MANILA — It started out as just another Thanksgiving Day stomachache, a nagging pain that sharpened until it reverberated from California halfway around the world.
When the ache in her lower right abdomen became excruciating, the twentysomething 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: An examination report had to be dictated, typed up and submitted to her insurer for approval.
So while the woman waited in agony, her doctor dialed an 800 number. An electronically perky voice invited the surgeon to press 2 if he was ready to start.
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.
Ear-bud 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 though the work had been done just down the hall, but much cheaper.
So goes the global traffic in Americans' intimate health information.
In a startling illustration of the life-or-death decisions involving low-paid workers thousands of miles away in today's globalized world, Americans' most personal details move 24 hours a day as U.S. healthcare providers outsource billions of lines of transcription work each year to offices across Asia in a bid to cut the massive cost of medical bureaucracy.
"It's a cyberspace miracle every time it's done," said Fred J. Kumetz, a Beverly Hills lawyer who founded and runs EData Services, one of the biggest companies transcribing U.S. medical records in the Philippines.
From dictated summaries of routine checkups to complete recordings of conversations between surgeons and nurses in operating theaters, the 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. But the cost can be 300 times that for "stat," or immediate, orders, such as when a doctor needs a transcript of an emergency medical team's radio report before its helicopter lands with a patient.
