Translating written medical documents, much like providing interpretation services, is a necessary step healthcare orgs must take to communicate effectively with their limited English proficient (LEP) patients.
Not only is it necessary from a communication standpoint, but it’s also the law.
Under Title VI of the Civil Rights Act, if federally funded healthcare entities provide vital documents in English, they must also translate those same vital documents into other languages, too.
Now, we know what you’re thinking: You likely have hundreds of documents and thousands of web pages written in English. Do you have to translate all of those into all the languages your patient population speaks?
Probably not. And we’ll walk you through why. We’ll cover what constitutes a “vital document,” how to determine which documents are vital and which aren’t, and how to identify what languages you need to translate vital documents into.
Let’s get started.
What are vital documents?
If you’re anything like us, you like a rule with no gray area. A rule that explains exactly what you need to do. A rule that delineates exactly what is and what is not considered a vital document . . .
Unfortunately for us, the U.S. Department of Health and Human Services (HSS), Office for Civil Rights, purposely left this term open for interpretation:
“Vital documents” are generally documents that affect access to, retention in, or termination or exclusion from a recipient’s program services or benefits.
We get it, though. Not all covered programs are the same; each has their own needs and individual considerations, so it makes sense that the guidance is flexible.
While there are some documents that you’ll always want to translate (see the list below), others will fall into that blurry “do we or don’t we” category.
If you’re looking for a little more guidance, HSS developed a helpful workflow to determine whether a document is vital or not:
- Could a member of the public access or participate in this program, service, or activity if they are unable to complete and/or understand the information in this document?
- No? It’s vital
- Yes? Move to the next question
- Could a member of the public be terminated from this program, service, or activity if they are unable to complete and/or understand the information in this document?
- Yes? It’s vital
- No? Move to the next question
- Could a member of the public suffer significant financial, physical, or other harm if they are unable to complete and/or understand the information in this document?
- Yes? It’s vital
- No? The document is likely not vital
Examples of vital medical documents
Certain documents will always be vital because they’re considered critical to accessing the service. Here are a few of those:
- Consent forms
- Privacy and security practices
- Visitation rights and responsibilities
- Information pertaining to financial responsibility and assistance (policies, applications, etc.)
- Notices advising of free language assistance services
- After-visit summaries and patient instructions
- Eligibility or participation criteria
- Patient information forms and questionnaires
This isn’t, by any means, an exhaustive list, but it will give you an excellent place to start.
Related: Community-Oriented Strategies that Can Help Deliver Effective Communication and Language Access
The languages you’ll need to provide written translations for
Title VI states that a covered entity needs to take reasonable steps to provide written translations in the “most frequently encountered languages.”
If you’re unsure what those languages are, you may have to do a self-assessment, a little research, and some data collection.
The work won’t be for naught, though. Not only will you get to know your patient population better, but you’ll also be able to build and structure your programs around their needs to better serve everyone.
To determine what languages you need to provide language assistance in (and written translations specifically), work your way through the four-factor analysis found in the Final Guidance:
- Find out the number of LEP individuals you could serve in your organization or program.
If you don’t already collect this data, start with the Census. You can also look at the Civil Rights Data Collection bank maintained by the U.S. Department of Education, and connect with community leaders and organizations in your area.
- Understand how and when LEP individuals use or come in contact with your services.
Because your patient population could contact you in a number of ways — over the phone, in person, online, etc. — make sure you’re collecting primary language data at multiple touchpoints. The more frequently a specific language group contacts or interacts with your program, the higher the chances you’ll need to support that language with translated documentation.
- Determine the importance of your service to your patient population.
Considering both the urgency and importance of your program will help you decide the type and timing of the language services you offer.
Examples:
- A patient needing life-saving surgery (urgent and important; language services will be needed immediately).
- Obtaining informed consent for non-life-threatening elective surgery (important but not urgent; language services will be needed but not immediately).
- Community members are taking a tour of your facility (not important or urgent; it’s likely language services are not needed).
- Know your available resources and the associated costs to help your LEP patients.
Not all programs, activities, and services are built the same. Some institutions will serve a greater number of LEP individuals than others, and larger institutions will have higher budgets than smaller ones. Therefore, you’ll need to consider your resources in relation to their cost. You, most likely, won’t be able to translate every document into every language, and that’s OK. At a certain point, the cost of translating a document could outweigh the benefit the community might receive from that resource.
Federal guidelines also established a safe harbor threshold that helps covered entities pinpoint what languages to translate documents into.
Safe Harbor
The safe harbor provision was created for those organizations that would like greater certainty that they’re in compliance with their written translation obligations under Title VI.
It’s not a requirement to follow safe harbor, and not doing so does not mean you aren’t in compliance. It’s simply another way to ensure you’re meeting the needs of your LEP population.
Safe harbor states that organization need to provide:
- Translated documents, including vital documents, to ten percent of the eligible population or 3,000 clients, whichever is less; and
- Translated documents, at minimum vital documents, to five percent of the eligible population or 1,000 clients, whichever is less.
To translate or not to translate
While the guidance above is helpful, it’s still not foolproof. And the decision to categorize a document as vital or not shouldn’t be made in a silo.
Before you start working with a document translations partner, bring all your findings and recommendations to your leadership team. They can help analyze the data, narrow down your document list, and solidify your top languages.
Above all else, know that this process isn’t finite. You’ll need to monitor progress regularly, and come up with your own process (with the help of leadership!) on how and when to translate new documentation.
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