Supply Excellence — Who Owns (Outsourced) Medical Records?

Who Owns (Outsourced) Medical Records?

May 8th, 2008 · by Crystal Liles · No Comments · LCCS and trade, outsourcing, supply management

Last week, the Wall Street Journal and USA Today featured terrifying reports about the state of medical records today. WSJ highlighted the incompetence and abuse by insurance companies, hospitals and the federal government, who have exposed private information about hundreds of thousands of patients in recent months. The incidents ranged from inadvertent posting of records on the web to a New York hospital admissions specialist caught selling 2,000 patient ID records (we still don’t know why, to whom and for how much $).

USA Today examined the other side of the coin, with a gut wrenching story of the challenges a mother went through trying to gain access to her deceased son’s medical records. Records, which had they been given to her before the statute of limitations run out, would have helped her malpractice case.

There’s another layer of potential complications that need to be factored into the equation; the outsourcing of records and services to offshore providers. The underlying question is a scary one at a time of identity theft and denied insurance coverage. Who owns and protects patient records - the patient OR the medical facility that pays the bills?

Low cost country sourcing has become standard practice in most any corporation, global or otherwise. And it seems that the medical services arena is looking to take advantage of these ‘perceived’ cost savings as well. The problem is, there’s much more at stake for the doctors and patients. This cannot simply be a question of cost savings and sourcing efficiency - patient identity, the ability to receive medical coverage and many other factors are at risk. And right now, there is little clarity on the accountability and enforcement of stateside regulations to allay these concerns.

For example, there have been a handful of stories in the past few years about the outsourcing of radiologists’ jobs to India. The idea is simple enough: x-rays, MRIs and such can be easily sent electronically overseas and analyzed by individuals ‘qualified’ to conduct such analysis for less cost (although The Economist’s recent report on the ~50% of India’s “doctors” who are actually quacks with no medical training or credentials does not inspire confidence). A few questions would then be: Who determines qualification standards, how are they enforced, who’s accountable for accurate analysis, particularly if medical procedures are conducted based on these analyses (think breast cancer diagnosis, blood clots, etc.)?

Perhaps this is a legitimate alternative to drive down costs, if certain safeguards are firmly in place. But in a time of identity theft, data leaks and the like, is it worth the risk? In other words, will this upfront savings end up costing more in the end in the form of legal disputes, public relations issues, breaches in patient-doctor confidentiality, and possible decline in patient care? The simple fact is, the more often data is passed from one entity to the next, the higher the likelihood of leaks or miscommunication. With the potential for providers to save on short term costs are we (the patients) giving up too much? Would regulators step in to protect records sent offshore? Even if they do, how much power can they exert abroad, where the work and records may actually reside? What recourse do patients have in attempting to obtain their medical records from these offshore companies that they likely don’t even know played a critical role in their care in the first place?

These are not easy questions to answer. But, it does serve as an example of the many implications that can stem from a seemingly simple cost-cutting measure. In the end, the decision to outsource has to make sense from the perspective of all stakeholders that receive or administer the service. Otherwise, the diagnosis, prescriptions and even amputations could be all wrong.

Crystal Liles is a Senior Consultant for Sourcing Strategy in Ariba’s Spend Management Services group. Prior to joining Ariba, Crystal served as Director of Strategic Analysis for ChoicePoint.

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