Hospital-record outsourcing raises privacy, safety fears

A Vancouver man who transcribes medical records for a living says patients have reason to worry about the privacy and accuracy of their medical information.

Donan Forde says that’s because all dictated reports by hospital physicians in B.C.'s Lower Mainland will soon be transcribed by private contractors, accessing and working on records from home.

“I think it should remain in the hospital — not in someone’s living room or kitchen or den,” said Forde, who has worked as a medical transcriptionist for 14 years, both in hospitals and as a work-at-home contractor.

“For five years I worked in the private sector and not once did anyone come and check to see if my home computer was password protected to see if I had a working environment that was private — not in five years.”

Forde said he’s also worried about the accuracy of reports done entirely by private transcribers, because they are paid per report, instead of per hour.

“[Working for a private contractor] I will just get through as many reports as quickly as I can — trying to make a buck,” said Forde.

Currently, many of the records generated by doctors in hospitals are transcribed by staff working in secure locations. Most of the 130 unionized transcriptionists will lose their jobs when the outsourcing happens this fall.

Forde said he’s not against outsourcing per se and he doesn’t speak for the union. He said he simply thinks contracting out all medical transcription services is too big and too risky.

“This is about to explode,” said Forde. “Who pays in the long run? It will be the patients. Because the reports that come out will not be accurate. They will not be a true reflection of what was dictated.”

“The difference between the technology and the labour combined will save our health system over $3 million a year,” said Yoel Robens-Paradise of Providence Health Care, who is in charge of the outsourcing project for the four health authorities in the Lower Mainland.

“That money goes back in to care delivery.”

Robens-Paradise points out that half of the medical transcription work in the region is already contracted out, and he said those reports come back faster than reports done by staff. Once the contracted work is edited, he said, the final product is just as accurate.

However, Forde claimed many of the reports currently done by private transcribers come back with numerous blanks and mistakes.

“Reports come in now [from private contractors] with incorrect medications…These things have to be corrected by in house staff,” said Forde. “It affects patient care. It affects the quality of patient care.”

On the privacy issue, Robens-Paradise said the health authorities can monitor which records private transcriptionists access on their home computer, electronically, in real time.

“We’ve had millions of minutes of dictation transcribed over the past six years from home and not had a [privacy] breach,” he said. “[The companies] have very elaborate systems to manage passwords and authentication.”

He said a small number of transcriptionists will be kept on staff, to audit work done by the private company. He indicated the contract will be awarded soon, to one of two shortlisted companies.

“Turnaround time and savings of money — we can improve both by outsourcing,” said Robens-Paradise. He also said the technology will be amalgamated, streamlined and upgraded by the contractor.

Although the health authority said it’s heard no concerns from doctors, four physicians contacted by CBC News said they share Forde's worries about accuracy. Neurosurgeon Dr. Mark Matishak was one who agreed to be interviewed.

“It may affect the quality of the reports,” said Matishak, who works at Royal Columbian Hospital. “If you get too many mistakes and then some mistake can translate into medical mistakes — and then that may result in an impairment on patient’s care.”

He said he’s already seen transcription errors that led to patients getting the wrong medication.

“And then they get the medication with disastrous complications or consequences,” said Matishak. “They’re trying to change a system that’s been working well for saving money but it may not actually be more efficient — so it’s a worry.”

There are reports in the U.S. of major privacy breaches by companies that do medical transcribing. In two separate cases, reported in 2010, hundreds of patient records were mistakenly posted on the web.

In one incident, 1,744 sensitive records were available on a company’s website for 10 months. In the other case, more than 1,000 patient records on the server were accessible through the internet, for a period of two years.

Robens-Paradise promised the B.C. health authorities will choose the best company with the best record for retaining staff and managing records.

He pointed out that transcribing is increasingly being done by voice recognition software, which will eventually eliminate the need for transcriptionists. He said health authorities simply can’t afford those systems.

“We want to leverage the technology. And these companies have the latest, greatest technology,” said Robens-Paradise.