Every physician or clinical medical student has interacted with a patient who doesn’t speak their language. Frequently, interpreters need to be called for emergency department or inpatient encounters or outpatient clinic visits, and the delays can be frustrating and even hazardous to patient care.

Families of patients are often used by healthcare providers, but there are situations where using family members to translate may not represent an ideal choice – family doesn’t speak the provider’s language, no family present, delivering bad news to a patient, or emotionally difficult decisions.

Here we review the Xprompt multilingual assistance app from Blue Owl Software, a promising program that seeks to overcome the language barrier so often present in the healthcare setting.

Blue Owl Software, the developer of Xprompt, is a Massachusetts-based enterprise. This young company, founded in 2008 by Guenther Haeussermann, has, in collaboration with Project Management Associates, put together “successful integration solutions” for the following clients: US Army, First Energy, Aera Energy, New Brunswick Power and Nebraska Public Power District. Blue Owl boasts Xprompt as its first iPhone/iPod Touch application. In attesting to the quality of their product, Blue Owl claims the development of Xprompt represents an international project in which “130 people from 50 countries have collaborated and continue to support Xprompt with their competence.” All of these collaborators, Blue Owl affirms, have a medical education.

As for the app itself, the home screen (shown above) presents the languages offered (here, the 3 languages that come pre-installed with the app), along with the white bubble to download more languages. Each language pack contains approximately 800 medically-themed phrases, and any two languages offered can be combined.

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From this home screen, users can assign languages to the “Care Staff” (represented by a stethoscope icon on the title bar) and to the “Patient” (represented by a Band-Aid icon on the title bar). Again, any two languages offered by Xprompt can be combined in this manner. After choosing the two languages to be combined, the healthcare provider can choose from a menu of seven categories (shown above) that include gestures, medical history, exams and procedures, care routines, supporting communication, instructions, and a general dictionary.

Through the different category screens (each category features well-organized sections to help hone in on a desired phrase), a phrase can be selected, which is then shown in the patient’s chosen language on the screen in large text, and also spoken in the patient’s language through the iPhone audio (shown below). Of note, there are two sign languages offered (British and German), for which video sequences (as opposed to audio outputs) are played. At the phrase bubble screen (shown below), 3 buttons are presented: one to re-play the phrase audio, one to mark the phrase as a favorite, and one to exit the phrase screen.

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At any point, the program can be quickly “reversed” by clicking on the patient box, and patients, from their languages, can select any phrase to be conveyed in the care staff’s selected language (shown below). Of note, the patient’s menu features somewhat different categories from the care staff’s: gestures, my answers, my questions, my needs, my complaints, manners, and the general dictionary. It quickly becomes clear that the Xprompt app can facilitate an interactive dialogue between the care staff and patient in this manner.

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As an alternative to using the menu of categories to find a phrase, a search function (opened by clicking on the magnifying glass icon on the title bar) allows for quick finding of specific questions/phrases (shown below).

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In summary, having done my clinical rotations in the ethnically diverse city of Saint Louis – some might find this diversity surprising – I quickly grasped the potential utility of this tool: I’ve had a number of patients that didn’t speak English. Often we’d enlist the help of family members, but there were cases when either the family members didn’t speak English well, or no family members were present. In these cases, calling and scheduling interpreters sometimes delayed healthcare, and having a tool like Xprompt handy could have facilitated taking a solid history from the patient and/or family, conducting physical exam maneuvers, and helping to explain what diagnostics or treatments could be offered.

As I had no German- or Spanish-speaking patients on my service this past week, several of my Spanish-speaking colleagues and I tried this tool out on each other for hypothetical patient encounters. We found the English-Spanish (and vice versa) translations to be pretty accurate, and almost everything we wanted to express in these situations was covered by the phrases offered in the app.

Pricing: Xprompt multilingual assistance is $6.99, with 3 languages (English, German, and Spanish) pre-installed. Approximately 20 more languages are available for purchase for $2.99 each from within the app (as shown below).

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Likes:

*Easy-to-use interface that is quick to master via well-organized categories and sections (with a search function to boot)

*Strong variety of “high-yield” medical phrases

*Any two languages offered can be combined

*Infinitely useful for foreign travelers

Dislikes/Future Updates I’d Love to See:

*Pricing – it would be nice if the basic purchase included all the offered languages, instead of paying an extra $2.99 for each language downloaded

*800 phrases in each language pack is terrific, but even more would be welcome

*Waiting for more languages to be offered (several are already in the works); for example, having Bosnian offered would be very useful in Saint Louis!

Conclusion:

The Xprompt Multilingual Assistance app represents a promising tool for clinicians working at medical centers or in practices where they often see non-English-speaking individuals. In these settings, this app has tremendous clinical utility to facilitate an interactive dialogue and maximize the healthcare provider-patient relationship.

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