This may be the closest I ever get to writing an expose, so pay attention.
And while this may not have much to do with natural beauty recipes, it has a lot to do with your health, and the health of your family.
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Imagine you’re at the emergency room. You have severe stomach cramps and you’re throwing up every 10 minutes. While you probably just have the stomach flu, you’re in so much pain and misery, you just want to make sure you’re not dying.
After waiting an hour or two, you’re admitted – checked out by nurses and then ushered into a curtained cubicle to wait for the doctor. She comes in. There are labs and x-rays involved, and she notices, as you throw up, that there’s a little blood tinge. She admits you for more observation.
While you’re waiting to find out the results of your labs, other things are happening in the background. You have no idea about these things. But they’re all about you, all about your health, and all about the treatment and medication you’re about to be prescribed.
The doctor is dictating into a little recording device, which will be hooked up to her computer, your medical history, your symptoms, your lab results, and how she’s going to treat you.
This recording, it’s sent to a medical transcription company to be transcribed. It contains a lot of really big words (like ileojejunostomy or pantoprazole), and the doctor was eating a sandwich while she was dictating it, so it’s pretty hard to understand. She also mumbles. Stutters a few times. It’s not an easy recording to listen to, much less decipher.
The accuracy of this report, though, it’s of the utmost importance. These are documents that will be referred to again and again while you’re staying in the hospital, and for years afterward when you visit your physician.
You need someone who knows what they’re doing, right? Knows the language inside and out. Knows that 50 mg of your diabetes medication is good, but 500 mg could kill you. Someone who knows the difference between your ileum and your ilium. Someone who doesn’t just understand English, but understands medicalese English spoken by a doctor with a heavy Louisiana accent (who still happens to be eating that dang sandwich).
Instead, my dear readers, this sound file, after it reaches the medical transcription company, is likely being sent over to India.
Why Outsourcing Medical Transcription to India is a Bad Thing
Off and on for the last 15 years, I’ve done a bit of medical transcription – either as my sole source of income or to supplement when I didn’t have the motivation to write. It’s not a glamorous job, but it used to have its perks. Not so much these days. The pay is going down tremendously, the expectations for independent contractors rivals or exceeds that of employees (who get benefits), and the majority of work available to U.S. transcriptionists is the worst of the worst. When you’re paid on production, the worst of the worst isn’t going to put food on the table.
One of the things that’s lead the transcription industry down this road is the offshoring of work to India. There, transcriptionists will work for less than half the amount that U.S. transcriptionists will work for, so it’s much more cost effective for hospitals and medical professionals.
But it comes at a price to us.
Not only is revenue exiting this country and going to India, but it’s on the back of a trade that’s so personal, so confidential, and so imperative that the English and medical language not only be understood (in any dialect), but known intimately.
I’ve seen, with my own eyes, reports come back from India – sent to the hospitals – with grave medical errors in them. Sound-alike words that could easily be mistaken by someone who isn’t familiar with a Texas accent. Dosages WAY off – either far too high or far too low. Surgical terms just completely botched in a way that makes you think they hit their head on the keyboard and hoped something legible came out.
While it may be funny to see a medical report saying, “The patient has flea bite his last leg” instead of “The patient has phlebitis in his leg,” it’s not so funny when the errors pertain to treatments and dosages that will be referred to repeatedly – and sometimes urgently.
I’ve been an editor (and have even run an entire transcription department) for several companies – some of which outsourced to India, some of which were strictly US-based. This may be subjective, but I can assure you that in no uncertain terms, the Indian transcriptionists were far worse than even the newest of the U.S. transcriptionists when it came to accuracy.
So what I’m saying here is: It’s dangerous for Indians to transcribe our medical records.
However, it’s far less expensive for a hospital to pay for a dozen potentially lethal mistakes caused by medical records errors than it is for them to pay for U.S. based transcription.
This is why it will not change.
And What About Privacy?
The other thing that’s always really bothered me about our medical records being sent to India is the privacy issue.
Here, in the U.S., HIPAA (Health Insurance Portability and Accountability Act) laws are STRICTLY adhered to. They’re no joking matter. There are entire committees and positions dedicated to making very sure that HIPAA privacy laws are being enforced to their fullest. The punishment for breaking a HIPAA law is very high.
Over in India, though, they’re not bound by the same laws.
And over in India, they have something else. Have you watched Outsourced yet? (It’s funny. You should.)
They have call centers. They have call centers for companies of all types, not the least of which are insurance companies, credit card companies, and other companies that have a big impact on your life.
With your medical records goes things like your social security number, your address, and your full name. This information could be very valuable to certain companies, when combined with medical information. This information could be shared with these call centers – to your detriment.
Now, I don’t want to be an alarmist here. That’s not my point. I have no proof that anything untoward is happening. I’m just saying it could. And that it wouldn’t be hard to do.
In fact, take a look at this article about a transcriptionist in Pakistan who threatened, in 2003, to release medical records to the public unless she received extra money for the work she did.
That’s right.
Your medical records – all over the internet.
But, more importantly, take a look at the important sentence in that article that states “U.S. laws maintain strict standards to protect patients’ medical data. But those laws are virtually unenforceable overseas, where much of the labor- intensive transcribing of dictated medical notes to written form is being exported.”
While my fears may be based on paranoia, they’re certainly not without merit.
What You Can Do About Offshoring of Your Private Medical Records
Okay. Let’s face it, in the long list of things to champion or get worked up about or fight for, worrying about your medical records in India probably isn’t going to take top priority. I understand.
It’s why this issue hasn’t made headlines. It’s why it’s not talked about. Heck, it’s why most doctors don’t even know it’s being done with their dictation.
You could write to your Congresspeople, you could even call them. That would be fantastic.
But you could also take a more personal approach.
When you’re in the hospital, for any reason, ask where your medical records are being transcribed. Ask if they have a strict no-offshore policy. Ask, ask, ask. And then demand that they do whatever they can to keep your medical records within the borders of this country.
Talk to your physician, when you’re in his or her office. Ask them what they know about the offshoring of medical information. Ask them what company they use for their transcription services.
Ask, ask, ask.
Again, I’m a realist and know that not much is going to be done about this issue. But I believe, with all my heart, we all have the right to know where our sensitive medical information is going, how it’s handled, and whether it’s accurate enough to help us get better – or to make us a whole lot worse.
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Did you know a huge percentage of medical records were being sent to India, or is this news to you?
Does it make you a little angry, or do you think it’s just good business sense?
Moreover, do you think you’ll have a little chat with the medical professionals you encounter from now on?
3 Weeks With No Shampoo And …???
With every article I read on here, I like this blog more and more (though I’m not very crunchy myself at all!).
I’m also a medical transcriptionist, and oh my word, the horror stories I could tell about the Indian company/ies my employer uses, and the things they’re doing and have done to try to force us local employees out. I am a “homebound employee” – I work at home and get paid not by the hour, but by the line.
When I started with my current employer, we handled all the dictation for our ~35-provider practice, plus the physical therapy department, the physicians’ and PAs’ hospital dictations, and our small Speciality Hospital. There were about 20 full time transcriptionists, 8 of whom would go homebound within a year, and 5 or 6 part-timers. We had to maintain a strict 95% accuracy rate and a 48 hour turnaround time (TAT). Errors that were identified in our transcription were pointed out and if an error was repeated after it had been identified, we were placed on a one-week “probation,” where our work was more closely audited and we received a lower line rate (or no productivity bonus, for hourly or “inhouse” employees).
Now, almost ten years later, there are five full-time employees and one part-timer, who’s no longer an employee but a “contractor.” I am the only homebounder left. One of the other full-timers is the de facto manager. I am the only full-time employee who does any actual typing – the rest of the full-time employees are doing 100% auditing of the work that comes back from India – trying to fix as many of the errors as they can, although there’s just no way to do it.
Did you catch that last bit, there? Do you see how it works? My employer sends work off to India, and pays that company about the same line rate it pays me to type it. (My line rate is about 2/3ds what a US-based private contractor would charge, because as an employee I also receive benefits – that puts it about on par with what the Indian companies charge.) Then the work comes back and they have to pay four full-time employees to try to fix the errors.
The Indian company gets the work back overnight, so it’s a less than 24 hour TAT – BUT THEN it still has to be audited before it can go in the patient’s chart, so for all intents and purposes we now have about a 30-DAY TAT for the work that is offshored. If a patient’s dictation is missing or incomplete, it will not usually be noticed until at least three weeks later – by which time the encounter has faded from the doctor’s mind so the note can’t be reconstructed.
I also worked, for about two years, as a “middleman” for the Indian company we use. THAT company was paying me $14 an hour to review some of the notes that it KNEW were erroneous, before sending them on to the Group. Every day I’d see the same errors, and every day I’d send a report of the corrections, and explain why this phrase or spelling or sentence configuration was still wrong. And the next day, there it’d be again, in all its glory.
Remember up there where I said that as an employee, I have to maintain a 95% accuracy rate or face undesirable consequences? While I was working for the India company on the side, I kept a running tally of the reports I was auditing using the same scoring criteria that we as employees were graded by. The India company’s accuracy rate hovered around 50-55%, and never improved. Ever. In two years.
The doctors complain – they know all too well the damage that will be inflicted on their careers and reputations should some of these India-typed notes have to be presented in court during a malpractice trial. (Let me tell you one of my favorites, which happened to a doctor who is one of our very BEST dictators, one who always speaks clearly and never eats or yawns and has virtually no accent. A patient with chronic pain had gone to the emergency room because she had a pain flare over the weekend and was out of medication. The ER doctors felt she was drug-seeking, and, our doctor dictated, “told her that she was addicted and the medicine was making her sicker.” That note came back from India reading “they told her she was a dick-chick and the medicine will make her sleep with a girl.” AND NO ONE CAUGHT IT, until the patient got a copy of her note to send with a letter of complaint to the hospital.)
So yeah, the doctors complain – but especially in a group practice, they often have little to no control over it, unless they want to pay out of their own pockets to have their notes dictated on the side. So just talking to the doctor him/herself might not be enough.
I encourage everyone, EVERYONE, to request copies of their notes at EVERY visit – and then read it. Go over it with a fine-toothed comb, and COMPLAIN about any errors. Long and loud, and don’t stop complaining until it’s fixed. That little error might be amusing now, but when the insurance company denies your claim because – as Betty offered – the complaint is on your official medical record as being a “flea bite” instead of “phlebitis,” or when they reject your worker’s comp coverage and you can’t get disability for your work-related injury, it won’t be funny at all. I have a few patients whose notes I type every month, who’ve been trying to get surgery approved for as long as two years, and they’re being denied because of a stupid, obvious error in the medical record – but once it’s in there, some of these insurance companies won’t let go. And even if you know that your notes are being typed by US-based worker, check them anyway – we’re human, we make mistakes too. But MOST of us will eagerly correct our errors, and do our damnedest not to repeat them, if you point them out. That’s the big difference I noticed with the India-based companies we’ve used – they don’t really care about the errors, and their employee turnover rate is too high for it to make much of a difference anyway.
I’ve typed far too long, sorry – should be working anyway. But thanks for discussing this, and thanks to all of you who will support and encourage your doctors to use US-based transcriptionists. Some of us are really good, and really need the work! (c:
Oh. My. Gosh.
You should’ve seen me nodding my head the ENTIRE time I was reading your comment. And, while I was just horrified at the story you told about the good doctor/dictator and that HORRIBLE outcome, I wasn’t the least bit surprised.
THANK YOU! for reiterating what I was saying here. Hopefully more people will get to read your story, too, and know that it’s a real problem. And I hadn’t even thought of the trouble it could cause with worker’s comp claims. Good grief!
Profits are all that matters. Our very lives are nothing if a few pennies can be saved. Sick, but not surprising.
I had no idea this was happening. My southern accent is so thick that when on vacation I had to have a trasnlator to ask about a quart of oil. Apparently some parts of the world put a “y” in oil. If people have trouble understanding my dialect two states away, I can’t imagine what someone from a country not familiar with these accents would do to our records. I’ll certainly ask next time I’m at the doctor. Scary!
You have improved my skin (loving the nutmeg mask) and now you are helping me with my uni work. I’m so using this blog post in an assignment where you have like examine articles and blog posts about topics relevant to the issue. Assuming you don’t have a problem with that. Finally my hours of slacking off and looking at Crunchy Betty and fashion blogs has helped my education. I knew this day would come.
Not being in the US, this doesn’t affect me but it is still scary. Especially how patients aren’t informed. I’ve had a lot of health issues and like being informed.
WOW, I had no idea and now I’ve added this to the list of things to be paranoid about!
My husband did many stints in the hospital over a 2 year period (big story, another time) I was glad that I could be there with him almost constantly as his advocate and I always encourage others to have an advocate if they aren’t well enough to do it for themselves. You HAVE to ask questions and you DESERVE the answers especially when it comes to your health of the health of your loved ones.
I will absolutely be bringing this up the next time I see my doctor. She’s fabulous, by the way, and loves that I want to be involved in my well-being and tolerates my many, many questions (even the hypothetical ones). I say if your doctor doesn’t, then it’s time to look for a new one.
I’m SO glad to hear you have a supportive physician! Those stories warm my heart. In my years as a transcriptionist, I don’t know how many times I heard physicians disparage people who wanted to be responsible for their own health by using natural alternatives. SO disheartening. But I do think, little by little, that is changing.
And, yeah – the most important thing for me when I wrote this was just to INFORM people. We have a right to know. Unfortunately, most people don’t … but the more we ask and talk about it, the more it’ll flesh itself out.
I had no idea medical records were being outsourced, but it doesn’t surprise me either.
I’m kind of torn about outsourcing. I get that it takes jobs away from Americans who need them, but, I think Indians need them too and probably live in deeper poverty than most Americans.
In the end, it will really come down to lawsuits, I think. Someday, someone is going to sue over a poor transcription that resulted in injury or death and it will come to light and there will be great outrage. Then it will go to Congress and they’ll mess around, creating a toothless law to prevent outsourcing, and it will wind up getting vetoed because it wound up part of a bill that would also negatively affect big oil. A broken system, just broken. (oops, guess that was a little rant. I’m not bitter or anything.)
See, I’m actually relatively okay with outsourcing. I don’t think good living conditions should stop at any border. Unfortunately, with offshoring also comes a lot of exploitation (see: Nike, Walmart, etc.). This is true, even, with the medical transcription. Just because people are willing to work for pennies doesn’t mean that’s what they should be paid.
I think the issue is a much deeper societal one and reflects on the fact that we’ve been living WAY too far beyond our means here in the U.S. If our businesses can’t support themselves in the economy in which they operate, then there’s far too many superfluous things going on.
But! I think this issue – the medical records one – is a whole different ballgame. This is our very, very, very private information and our country has set up laws to strictly enforce that privacy. Then what? Then we turn around and just send this information out of the country, where it’s not protected at all? It just doesn’t make sense to me. Add into the mix the fact that the people who are entrusted with this sensitive medical information have a very difficult time understanding the nuances of our language … it’s just bad, bad sense. Not bad business sense … bad life sense.
Offshore (and pay well) for things like manufacturing or website coding or whatever … but don’t offshore our health. Y’know?
very very important, and seemingly “insignificant” to most people! My mom has been in medical records her entire working life and can’t believe they do this, either. So although I did know a little about it, it still needs to be talked about…a LOT.
It’s insane to me that the companies in the US are legally allowed to do this with our vital info. I get annoyed when I have to talk to someone I can’t understand when I have internet trouble, I can’t IMAGINE this happening to me with something like medical history and drug dosage.I just hate the fact, too, that while Americans are looking at the highest unemployment rate in a long time, we’re sending our jobs overseas so a few top chairman and their investors can make Even.More.Money.
Shame.
oooh I’m still stewing. Sorry. ((deep breath))
Thanks for the article.
Sarah M
I know what you mean. It’s very frustrating!
The good news is, the more we talk about it, the more we can change things. There are already a handful of medical transcription companies here in the United States (and at least one really big one) that refuses to play the offshoring game. Unfortunately, most hospital directors are still looking at the bottom line, and when you have one company offering a rate of $0.10 per line and another offering $0.25 per line, the hospital director’s not going to care one whit where the work is being done … they’re going to go for the lowest amount.
Unfortunately, medical records is looked at as being pretty low on the food chain in hospitals – a necessary evil. No one wants to pay for them, because they don’t actively generate money.
What about doctors that do their own transcription? (Do you call it that if there’s no dictation?) At my OB’s office every doctor comes in with a computer and basically transcribes almost your entire appointment while they’re in there with you. It’s kind of annoying because it’s really distracting for them and for me. Do you think they do additional dictation after that or just finish up any additional notes after the appointment? They’re always standing around at their laptops in the hallway typing away. I suppose I could ask, huh?
I’m so glad you asked, sister! I’m not a huge proponent of the EMR (electronic medical record) either. In one of the last hospitals I worked at, they were moving to the EMR and the general consensus was that it stole vital patient contact time away from the physician (because of all that entering stuff into the computer).
And instead of the doctor both being able to ask more personal information (which is where most diagnosis lies) or record more personal information, you’re mostly stuck with following a multiple choice questionnaire.
Not to mention, in the times that the physician DOES enter their own information in the notes section, they’re never proofread. And do you know how many doctors actually know how to spell? Not many. (I don’t know how many times a “helpful” doctor tried to spell a word for me in their dictation, only to botch it completely. It was kinda funny, really.)
Anyway, it’s all about cost reduction – not really about patient care at all. Makes me sad.
Had no idea that this was happening but I can’t say I’m surprised at all. It’s pretty scary stuff, downright frightening when you think about it. Thankfully I haven’t had to see a Dr. for a quite awhile, but when I do (inevitably), I will be sure to ask. Thanks for bringing to light something a lot of people probably didn’t know about.
And I loved the movie “Outsourced”.
It’s disconcerting stuff. It was while I was doing it, and I think it’s even more disconcerting to me now – now that I’ve had time to reflect on it. Seriously, the errors were so unbelievable. What companies won’t do to save money, though.
And that’s the problem here. Medical records are looked at as an unfortunate necessity. No hospital really wants to pay for them, because they don’t generate revenue in any way, shape, or form.
And if it doesn’t make money, it’s not important. Never mind that it’s imperative to the quality of care a patient gets.
What a great topic to address. First, I hate the fact that jobs are being outsourced while people who are perfectly capable and more than willing to work are left in our country unemployed and struggling, it drives me nuts! Second, you are so right about the issues with correct medical information making it in to our medical record, it’s scary to think of all the guess work and mistakes that go into the files. Third, I never even thought about how our privacy could be compromised. I’m taking a nursing assistant class right now and the way HIPAA has been stressed I would never have even though about the fact that the minute I leave the doctor’s office my information is heading to another country with no such privacy act. You’ve got my wheels turning, great post! Next time I am at the doctor’s office I am going to ask where their transcriptions are done, think I’ll get an honest answer?
That HIPAA thing, that’s the part that floors me the most.
Why go through so much INSANE law-making and enforcing, just to send our private medical records OUT OF THE COUNTRY where they’re not protected at all? It just doesn’t make any sense whatsoever.
One thing I failed to mention in the post is this: When you ask, you’ll most likely get an honest answer – but that won’t mean it’s a correct one. There are tons of medical transcription companies here in the United States that own sort of a “shell” company here. For all the hospital or clinic director knows, it’s a US-based company. But the transcription is not done here in the states. It’s sent overseas. Unless the director knows to specifically ask for or demand work stay in the United States, it probably won’t.
That doesn’t mean we shouldn’t ask, though! The more we talk, the more everyone’s aware.
I’m going to naively assume that this doesn’t happen in Canada. Though I’m sitting in a waiting room, for a doctor. I will ask.
Love outsourced. It’s my new fav show. Are you barfing?
Y’know, it might not happen in Canada. I think the main reason it happens in the states is because healthcare is so profit driven – maybe with nationalized healthcare, quality medical records are more important than focusing solely on the bottom line.
And, yes. Yes, I was barfing. Thank you for reminding me of that word. I haven’t see it in years. Haha.