Y2K could flatline the health care industry

Tackle millennium bug while there’s still time

The clock ticks past midnight. It’s Jan. 1, 2000, seconds into the new millennium. Are biomedical devices refusing to function, swipe card doors steadfastly remaining locked, computers balking at requests for access to patient records?

No one knows for certain the answer to these questions, but feverish preparations are under way in some facilities to address the problem of computer-driven devices designed to accept date codes only by their last two digits.

The health care industry is woefully unprepared to deal with the year 2000 bug commonly called Y2K, says a U.S. Senate special committee report.

"Y2K could put the health care industry in intensive care," according to Sen. Chris Dodd, vice-chairman of the U.S. Senate Special Committee on the Year 2000 Technology Problem.

The year 2000 date problem spreads across hospitals, clinics, laboratories, pharmacies, and doctor offices. While no one is exempt, experts say physician practices and clinics are particularly vulnerable — and particularly unprepared.

"Y2 what?" a doctor’s receptionist answers in response to a reporter’s request to speak with the physician about the millennium computer bug.

It’s that lack of understanding of the potentially sweeping impact of the Y2K problem that is "frightening," says David Kibbe, MD, MBA, CEO of Future Health Care in Chapel Hill, NC, and a major contributor to the Y2K guidelines published by the American Academy of Family Physicians (AAFP) (see chart, inserted in this issue.).

Kibbe, who spends most of his time speaking to groups of physicians, helping them find solutions to the Y2K problem, says physicians and their offices are "absolutely not aware of the problem. They are clueless and worst of all, they have no interest whatsoever in the problem. They think if they have Windows 98, they’re OK."

The solution to the problem is "a lot more than Windows 98," says Elizabeth Wheeler, a registered records administrator with Superior Consultants of Southfield, MI.

It’s not too late to get started, say Kibbe and Wheeler, both of whom spend most of their days urging physicians and health care providers to get moving before the clock strikes midnight and their coach turns into a pumpkin.

No crystal balls

"It’s actually worse than the Senate says, particularly in the physician practice sector," Kibbe says. He thinks the problem is particularly alarming because "no one can really predict the effects."

But some effects are certain, says the Senate report released early March.

Everything — from software driving a plethora of records and billing systems to computer chips that drive biomedical devices to electronic interfaces between physicians, hospitals, and patients — could potentially shut down.

All of those reflect what Kibbe calls the "interdependency" of these systems and their vulnerability if one link in the chain fails.

Susan Rehm, MBA, AAFP’s manager of practice development in Kansas City, MO, says the lack of awareness of the problem is "the rule, not the exception."

"I think that’s why the health care industry is lagging way behind," she says.

Rehm adds that the issue is most prevalent among small clinics and medical practices, so "those are the ones we’re trying to reach."

Rehm and Kibbe collaborated on the AAFP’s guidelines to help members find their way through the Y2K morass, liberally sprinkled with a few dire warnings. Among them: The possibility of legal liability for non-compliance from patients who might be injured if systems fail.

Ensure all vendors are compliant

Y2K failures could trigger a tidal wave of lawsuits costing an estimated $1 trillion in legal expenses across public and private sectors, the AAFP predicts.

While there is a great divergence of opinion on the potential failure of biomedical devices like pacemakers, Rehm says, "If I were a physician with patients with pacemakers, I would be contacting the vendor or distributor of that particular appliance and determine it’s Y2K-compliant and get the answer in writing."

AAFP warns its members that they must go "much farther than ensuring office computers are compliant," says Rehm.

Among those recommendations: Physicians should communicate with all vendors of computer-related hardware or software, plus they should contact third parties, like banks, credit unions, reference laboratories, pharmacies, claims processing clearinghouses, billing services, third-party carriers, utility companies, alarm/security services and elevator companies.

April 5 was the first wake-up date when the Health Care Financing Administration (HCFA) began to require full eight-digit dates on all Medicare and Medicaid claims.

The agency promised to reject all claims not submitted in the proper format.

Rehm says some doctors have had claims rejected, which "got their attention since most practices live month by month, hand to mouth, and don’t have the cash reserves" to withstand delays in payments.

On March 2, Congress’ General Accounting Office reported HCFA was overstating its Y2K readiness and that systems crashes could cause billions of dollars in Medicare and state-administered Medicaid health benefits to be delayed or even go unpaid.

The agency’s administrator, Nancy-Ann DeParle, told the House subcommittee on government, management, information and technology she is "confident that HCFA’s own year 2000 systems issues will be resolved well before Jan. 1, 2000."

Device failure

Could Y2K problems cause the failure of biomedical devices? The Senate report says they will.

Wheeler and several other experts say hospitals are particularly vulnerable to the failure of devices like fetal monitors, infusion pumps, and other complex equipment that interface with other computers because of the sheer volume. There are hundreds of such devices in the average hospital.

She recommends extensive in-house testing of all such devices, even if manufacturers have certified they are compliant and suggests checking for compliance certifications on the Food and Drug Administration’s (FDA) Web site.

"Yes, some devices are going to fail, even if they have been tested and found functional," Wheeler says. "A case or two of litigation where liability could be millions of dollars for one incident could put a practice or a small hospital out of business."

"Due diligence and documentation are essential," Wheeler warns.

Hospitals have to address all those hardware and software issues, plus take a long, hard look at every piece of medical equipment that is date-aware, ranging from IV pumps to centrifuges which can quite literally be essential for life or death. They must also be sure their vendor supply chain is Y2K-compliant, experts say.

"Health care organizations have traditionally been the slowest responders in regard to Y2K," says Jim Klein, research director at the Gartner Group, information technology research consultants in Stamford, CT.

Klein says the health care industry "has never really been technologically adept and has relied far too heavily on vendors to assure them everything is OK."

"They need to do their own research to be sure," he adds.

Compliance is expensive, as Tom Bauld knows.

Bauld, PhD, a biomedical engineer at Mercy Health Services in Farmington Hills, MI, says his system of about 25 hospitals, covering 13 communities in Michigan and Iowa, has spent $70 million on Y2K compliance and the job is still far from done.

Mercy devised a version of Y2K triage to weigh the possibility of failure of various devices against the impact of such a projected failure.

Based on manufacturers’ certifications of compliance, Bauld says, "We are making good progress, but we still have a lot to do. We don’t see anything out there that would cause a Level 4 problem (serious injury or death)."

"It’s important for people to put it in perspective. It’s a big problem, and huge resources are going into fixing it," Bauld says.

In addition to the hardware and software issues that all industries face, health care providers have to consider Y2K issues for every piece of medical equipment that is date-aware, ranging from IV pumps to centrifuges, Klein says.

He says the biggest problem will be in imbedded devices such as pumps and monitors, not because there is a "huge" likelihood of failure, but "because of the potential for embarrassment and lawsuits is enormous" if there are glitches health care providers should have been able to identify before the fact.

Gregory Bergman, MD, a family physician who practices in rural Minster, OH, has made some preparations to ensure the smooth transition to the new millennium, even though he admits there is probably more he can do.

He invested in a new computer system, complete with about $30,000 in upgraded software a few months ago, so he’s as computer ready as he thinks is necessary.

While he has computerized patient records, he still keeps paper records.

Bergman also sent letters to all vendors with whom his practice does business.

"Of course, nobody replied to my letter," Bergman laughs. "I’ve been on the receiving end of a few of those letters myself, and I have to admit, I didn’t answer them either."

"I’ve done what I can, but I know there are more aspects of Y2K compliance," he concludes.

For more information, David Kibbe of Future Health Care can be reached at (800) 757-1354; Elizabeth Wheeler of Superior Consultants at (248) 386-8300; AAFP’s Susan Rehm at (800) 274-2237; and Tom Bauld of Mercy Health Services at (248) 489-5047.

What is the Y2K problem?

Many computers, including virtually all older generation computers, recognize the year by a two-digit number, i.e., "99" for 1999, etc. When the year 2000 (Y2K) arrives, many computers will not accept the "00" designation at all and others may read it as 1900. Y2K-compliant computers and computer-driven devices will show a full date as an eight-digit number, i.e. 01042000 rather than 010400.