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You are the president of a multi hospital system that is growing at a rapid pace. There are strains on resources, and pressures to find new ways to achieve an economic scale in operations. In a meeting with the staff, a suggestion was made to look overseas for two services the system normally did internally.The first was to consider outsourcing the reading of radiological images to an India-based radiology company. They would have radiologists available 24/7, and the images can be sent to them digitally. There would be a 50% savings and would eliminate the need an on-call radiologist in the hospital. It would also call for a reduction in staff and a reduction in supply acquisition.The second suggestion was to outsource medical records transcription to a Pakistani company. Voice transcriptions could be sent digitally in real time (as notes were dictated), at a cost of nine cents per line versus the current 22 cents per line that the hospital is paying with a local transcription company. The turnaround time was comparable. The negative aspect is that sometimes language differences could cause errors in transcribing. In addition, the decision to take business away from local companies would impact the local economy.Weighing all the facts, what choices would you make? Keep in mind you want to move your organization forward, yet at the same time, you want to consider your working relationship with the present providers of these services.