The ER: Are Translation Apps Safe?

May 21, 2020 by
The ER: Are Translation Apps Safe?
Maria Apgar
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Translation apps are popping up everywhere. You can order food in your favorite restaurant in Paris, ask for directions in the streets of Buenos Aires, or even hold an informal business meeting with your prospective customer in China. These apps are convenient and provide an instant solution to a very old human problem: communication barriers.

Using translation apps in a healthcare setting is definitely tempting, but it should be approached with an abundance of caution. Trying to interact using a translation app that sounds funny, scary or confusing to the patient has implications for both patient safety and compliance. A patient may face the terrifying prospect of going through medical procedures without fully understanding what’s happening, or what to do.

Let’s look deeper into the most commonly used translation app. A 2019 study from UCSF[1] assessed the use of Google Translate for Spanish and Chinese medical translations in an emergency department. It found that the new Google algorithm had improved its accuracy from 60% to 92% in Spanish and to 81% in Chinese. This sounds impressive, and has encouraged providers to use it more. Unfortunately, it gives them a false sense of security. The same study shows how dangerous translations are when they fail to convey the right information. When discharge instructions were translated into Spanish by the app, 28% of the results contained life-threatening mistranslations. The Chinese translation of the same instructions had 125 inaccuracies and 50 of them had the potential to put life at risk. This makes for a shocking 40%. We often think of translation mistakes as being comical, but in this situation they are quite disturbing. When discharge instructions, like those evaluated in this study, have significant inaccuracies and errors, it poses a risk for clinically significant harm.

Nobody can predict what goes on in the mind of a patient, but we do know more patients than we would like to admit fail to exercise sound medical advice, even when they speak the same language as their care provider. Patients who don’t speak English or have poor English proficiency adhere to instructions even less. They also generally have worse outcomes and experience more adverse events. Studies [2] have shown that patients who have low English proficiency don’t understand information about follow up appointments, medication type, dose or usage. Would a translation app help in these situations? The short answer is probably not. Compliance of non-English speakers mostly depends upon understanding cultural beliefs, creating rapport, and providing complete guidance that is fully understood. Research [3] that compared the completeness of discharge instructions for English and Spanish-speaking patients in a pediatric hospital found that English instructions were more comprehensive. Other reports [4] from a neonatal intensive care unit showed that physicians provided updates to Spanish-speaking parents in their native language only 39% of the time.

In addition to concerns about patient safety and compliance, translation apps could violate HIPAA and privacy laws. Most translation apps send information to cloud services. Here things get complicated, depending on how many third-party vendors are required to store and transmit the data. Using these technologies makes it unclear where the data goes, and who has access to it.

Considering all the potential harm, should we even use translation apps in a medical setting? We can all agree they have improved, and they may have some potential use in healthcare translations in the future, but we are not yet to the point where we can feel completely confident putting patients’ care at the mercy of an algorithm. Medical translations still require a human with a clear understanding of clinical terminology, who has cultural sensitivity, and can accurately convey complex medical concepts and instructions.

Using clear communication practices can improve outcomes, reduce readmissions and prevent adverse events from happening. This includes using interpretation services more frequently, combined with more comprehensive medical translations such as consents, educational materials and discharge instructions prepared by professional medical translation services. The data proves it, accurate healthcare translation cannot be treated as an afterthought. It is in fact at the very heart of patient welfare.

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