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Five last-minute strategies to head off Y2K woes

Time is running out, but there's still plenty you can do to get ready for the new millennium

From the September 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Edward Martin

Exactly what will happen to computers around the world when the new century dawns remains a mystery. But in a matter of months, many physicians will find out whether it's medicine as usual, or if the Y2K bug has caused their software and vital building systems to fail.

Small medical practices are thought to be the least prepared in health care to deal with Y2K problems. Researchers estimate that only half of the nation's internists are fully ready, and that as many as one in 10 has made no preparations at all.

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The big question is whether physicians who have put off dealing with Y2K issues can still avert disaster in the short time that remains. "Some of us might end up on New Year's Day saying, 'I didn't take care of this, so let's just see if the lights go off,' " said Charles Safran, FACP, associate professor at Harvard Medical School and faculty member of the Harvard Center for Clinical Computing.

The good news is that because internists have long lagged behind other professions when it comes to embracing technology in their practices, they may face fewer technical glitches than other specialties. "My stethoscope and my eyes and ears will still work," said Dr. Safran, a member of ACP-ASIM's Medical Informatics Subcommittee. He predicted that in the private office setting, general internists "won't confront issues such as critical-care patients on ventilators or intravenous infusion pumps. We'll weather the storm."

Experts agree that there's little risk of office-based medical equipment giving dangerous false results and posing a serious clinical threat. Physicians who haven't replaced or updated their scheduling and accounts-receivable systems, though, could find themselves entering the new millennium with no financial data and faced with lengthy delays in billing and collections.

To avoid such a scenario, many experts are urging physicians to immediately create a triage program for critical areas of practice operation. Here is what you need to think about—and five steps that can help you head off Y2K woes:

1. Take an inventory and assess the danger. Start by listing everything from administrative systems, such as answering machines, to software, hardware and treatment equipment, said Joel Nobel, MD, president of ECRI, a non-profit health services research agency in Plymouth Meeting, Pa. Refer to original purchase and installation orders from hardware and software vendors, because many programs—such as modems—are embedded and could be overlooked. Remember to also check for items that operate using a computer chip, such as automated lighting systems and smoke alarms.

Next, take a hard look at what really needs to be fixed and what you can afford to let break. "Your electrocardiograph is still going to measure electrophysiologic heart activity, although it might print out an incorrect date of the exam," Dr. Nobel said. "The obvious thing to do is annotate the date and sign it. If you're insecure, have someone countersign it."

One way to assess the Y2K readiness of your office equipment is to consult the Web sites of your vendors, most of which list the status of their equipment. Because time is running out, you should pay particular attention to systems that can cripple your practice. "If your building access card doesn't work, you can always break down the door," explained Dr. Nobel. "But if it's January in Maine and your heating system doesn't work, you are in deep doo-doo."

2. Look at hardware.While most of the Y2K attention has focused on problems with computer software—medical record programs, billing software, etc.—Y2K compliant software will do nothing if your hardware isn't up to snuff. Your software's only way of keeping track of time is through the clock built into your computer's nerve system, called the basic input/output system, or BIOS.

"Bad dates are widely hard-coded into computers," explained Diana Parish, Y2K project coordinator for Nationwide Medicare, a subsidiary of Nationwide Insurance Co., in Columbus, Ohio. "The average physician is listening to his software vendor say, 'Don't worry, our application is ready,' but he isn't asking about his hardware."

When Ms. Parish, whose company processes electronic claims, carried out a test in mid-July, she found that almost a quarter of the practices submitted claims with erroneous dates. Part of the problem, she said, was not the physicians' software, which Nationwide provided itself and knew was Y2K compliant, but their hardware. (A report detailing Nationwide's experience is available on the Web at www.hcfa.gov/ y2k/y2kprbpv.htm#results.)

One source of help is the Internet. Computer manufacturers offer download programs from Web sites to test and update basic input/output systems.

3. Update software. When it comes to software, many large vendors have already supplied software upgrades or patches to physicians. Many smaller vendors, however, have closed shop rather than face Y2K issues.

Can you salvage data without help from the original vendor? Possibly, but it may cost considerable time and money. What's at issue is not just saving existing records, but converting them for use by off-the shelf applications. This can be a complicated process taking anywhere from several days to two months. Experts say you should start no later than mid-September.

For a small practice that decides to scrap its old practice management software, it's possible to get by spending only $300 to $700 for simple, off-the-shelf software that handles patient scheduling and billing. That price doesn't include hardware, data conversion, clinical support or medical records features.

Unlike software designed for large group practices, off-the-shelf software packages do not require professional installation. You can order them via mail or online and typically have them in hand within 48 hours. Installation typically requires several hours and can be done by a technologically savvy physician or office manager.

Several vendors of these off-the-shelf practice packages have said that demand has increased by 50% this year, although they expect to be able to keep pace with new orders, at least through early fall.

Similar packages are also available for larger practices. Off-the-shelf software to link a five-doctor practice with networked terminals will cost between $1,000 and $3,000 if used on existing hardware and network software. By comparison, a fully supported vendor-installed system could cost triple that amount.

Most physicians with networks will want to hire a professional consultant to help install off-the-shelf software. At the upper end, the installation process should come with two to three days of staff training provided by the vendor.

If you don't have enough time to complete a full data conversion, one solution is to leave your old system running but to set up a new, parallel system alongside it. Here's how it works: If a practice on a typical 90-day billing cycle installs a parallel system in October, most new appointments and many active patients' information, along with new charges, will have been entered into the new system before January. You'll still need to print out and re-enter remaining records in the new system manually, but that can be done after Jan. 1.

4. Test your systems—cautiously. This step is controversial and potentially dangerous. While a number of experts suggest extensive trials of hardware and software, others, like Dr. Nobel, urge physicians to avoid testing systems on their own. "Don't test," he said. "You will likely cause what you fear to happen."

Dr. Nobel's caution is well founded. In some instances, diagnostic tests where computer clocks were advanced to the year 2000 caused software to purge what it perceived to be outdated patient records. In other instances, the computers shut down software because they thought software licenses had expired. Hardware and software vendors can perform these tests safely with more effective results.

Carolyn Albert of ACP-ASIM's Center for A Competitive Advantage recommends scheduling a thorough on-site testing and system review with your computer maintenance company. "Explain that you will require written confirmation of the results and an accurate survey of all hardware and software components, including model and serial numbers," said Ms. Albert.

Before having a technician test your system, take the precautionary step of printing any schedules, accounting information, follow-up reports and other critical documentation. Talk to your technician in advance about recovery procedures should your system crash.

Make sure your technician tests the operating system, as well as modem communications, backup software, laboratory interfaces, claims-submission software, accounting and payroll programs, report-generation and diagnostic software. And don't forget electronic claims-submission data. "Although the formats may be correct," said Ms. Albert, "the electronic record sent to the carrier may add unacceptable dates." Speak to your carriers to find out if they will accept test batches.

Finally, make sure your technician reviews all programs in your office that exchange data, including laboratory interfaces, accounts receivable, payroll, accounting and report generation software. Even if each system is individually compliant, systems may still be incompatible with each other.

For more information on testing systems, visit the College's Y2K Web site at www.acponline.org/y2k/.

5. Nail down a contingency plan.Even if you think your hardware and software are Y2K compliant, outside vendors, payers and even public utilities are all beyond your control. If anything in your practice goes wrong, you'll bear the consequences, regardless of who is at fault.

You need a contingency plan, but how far should you go? Some consultants have suggested that physicians with offices in high-rises set aside first-floor rooms in their homes to see patients in case the public infrastructure fails. But with little evidence that such a collapse is likely, most measures should focus on more imminent threats.

Computer crashes are the major threat. Even if you think your systems are ready for the new millennium, you should create extra tape, optical disk or paper backups of records as a standby measure. "Put them in escrow, so that if you're ever called by a lawyer, you can produce that tape and show what was known by doctor and patient on a certain date," said Blackford Middleton, FACP, vice president of the medical software company MedicaLogic Inc.

By December, you should have stocked up on paper forms and ledgers as a backup for your computerized systems. You should also have located possible sources of temporary billing help. If you use an outside billing agency, Ms. Albert said to make sure that it has had an experienced consultant conduct Y2K testing on its systems, and get a written confirmation of liability.

Disregard earlier suggestions to submit paper claims to payers in late December as a precaution against January disruptions. Most experts now fear such a strategy itself will cause a crisis. "We don't have a problem, but we will if everyone does that," said Neal Burkhead, an administrator at Palmetto Government Benefits Administrators LLP in Columbia, S.C., a fiscal intermediary for Medicare and other payers. "We have to convert paper claims to electronic records to process them."

Similarly, HCFA officials say that physicians should discourage patients from stockpiling prescription drugs. While drug makers say they expect no disruptions, they fear hoarding will interrupt supply channels.

Consider your schedule for January. Are you prepared to see patients on Jan. 2? If you are implementing new software systems, consider your patient load and staff scheduling to allow for data entry projects and last-minute fixes. Allow one or two days for staff to complete year-end procedures and obtain backup data before the end of December.

Other provisions include postponing elective procedures and establishing backup systems for the next 12 months. "Unfortunately, there's reason to suspect significant failures throughout the year 2000," said Gary Setterberg, senior vice president of the RX 2000 Solutions Institute, a non-profit Y2K information clearinghouse in Minneapolis. Particularly vulnerable periods include the end of each quarter when reports are due, and Feb. 29, a leap-year date.

Finally, any contingency plan should insure your practice's financial viability. You may want to consider a loan from the U.S. Small Business Administration (SBA). The loans go up to $150,000 and are specifically for Y2K-related equipment and software upgrades. After the beginning of the year, SBA loans will be available to cover business disruptions or breakdowns in accounts receivable and billing.

The loans require some documentation and can be approved in 36 hours or less for practices with receipts less than $5 million, said Roscoe Hanner, SBA's financial assistance director. (For more information about SBA services, go to www.sbaonline.sba.gov.)

Edward Martin is a freelance writer in Charlotte, N.C.

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