MANILA – It started out as a 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.
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.
From dictated summaries of checkups to complete recordings of surgeons’ conversations 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. 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, Americans typed out medical records.
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 transfer decades-old medical documents into computer files.
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.
