Overseas medical transcription: Does global reach mean greater risk?
Overseas medical transcription: Does global reach mean greater risk?
They speak the King’s English there
Cars made in Japan; computers manufactured in Taiwan. Sure. But medical dictation transcribed in India? Increasingly, yes. And if your medical records department outsources its transcription, chances are growing that your medical records contain notes transcribed an ocean away in another English-speaking country.Many experts say the practice fills a shortage of trained medical transcriptionists in the United States, cuts costs, and offers the same quality of service as American transcriptionists. In addition, transcription agencies can take advantage of time-zone differences to work round the clock, increasing production.
But some in the industry argue that the practice erodes quality and undercuts the transcription pay scale, driving skilled transcriptionists into other fields, further hurting quality control and raising risk management issues.
The number of companies sending medical transcription overseas currently is estimated at less than 2%, says Molly Malone, executive director of the Seattle, WA-based Medical Transcription Industry Alliance; its membership represents roughly 40% of the $6 billion industry. But by one estimate, the number of companies sending transcription overseas is growing by about 10% a year, Malone adds.
"I believe its time has come," says Pat Forbis, associate executive director for professional affairs at the American Association of Medical Transcriptionists in Modesto, CA. "One of the things that’s important to simply accept is that technology does not stop at the U.S. border. I think it’s going to be a global effort particularly if the world is going to be successful in creating this global electronic record that we want."
Like other products and services produced out of the country, sending medical transcription overseas is simple economics, those involved say.
"For the most part it’s a cost savings," says Barbara Manny, manager of international operations at Heartland Information Services, a medical transcription company in Toledo, OH, that sends a large portion of its work to India.
"It’s becoming very difficult for hospitals and transcription companies in the United States to keep experienced MTs [medical transcriptionists] because it’s relatively easy for them to set up a business on their own after hospitals train them. And it’s not a profession that a lot of people are flocking to."
India was chosen because of lower wages and a large English-speaking population, she says. In addition, its large work force fills a gap in the American work force, Manny says.
Others agree. "There is so much work now that American transcriptionists can’t get it all done. So this is another avenue," Forbis says.
Other English-speaking countries where American medical transcription is sent include the Philippines, Barbados, Jamaica, England, Wales, and Ireland.
Should you be concerned about your medical transcription being sent overseas?
"If an injury were caused by an error in transcription, then I think it’s likely that a lawyer representing the injured person would make the assertion that the error perhaps could have been avoided but for the attempt of the hospital to save some money," says Phil Lebowitz, JD, a partner with law firm Pepper, Hamilton and Scheetz, in Philadelphia, who represents hospitals in law suits.
A hospital whose medical records are outsourced overseas would be well advised to spot check the records for accuracy, he adds, "to be able to say that it has imposed its own monitoring or quality control on what it gets."
But plaintiff’s attorney Grieg Coates, MD, JD, with the Austin, TX, law firm Mithoff and Jacks, says the hypothetical scenario of fingering a hospital in a malpractice suit based on the attempt to save costs on medical transcription would be very tough to prove.
Some argue the practice raises risk management issues because of different — or a lack of — patient privacy laws in other countries. "If you send that transcription overseas, [U.S.] laws don’t apply," argues George Heymont, managing partner for Alert and Oriented Medical Transcription Services, in San Francisco.
Such confidentiality issues were raised when hospitals began outsourcing transcription from their own medical record departments, says Joan Hajny-Leeds, RN, FASHRM, BSN, director of risk management at Cedars-Sinai Medical Center in Los Angeles. "All of those issues were taken care of by confidentiality contractual arrangements. Those same principles would be effective if we went overseas. Each transcriptionist in any business overseas would be signing a confidentiality agreement. If they breach it, they’re at risk for losing their jobs."
What do you know about international laws?
Another possible problem of sending transcription overseas concerns international laws. "If something does happen to the work, if a cable goes down or a whole day’s worth of work is lost — if someone is going to be responsible for that, whose laws apply?" Forbis wonders.That, Hajny-Leeds, says, could be a sticky situation. "International law is always a concern because it’s so difficult to manage and because it’s so costly to manage. It’s new territory, and new territory is always scary."
"Anytime technology permits a new way of doing things, many hypothetical situations are raised and the law has to catch up to the technology," she adds.
But whether the transcription is done in Bangalore or Chicago, what matters is the language used for the contract signed between the health care provider and the transcription agency, legal experts say. That spells out the responsibility of the parties involved and would be used in the event of a disagreement.
"The contract — in terms of the commitments, confidentiality, turnaround times, and accepting some responsibility for accuracy — you’re going to look for that [language] no matter what contract you’re looking at," says Sam Bishop, ARM, CHPA, director of risk management for Promina Northwest Health System in Atlanta. "Basically once something is transcribed and the provider signs off on it, they’ve accepted it as being a true accurate accounting of the transcription."
But do they understand American slang?
But what about the variations in phrases and meanings among English-speaking countries? Heymont argues that quality control is compromised by overseas transcription because of a lack of familiarity with American slang, acronyms, and abbreviations. Forbis agrees that American slang can be a challenge."The barrier is teaching them the slang, the claim terms, and the dialect," Forbis says. "Other [English-speaking] countries don’t have as much [slang]. [Transcriptionists] would need to learn how Americans shorten words and phrases. If you don’t understand the abbreviations and acronyms, you can hardly figure out who’s talking about what."
But she insists that quality transcription is the same regardless of the time zone in which it is done, and medical transcriptionists overseas can be trained to recognize American slang just as well as any kind of medical jargon since they already have a solid knowledge of the English language.
"First of all, the people [in other English-speaking countries] speak the King’s English better than we do. We aren’t graduating students from our high schools who speak the language properly. When you go to a country that’s well prepared to begin to teach medical transcription and you don’t have to teach remedial English, you have a leg up already," Forbis says.
"It’s a matter of educating the educators to teach people to do medical transcription. There are things that would be a bit more of challenge to teach people offshore, but in no way am I saying it can’t be done."
Like dictation transcribed in the United States, notes are sent overseas to be transcribed electronically. The growth of the Internet has made the process quick and efficient and no more complex than sending e-mail. And national standards require the information be encrypted, Forbis says. Satellite transmission of digitally recorded notes also is used to send the information back and forth.
Transcription companies say they are solving the lack of familiarity with American slang and abbreviations by using American transcriptionists for quality assurance. At Heartland, Manning says, every report transcribed overseas is checked for accuracy.
In addition, American instructors are sent over to teach a five-month training program, which overseas transcriptionists must pass in order to work for the company.
The training — and the fact that cost savings are passed on to customers — says Manny, is the reason overseas transcription is here to stay.
Still, many question the ability to assure a sufficiently high level of accuracy. "You shouldn’t be able to see any difference," Malone says. "But the underlying concern is if it’s hard to get 98% quality with American transcriptionists, how do you do it with overseas transcriptionists?"
The matter shouldn’t be decided by cost alone, Heymont says. "Ask your doctors if they want [transcription] going overseas. Your doctors may not like the idea. The doctor should make a decision not just based on price. If that document then ends up in a medical malpractice claim, that discredits the doctor."
Pat Forbis, Associate Executive Director for Professional Affairs, American Association of Medical Transcriptionists, P.O. Box 576187, Modesto, CA 95357. Telephone: (209) 551-0883.
Barbara Manny, Manager of International Operations, Heartland Information Services, 3103 Executive Parkway, Suite 600, Toledo OH 43606. Telephone: (800) 626-3830.
Molly Malone, Executive Director, Medical Transcription Industry Alliance, 711 Broadway Avenue East, #7, Seattle, WA 98102. Telephone: (800) 543-MTIA.
George Heymont, Managing Partner, Alert and Oriented Medical Transcription Services, 584 Castro St., Suite 275, San Francisco, CA 94114. Telephone: (415) 863-5992. For further information on Heymont’s book, Dictation Therapy for Doctors, visit Web site: http://www.wwma.com/ mt.html. The book is only available by downloading it from the Internet.
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