HIPAA, patient privacy and offshoring medical transcription
By Marilyn Trapani
This article originally published as a Letter to the Editor in the Journal of AHIMA in response to this article.
HIPAA was deliberately designed to protect patient privacy. In mid-October, a Pakistani medical transcriptionist threatened, actually extorted UCSF Medical Center, threatening to release to the web the hospital’s patient records that she had been transcribing. To show just how serious she was, she sent UCSF an e-mail with actual patients’ records attached.
The incident, perhaps the first of its kind, should make every HIM executive and administrator, and every hospital president review exactly what is happening to their medical records when they leave their facility. Outsourcing MT services is a highly efficient and effective solution to transcription. But, as this case clearly illustrates, let the buyer beware.
For UCSF, the vendor contracted with sub-contractors, who then sub-contracted again to other sub-contractors who ultimately sent the MT work to Pakistan. In this case a chain of three different sub-contractors was used. The original subcontractor, Sausalito’s Transcription Stat, says that they had no knowledge that the work eventually would find its way off-shore. We can only wonder how well the information flow was being managed if it could go through so many vendors before finally reaching the transcription stage.
The Pakistani woman’s threat, according to the news report in the San Francisco Chronicle, was eventually withdrawn after “she received hundreds of dollars from another person indirectly caught up in the extortion attempt.”
The American Association of Medical Transcription estimates that 10% of all the work in the U.S. is now going offshore. Those that send MT work overseas claim they can provide quality transcription at lower prices, and that there is a shortage of trained, competent transcribers here in the U.S.
As the flow of documents offshore continues to grow, we have seen a steady increase in the number of MT professionals looking to US based companies for employment. Highly trained to meet the demands of the healthcare industry, and well-qualified to provide the quality service expected by hospital standards, they watch as their jobs erode to foreign competitors.
We are a long-time provider of MT services to some of the finest hospitals in the country. Competitive pressures ensure that we continue to improve productivity, reduce costs, and still provide zero error rates to our clients.
As this case suggests, HIM executives must weigh all the factors when choosing a MT provider, because there is more to their decision than cost alone. Some of the unintended consequences can put patient privacy and hospital security at risk, the very things the HIPAA was intended to avoid.