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Medical transcription in trouble again

By Sumit Bhattacharjee

VISAKHAPATNAM NOV. 27. The recent development in the medical transcription (MT) industry involving a Pakistani woman transcriber who had threatened to post the confidential medical reports of patients on the Internet for more money, took a serious turn with the United States Senator from California, Liz Figueroa, announcing that she would introduce a legislation in January to ban doctors, HMOs and hospitals from sending abroad confidential doctors' notes and other medical records for transcription.

This incident could throw a spanner at the wheel of the Indian MT industry, which is just trying to look healthy after years of lull.

According to NASSCOM, India is the destination for over four per cent of the total 10 per cent of the outsourcing of the booming $20 billion business from the U.S. alone.

The U.S. is one country where issues regarding encroachment of privacy is viewed very seriously and sensitively, especially in the case of health. And there is a federal law, Health Information Portability and Accountability Act (HIPAA), to govern and uphold the standards. But this law is virtually unenforceable overseas.

Recording of the doctor's dictation and transcribing the same has been a routine procedure in the U.S. for quite some time. Farming out for transcription to private transcribers throughout the country has also been a regular practice. These private transcribers, of late, especially after the global IT boom, have been frequently outsourcing the job to sub-contractors in different countries like India and Pakistan, mainly due to the low labour cost, quality of work and the day and night time difference that enables a quick turnaround. The mysterious Pakistani woman was one among the many such sub-contractors down the line. Would it be fair to blame and ostracise the entire overseas transcribing community for one black sheep?

According to NASSCOM, India is ahead of all in the race due to its quality and transparency and so far, around 75 companies of different sizes have sprung up as per its records. There could be over 400 companies operating unofficially with each employing between 15 and 500 persons on round-the-clock basis.

Says the CEO of VIS Info Tech, R.V. Prasad: "We have spent years in building up our standards and credibility to match their demands. Most of the MT companies like us, which are directly under contractual obligation to the U.S. hospitals, follow strictly the norms of personal privacy as per their HIPAA standards. We make sure that each employee signs a contract to uphold the privacy of the patient's records and enforce methods like dismantling the floppy drive in the computers and see that no terminal is connected to a printer so that the records cannot be copied or printed. But with this incident, we are under the grave threat of losing our business."

This was for the first time that an overseas transcriber had used confidential records to threaten a U.S. medical institution, and this could also seal the fate of the overseas transcribers if the law is enacted. It would not only be a loss of foreign exchange for the Government but also the livelihood of many young aspirants would be stifled.

"To insulate India from being banned from the U.S. list of outsourcing destinations, the Union Government needs to lobby with Senators or pass a legislation validating the HIPAA law in India with similar punitive measures for offenders," says Mr. Prasad.

He has already mailed the request, supported with evidence, to 330 MPs and to the Andhra Pradesh Chief Minister, N. Chandrababu Naidu, seeking their intervention.

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