"There's a lot of personal information in there," she said. "Your name, address, Social Security number, whether you have problems with drugs or alcohol. I didn't want that getting out."

Farragut had reason for concern. She's been a professional medical transcriptionist for the past 28 years and currently works out of her Riverside County home in Corona.

She handles people's confidential medical records every day as doctors and hospitals increasingly farm out the labor- and time-intensive task of transcribing recorded notes into electronic format.

"The problem," said Farragut, who also serves as president of the California Association for Medical Transcription, "is that you never know where your records will go or who could end up looking at them. I wouldn't want my own chart sitting in someone's living room."

The fact that doctors and hospitals are routinely outsourcing medical transcription will probably come as a surprise to most people -- it did to me.

Even more disconcerting is that a growing share of this work is heading to cut-rate firms in other countries, where strict U.S. privacy laws either do not apply or are difficult to enforce.

Last month, for example, India celebrated World Medical Transcription Week. "India has become the favorite country for outsourcing in the U.S.," Prasenjit Ganguly, vice president of the country's largest medical transcription service,

Max HealthScribe, told the Times of India.

Max HealthScribe alone employs more than 1,000 medical transcriptionists in Bangalore to handle the workload from U.S. health care providers. The company says it can cut a hospital's transcription costs in half.

Nearly all Bay Area hospitals -- including those run by Sutter, Kaiser, UC San Francisco and Stanford -- outsource at least a portion of their transcription work.

It's unclear, though, how much of that goes to domestic services and how much makes its way overseas either directly or as subcontracted work.

"We outsource all our transcription," said Courtney Conlon, spokeswoman for Seton Medical Center in Daly City. "If we didn't, we'd probably need eight to 10 full-time employees on staff. It's very cost-effective for us."

Seton, like many health care providers I spoke with, contracts with MedQuist, the nation's largest provider of medical-transcription services. In April, the New Jersey company reported quarterly net income of $10.51 million on revenue of $125 million.

MedQuist employs about 9,000 transcriptionists, most of whom work out of their homes in various parts of the country. More than 1,000 are in California.

Brian Kearns, the company's chief financial officer, said that "only a little" of MedQuist's work is subcontracted to Indian transcription firms.

But he acknowledged that lower-priced Indian competitors are attracting more business. "As a result," Kearns said, "we're not growing."

Margie Kahn, an Oakland transcriptionist (don't call them transcribers; that's the name of the machine they use) said few patients are aware of the scope of information being outsourced by hospitals.

"The goal is that every piece of information about you and your medical history will be available electronically," she said.

External transcriptionists now handle patients' admitting histories and physical exams, discharge summaries, consultations with specialists and surgical reports. They also frequently transcribe notes on patients' X-rays.

Often, said Farragut of the transcriptionists' association, tape recordings from doctors and hospitals are accompanied by patients' complete medical charts, which include all of one's personal information.

"There's a lot of information in the chart that we need for our work," she explained. "It all has to be accurate."

Transcriptionists in the United States and abroad are required by the Health Insurance Portability and Accountability Act, or HIPAA, to keep confidential medical info to themselves.

"But it's all on the honor system," Farragut said. "How many places can the HIPAA people be checking? They can't inspect everywhere."

Indeed, most transcriptionists at home and abroad use the Internet to transmit data. Doctors dictate their written notes into a phone. The notes are then converted into digital format by archiving services and sent via the Net to a transcriptionist.

Zix Corp., a Texas maker of e-mail security software, said it analyzed transmissions by the top 100 U.S. health care providers. More than half had violated HIPAA by sending confidential information over the Net without proper safeguards, the company found.

"Despite many public statements asserting compliance with HIPAA, the fact is that many organizations aren't successfully enforcing the regulations," said Dan Nutkis, Zix's vice president of strategy and products.

So how worried should people be? At this point, it's hard to say. No one I spoke with said they could think of a single instance in which confidential info leaked from a transcriptionist.

Yet, as with the trend of overseas companies providing tech support for U.S.

health care providers, including Oakland's Kaiser Permanente, a danger exists that one's privacy can be violated.

"When you see your doctor, you have every right to say that you don't want your charts going somewhere else," said Farragut. "They can get lost. You don't know who will see them.

"In my own case," she added, "I didn't want my chart out and about."