By Rose Clifford, RN, LNCC, editor
© 2009 The Medical-Legal News
Something of a scuttlebutt has arisen in the medical records review community about sending work to other countries. As with many other professional services, from telemarketing to medical tourism, the possibility of getting cheap medical record reviews from foreign countries looms large. One records review firm contacted us, and, as a test, we sent some closed-case records to be put in chronological order.
The work was well done, and cheap.
But, after some careful review, we have decided not to engage the use of foreign, in this case Indian, records reviewers.
First, our biggest concern is with identity theft. (And for our experiment, we redacted all social security numbers, birth dates and addresses from the records.) The foreign company we used claims to have great security, firewall protection, and such. But we are skeptical that identity theft will occur only by hackers or a “corporate” entity. What about the foreign rank-and-file workers who do data entry and see the records? Anyone could remember at least one birth date, name and social security number each day and walk out of the office armed with marketable info for the black market. This is to say nothing of cell phones, cameras and other devices. And if a breach occurs, who’s liable? Even a U.S.-based company may be simply a marketing company, with layers of corporate and international protection all the way back to the ground level employee in a foreign land.
Second, will these firms go the next step and do merit reviews? Do they have nurses or doctors who know American clinical standards? Knowing how to be a great consultant is more than textbook learning, as it is based on real world experience and networking.
Third, will these firms provide nurses or attorneys who know the law, and who can ferret out breaches in standards? Will they know how to determine which records are missing, or other avenues of liability or defense to explore?
Also, will courts accept affidavits from these reviewers, and if so, would an attorney then have to ask an American consultant to step into the shoes, as a fact or expert witness, and grab the baton from the foreign consultant? This would seem insulting, I would think.
And what of ongoing professional relationships? Hopefully this means something.
Would there be a backlash against foreign reviewers, not unlike the griping that U.S. customers sometimes have against foreign-based technical support or sales calls?
Many questions are unanswered here.
Even if foreign reviewers are much cheaper, the savings don’t seem worth the risks, on balance, to high-dollar cases or to the identity risks of the patients