More and more U.S. industries are saving money by outsourcing work to foreign companies, and healthcare is no exception.
In response to concerns that confidential medical information sent overseas is not fully protected, Illinois physicians attending the annual American Medical Association's House of Delegates meeting in Chicago introduced a resolution calling on the AMA to adopt a policy stipulating that medical data processed by offshore companies be subject to the same privacy regulations that apply to U.S. physicians.
Specifically, the resolution stated that "the outsourcing of medical and financial information outside of U.S. jurisdiction should meet with Health Insurance Portability and Accountability Act regulations for the appropriate licensing of individuals providing services."
On Tuesday, the resolution was referred back to the AMA board of trustees for further study, and Champaign, Ill., neonatologist Nestor Ramirez, M.D., was pleased that the issue will go forward.
"There's a lot going on with radiology, transcription and lab results going overseas, and there has been some concern that this information has been misused," Ramirez said. "This is not information going to Alabama for a patient in Georgia, this is going across the ocean."
Richard Peer, M.D., a Buffalo, N.Y., surgeon who chaired the AMA legislation committee that reviewed the resolution, said there were "technical issues" with the measure that need to be clarified, such as licensing authority and existing regulations regarding business associate agreements.
Nevertheless, this is not the first time organized medicine has reviewed the issue.
In March 2004, the American Health Information Management Association, the California Health Information Association, the American Association for Medical Transcription and the Medical Transcription Industry Alliance issued a joint position statement saying that legislation prohibiting or encumbering outsourcing could lead to disruption of patient care, loss of accreditation and interference with payments.
The statement, which included an estimate that less than 10% of medical transcription is outsourced overseas, also called for improved due diligence in establishing and monitoring outsourcing contracts, identification of areas where HIPAA regulations need to be improved, and punishment of those who violate rules.
In May 2004, the American College of Radiology adopted a statement calling for strict standards on the interpretation of radiology images outside the U.S., including that physicians who interpret images by teleradiology should meet or exceed the standards for physicians practicing in the U.S.
The ACR statement also called for physicians who interpret images by teleradiology to be licensed to practice medicine and have appropriate liability coverage in the state where the imaging exam took place and be credentialed as a provider in the healthcare facility where the exam was done.
Ramirez said what he would like to see is some sort of clearinghouse established and maintained by hospitals, states or specialty societies that certifies foreign companies are HIPAA-compliant and says "these people are following the rules."
He said such an effort might eventually include the federal government.
"If we don't let stuff in that we can't guarantee is kosher, why should we let stuff like critical patient information go out?" Ramirez asked.