I worked at a startup in Toledo called Heartland Information Services. We provided transcription services to some of the biggest hospitals in the United States, and we weren't small. Heartland was one of the larger medical transcription organizations in the country, one of the companies at the center of offshore transcription in that era. While that sounds simple enough, we were the kind of service where downtime had real consequences. Imagine needing emergency surgery but having to wait on a written copy of your procedure. Waiting may not be an option. The engineers we worked with in India were talented. The company operated as a hybrid, and at various points our most critical work was being developed overseas and deployed stateside. The reason was straightforward: cost. Offshore development was dramatically cheaper, and for a startup watching every dollar, the savings were impossible to ignore.…