E-Learning Products Help Providers Improve Their Medical Bilingual Proficiency

Patients with limited English proficiency (LEP) tend to experience lower quality of care and worse outcomes. Language barriers contribute to poor communication and can impair patients' ability to access healthcare, understand diagnoses, adhere to treatment, and arrange follow-up treatment. In this Q&A, Bill Tan, founder of Transcendent Endeavors, discusses the development of Canopy e-learning products through an NIMHD Small Business Innovation Research (SBIR) grant. These products help close the communication gap between providers and patients who have LEP and help providers improve their medical bilingual proficiency.

What did you do prior to starting Transcendent Endeavors?

I essentially started the company right after college. After a very brief time working at a large IT consulting firm (Accenture), I became ever more convinced that my passion was in entrepreneurship and in creating social ventures that tackled health disparity issues. When I was still in college, at the Stern School of Business at New York University, I was elected president of the Entrepreneurs Club and got to know a lot of aspiring as well as accomplished entrepreneurs. As for academic affiliations, I had an appointment as adjunct assistant professor of medicine at New York University School of Medicine, and I served on the External Advisory Board for the Center for Advanced Information Management at Columbia University. Transcendent Endeavors is structured as a venture studio where we build solutions and companies to solve tough problems. Canopy is one of our successes and specifically focuses on the multilingual communication space. As our work began to gain more attention, I was named one of Crain's 40 Under 40 Rising Stars and was named by former mayor Michael Bloomberg as an NYC Venture Fellow. The accomplishment I am most proud of is serving as the Principal Investigator on several NIH SBIR grants, as those experiences truly informed our work and were directly responsible for the innovative products we have developed.

What was your intent in creating Canopy?

The Causes of Asian American Mortality Understood by Socioeconomic Status (CAUSES) Study has three specific aims: There are currently more than 26 million individuals in the United States who have LEP—a number that has grown from 20 million in the past decade. Despite this ever more pronounced demographic shift, the healthcare system has remained woefully unequipped to manage their encounters with LEP patients. The process of accessing telephone or staff interpreters is costly and cumbersome. As a result, providers are frustrated by the status quo and often go without language assistance for routine conversations or must rely on patients' family members—many of whom are children, as they are more likely to be bilingual. This practice is not just a safety issue; it's also a violation of Title VI of the Civil Rights Act of 1964, which prohibits discrimination based on national origin. In 2000, the Office of Civil Rights, which is part of the Department of Health and Human Services, issued a mandate requiring that any entities receiving federal funding “must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/customer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.”

In order to move away from the current state of inadequate language assistance to the inspiring vision set forth by this mandate, there is an enormous need for better tools that can benefit patients, clinicians, and the institutions that serve them. Our vision is to create a comprehensive array of tools that are simple to use, cost-effective to deploy, relevant to specific points of contact across the continuum of care, and scalable to multiple languages.

How are Canopy products helping to improve minority health and reduce health disparities?

The LEP population has increased 30 percent over the past 10 years and accounts for more than 10 percent of the population in nine states. LEP patients are one of the most vulnerable populations with respect to healthcare, as they are often immigrants who are uninsured/underinsured or lack the knowledge to seek social and medical services. LEP status has been correlated with a number of negative health outcomes, including greater likelihood of hospital admission, re-admission, increased time spent in the emergency room, misdiagnosis, incorrect treatment, drug complications, lengthened stay for certain medical and surgical conditions, and limited access to preventive screenings. LEP individuals are also less likely to have a regular healthcare provider and tend to rely on the emergency department for care, where they often undergo more diagnostic tests than English-proficient patients, resulting in greater costs for the facilities that treat them. After discharge, LEP persons have difficulty following medical advice and medication instructions and receive little, if any, follow-up support. The language barrier and associated miscommunication in the clinical setting therefore directly contribute to persistent health disparities for these populations. Without a cohesive solution, LEP patients will continue to receive substandard care.

In light of these issues, we are developing the most comprehensive set of language assistance solutions for healthcare. Canopy's language training products increase the number of bilingual healthcare providers. These providers are able to engage in more accurate communication with patients in their own language, contributing to better understanding of care, improved adherence to treatment plans, improved throughput in healthcare settings, and improved patient satisfaction.

The Canopy Medical Translator enables healthcare providers to quickly and reliably access telephone interpreters when needed. In cases when telephone interpreters are not available or the nature of the interaction is routine, providers can access a library of thousands of pre-translated medical phrases in 15 languages, covering a broad spectrum of topics such as physical exams, patient histories, and laboratory results. The on-demand availability of the Canopy Medical Translator app encourages clinicians to provide assisted communication to a greater percentage of patients who need it, and its low-cost nature enables hospitals to conserve their language interpretation dollars for more complex situations that truly require a live interpreter.

How were the SBIR grant funds applied to develop Canopy products?

The grant funding has allowed us to take a systematic approach to product development, which in our case involves significant levels of content development and software engineering. We began with Canopy's e-learning products, designed to help providers improve their medical bilingual proficiency, including the Canopy Medical Spanish Training system, which is now the number one product of its type in the U.S., and Canopy Healthcare English Training System, which has appeals beyond the U.S., as the interest for learning medical English is high in many overseas markets. SBIR funding then enabled us to expand the product lines to real-time clinical interpretation in the form of the Canopy Medical Translator, which consists of 4,000 frequently used medical phrases available in 15 languages that can be accessed via a mobile app immediately at point of care. When a conversation becomes more complex or nuanced, a provider can dial a live medical interpreter directly from a one-touch button that is present on all screens. Because of its gateway function to medical interpretation services, the Canopy app has been dubbed “the Uber for language services.”

What was your experience going through the SBIR program?

We've found that the structure of the SBIR program—starting with proving feasibility in Phase I, moving on to full-scale research and development in Phase II, and finally commercialization in Phase III—provides an efficient framework for managing the otherwise chaotic and haphazard innovation process.

What was the process for developing Canopy products?

We have honed a proprietary product development process over the years that we call VIP, named after its three core components of Vision, Implementation, and Progress. A key aspect of the process is listening intently to our end users, using a framework called Jobs To Be Done. For Canopy Medical Translator, our team assembled a task force of physicians, nurses, residents, and medical students to create the initial medical content and taxonomy within the database. This content was cross-checked and verified by multiple healthcare providers and then translated by qualified medical translators. In order to ensure their needs are met, we also organize stakeholder interviews and in situ observation of providers and patients engaged in communication. At the same time, our development team of software engineers and product managers built the systems that could deliver this content seamlessly into the workflows of healthcare providers. Iterative versions of the product were released for user testing.

How long did it take to develop Canopy products?

It took two years to develop Canopy's language learning products, and it took one year to develop Canopy Medical Translator. These products are continuously being augmented with additional language versions and content modules, as well as updated technical capabilities.

How has participating in the SBIR program impacted your company?

The SBIR program has been a tremendous source of support for our company. It has given us the ability to recruit a group of like-minded colleagues, with whom we began looking into the various methods by which language assistance was provided at hospitals and other settings. We arrived at the conclusion that there was a tremendous unmet market need and a thirst among individual providers for much better tools that would be accessible on-demand, cost-effective, and aligned with their workflow and expectation with technologies. By bringing together a team of motivated individuals with expertise in linguistics, cross-cultural communication, information technology, and healthcare delivery and administration, we can move the needle on language assistance services. The SBIR program's financial support has allowed us to make a full-time commitment to pursuing this vision and to recruit the necessary talent along the way.

Do you have any advice for potential applicants to the SBIR program?

Our success with the SBIR program has taught us several valuable lessons that we consistently apply to our products. The first is to think about commercialization early on—even in Phase I. It's never too early to start working with community and commercial partners to conduct pilots, validate product–market fit, and explore different pricing options. Second, we have learned it is critical to focus on more than evaluating an innovation's efficacy within the context of a pilot; one must also examine its adoptability and longer-term sustainability in the real world. Finally, it's important to understand users' existing habits around the issues we're trying to address and the behavior modifications necessary for adopting a new product or service.

What types of customers use Canopy products?

Any healthcare provider who delivers care to LEP patients can use Canopy's products. They include physicians, nurses, physician assistants, medical techs, medical students, residents, nursing students, physician assistant students, nurse practitioners, and more. What excites us most is that the next generation of medical practitioners—students who are pursuing education and training in healthcare—are among the most enthusiast users of our products.

What future plans do you have for Canopy?

We plan to release a mobile companion app to the Canopy Medical Spanish Training System, giving our users the ability to learn on the go and a gamified experience to practice speaking the target language. We are in the process of obtaining accredited credentials for the summative proficiency exam that is part of the e-learning system, so that our users will receive not only a certificate of completion and continuing education credits for their efforts but also an accredited certificate of medical language proficiency. One of our future product rollouts may be an analytics and reporting dashboard for healthcare administrators and clinicians, giving them critical access to utilization data and insights about their hospital's deployment of language assistance services and the ways in which such deployments can be improved to benefit their non–English-speaking patients. That dashboard would be a culmination of the various tools we have been developing to address specific points of contact in the care-delivery continuum.

For more information about the SBIR program, contact Dr. Derrick Tabor or Mr. Vincent Thomas.

Gerda Gallop-Goodman, posted 05/12/2016