Unison condemns offshore medical transcription

Tags: Government iS Outsourcing South

22 Jun 2006

NHS trusts that outsource the transcription of medical notes to South Africa, the Philippines and India received a sharp rebuke from health union, Unison, yesterday.

General secretary, Dave Prentis, speaking at the union’s annual conference this week, condemned the outsourcing as “a very dangerous practice.” The union has accumulated anecdotal evidence of potentially life-threatening mistakes made by overseas transcribers, including:

• confusing "hypertension" (high blood pressure) with "hypotension" (low blood pressure);

• confusing "A septic" (infected) with "aseptic" (not infected);

• mixing up "15mg" and "50mg" drug dosages.

Confidentiality is also a concern when notes are sent to countries that do not have the kind of data protection laws that operate in the European Union.

The issue of processing data offshore was raised earlier this year by Connecting for Health (CfH) chief executive, Richard Granger, when he expressed the view during a round table discussion in India that the lack of a regulatory framework for processing personal data in India was a constraint on the country’s large players.

He was quoted in the Economic Times of India as saying that the NHS had not crossed the line in terms of data being processed offshore and that data would not go outside the European Union until there is a regulatory framework in place.

Unison’s protest appears to relate to data processing outside CfH’s areas of responsibility. The union says that transcribers in South Africa, the Philippines and India are paid to transcribe NHS doctors' dictations - but do not have the benefit of supporting medical notes, letters and prescriptions against which to check the accuracy of their transcriptions.

"It's beyond belief," said Prentis. "It does not improve the service and the health and welfare of patients is being put at risk. Look what happened to hospital cleaning when it was privatised - a 50% increase in infections. The government needs to rethink this off-the-wall idea."

In addition to concerns about accuracy and confidentiality, the union says medical secretaries' jobs are being put at risk. It cites the case of East and North Herts NHS Trust which, it claims, has issued redundancy notices to 160 medical secretaries, asking for 58 volunteers.

"With more staff and an unknown technology there is greater scope for error," said Unison head of health Karen Jennings.

"All the government is doing is looking for a cheaper workforce - yet it's doctors and medical students in these other countries that are being used to do the transcriptions."

Prentis added: "Medical secretaries in the NHS work to 99.8% accuracy targets and once 'phased out' their knowledge and expertise will be lost forever."

James Fellowes, managing director of Dict8, a medical transcription firm that uses only UK medical secretaries for its service, said he was pleased to see the subject had been raised. “You can’t compare the skills of people who have worked in the NHS as medical secretaries for a long time with people who are offshore,” he told E-Health Insider.

Readers Comments

Ahh for the good old days

22 Jun 06 13:10

. . . because NHS Medical Secretaries *never* made such mistakes and turned around dictations much faster than these offshore agencies.

Or maybe I'm looking back through rose-tinted specs and this is another protectionist attempt to keep the NHS's business processes in the labour-intensive 1950's.

I sometimes despair!

Change is inevitable- it is how you mange it

22 Jun 06 16:21

I think that change is inevitable- and outsourcing of medical transcription is a part of that. The question is whether the change results in a reduction in the quality of service or not. Whilst it would be best if transcription could stay inside of the hospitals, this will not occur due to the cost pressures and long turnaround times that have become commonplace. Sending work out of the country strikes me as not being a great option (I know what it is like when I ring a call centre that is abroad- and I would not want that type of service on my medical typing!), I am also not convinced that it will be particularly cost effective as there would be a need to check all of the letters back at the Trust, which would require more staff! The concept of outsourcing it but keeping it in the UK seems to be the best compromise, as long as it is typed by proper medical secretaries and not just temps and medical students!

Not just protectionism

23 Jun 06 09:12

Medical Secretarial staff working alongside clinicians fill in in so many ways for them, including reminding about "that result that just came in which you forgot to mention", fielding calls from patients and carers, turning rushed commands into meaningful texts.

Like so much outsourcing, it may do the basic job, at variable quality. Wouldn't it be good if we empowered the NHS staff with decent systems to make their workflow better.

With Voice Dictation systems, the throughput can go up very significantly, and 'on-the spot' troubleshooting secretarial/clerical staff are still a valuable asset.

If it is "Doctors and Medical Students" doing the work in the developing world, then we are further depleting the capacity to deal with their own population. Which is pretty poor too.

Data leaks from the weakest points

23 Jun 06 10:04

We all debate about privacy and confidentiality within the new NHS computer systems and yet at the same time we send that same data to countries not covered by our data protection regime. The ONLY reason for sending the data there is because it is cheaper. But it's common knowledge that id theft and breaches of confidentiality usually occur at the weakest points in a chain.

The financial sector have know for years that the weakest link is usually the outsourced offshore operation, because the pay is so low. It's just plain stupid to send this data to such places and it makes a mockery of the whole privacy debate. We might as well make Yahoo or Google the master patient record store and let everybody access it for free from anywhere!

Poorly Paid Medical secretary

23 Jun 06 12:46

Difficulty in recruiting Medical Secretary in London is the main reason for off shore dictation services. Agreed with "Not Just Protection" Medical Secretaries do more than just typing letters and dictations, they are fully engaged with the patient of his/her consultants

Failure of management

23 Jun 06 13:53

I tried to introduce external typing into a Trust shortly to hit the headlines for making secretaries redundant. That was 4 years ago. The secretaries at the time were inundated and welcomed the chance to lose some of the typing work to increase their PA style work. However, due to a complete lack of management imagination the project rapidly died; instead we recruited more secretaries who are now to be made redundant in swingeing cuts. Working in a system where planning runs in cycles of election/2 (ie expand before and contract after an election) is not a way to run good, or economic, health care. I predict that in 2-3 years we will be expanding again. Watch and see if I am wrong.

How did they get the data ?

playpaddy@yahoo.co.in

23 Jun 06 15:36

The very fact that the Unions got hold of the recorded examples shows how secure the data is within that organsiation where they got it from.

Now please dont tell me that they have paid someone in a third world country to get hold of the records. I often find the argument people in third world conuntry will do anything for money very repulsive.

Quality matters and not location...

28 Jun 06 18:18

It is really very foolish to make a general statement that Medical Transcription work done in India are of poor quality while those done in US or Britain are perfect. Regardless of the location of work, a medical document has go through different levels. First, the basic transcription/typing by a medical transcriptionist, then proofing at different levels by experienced/experts including medical doctors. If the number of levels of transcription/proofing/checking are decreased or if it done by inexperienced people, definitely there are going to be errors regardless of the country. It should be also remembered that Indian Medical Transcriptionists use American/British softwares (Quicklook, Stedmans) and American/British reference sites on internet to verify the drug name or dosage (like 15 mg or 50 mg). Error of mistaking hypotension with hypertension will be done only by inexperienced ones, experienced ones will definitely search previous medical records of patient and look for other things like the value of blood pressure in the dictation. So be it any place, inexperienced make mistakes, but not the experienced ones. One should not compare an inexperienced Indian MT with an experienced MT of US. At last, there are dictators who dictate clearly (even those who spell out the spelling) and other careless dictators who may dictate while chewing a buble gum or dictate with their TV running loud in the background. So ultimately, it is not the location that matters, but medical transcriptionists and doctors, who are experienced and care for quality !!

You get what you pay for

29 Jun 06 08:28

In every market the price of goods vary for any item. The quality depends upon the price you pay. So is the case of Medical Transcription in India. If you go for low rates it is obvious that you will get something like "hypotension" in the reports.

There are players in India who demand more rates and you obviously get what you pay for. Why blame all for that.

Medical Secretaries ..more that just typists!

01 Oct 06 15:23

I work as a Medical Secretary in a large teaching hospital in the Midlands. Our Trust is significantly overspent and the first round of redudancies are imminent. Medical Secretaries will be no more. A few lucky secretaries will be given PA jobs, but the majority will be down graded to clerk typists at a significant reduction in pay or be made redundant.I understand that the Trust I work in are not keen to outsource the typing, but ultimately no secretary worth her salt will want to remain in a typing pool and I suspect that there will be a mass exodus of typists! Whilst I agree that NHS Trusts do have to make significant changes to be more cost effective I think that losing experienced medical secretaries will be detrimental to any NHS Trust and although will not affect front line patient care per se, it will affect the patients adversely. I do wonder how long it will take for the Trust to realise what a big mistake they are making!

Outsourcing is great

07 Oct 08 05:33

I work in this area, and because all these centres in India and Philippines use local doctors and nurses to do the transcription, it saves lives in the UK. For a fact I have seen the mistakes above made by UK Doctors, but beacause doctors here know that this would not be correct dosage or is something strange, they underline or highlight this back to the UK. Not just typing, these people check the sensibility of the work, and increasing they are picking up more and more mistakes made by UK Doctors and Nurses. In many case the wrong dosage, in other cases it is the wrong medicine. Lives have been saved because of oursourcing.