[ Tuesday, November 29, 2005 ]


Offshoring issues:

[First, let me apologize for the light blogging. There's plenty of HIPAA news out there; nothing earth-shattering, or I would've posted on it, but the little stuff has been trickling in, and I've just been way too busy to keep up with the blog. My apologies. Now that the first wave of the holidays is over -- BTW, happy Thanksgiving, everyone -- I'll try to catch up and keep up. No promises, but I'll try.]

We've discussed here in the past the problems that can be raised when medical data is sent outside the US for processing. As with most areas of commerce in this day and age, there is often the opportunity to take advantage of lower-cost workers elsewhere to do lower-skill or lower-impact jobs, particularly if the raw materials can be easily transported. That holds true for foreign manufacturers of car parts, computer hardware, or other components, where the transportation delay and costs involved in shipping are overcome by the volume of work and the total cost savings. Where the raw material is something that can be digitized and sent electronically, like a physician's voice dictating case notes into a patient's file, there is virtually no time delay or transportation cost. In the health care arena, the obvious use of outsourcing is for transcription, but there are also good telemedicine reasons to use offshore resources: for example, if you took a handful of US-licensed radiologists and set them up in a radiology reading room in Australia or India, they could look at X-rays or CTs produced in a hospital emergency room at 3:00 am, except it would be 3:00 in the afternoon for the radiologists. However, there is a big concern that foreign companies might not be as careful with medical confidentiality as American companies would be. The OCR doesn't exactly put the fear of God into US healthcare workers; foreign workers would be much less fearful of the wrath of US regulators.

There have been a couple of high-profile cases involving medical transcriptionists in Pakistan and India disclosing, or threatening to disclose, PHI they were given to transcribe, due to payment disputes. We have proposed federal law, and I believe some states may have actually passed laws prohibiting the offshoring of PHI for medical transcription purposes.

If you're interested in the pros, cons, and underlying issues, the GAO has a report out on the offshoring of all sorts of services and the impact on the US economy. One of the 4 major impacts is the impact on consumer privacy and security. I haven't read the whole thing, which doesn't reach any major conclusions but which does contain a ton of background information and seems to do a good job of evenly getting the pro and con arguments out on the table, but if you're interested in offshoring issues, it's worth a look.

[UPDATE]: Here's another article on "business process outsourcing" which looks pretty interesting. Again, not specific only to healthcare, but an interesting of what can go wrong from a privacy and security standpoint.

Jeff [10:32 AM]

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