By Paul Watson
The Chicago Tribune
MANILA, Philippines — It started out as just another Thanksgiving Day stomachache, a nagging pain that sharpened until it reverberated from California halfway around the world.
When the ache in her lower abdomen became excruciating, the young woman was rushed to a surgery center, where the doctor diagnosed a ruptured appendix.
The woman needed an operation — fast. But before the surgeon could wheel her into the operating theater, he had to find out whether the patient’s insurance company would pay. That meant paperwork: A report had to be dictated, typed up and submitted to her insurer for approval.
So while the woman waited in agony, her doctor dialed a toll-free number.
The instant he hung up a few minutes later, a digitized recording raced through fiber-optic cables on the Pacific Ocean seabed and into a computer server on the 17th floor of a Manila office tower, where medical school graduate Dinah Barrete was working the graveyard shift.
Headphones plugged in, she tapped a pedal to start the doctor’s voice file and began typing. Her transcription of his report was on its way to him via the Internet in 15 minutes, as quickly as if the work had been done just down the hall, but much less expensive.
So goes the global traffic in Americans’ intimate health information.
In a startling illustration of the life-or-death decisions involving low-paid workers thousands of miles away, Americans’ most personal details move 24 hours a day as U.S. health-care providers outsource billions of lines of transcription work each year to Asia in a bid to cut the cost of medical bureaucracy.
“It’s a cyberspace miracle every time it’s done,” said Fred Kumetz, founder of EData Services, one of the biggest companies transcribing U.S. medical records in the Philippines.
From dictated summaries of checkups to complete recordings of conversations between surgeons and nurses in operating theaters, foreign workers are transforming the digital audio files into the documents that tell Americans’ medical histories.
Most of the work is done for 10 to 15 cents a line in less than 24 hours. But the cost can be 300 times that for immediate orders, such as when a doctor needs a transcript of an emergency medical team’s radio report before its helicopter lands with a patient.
Regardless of the price, the process is largely the same. Audio files dispatched across the Internet are transcribed and the text is fired back to the U.S. to meet government demands for a shift to electronic medical records.
Before broadband connections made it easy to outsource office work in the 1990s, Americans typed out medical records, and the cost of health-care bureaucracy steadily ballooned.
Now thousands of low-paid workers in countries such as India, the Philippines and Pakistan work in offices that never close.
Tapping feverishly at keyboards, Asian transcriptionists often strain to understand what American doctors have dictated through phone lines or into digital recorders.
Other typists work under similar pressure to keep up with the demand to transfer decades-old medical documents into computer files.
The business of transcribing medical files employed 34,000 Filipinos and generated $476 million in revenue last year, said Ernesto Herrera, who heads the Trade Union Congress of the Philippines. He expects the number of transcriptionists to more than triple, and annual billings to jump to more than $1.7 billion, by the end of 2010.
“Outsourcing is unavoidable because the cost in the U.S. is just too high,” Herrera said. Filipinos can beat Indians in the race for U.S. medical transcription work because, as a former American colony, the Philippines is more familiar with American accents, Herrera said. This country also has a vast pool of jobless medical workers who need little additional training to take dictation from U.S. doctors, he said.
“Right now, we have about 400,000 licensed nurses who are unemployed in the Philippines,” Herrera said.
Transcript editors are usually doctors, who sometimes pick up errors in American physicians’ dictation, even what they suspect are misdiagnoses, as they check for typos. Unless clients give permission to correct mistakes, they stay in the text, to make sure the transcript is verbatim, said Danilo Navarro, executive vice president of Xynet Communication Solutions Inc., which transcribes about 4 million lines of American medical files a month.
Outsourcing isn’t expected to harm job prospects for American transcriptionists because there is so much work to be done, said a report by the U.S. Bureau of Labor Statistics. About 101,000 Americans were employed as medical transcriptionists in 2002, according to the bureau.
Even if new technology automates more transcription, Navarro said, there is a backlog of about 40 years of paper American medical files to be typed into computer files.
Copyright 2009 Chicago Tribune Company