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. 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.