MTStars Newsletter
Special Edition

Overview: "Outsourcing California: Our Jobs and Privacy Risk"

By: Admin
03.12.04 , 04:41 PM CST

On Tuesday, March 9, 2004, a joint hearing of the Senate Business and Professions Committee and the Senate Select Committee on International Trade Policy and State Legislation called "Outsourcing California: Our Jobs and Privacy at Risk" was held.

Present at the Medical Privacy portion of the hearing was:
Clifton Louie, UCSF Medical Center; Faith Raider, AFSCME Local 3299; Penna Rivatto, MT; LaVonne LaMoureaux, CHIA; Amy Buckmaster, AAMT; Sean Carroll, MTIA; Steve Mandell, Heartland Information Systems; Roseanne Sullivan, MTStars; and Astrid Meghrigian.

Clifton Louie of UCSF Medical Center gave a detailed explanation of the Pakistani MT extortion attempt and outlined that they conducted an investigation and found that the Pakistani MT's email could only be traced back as far as Virginia. Additionally, the transcription vendor was suspended until their review was complete. Mr. Louie further elaborated that Business Associate agreements with their vendors now include that full disclosure must be provided, social security numbers of the Business Associate's subcontractor's must be provided, and that an audit can be required of the Business Associate with proper notice.

Senator Liz Figueroa asked if the facility was aware of their vendor utilizing offshore transcription and Mr. Louie said that UCSF had no knowledge, but that steps have been taken to ensure that the medical center's protected health information would not be sent offshore in the future.

Senator Figueroa then asked how much of the UCSF's dictation was outsourced to vendors and Mr. Louie said that 90% is sourced to the vendor community and that 6 Medical Transcriptionist's were employees, working onsite to transcribe immediate turnaround time reports.

Faith Rader of AFSCME Local 3299 presented only to introduce Penna Rivatto, a Medical Transcriptionist working for the UCSF Medical Center. Ms. Rivatto said that distance and anonymity were catalysts for extortion attempts. She went on to say that Medical Transcriptionist's make physician's sound good, and that she had, for another medical facility, edited reports that had been transcribed by an offshore service and that she correct many errors, including terminology, sentence structure, punctuation, etc. and that oftentimes had to retranscribe reports completely. Ms. Rivatto felt that had the dictation been kept in the United States and been transcribed correctly initially that it would have cost no less than if it were sent offshore. Ms. Rivatto also added that hackers for hire gain information to provided to insurance companies and the like. She proposed that offshore transcription cease and that patient's must be given the opportunity to be aware and authorize their protected health information from leaving the United States.

At this point, Congressman, Joseph Dunn addressed the Chair and announced that he would have to leave but wanted to pose a question to the panelists. His question was;
"If, hypothetically, we assumed that the situation involving the worker in Pakistan were to occur tomorrow, what recourse is available to the patient whose records are threatened to be disclosed?"

Steve Mandell of Heartland said that because Heartland workers are employees and are not subcontractors that the recourse would be in the court systems of the northern district of Ohio, therefore, the contract would be with Heartland.

Congressman Dunn adamantly said, "No, the problem is that the worker is in Pakistan and that worker is threatening to disclose the information. I can go into the northern district of that state and seek a temporary restraining order that has no impact in Pakistan, so what recourse does the patient have to preclude the disclosure of that information when the information is overseas?

Mandell referenced monetary damages, but Congressman Dunn interceded saying that he was not asking for "after the fact" and that private information that has been disclosed isn't of much value and that disclosure was threatened. Dunn said that had this happened in the state of Ohio that he could have gone to the courts and gotten a temporary restraining order precluding the witness from disclosing the information, but that he couldn't do so when the worker holding the information was outside of the United States.

Mandell argued that they would go to the appropriate office in the location where they have their facility (Bangalore) and get the police, governmental service group, and white collar crime unit in Bangalore to move forward and proceed with all the legal ramifications necessary.

Dunn responded, "so, the patient would have to rely on the court system in India?"

Mandell replied, "for specific action toward that particular individual, non monetarily or physically, constraining that individual in jail."

Dunn queried again, "so, I would have to rely on the court system and law enforcement division in that country to preclude the disclosure of that information?"

Mandell responded, "for criminal jurisdiction...yes."

Congressman Dunn was concerned and wanted to know what alternative the patent would have from companies not as good or well intentioned as Heartland that do not go through the court system or law enforcement.

Mandell of Heartland said that he had no way to provide an answer.

At this point, Congressman Dunn responded saying, "I would say the answer is, none." Further, Dunn said, "legally protected information where the person who enjoys the legal protection has no recourse when that information now rests overseas, other than an after the fact damage claim against the contractor that exists here in the United States and that is not much solace if we're talking about disclosure of private financial information, private medical information, or otherwise legally protected information. There is very little recourse for a patient that is threatened with disclosure as all that happened with the Pakistani worker."

LaVonne LaMoureaux of CHIA said that technologies available today could have prevented the Pakistani MT from being able to carry through the threat to the UCSF Medical Center. LaMoureaux also said that the reason medical transcription is being processed offshore is due to the lack of experienced US Medical Transcriptionists. She further mentioned that turnaround expectations are now shorter demanding offshore intervention for dictators recording in the middle of the night. Ms. LaMoureaux said that coding, abstracting, and claims management are also outsourced offshore and again blamed a lack of staffing in the US as the culprit.

Senator Figueroa asked if other types of jobs were being performed offshore and Ms. LaMoureaux said that besides, coding, abstracting, and claims management, that Medical Transcription, billing, and case reviews were also outsourced.

The question was asked, "Was HIPAA sufficient to cover the Pakistani incident?" LaMoureaux said that directly HIPAA does not reach offshore because it's a federal law, but that in April of next year, a new law with security rules governing the security of the electronic record would be mandated and both the Covered Entity and Business Associate will be held accountable to the law.

Amy Buckmaster, representing AAMT said that they believe that offshore companies just like their US counterparts have an obligation to safeguard protected health information and that privacy and security laws must be constructed overseas that will be as stringent and enforceable as those in the US.

Buckmaster said, "MTs are frightened and frustrated about losing their jobs to offshore transcription companies. It is impossible to compete with an offshore labor pool that works for wages that fall significantly below a reasonably competitive margin.

Ms. Buckmaster went on to say that AAMT was troubled that some members are losing jobs as a result of this practice and AAMT would rather US healthcare documentation stay in the US with certified American MTs.

Senator Figueroa asked if MTs obtain a course on medical privacy laws in California and the US and Buckmaster responded that privacy training was not mandated.

Sean Carroll of MTIA said that 30% of their members has offshore connections and said that outsourcing lowers cost to healthcare providers by 20%. Carroll further said, "The notion that offshore production has served to eliminate jobs is simply not true." And, went on to say that because of offshoring that additional jobs have been created in the form of QA jobs.

Senator Figueroa asked how many MTs in California were homebased workers, to which Caroll responded 75%, but also added that a "balance to the good would be night shifts offshore."

Steve Mandell of Heartland explained their companies operating procedures and that Heartland only has employees and no subcontractors.

Roseanne Sullivan of MTStars said that they were present in support of Senator Figueroa's bills that included restricting protected health information from leaving the US. Sullivan explained that there is no language that restricts the offshoring of patients' protected health information and that such data was freely sent overseas for processing. Sullivan elaborated that information contained included patient names, addresses, telephone numbers, social security numbers, and the most intimate details of the patient's diagnosis and that the information oftentimes was sent offshore without the patient's knowledge.

Ms. Sullivan also said that data is commonly stored in databases offshore and that the databases were then sold to clearinghouses, insurance companies, pharmaceutical companies, etc.

Senator Figueroa asked if Ms. Sullivan had proof of this occurring and Ms. Sullivan said she would provide the Senator with the information. Senator Figueroa said that it was a bold statement to make, as it is illegal to do in the state of California.

Sullivan went on to say that besides the extortion attempt by the Pakistani MT to UCSF Medical Center that another service (Heartland) has two of their India staff attempt to extort the company similarly.

Sullivan addressed the problem of redress and that the average American citizen or healthcare provider would face enormous costs to attempt to prosecute entities overseas since offshore entities are not bound by US laws. Sullivan also added that enhancements in technology such as voice recognition has made the MT industry much more competitive to the point where offshoring protected health information is not longer necessary. Finally, Sullivan encouraged the committee that by passing the bills that they would be ensuring California citizens' their right to privacy as well as their dignity.

Astrid Meghrigian of the CMA was concerned that 25% of claims management is being done offshore and said that HIPAA doesn't do enough, specifically for the Business Associate and that even the Covered Entity doesn't have any responsibility where the Business Associate is concerned, only to rectify the problem.

This concluded the Medical Privacy portion of the hearing.

MTStars Testimony

Good morning, Madame Chairman and members of the Committee. My name is Roseanne Sullivan and I am a consultant for MTStars. MTStars is an organization that does not advocate offshore transcription and works to encourage legislation to ban the offshoring of protected health information and is working to implement MT licensure as well as Allied Health professional status. MTStars has a membership consisting of 6,900 members and which operates one of the largest Medical Transcription Networking websites on the Internet. MTStars provides a JOB bank, assists Medical Transcriptionist's in job placement, provides a multitude of resources, such as free software to aid the Medical Transcriptionist in ways that they can be productive in a cost effective manner. I represent Medical Transcriptionist's in the United States. I am speaking today in support of the introduced Senate bills, which would restrict private health information from leaving this country.

As I am sure you all know, under the current HIPAA law, there is no language that restricts the offshoring of patients' private health information, yet some of the most personal details of those patients' records are freely sent overseas for processing. Within this information are patient names, addresses, telephone numbers, social security numbers, and the most intimate details of the patient's diagnosis, and these are sent out of the country without the patient ever knowing.

This date is commonly stored in databases offshore and then these databases are then sold to clearinghouses, insurance companies, and pharmaceutical companies, to name just a few.

This is a grave concern on a nationwide basis.

There is also another concern. To give a couple of example, late last year the University of California San Francisco Medical Center was contacted by a transcriptionist in Pakistan who threatened to post patients' confidential files on the Internet unless she was paid. This individual provided proof by emailing a couple of samples to show that she was, indeed, serious. The Pakistani transcriptionist's threats were only withdrawn after she received payment.

In another case, later that same year, a huge corporation by the name of Heartland Information Systems had two of their India staff try to extort the company if certain demands were not met in a specified timeframe.

Besides the lack of patient privacy, there is also the problem of redress should the average American citizen or healthcare provider attempt to pursue legally. Offshore entities are not bound by US laws and the cost factor would be immense.

There is absolute no reason to send our medical records to another country. With programming developments such as voice recognition and electronic medical record software, Medical Transcriptionists' in America are quite capable of handling our medical records. It is no longer necessary, as a cost savings benefit to healthcare providers, to send such sensitive patient data outside of the state of California or even the United States of America.

By passing these bills, you will ensure California citizens' their right to privacy, as well as their dignity.