Offshore - revisited - DM

Following is an older article but I feel it is worth circulating now.

Most people have no idea who has access to their medical records.
Though this article was written 6 years ago, it is an even more common
practice today in 2009 for hospitals, clinics and other health care
facilities to outsource their dictation/patient records to other
countries  - thereby not only making it impossible for
transcriptionists in the United States to continue to make a living
working in the US as a transcriptionist, but also continuing to bypass
any HIPPA regulations.

In the next several weeks I will explore any options available to gain
the support of other MTs/CMTs in a quest to seek that AHDI
(Association for Healthcare Documentation Integrity) stand behind
their promise to its members.  Not a simple task -  and this is but
the first step in reaching out and asking that you also take a small
part in this effort by circulatiing this article, making your family
and friends aware of the ongoing issues.  

OFFSHORE TRANSCRIPTION ARTICLE

A tough lesson on medical privacy
Pakistani transcriber threatens UCSF over back pay
David Lazarus
Wednesday, October 22, 2003
©2003 San Francisco Chronicle
URL: sfgate.com/article.cgi?file=/chronicle/archive/2003/10/22/MNGCO2FN8G1.DTL
"Your patient records are out in the open... so you better track that
person and make him pay my dues."
A woman in Pakistan doing cut-rate clerical work for UCSF Medical
Center threatened to post patients' confidential files on the Internet
unless she was paid more money.To show she was serious, the woman sent
UCSF an e-mail earlier this month with actual patients' records
attached.
The violation of medical privacy - apparently the first of its kind -
highlights the danger of "offshoring" work that involves sensitive
materials, an increasing trend among budget-conscious U.S. companies
and institutions.
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.
"This was an egregious breach," said Tomi Ryba, chief operating
officer of UCSF Medical Center. "We took this very, very seriously."
She stressed that the renowned San Francisco facility is not alone in
facing the risk of patients' confidential information being used as
leverage by unscrupulous members of the increasingly global
health-care industry.
"This is an issue that affects the entire industry and the entire
nation," Ryba said.
Nearly all Bay Area hospitals contract with outside firms to handle at
least a portion of their voluminous medical-transcription workload.
Those firms in turn frequently subcontract with other companies.
In the case of the threat to release UCSF patient records online, a
chain of three different subcontractors was used. UCSF and its
original contractor, Sausalito's Transcription Stat, say they had no
knowledge that the work eventually would find its way abroad.
The Pakistani woman's threat was withdrawn only after she received
hundreds of dollars from another person indirectly caught up in the
extortion attempt.
The $20 billion medical-transcription business handles dictation from
doctors relating to all aspects of the health-care process, from
routine exams to surgical procedures. Patients' full medical histories
often are included in transcribed reports.
While it's impossible to know for sure how much of the work is heading
overseas, the American Association for Medical Transcription, an
industry group, estimates that about 10 percent of all U.S. medical
transcription is being done abroad.
For two decades, UCSF has outsourced a portion of its transcription
work to Transcription Stat. Kim Kaneko, the owner of the Sausalito
firm, said she maintains a network of 15 subcontractors throughout the
country to handle the "hundreds of files a day" received by her
office.
One of those subcontractors is a Florida woman named Sonya Newburn,
whom Kaneko said she'd been using steadily for about a year and a
half. Kaneko knew that Newburn herself used subcontractors but assumed
that was as far as it went.
What Kaneko said she didn't know is that one of Newburn's
transcribers, a Texas man named Tom Spires, had his own network of
subcontractors. One of these, apparently, was a Pakistani woman named
Lubna Baloch.
On Oct. 7, UCSF officials received an e-mail from Baloch, who
described herself as "a medical doctor by profession." She said Spires
owed her money and had cut off all communication. Baloch demanded that
UCSF find Spires and remedy the situation.
She wrote: "Your patient records are out in the open to be exposed, so
you better track that person and make him pay my dues or otherwise I
will expose all the voice files and patient records of UCSF Parnassus
and Mt. Zion campuses on the Internet."
Actual files containing dictation from UCSF doctors were attached to
the e- mail. The files reportedly involved two patients.
"I can't believe this happened," Kaneko said. "We've been working for
UC for 20 years, and nothing like this has ever happened before."
The files in question were quickly traced to Newburn, the Florida
woman, who typically handled about 30 UCSF files every day.
An emotional Newburn said in an interview that she's as much a victim
as Kaneko. "I feel violated," she said.
Nevertheless, she said she's taking responsibility for what happened,
even though she said she explicitly told Spires not to send any work
overseas. "What he did was despicable," Newburn said.
Spires could not be reached for comment. E-mail to his company,
Tutranscribe, was returned as undeliverable this week.
Newburn said she contacted Spires as soon as she learned about
Baloch's threat and obtained a number to reach the Pakistani
transcriber at her home in Karachi.
"I spoke with her," Newburn said. "She was very upset but said she
wouldn't have really released the files. So I said she had to take
back the threat."
Newburn agreed to pay a portion of the money Baloch claimed she was
owed - about $500 - and Baloch said she would tell UCSF that its files
were safe.
On Oct. 8, UCSF received a second e-mail from Baloch. "I verify that I
do not have any intent to distribute/release any patient health
information out and I have destroyed the said information," she wrote.
"I am retracting any statements made by me earlier."
The problem, however, will not go away so easily.
"We do not have any evidence that the person has destroyed the files,"
acknowledged UCSF's Ryba.
Moreover, how can UCSF or any other medical institution prevent
something like this from happening again? Should legislation be passed
barring U.S. medical data from going overseas?
"I don't know the answer to that," responded Amy Buckmaster, president
of the American Association for Medical Transcription. "We don't say
that outsourcing is a terrible thing. We say that it needs to be
disclosed."
UCSF has reached the same conclusion. Ryba said the medical center is
revising its contracts with transcription firms to require up-front
notice of all subcontracting.
At the same time, she accepts that with a growing percentage of
transcription work being exported abroad, there will always be a
chance that something like this could happen again.
"We'll have to live with this risk on a daily basis," Ryba said.
David Lazarus' column appears Wednesdays, Fridays and Sundays. He also
can be seen regularly on KTVU's "Mornings on 2." Send tips or feedback
to dlazarus@sfchronicle.com.
©2003 San Francisco Chronicle