How does it work?

This software questions patients without the assistance of a human interviewer; i.e. without demands on staff time. It presents questions on the screen in an easy-to-read format that begins with general questions and branches to more specific questions depending upon the patient's responses.

When the interview is completed it provides a video display of the patient's sorted responses as well as a compact, printed report suitable for inclusion in the patient's chart. The physician does not operate the software but simply receives the report of the interview. There is, virtually, no staff training involved. Multiple patients can be interviewed at the same time. The number of patients interviewed concurrently is limited only by the number of computers the clinic wishes to make available for this purpose.

Multi-lingual capability

The Interviewer can interview the patient in their own native language, and produce a report in the language of choice of the physician. The Civil Rights Act of 1964 has been interpreted to imply that some health care facilities receiving Federal funding may, in certain circumstances, be required to provide translation services for their patients. *. In certain urban areas, such as Los Angeles, over 80 different languages may be spoken. It would be a financial impossibility to pay for translators 24 hours per day in all the possible languages that might be encountered. A product like The Interviewer goes a long way toward solving this problem.

Suggested Actions

This product provides the practitioner with specific actions to consider, such as lab tests, radiographic studies, etc. These suggestions are based on the patient's responses.

Query

The physician is provided with the ability to search the database of responses for medications and symptoms. Thus if a drug is recalled, if this drug name is entered the names of patients taking this medication will be retrieved in seconds. Similarly, the names of patients who identified themselves as diabetic can also be recalled. This facility is of great use in Quality Assurance and Peer Review surveys.

Label Printing

The program will print labels in two sizes which can be used on forms or on specimen containers.

Reviews of this product
The Interviewer™ v. 1.0

"All in all, . . . a program that can give you the kind of complete and thorough patient information that is essential for your treatment . . . and reward you with some extra time to spend with that patient in the process of doing so."
Physicians & Computers
December 1987

The Interviewer™ v. 2.0

Medical Software Reviews, September 1993 / Vol. 2 No. 9
Reviewer: David W. Bauer, M.D.

JAMA 1994 Vol 271
Reviewer: Ray van Wolkenten, M.D., Ph.D.

System Requirements: Microsoft Windows '98 or above.

* "Section 601 of Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d, provides that no person shall "on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance." Section 602 authorizes and directs federal agencies that are empowered to extend federal financial assistance to any program or activity "to effectuate the provisions of [section 601] * * * by issuing rules, regulations, or orders of general applicability." 42 U.S.C. 2000d-1.

Department of Health and Human Services regulations promulgated pursuant to section 602 forbid recipients from "utiliz[ing] criteria or methods of administration which have the effect of subjecting individuals to discrimination because of their race, color, or national origin, or have the effect of defeating or substantially impairing accomplishment of the objectives of the program with respect to individuals of a particular race, color, or national origin." 45 CFR 80.3(b)(2).

The Supreme Court, in Lau v. Nichols, 414 U.S. 563 (1974), interpreted regulations promulgated by the former Department of Health, Education, and Welfare (HHS's predecessor), 45 CFR 80.3(b)(2), to hold that Title VI prohibits conduct that has a disproportionate effect on LEP (Limited English Proficiency) persons because such conduct constitutes national-origin discrimination." Source: quote from U.S. Dept. of HHS Guidance.

The Guidance goes on:

"...in certain circumstances, the failure to ensure that LEP persons can effectively participate in, or benefit from, federally-assisted programs and activities may violate the prohibition under Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d, and the Title VI regulations against national origin discrimination.

**Specifically, the failure of a recipient of Federal financial assistance from HHS to take reasonable steps to provide LEP persons with meaningful opportunity to participate in HHS-funded programs may constitute a violation of Title VI and HHS's implementing regulations.** "

..."Recipients of HHS assistance may include, for example:

a.. Hospitals, nursing homes, home health agencies, and managed care organizations.
b.. Universities and other entities with health or social service research programs.
c.. State, county, and local health agencies.
d.. State Medicaid agencies.
e.. State, county and local welfare agencies.
f.. Programs for families, youth, and children.
g.. Head Start programs.
h.. Public and private contractors, subcontractors and vendors.
i.. Physicians and other providers who receive Federal financial assistance from HHS.
Recipients of HHS assistance do not include, for example, providers who only receive Medicare Part B payments..."

"Recipients are required to take reasonable steps to ensure meaningful access to their programs and activities by LEP persons. While designed to be a flexible and fact-dependent standard, the starting point is an individualized assessment that balances the following four factors: (1) The number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee; (2) the frequency with which LEP individuals come in contact with the program; (3) the nature and importance of the program, activity, or service provided by the program to people's lives; and (4) the resources available to the grantee/recipient and costs. As indicated above, the intent of this guidance is to suggest a balance that ensures meaningful access by LEP persons to critical services while not imposing undue burdens on small business, small local governments, or small nonprofits."

In applying factor (3), the following guidance is given: "...If the activity is both important and urgent--such as the communication of information concerning emergency surgery and the obtaining of informed consent prior to such surgery--it is more likely that relatively immediate language services are needed. Alternatively, if the activity is important, but not urgent--such as the communication of information about, and obtaining informed consent for, elective surgery where delay will not have any adverse impact on the patient's health, or communication of information regarding admission to the hospital for tests where delay would not affect the patient's health-- it is more likely that language services are needed, but that such services can be delayed for a reasonable period of time. Finally, if an activity is neither important nor urgent--such as a general public tour of a facility--it is more likely that language services would not be needed. The obligation to communicate rights to a person whose benefits are being terminated or to provide medical services to an LEP person who is ill differ, for example, from those to provide medical care for a healthy LEP person or to provide recreational programming."

"After applying the above four-factor analysis, a recipient may conclude that different language assistance measures are sufficient for the different types of programs or activities in which it engages, or, in fact, that, in certain circumstances, recipient-provided language services are not necessary."

You can view the complete guidelines at
http://www.os.hhs.gov/ocr/lep/revisedlep.html

To sum up, only recipients of federal financial assistance are affected by the regulations. Those that are affected must apply a 4 step analysis to see what is required of them. In the case of informed consent to emergency surgery, the answer is clearly that translation services must be provided immediately. In other cases, such as elective surgery, the services likely must be provided, but may be delayed. Where the health of the patient is not involved, it is possible that no language services are required."