American College of Physicians: Internal Medicine — Doctors for Adults ®


Is your practice prepared for the millennium bug?

If the year 2000 computer problems seems like a lot of hype, consider the possible consequences

From the May 1998 ACP Observer, copyright 1998 by the American College of Physicians.

By Howard Wolinsky

If you're like most internists and use a computer in your practice for records, appointments or billing, take a look at the calendar. The year 2000 is approaching, and it may mean a technological disaster unless you have already begun to deal with the millennium virus.

The virus, also known as the Y2K bug, has received a lot of attention over the last few years. Experts predict that it will shut down factories and power plants, bring down phone lines and ground air traffic. The problem, which stems from the inability of many computers to read four-digit dates, is expected to cost as much as $600 billion to fix.

Put simply, the Y2K bug is a byproduct of computing's early days, when programmers left off the first two digits of the century—representing 1968 as 68, for example—to save precious computer memory. Programmers thought that the abbreviated dates would later be expanded to include four digits as technology improved and memory became cheaper. While technology improved, the Y2K defect was not corrected in many cases. Thus, when the year 2000 arrives, many computers will think it is 1900, not 2000.

While the millennium bug may seem like a lot of hype, experts warn that health care may be hit particularly hard. The medical industry depends on computers for both patient care and business functions, but it is lagging far behind banks, insurance companies and manufacturers in efforts to inoculate against the Y2K bug.

Last fall, for example, the Gartner Group Inc., a technology research company in Stamford, Conn., found that two-thirds of health care organizations had not started to prepare their computer systems for the year 2000. Gartner predicted that health-care organizations that had not launched repair efforts by last fall can expect at least 10% of their information systems to fail.

Problems in your office

For individual doctors, the millennium bug presents serious problems. Edward Yourdon, a computer expert and co-author of "Time Bomb 2000," warned that doctors who run software on desktop computers that are more than two years old are especially vulnerable to Y2K problems. Much hardware from that time is not year-2000 compliant and can present problems.

Aggravating the situation is the fact that many physicians are incredibly lax when it comes to backing up their data. "It will be of little surprise if doctors begin reporting massive failures, disruptions and data loss after Jan. 1, 2000," Mr. Yourdon said.

Another potential trouble spot, Mr. Yourdon said, is software written by individual physicians in the early days of computerization. If such "legacy" software is still in use, it is far more likely to cause problems than packaged software from vendors who update their programs.

In fact, the good news is that most large vendors are addressing the Y2K problem for doctors. For example, the latest version of Medical Manager software, which is used to manage the offices of nearly 120,000 physicians, is year-2000 compliant. John Kang, president of Medical Manager Corp., said his company has also been educating its customers through a direct mail campaign about millennium compliance. It has also created special teams dedicated to upgrade installations.

To avoid problems, however, physicians should contact the vendor of their software and look into upgrades or other fixes. "Physicians must immediately obtain information from their vendors about this matter and take steps well in advance of that date to update, upgrade, or change those systems to prevent failure in their billing systems," said Mark Leavitt, ACP Member, chief executive officer of MedicaLogic Inc., the Hillsboro, Ore.-based maker of the Y2K-complaint Logician and ClinicaLogic medical records software.

But what about physicians who are using software that was custom-made or came from vendors that no longer are in business?

"The problem with Y2K is that in many cases you won't know you have a problem until too late," explained J. Wade Yarbrough, PhD, senior vice president of consulting services at Future HealthCare Inc., a national clinical informatics consulting firm in Chapel Hill, N.C. "Unless you have a way to change the system date to 2000 and test the system, you can't tell if you have a problem or not."

One way to test your system is to set the clock for a date in the year 2000 and see how it responds, but experts say that such a test may do more harm than good. "Setting the clock forward and testing a program can cause a complete disaster," explained Dr. Leavitt from MedicaLogic. "Many programs lock up when log-in dates appear to be out of sequence." His advice: "Get skilled help."

Problems elsewhere

Physicians also need to remember that not all year 2000 problems that affect physicians will take place inside the office. Experts note that many devices with chips vulnerable to Y2K failures are found in hospitals and include ventilators and MRI equipment.

Pam Walter, a partner at the Chicago law firm Gardner, Carton & Douglas and co-chair of the firm's Year 2000 task force, said that problems with these devices can threaten patient care. If records are inaccurate or unavailable, for example, patients could receive the wrong doses of medicine or diagnoses. If patients are injured or die as a result, physicians may have to establish that they were not the cause of the harm, she said.

To protect their patients from potential problems as well as to protect themselves from potential lawsuits, physicians ought to take an inventory of every way in which their practice may be affected by Y2K, Ms. Walter said.

"Physicians should inquire about the year 2000 remedies of every system that could affect their patients or their billing systems, including hospitals, clinics, HMOs and other providers and insurance companies," she said. "If they do not receive adequate answers, they should consider contingency planning."

In general, experts suggest that physicians ask hospitals, clinics and other health-care institutions they work with about potential year 2000 problems. Just asking could help minimize adverse patient experience by forcing institutions to address their year 2000 issues, they said. Ms. Walter added that it also helps demonstrate the doctor's diligence in attempting to assure quality care for their patients.

Meanwhile, you might want to hold off on making plans for the night of Dec. 31, 1999. Already, some travelers are shying from the skies, worried that airports, if not the planes themselves, could encounter problems.

And some hospitals are already trying to limit liability by asking their staffs now not to make plans, said Mr. Kang from Medical Manager Inc. "They are requiring a large staff of doctors and nurses to be present when the clock strikes midnight," he said. "They want to make sure the IVs are dripping and the heart monitors are working."

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