Coming Summer 2023: The Next Phase of CareMessage Language Support

CareMessage customers serve a diverse population and need a messaging solution that facilitates delivery of accurate information in patient-preferred languages. Beginning this summer, our customers will have the capability to deliver Outreach messages in many languages at once. Here are some insights from our Product team on how we’ve approached Language Support.

Cecilia Corral, Co-Founder and VP of Product

Why Language Support? Why now?

Almost 25% of FQHC patients nationally are best served in another language. The majority of FQHCs and free and charitable clinics- our customers- need to serve patients in languages other than English. That translates to over seven million people. It’s also part of my own personal experience, because my first language is Spanish, and I grew up translating for my parents, whether that was in healthcare settings, or elsewhere. I still translate for my mom all the time, which I think is the experience of most children of immigrants in this country.

My personal experience gave me insight into what product experience will be helpful for our customers’ patients. We needed to be prepared to launch a very seamless experience for the patient, and we have thought a lot about how to enable this, while simultaneously reaching as many patients as possible. Our technology needs to facilitate communication and automate as much work as possible on behalf of the clinic, who may or may not have the staff to be actively monitoring patients in 50 languages. Now we are ready, and I’m really excited about the approach that our design team has taken with the user experience on both the clinic and patient side.

Can you give an example of how you’ve approached Language Support in a patient-centered way?

One of the first decisions we had to make when we were initially approaching this project was to decide what languages were going to be supported in the patient profile. We started by asking our clinics to send us the list of languages that they would like to see. We were not surprised at the breadth of languages. We pulled a list of languages from the Centers for Medicaid and Medicare Services. We looked at that list, and also the ISO 639–1 and ISO 639–2. We looked at what EHRs are using as a standard, and at what is supported in terms of translation services, text-to-speech, etc. We asked: What is CMS saying underserved patients need in the United States, in terms of language support? And what are our clinics requesting? We ended up finding a lot of consistency in some languages that we all probably recognize: Chinese, Mandarin, Cantonese, Portuguese, etc.

But we realized that there were some languages only available on the ISO 639–3 list that were unique to our customers, primarily indigenous languages for Native American communities in the United States, or indigenous languages from communities in Latin America, who our clinics tend to see, especially if they serve farmworkers or primarily immigrant populations. When we were making the decision to settle on a language list, we were very intentional about making sure that we were including the indigenous languages that were important to our patients, and to our clinics. This was something that we thought should not be overlooked, especially given the types of health care disparities that indigenous populations tend to have in the United States. That was a very intentional design decision on the patient experience side. We are now starting to see some of those languages be added to patient profiles, which is an exciting validation of this decision.

Matus Kliment, Senior Product Manager

From your standpoint, what are the biggest challenges in adding Language Support to our Product?

Adding Language Support to our product has been challenging, particularly in maintaining a consistent language experience for patients, enabling the customer to provide and customize messages, and meeting compliance standards.

However, it’s so important that we do it right. Research has shown that language barriers can adversely affect healthcare outcomes, resulting in increased hospitalization rates, longer stays, and higher mortality rates. The enthusiasm shown by our customers during the research and usability testing phase is a great indicator of the positive impact this feature can have.

What is your favorite thing about this project so far?

My favorite aspect of this project is the opportunity to assist minority communities with limited English proficiency in communicating more effectively, particularly in healthcare settings.

Targeting unique and rare languages, such as Pashto or Tigrinya, can promote better health outcomes for these underrepresented groups. Compared to English-speaking patients, people with limited English proficiency are less likely to have a regular health care provider, have fewer physician visits, and lower rates of screening for issues like blood pressure and cancer. This is a gap that needs to be closed. Our team’s relentless pursuit of excellence and collaborative brainstorming have been great assets in developing and implementing Language Support.

Eric Ruelas, Product Designer

What product design principles were most important in bringing our Language Support to life?

The main one is maintaining consistency. We didn’t want to redesign the interface so that our customers had to change the steps they take when creating an Outreach. We prioritized keeping the user experience consistent. We also prioritized the consistency of the experience of the patient who is receiving the message. For example, if a patient gets an Outreach message in Vietnamese, they should also expect that they can respond in Vietnamese, and that any error messages are in Vietnamese. This respects their preferred language throughout their experience, and maintains consistency in the product.

You were involved in customer interviews as part of the design process for Language Support. What did you learn?

It’s so cool to see all the different ways that people are using the product. Our platform is so flexible and our customers are so creative. They’re using CareMessage to facilitate food deliveries, or they are already using the existing platform to send messages in other languages. So we examined their usage, and we said, how can we improve on that?

All the customers we spoke with were very excited and so open to giving us feedback. It will be amazing to see them use this new functionality once it’s released.

Orit Mohamed, Principal Product Manager

You were involved in many conversations with customers at the beginning of our Language Support exploration. What did you learn?

Our customers have so many patients who speak languages other than English and Spanish, and our customers will overcome just about any hurdles to engage with their patients. Patients need to be communicated with about gaps in care, or flu shots, or other preventative care- and our customers figure out novel ways how to do it, because they are so committed to their patients. It was inspiring, and inspired our desire to build a product that made their work simpler and easier.

How did you see Language Support fitting into our long-term product vision?

I manage the integration strategy for our product, and what informed my work on Language Support was my belief that it’s crucial for us to build a product that is as “plug-and-play” as possible with the variety of technology tools that our customers use. So, initially, from a patient data perspective- the primary question was, how are we going to get data on the right patient languages that our customers are storing in their EHRs? We needed to do that in a way that’s standardized, to enable us to scale our API platform.

That led to our very first foundational step in Language Support, enhancing the patient profile and the API to allow us to capture the correct, preferred language to the patient profile. I think that foundational step forced us to think critically about multiple different use cases and different users. We considered not only users that are logging in manually to the application and updating languages, but also the language data being sent through CareMessage via our integrations, whether it be through an EHR or through a Population Health tool. And then we considered API partners that are building applications on top of our API, who need to be able to set the right languages for their patients. That informed our holistic approach to how this would work from a data perspective, which paved the way for us to plan changes per feature on the user interface.

Martin Lozano, Editor/Translator

From your perspective as a translator, what makes a good or bad multilingual Product experience?

Building patient trust is key. When you engage patients in their preferred language, you can build trust, or you can tear it down. If the content is poor from a linguistic standpoint, you will drive people away instead of engaging them. Not addressing cultural barriers or beliefs will do the same. In short, people don’t want to engage with your product if they believe their most essential needs, of being understood and acknowledged, are not properly met.

What are some considerations for effectively delivering healthcare content in multiple languages at the same time?

There’s a concept of “transcreation”, which is more than merely a word-for-word translation- it’s an interpretation that more accurately reflects the intended meaning of the content. Is the content attuned to its reader’s cultural values? Are you aware of how the tone will be perceived? In translating for healthcare, it’s a balance of ensuring friendliness and scientific accuracy, and avoiding colloquial language that might be misunderstood.