Overseas Outsourcing of Medical Transcribing - 2GB interview

There's many problems here I see. Firstly, what about privacy issues?

I mean, don't we believe that our medical history remains in the confidential surrounds of our doctor or the hospital that has treated us? And what about the language barrier? Can we guarantee that exact detail is being translated by those who may not normally speak English?

I don't know. I think a lot of questions have to be asked. Joining me on the line is the president of the AMA, Dr Mukesh Haikerwal.

Good morning to you, Doctor. Good to talk to you again.

DR HAIKERWAL: Good morning, Luke. How are you?

LUKE BONA: Good. Is this the first you've heard of this?

DR HAIKERWAL: No, I mean, we know that many things are now done in a global network. So whether it's reading the X-ray reports or whether it's … transcribing transactions in the bank or indeed these medical transactions, they're certainly going on.

What we need to do, however, is ensure that we go back to basics. Number one, you're right. What takes place in the consulting room has got to be confidential, and got to be secure. And that's the discussion we had around the access card, if you remember.

The access card, having information, has got to be secure. And we've got to have confidence in it. So we're trying to build up in Australia a whole network of security around these things. So today, if the doctor has a computer and writes you a note on the computer, all that information is there.

But actually, if we're trying to send it to a specialist, we're trying to send it to a hospital, we can't do it - even at those few kilometres down the road - because the environment we have is not secure.

We can't encrypt our notes to send them down the road to say "here's a letter about this person, and here, off you go". So we actually have to print out a letter and fax it, because a fax, even though it's open, is supposed to be more secure. But you've got a fax cover sheet on.

LUKE BONA: How many hospitals are sending our records overseas to be typed up?

DR HAIKERWAL: Well the numbers, we don't really know.

LUKE BONA: What do you reckon?

DR HAIKERWAL: Well I would imagine it's an increasing number of hospitals. And the reason for that is, they're trying to downsize the medical administration within the hospitals.

LUKE BONA: How can we be absolutely sure, guaranteed, that what our doctor, he or she wrote, in the report is actually being translated correctly?

DR HAIKERWAL: Well I mean, the same errors in transcription would occur whether the transcriber sits here or sits in Perth or sits...

LUKE BONA: No. This is going overseas to the Philippines. Surely those risks are increased unbelievably.

DR HAIKERWAL: Well the risks will be increased because of the quality of the recording, the quality of the decoding at the other end, the person at the other end. But that comes back to basics. If you're sending your work out, wherever you're sending it to be transcribed, you've got to be assured, first of all, that's a secure environment, that confidentiality is maintained. And when it comes back to you, you check it.

So they're very important parts of that process. But you know, it's important that we do have a secure environment in Australia to be able to send our own information from hospital to hospital, from hospital to specialist, and from specialist to GP, which currently doesn't exist. But of course, we're trying to make sure that we do provide that secure environment, so that people do get that information and can do it in electronically, so that you don't have to transcribe it into a letter.

And so the letter then doesn't have to go off and be typed and then sent back in. And we're looking at very old technology, really, if we're looking at having to type letters and send them back.

I don't think we've got the whole three inches of somebody's medical file going to and fro on the Internet. What we've got here is, you know, recordings of a conversation, which needs to be transcribed as a letter or recordings of findings in a hospital admission that needs to be transcribed into a letter and sent out.

Nonetheless, it's got to be confidential. We, the public, have to be confident in it. We've got to make sure that confidentiality is maintained throughout this whole process.

And indeed, these very important key privacy concerns you mentioned are vital to this whole process.

LUKE BONA: You don't have a problem with this, then?

DR HAIKERWAL: I have a problem if it's not done in a confidential way, if the privacy is not maintained, if the letters are not checked - that's also not correct - and what we're seeing, unfortunately, is a lot more outsourcing.

And I suppose it's unfortunate, because we should be able to do some stuff within rather than without; and we need to make sure that the IT environment that we have actually allows us to share that information within Australia, within our suburbs. And we can't do that because, you know, the encryptions required to make sure the information sent on the Internet is secure, isn't currently widely available, widely used.

LUKE BONA: How much cheaper is it?

DR HAIKERWAL: The cost of doing this electronically, compared to having somebody here, would obviously vary on the size of the letter. But obviously, there are cost savings; otherwise it wouldn't be done. And I suppose there may be some efficiencies in time. Because if you finish your work at six o'clock in Australia and send it to somewhere else in the world where it's several hours earlier, you go back to work in the morning and it's done, rather than waiting for the whole process to start the following day.

LUKE BONA: All right. I think there'll be a lot of my listeners that may have a problem with this. Maybe not. Maybe I'm reading it incorrectly. Doctor, I thank you for your time. You're always very available. And I know it's Sunday morning. I'll let you get back to your family.

DR HAIKERWAL: Thank you.

LUKE BONA: Dr Mukesh Haikerwal, who is the president of the AMA.

I mean, were you aware of this? I mean, there are a couple of serious issues to be addressed. I mentioned privacy. Surely this breaks any code of confidentiality between doctor and patient. And how can the hospital or doctor be guaranteed that he or she... what he or she wrote in the report is being translated exactly.

Dr Mukesh Haikerwal said, well there... you know, reports could be sent to Perth or Adelaide.

Now, I don't wear that. These reports are being sent to the Philippines. I think the chances of the translation not going ahead correctly are multiplied unbelievably, but most... that's just me.