Asked for an example of this, he explains that his institution’s initial foray into medical outsourcing was a bit of a cautionary tale. Unbeknownst to UCSF, their domestic medical transcription company sub-contracted with a transcription company in Pakistan. Administrators discovered this fact when a Pakistani transcriptionist contacted the university, threatening to put all the medical records she had transcribed on the Web if she did not get a raise. This would have constituted a breach of HIPAA and would have created multiple liability issues for UCSF. Contractors dealing with the medical center now have to guarantee, in writing, that they will use only domestic subcontractors, says Dr. Wachter.
Because of the “high-touch” nature of hospital medicine, Dr. Wachter does not think that hospitalists’ services are feasible candidates for outsourcing.
“I guess one could conceive of a robotic hospitalist running around the building being controlled by a joystick in Singapore, but that’s science fiction and not a real risk,” he quips.
Still, relationships with specialists such as radiologists and intensivists may more likely be formed over the telephone, through video conferencing, and in online interactions—phenomena with which younger physicians may be much more comfortable.
Dr. Maheshwari, who, like the company’s founder Arjun Kalyanpur, MD, trained at Yale University in New Haven, Conn., expects that Teleradiology Solution’s business will continue to grow and that, over time, “the world will truly be flat—hopefully!”
Wade admits that the need for outsourced services is not going to diminish. “Our need to be able to harness technology to provide [a high] level of intensive care to patients, no matter where they are, is going to be very strong,” he says. “So I think we will see more of this [outsourcing]. But I also think we’ll see a much greater emphasis on trying to train new physicians. Outsourcing is part of the same phenomenon as medical tourism. Hospitals that go this route are going to have a responsibility to demand high-quality physicians, demand Joint Commission certification, and demand to know the background and training of these [outsourced] physicians, because the patients and families are going to have questions. That’s part of the doctor-patient relationship that the hospital is going to create.” TH
Gretchen Henkel is a frequent contributor to The Hospitalist.
- Wachter RM. The “dis-location” of U.S. medicine – the implications of medical outsourcing. N Engl J Med. 2006; 354(7):661-665.
- Larson DB, Cypel YS, Forman HP, et al. A comprehensive portrait of teleradiology in radiology practices: results from the American College of Radiology’s 1999 Survey. AJR Am J Roentgenol. 2005 Jul;185(1):24-35.
- Dimmick SL, Ignatova KD. The diffusion of a medical innovation: where teleradiology is and where it is going. J Telemed Telecare. 2006;12 Suppl 2:S51-58.
- Breslow MJ, Rosenfeld BA, Doerfler M, et al. Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing. Crit Care Med. 2004 Jan;32(1):31-38.