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Here’s how to keep from getting squashed by the Y2K juggernaut
News reports have shown people stockpiling toilet paper and building underground shelters to protect themselves from the chaos they fear will occur when the clock strikes midnight on Dec. 31, 1999. Banks have already begun taking out newspaper ads to assure their customers they’ll still have access to their cash on Jan. 1. Some patients may be wondering if January 2000 might be a bad time to be in a hospital.
Will there be chaos when the year 2000 (Y2K) arrives? Will there be a run on the bank and a shortage of essential items? And, more importantly for you, will medical devices fail and hospital operating systems shut down?
No one knows for sure, but experts do know health care lags behind other industries such as banks and insurance companies that already have conquered the Y2K problem. Experts say even those health care organizations that have begun Y2K remediation efforts will be racing to finish. And they advise every health care organization to begin work immediately to determine what medical devices and operating systems might falter or fail because of the so-called millennium bug. (For tips and resources on Y2K issues, see boxes, pp. 38, 39, and 41.)
It may sound crazy that one tick of the clock could result in chaos. But because computer programmers decades ago routinely denoted years with two digits instead of four, many systems will recognize "00" as the year 1900 instead of 2000. So anything that depends on a computer and has some type of date or time dependency could fail. Systems that could be affected include medical devices such as defibrillators, X-ray machines, and infusion pumps; administrative systems that track patient health status; billing systems; pharmacy systems; admission and discharge systems; and building systems such as elevators, automatic doors, and climate controls.
"For some industries, software glitches or even system failures can, at best, cause inconvenience, and at worst, can cripple the business," says Donald Palmisano, MD, JD, an American Medical Association trustee who testified about the Y2K issue before a U.S. Senate special committee last summer. "In medicine, those same software or systems malfunctions can, much more seriously, cause patient injuries and deaths."
Palmisano, like other experts on the Y2K issue, is concerned about health care’s lack of attention to the problem. He says hospitals, physician practices, and other health care providers need to step up their efforts and prepare for the worst-case scenario.
"You’re not going to get an extension of this deadline. This is not elective; this is mandated by the unique circumstances of Y2K. It’s going to happen," he says. "But it’s not a reason to panic; it’s a reason for us to get prepared. We [at the AMA] believe the problem can be successfully handled in the medical community using the approach of communication, education, and cooperation."
The GartnerGroup, an information technology advisory firm based in Stamford, CT, does quarterly Y2K readiness surveys of more than 15,000 organizations in 50 countries. Research director Kenneth Kleinberg says the firm’s research shows health care has only recently — in the last quarter of 1998 — begun making strides toward being prepared for Y2K while other industries, such as banking, are nearly finished.
"Almost half of health care organizations are not going to get it done and are going to have mission-critical failures or interruptions," Kleinberg says. "Half of health care is going to get bitten by this bug in some kind of significant way that at least one of their mission-critical systems is going to take a hit that will damage the business or make life unpleasant for patients."
The GartnerGroup has developed a scale for apples-to-apples comparison on the Y2K issue: Level 0 is for organizations that haven’t started at all; Level 1 is awareness; Level 2 is doing an inventory; Level 3 is remediation; Level 4 means the facility is operationally sustainable (mission-critical systems only); and Level 5 means that all systems are sustainable (including noncritical systems). Kleinberg says Level 3 is the current average for health care organizations, while insurance and banking are mostly into Level 5. Within health care, medical practices and in-home service providers are the furthest behind.
Cassandra Junker, one of the founders of the Rx2000 Solutions Institute in Edina, MN, says her organization’s research shows similar findings. Rx2000, a nonprofit organization dedicated to helping the health care community address the Y2K problem, does periodic provider surveys. "Health care’s been late on this issue," Junker says. "In the smaller, more rural areas, we suspect many haven’t started. We’re nervous about health care readiness in general. It’s the interdependent nature of things that’s unpredictable."
The problem in health care, Junker says, is that many organizations aren’t used to long-range planning beyond five years like other industries are. Since their business is "real time," health care providers didn’t start on Y2K until recently. Also, with all the consolidation going on in the industry, Y2K efforts have taken a back seat in terms of time and money. And since that consolidation is fairly recent, most hospitals have traditionally stood on their own as opposed to being part of a system that might have alerted them to this problem years ago. Banking networks, she says, got the alert 10 years ago. Finally, many providers see Y2K as a systems problem and not a business problem or a risk management problem.
But hospitals and other providers should be concerned about Y2K glitches for two reasons, Junker says: They need to make sure they don’t cause harm to patients, and they need to make sure they will still get paid. Fortunately, she says, those are two areas providers can do something about.
First on your list should be making an inventory of all the possible devices and systems that could be affected by Y2K, says Tony Montagnolo, vice president for technology planning at Plymouth Meeting, PA-based ECRI, a nonprofit health services research agency and a collaborating center for the World Health Organization. You’ll need to consider such items as computer-based hardware, software, networks, and databases; medical devices; environmental and facilities management areas such as elevators, sprinkler controls, and automatic timing devices; telecommunications, including fax machines, pagers, and cell phones; utilities; and transactional methods such as direct deposit.
To be Y2K-compliant, you have to be sure that whatever systems you have will function without interruption and without ill effect through the next millennium, Montagnolo says. And that means not just on Jan. 1, but also through the crossing over of the leap year. Because 2000 will be the first century leap year since 1600, many computer programs will not be able to recognize Feb. 29.
Given that it’s fairly late in the game, you need to start thinking like an emergency department physician. You can’t get it all done at one time, so decide who are the sickest patients and address them with your heaviest resources. The areas most likely to cause some type of harm should be first on your list, Montagnolo says.
Most every facility should put environmental systems such as electricity and heating high on the priority list, since those areas affect everyone. Imagine a scenario in which the lights go out in the operating room and the backup generator doesn’t work, and you’ll see why electricity should be a higher priority than a rarely used medical device.
"Time is obviously running out. There’s a fair amount of people who really need to run a little bit faster," he says. "The bulk of people really are at the stage of finishing up their inventory and assessment, but even at that stage, it’s still going to be a race to finish on time."
Montagnolo offers two quick tips:
1. Don’t get stuck in "analysis paralysis." Get the best information you can, make decisions, and move on.
2. Assign clear responsibilities and tasks with clear deadlines.
The GartnerGroup’s research shows that anywhere from 10% to 30% of medical devices that depend on the date will have a Y2K problem and 5% of health care organizations will not locate all the noncompliant devices in time. It also found that most of these organizations do not have the resources or the expertise to test these devices properly and will have to rely on the device manufacturers for assistance.
Kleinberg says that since most providers will catch possible glitches ahead of time, the risk to patients is small. Many of the problems will be more of an annoyance — only two digits showing on a date — but some devices won’t sort reports accurately, will create incorrect results, may seize up, or completely fail. Most organizations will need to replace about 5% of their medical devices that have any kind of clocking function.
One of the problems, he says, is that it’s not always easy to determine if a device depends on a clock. You’ll need to contact the manufacturer, many of whom have Web sites that address such questions. You may find, however, that the manufacturer has gone out of business or has been bought by another company and that they can’t find the proper information. Then you’d be wise to replace the device.
"If you have a device where the manufacturer assures you it will work, and you’ve tested it at your site and you’ve checked Web sites like the FDA and ECRI to see if the device works, then you can feel pretty comfortable," Kleinberg says. "But if you can’t find the information or it differs depending on the source, then you probably need to get rid of it."
Realize upfront that you’re going to miss something and that something is likely to go wrong on Jan. 1, Kleinberg says. "You need to make contingency plans, but it’s tough to decide what to do because you don’t know how bad things will be. But know that there will be bugs not caught at first that will be caught later over time. You’ll never really be done. You will have to keep installing fixes and testing them."
Following are some tips on contingency plans from Kleinberg, Montagnolo, Junker, and Palmisano:
- Take testing more seriously than you had planned. Set up a completely separate computer or network to isolate for running the tests. Don’t rely on a vendor’s assurance or on a proxy test. Do it yourself.
- Decide what’s most important to your business. If you’re a world-class cardiac unit, focus on those devices and systems. If you’re not sure a rarely used device will function, shut that procedure down until you are sure.
- Find out if your suppliers are Y2K-compliant. Have backups for your most critical suppliers, even if they say they are compliant.
- See if your backup generator works and how long it will run. Even if you’re reasonably sure it will handle any problems, stock up on battery-powered lights and radios.
- Schedule extra staff for Dec. 31 and Jan. 1 in case you need to do more things manually. Only schedule urgent procedures for those dates, and leave the schedules looser than normal.
- Interact with your payers and decide what you’ll do if payments are late.
- Talk to your insurance company and find out what happens if Y2K-related problems occur.
- Back up your computers before you do any testing. If the test shuts down your system, you’ll have Y2K right now.
- Decide what you’ll do if communication devices such as beepers don’t work. How will you contact physicians on call?
- Have a plan for transporting patients if the elevators don’t work.
The bottom line, Kleinberg says, is to try to minimize the risks to your business and your patients. To protect yourself legally, you have to recognize that the Y2K problem is foreseeable and correctable. "You have to figure out what’s the right thing to do, do as much of it as you possibly can, and keep an eye on how much your neighbors are doing," he says. "You’re going to be compared to them in addition to being compared to the job at hand."
[For more information, contact:
Kenneth Kleinberg, Research Director, The GartnerGroup, 56 Top Gallant Road, Stamford, CT 06904. Telephone: (203) 316-1111.
Donald Palmisano, MD, JD, 4417 Lorino St., Suite 200, Metairie, LA. Telephone: (504) 455-5895.
Tony Montagnolo, Vice President for Technology Planning, ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298. Telephone: (610) 825-6000, ext. 5175. Web site: www.ecriy2k.org.
Cassandra Junker, Rx2000 Solutions Institute, 4550 W. 77th St., Suite 240, Edina, MN 55435. Telephone: (612) 835-4478. Web site: www.rx2000.org.]
Plymouth Meeting, PA-based ECRI, a nonprofit health services research agency and a collaborating center for the World Health Organization, is offering monthly telephone seminars on Y2K issues:
April 14: Y2K Remediation: What To Do About Noncompliant Devices
May 12: The Many Legal Issues of Y2K
Oct. 13: Y2K Staff Awareness and Media Relations
Nov. 10: It’s Quarter to Midnight: Are You Ready for Y2K?
The seminars are held from 1 p.m. to 2:30 p.m. EST on the second Wednesday of the month. Registrants can call in from the office or home, and the cost for each seminar is $129. For more information, call (610) 825-6000, ext. 5888.
American Medical Association (AMA): www.ama-assn.org/not-mo/y2k. This site includes information on the AMA’s national Y2K campaign as well as links to publications and Y2K specialty sites, frequently asked questions, and information on known solutions.
RX2000 Solutions Institute: www.rx2000.org. This site bills itself as "Health Care’s Year 2000 Information Clearinghouse." You’ll find information from readiness surveys and links to other sites and articles.
ECRI: www.ecriy2k.org. ECRI offers the Year 2000 Medical Device Knowledgebase, an inventory collection and management system that allows health care facilities to match their medical device inventory to a dynamic Y2K compliance database.
Food and Drug Administration: www.fda.gov/cdrh/yr2000/year2000.html. This is the place to look for information on the impact on medical equipment.
American Hospital Association (AHA): www.aha.org/y2k/default.html. This site provides results of AHA member surveys on implications of the Y2K issue as well as steps you should take to be compliant and a timeline for completing them. The access is mostly restricted to AHA members.
Health Care Financing Administration: www.hcfa.gov/y2k/default.htm.
President’s Council on Year 2000 Conversion: www.y2k.gov.
Year 2000 Information Center: www.year2000.com.