Sign Translate Hospital: Sign Translate Ltd
Winner: Healthcare ICT Product Innovation sponsored by Quicksilva

SignTranslate Hospital won the Healthcare ICT Product Innovation category of last year’s BT e-Health Insider Awards; a category sponsored by Quicksilva. It is a web-based programme designed to improve communication between doctors, British Sign Language users, and foreign language speakers. Sandra Hempel finds out more.

While 70,000 people in the UK use British Sign Language, there are currently just 400 interpreters. This makes life particularly difficult for people with hearing problems when they need healthcare.

While deaf people are known to have higher rates of illness than hearing people, including diabetes, heart disease, obesity and depression, they often don’t seek medical help until their problems become severe because of the difficulties they can have in communicating.

At the same time, finding an interpreter is both difficult and expensive for hospitals and GPs, especially when their travelling time and fares have to be paid for. Hence the web-based programme SignTranslate Hospital, launched by SignTranslate, at the beginning of 2009.

Questions and answers

SignTranslate is a subsidiary of the charity SignHealth, which campaigns to improve the health of deaf people. It is targeting A&E, maternity and audiology departments and general wards with its new service, contacting diversity and equality leads and commissioning leads at every acute trust in England.

The service offers doctors and other professionals a list of 500 questions that are commonly asked in consultations. When the clinician clicks on a question, a signer appears on the screen to translate for the patient.

The questions mostly require a simple yes or no answer, but there is a patient response button for multiple-choice questions. If a more in-depth discussion is required, the clinician can access a live interpreter online; in most cases straight from their desktop. Another feature is a foreign language translation service for 12 languages, both in written and spoken form.

“We asked doctors what structure would be most appropriate for the way they worked,” explains SignTranslate’s managing director Phil Murden. “We asked them about the various clinical categories and about the triage process and then constructed the site around what they told us.”

The results of this research complemented a study carried out at the University of Manchester in 2005, in which people with hearing difficulties were asked their views on using a web-based signing service.

The initial response was hardly encouraging. “People thought they would have to get a webcam and get really involved with the technology,” says Murden. “But when they realised that the clinician was driving it and that all they would have to do was to look at a video clip, they changed their minds.

“This is not a replacement for a live interpreter, but it’s better than nothing in an emergency. And because it’s web-based it is available 24/7.”

Experience in the US, however, suggests that an online system might well prove a replacement for a live interpreter. A similar service in America clocked up nine million minutes of interpreter time in the two years since its launch.

Wider benefits

Andrew Alexander is a consultant in respiratory medicine at the Royal United Hospital Bath NHS Trust, where the system is about to be installed. He describes the programme as “a real step forward” and not only for the obvious benefits that it brings to consultations.

“We are training over 200 staff not only in SignTranslate but in the communication needs of deaf people in general,” he says. “How and when to use SignTranslate is just part of a wider exercise in awareness raising: it’s about more than clicking a mouse on a question.”

Having a qualified BSL interpreter available online, instead of relying on a colleague or friend, is especially welcome, Dr Alexander says. “That’s the clever bit. The patient needs to understand the doctor 100% and the doctor needs to understand the patient 100%. It’s no good getting someone’s medication half right.”

The ‘live’ interpreter will be particularly useful for clinics, such as in cancer medicine, where appointments are booked as little as two weeks ahead, he adds. “We try to get an interpreter but they are not always available at short notice. At the moment, though, the online SignTranslate interpreting service is only available during working hours and I’d like to see that extended.”

The technology required to use SignTranslate Hospital is a desktop PC or laptop, an internet connection of at least one megabyte and a webcam. The service is being expanded so clinicians can send a free text message to the patient, who will be able to text back; with the text converting to email.

The next stage will be to enable the programme to be downloaded to handheld devices; and perhaps made available through the 3G mobile phone network. SignTranslate’s income is from two sources: a user licence (currently £1,000 a year for a hospital or primary care trust, and £65 for each GP surgery) and a per-minute cost for the live online interpreter. Profits will be ploughed back into the charity.

Proving its worth with GPs

SignTranslate Hospital follows the launch of a similar programme for GPs a year ago. Kevin Reynolds, one of 12 doctors looking after 17,000 patients at a Southampton surgery, tried out SignTranslate GP with both deaf and foreign language clients.

He says the way that the programme has been set up suits both patient and healthcare provider: “It gives the patient control but also the clinician some control over the conversation,” he says. “The fact that the questions are written down alongside the image is particularly helpful.”

One of his patients, Sue Chivers, says that before the practice introduced SignTranslate she often had to rely on members of her family to interpret, since there is inevitably a delay in finding a live translator by phone.

The system also allows the doctor and practice staff to use SMS to send appointments, test results and prescription pick-up reminders to hearing impaired patients

Feedback from users of the GP service has been good, says Phil Murden, but the drive is on to make sure that all hearing impaired people know what’s on offer and ask for it. “We’ve produced a card for deaf people to present at the hospital or surgery saying that they want to use SignTranslate, and we hope that hospitals and surgeries will display a sign saying it’s available.”

To boost take up in these early days, the service is will be free to GPs in England until June, and GPs using EMIS can access the programme directly through an EMIS internet link. Currently just over 20% of PCTs in England have signed up.

“There is currently a lot of attention in the NHS at the moment on improving access to communication for deaf people, so our focus and that of the NHS are quite similar,” Mr Murden says. “We just want to get SignTranslate out there as quickly as possible and to as many people as possible.”


More about the Healthcare ICT Product Innovation of the year and the awards:

Healthcare ICT Product Innovation runners up

Live on the Night: from the awards dinner

SignTranslate’s website