The Americans with Disabilities Act of 1990, (ADA) requires medical facilities to provide, "effective communication" for all of their patients, and many do so willingly by hiring local sign language interpreters for their Deaf patients. Of course this communication is crucial for both doctors and patients but the question has always been, "What is effective communication?" According to the revised ADA requirements, VRI is considered an acceptable form of communication in some medical settings so long as, "specific performance standards are met," such as clear video and audio connection. It seems that VRI works in some settings and it will continue to be an asset for the Deaf community. Advancing technology in video conferencing platforms are helping us to reach the goal of equal communication access for all.
The growth of VRI services will have an evolving impact on the Deaf consumers, clients, interpreters, and interpreting agencies that utilize the VRI platform. The perspectives are all different but equally important to understand as we all move forward together. The challenge is to address the various concerns of all perspectives, in hopes of navigating through these unknown waters. Where will VRI take us, and are we all ready to make that leap?
The Deaf Perspective
First, I do not claim to speak for, "The Deaf" but through my interactions and feedback within the community, I have a general sense of mixed acceptance and resistance. Of course there are some who LOVE having access to the service and they stand in full support of VRI. Why wouldn't they?! The concept is amazing and something that few could envision 10 years ago. Having instant access to interpreters changes the playing field. Gone are the days of waiting hours in the ER for an interpreter to arrive. No longer will a Deaf patient have to sit in the waiting room only to learn someone forgot to schedule an interpreter. The change from "in-person interpreting" to VRI could be as impactful as the change from the old TTY to Video Relay Services. That might be too bold a statement but as technology frees us from wires and faster Internet speeds, (such as Google & AT&T 1GB expanding Internet service) grow exponentially, the Deaf will have access to an interpreter 24/7 and in any location. That was inconceivable not to long ago...
There is so much to look forward to that you almost forget some of the drawbacks. VRI is and will be an awesome tool for the Deaf but it comes at a cost. Many would still prefer a live interpreter for their medical appointments. Its easier to communicate in person and there is never a worry about technical difficulties. Some find it harder to view the interpreter on a mobile device, (such as an iPad or monitor) and others just aren't comfortable with the technology. As the case with some of the larger national agencies, there tends to be a "Quantity over Quality" approach as many Deaf have recognized in parts of the VRS industry. The demand becomes too high and the overhead costs too much for these agencies to retain the best interpreters. The result is a, "warm body" in the seat approach to interpreting which dilutes the overall quality of service. In short, accepting VRI over a live interpreter could be subtraction by addition, especially if agencies use the same business model as some VRS companies.
The Client Perspective
The clients are those who pay for the interpreting services. I haven't met a client yet that loved the cost of interpreting services and just like any good business, most are trying to find quality services at a lower price. VRI will be intriguing because it seems to be a great deal. The concept is to pay for what you use and since there isn't any travel time then in theory, it will cost less. Clients are quoted prices ranging from $1.25 - $4.00/per minute, (admittedly higher or lower as I don't know everyone's rates) and if we used a $2.00/min average, an appointment lasting 15 minutes should cost $30. Granted, most agencies have a minimum of 15-30 mins per request but even paying for VRI for 30 mins is considerably less expensive than paying for a live interpreter. Depending on your city, live interpreting rates vary considerably. If we look at Austin, TX as an example, live interpreting rates range between $75-$140 for a 1 hour appointment, (M-F 8-7pm) and those rates depend on the agency. It is clear that the cost of VRI is less so it is attractive to any medical facility trying to lower costs. So long as the client is in compliance with ADA laws and a certified VRI interpreter is used, they have met their legal obligation to provide a solution for effective communication, (in most cases.) At the end of the day, that should be enough reason for clients to examine VRI services to see if its a good fit for their needs.
There are some concerns about VRI that the client would want to consider before making the switch. The first concern would be the ability to adhere to the ADA requirements of VRI by providing a clear video and audio connection. The Internet connection and the staff's ability to troubleshoot any problems is first on the list. If a connection fails for whatever reason, will the doctor be responsible and willing to be trained to find a solution? Although many agencies provide a simple platform to host the VRI appointments, the overall success will depend on the client's ability to maintain proper internet connection speeds and on the spot diagnostics. Another concern is the check-in and discharge of Deaf patients. Does the clock start the moment the doctor enters the room and ends when they leave? The appointment starts when the Deaf patient checks in at the front desk and continues into the waiting room when their name is called and it carries into the initial nurse vitals check. At that point, it is normal to wait on the doctor for a few minutes before the patient is seen. After the visit, there are often nurse instructions and the patient scheduling future appointments then check out. Estimating the total appointment time with the meter running can make the cost about the same, if not more. So again, the client must weigh the pros and cons to see if VRI is the right solution for their office.
The Agency Perspective
As the owner of 3 Bridges SLS here in Austin, I can only share my perspective and in no way do I claim to know the right answers. Each agency has their own business model that works for them and I strongly support the work and effort they all put in to provide great services for their clients and consumers. A majority of agencies provide some kind of VRI service and that number is growing. The traditional business model of agencies has worked for decades with recruiting interpreters, scheduling assignments and invoicing for services. In business, to adapt is to survive and as technology becomes more prevalent in our profession, we have to embrace the changes and work for the interests of our clients, consumers AND the interpreters.
I believe we will see VRI implemented on a large scale in the coming years. The profession is changing and as a result, agencies are adapting to catch up with the demand. This means agencies have and or will be developing new business models that focuses on VRI as primary and live interpreting as secondary sources of assignments, (revenue.) The larger national agencies have an advantage due to their marketing resources and larger pool of interpreters, while an advantage for smaller local agencies is that VRI costs should be lower due to the difference in overhead. In this respect, both national and local agencies can and should co-exist but the role of the interpreter will change.
The Interpreter Perspective
Near and dear to my heart, the interpreter perspective… Where will VRI take the interpreting profession? As interpreting agencies and medical providers set the new standards and rates for VRI services, is the interpreter the "loser" in the deal? Its ugly to pose the question because VRI is a great tool for the Deaf, affordable for clients, and profitable for agencies but it comes at a real cost. As agencies rush to develop contracts for VRI services with large medical facilities, they are trading the traditional live interpreting jobs into less expensive VRI assignments. Its almost the same concept of outsourcing jobs overseas. Interpreters will lose these jobs to other interpreters who will accept less. This is the savings and profit, passed on to the client and agency while the earning capacity of interpreters drops significantly. For example, if 1,000 assignments are switched from live interpreting to VRI, what would be the financial impact for just one interpreter? The agencies have found a way to maintain profit, provide a savings to the client, and comply with ADA laws all while convincing interpreters that this pay cut is a good thing.
How is VRI a “good thing” for interpreters? Some LOVE doing VRI work because they can stay home and not have to travel all over town. They are compensated at a set rate and it works well for them, usually so long as they have another source of income, (community, educational or VRS work.) VRI is considered a secondary income for some interpreters in the industry. My question is not necessary concerning the immediate impact that VRI will have on the industry but rather the long-term consequences. Older, experienced interpreters could see a drastic reduction of their yearly earnings if VRI replaces live interpreting. Whereas an interpreting veteran might have an earning capacity of $60k+ under the current pay structure, how many VRI assignments must be completed to reach the same pay rate? Is it possible that these interpreting experts will be “weeded out” and replaced with more affordable options? Then the question remains, what will happen to the quality of our service if we lose our best interpreters? If VRI is not able to sustain the higher-level professionals, our industry might have a bleak future.
A Final Word
As a business owner, I understand the need to find services at a lower cost. I manage an interpreting agency so I can appreciate the pressure to provide cost effective solutions to our clients. My family is Deaf so I have great respect for maintaining the highest quality of interpreting services. Also, I am an interpreter with concerns about the future of our profession.
The common goals of the above 4 perspectives are somewhat different, and as we embrace this newer model of interpreting, I hope we all take a moment to look before we leap.
3 Bridges Sign Language Services, LLC