Your medical records and privacy shipped to India

Self with corroborating links ^ | March 24, 2002 | Hostage

[Hostage]

A well known fact about American medical privacy to those that work in the industry is that protective barriers to such privacy are easy to overcome.

A little known related fact is that the transciption of American medical records are shipped offshore and in this report, that offshore country is India.

For years now, it has been known that a local network of medical clinics tied to a community based hospital serving a community of more than one hundred thousand people, has been in the red (very red). The medical network's continued subsidization by their associated hospital has been justified and tolerated by the revenues generated by referrals to hospital specialists. However, in recent years this clinic network has become top heavy with well-paid managers with little medical training, who carry on the practice of delivering diminishing medical care under a managed care umbrella. Sound familiar? Such a system is often seen in communities across the country.

Under a Gone-With-The-Wind American business heritage, top heavy managers of medical networks who serve little purpose would be given a prompt exit notice, or better they would never have risen to such well-remunerated levels of incompetence. Further evidence that Americans have lost their collective business minds is revealed by a little known fact.

The American medical transciption service industry is being shipped offshore. Transciption services that often employ stay-at-home moms are being cut in favor of transcription services in foreign countries. What costs six cents a line in the USA costs two cents a line in Calcutta. It is not too hard to imagine that our medical privacy has become an international joke.

We have known for sometime that healthcare "managers" fight for their jobs by denying health procedures that they arbitrate even with little or no medical training. Sometimes they get it right but it is more a stroke of luck that an actual insight into a patient's needs. Physicians that have more insight and training to manage a patient's care are often overriden not only to cut costs but to add costs driven by government social service agencies. There are daily incidents of experienced and respected physician's recommendations being overriden (for example, recommending a patient should return to work) by a state government worker holding a bachelor's degree in psychology recommending disability based on some psycho-babble excuse of stress related impairment.

Against the backdrop of competing against the dictates of state social service agencies, community based healthcare mismanagement organizations, who cannot respond as private medical networks can by refusing to see medicare patients, are reacting not by voicing opposition to state dictates (such actions would be political suicide) nor by cutting the excesses from their own ranks, but by shipping the work of stay-at-home moms to third world countries.

Although these healthcare mismanagement organizations may claim to have patient privacy agreements with the offshore companies they contract, it is not hard to imagine that a sweat shop of offshore transcriptionists typing into their computer networks all of our most intimate and guarded health secrets could just as easily hit a send button to broadcast secrets and personal information to agencies of hostile nations or anyone else willing to pay for the information.

For some examples of such offshore companies, click on their websites below:

http://www.iteshorizon.com/
http://www.gisystems.org/

We'd like to hear from FR about this issue.

To read about groups opposed to offshore medical transcription, Click here

[Helix]

Well, I'm certainly not happy about it. Didn't they also have prisioners doing this at one time? I know they were being used for credit card data entry.

Eventually, the transcription business will probably be replaced by voice and handwriting recognition software. Transcription could take place immediately as the doctor talks into a recorder or writes on a data pad. Or, either could be uplinked to his PC which would then transcribe his notes.

That, in my opinion, is the best use of such technologies as it will enhance comsumer privacy, instead of violating it. Perhaps, you could form alliances with software companies to speed the process along and to lobby for increased use of such software. However, the companies would have to take measures that such software was as secure as possible.

[Hostage]

I consider meself an expert in technology. I attend and organize conferences on medical technology and I hold a Ph.D. in a technical field from one of the top ten universities in the UsS. and one of the top three in my field.

One cough can throw a whole paragraph of gibberish onto the screen through voice recognition software. I have seen the best and brightest from MIT and other same caliber institutions, including corporations such as Microsoft, provide examples of phrases that cannot be translatable until artificial intelligence is more sensitive to intent and context. This will take decades and maybe longer. For now, it is still sci-fi category. Don't take it wrong. There are applications for voice recognition software such as repeating your account number into the telephone for access to your information. However, if you have ever used such a system, you may recall how slow the system is.

Medical transcription is far too variable and unpredictable in its context to be of general applicability for the voice recognition technology, although many companies have tried.

In my family, there are many physicians. I can assure you that they do not have the time, especially in managed care, to edit their voice recognized transcription. The real problems are in excessive paperwork caused by excessive government regulation and legal requirements. The problem is exacerbated by the increasing number of patients that a physician must see just to meet an HMO's production goals, which in turn is driven by rising costs due to HMO performance. How many of us have lingered in a waiting room for fifteen minutes only to see a doctor for three minutes? Physicians usually play catchup at the end of the day to their patient charts and they are in no mood to suffer the technological shortcomings of voice recognition software. They simply don't have the time.

Again, don't get me wrong, I like technology. As a matter of fact, it accounts for the bulk of my livelihood. But my scientific credentials are seasoned with a pragmatic maturity. Technology may **eventually** help in issues of this sort, but the problem faced with unveiling our medical history is here and now. The problem I alluded to in the above has to do with selling ourselves out and not applying our common sense heritage towards solving societal problems.

[Moonmad27]

I'm in the hospital business and deal daily with transcription services. Where confidentiality is concerned, I would worry more about the old-fashioned in-hospital transcriptionist hearing about her own neighbors' medical problems than I would someone around the world who has no idea or even cares who the patient is. When I had to choose a new transcription service for my hospital not long ago, my bias was not to accept those who transcribe in India or overseas - not because of the quality of the work or anything, but because I wanted Americans to get the jobs. The work is transcribed by people thousands of miles away - in other cities and towns across the USA. Again, the distance isn't the issue, it's the sending of jobs overseas that bothers me.

[sten]

There may be a way to get the transciption done without having to forfiet privacy. If you are interested in getting together to produce/market such a service, I would be very interested to hear from you.

FReepMail me to discuss...

[pragmatic]

Half the tech industry ships overseas work to India, I'm not surprised other industries do as well. Poor third-world country = cheap labor.

[right-sidedNYer]

The American medical transciption service industry is being shipped offshore. Transciption services that often employ stay-at-home moms are being cut in favor of transcription services in foreign countries. What costs six cents a line in the USA costs two cents a line in Calcutta.

I am sure you meant no disrespect - but I feel compelled to open my mouth here.

Excuse me? Stay-at-home moms????????? I have been a medical transcriptionist for 16 years. I am a professional. I take my profession and my job very seriously. I am very good at what I do. I am not alone. This is not something I just sit down to do in between baking cookies and wiping runny noses. Geeze.

So why are medical records going overseas? Because "stay-at-home" moms found out that you cannot do this job in between baking cookies and wiping runny noses. It takes dedication and time and exerptise. It takes more than the cheap ridiculous courses offered by the schools you see advertising on TV "become a medical transcriptionist in your spare time..." The demand for skilled MTs is greater than the supply in this country. Head over to India and you'll find a determined supply of people who are willing to work endless hours transcribing medical records for basically squat. Frankly - they stink at it. While English may be their second language - the nuances of the language escape many of them and a lot is lost in translation. I've seen a good portion of work that has come from India - and it's downright scary. These are your medical records, yet no one seems to care. It's not just about the money - since most services have learned that it costs them just as much to hire an MT from India as it does to hire an MT in the US. Services in India are no longer charging that much less than services here in the US.

This is not a new issue - it's been going on for years. Unfortunately - most people don't care. They don't care what their medical records look like. If they did, I'd be willing to bet doctors would take the marbles out of their mouths before they dictate, or they'd be sure they list the proper medications with the accurate doses, etc., never mind worrying about your medical records going overseas.

Now you've got my curiosity up, Hostage. Are you an MT? How does this affect you and how did you come to know about this? You linked to the website of someone I know, so I was just wondering if I know you.

[Hostage]

No I already stated what my background was and I apologize for implying that this was M/T is only for stay-at-homes.

The reason I brought it up was because the medical network that shipped their transcription to India is the employer of a family member who is a physician. I was told that 39 M/T's mostly working from home (hence my poor insinuation that they were stay-at-home moms) were being laid off by this network.

Perhaps what pained us most was the firing of a medical secretary for spilling the beans that the M/T's were losing their jobs because of offshore competition. As soon I heard of this I checked out the background and verified it to be true. There were several things that stuck in my mind at once when I heard of this. One was the issue with privacy. Another was the top heavy HMO management that could disappear tomorrow and no one would notice.

Again my apologies to your profession. I would like to see your opinion on the privacy question as well as your response to shipping such jobs offshore.

[Hostage]

You are quite correct in calling out the danger of neighbors working on your medical records. There are so many things people can be vulnerable to if their medical conditions are known by unscrupulous predators. But if there is an illegal release of medical records from a local company, it seems to me it would be easier to trace and seek punishment. I could be wrong.

[right-sidedNYer]

Again my apologies to your profession. I would like to see your opinion on the privacy question as well as your response to shipping such jobs offshore.

Apology accepted. I've been personally battling the "stay-at-home" mom mentality for 16 years with this job - it's like hearing fingernails on a chalkboard for me. :)

My opinion? I've been fighting sending work overseas for the past 6 years that I have been aware of it - for a multitidue of reasons.

Keeping medical records here in the US transcribed by US MTs only does not guarantee your medical privacy - but there is retribution and punishment should an MT here breach patient confidentiality. Overseas MTs are not going to be held to the same laws that hold us accountable. The first thing I was taught as an MT was how important patient confidentiality is - something that is still stressed - even though I've been at it for 16 years.

Like I stated in my previous post - there is a lot lost in the translation. Some of the work (most, actually) that comes from overseas is enough to bring tears to a professional MT's eyes. I care about the reputation of this profession and I care about the quality of the medical record. The quality from overseas work leaves a lot to be desired.

I do not know of one experienced MT who is out of work because of work going overseas - yet. I don't know this will ever happen; however, what I do know is that there are a lot of inexperienced MTs (fresh out of school) looking for work who are turned down for lack of experience. These same companies, though, will take on MTs from overseas (with no experience). Makes no sense to me - because it takes a whole lot longer to train overseas MTs than it does to train US MTs.

On a personal level - I don't particularly care for the thought of my medical records, with my name, address, date of birth, and SS# going overseas. Like I said - anything could happen to that info here in this country - we all know that - but at least there is some retribution here.

What I don't want is the government's involvement. Very few MTs do. This HIPAA stuff has created enough of a mess. Ideally what I would like is for the general population to wake up and pay attention to their own medical records!!!! Ask to see them.....read them....you're allowed, for Pete's sake. They are YOUR records. If patients started demanding quality then physicians/clinics/hospitals maybe would pay attention and stop looking for the "cheap" way out. Ultimately - the joke of it is - is that it's not cheaper. It really isn't. It won't be when one of these "cheap" bozos ends up being sued for an error in a patient's medical record.

[dighton]

Oh dear. Some bloke in Ghaziabad knows all about my ...... never mind, let's just leave it at that.

[aculeus]

Oh dear. Some bloke in Ghaziabad knows all about my .......

Web site coming soon: lookatthis.com.in.

[dighton]

DestinedForAJarAtHarvardMedicalSchool.com

[jellybean]

DestinedForAJarAtHarvardMedicalSchool.com

Pickled_in_Punjab.com

[Orual]

Now I understand my latest medical report.

[lelio]

It won't be when one of these "cheap" bozos ends up being sued for an error
Do hospitals keep records down to this granularity of who is doing the transcripting? It would be interesting to see this brought up in court.
How do the hospitals expect a person over in India to understand the nuances and difficult medical terms used in the profession just baffles me. Hopefully they use better people than those that write some (computer) technical docs I've seen.

[right-sidedNYer]

It will never be the transcriptionist and/or the company she/he works for. Once a physician signs a transcribed medical report - that's it - they're responsible for the content. It's up to them to verify the contents of the finished reports before they sign off on them.

Hospitals/physicians who are looking for cheaper ways to get their transcription done will be the ones in court when a mistake is made regarding a patient's health care because of an error in a medical record.

Real shame I see so many making jokes about this. Hope those of you who have done so aren't the ones in the ER one night being given a medication you are allergic to because someone erroneously listed NKDA in your medical records.