate enough to have leadership who support these efforts and understand the importance of inclusiveness. Dr. Clint Purvance, our new chief executive officer, scheduled training time on the equipment prior to the events to ensure he was prepared to deliver at the highest level. His message: “Employees are our most valuable asset at Barton Health. My new role includes connecting, inspiring, and leading with each one of our employees. Developing systems and programs that are inclusive of all employees will result in cohesion and high performance, ultimately leading to better patient care.”

The Cost and the Bottom Line

In terms of expenses, we pay the interpreters by the hour and ZipDX per the minute. In spite of occasional technical challenges and a relatively steep learning curve for myself and Eder, I’m very pleased with the outcome and am confident that we can meet our 2016 goal of providing simultaneous interpreting services for our meetings in South Lake Tahoe. Our listener evaluations have been positive, which is no surprise—isn’t it better to hear all about pillars of excellence, financial stewardships, patient-centered medical home models, human capital, operational excellence, and employee and physician engagement in your preferred language? Overall, the system has proven to be worth every penny and drop of sweat.

An Interpreter’s Perspective: (Judy Jenner, Twin Translations, Las Vegas, Nevada)

Remote interpreting has not had a great reputation in interpreter circles. Most of this reputation is due to companies who pay over-the-phone consecutive interpreters by the minute—and at a very low rate. My own remote interpreting experiences are limited to court situations, which usually feature less-than-ideal audio. In federal court, I frequently use video interpreting software that reduces the amount of time I have to travel to remote places such as federal prisons, but there is room for improvement because there’s oftentimes significant echo. Before ZipDX, I had never worked with a system that allowed for simultaneous conference interpreting, and I was intrigued when Tracy approached me to ask if I would be part of the interpreting team.

The Client’s New Project

I knew that my colleague Barry Slaughter Olsen helped design the ZipDX remote interpreting platform, and since he’s a very well-known interpreter himself, I was quite certain that the software would be interpreter-friendly. Since I was able to choose my remote booth partner, I initially picked my usual in-person booth mate (certified court interpreter Lorena Pike). However, when Lorena moved to take a full-time interpreting position, I teamed up with the very talented Julie Burns in northern California, who is known not only for her great interpreting skills, but also for her ability to keep calm under pressure. Our training sessions went very well and the people at ZipDX resolved all my technical issues during a one-on-one session. I’m in the lucky position not only to have a client who pays me to test and train on the software, but who is an interpreter herself. Tracy truly understands the challenges that interpreters face and is committed to making the process work for everyone.

My Set-Up

During many conference interpreting assignments, I oftentimes feel that there’s a lack of buy-in from the organizer, and you have to work with incomplete information (no PowerPoints, no booth, etc.). That wasn’t the case here. Tracy made sure that one of the interpreters always translated the PowerPoints ahead of time. So in many ways, this is the ideal conference interpreting assignment. I have no distractions, as I am in my home office or shared downtown office by myself. I have a clear audio feed, two computer screens, and access to plenty of electronic and print resources. I live in Las Vegas, which is some 450 miles away from South Lake Tahoe, and it’s a bit strange to be so far away from the listeners for whom I’m interpreting. However, I was ready for the challenge of interpreting for Barton’s chief executive office: I did my warm-up vocal exercises, took some deep breaths, and turned on the microphone.

Learn as You Go

There are, of course, some drawbacks to remote interpreting, whether it be simultaneous or consecutive. ZipDX only provides audio, so you don’t have a visual of what’s going on in the room and cannot see which slide the presenter is on. During a recent visit to Barton, we did a test run of the equipment. Just knowing how the room is set up helps me, mentally, during the interpreting process. Things get tricky when many people are talking and I’m not sure if the event has already started or if people are just chatting. We’ve resolved this issue by having the organizers tell us when we’re live via the ZipDX chat box. (There are separate channels, including a Spanish channel that Julie and I use when we take over for each other every 10 minutes.)

We’re learning as we go and have a very fruitful debriefing at the end of each session. ZipDX is user-friendly, but as with any software, there are always ways to do things better. Also, some aspects of the software could be made a bit more intuitive. For example, there was relatively limited information on tips for interpreters available from ZipDX, so we created our own living document with best practices for interpreters.

Overall, this has been an exciting and challenging project, and I look forward to more events at Barton in the future.


Judy Jenner is a Spanish and German business and legal translator and court-certified Spanish interpreter. She has an MBA in marketing and runs her boutique translation and interpreting business, Twin Translations, with her twin sister Dagmar. She was born in Austria and grew up in Mexico City. A former in-house translation department manager, she is a past president of the Nevada Interpreters and Translators Association. She writes the blog Translation Times, pens “The Entrepreneurial Linguist” column for The ATA Chronicle, and is a frequent conference speaker. She is the co-author of The Entrepreneurial Linguist: The Business-School Approach to Freelance Translation. Contact: judy.jenner@twintranslations.com.

Tracy Young is a medical interpreter, medical interpreter trainer, and long-time advocate for the profession. As both a registered nurse and a nationally certified medical interpreter, she currently is the language access services coordinator at Barton Health in South Lake Tahoe, California. She has an MA in Spanish from the University of Nevada, Reno, and is the founding president of the Nevada Interpreters and Translators Association. In 2015, she was awarded the Language Access Champion Award from the National Council on Interpreting in Health Care. Contact: TYoung@bartonhealth.org.

1 Responses to "Adventures in Remote Interpreting at a Rural Hospital"

  1. Maria Hayes says:

    Sounds very exciting, would love to apply to be a remote interpreter.

Comments are closed.

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