Many healthcare providers opt for offshore transcription to take advantage of lower labor costs and the time zone advantage in other countries. However, many providers felt the option as a double-edged sword in the mid 2000s as data quality deteriorated with low paid outsourced workers. Quality became compromised as the transcription industry faced a shortage of workers and there was increased pressure for quick turnaround times. Even the integrity (PHI) was breached by workers overseas who had little reason to show loyalty to the healthcare entity. Now, providers can heave a huge sigh of relief as concerned authorities including the federal government, American Health Information Management Association (AHIMA) and Association for Healthcare Documentation Integrity (AHDI) have adopted strict measures to address the problems in foreign outsourcing.
AHIMA and AHDI Measures
AHIMA published a list of questions for healthcare professionals to ask transcription companies that would help them determine whether their data would remain secure even when the transcription work is done overseas. AHDI released a Manual of Ethical Best Practices for healthcare documentation organizations in 2010 that guides transcription businesses on ethical practices and other important matters. The manual also guides how transcriptionists are to deal with requests that are unethical and violate policies or compliance. Now, the AHDI is acting as a disciplinary organization that oversees healthcare documentation. Not only does the organization establish industry requirements, but also strives to improve the protection for patient healthcare records through legislation.
Two Key Laws
The major turning points that resulted in stricter regulations of the transcription industry were the strengthening of the Health Insurance Portability and Accountability Act (HIPAA) and the passage of the American Recovery and Reinvestment Act (ARRA). While the Title II of HIPAA insists upon setting up national standards for electronic healthcare transactions, the ARRA established nation-wide adoption of clinical information systems including electronic health records (EHRs). These new directives helped generate ethical guidelines for the transcription industry that introduced user identification safeguards and audit control when business partners accessed electronic records that were stored in secure data centers. This helped to enhance security and provided more control over how home-based transcriptionists could access PHI.
Importance of a Well-written Contract
Though there are several security measures in place, it is up to the healthcare provider to follow the relevant guidelines and adhere to security policies. The important thing is a well-written contract that describes all specific requirements and expectations while negotiating an agreement with a medical transcription service organization. The most important considerations are terms, pricing, remedies, indemnification and cancellation provisions which are followed by a detailed breakdown of service levels including turnaround times and quality assurance levels. Review the companys contract with your legal department to see whether every detail has been addressed and what would happen if anything doesnt go as planned.
Build strict safeguards and severe penalties into all contracts along with the right to inspect at will as well as periodic audits to ensure compliance. Include strong financial penalties and for cause early termination clauses in the contract if it is necessary to keep the PHI onshore a priority. The other things to consider are as follows.
Preclude the use of offshore services when appropriate
Forbid subcontracting without your prior approval and knowledge
If you have approved subcontracting, establish limits to transmitting your patient information across U.S. borders
Require indemnification from the vendor and any of its contractors when there is a confidentiality breach
All confidential PHI must be kept within the United States
Get a list of assigned team members and their credentials from the vendor and make sure that the reports are transcribed by these members
Make sure that contract contains content that supports termination for cause and no cause
You should carefully evaluate your potential transcription partner looking into their reputation, the number of years they are into the business, expertise in the specialties and the ability to contractually agree to service-level requirements before negotiating an agreement.