Wednesday, September 19, 2007

Happy Entrails To You

The proverbial “you-know-what” has finally hit the fan. In mid October, the San Francisco Chronicle’s business columnist, David Lazarus, reported an incident in which a subcontractor in Pakistan (purportedly a doctor) who had not been compensated for her work as a medical transcriptionist threatened to place the medical records of several UCSF patients on the Internet unless she was paid.

It was interesting to see how quickly the news of UCSF’s dilemma spread. Normally buried in the print edition’s business section, the story hit the top of the morning’s news at the website. As links to the article were posted on medical transcription websites, and forwarded from one reader to another in emails, a news item which didn’t necessarily get picked up by Associated Press or other newspapers, spread like wildfire.

Following the firestorm that erupted after disclosure of how someone’s medical records had been subcontracted from UCSF to a transcription service in Sausalito that subcontracted work to a medical transcriptionist in Florida (who subcontracted work to another transcriptionist in Texas, who then sent the work offshore to someone in Pakistan), California State Senator Liz Figueroa announced plans to introduce a new privacy bill that will prohibit anyone possessing information involving California patients from sending that information abroad. While it gives me little solace to remind people that readers of this column have consistently been warned about the perils of sending work offshore, it should be noted that medical transcription was one of the first white collar industries to be sucker punched by the overseas outsourcing phenomenon.

David Lazarus has since run a series of follow-up columns in the San Francisco Chronicle explaining how major corporations like SBC Communications are planning to send work offshore. He even wrote about certified public accountants who are sending their tax preparation work (that contains people’s Social Security numbers and financial information) overseas as well as Bank of America’s plans to use offshore labor – and its assertions that doing so would in no way endanger the financial privacy of its clients. A subsequent letter to the editor didn’t hesitate to point out how BofA had already bungled some payroll privacy issues while outsourcing work.

What I find acutely perverse about this situation is that, following the 9/11 catastrophe, Osama bin Laden made it clear that one of his goals was to destroy the American economy. I’m trying to resist a wave of cynical paranoia about identity theft, but is it too much to suggest that sending everyone’s financial data overseas could transform some American corporations into the biggest fools on the planet?

Following the strangest recall election in California history, there can be little doubt that change is the wind (and not just because 2004 brings us another Presidential election). State Senator Shirley K. Turner’s anti-offshoring bill S1349/A2425 unanimously passed the New Jersey State Senate this summer but has subsequently been held up in committee. “Having heard from thousands of individuals who have lost their jobs due to outsourcing, I am more determined than ever to see my bill become law,” Senator Turner stated in a recent email. “While I realize that it will have only a small effect on jobs sent overseas, I still believe that it is sending an important message that such practices must be stopped.”

With newspapers predicting a jobless recovery for the American economy -- and Americans waking up to the rude concept that once jobs go offshore they do not return – the media has finally begun to focus its attention on the hidden costs of offshoring. The September 1, 2003 issue of CIO magazine ran a major article stressing the potential backlash against firms that send American jobs offshore. Some economists note that the more high-paying jobs we lose to offshoring, the more purchasing power Americans lose in their efforts to keep the economy alive.

As more and more high tech jobs have headed overseas, displaced workers have used websites such as and as a way to organize and gain political power.There’s an important lesson to be learned here – which is that whenever a vendor tells you too many good things about his product or service, there is a chance there’s a vital piece of information he’s not sharing with you. It doesn’t matter whether the vendor is trying to sell you on the low costs of offshoring, the use of back office speech recognition, or the need to go to war. You should always take some time to perform due diligence and question authority before you sign the check.

Don’t just respond to the nifty claims and testimonials in the marketing presentation. Ask some hard questions about process, costs, liability, and legality. You might not make a lot of friends that way. But, further down the line, you might be glad you covered your tracks. If you don’t believe me, ask the folks in Washington who just signed off on an as-yet vaguely defined $87.5 billion expenditure.

Doctors and vendors are no different from politicians. They’re human and are often motivated by greed. I recently got a notification from a physician telling me I was due for another colonoscopy a mere eight months after I had gone for a ride on his garden hose. Was his record keeping that sloppy? Or was he trying to boost his year-end income? Having changed HMOs, I’m not all that interested in finding out. Having received a clean bill of health earlier this year (with an assurance from this particular physician that I won’t need another colonoscopy for five years), I doubt there have been dramatic changes taking place inside my colon.

However, several timely changes are transpiring within the medical transcription industry. AAMT has a new Executive Director (Peter Preziosi, PhD, CAE) who has a strong background as a healthcare activist. I’ve spoken with Peter -- who understands some of the challenges facing medical transcription as well as the need to shed AAMT’s tired image as a ladies garden club and transform it into an aggressively activist organization that can put the “American” back in “American Association for Medical Transcription” – and think that some testosterone at AAMT’s helm will do the organization a world of good. Meanwhile, Molly Malone, who has been Executive Director of MTIA for the past seven years, has announced her plans to retire after next spring’s annual conference in Reno.

Now it’s time to announce another change. Having written more than seventy Transcription Trends columns, I’ve decided to step down and let someone else pick up the torch. During the four years that my writing has appeared in For The Record magazine, I’ve pretty much said all I have to or want to say on the topic of medical transcription. As 2004 looms on the horizon, I look forward to pursuing some personal goals without the nagging sensation of a deadline on my mind.

I want to give special thanks to the two editors I’ve worked with at this magazine -- Kate Jackson and Lee DeOrio -- and explain to readers of this column why these two have been such a joy to write for. First, there has been very little meddling with text (which is an important consideration for any columnist). Second, Kate and Lee have shown exceptional courage and fortitude in the face of irate advertisers whose delicate egos have been provoked by some of the statements I have made in my column.

In an age where corporate communications have evolved into the art of getting your company’s press release to appear verbatim in a trade publication (and where some magazines lure vendors to their pages with the promise of an editorial puff piece as part of their “new advertiser’s package”), publishers struggling to stay afloat in a sagging economy are justifiably fearful of losing any advertising revenue. Publishing overt and sarcastic criticism of industry policies and practices can be a costly move that readers often do not understand. But that’s the price you pay for freedom of speech -- even in a field like healthcare information management. That’s why I want to salute these editors for their integrity and willingness to take risks. Having recently sent a friend a T-shirt that states “My Dog Ate The Weapons Of Mass Destruction,” I only wish Kate & Lee’s counterparts in the increasingly corporatized mainstream media were as bold and adventurous.

My operatic column Tales of TessiTura, ran for 15 years in San Francisco's Bay Area Reporter. As I bring down the curtain on For The Record’s chapter of my writing career, I can think of no nicer sentiment to close with than Carol Burnett’s immortal refrain: “I’m so glad we had this time together......”

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