The looming millennium bug. (Health Policy Update).

Health care executives are planning for the turn of the century and the millennium bug (Y2K). They are aggressively working with a broad range of providers to ensure uninterrupted service delivery and reimbursement for health care services. The Y2K bug, as It has come to be known, is the result of the decision by early computer programmers to use a two-digit designation for the year instead of four digits for date sensitive programming. Many common computer-based systems and biomedical devices may fail to function normally when tasked to perform operations that require correct identification of dates beyond the year 2000.

This problem is further exacerbated because the year 2000 is a leap year that does not follow the normal pattern. In 1582 the Catholic Church established the convention that a leap year would occur ever four years. The one exception was that a leap year would also occur every 400 years. The year 2000 is one such year. (1)

Health systems concerns

Health care executives should have identified their critical business/clinical operations and taken an Inventory of all date sensitive equipment and evaluated it for Y2K readiness. Most systems should have been updated or replaced. Post-remediation testing should also be done to ensure proper functioning. Because of the critical nature of many of these systems to the proper delivery of health care, contingency plans must be developed in case they fail. The Federal Health Care Financing Administration (HCFA) has developed a sample Y2K readiness checklist to focus providers on items that should be evaluated (please see Figure 1). (2) Examples of critical business/clinical systems include:

* Appointment/scheduling systems

* Medical records

* Communications equipment (beepers, telephones)

* Payroll

* Security

* Billing/financial systems

* Diagnostic and other biomedical equipment

* Medical supply

* Pharmaceutical supply

* Emergency care systems

* Facility infrastructure

Contingency planning

Physician executives need to have a contingency plan in case Y2K-related failures occur. Most health care facilities have a disaster plan that has been tested in clinical scenarios. These plans should be reviewed to ensure they include procedures for handling problems with office operations, power outages, equipment failure, supply or pharmaceutical shortages, and patient evacuation.

Financial systems are at risk at multiple points, including determining eligibility, claims submission, billing, and payments. Addressing year 2000 problems is HCFA's top priority. It has worked to ensure its systems are prepared to verify enrollment, consumer eligibility, coverage issues, and effect payment for Medicare. Operational responsibility for the Medicaid program rests with the states, however federal and state officials have been working jointly to ensure Y2K readiness. Commercial insurance plans have also been working to make sure they are prepared.

Physician executives must ensure that their systems can effectively communicate with federal and state systems. This means that end-to-end testing of computer systems should be done, even if they are deemed Y2K compliant. Failing to do so could result in not being able to bill for services or having inaccurate eligibility information. Contingency plans for billing operations include keeping paper and electronic records of critical billing documents. There should also be procedures for paper billing operations, which could result in payment delays and should be planned for.

Important information on computer systems should be backed up both electronically as well as on paper if possible. Procedures for manually managing appointments, medical records, and other computer-based systems should be in place.

Building systems, such as security, heating and cooling, and elevators need to be evaluated. This is especially true for automatic locks used in psychiatric units and fire protection systems.

Quality assurance procedures should also be addressed. While most practitioner licensing boards should be able to process licensing and verification procedures, quality assurance managers should credential health care providers before or after the new year to avoid peak Y2K risk periods. Backup records should be kept to ensure these valuable provider documents are not lost.

Emergency medical systems should make certain that essential communication systems are able to process 911 and other emergency calls. Emergency system medical directors should also see that these systems can properly triage, dispatch, and track emergency operations. Emergency equipment such as defibrillators, infusion pumps, and patient monitoring equipment must be checked. Routine service on emergency transportation vehicles should be done early and worn or wear-prone parts replaced. This will ensure uninterrupted service should repair part supply lines become disrupted. Gas tanks should be filled, at least when the tank is half full. Similar guidelines apply to preparing non-emergency patient transport units.

Biomedical equipment relies on computer chips for timing of various functions, date and time stamping, or maintenance. The Food and Drug Administration's website provides access to Information on the Y2K readiness of selected medical devices (www.fda.gov). Individuals should review these sites with caution since much of the information is general and should consult equipment manufacturers directly. A medical device's specific make and model is needed to make sure the device is compliant.

Critical power systems may experience brownouts, blackouts, or irregular voltage spikes. Make sure that backup generators are available for medical devices and critical patient care systems. Protect sensitive electrical equipment with surge protectors. Identify alternative methods to assist critical patient support systems such as ventilators.

The pharmaceutical industry addressed the Y2K problem early on. The pharmaceutical supply chain is short and can function manually. In most cases there is a 30 to 90 day inventory of drugs and supplies. There is also extensive national experience with supplying large volumes of pharmaceuticals during disasters such as floods and hurricanes. The greatest risk is not the availability of drugs, but shortages due to hoarding. The health care community is working to educate the public and to prevent stockpiling medications. Patients should be advised to refill medications when they have a one-week supply left.

Contingency planning for routine medical supplies is subject to the same constraints as for pharmaceuticals. The American Hospital Association has released guidelines for health systems to prepare for Y2K: (3)

* Identify mission critical medical and surgical supplies and pharmaceuticals needed for clinical services. Review normal purchasing requirements.

* Develop contingency plans with suppliers to meet current needs for essential supplies and pharmaceuticals. These plans should identify substitute products that can be used and their source. Emergency planners should also plan for disruptions in the normal supply process.

* Health care providers should have emergency agreements between themselves to define how they can support each other in a Y2K emergency.

Physician executives need to document their Y2K efforts in order to show "due diligence." Demonstrating that the health care system has done the proper evaluation, remediation, and contingency planning should reduce the risk of successful litigation if a Y2K failure occurs. Contact your attorney with any particular concerns or questions.

Public health systems

Several public health safety messages should be reinforced throughout this period by all parts of the health care system. Examples include:

* Encourage consumers to heed expiration dates on all foods and watch carefully for spoilage. The risk of food bourn infection could be increased during prolonged power outages.

* Injury control efforts should be encouraged by educating consumers to use flashlights over candles (prevent fires) and avoid using outdoor stoves indoors, for cooking or heating (carbon monoxide toxicity).

* Check frequently on elderly neighbors.

* Since the turn of the century occurs during the winter and over a weekend, consumers should prepare as if they were preparing for a four-day snowstorm.

Conclusion

Addressing the Y2K bug requires intense remediation efforts. It is hoped that these efforts will result in few problems that affect health care. Contingency planning by physician executives should ensure that patient care is not unduly affected during this critical period. Places to go for further information include computer and software vendors, professional or business associations, and federal and state government websites (please see the listing of related websites).

FIGURE 1 SAMPLE Y2K READINESS HEALTH CARE PROVIDER CHECKLIST

* Bank Debit/Credit Card Expiration Dates

* Banking Interface

* Building Access Codes

* Claim Forms/Other Forms

* Clocks

* Computer Hardware

* Computer Software

* Custom Applications

* Diagnostic Equipment

* Elevators

* Fire and Smoke Alarms

* Heating and Cooling Systems 

* Insurance/Pharmacy Coverage Dates

* Membership Cards

* Medical Devices

* Monitoring Equipment

* Payroll

* Telephone/Communication Systems

* Spread Sheets

* Treatment Equipment

* Security Systems

* Vaults

Health Care Financing Administration

Note

The stated views are those of the author and do not represent those of the State of Maryland or the Department of Health and Mental Hygiene.

References

(1.) How to Prepare tar Y2K," Consumers Reports. Consumers Union. Vol 64, No.5, p23-27, 1999.

(2.) www.hcfa.gov.y2k (Health Care Financing administration)

(3.) American Hospital Association Y2K Advisory. June 16, 1999.

HELPFUL WEBSITES AND INFORMATION LINES

www.aha.org/y2k

(American Hospital Association)

www.fda.gov

(Medical Devices)

www.rx200.org

(General)

www.ama-assn.org/not-mo/y2k/index.htm

(American Medical Association)

www.hhs.gov/y2k/addinfo/faq.html

(U.S. Department of Health & Human Services)

www.y2k.gov

(President s Y2K Council)

www.fema.gov/y2k/ccmp.htm

(Federal Emergency Management Agency)

HCFA Y2K Outreach Line 1-800/958 HCFA

(4232) (Health Care Financing Administration)

1-888/HHS-Y2K1

(Health & Human Services Hotline)

Georges Benjamin, MD, FACP 

Georges Benjamin, MD, FACP, is the Secretary of the Department of Health and Mental Hygiene in Maryland, Baltimore. He can be reached by calling 410/767-6505 or via email at [e-mail].