Doctors also ship work overseas (but they don't always know it)

Offshore outsourcing can save physicians money, but can also present potential HIPAA problems.

By Tyler Chin, AMNews staff. Nov. 10, 2003.

A woman in Pakistan threatened to post patient files on the Internet unless the University of California, San Francisco, Medical Center paid her money she claimed a third party owed her.

How did files on patients from San Francisco end up in Pakistan? The woman had been hired, through a series of subcontractors, to transcribe them.

Increasingly, technology help- desk support, transcription and other services physicians rely on are being moved out of the United States, not only to Pakistan but also to India, China, South Africa and Russia. The companies providing those services hope physicians won't notice any changes -- except perhaps for the cost savings. This is all part of a larger trend of American companies sending work out of the country because it can be done cheaper somewhere else.

In health care, transcription continues to be done mostly in the United States, but a growing percentage is being done in India. Three key factors are the shortage of qualified U.S. transcribers, the availability of lower-cost English-speaking transcribers elsewhere and a quicker turnaround time, observers say.

The American medical transcription industry is a $15 billion to $20 billion market, said Amy Buckmaster, president of the American Assn. for Medical Transcription, Modesto, Calif. About 4% of that goes to India, she estimates. Others think the figure is as high as 10%.

Although many physicians may not even know where their transcription is done, others have seen the options displayed.