In researching the viability of my current employment choice, I'm finding that a lot of us medical transcriptionists here in the USA are losing our jobs to India and Pakistan. I came across a lawsuit by the Veteran's Administration against an American transcription company (MedQuist) who shipped off sensitive medical information on military personnel to be typed up overseas. They say the practice of outsourcing VA medical records for transcribing has been stopped since, but it's only because THEY were caught.
I found it especially interesting that many, many physicians or hospitals have no idea, or really care, where their dictation is ending up to be transcribed, just that the bottom line is that it is begin typed up and cheaply. It seems that when a transcription company is hired to do the work, they seem to fall back on the old "don't ask, don't tell" bit. If the customer were to ask, "Is this work being typed up here in America?" The company would have to answer yes or no. If they fail to ask, or don't know to ask, it certainly isn't being offered up.
The quality of the transcription overseas is third rate, to say the least. Thus the new job niche for us American transcriptionists is to re-listen to the doctor's audio, then re-proof read what the third-world country typed up, and fix their errors before sending it back. Major errors, some posing possible risk to patient's health, are being found ([i]sometimes[/i]) but it doesn't matter, because the bottom line is this route is still cheaper.
Very few medical records are kept via hand writing anymore due to HIPAA laws and what not, so chances are your medical information is not between only you and your doctor any more. Feel free to ask your physician if he/she knows exactly how your medical records are being handled, but don't be surprised if you can't get a straight answer.
Edited to add: Also, many times a patient's personal information i.e. DOB, address, and employment info may be included in medical documents, so it's not only an issue of health care privacy.