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Development of an Automated Language Interpreting Tool
for Hispanic Mental Health Patients
The Way Forward:Advancing Mental Health Equity in California
March 30, 2017
Behavioral Health Center for Excellence
Colaborators
• Steven Chan• Alberto Odor• Alvaro Gonzalez• Andrés Sciolla• Glen Xiong• Michelle Burke Parish• Shang Wei• Ana-Maria Iosif• Peter Yellowlees (PI)
Support / Grants
• Blue Shield of California• Virtual Collaborative
Health Network• Behavioral Health Center
for Excellence• AHRQ – 2 R01 Grants
Behavioral Health Center for Excellence
Research• 2006 – 2020
• Transcultural Telepsychiatry Across Language Barriers (AHRQ – R01)
• 2013 – 2020• Automated Translation System for Transcultural Telepsychiatry (AHRQ - RO1)
• 2017 –• Automated Facial Expression Recognition in Telepsychiatry (Pilot)
• 2017 –• Augmented Reality to Show Visual and Auditory Hallucinations to Non-Psychotics
• Need to buy some FTE
Behavioral Health Center for Excellence
The Problem
4.7%of the population(over 5 years of age)had limited English-speaking abilities.
This is nearly the size of Illinois.
Behavioral Health Center for Excellence
The Problem
79%16%
3%2%
21%
English only English OK + Other
English "not well" + Other English "not at all" + Other
2010 U.S. CensusLanguage Use
Behavioral Health Center for Excellence
The Problem
Sacramento County languages
90+non-English languages, like
SpanishMiaoChineseVietnameseTagalog
RussianUkrainianHindiGermanHmong
Behavioral Health Center for Excellence
Old Practice
Patient
Provider
Ad hoc
Behavioral Health Center for Excellence
Current PracticePatient
Provider
Behavioral Health Center for Excellence
Current Practice
Patient
Provider
Live interpreter
Behavioral Health Center for Excellence
Current Practice Problem:
•Unfunded mandate.
•Additional $30 - $50/hour
•Most private insurers do not reimburse interpretation. Except in
California. (Wilson 2013, Guntzel 2012)
•35% difference in interpreter salary
Money, Time Quality
Behavioral Health Center for Excellence
Current Practice Problem
Money, Time, Quality
• Increased encounter time by 57% (live vs phone interpreters) (Locatis 2010).
•Travel time delays (Masland 2010)
•Perceived time constraints (Diamond 2009)
Behavioral Health Center for Excellence
Current Practice Problem
Money, Time, Quality
• Health systems determine what’s “reasonable” for quality of language interpretation (The Joint Commission, 2010)
• Hospitals often don’t test staff competency, utilization, or effectiveness of interpreting services(Tschurtz et al., 2011)
• Only 100 of 3,500 medical interpreters in Oregon have proper qualifications (Foden-Vencil, 2014)
Behavioral Health Center for Excellence
Current Solutions
Live interpretersPhone interpretersVideoconferencing interpreters
• Little information about accuracy of live interpretation
• Individual variabilities
• Hypothesis: Machine translation has similar levels of accuracy in a clinical setting.
Behavioral Health Center for Excellence
Ultimate Goal
• Analyze language as data.
• Create new clinical processes for in-person
care and telemedicine.
• Create a better standard of care with
improved interpreting, more efficiently, and
less expensively.
Behavioral Health Center for Excellence
Asynchronous S&F Telepsychiatry Workflow
History (10 years ago)
Visalia
Tulare
History (10 years ago)
Behavioral Health Center for Excellence
Current State of Automated Translation
Behavioral Health Center for Excellence
SDKs Assessment
Se
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wit
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ns
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pti
on
Tra
ns
lati
on
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nd
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str
ea
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ga
ud
io
Un
de
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nd
s
me
dic
al
term
ino
log
y
Co
ns
um
er
ap
p
ava
ila
ble
to
de
mo
?
Google Translate SaaS API ✓ – – ✓ ✓ ? ✓ ? Android, iOS
Nuance online SaaS API ✓
Nuance Dragon NaturallySpeaking SDK
Client DSClocal software –
✓—
local✓ – – ✓
Nuance Dragon NaturallySpeaking SDK
Server DSSWindows local ✓ ✓— ✓ – ✓ – ?
Nuance Dragon Dictate local software –✓—
local✓ ✓
Nuance 360 SaaS API ✓ ✓ – ✓ ✓ third-party apps
Nuance NDEV SaaS API ✓ – ✓ – ✓ Android, iOS
Mac OS X
Client & Apple-
operated
servers✓ – ✓ – – ✓
Microsoft Bing Voice Recognition &
Microsoft Translator on AzureSaaS API ✓ ✓ ✓ ✓ ✓
Windows Phone, web
translation
IBM BlueMix SaaS API –✓ English
only✓ ✓ – web translation
SRIlocal & client-
server✓ ✓ ✓ ✓ ✓ –
SysTran 7 Business Translatorlocal, server, &
SaaS✓ ✓ – ✓ N/A ✓ iPhone, web
Behavioral Health Center for Excellence
Transcripts
Target
language (HUMAN)
Original
language
Target
language (COMPUTER)
Behavioral Health Center for Excellence
Error Types
omission, in which the interpreter (human or machine) did not interpret a word/phrase uttered;
addition, in which the interpreter added a word/phrase not uttered by the patient;
substitution, in which the interpreter substituted a word/phrase for a different word/phrase; and
false fluency, in which the interpreter used an incorrect word/phrase that does not exist in that particular language
Behavioral Health Center for Excellence
Errors in a PTSD Transcript
Inte
rpre
ter
1
Aggregate counts Transl #Data types J L K M NGrand Totaltotal_added_word_count 2 11 1 0 1 15total_drastic_word_count 214 225 277 189 265 1170total_unusual_word_count 25 12 21 33 31 122total_word_count 1202 1303 1181 1189 1253 6128Grand Total 1443 1551 1480 1411 1550 7435
Aggregate counts Transl #Data types J L K M NGrand Totaltotal_added_word_count 4 3 0 6 2 15total_drastic_word_count 244 343 398 278 477 1740total_unusual_word_count 19 68 74 96 71 328total_word_count 1214 1305 1186 1192 1261 6158Grand Total 1481 1719 1658 1572 1811 8241
Inte
rpre
ter
2
Behavioral Health Center for Excellence
Automated Evaluation of Languages
BLEU (Bilingual Evaluation Understudy), an error-scoring algorithm that has found to have high correlation with human error quality with a score between 0 to 1.
Higher scores indicate a higher degree of similarity between human-translated and computer-translated texts.
The BLEU formula is the most widely used automated metric for testing MT apps.
Behavioral Health Center for Excellence
Implications
• Language apps can be incorporated in both asynchronous and synchronous telemedicine video encounters and workflows.
• Not all translation apps are alike: significant differences in the quality between apps.
• These apps are already being used in commercial industries to replace or augment language interpreters. Expect increased reliability and accuracy in the future.
Thank you