The Queen’s Health Systems Brings Care Home with Telehealth and Language Access

The broad-based ExtendedCare and Cloudbreak partnership has helped the Hawaiian health system better serve its patients.

The Queen's Health System

The Queen’s Health Systems has a long history rooted in their community, with the system’s first hospital founded in 1859 by Queen Emma and King Kamehameha IV. Now, Queen’s has operated for more than 160 years as an intrinsic part of Hawaii’s culture.

The health system includes a total of four hospitals and 70 healthcare centers and labs throughout the region. Queen’s commitment to their mission – as embodied in “The Queen Emma Way”– is evident in the team’s patient-first mindset. In 2019, Queen’s ranked as one of the nation’s best hospitals according to Newsweek.



Overcoming a unique population in a unique location to deliver exceptional care.

Geography poses a difficult challenge for The Queen’s Health Systems. Located on an island state far from the mainland, patients sometimes need to catch a plane to see their primary care physician. Distribution of resources across the islands is one of the system’s chief concerns. “About 97% of all specialty providers live in Honolulu, whereas we have 7 islands we need to provide care to,” said Burke Holbrook, Clinical Operations Manager of Telemedicine for The Queen’s Health Systems. “That makes providing specialty services extremely difficult. The rest of the country has a primary care and doctor shortage overall, but it’s especially accentuated here on the island and having to deliver care to our dispersed population.”

Additionally, Queen’s unique patient population vastly differs from the rest of the United States, with language requirements difficult for mainland-based partners to meet. “We have counterparts in California, and something like 80% of their calls require a Spanish interpreter, one of those common languages. One of our most common languages is Chuukese. We have consulates from many countries here in Honolulu, we have large populations from cultures that don’t speak any English and having medical interpretation services is really a requirement for us,” explained Holbrook.

The COVID-19 pandemic brought even more limitations to the system’s already challenging care environment. Not only did the pandemic make the hospital system even more difficult to reach for geographically dispersed patients, but it affected patient morale as well. Restrictions in travel further isolated communities, while on-site visitation restrictions in care facilities isolated patients. “When Covid 19 struck, no visitors were permitted,” said Wanda Sharp, Queen’s Director for Patient Relations and Patient Experience. “We knew that this would further isolate our patients from their loved ones.”

Queen’s, along with the rest of the nation, faced financial loss as visits slowed, or in some departments came to a full stop. How would the system remotely deliver the same kind of onsite-quality care to a community spread across the islands? How could they return to business as usual, when absolutely nothing was usual?



Combining existing platforms to create an interoperable and equitable solution.

Queen’s digital strategy already leveraged telehealth built on the ExtendedCare platform. They were also already utilizing Cloudbreak’s Martti across the system in a number of departments. When COVID hit, the language access solution was integral to keeping the hospital ahead of the curve. “The minute we started treating COVID-19 patients, we knew that Martti was going to be able to help us do that in some form or fashion,” said Sharp. But seamless language access integration was still missing for their unique patient population.

“Before we integrated Martti with ExtendedCare, if the doctor wanted a medical interpreter, you’d have to go and get an iPad, and then have a three-way conversation with the interpreter, the provider that’s on the computer, and then the patient and the providers that were in the room,” said Holbrook. “We knew that needed to be addressed. So we asked Martti and ExtendedCare to integrate and provide a simple solution where we could invite a Martti Interpreter directly into the ExtendedCare telehealth visit.”

That integration was leveraged on ExtendedCare’s platform, with a deep Cisco-Webex integration that didn’t disrupt Queen’s level of care or existing workflows. The result was a combined, easy-to-use telehealth solution that included 24/7 access to more than 250 languages. The integration came just in time, as the health system kept pace with an increasing demand for virtual care that suddenly required more robust platform support.

“Before the pandemic, we were only seeing about 200 virtual patient visits a month, and growing. When the pandemic hit, we skyrocketed, and today we’re doing about 13,000 visits a month. We’ve grown in tremendous amounts, we’ve learned a lot,” reflected Holbrook.

Departments utilizing ExtendedCare Telehealth™

Cloudbreak Martti carts deployed at Queen’s

Minutes of interpretation at Queen’s in 2020

Coverage of 4 hospitals + 70 clinics and labs

Quote icon

Quote StartWe are thrilled about this partnership. With a system as diverse as ours, having language access available at every point of care truly enhances the patient experience. The integration of Martti into the ExtendedCare interface improves our patient/provider communication and fully integrates with our existing workflows.Quote End

Matthew A. Koenig, M.D., Medical Director, Telemedicine, Neurocritical Care Neurology


Increased impact and expanded reach have helped The Queen’s Health Systems overcome disparities in care.

ResultsBy leveraging their deep integration with ExtendedCare and adding language services with Cloudbreak’s Martti, Queen’s reached more patients than ever via telehealth. As telehealth platform usage skyrocketed, so too did the need for equitable care with qualified medical interpretation. Queen’s saw a 9% increase in language services usage in 2020 over the previous year, despite an initial decrease in visits. They totaled more than 280,000 minutes of interpretation in 2020.

Increased telehealth platform usage allows Queen’s to connect patients, providers, friends, and family over any distance, with ExtendedCare’s multiparty calling options. “I think that the multi-party invites are really helpful,” said Brendan Fitzgibbons, the Telehealth Clinical Trainer for The Queen’s Health Systems. “The ability to instantly add people into this virtual care room is something that a lot of providers have voiced enthusiasm for. Anyone can receive a link and join the telehealth call. We see a lot of requests to add friends and family members into a video visit, so that’s been really nice.”

The ExtendedCare and Martti integration has supported massively increased telehealth traffic. Today, the Queen’s team is seeing that impact and anticipating how the technology will advance future digital strategy for
the patient experience.

“We’re happy with how the integrated solution has performed. In the near future, we’re hoping to expand ExtendedCare to be the main video platform for communicating with all of our hospitals and clinics,” said Holbrook. “This way, we can maintain and utilize the Martti integration on all of those virtual visits.”

Queen’s requested language services in more than 66 languages in 2020

Increase in language access usage from 2019 to 2020

Telehealth usage increased from 200 visits a month to 13,000 during the pandemic


Leverage leadership buy-in to build a successful digital care strategy

The Queen’s dedication to delivering quality care is a tangible part of their culture and decision-making. The ExtendedCare/Martti integration has not only answered the hospital’s immediate need, it has helped Queen’s reach their mission-driven goals. “It’s part of our mission at Queen’s, called Kina’ole, to provide the right care, at the right place, at the right time,” said Holbrook. “In my mind that’s what telemedicine is doing. I think that’s where telemedicine is helping close the gap.”

What has made the program so successful? “At Queen’s, I think having clinical and information technology relationships is huge. Getting buy-in from both your clinical leadership as well as your information technology
leadership has made my job so much easier. Those relationships are huge,” said Fitzgibbons.

Burke Holbrook added, “Anyone developing a new program or technology is going to have a lot of challenges. You often need to change tactics and collaborate with other team members and vendors to bend and mold your technology.” Holbrook’s most important takeaway from the integration? “When the efforts and vision of your team and vendors are aligned, anything is possible. The Queen’s Health System’s telehealth program and ultimately the care of our patients is finding tremendous benefits from these efforts. Such alliances continue to help promote and attain Queen’s Mission; to provide in perpetuity quality health care services to improve the well-being of Native Hawaiians and all of the people of Hawaii.”

High-Impact Telehealth

Growth at Queen’s over recent 6-month period

Average video visits per day

Clinicians using ExtendedCare

Departments using ExtendedCare

The integration between ExtendedCare’s Telehealth™ platform and Cloudbreak’s video remote interpretation provides patients and clinicians with seamless communication regardless of language.