A few years back in early spring, a patient with my last name was admitted to my unit; Nguyen is one of the most common last names in the world. During handoff, the previous nurse informed me that this patient didn't speak a word of English and required the hospital’s translation services. I told her not to worry, that I could take on that patient assignment since I speak Vietnamese... I was wrong. Turns out, speaking a language fluently enough to communicate medical terminology is very different from being conversant with friends and family.. I quickly swallowed my pride and started to use the translation services that the hospital subscribed to.
To describe how these services worked, imagine playing the most elaborate game of phone tag ever. You - the nurse - speak into a phone, then hand it to the patient, who listens to someone else translating what you just said. Then the patient speaks to the translator, passes the phone back to you, and you listen to the translator repeat what the patient said. It’s essentially the same as any in-person translation service, but when you add a phone into the mix it introduces room for a lot of the dialogue to fall through the cracks.
the entire medication administration process took ten times longer than usual, which delayed my other patients from receiving care.
Put yourself in my shoes for a second; imagine the first time I had to give this patient her medication. The first time meds get administered, nurses should take the time to explain what they are for and how the patient might feel on them (good practice actually states that we should do this every time). Let’s review what I was physically carrying at the time: a cup full of unopened pills, a glass of water, the medication barcode scanner, the translator phone, my notebook and pen, my stethoscope, and that’s not even everything. The juggling of scanning the medication, passing the phone to the patient, opening up the medication package… needless to say, the entire medication administration process took ten times longer than usual, which delayed my other patients from receiving care.
Communicating this patient’s treatment plan to her and her family was delayed enormously due to this translation barrier. I felt awful knowing that I wasn’t able to communicate effectively; the asynchronous nature of our ‘dialogues’ prevented our conversations from feeling genuine, and we're often rushed so that I could get to my other patients. These delays had downstream results, and impacted the length of the patient’s stay as well as how long it took them to start any new treatment. This lack of synchronicity and its downstream effects are not unique to patient communication, but apply to health information systems as a whole.
Communicating this patient’s treatment plan to her and her family was delayed enormously due to this translation barrier.
Much like my experience with this patient, asynchronous communication between back-end systems & repositories with end user interactions & their context must overcome the hurdles of latency. Data that clinicians are looking for and want to share between each other is not always readily available; documents get created by users and systems but is not accessible in one convenient place. Many health information systems are not modelled to have data flow in real time; the traditional message broker and ESB models are not capable of supporting context sharing in real time. With technologies and models such as the Semantic Web pushing the envelope of how we think about data sharing, the healthcare world is ready for data in real time.