AI Medical Translation in Pediatrics. Trusting Real Time Communication in Clinical Care

Aurelio Muzaurieta (00:08)
We were kind of just talking about the problem of caring for patients with limited English proficiency and how that's a really big issue in our healthcare system in the US. Nathan, I'd love to hear about the practice kind of environment that you are in. What's your role within that? What kind of patients do you guys typically see? We'd love to hear about it.

Nathan Stack (00:29)
Yeah, yeah. So we're in Steamboat Springs, Colorado. We've actually got three clinics in the area, two in Steamboat, one west in Hayden, Colorado. Very rural, very cold mountain town, smaller population than most people are probably used to. We've had quite a growing Spanish-only speaking population. So definitely some challenges we've had. I've been practice Manager for the company for just over four years now.

And I've definitely helped them grow and expand with that and how to handle that. From when I came on board four years ago, they didn't have any company set up, no software. Kind of winging it on the spot, honestly. We had a physician that's very fluent in Spanish and one nurse that I actually ended up hiring that's fluent. So it's been interesting. There's been a lot of changes that we've had and experiences over time.

Finally now being set up with this program is incredibly helpful.

Aurelio Muzaurieta (01:22)
What has been your role as Practice Manager for the past four years? How have you seen your role in that?

Nathan Stack (01:28)
It's been exciting. I came on board after running physical therapy clinics. I started orthopedic and pediatric clinics. I ran those for five years and then they hired me on in Peds here in Colorado for their two clinics they had at the time. Started off real slow, just billing, little bit HR and just some operations stuff.

Since I've expanded greatly to do basically all finance, all operations, IT, HR. I have a billing team under me that I run to do everything as well, but it's awesome. I love being involved with every part of the company and to improve it and just having that high level understanding of everything allows me to really make things efficient and effective and see where we can improve care.

Specifically, one thing that was pretty bad was translation services. So pretty early on, I got us set up with somebody in town for a flat fee per month. That was OK. It worked well. It was good for document translation. Also, you would send over some documents that we made, and they could translate it into Spanish and a couple other languages. But most of our patient population's Spanish, for sure.

There is a lot of Spanish only speaking. So it was very important to me to be able to have that and provide that. We only had one physician that was completely fluent in another physician that was fairly comfortable, I'd say. And so, you know, they would kind of get overloaded with those patients. And so over time, we utilize that local service and

besides document translation, it was a hit and miss. There'd be times where we'd call and schedule an appointment and they just wouldn't show up. So we'd be unable to speak with them because obviously we're with a provider, it's not fluent. So we do our best in that moment to make it work. But it was important to me that we'd be able to fluently speak with and communicate their medical problems and issues and how we can help and treat them with their families. It's vital.

So I just kept doing more and more research and eventually I got to set up simultaneous with them, an online translation service and found out that they're not cheap. They're very expensive. So those services were all right. It charged per minute which was kind of a weird position to be in where, you know, you're wanting to take the time that you, you need to handle all the questions and concerns and

Nathan Stack (03:48)
be able to thoroughly evaluate patient and it's kind of the opposite pressure you have on you when the service is charging you multiple dollars per minute to do this at the same time. It's just kind of an uncomfortable situation ⁓ that puts us in and the pediatrics is the lowest paid specialty there is out there year after year and so it's challenging for us to be able to even afford those appointments.

Nathan Stack (04:14)
Honestly, so I just kept looking for more and more solutions. It's kind of where that's been at. My role's changed over the years, but this with specifically translation services, that's kind where we've been at.

Were all of these services offered over the phone or were they done through iPads or other kind of visual technologies at all?

Nathan Stack (04:34)
So...

Early on, one of them was on the phone, and then we moved away from that one pretty quickly. That was extremely expensive. We moved over to another service where you could have a choice of audio, video, or just audio on the phone. And that's what we've been utilizing for the past few years, which it works, but there's issues. There's concerns that families have as far as having a third person in the room,

listening to it, there's delays, there's awkward delays involved. There's just moments that it's not as smooth a care as I wish for our team to have. The interaction's not quite as smooth as, you if you spoke fluently, same language.

Nathan Stack (05:14)
And what if you said it

Aurelio Muzaurieta (05:14)
And what have you guys kind of

settled on to do in like the current state?

Nathan Stack (05:18)
I switched over from all those services to No Barrier, which I'm more than happy with. We've evaluated it for a few weeks and then we got moving forward on it pretty quickly because it is so nice. I got my team in to evaluate it and utilize it with patience and pretty much mostly Spanish speaking. We do have a few other languages.

They've just found right from the get-go, it's just more comfortable. You can load it on their laptop or their iPad, honestly, many different devices. And right away, they feel like it's much faster. And with the visualization, there's a visual on the screen that shows everything, the whole conversation, which is awesome. And I mean, one thing is it's kind of a weird comparison, but...

Nathan Stack (06:02)
One of my nurses was just saying how much better it is versus a human translator where it's so much smoother. They feel like they could be themselves, right? Like even like, your baby's so cute. And just comments like that, that are kind of important for that climate culture, the comfort of that clinic to be able to say those things and still make that connection, which they weren't doing with a live translator, a live person, because you know, there's small audio delays and

Nathan Stack (06:30)
time for them to think about it and then say it. And then a lot of times, you know, the translator would be quiet or... That's one thing we found is those services were very unreliable for consistency. You'd get a couple that were great. They would speak up. They would know how to translate well. And then you get some others that audio problems or they're too quiet. They don't know exactly how to translate. There's, there's like a stutter issues like that.

Whereas now they go in the room, they have this software right up there on their laptops most of the time, sometimes an iPad, depending on who it is. And real quickly, they're just talking with them. It informs them that, we're utilizing this service, gives them the spiel right away. And the team really feels comfortable, like they can have humor naturally with the family. And it really...

Nathan Stack (07:18)
has opened up that comfort in a way I never really realized possible with software.

Aurelio Muzaurieta (07:23)
That's super encouraging to hear. I haven't heard the comment about actually feeling like the quality is better than a person. Cause that's obviously one of the biggest concerns around AI leading interpretation and translation services is, it actually better? You know, or is it going to be worse is basically a lot of people's concerns. But I mean, if at least anecdotally, it sounds like a lot of your staff are enjoying the

type of care that you're able to provide. And even just like the more casual, serendipitous human interactions that you can make from the initial patient shows up and is welcomed into the room by reception and gets kind of set up and all the documents set before they even see the nurse or the physician or anyone else that's going to be on their care team. So I feel like that's really great to hear. It almost feels like more reliable in a lot of ways

than what the current sort of status quo is. So I'm glad to hear that, that's I mean, or were you feeling like there were, for the type of visits that you guys are typically having, it sounds like they're all pediatric visits and they're typically, are we talking kind of wellness care, general Are they subspecialized things?

It's just pretty much peds, newborns to, we see up to 21. Most of the patients in most of our clinics are zero to 18, but mostly well-childs and then just some acute stuff. It is a ski town. A lot of people come in with injuries and Steamboat produces a lot of Olympians. There's a lot of ski jumpers and just kind of some fun places.

Aurelio Muzaurieta (08:39)
Yeah, I've heard it, yeah.

Nathan Stack (08:56)
So, I mean, I was super critical about AI replacing humans already. Like, I'm all for IT. That's one thing I do for our company too. And so I was excited to try it, but, it still seemed a little early in time to have a service where people would be able to actually be happier with it. But we really did a lot of testing and

Nathan Stack (09:19)
it really actually was an improvement. I'm wondering now if it's based on being in pediatrics how different it is to how much even better for peds. Just again because of those conversations and it can be a little bit lighter, it can be funner, you know with kids around there that we just immediately are able to have more of that natural conversation with the way it works.

Fantastic. We're always kind of talking about the different clinical spaces that, No Barrier and technology can be applied and where are those limitations. For practical sense, from an ethical sense, we have to sort of think about, and then the ideal areas. It sounds like there's a quite good match and fit

with the office setting, the pediatric population and the families. From an implementation standpoint and getting people adopting the new technology, did you find any obstacles in that process or was it pretty straightforward? How was that whole endeavor?

Nathan Stack (10:15)
You know, I spent a lot of time with my team, updating technology all the time anyway, so they're a little bit used to me in my ways, but No Barrier made it easy. I just sent him a full list of all my employees emails and it just made super easy login. I show them off the website essentially and let them know basically any device you have. Your work laptops or the iPad. Just got it set up with a couple of them over some phone calls.

And I had a test with each other right away too, so they kind of understood the software and the hands-free method versus basically hitting a key to start and stop, which actually is what my team prefers. They were pretty simple, honestly. They got it really easy. There was no huge trick.

Aurelio Muzaurieta (10:55)
pretty easy user interface for folks and with different comfort levels of technology adoption. Yeah. Wonderful.

Nathan Stack (10:58)
Absolutely.

and we did have patient families comment that they are more comfortable with that method again, instead of a human too. So not just our team, but even moms let us know. Yeah.

Aurelio Muzaurieta (11:11)
Very That's great to hear. Yeah. Are there, are there any aspects of the technology that your teams kind of wished it there was, there was more of or another aspect? Like what kind of critiques have you heard around it?

Nathan Stack (11:24)
Yeah, absolutely. Actually, to be able to utilize this service over the phone. Because right now, in person, all of our nurses, all of our providers can do this on iPad or laptop in person, human-to-human. But not on the phone, except for I'm in a beta program right now, where I'm just now getting signed up to be able to test this out. And I'm super excited about that, because that opens up

our whole reception team, because that's super important to be able to communicate what your appointment's for, the time, the location. We've got three locations. People showed up to the wrong ones. Just screenings and forms that need to be filled out. My reception team is super excited to be able to test this out and move forward with that. So I'm hoping for a smooth transition.

Aurelio Muzaurieta (12:11)
That is very exciting. I think that's a hugely important application for translation services over the phone. It's really difficult. I hope that that transition goes well and please let us know how the adoption goes and if there are any kinks. We'll work with you guys to smooth it out. But fantastic. Well, it's encouraging to hear that things have been going well.

It sounds like this pretty formidable problem of bridging the gap with your Spanish speaking patient base has been, this has been a big step forward, maybe not completely perfect, but, ⁓ working towards a better, a better system. You had mentioned a little bit about

the financial model that you had had before of pay per minute, in a sense, with patients and how that was like pretty problematic in a clinical setting when you want to be able to provide enough time in already a very limited time constraint clinical visit to be able to hear patients and that that added costs with how things are reimbursed and you trying to keep the lights on in the business is a really complex set up. You have the hat on of both making sure that the clinical medicine is happening and the operations and finances happen. What do think the best sort of

Aurelio Muzaurieta (13:26)
service model is for making it work?

Nathan Stack (13:26)

I strongly believe in the flat fee per month. It's just something reliable. This is what this expense is going to be. I can plan on that. I can look at that in our whole financial picture and say, okay, we're going to rely on this much and not have this variable amount. There was a provider that was newer that accidentally left his previous service on after his appointment once. And so it was like,

Nathan Stack (13:54)
70 some minute time that we charged, you know, multiple, multiple dollars per minute on. And the translator wasn't even doing any, any work at all after like 20 minutes. But you know, that company still charged us that entire time and wouldn't, waive it. ⁓ And it's, it's clear. Yeah. And clearly the translator knew that, I'm not working. There's nobody talking. You could add did the phone call.

Aurelio Muzaurieta (14:09)
Wouldn't budge on it, wow. That's a shame.

Nathan Stack (14:19)
With a program like this, you don't have to worry about that at all. There's no pressures on even thinking about time. It allows you to be unleashed and to completely focus on the care and the patient and their needs. So you just basically are able to have our entire team just focus on that task at hand, whether it be reception on explaining billing or insurance or nursing with vitals and the providers doing all they do. It really takes that whole piece out of their mind to let them focus on medicine. And that's just so much more important to me than having to think about, man, I got to, because we actually would turn it off in between reception to nursing to the providers where I'd say, okay, turn it on right before you go in the room, do what you need to, and then hit stop with the translator before you even walk out.

And go talk with the provider, update them on what's going on, vitals, et cetera. And then the provider get caught up, ready to go, get in there with their laptop and be able to hit start right as they talk to you. It's just not having to worry about all of that nonsense. It's so much more comforting. It's efficient. We know what it's going to cost. It's wonderful to be able to have a model where, hey, it's going to be this much per month. Use what you need to.

Nathan Stack (15:34)
Don't worry about it. There were phone calls in time to really like ⁓ does this need to be called should I call these guys? If you've been questioning then yeah, you probably need to call them and before it was like well It's gonna cost so much money to do this maybe an email or no we want to be able to communicate and we don't want to held behind restrictions and whatnot.

Aurelio Muzaurieta

Good. It's good to hear it. That's really all I had to talk about today, but I appreciate you taking the time and thank you.

Nathan Stack (16:01)
Yeah, Nice meeting you. Thank you so much for this.

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