[ Monday, March 29, 2004 ]


Outsourcing and Business Associate Agreements: Back in October, I noted a story about a medical transcriptionist in Pakistan who was threatening to expose patient records unless she was paid her past due bills. Doctors usually dictate their chart notes into some recording device, and their voice recordings are transcribed by a typist somewhere. That used to be done within the hospital medical records department, but now is often outsourced to a medical record transcription company. Those companies may then subcontract with other individuals or groups, so that a housewife in Peoria might sit at home with headphones on, transcribing what she hears into her computer, to be resent back up the line, eventually to the hospital. The hospital must have a Business Associate Agreement with the company it contracts with to do the transcription, and that company must (according to that contract) obtain the same types of promises from whomever it subcontracts with to protect the PHI. Often, that type of transcriptionist job, like call center jobs, can be done much more cheaply overseas, particularly in and around the Indian subcontinent. That happened here, but the sub-sub-sub-contractor wasn't paid by someone else down the line, and she threatened the hospital that she would disclose the information on the internet unless she was paid.

Now, as you know, outsourcing, particularly of white-collar jobs like transcription and data processing, is a hot topic in the news. And this type of outsourcing was something of an open secret: everyone involved in the practice, and most people involved in the health care field, knew it was going on and didn't consider it a problem, but the general public did not know and would consider it a problem. So, this story has resurfaced, perhaps as something of a cautionary tale for everyone involved. It has led to calls for legislation barring the overseas outsourcing of PHI for transcription, even though the real "bad actor" here is the American who failed to pay his subcontractor. And for the Pakistani woman who made the original threat, just hoping to get paid, she found that she killed off her own business.

Jeff [8:59 AM]

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