CLINICAL DIABETES These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. MEDICAL COMPUTING The Year 2000 Computer Bug: How to Beat It Lynn Witherspoon, MD, and Lawrence Blonde, MD What Is
the Problem? As the inevitability of January 1, 2000, becomes reality, this inference may no longer be correct. The resultant date ambiguity may cause significant problems for computers and their users. Incorrect date representation within the computer system probably will not cause it to stop running altogether but may cause it to run incorrectly or, worse still, may cause data corruption. As computer microprocessors are now ubiquitous, this problem is pervasive. Any device with an embedded microprocessor or that is date-dependent is at risk. Computers and telephones and their associated software, including office practice management and patient data systems and claims and billing systems, may fail. Biomedical equipment, including electrocardiograph machines and laboratory and radiology equipment, are also dependent on computers. Glucose meters have embedded microprocessor chips and are time/date dependent. Facilities and infrastructure—the office building ventilation, heating, cooling, power, water—and external business partners—banks, creditors, insurance companies, and suppliers—are all potential sources of Year 2000 (Y2K) problems for your medical practice. According to the U.S. Senate Special Committee on the Year 2000 Technology Problem, the health care industry is less prepared than industry in general for the millennium change. The nation's largest hospitals, while progressing with remediation of their computer programs, lack the facilities to completely test their systems. Rural and inner-city hospitals are even less likely to be ready because they have more limited resources and older equipment. All hospitals rely heavily on vendors of medical devices and at present have limited contingency plans in the event that problems arise. Doctors' offices face many of the same issues but are generally without access to the technical and financial resources required to repair older computer systems. Although doctors' offices frequently use computer-based practice management systems and submit claims electronically, they fortunately have little in the way of automated patient records. There is universal electronic data interchange with Medicare. Perhaps of greatest concern to physicians' practices is the health care payment system. The Health Care Financing Administration (HCFA), which administers Medicare, is responsible for about half of all health care payments, amounting to about $1 billion daily. There are 38 million Medicare recipients. The nations 5,200 hospitals and 780,000 physicians rely heavily on this source of revenue. HCFA required four-character year representation on all claims submitted after April 1, 1999, and has stated that, "We are confident that all Medicare claims processes will be ready and able to function come January 1, 2000, so that you can be paid promptly." (DeParle N.M., HCFA Letter to Providers, Jan. 12, 1999.) Assuring that pharmaceutical supplies will be uninterrupted is particularly problematic. Pharmaceutical suppliers rely on foreign suppliers and subsidiaries. About 80% of the basic ingredients for pharmaceutical products come from abroad. More than 80% of the world's supply of insulin, for example, is produced in Denmark. Pharmaceutical suppliers employ "just in time" inventory processes. They have many business partners. The supply of certain drugs may be interrupted if any of the suppliers, subsidiaries, or business partners have significant Y2K problems. What
Should I Do Before January 1, 2000? With the inventory in hand, contact all vendors and request certification letters. You can get more information about biomedical equipment from the Food and Drug Administration Internet site listed in the Internet Resources section below. Pay particular attention to your claims processors' requirements. Contact all external business partners, including your bank, creditors, and the insurance companies and health plans with which you have contracts. Discuss payment options if either you or they are temporarily unable to process claims. Think carefully about your office's facilities, contacting all providers of equipment, including elevators and environmental controls. Contact pharmaceutical suppliers and other suppliers to evaluate the possibility of interruption in their deliveries. With this information, you can determine your compliance options. Focus your efforts on assuring uninterrupted patient care and safety, on your office operations, and on fiscal integrity. Fixing noncompliant computer programs comes in the form of software "patches" or by replacing the software with a new version. Patches generally provide an interpretation of the two-character year field using a "window." A 30:70 window, for example would interpret two character years "00" through "30" as belonging to the new century and "31" through "70" as belonging to the old. The window may "slide" along as the next several years go by, always looking forward 30 years and back 70. Rewritten software may use date expansion so that the year is represented in four characters rather than in two. Expanded year fields are unambiguous, and programs running now with such year representations do not have a Y2K issue. Even if windowed programs run correctly now, they may fail when presented with "00" next year. Of greater potential problem are programs that exchange data, one using date expansion, and the other windowing. In such cases both programs must know how to correctly interpret and reformat the date data of the other. While such issues are the concern of your computer, software, or device vendors, they may offer you the option of "patches" or new remediated programs. Patches are generally satisfactory and often less costly, especially if you plan to replace the system within the next several years. Your personal computer has an internal clock, which returns the time and date to your computer's operating system. Your computer's Basic Input/Output System or "BIOS" is the intermediary between the real-time clock (hardware) and the operating system (software). The year-portion of the date is currently represented in the clock's year register as "19." In older (generally, non-Pentium) PCs, the year register in the real-time clock may not be able to roll over from "19" to "20" at the end of this century. Depending upon the real-time clock, the BIOS, and the operating system, your computer may or may not set the time/date correctly on January 1, 2000. The real-time clock and BIOS can be tested using one of several available test packages. Two are listed in the Internet Resources section below (Check 2000 from Greenwich Mean Time and The RighTime Clock Company). Additionally, Norton Year 2000 is widely available. These test packages check your PC's real-time clock, BIOS, and operating system and provide information regarding required remediation. This may be as simple as resetting the year register in the real-time clock or may require a BIOS upgrade. If you have a small number of PCs in your office environment, this is relatively easy to do. If there are a large number of PCs, more time will be required to "fix" noncompliant PCs. User-configured PC software, such as Excel spreadsheet templates, may contain dates with the year represented in two characters. These templates may produce incorrect data after the end of this year. They can be checked for compliant equations using Visual Audit from Astratek (see Internet Resources below). What Contingency Planning Should I Carry Out? In general, significant failures in the nation's infrastructure are highly unlikely. Power and other utilities, transportation, banks, and insurance companies are unlikely to have major problems. The Gartner Group, one of the nation's premier sources of information regarding computer systems, expects only "brief glitches and data loses." They suggest that most Y2K-related problems will be brief with only 10% of failures lasting longer than 3 days. They suggest, however, that only 8% of disruptions will occur on January 1, 2000, with others occurring later this year and others on into 2000. Most disruptions will be easily recognized. Jones (Artemis Management Systems) suggests that half of failures will cause the system to stop, while another 40% will cause the system to run obviously incorrectly. The other 10% or so of problems will be subtler, often associated with data corruption, which will be more difficult to detect and fix. Despite your best efforts, there may be some things that you know are not compliant and that, therefore, may fail to operate correctly. The more likely problems will come from systems you believe are compliant but that fail to operate correctly. Contingency planning is therefore essential. (See the Mitre website in Internet Resources section below.) Contingency is really a business continuity issue: if computers and systems fail, how will you provide patient care, continue to support care with your office operations, and recover from any financial system failures? In the last week of December 1999, make complete backup copies of all of your practice management system and accounts receivable files. Normally, backup tapes are reused. Preserve the end of 1999 backup tapes until there is no doubt that your office systems are functioning correctly. Print your appointment schedule and medical record pull slips for the month of January. Plan what back-up systems you will use if office practice management software fails. Increase your normal inventories of key pharmaceuticals and office supplies so that you can function through January if supply deliveries are interrupted. It is prudent to document everything manually in December 1999 and January 2000. Maintain logs and records of all financial transactions. Send significant payments certified, return receipt requested. Review your available credit and increase it if necessary to cover payment delays. Review all maintenance and service contracts and contact service providers to understand their coverage and availability in the event of failures. Know how to get help in the event that your practice management or billing system has problems. Plan staffing at the end of the year so that key people can be reached if systems fail. Above all, increase your surveillance as the year draws to a close and the new year begins. A Final
Thought
Lynn Witherspoon, MD, is chief information officer at the Ochsner Clinic, and Lawrence Blonde, MD, is head of the Section of Endocrinology, Diabetes, and Metabolic Diseases and vice chair of the Department of Medicine at the Ochsner Clinic and Alton Ochsner Medical Foundation in New Orleans, La. "Medical Computing" is an ongoing series on electronic products and Internet sites of interest to medical professionals who treat patients with diabetes. To suggest topics for future installments, e-mail lblonde@ochsner.org or write to Dr. Blonde at Ochsner Clinic, 1514 Jefferson Hwy., New Orleans, LA 70121. Copyright © 1999 American Diabetes
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