The 25 million individuals in the United States who speak English less than "very well" receive medical care that is worse by nearly every measure studied: worse comprehension and adherence, worse clinical outcomes, higher costs, and more frequent serious safety events. Language barriers affect care delivery through both spoken and written communication. While significant gains have been made in facilitating quick, reliable access to professional interpreters for spoken communication via video and telephone, strategies to provide safe and accurate real-time translation of written materials, such as discharge instructions or patient portal messages, have remained elusive.