Opening the doorway to listen: Auto-captioning now available in Zoom for Healthcare virtual care appointments

Shae Chapman-Doucet, speech-language pathologist with Hearing and Speech Nova Scotia and Alyson Currie, clinical social worker, psychosocial oncology with the Nova Scotia Health Cancer Care Program.
Shae Chapman-Doucet, speech-language pathologist with Hearing and Speech Nova Scotia and Alyson Currie, clinical social worker, psychosocial oncology with the Nova Scotia Health Cancer Care Program.

The broad range of challenges brought on by the COVID-19 pandemic were significant for Nova Scotians, impacting each person and household differently. For some people who are d/Deaf*, hard of hearing, or those who've experienced hearing loss later in life, the impact of masking and the move to more virtual appointments took away significant access to communication. A solution was recently launched for Zoom for Healthcare virtual appointments that delivers improved service for those with lower access to sound and continues mitigating the risk of spreading the virus.

“For individuals with lower access to sound, speaking with someone who wears a mask takes away all the visual information from speech reading and some of the information available through facial expressions. Social distancing also creates challenges for people with lower hearing levels,” said Shae Chapman-Doucet, a speech-language pathologist with Hearing and Speech Nova Scotia.

Chapman-Doucet’s role is focused on aural rehabilitation, supporting communication and development for people with different levels of hearing. She is also part of the cochlear implant team where she works alongside a team of audiologists, communications disorders technicians and ear, nose and throat (ENT) surgeons. A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who has severe to profoundly low hearing levels. 

“Amid the pandemic, we tried lots of different strategies to better communicate with our clients. We used masks with transparent windows so that our clients could access more visual information from our faces, I would write a lot of things down in our sessions for my clients to read and we were also transitioning to start using virtual care,” explained Chapman-Doucet.

Virtual care encompasses any remote communication between patients and their circle of care. In Nova Scotia, health care providers can connect with patients remotely using approved virtual care technologies, one such example is Zoom for Healthcare (Zoom). Zoom is a web-based virtual care technology (video, audio and chat) that enables remote communication, including the secure sharing of personal health information during appointments, between patients and their circle of care from any location using internet or cellular connection. Nova Scotia Health Virtual Care Services from the organization’s Information Management & Technology (IM/IT) team have worked to onboard and train over 5,000 providers in the use of Zoom for Healthcare.

“Virtual care has many benefits for our clients in that they can save time on travel and there is no need for us to wear masks. One challenge that persisted in the beginning stages of our virtual care roll-out was the unpredictability of some people’s digital devices and set-up. Everyone has different access to quiet spaces, stable internet and speaker quality. This unpredictability mixed with the low hearing levels of our clients was still something we needed to find a solution for to improve the care we were providing.”

Nova Scotia Health Virtual Care Services enabled live closed captioning for all Zoom for Healthcare providers in September 2022. This new feature allows health care providers to display closed captioning in their virtual appointments, showing live subtitles embedded over video conferencing. This allows patients, clients and staff to easily follow the conversation by using the secure combination of video, sound and captions to drastically improve accessibility and quality of care.

Though the Nova Scotia Health Virtual Care Services team has launched live auto-captioning through Zoom for Healthcare, not all Nova Scotia Health virtual care technologies currently offer this capability. Learn more about the different types of virtual care available to Nova Scotians at nshealth.ca/virtualcare.

“Having the auto-captioning feature offers the visual access patients need to support the auditory access, giving our clients the best possible set-up to work with us virtually. This new feature has opened doorways and removed barriers for many of our clients, especially those who were apprehensive about virtual care because of their comfort level with technology,” explained Chapman-Doucet. “When I shared that closed captioning would be available and explained that they would be able to watch what I'm saying, listen and see my lips to speech read at the same time, they were more open to trying it. I’ve even had some clients who have started to prefer our virtual appointments over in-person ones.”

The new auto-captioning feature is further enabling Chapman-Doucet’s passion for supporting her clients to increase their access to communication. “Whether it be through language, visual or auditorily, we all have a right to access health care and our health information. It’s our responsibility as health care providers to improve that access and use the tools we have available to maximize the quality of our services,” said Chapman-Doucet.

The auto-captioning feature is available to all Zoom for Healthcare providers, not just those working in speech and language. It could be helpful for both patients and staff across the system, whether in mental health care, cancer care, neurology and beyond. The feature can also be beneficial for those who have difficulty understanding speech whether that be a result of hearing specific issues, neurological issues or auditory processing issues. Even for those with the ability to understand speech well closed captioning can be helpful in noisy environments.

Pat Joyce
 

When Chapman-Doucet reflects on how this new feature has made an impact on patient care, she is reminded of Pat Joyce, a patient of Alyson Currie, who is a clinical social worker, psychosocial oncology with the Nova Scotia Health Cancer Care Program.

Joyce loved good conversation, she could talk to anyone, about anything even despite living with severe deafness all her life. After her cancer diagnosis, Joyce navigated a complex health care journey to access the care she needed with support from her health care team and family. 

Joyce faced communication barriers daily but with determination, spirit, and a good sense of humour, she was not afraid to ask for any accommodation she needed. With her hearing aids, in a quiet room, with a speaker she knew (with visible lips for reading), she was able to communicate. 

Like many patients, COVID-19 created new barriers for Joyce - masks that blocked sound and lip reading, and appointments over the phone. Joyce relied on her essential care partners to relay information from her physicians, but it was far from the level of active participation she was looking for.  

Joyce and Currie took action to improve access to care for other patients, teaming up to advocate for a better solution and advising on the benefits that auto-captioning through video conferencing could bring to patients. They got in contact with Leslie Hill, Engagement, Diversity and Vulnerable Populations Lead in Cancer Care to get the ball rolling and the Virtual Care Team began a project with interested partners to test the new feature and to ensure clinicians were able to use it proficiently and safely before enabling it widely.

“From there, our small but mighty team came to fruition, from multiple departments and sites across Nova Scotia Health. I kept Pat updated on our progress and she volunteered to share her story as a way to advocate for the need,” shared Currie.

After exhibiting tremendous grit and determination through her treatment, Joyce’s illness advanced and she passed away in the summer of 2021.  “Pat’s family knows that she would be proud of the work to bring auto-captioning to Zoom for Healthcare,” shared Currie. “I think of her every time I turn on the captions. I thank Pat’s family for giving their blessing to have us share Pat’s story and contribution to this very meaningful change.”


* The terminology D/deaf is used as a collective noun to refer to both those “Deaf” people who identify with the Deaf culture and those “deaf” people who do not.

deaf
A medical/audiological term referring to those people who have little or no functional hearing (deaf, Deaf, and deafened). May also be used as a collective noun (“the deaf” or “small-d deaf”) to refer to people who are medically deaf but who do not necessarily identify with the Deaf community. In addition, children who are deaf are usually referred to as “deaf” because they may not yet have been socialized into either the Deaf or the non-Deaf culture. If they use Sign as their first language, they are referred to “Deaf”.

(“big-D”) Deaf

A sociological term referring to those individuals who are medically deaf or hard of hearing who identify with and participate in the culture, society, and language of Deaf people, which is based on Sign language. Their preferred mode of communication is Sign.

Reference: https://cad.ca/our-work/terminology/


About the Virtual Care Services team

Virtual Care Services is a Nova Scotia Health / IWK Health team that assists health care providers and patients in connecting through approved technologies. The team consults and collaborates across all specialties, clinical use cases, approved platform choices, and methods of delivery for virtual care supporting clinical adoption and quality standards.

If you are a health care provider and want to learn more about launching a virtual care service, please get in touch with our team by contacting virtualcare@nshealth.ca.

Learn more at nshealth.ca/virtualcare.