Wave Two is Here. What Have We Learned?

November 30, 2020

Written By: Cloudbreak Health

The pandemic’s second wave has arrived, bringing with it an increase in overburdened hospitals and distraught communities. So, what have we learned? We know hospitals will need to control spread by reducing onsite staff, canceling elective surgeries and routine visits, and quarantining patients as best as they can.

We also know just how brutal high incidents of COVID-19 can be.

The rise of telehealth in 2020 has shown how digital solutions can help us continue to deliver care under extreme conditions. Trust in those platforms can help us better weather the storm ahead. Telehealth is often considered an option for calls beyond the hospital to connect with patients at home. But the real strength of telehealth in the fight against COVID-19 is leveraging onsite devices within the hospital, paired with telehealth platforms, to provide immediate access to the care team, family members, and resources like interpreters and specialists. Telehealth can expand the reach of your care both inside and outside of the hospital for COVID-19 patients.

Here’s how.

Telequarantine – Devices that support high-quality video streaming can be used to employ telequarantine, helping to rapidly and safely isolate patients, while providing access to care team and family members. With Cloudbreak Telehealth, you can add telequarantine capabilities to existing Martti devices already onsite. 

Protect Staff and Save PPE – Doctors, nurses, and other care team members can reach patients by connecting virtually over video to bedside devices. This reduces exposure risk for staff and helps maintain PPE reserves when times are uncertain.

Multi-Party Calling – Platforms with multi-party calling capabilities expand the impact of your resources. Providers can easily add specialists to ongoing consultations, no matter their location. Care teams can meet and debrief over video without coming into contact with one another or traveling across campus. 

Qualified Interpreters – Language access improves communication and provides more equitable care for limited English proficient, Deaf, and hard of hearing patients. By delivering video remote interpretation (VRI), you can add an interpreter to a consultation. Cloudbreak’s Martti can be added to your existing Telehealth, Patient Experience, or EHR platform for immediate access to a qualified interpreter. 

In a COVID situation, when we’re in full PPE gear, most of your face is covered. We’re just screaming through layers of plastic and mask, trying to communicate with the patient. Cloudbreak’s technology has made our interactions mid-pandemic more humane, to be able to  speak with someone on that level.”
Evan Lee-Ferrand, VCU

Read the VCU Case Study Here.

Add Family and Guests – It is important that quarantined patients still connect with their loved ones, so leveraging telehealth to connect family members is vital. Applications like Cloudbreak Guest make it easy for guests to join a consultation and stay up-to-date on patient’s status. 

Adopting telehealth solutions into daily clinical workflows makes care more accessible, flexible, and scalable for patients, family members, and care teams. At the center of care is our need to connect. Telehealth helps us do that.

If you need help integrating language access into your telequarantine solution, contact us at info@cloudbreak.us.

Cloudbreak Begins AWS Cloud Journey

November 19, 2020

Written By: Cloudbreak Health

Download the AWS Tech Sheet

November, 2020Cloudbreak Health is proud to partner with Amazon Web Services to continue building their Cloud solutions. Cloudbreak revolutionized patient and provider communication with the introduction of video remote interpreting (VRI), establishing Cloudbreak as a pioneer in telehealth technology. Committed to overcoming healthcare disparities and bringing language access to the point of care, Cloudbreak Health seamlessly integrates their language access solution, Martti, into a host of platforms including Epic, Zoom, and Caregility. Performing more than one million minutes of telemedicine consultation each month on over 15,000 video endpoints at 1800+ healthcare locations nationwide, Cloudbreak Telehealth simplifies how providers care for patients, putting a full care continuum at their fingertips 24/7. 

Cloudbreak continues to innovate with Cloudbreak Telehealth Solutions, including telepsychiatry, telestroke, telequarantine, remote patient monitoring and other specialties. In the expansion of their services, Cloudbreak plans to utilize Amazon Web Services for their existing workloads as well as for all new application development. 


Why AWS cloud platform?

Cloudbreak chose Amazon Web Services (AWS) to kickstart the project for its powerful capabilities and performance. AWS was the most cost-effective solution on the market that met Cloudbreak’s high quality standards, including automated deployments, comprehensive monitoring, and unsurpassed security. Cloudbreak is able to build a scalable, redundant, and geo aware solution that meets all HIPAA requirements. In the Gartner 2020 Magic Quadrant for Cloud AI Developer Services, AWS is identified as the clear leader for the breadth of its AI portfolio and distinguishes itself with the comprehensiveness of its cloud AI and ML environments. AWS is recognized around the world for reliability, performance, and its powerful capabilities. Garter Research notes this with the highest score in both axes of measurement: “Ability to Execute” and “Completeness of Vision”. 


“With our business rapidly growing across the nation to meet the pressures of the pandemic, it is more critical than ever that we deliver impeccable service 24/7 alongside our healthcare partners. AWS allows us to build a HIPAA compliant, scalable solution that helps us continue to provide our partners with excellent service.”
– Nashina Asaria, Chief Product Officer, Cloudbreak Health


Evaluation of AWS Architecture

As part of their exploration of AWS’ capabilities and fit, Cloudbreak conducted a review of the application architecture for their workloads. Based on this review and discussions with AWS solutions architects, Cloudbreak has documented a proposed architectural approach for deploying workloads on AWS, including the infrastructure as code framework to be used (i.e. CloudFormation, Terraform), the CICD workflow to be used (i.e. AWS CodePipeline, Jenkins), and reference architectures for Cloudbreak workloads (i.e EC2-based Auto Scaling Groups, ECS clusters, Lambda). 

Cloudbreak will also ensure that AWS best practices are followed in account setup and governance.  These recommendations will take into account multi-account setup, different development environments needed by Cloudbreak, as well as security requirements to maintain HIPAA compliance.

Productivity Gains Lead to Rapid Deployment on AWS

Cloudbreak will use AWS computing (EC2, ELB, ECS) and storage services (S3, RDS) to expedite its product development. To ensure security and access control, Cloudbreak will leverage AWS IAM policies, and advanced monitoring services such as GuardDuty, Shield, Security Hub and Cloudwatch. For networking and content delivery, Cloudbreak will leverage AWS Cloudfront, Route53, API Gateway, while leveraging advanced AI/ML services such as Amazon Rekognition, Transcribe Medical and Comprehend Medical. Lastly, Cloudbreak will integrate with Amazon Chime and Amazon Connect AV services. AWS Architecture is shown below:

Opinion: How Telehealth Can Save Healthcare

November 5, 2020

Written By: Cloudbreak Health

Opinion: How Telehealth Can Save Healthcare

The New England Journal of Medicine recently published an article titled “Covid-19 — Implications for the Health Care System.” In it, the author team, David Blumenthal, M.D., M.P.P., Elizabeth J. Fowler, Ph.D., J.D., Melinda Abrams, M.S., and Sara R. Collins, Ph.D., discuss the four core crises that have arisen in healthcare as a direct result of COVID-19. 

Blumenthal et al outline the crises and their suggested solutions under four main topics: Insurance Coverage, Financial Loss, Racial and Ethnic Disparities within the System, and the Public Health Crisis. These are not only the four main crises of healthcare, but of our nation, as we continue to struggle through the pandemic. Much of Blumenthal et al’s advice hinges on the need for drastic reform and federal oversight. While we agree, we also think that the conversation about the future of healthcare must include telehealth. 

Below, we reflect on these crises, and how telehealth can help us overcome them. 


“The pandemic has significantly undermined health insurance coverage in the United States…These developments will add to the 31 million persons who were uninsured and the more than 40 million estimated to be underinsured before the pandemic struck.”

Blumenthal et al discuss how the recent surge in unemployment has left more than 20 million additional Americans without employer-provided health insurance. Additionally, as employers take on the brunt of economic decline they may be tightening their belt, as it were, on employee plans. 

Initially the Public Health Emergency (PHE) and CARES Act extensions afforded to healthcare helped bear the brunt of the Coronavirus on our existing systems, helping cover telehealth service charges and aid care systems as they quickly pivoted to meet the pandemic head on. Telehealth claims increased 4,000% from the previous year (Mallow). Now, insurance companies are pulling back their coverage of telehealth and patients and care systems are left in limbo, unsure of what will be reimbursed. 

These instances further highlight the obvious need for healthcare reform. 


“For the first time since the Great Depression, crippling financial losses threaten the viability of substantial numbers of hospitals and office practices, especially those that were already financially vulnerable, including rural and safety-net providers and primary care practices.”

Many non-essential visits have been canceled for the same reason they can be conducted virtually – they require little physical or immediate intervention. There are a host of procedures and tests that must be conducted in person, but safety precautions should not limit providers from connecting with their patients. Now more than ever we need to connect, not just as the healthcare industry, but as humans. Fear and worry over the dehumanizing features of digital interaction are old biases. In the same way we join a Zoom meeting or FaceTime with our family, connecting with a provider over video can provide reassurance, guidance, and even the joy of human interaction. 

Telehealth is not complicated or difficult to obtain. While the worry of weak internet infrastructure in rural America is very real, the tools needed to conduct sound telehealth consultations are not beyond the reach of most. A smart phone is all that is needed to smoothly run simple telehealth solutions like Cloudbreak Telehealth.

For patients without access to smartphones, it is important that we apply regular pressure to our lawmakers to include phone consultations in telehealth coverage. Blumenthal et al raise valid questions about the way we pay for healthcare, suggesting that our current insurance coverage system is part of what makes healthcare so financially weak. Again, reform is undoubtedly needed.

“It creates incentives to raise prices and push up volumes, shortages of poorly compensated services such as primary care and behavioral health, and an undersupply of services in less financially attractive poor and rural communities. But in the extreme circumstances of a pandemic, a new question arises: is health care an essential national resource that warrants secure financing beyond what the current fee-for-service system offers?”

How insurance covers telehealth, how providers bill for telehealth, and how patients pay for telehealth sessions all comes down to our mindset. What is the burden and subsequent cost of a virtual versus in-person consultation? If virtual care becomes more lucrative, will it discourage providers from hosting in-person consultations when they’re more applicable?

“Upfront, global payments also offer providers the flexibility to innovate. For example, they could substitute virtual care for in-person care without worrying about how telemedicine is compensated under fee-for-service rules.”

The answer is to recognize that telehealth is healthcare, and to include it in any future payment models as an equal to in-person care. This eliminates patient worry about payment processing or confusion over co-pays and makes it easier for providers to  explore mixed in-person and virtual care plans that support better connection with patients and better outcomes.


“Black persons constitute 13% of the U.S. population but account for 20% of Covid-19 cases and more than 22% of Covid-19 deaths, as of July 22, 2020. Hispanic persons, at 18% of the population, account for almost 33% of new cases nationwide.”

The mobility and flexibility of telehealth lends itself to overcoming healthcare disparities, from breaching healthcare deserts to providing language services to overcome linguistic barriers. Mobile units equipped with tablets and a comprehensive telehealth platform could help expand a care team’s impact on their community without displacing doctors. While current telehealth development is trending towards expanding virtual care at the bedside to help institutions weather quarantines, we should also be adapting our care to reach patients where they work and live.

“Disparities in access and health outcomes are entrenched features of the U.S. health care system. They reflect a history of racism and discrimination that permeates society generally.”

Technology is not intrinsically without bias and we must take our own biases and faults into consideration when employing technology, to ensure we are building the most equitable solutions possible. One such example is integrating language services throughout a healthsystem so that every step of care is accessible. It is important that equitable accommodations follow patients through the full care continuum, instead of focusing on the point of care alone. To build these systems, telehealth must be interoperable, easily integrating with other platforms and EHRs. Otherwise, the cost of overhauling existing digital investments, as opposed to scaling them as needed, will be too high for healthcare systems to provide necessary resources with consistency. 

“Greater support for safety-net facilities and small community providers, including inner-city and rural hospitals and community health centers, could also improve access to basic and advanced services for populations of color.”

Scalable technology is key to overcoming healthcare inequities. Comprehensive systems can support multi-specialty care at the bedside, but there should also be affordable and easily employed options for small and rural clinics. It is the responsibility of telehealth innovators to build scalable solutions to carry healthcare into a more equitable future. 

We must also recognize that telehealth is not only a resource for patients, but for providers as well. Important bias training, certifications, and reporting can all be delivered through telehealth platforms to users so that all staff members have access to the same tools and resources to provide equitable care. 


“The United States has 4% of the world’s population but, as of July 16, approximately 26% of its Covid-19 cases and 24% of its Covid-19 deaths.These startling figures reflect a deep crisis in our public health system.”

The US handling of the pandemic has been internationally regarded as a failure. Largely this has hinged on inconsistent and confusing direction from the federal level, from lack of participation to lack of regulation. As Blumenthal et al warn, this will not be the last pandemic we will have to weather, and we must use this failure as an opportunity to build a more robust response. Again, this depends on federal direction and oversight. But telehealth’s role should not be overlooked.

“Tellingly, there is no national public health information system — electronic or otherwise — that enables authorities to identify regional variation in the demand for, and supply of, resources critical to managing Covid-19”

Telehealth can be leveraged to not only connect providers with their patients, but to connect care systems across the nation, building a dependable system that would pool information and resources nationally.


Telehealth is healthcare with greater reach, built in accessibility, and more flexibility. The future of healthcare depends on integrating telehealth solutions into every level of care. For future pandemics, an investment in telehealth will enable healthcare to remain nimble and reduce future risk of lost revenue while protecting care teams from undue exposure. Telehealth is the next logical step in healthcare advancement, and as the industry struggles against the crises created by Coronavirus, telehealth is also the next necessary step.


Blumenthal, D., M.D., M.P.P., Fowler, E. J., Ph.D., J.D, Abrams, M., M.S., & Collins, S. R., Ph.D. (2020). Covid-19 — Implications for the Health Care System. New England Journal of Medicine, 383(17), 1698-1698. doi:10.1056/nejmx200018

Mallow, J. A., & Davis, S. (2020, October 27). Health insurers are starting to roll back coverage for telehealth – even though demand is way up due to COVID-19. Retrieved November 05, 2020, from https://theconversation.com/health-insurers-are-starting-to-roll-back-coverage-for-telehealth-even-though-demand-is-way-up-due-to-covid-19-147648

Volume V: Behind the Scenes of Video Remote Interpreting

October 23, 2020

Written By: Sarah Stockler-Rex, CHI and Tatiana Cestari, PhD, CHI

This piece is the fifth in a series, written by Cloudbreak Health’s quality, training and advocacy leaders, that discusses medical language access and related topics.

In our last installment, we discussed implications of providing telehealth and remote language services in tandem, as well as what telehealth providers and remote interpreters can learn about working together.

In this volume, we focus on what goes on behind-the-scenes to make a video remote interpreting (VRI) session possible.

The Tip of the VRI Iceberg

In a VRI session there are typically three main participants: the patient, the healthcare provider and the interpreter (Figure 1). These individuals are the key visible players, however there many more parties involved behind-the-scenes. In this volume, we will discuss what other essential elements support VRI and their importance.

Figure 1. 

Why is this important?

When a consultation is seamless, you don’t notice the time, effort, creativity and resources that go into a video remote interpretation. What you don’t see is a critical part of what makes an experience work. The VRI support system is vast. It’s important to recognize the innovative professionals who make remote interpretation possible. Additionally, all of these components offer many career path opportunities in the remote healthcare communication industry.

VRI may seem simple, but you need more than an interpreter and a camera to ensure quality, compliance, and effective language access.  For example, imagine you want to make a movie and all you have is a smart phone to record and your neighbor to act. You could certainly make a movie with these two components alone, but a professional crew, trained cast, high tech equipment, and professional lighting make a huge difference in quality.

Let’s look at what the equivalent elements are for VRI…

Below the Surface of VRI

There are a variety of moving pieces behind the VRI interaction. Below, we review the support systems for the interpreter, the healthcare organization, and the patients.


Interpreter support system

If a remote interpreter works for a language service organization (as an employee or contractor), they may have a support network (see Figure 2) composed of teams in charge of:

    1. Development, implementation and management of technology. This team makes a remote interaction possible, from managing a reliable HIPAA-compliant network, developing user-friendly interfaces to handling millions of pieces of data securely.
    2. Leadership, mentoring, and support of interpreters.
    3. Acquiring and managing accounts to engage true partnerships with customers, provide customer analytics and support (identifying needs, providing solutions and education while being transparent).
    4. Forecasting language needs based on patient population and ensuring adequate coverage while incorporating needed rest time for the remote interpreters.
    5. Monitoring, coaching, tracking, and reporting quality metrics based on remote interpreting best practices.
    6. Sharing compliments as well as investigating and resolving grievances related to the service.
    7. Training interpretersand other professionals to provide timely, high quality, and effective communication services. Education approaches should include initial and ongoing training.
    8. Promoting peer interaction for learning and support.
    9. Management and coordination of timely completion of all projects that support the service, from coordinating meetings and shipping equipment to fully activating services for thousands of users in multiple locations.
    10. All other aspects of being an organization: accounting, human resources, communications, marketing, etc.
      Figure 2. 

It is important to note that if VRI services are provided by hospital staff or self-employed interpreters under a direct contract with the healthcare organization, all aspects mentioned in this section should be provided by the healthcare organization.

Healthcare organization support system

Figure 3 illustrates how healthcare organizations support VRI. Some of theaspects identified are:

  1. A language service department that manages, organizes, provides and evaluates language access solutions in all interpreting modalities; that safeguards language access compliance; that educates hospital staff on the importance of working with interpreters, how to work with them, and best practices on working with patients with limited English proficiency (in the case of the United States).
  2. An information technology department that develops, implements and manages the access and structure needed at the healthcare system level for remote interpreting services. This team is key in opening the “network gates” so to speak and adapting to the remote interpreting technology making communication between the organization and the remote interpreter possible.
  3. Healthcare personnel who complement the work done by the language service department in many aspects. For example, supporting effective communication through interpreters, learning and following best practices in language access, coordinating implementation or expansion of VRI services.
  4. Healthcare administrators and leaders who develop Language Access Plans which include VRI solutions, taking into consideration different clinical and operational needs of varying departments. This group allocates resources to support appropriate language access among other programs.

Figure 3.

Patient support system

Last but certainly not least, patients, relatives and caregivers need a support system in order to have access to VRI (see Figure 4). In the past, patients accessed VRI onsite in the healthcare facility with the interpreter connected via video. This still can be the case, of course, but we’re also seeing entirely remote telehealth encounters become more common. The patient support system may need to include a personal mobile device, tablet, or computer and an internet connection.

Figure 4.

Many people now own a smart telephone; however, in some instances, patients rely on relatives, friends or acquaintances to have access to VRI. In this case, these individuals are part of the patient’s support system. The equipment and internet connection needed are further supported by the companies that provide them.

Many individuals in the U.S. don’t have access to the technology needed due to various constraints, including socioeconomic, linguistic or other barriers. Everyday organizations, providers and patients present new innovations and solutions to address these obstacles.

Collaboration between support systems

It is common to see these support systems working separately but the best outcomes in VRI have been obtained when they interact with one another for effective communication (Figure 5).

Figure 5.

Some examples of having these teams collaborating successfully are:

    • the IT team of a language service organization setting up and problem solving with the IT team of a hospital
    • language access experts from hospitals and language access companies discussing or auditing the hospital’s language access plans
    • Users of the service communicating feedback to the language service’s Quality Assurance/Training teams to identify strengths and areas for development.
    • The healthcare organization’s development team working with the language service development team as well as other software developers to integrate patient care platforms (for telehealth as well as medical charting tools).
    • Healthcare providers engaging patient populations for training to overcome barriers to remote technologies and new remote processes.

As we have identified in this article, there are real people behind the scenes making real things happen and true partnership goes a long way when providing quality of care in multiple languages.

Opinion: The Desperate Need to Bridge Healthcare Disparities

October 7, 2020

Written By: Cloudbreak Health

Opinion: The Desperate Need to Bridge Healthcare Disparities

A reaction to the recent Apple News article “‘Covid is all about privilege’: Trump’s treatment underscores vast inequalities in access to care


Yesterday, Apple News published an article on the ways in which privilege impacts Covid treatment, particularly showcased by President Trump’s recent hospitalization at Walter Reed National Military Medical Center. Written by Casey Ross and Priyanka Runwal, the article titled “Covid is all about privilege’: Trump’s treatment underscores vast inequalities in access to care” explores the discrepancies in care for the rich and famous versus the average American. While we all know society’s most powerful influencers receive different treatment, even in cases of life and death, the most important disparities that Ross and Runwal touch on are socioeconomic and racial.


“Covid is all about privilege. The more privilege you have, the more you can ignore some of the rules of Covid. Where one person would need to be in the hospital, another person can have the hospital come to them. That’s privilege,” said Lakshman Swamy, an ICU physician at Cambridge Health Alliance in Massachusetts.


Healthcare access has always been different for minority populations, but the sheer prevalence of coronavirus has dragged healthcare’s darkest statistics into the light. The following is a reaction to the points made in Ross and Runwal’s piece, as well as additional data and research that exposes not just the disproportionate impact of the pandemic along racial divides, but linguistic ones as well. 

Much like the rest of his presidency, Twitter has been ablaze over the last few days as President Trump’s diagnosis swept the media. His ability to access care, while thousands died at home or waiting for treatment, was met with harsh criticism.

And privileged access isn’t just about cutting in line to get a bed or the attention of doctors. Privilege means access to treatments that simply aren’t available for anyone else, like the experimental drugs the President received. He’s one of less than 10 people to have been treated with a special antibody cocktail, Ross and Runwal reported.


High-profile individuals — in particular, professional athletes — have had frequent access to testing with fast-turnaround results. For much of the rest of the population, however, confirming a case of Covid-19 has meant waiting in line for a test, and waiting even longer for results.”


The disparate line is not just drawn between the famous and the average American. Covid-19 has spotlighted healthcare disparities already plaguing our nation. Black, Hispanic, and Native American populations have been disproportionately affected. NPR examined racial disparities by comparing the percentage of deaths versus percentage of population, concluding that “African-American deaths from COVID-19 are nearly two times greater than would be expected based on their share of the population. In four states, the rate is three or more times greater.” (Godoy)


“You have this pandemic where you literally see the numbers and faces in front of you that shows you that this disease impacts people differently, depending on what they look like and what jobs they work,” said Alison Bateman-House, an assistant professor of medical ethics at New York University’s Grossman School of Medicine.


Research also links limited English proficient (LEP) populations to areas most greatly impacted by coronavirus. The National Coalition for Asian Pacific Americans Community Development (National CAPACD) concluded that “The percentage of LEP speakers is higher in the COVID-19 hot spots – e.g., a total of 13.5% for the top 30 metropolitan areas – than for the US as a whole (8.3% LEP).” Larger cities are more likely to host diasporas and immigrant populations (New American Economy).  But that doesn’t dismiss the desperate need for language access in pandemic-logged hospitals. And when no one is allowed into a quarantined room, or PPE is short, on-site and in-person interpreters simply aren’t available.

We know that language access leads to better outcomes. Improved communication through medically trained interpreters leads to more engaged patients and a reduction in communication errors that can save lives. Still, recent study “A Systematic Review of the Impact of Patient–Physician Non-English Language Concordance on Quality of Care and Outcomes” was able to conclude that more than 75% of patients provided with language-concordant care had better care outcomes than those who did not (Diamond). 

Knowing that LEP populations are at greater risk from COVID, and knowing that their care outcomes are materially better when an interpreter is provided, it is imperative that healthcare systems support comprehensive language access to prevent further disproportionate illness and death. When interpreters can’t safely be in the room with patients, virtual remote interpreting (VRI) is not only sufficient, but abundantly available and a sustainable long term solution. These disparities must be addressed, and with today’s technology, they can be.


“A portion of the people who are severely symptomatic don’t have access to health care … and they are the population that is just being decimated by this.” – Josh Barocas, an infectious disease physician at Boston Medical Center


Cloudbreak is committed to bringing health equity to the forefront, bridging the gap for limited English proficient and deaf patients. While we cannot root out the societal inequalities of our nation overnight, it can no longer be denied that these inequalities not only exist but have a body count. It is more important than ever that the healthcare industry commit itself to recognizing disparities in care and the social determinants of health that reinforce them.  Overcoming them with resources like community outreach, language access, and digital health aren’t just the right thing to do but also the most effective.  They can help us bridge equity gaps nationwide and level the playing field for underserved populations.


References & Resources

Diamond, L., MD, MPH, Izquierdo, K., BS, Canfield, D., MD, Matsoukas, K., MLIS, & Gany, F., MD, MS. (2019). A Systematic Review of the Impact of Patient–Physician Non-English Language Concordance on Quality of Care and Outcomes [Abstract]. Journal of General Internal Medicine, 34, 1591-1606.

Godoy, M. (2020, May 30). What Do Coronavirus Racial Disparities Look Like State By State? NPR. Retrieved October 06, 2020, from npr.org

National CAPACD. (n.d.). The Need for Language Access in COVID-19 Hot Spots. Retrieved October 06, 2020, from https://www.nationalcapacd.org/wp-content/uploads/2020/06/COVID-19-LEP-by-Language-.pdf

New American Economy. (2019, July 10). Immigrants and the Growth of America’s Largest Cities. Retrieved October 07, 2020, from https://research.newamericaneconomy.org/report/immigrants-and-the-growth-of-americas-largest-cities/

Ross, C., & Runwal, P. (2020, October 6). ‘Covid is all about privilege’: Trump’s treatment underscores vast inequalities in access to care. Apple News. Retrieved October 6, 2020, from https://apple.news/AhfVI4L4hRJaXIX0jWcepsQ

Healthcare Heroes: Evan Lee-Ferrand

September 21, 2020

Written By: Cloudbreak Health

Evan Lee-Ferrand’s commitment to patient experience has helped guide him during the pandemic

 Evan Lee-Ferrand is the Medical Interpreter Supervisor for VCU Health in Richmond, Virginia. He’s been working in language services his entire career, beginning as an interpreter himself. Evan knows how integral language is to culture. Growing up in historically mutli-lingual communities in Minneapolis and Hong Kong, he speaks five languages: English, Spanish, Cantonese, Portugese, and French. His unique background is one of the reasons Evan is so passionate about language access. We sat down with Evan to find out more about what drives him, and how recent changes to telehealth have changed the way he thinks about language services. 

 CBK: The world has changed a lot this year. What has been your greatest challenge in the last six months?

Evan: I wouldn’t say the biggest challenge, but the biggest change we’ve undergone has been an all hands on deck mentality. That’s been a universal change in pace for everybody. We have an incredible sense of teamwork at VCU, and everyone has just adapted to this new mindset. People have had to go beyond their roles and understand the coordination and technology behind them. It’s a game of pace, patience, and understanding that we don’t know what’s going to happen next.


CBK: As a result of COVID-19, Telehealth has rapidly become a much larger part of health systems and how they are able to meet their patient’s needs. How has this impacted your team and how they deliver language access?

 Evan: There has always been a discourse in the interpreting world about the differences between in-person language services and remote language services, and there’s been some worry that technology might be getting in the way of human interaction. It really is amazing that all this technology came just in time for a world pandemic, where we need to figure out how to keep going and how to provide another level of service for people who are impacted by COVID-19. One of my favorite quotes is “There’s no such thing as luck, just preparation for opportunity.” And I feel like we were prepared for this opportunity. Because of Cloudbreak we were able to increase our digital reach. Everything has changed, and definitely for the better.


CBK: You’ve been using Cloudbreak’s interpreting service, Martti, for many years and have recently incorporated our telehealth platform to not only connect providers and patients, but to keep your staff interpreters working and connected as well. Can you tell us more about that?

 Evan: In a COVID affected set up, when we’re in full PPE gear, most of your face is covered. We’re just screaming through layers of plastic and mask, trying to communicate with the patient. Staff didn’t want to lose the relationships they have with on-site interpreters, especially for their patients with complex care. So that was a big concern. How do we maintain that communication with our on-site in-house interpreters but also keep them safe? 

 Our Partner Engagement Manager helped get our in-house interpreters’ access to Cloudbreak Telehealth. Through the telehealth platform, we could bring our on-site interpreters into the room. There are so many advantages because the video quality is so strong, you can clearly see lip movement and facial expressions in detail. This technology has made our interactions mid-pandemic more humane. To be able to work with patients in the intimate way we are used to, but with high quality video and audio remotely, has really been a gift for our teams.

 A lot of doctors were reluctant to use VRI. But when they saw the Cloudbreak technology it changed everything for them. It changed a lot of doctor’s attitudes towards technology and interpreting services. 


CBK: I heard that Cloudbreak has helped VCU save 40-50 sets of PPE a week during COVID-19 peaks.

 Evan: We didn’t know what was going to happen with our PPE supply in the state of Virginia. There was a lot of uncertainty. Conserving PPE was a big deal. Interpreters have to move all over the campus. VRI and telehealth helped us keep our interpreters, providers and patients safe, while saving 40-50 sets of PPE a week during COVID-19 peaks.


CBK: It’s great that technology has expanded how your staff has been able to connect with patients during the pandemic. I know that Cloudbreak enables guests and family members to log-on too. Have you had success in helping families stay connected as well?

Evan: We had a mother who was COVID positive who had to be separated from her baby at birth. We had Cloudbreak on a device in the NICU, and the mom had Cloudbreak in her room, and she was able to call the father who also hadn’t seen the baby. We put the iPad on top of the incubator so that it was looking down on the baby and the mom saw her baby for the first time, real-time with high definition. I was able to tell the nurse, through the glass door, how to add a Martti interpreter to the call. The interpreter was able to work with that nurse to talk about the baby’s care. For the mom to be empowered with all this knowledge and a visual of her newborn for the first time, it was a really touching moment. To see technology work in that way was amazing.


CBK. Wow. That’s an incredible story. 

 Evan: It’s always great to be able to help families, especially kids. It definitely keeps the staff going as well, to have wins like that. We understand the situation – people aren’t getting better overnight, they’re staying quarantined for a long time. We don’t want to see people suffer. You’re taken care of when you get here, and that’s a really rewarding thing about working in this system.


CBK: That’s a great accomplishment, to be able to provide relief like that to your patients. And you’ve been recognized in your community for that kind of service as well. Your department was praised by local non-profit Here2Hear for the Language services you provide. 

 Evan: A big part of our hospital has been re-establishing our relationship with the Deaf and Hard of Hearing community, who have been really reluctant to use video remote interpreting (VRI). Previously, we weren’t equipped with appropriate technology – both because of our own technology and the solutions available on the market. But you can’t always have an on-site interpreter, especially when we have really bad weather or we don’t want to bring on-site staff because of the pandemic. That being said, with all the improvements we’ve had, both improving our own network and working with Martti Next, in conjunction with Cloudbreak, patients have been excited and expressed their positive experiences using VRI at VCU and how they’ve been accommodated and how, when on-site interpreters weren’t available, the VRI services were adequate and how they felt safe.

 Here2Hear is the largest non-profit that helps the Deaf and Hard of Hearing community get access to resources for their communication needs. Anything from medical, legal, education, even entertainment. It was an honor to be recognized by this important community organization advocating for our deaf and hard of hearing community.

 It’s been a huge journey for me to appreciate how difficult it is to have a productive conversation in ASL when your video technology is shoddy, especially when it’s about your health. To understand how important it is to have great video technology, to be able to see that transformation, to be a witness to that transformation, and continued development, it’s one of the most satisfying things ever. 


CBK: It’s nice to hear that despite the current climate, you’ve had some wins that keep your spirits up. What else inspires you to keep going?

 Evan: Really respectful leadership. I’m really happy at VCU.  Our leadership did an amazing job keeping us safe here. It feels very safe to work here. And when we have curveballs, no one is expecting perfect results. Everyone just appreciates progress. Everyone appreciates “This is the best that we’ve got, where can we go from there?” And I think just having that very authentic partnership with leadership really has determined the success that we’ve had and the morale of our team. 


VCU utilizes Cloudbreak’s interpreting service, Martti, for video and over-the-phone interpretation as a part of their language services department. They also use Cloudbreak Telehealth to connect their on-site team safely, including reducing PPE usage and leveraging VRI options for their staff interpreters. To learn more about how you can expand your language access with Cloudbreak, contact us here.



Best Practices for the Use of Whiteboard Features in Remote Healthcare Interpreting Platforms

July 13, 2020

Written By: Tatiana González-Cestari, PhD, CHITM, Director of Language Service Advocacy

What is a whiteboard in this context?

In the digital world, a whiteboard is an area on a display screen common to several users, on which they can write and draw. It is not closed captioning, CART (Communication Access Realtime Translation) services or a tool for real time translations, transcriptions, etc. 

Why have a whiteboard in a video remote healthcare interpreting platform?

Many video remote interpreting companies have now added a whiteboard feature to their platforms. The reasons for it seem to vary. Based on our review of marketing information whiteboards are often added as a new gadget or as a marketing tool. In other cases, whiteboards are intended for further written clarification of medical jargon or prescription instructions. Whiteboards have also been used to clarify non-medical terms when the language organization provides interpreting services in other specializations (financial, customer service, etc.).

Cloudbreak Health recently added a whiteboard feature to our Martti Next app solution. The market guided us to make this update as more and more platforms featured the tool, but it isn’t an empty marketing effort. We recognize the benefits of this tool when drawings or schematics are needed to deepen understanding in a consultation. This, in turn, helps interpreters follow along, ensuring they deliver the most accurate interpretation. Whiteboard usage may also reduce the need for clarification.

With no industry standards for the whiteboard feature widely available, we found it necessary to create best practices for the use of this tool. Below, we share these best practices, why they are necessary, and the benefits of the whiteboard feature.


This is a portable tool, to which providers have quick access to use as a visual aid. For example, a provider can draw a heart or a thyroid gland to help explain a procedure.

Additional applications of the whiteboard include asking patients to write as part of an exercise (but not as a tool to evaluate skills). Also, patients may need to draw as part of an explanation to the provider. For example, to explain to a physical therapist how their home is set up, which is relevant information when assessing what kind of equipment is needed at home.

Why are best practices for the use of a whiteboard feature in VRI platforms needed?

  • Interpreters may attract attention to themselves and break communicative autonomy during the session. This means that they may violate NCIHC’s standards of practice number 12, “The interpreter promotes direct communication among all parties in the encounter”, or standard number 13, “The interpreter promotes patient autonomy.
  • Translating is a separate skill set from interpreting, and interpreters should not be put into a position where they are expected to translate.
  • Most likely, there is no way to record the information added to the whiteboard, which may increase risk and prevent companies from ensuring quality of what is being shared.
  • Interpreters are typically tested for fluency, interpreting skills and protocols in oral or visual form (signing), not in written.
  • Multiple visual interactions at the same time can be distracting for signed language interpreters and patients as they may try to read while someone is speaking, and the interpreter is trying to interpret. This can cause confusion, and information may get lost.
  • Hearing individuals may promote communication in written English with patients who are Deaf. It is incorrect to assume Deaf or Hard of Hearing patients know written English or that it is their preferred method of communication. This can be frustrating for patients and can set a bad precedent, set the wrong expectations, or can even compromise the reputation of language service organizations. Of course, many patients who are Deaf do communicate in written English, but patients should have agency in deciding the most effective method of communication for their visit.
  • Additionally, there is risk of confusion with:
    • Handwritten notes. Think about this: how well do you write with your fingertips or a stylus pen on a screen? Do all letters and numbers look the way they should to ensure understanding? How does this affect written characters in languages that don’t use the Roman/Latin alphabet?
    • Misspelled words in any of the working languages. This happens in any field, but it is a particularly sensitive matter in healthcare; it can cause confusion and even life-threatening problems. For example, when words like “cord”, “chord”, “cor” (heart) and “core” get mixed up. Also, “scarring” versus “scaring”, “valacyclovir” versus “valganciclovir”, “Tdap” versus “DTaP”, “Bidex” versus “Videx”, “Cedax” versus “Cidex”, “cycloserine” versus “cyclosporine”, “Diovan” versus “Dioval” … and many more!
    • Words that have the same spelling but different meaning in multiple languages (false cognates). For example, the word “once” exists in English and in Spanish; however, it has meanings such as “on one occasion”, “for one time only”, “as soon as” or “when” in English but it means “eleven” in Spanish. Think about treatment compliance or medication toxicity when a patient associates that word (and remembers seeing it written) with “eleven” instead of “once” -a day, for example-.

Best Practices

Based on the information collected, the nature of the remote healthcare interpreting profession, the National Council on Interpreting in Health Care’s code of ethics and standards of practice, our quality standards, and to reduce risks, we formulated the following best practices for the use of whiteboard features in video medical platforms.

  1. Remote healthcare interpreters should only interpret what is spoken or signed in the room during a consultation.
  2. The whiteboard should not be used:
    • As the primary form of communication for the consultation.
      • Avoid extensively communicating in writing (text) with participants.
    • For sight translations.
    • To assess patient’s skills when writing (such as in certain speech or occupational therapy sessions).
    • To type prescriptions.

What should interpreters do if a provider/patient is asking them to write or draw on the whiteboard?

Assess the situation. Using the guidelines above, determine if this is an appropriate use of the whiteboard. Ask yourself if these are special circumstances and the whiteboard is the only option for communication. Use the whiteboard sparingly and as a last resort. Document the reason for the request if it falls outside of these guidelines. You may have to refer providers to their internal language service department.

The author would like to thank Sarah Stockler-Rex, Manager of Quality Assurance at Cloudbreak Health, for providing valuable input on best practices in remote healthcare interpreting.


The National Council on Interpreting in Health Care’s National Standards of Practice for Interpreters in Health Care: https://www.ncihc.org/assets/documents/publications/NCIHC%20National%20Standards%20of%20Practice.pdf

Martti’s Guide to Utilizing Extra Features of Martti Next: Explore the Whiteboard Feature.

Volume IV: Video Remote Interpreting: Telehealth in Their Language

June 4, 2020

Written By: Sarah Stockler-Rex, CHI and Tatiana Cestari, PhD, CHI

This piece is the fourth in a series, written by Cloudbreak Health’s quality, training, and advocacy leaders, that discusses medical language access and related topics.

In our last installment, we discussed what interpreters need for general setup and preparation to deliver a quality Video Remote Interpreting (VRI) experience. In this volume, we focus on the implications of providing telehealth and language services in tandem, as well as what telehealth providers and remote interpreters can learn about working together.

At Cloudbreak Health, we have been developing platforms for remote interpreting, telehealth, and their intersection for many years. We were ready to face the challenges of the global shift to telehealth catalyzed by the COVID-19 pandemic. Our experience has also enabled us to help healthcare team members (like interpreters, doctors, nurses, chaplains, technicians and other healthcare staff) that have not previously worked in a remote environment.

In the spirit of serving our community, we are happy to share our experiences providing unified telemedicine with integrated language services. Below we include tips for both healthcare providers and interpreters who may be new to navigating remote interpretation.

Interacting remotely with patients needing health care in a language other than English is only going to become more frequent. The following guidelines for these interactions are based on both our own and others’ experiences with multiple technologies on the market. The technology available will continue to evolve, but there are intrinsic aspects of effective communication that need to be maintained no matter the platform or experience.

Providing telehealth and language services

There are many telehealth solutions on the market; however, many lack language service integration and as such, alienate a large percentage of the patient population. This is a concern across the industry and is one of the many reasons we, as well as others, advocate for the integration of language services in telehealth platforms (DaMassa 2020, Mar 25; Marking 2020, April 3; Found in Translation 2020, Jan 21).

Using telehealth and language service platforms in a way they were not necessarily designed to be used could pose security/exposure risks to users. Improper language service use includes two separate video units in a single patient room or dialing out to an interpreter line from a platform that does not allow language service integrations. These setups are also typically not ideal for effective, accurate interpretation.

Interpreters and providers working together in a telehealth consult

As we mentioned above, having language services as part of a telehealth solution is imperative in order to serve as many patients as possible. How those remote interpreter interactions are conducted, however, is also vital for the success of the session and better outcomes.

There are many best practices resources for performing a telehealth session, but they often don’t include working with an interpreter who is also remote.

Here are some guidelines for interpreters and providers working together in a telehealth consult.  These guidelines were developed based on our own interpreters’ experience and feedback from our quality assurance team.

For providers:

  • If working with a team of providers, select one as moderator for the call. This ensures not all participants are speaking/signing at the same time.
  • Interoperability of platforms does not mean that each user has the same controls or views of each other. For example, the instructions you give an interpreter to pause video for patient privacy may not apply. The settings/controls could look different on their end.
  • Patients may join the session with their device from any place (private or not). Asking them if they can move to a more private area can help in many ways (privacy, audibility, appropriate setting to receive bad news, etc.).
  • Interpreters and users that sign need to see each other at all times—this means the videos cannot toggle between active speakers but must remain fixed (gallery view may work based on the number of participants in the interaction. Another consideration to keep in mind “Is the video size adequate for Deaf/Hard of Hearing consumers?”).
  • If you would like a spoken language interpreter to disable the video at any time during the session, confirm that they are able to do so before proceeding.
  • Patients may need to be guided on navigating the platform (e.g. unmute or mute audio/video feed, reposition themselves within view, etc.).
  • Audio issues can happen in telehealth, in remote interpreting, and when these two are combined, and not just because of connection issues. Be patient and take turns.
  • It is even more vital to pay attention to your patient’s and interpreter’s tone of voice during remote sessions as you will not have all the visual cues.
  • Interpreters may sometimes need something to be repeated or clarified, like any member of your care team.

For interpreters:

  • Give a pre-session or briefing like you normally would.
  • Remind each party to please speak one at a time. Someone from the providers’ side may be moderating the session, ensuring that participants are not speaking at the same time.
  • Just like in any VRI session, if you are not be able to see what the patient is doing, request repositioning of the camera or device.
  • Interoperability of platforms does not mean that each user has the same controls or views of each other. You may be giving or receiving certain instructions and the settings/controls could look different on the participants’ end.
  • You may interpret an informed consent for telehealth services. This may be new to you and it is an important part of the session. We have dedicated the following section to telehealth consent.

Interpreting the telehealth consent

When working in telehealth, you will likely interpret telehealth consent: the patient agreeing to use these services to deliver healthcare while acknowledging possible gaps in the medium. There may be additional implications and explanations needed from the provider when a patient declines video or is only able to join with audio as seen in the example below.

The patient has been advised of the potential risks and limitations of this mode of treatment (including but not limited to the absence of in-person examination) and has agreed to be treated in a remote fashion in spite of them.

Explanation of this consent may be provided verbally but, if for some reason a written consent is required, the American Telemedicine Association (ATA) states that “ […] electronic signatures, assuming these are allowed in the relevant jurisdiction, may be used. The provider shall document the provision of consent in the medical record.”

The following guidelines for video-based online mental services from the ATA, which are applicable to telehealth consents in other medical specialties, state that:

“The consent should include all information contained in the consent process for in-person care including discussion of the structure and timing of services, record keeping, scheduling, privacy, potential risks, confidentiality, mandatory reporting, and billing. In addition, the informed consent process should include information specific to the nature of videoconferencing as described below. The information shall be provided in language that can be easily understood by the patient. This is particularly important when discussing technical issues like encryption or the potential for technical failure.

Key topics that shall be reviewed include: confidentiality and the limits to confidentiality in electronic communication; an agreed upon emergency plan, particularly for patients in settings without clinical staff immediately available; process by which patient information will be documented and stored; the potential for technical failure, procedures for coordination of care with other professionals; a protocol for contact between sessions; and conditions under which telemental health services may be terminated and a referral made to in-person care.”

Solutions like telehealth will continue to grow. Together, we can work to provide telehealth integrated language services in the best way possible. 

References and Resources

DaMassa, J. (2020, Mar 25) Telehealth Startup CEO On How COVID-19 Is Changing Telemedicine Use In Hospitals. Retrieved from The Health Care Blog, WTF Health website: https://thehealthcareblog.com/blog/2020/03/25/telehealth-startup-ceo-on-how-covid-19-is-changing-telemedicine-use-in-hospitals-wtf-health/

Marking, M. (2020, April 3). Interpreting Providers React to US Medicare Telehealth Expansion. Retrieved from Slator, Demand Drivers website: https://slator.com/demand-drivers/interpreting-providers-react-to-us-medicare-telehealth-expansion/

Martti’s QA Handout on Interpreting Telehealth Informed Consent.

Found in Translation (2020, Jan 21). Retrieved from StartUp Health website: https://healthtransformer.co/found-in-translation-76283132389f




Volume III: Video Remote Interpreting: General Setup and Preparation

April 22, 2020

Written By: By Sarah Stockler-Rex, CHITM; Tatiana Cestari, PhD, CHITM, Paloma Peña, MSW, LSW; Cat McAlpine

This piece is the third in a series, written by Cloudbreak Health’s quality and training leaders, that discusses medical language access and related topics.

In our last installment, we discussed how to create a Language Access Plan that includes Video Remote Interpreting (VRI) to ensure your facility is not only compliant but providing appropriate patient care. In this volume, we focus on what interpreters need for general setup and preparation to deliver a quality VRI experience.

The global pandemic has forced entire industries to convert to remote workforces, and medical interpretation is no exception. At Cloudbreak, we’ve been able to adjust to shifting daily needs through our many years of experience providing quality video interpretation and telehealth services.

For those new to video interpretation, or interpreting remotely, the following guide will help you pivot to remote work during these unpredictable times. Supervisors and Managers of interpreters will also find this information helpful before they begin supporting interpreters in a new environment.


Let’s assume you have the proper training and experience to interpret. Now, you need to translate those skills to a remote work setup.

The following list includes both items you need to have ready and tasks you need to complete to work as a video remote interpreter. While this list is written with the remote interpreter in mind, who may now be working from a home office during the pandemic, these guidelines apply to video medical interpretation whether it’s conducted at home or in an office.



Your work area should be compliant with the Healthcare Information Portability and Accountability Act (HIPAA), well lit, quiet, and well ventilated.


What it means

A HIPAA compliant space is a private and secure space. This means your home office has doors and if there are windows, that they have blinds and close. This is very important so no one else can see or listen to calls. No one else should enter or be in the room with you while you are interpreting.

You should have a computer connected to a high-speed, private and secured internet connection; and a desk drawer that locks, to store your notebook, or a way to destroy notes after every session such as a shredder.

Dedicated workspace

Your home office should be a room dedicated to your work. It should not be a room that also doubles as a laundry room, dining room, etc. 

Keep it quiet

Your home office isn’t just the room you work in, but also the surrounding environment. There shouldn’t be distracting noise from children, pets, or the surrounding area.


Start with a blank slate

It is recommended you use backdrops or mounts that are totally blank, to keep your image professional and not distracting. If you cannot obtain a backdrop or mount you should have a blank, untextured wall behind you, with no photographs or other decoration hanging on it.

Once you’ve set up your camera, the camera view shouldn’t show anything other than a blank wall or a professional backdrop that has been approved by your company (if applicable). The ceiling, floor, doors, or windows should not show.

Make it bright

Your workspace should be well lit, with no heavy shadows. Make sure your light source isn’t behind you, which will make you appear in silhouette.

 Ready your tools

Your space should have everything you need on hand. You should never have to get up from your desk during interpretation. Have your reference webpages saved on your browser and a notebook and writing utensils at your desk. Use an ergonomic chair and set it up to maintain good posture.



Attach your webcam

If you’re using an external webcam, affix it to the top of the monitor you’ll be looking at for interpretation. Make sure the webcam is centered on the monitor.

Attach your headset

Use a comfortable, noise cancelling headset with a microphone. It’s recommended you use a headset with a mic which will stay in place once adjusted rather than one where the microphone is built into the wire/cord. Test the speakers and microphone that are incorporated in the headset. All other microphones and speakers in your computer must be turned off.

Position yourself

When seated, with both feet flat on the floor, in a comfortable straight-back position, your head and shoulders should be fully in view on camera. Your eyes should be centered on screen. There should be space above your head. The camera should be facing you head-on not at an angle pointing up or down.

Check your surroundings

You should be well lit, without any heavy shadows. Angle your camera to only show you and your signing space (for signed language interpreters). The camera view shouldn’t show the ceiling, floor, a hallway, a door, a window or personal items. Again, the backdrop (or wall) behind you should be blank.


After you have set up of your space, test and ensure the following are working properly prior to taking any calls:

  • Internet Connectivity
  • Devices and software
  • Noise cancelling capabilities and lighting with test calls or with software testing abilities
  • Sound levels
  • Camera view


Be ready

  • Dress professionally and wear solid colors (reds are strongly discouraged for video).
  • Be on time by testing all settings prior to the beginning of your shift (see part III above).
  • Be seated, facing forward, and have your headset on before you answer a call.
  • Make sure you are sitting square in your chair with your shoulders back and centered in camera view.
  • Have all the appropriate computer settings and software open and ready as mentioned above.
  • Have information resources collected and ready to be used (online or not) prior to beginning interpretation to ensure accuracy and clarity. It is helpful to have medical dictionaries or other resources open and ready to go at the beginning of any interpretation.
  • Have a note taking method set up (online/pen & paper) and ready.
  • Have any scripting needed or assigned ready to be used.

Greet the partner

Make sure to smile and use an appropriate scripted greeting. For example, “Hello, my name is Cat, interpreter ID 1234. I will be your Spanish<>English interpreter”, followed by your interpreter pre-session. Your presence should be professional yet reassuring.

Make eye contact

This is another area where onsite interpreting differs from video remote interpreting. Video remote interpreters look directly at the camera to show professionalism. Eye contact lets the user know you are engaged. Focusing on the video also helps you read additional context clues like body language. Set your viewing window directly below your camera to help maintain eye contact.

Try these tips. They should help you feel more prepared and confident with your video interpretation. Stay safe!

Interpreting for Spiritual Care: Importance, Controversy and Solutions

February 19, 2020

Written By: By Tatiana González-Cestari, PhD, CHITM, Director of Language Service Advocacy

Presenting the case

Visualize the following scenario:

“Good morning! We are calling from the prepping area in the operating room,” a nurse says to the video remote interpreter on the screen. The interpreter, a professional accustomed to the fast-paced environment of remote interpreting, is already thinking and processing, within the few seconds available, what areas of medical vocabulary to focus on and picturing in her head what kind of complicated procedure she will be interpreting for. The nurse continues, “Our patient is about to have a very important surgery and has requested someone to talk to and receive a blessing from, so here is our chaplain who came to pray with him.”

The interpreter quickly realizes that the vocabulary and context of the interpretation that is going to happen has NOTHING to do with what she had just formulated in her mind. In only milliseconds, the interpreter needs to make a decision (which is a process we always go through, but we don’t think about the fact that WE, the interpreters, are making that decision before we accept every session and in many times during the interpretation). The interpreter’s options are:

  1. to adjust to the new scenario and proceed with the interpretation;
  2. to ask more questions or clarify that this is going to be a challenging experience, but she is still willing to give her best during the encounter;
  3. to refuse to interpret based on the terminology and scenario.

Option ‘c’ is definitely one I would not recommend and one that would make the interpreter part of a problem and not a solution. So, how could interpreters be prepared to choose ‘a’ or ‘b’? Believe it or not, very little of this scenario is different from other interpreting sessions.

Scenarios like the one described above are common. This has been a controversial topic among interpreters, language service organizations, and providers (both medical and spiritual) for multiple reasons, and the worst part is that only few people talk about it. The debate seems to be limited because human beings have made this subject so taboo or because many would like to be respectful of people’s different beliefs. By not talking about it, we may think we are being more respectful, or that we are in a better place because we don’t have to deal with a potential conflict, or all of the above!

Digging deeper

As with many other things, I have come to the realization that NOT talking about it doesn’t really make the problem go away. My personal and professional way of thinking about this topic is that it is OK to have different spiritual beliefs or faiths, and it is also OK to have no spiritual beliefs at all. We must respect that. Bottom line is, as interpreters, we are called to serve our patients and healthcare communities, and spiritual care may be an important part of a patient’s healthcare.

Looking for answers to some questions about this topic, my team performed a survey in which 80 video healthcare interpreters from  different U.S. states participated. The main purpose of the survey was to determine how video healthcare interpreters felt about interpreting for spiritual care. In addition, we wanted to make data-derived suggestions to the remote interpreting community on how to enhance training for these types of sessions and obtain preliminary data for potential further research.

More than 63% of the participants agreed with the statement, “I like to interpret for spiritual care,” because of the importance it has to the patient or the patient’s health. About 23% were neutral and 14% did not agree with this statement.

More than 48% of participants feel confident when interpreting spiritual care because they are familiar with the subject; 20% were neutral and 31% did not agree with the statement.

When asked if they liked having fixed vocabulary or more from-the-heart prayers to interpret, we found an almost equal number of respondents liking one type of vocabulary over the other.

It was surprisingly good to observe that only 10% of the interpreters in this pool feel uncomfortable when interpreting a spiritual session if it involves a faith that they don’t follow because it is disrespectful to their own faith. And almost 80% of them did not mind interpreting in a spiritual care session even if it is a faith that they don’t follow.

Elba Nazario, former hospice chaplain and current video remote interpreter, comments about the topic: “I think people interpreting in cases of pastoral care should be genuine and show compassion […]. Body language is very important. People can tell when you are being sincere or when you are just playing a part or doing your job. People that are in distress want to know that other people care. For me, as a chaplain, it was more important to show compassion than to say the right words, but I understand that as an interpreter, both things are important.”

A non-spiritual view

Apart from the spiritual aspect of things, we healthcare interpreters may not believe in many things in life, but we still interpret about them and we do a terrific job at it. Thus, we interpret for many things we may not share, follow or practice, such as:

  • Abortions
  • Bottle or breast feeding
  • Sex change
  • Diets
  • Circumcisions
  • Profanity
  • Hormone replacement
  • Gastric bypass
  • Birth control
  • Natural family planning
  • Blood transfusions
  • Breast augmentation
  • Liposuction

And there are many others. We have to focus on the fact that the content of the interpretation has nothing to do with us as interpreters; we are there to serve others and convey the message following our professional guidelines.

Responsibility and outcomes

Any interpret who abides by the NCIHC Code of Ethics must practice:

  1. Impartiality: The interpreter interprets everything without allowing their own thoughts and beliefs to affect the interpretation in any way, even when they conflict with the interpreter’s beliefs.
  2. Transparency: The interpreter makes all parties aware of any challenges or struggles that the interpreter faces during the encounter.
  3. Professional Development: The interpreter strives to continually further his/her knowledge and skills and spiritual care is included in this.
  4. Accuracy: This must be the star in any interpretation. However, I believe it is fair to say that interpreting in spiritual care is an area that is slightly more flexible when it comes to accuracy of the message. Allow me to explain: A prayer, if prayed/interpreted with the heart, even if it is not 100% accurate, will NOT cause harm as other accuracy errors in healthcare terminology may. Of course, it is important to be as accurate as possible but minor edits or omissions may be even “lighter in weight” when it comes to a prayer.

The goal of healthcare providers, including interpreters, must be the well-being of the patient. Refusing to interpret for a spiritual care session can have deleterious effects on the patient. On the contrary, helping to communicate in those circumstances may be what a patient needs to make a recovery, cope or feel peace (the most precious prize a human being can have in life!) (Puchalski, 2001).

In addition, spiritual care is the main reason chaplains and priests call for interpreters. If interpreters refuse to help, these providers get the impression that interpreters never want to serve. No healthcare interpreter acting as an exemplary professional deserves that reputation.

Toolkit and resources

Let’s be ready! Below are some ethical principles and tips to keep in mind to help navigate some scenarios when interpreting for spiritual care sessions—


  • As with any other interpretation, the patient’s words are their own and not the interpreter’s. On the other hand, shared beliefs could make the encounter very emotional for the interpreter.
  • Debriefing with a trusted colleague after one of these encounters may be needed.


  • Let the chaplain/patient know that a specific term or concept is unfamiliar and if clarification is needed.

Professional Development:


  • The tools under Professional Development (above) will help you enhance your accuracy.