compared to the US dollar. There is a volatile controversy on whether medical transcription work should be outsourced, mainly due to three reasons: The greater majority of MTs presently work from home offices rather than in hospitals, working off-site for "national" transcription services. It is predominantly those nationals located in the United States who are striving to outsource work to other-than-US-based transcriptionists. In outsourcing work to sometimes lesser-qualified and lower-paid non-US MTs, the nationals can force US transcriptionists to accept lower rates, at the risk of losing business altogether to the cheaper outsourcing providers. In addition to the low line rates forced on US transcriptionists, US MTs are often paid as ICs (independent contractors); thus, the nationals save on employee insurance and benefits offered, etc. Unfortunately for the state of healthcare-related administrative costs in the United States, in outsourcing, the nationals still charge the hospitals the same rate as they did in the past for highly qualified US transcriptionists but subcontract the work to non-US MTs, keeping the difference as profit. There are concerns about patient privacy, with confidential reports going from the country where the patient is located (e.g. the US) to a country where the laws about privacy and patient confidentiality may not even exist. The offshore provider has a clear business interest in preventing a data breach and could be prosecuted under HIPAA or other privacy laws, yet the counter-argument is made that such a prosecution might never happen or if tried wouldn't get anywhere. Some of the countries that now outsource transcription work are the United States and Britain, with work outsourced to Philippines, India, Sri Lanka, Canada, Australia, Pakistan and Barbados. The quality of the finished transcriptions is a concern. Many outsourced transcriptionists simply do not have the requisite basic education to do the job with reasonable accuracy, as well as additional, occupation-specific training in medical transcription. References External links The Association for Healthcare Documentation Integrity (AHDI) American Health Information Management Association (AHIMA) Joint Commission on Accreditation of Healthcare Organizations, Accreditation Manual for Hospitals, Oakbrook Terrace: JCAHO, 1993. Health informatics Health care occupations Information privacy Transcription (linguistics)