Very interesting article today on offshoring

About India take on offshoring.  I don't think they are worried about loss of American jobs.

http://worldblog.msnbc.msn.com/archive/2008/10/17/1548054.aspx

• Very interesting article today on offshoring - anon

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But this article states it would only affect new customers right now.  So I am upset over nothing.  I went through heck with BellSouth when they charged me a surcharge of an extra 50 a month and then would write a letter saying I had to switch to a long distance service and pay by the minute because of my "excessive" use. They told me the unlimited charge was for an average of an hour a day not somebody who worked out of their home and I needed to switch a business plan at over 200 a month charge.  I switched over to cable because of that and then to read that cable was going to charging on a per use fee and not a flat monthly fee it upset me.  It is the nature of our work, VR, only paying for VBC, having headers and footers taken away, now being charged for being on line, etc.  It just seems that everything is done to keep to insure less money.

I check the Craigslist website quite often, and on a whim I clicked on India and then jobs.  SO MANY POSTINGS FOR JOBS AVAILABLE FOR U.S. BASED COMPANIES - customer service, call centers, computer techs, and yes even MTs.  There was even one posting a few weeks ago from a "company" that would set you up with a U.S. based physical address, phone number, fax number so that you could have your business "based" in the U.S., obviously to actually be in another country and get the U.S. tax break.  Sickening

Please see article below that was published in 2003. Does anybody know if the law it mentions was ever passed in California?

Following news that a Pakistani medical transcriber threatened to post UCSF Medical Center patient records online unless she received more money,

a state senator said she will introduce legislation barring all California hospitals from allowing medical data to leave the country.

Sen. Liz Figueroa, D-Fremont, said she will introduce the bill in January when the state Senate returns for its next regular session. (A special session on financial matters is likely before then.)

"California already has the strongest medical-privacy laws in the nation, " Figueroa told me. "But not strong enough. There's always something you didn't anticipate."

What she and other framers of the state's medical-privacy laws, which prohibit the sharing of medical information unless for clear medical purposes, didn't see coming is the explosive growth of the $20 billion medical- transcription industry.

U.S. hospitals have such a huge need for help transcribing doctors' dictated notes into written form that the work is routinely farmed out to private transcribers throughout the country. Those transcribers, in turn, frequently subcontract with other transcribers.

In the case of UCSF Medical Center, three separate subcontractors were involved in handling the facility's records. The last link in the chain was a woman in Karachi, Pakistan, who sent an e-mail to UCSF earlier this month demanding help in resolving a financial dispute with the Texas man who'd hired her.

The Pakistani transcriber said she'd post UCSF's files on the Internet unless the medical center assisted her. She backed up her threat by attaching actual UCSF patient records to her message.

This was the first time an overseas transcriber had used confidential records to threaten a U.S. medical institution. The transcriber withdrew her threat only after receiving hundreds of dollars from another subcontractor in the case.

Figueroa said her bill would prohibit anyone possessing information involving California patients from sending that information abroad.

State hospitals would likely be barred from outsourcing transcription work unless they could guarantee that all related files remain within the country -- a move that would make hospitals accountable for any subcontracting that ensues.

"We're not banning the practice of overseas workers doing transcription," Figueroa said. "But we can regulate the practice of medicine within California. "

The law, at least on the health care front, may be on her side.

In most instances, federal law would trump state law, and the federal Health Insurance Portability and Accountability Act of 1996 outlines rules for safeguarding medical data. Anyone doing transcription work for a U.S. hospital would be required to uphold HIPAA standards, although the law is virtually unenforceable overseas.

A unique aspect of HIPAA, though, is a provision that if a state adopts more stringent restrictions, state law will prevail.

"If there were a statute that no health care information in California could be disclosed outside the country, HIPAA wouldn't have a problem with that," said Paul Smith, a San Francisco attorney specializing in health care issues.

"The state has a clear interest in protecting health information," he added. "This would seem a legitimate exercise of state regulatory authority."

At the same time, though, Matthew Nakachi, a San Francisco lawyer who specializes in trade issues, said it's unclear how the proposed legislation would square with federal laws related to commerce. A hospital might argue, for example, that it has a right to do business with whomever it pleases.

"If California decides to do this," Nakachi said, "it would probably go into the courts and take years to fall out."

For her part, Figueroa expects the health care industry to fight the legislation, just as the banking industry opposed state restrictions on the use of customers' information. But she thinks that in light of the public's increased sensitivity toward privacy matters, her bill would eventually pass.

"The interesting thing will be to see where our new governor stands on privacy issues," Figueroa said. "At this point, we don't know."

Mystery woman: The Pakistani transcriber at the center of the case involving UCSF is still something of a mystery.

In her e-mail to UC officials, she identified herself as Lubna Baloch, "a medical doctor by profession." Beyond that, little is known of her.

In May, however, an interesting little exchange occurred on MT Stars, an online network for medical transcribers. Baloch, using the same e-mail address she used in her threatening message to UCSF, posted her resume at the site in hopes of attracting work as a subcontractor.

Sheri Steadman, who runs MT Stars, of Phoenix, said she's against U.S. transcription work going abroad and routinely deletes postings from overseas transcribers. In Baloch's case, she said she was concerned by the vagueness of Baloch's resume, especially as to her whereabouts.

Steadman wrote to Baloch to say that MT Stars is only for U.S. job seekers.

"I am US based," Baloch replied.

"Not enough info," Steadman responded. "Where?"

"Santa Monica, LA," Baloch wrote back.

For Steadman, this wasn't a very good answer.

"Santa Monica isn't in Los Angeles and it's not in Louisiana," she told me. "It was pretty clear that Baloch wasn't in the country."

Steadman confronted Baloch with her suspicion. Baloch never wrote back.

"She was trying to gain work in any way, shape or form," Steadman said. "She was trying to sucker U.S. medical-transcription services into sending her business."

It didn't work that time. A few months later, though, probably using a different online service, Baloch was more successful in her efforts.

That would turn out to be a very dark day for UCSF.

David Lazarus' column appears Wednesdays, Fridays and Sundays. He also can be seen regularly on KTVU's "Mornings on 2." Send tips or feedback to dlazarus@sfchronicle.com.

EMR might not soon replace us after all....

http://health-information.advanceweb.com/common/Editorial/Editorial.aspx?CC=66392&CP=1

August 9, 2006 - EMR has revolutionized the healthcare industry in recent times. Many experts felt that EMR & Voice Recognition would totally replace Medical Transcription - however; the industry soon realized that transcription has certain advantages over point & click charting and many physicians preferred to dictate notes rather than document the data at the point of care themselves.

The most critical part of any Electronic Medical Record (EMR) is the method of data entry. EMR is about aggregation of patient encounter data at the point of care in order to provide a complete, accurate, and timely view of patient information. An electronic medical record is not just a typed record of the patient encounter, but an extremely useful decision support tool. The data can be entered into the EMR via any of the two general mechanisms: direct entry by the physician using point and click templates or transcription of dictated notes. Point and click template indicates that each data element, which is to be inserted, requires selection, navigation, point and click process for capturing patient information.

Transcriptions have been around for years for documenting patient encounters. A medical provider dictates the medical note into a phone or a recording device. The Transcriptionist receives the dictation and transcribes it. It may be reviewed by the supervisor for checking errors. The final computerized file is then either emailed directly to the healthcare provider or the file is transferred to a web site and is later downloaded by the provider.

Each method has its pros and cons.
Point and Click Templates
Most EMR systems allow providers to generate clinical documentation, by selecting variable terms from pre-structured point-and-click templates. Users simply point and click to select appropriate choices from lists of choices to record a patient encounter. The end result would be a document that closely resembles a transcribed procedure note.
 
Advantages 
Completely customizable templates. The doctor can specify the layout of the template, which helps him to adjust the template as per his practice & procedure.
§    Provide consistent, complete and accurate data. The chances of medical erros are reduced since the data is documented in customised forms.
§    Notes for similar type of exams will appear to be standard and similar
§    Store / organize data for subsequent retrieval. 
§    Each click adds data elements to the database. Point-and-click systems create data that can be used to generate clinically useful reports, such as health maintenance reminders, disease management etc.   
§    One of the major advantages of template based charting is the time needed to make the document available as a medical record. Since notes are created within the EMR, they are available immediately upon completion.

Disadvantages
§    It takes more time, and definitely more concentration for a physician to navigate through large data set and create progress notes using point and click templates. 
§    Templates must be customized as per the physician’s requirement. Customization can be inflexible and costly.
§    Well accepted by only tech-savvy doctors. 
§    The approach of direct data entry by the physician has generally failed because busy providers reject it altogether.
§    Output from these templates is too canned and identical. It loses individuality for each patient. 
§    It is difficult for a provider to capture complete patient encounter on computer in front of a patient.  

Medical Transcription
Transcription has long been the standard for documenting patient encounters. It is more convenient for a provider as compared to handwritten notes or electronic data entry.  There are many advantages of transcription in comparison to point and click charting. There are a few disadvantages as well.  
 
Advantages
 
§    Corresponds intuitively to the physician's usual method of working. Dictation remains the most intuitive and least time-consuming means of data entry.  
§    Physicians can dictate anytime, anywhere using PDA, Dictaphone or telephone at their convenience.
§    Providers need not change the way they practice just to accommodate an EMR. EMR can interact with transcription service so that transcriptions can be attached directly into the patient’s electronic medical record, if such a facility is provided by the EMR vendor.
§    It requires minimal training for physicians. 
§    Provides expressive power to describe patient’s condition and other health related events. 
 
Disadvantages
§   Details of the exam can easily be forgotten and omitted while dictating, if dictation is not captured immediately at the point of care
§   It cannot be queried for generating reports unless transcribed in pre-formatted templates
§   Transcribed reports are not immediately accessible. Physicians would normally have to wait for 12 to 24 hours for charts to be delivered, unless few vendors supporting 2-4 hours short turn around time.
§   Transcription provides for more efficient use of doctor's time.
§   Although average transcribed report costs $2 to $4, it can reduce the doctor's time spent on data entry. Considering the value of doctor’s time, transcription is not a costly proposition.
 
EMR should give the freedom to the physician to decide to use either Point & Click or Medical Transcription. For a physician, the EMR that fits into his practice workflow would be invaluable. A competent EMR must have a template driven charting feature and the ability to interact with a transcription service at the same time. Both are indispensable features of Electronic Medical Record Software, as doctors are not unanimous on point and click charting or transcription. Such an EMR will be both efficient and cost effective. 

The trends in transcription itself are changing with Medical Transcription service providers aiming to adopt new technologies. These technologies will evolve to increase efficiency & accuracy, decrease turnaround time and support data capture. While many of these technologies like such as digital dictation and electronic signature exist today, several technologies are still on the horizon.

I watched a show on MSNBC last night about identity theft.  You probably have seen it.  They follow the chain of theives all the way to Europe and then they cannot even arrest the people. 

About the medical records, the records would not be physically visiting any country, per se.  Once they are in a computer and uploaded somewhere, they are already out there, so to speak.  So, regardless of whose computer they are transcribed on or where that computer is located, the information is still out there.  I know many insurance companies have online access to medical records and some physicians offer that as well to their patients.  You're right, though, they should have asked that question.

This article was part of a reading assignment I had for one of my HIM classes.  It is an old article, but I think MTs can understand this situation quite well.  It just goes to show how quality is becoming decreasingly important in the healthcare industry.

http://www.nurseweek.com/features/99-5/allied.html

BANGALORE -- After seeing patients at the Arizona Medical Clinic in Sun City West, dermatologist Anthony Santos describes their cases on a hand-held digital recorder. Mahesh Barat, Special to the Post-Gazette Parimala Jaggesh is an architect turned home worker in Bangalore. Each day, she receives audio files from doctors in the United States and types transcripts of their case notes for the Pittsburgh-based firm of Acusis Inc. Click photo for larger image. Before going home, he plugs the recorder into one of the hospital's computers. From there, his audio files are encrypted, compressed, shipped via the Internet through Pittsburgh and sent on to this bustling Indian city 9,100 miles away from Phoenix. A few hours later, Santos' words end up in the laptop computer of Parimala Jaggesh, an at-home worker for Pittsburgh-based Acusis Inc., who will type a transcript of his dictation. Santos and Jaggesh have never spoken to each other, so he has no idea that his voice is her favorite among the doctors whose dictation she transcribes. When the Acusis staffers in Bangalore call Jaggesh to ask her to do extra transcribing, they only need mention they have a digital recording from the clear-voiced Santos. "They know how to get work done from me," she says with a laugh. "They say it is Anthony Santos. Then I cannot say no." Jaggesh is one of about 350 home transcriptionists Acusis employs in Bangalore and other Indian cities. The company, founded by native Pittsburgher David Iwinski Jr., has a lofty goal: to become the dominant player in the medical transcription business in the United States, using its cyber-partnership with educated, English-speaking workers in India. Bangalore wakes up as night falls in the United States, so while American doctors sleep, Jaggesh and her colleagues transcribe their dictation. Jaggesh, an architect turned home worker, hits the shortcut keys on her Compaq laptop to insert familiar phrases and consults online reference files when she is stumped by an unusual medical or pharmaceutical term. Her finished work is downloaded to the Bangalore offices of Acusis. Editors there compare every line of her transcription to the original recording, make corrections if necessary, and grade her daily performance. Santos' transcripts are sent back to the Arizona Medical Clinic within 12 to 24 hours after the doctor plugs his recorder into a PC. They can be returned even faster, under two hours, for an extra fee. Faster, more accurate Even though the work is taking place halfway around the world, the result is speedier and more accurate than that done by a smaller local service, which used to take five to seven days to return transcripts, said Terry Daly, the clinic's chief information officer. Medical transcription has a huge potential market of perhaps $12 billion to $15 billion a year. The current transcription companies are fragmented, ranging from small mom-and-pop operations to the industry leader, New Jersey-based Medquist Inc., which employs 10,000 transcriptionists to serve 3,000 health-care providers. Acusis, just 3 years old, considers itself mid-size. The privately-held firm employs about 650 people here and abroad, 460 of whom are in India. The company serves about 40 hospitals and clinics across the country, including Children's Hospital of Pittsburgh. Iwinski's hopes for becoming an industry leader rest on proprietary software written by 50 company programmers in India to manage the nearly instantaneous flow of words from hospitals in the United States to home transcriptionists in India and back again. But it also relies on the cost advantages of Indian employees. The Acusis pay system for transcriptionists, based on volume and accuracy, ranges from 1 to 2 Indian rupees per line. Jaggesh may do 1,000 lines a day. At the average pay rate, that would earn her roughly $27 a day, or $135 for a five-day week -- good wages in India, where the average annual income is about $500. At the Acusis headquarters in Bangalore, each space has a name. A training area is called Gurukul, meaning "abode of the teacher" in Sanskrit. A visitor's room is named Athithi, or guest. Quality control is dubbed, in English, the Potter's Wheel; software development, the Cutting Edge; and startups, the Test Tube. "It's very challenging work," Naveen Janarbhan, a quality control specialist, said as he compared a transcriptionist's work to an original recording of a doctor reciting medical jargon at a fast clip, describing a patient who is a heavy smoker and has a family history of cancer. A mechanical engineer by training, Janarbhan carefully went over the transcript, taking extra care when it came to the medications the physician had prescribed for the patient. 'Concentration is the key' "We have to be careful. Our eyes should be here. Our ears should be here. Our mind should be here," Janarbhan said. "Concentration is the key." He found a few mistakes in the transcription he was editing, all minor and none involving medication or diagnosis. Nevertheless, he called the home Transcriptionist to ask her to be more careful. The system grades each transcriptionist and the results are available to everyone in the company. That peer pressure, according to Iwinski, is "a strong motivator" to do well. The job isn't that easy. Sometimes, doctors are munching an apple or eating lunch while they talk, making them difficult to hear. A nurse interjects to ask about a patient's medication. Papers rumple in the background. The topics can be technical, the jargon heavy. Occasionally, Jaggesh is distracted by music playing in the background of a doctor's recording, the noisy atmosphere of a hospital or extraneous chatting of passersby. But she takes most of it in stride. "It's fun. It's very challenging," said Jaggesh, who likes working in her three-story apartment, which she shares with two sons, two dogs and husband Navarasa Nayaka Jaggesh, a well-known comedy actor in Indian films whose screen name is simply Jaggesh. Parimala Jaggesh works around her family's schedule, taking her laptop with her as she moves from floor to floor, and occasionally typing in a serene rooftop garden overlooking the city. At other times, she works in a top-floor room that contains a figurine of the elephant god Ganesh, thought to bring good fortune. She keeps track of her daily reports, and if her accuracy dips below 96 percent, she studies the file so she doesn't repeat the same mistake. Sometimes she has a bad day, and she gets called by the office. "We do appreciate the feedback. You get a call that you have dropped down in accuracy on one file. Then it's a challenge," she said. "I take it that if my editors find the fault, I should have been able to do it." She enjoys the small personal things that sometimes show through in a doctor's dictation -- a laugh made over a mistake or a spouse in the background trying to hurry things along. E-mail this story  Print this story  Get home delivery of the Post-Gazette - click here for a special offer.		BMW Z3 2.8... $14,500 9th All Ford-powered Car Show. Sun., June... $10 Tahoe '03 White, Grey Lthr, P/roof... $9,900 Navigator '03 Taupe/blk 51k... $23,900 Explorer '04 Sport Trac... $17,951
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The below quote is at least good news for US MTs. Now, if the rest of the hospitals and doctors would get in line, we might have a chance to keep our jobs here.

"Also in 2006, government investigators found that the VA's overseas contractors were handling personal information with lax security and oversight. The VA no longer uses international contractors, Budahn said."

So we're considered a thing of the past, ah-hem!  Here are the 10 jobs. ~

Administrative Assistant
Also known as virtual assistants, home-based administrative assistants use office experience and computer skills as support personnel. Many skills easily transition into this position which offers many part-time and temporary opportunities.

Advertising Sales Agent
It's said that Americans are exposed to more than 3,000 ad messages a day. Advertising sales representatives sell or solicit advertising space in print and online publications, custom-made signs, or TV and radio advertising spots.

Computer Software Engineer
Computer software engineers are projected to be one of the fastest-growing occupations over the 2002-2012 period. Duties include design, development, testing and evaluation of computer software, and continual training is suggested for the quickly evolving industry.

Corporate Event Planner
Employed by a private company rather than a hotel or convention facility, a corporate event planner coordinates staff activities including group meetings, client presentations, special events, conventions and travel.

Copy Editor
Copy editors mostly review and edit a writer's copy for accuracy, content, grammar and style. This is a competitive field; however, the growth of online publications and services is spurring the demand for writers and editors, especially those with Web experience.

Desktop Publisher
Desktop publishers use computer software to format and combine text, images, charts and other visual elements to produce publication-ready material. Duties of this fast-growing profession include writing and editing text, creating graphics, converting photos and drawings into digital images, designing page layouts and developing presentations.

Data Entry Clerk
Like administrative assistants, job prospects should be best for those with expertise in computer software applications. By typing text, entering data into a computer, and performing other clerical duties, these workers ensure companies keep up with information and technology.

Insurance Underwriter
Insurance underwriters serve as the main link between the insurance carrier and the insurance agent. Underwriters analyze insurance applications, calculate the risk of loss from policyholders, decide whether to issue the policy and establish appropriate premium rates.

Market Research Analyst
Market Research Analysts gather data on competitors and analyze prices, sales, and methods of marketing and distribution. They often design surveys, compile and evaluate the data and make recommendations to their client or employer based upon their findings.

Paralegal
While lawyers assume ultimate responsibility for legal work, much of their work is delegated to paralegals. Paralegals not only assist in preparation for closings, hearings, trials, and corporate meetings, they also perform a number of other vital functions including draft contracts, mortgages, separation agreements, trust instruments and may assist in preparing tax returns and planning estates.

I saw an interesting article on line from the local Rochester newspaper about captionists.  They are people who assist with deaf students in helping them take notes in class.

This is a brief side box from the article:

http://www.democratandchronicle.com/apps/pbcs.dll/article?AID=/20060329/NEWS01/603290337

NY TIMES today stating that not only is Dell's tech dept over in India but they are now opening up manufacturing plants in India to make Dell computers there.

See article in its entirety over at the offshoring concerns forum here....at mtstars.

Been a DELL diehard for 7 years and also an HP printer diehard person for 11 years. 

paper about increasing car sales in India.  The Indian people are enjoying higher wages and are now able to purchase cars.  Car makers are scrambling to get pieces of this new, juicy pie. 

I wonder how long it's going to take before sending our work to India is not cost effective for the MTSO anymore.  The Indian MTs won't be able to live on their 2 cpl anymore and will need more, and more.  It's going to be interesting to see this evolve. 

There's hope for us!

outsourcing (their wording) work to India.  The contractors in India are now outsourcing the work to other places in India.  They figure if  we (the US) can outsource American work to India, why can't they outsource the work also.   Your medical info is going to be as private as if you took out a billboard and posted it there. 

A three-year-old boy was struck by a vehicle and killed early Monday after wandering away from the Gwinnett County condominium where he was staying.

Gwinnett County police spokesman Darren Moloney said Anthony Lloyd Oscar Littrean was staying with family friends at Olde Mill Crossing complex off Graves Road while his mother was hospitalized giving birth to a sibling.

Officers responding to a 4:30 a.m. report of the missing child found Anthony on Graves Road, across from the complex, Moloney said. He had been hit by a southbound vehicle.

Anthony was taken to Children's Healthcare of Atlanta at Scottish Rite, where he later died, Moloney said.

"They child was staying with family friends while the parents were at Northside Hospital," Moloney said, adding that Anthony's mother gave birth early Sunday morning.

Moloney said investigators believe the child "defeated the locks at the apartment he was staying at."

"When the family friends became aware the child was missing, they immediately began to search and called 911," Moloney said. "At this time, there is on indication of criminal neglect on the part of the child's caretakers."

He said Gwinnett police were "asking for help from anyone who might have been traveling down Graves Road toward South Norcross Tucker Road, away from I-85."

Moloney asked that anyone with information on the accident call 770-513-5048.

"Our investigators want to stress that it is possible that a [driver] struck the child without knowing exactly what they did," Moloney said. "It's possible a person struck the child without even causing damage to their car."

my ShortHand would type only the first letter of an expansion and then take all the letters away!  I checked and the Type It button is grayed out!  I have restarted the computer and looked on the Shorthand Help menu but can find nothing that applies.  Can anyone please help me ASAP?  I am lost without it!  TIA

they are no longer interested in entering this field.  In fact, their mouths about drop to the floor.

Having another American MT is not going to save another American job.  They will send their work offshore if you are living next door and can do a 4-hour turnaround, just because the price is lower.

I'm getting out also, only doing part-time now and probably won't be doing part-time much longer.

Ah, thanks for clearing that up for me. All this happened before I started. New employees are probably not aware of it, like me.

I probably got myself on the $hit-li$t now, but that's okay for something I did today to see any reaction.  It wouldn't be the first time I've been on the list and probably won't be the last.

I will stay, though, as I really do like working for them...and I like the work..

Ah, thanks for clearing that up for me. All this happened before I started. New employees are probably not aware of it, like me. This breaks my heart.

I probably got myself on the $hit-li$t now, for something I did today to see if there was any reaction, but that's okay. It wouldn't be the first time I've been on a list and probably won't be the last.

I will stay, though, as I really do like working for them. I like the work, and really don't have much of a choice anymore.

I think if these companies are going to offshore, they should send the work from the ESL's that can't speak English correctly. That work should be easy for the offshore companies for them to do.

I need some Positive Proof that offshoring is occurring.. .will help in our hospital's fight against outsourcing all of us..  thanks

I agree.  I am also wondering where they are making out on this deal.  I have lost 5 Docs due to outsourcing to India.  They are not making out in the end.  They just think they are.  It is such a shame that the US Transcriptionist is the one that are suffering because they do not know what they are doing.  Maybe they should have asked one of us to do the math and we could have showed them that they are not making out.  Also, you have to take in consideration that all these people's(patient) records are going over to another country.  I bet they would have something to say about that.  It is such a shame that someone thought they were going to save a buck and did not do the math, and now we are the ones that are being hurt.