Before they can even start fixing millennium-related computer glitches, healthcare organizations must evaluate their entire automation inventory.
Multimillion-dollar software systems are obvious targets. But the proliferation of microprocessors in medical technology also makes it necessary to check every square foot of a facility for chips that could go haywire after 1999.
"This phenomenon is characterized by what we don't know about it," says Dick Holden, coordinator of year-2000 services with VHA, an Irving, Texas-based healthcare alliance.
Some groups are mobilizing to chip away at the unknown, however. Their initiatives recognize that hundreds of healthcare organizations are working concurrently to trouble-shoot an inventory purchased from many of the same manufacturers and resellers.
A number of registries are springing up to report the millennium readiness of chip-embedded medical devices. Sponsors include two major provider alliances, a state hospital association and a group assisting healthcare organizations on year-2000 issues (See chart).
If hundreds of bug-hunters give and take information from a central location, their pooled findings could accelerate repairs or replacements of glitch-ridden computers and devices.
The registries are the first step by allies and competitors to head off havoc. "With regard to the year 2000, there are no competitors," Holden says. "We're all in the same boat."
It's about time. For those who may have missed the ubiquitous news coverage during the past several months, the coming millennium could cause widespread malfunctioning of devices programmed to run automatically based on time and date calculations.
Those calculations often are programmed to assume a date in the 1900s and to treat two-digit references as the last two digits of a year. With the new century, all assumptions are off.
Heading off the problem requires a detailed accounting of any and all devices that might harbor a microchip. While some chip-loaded products, like intravenous drip pumps and defibrillators, are obvious, other devices are more obscure, Holden says. "We have a tendency to overlook them because we don't even know they are there."
As registry entries multiply, providers will have a growing resource to help identify products that should be checked out.
Besides listing all products that contain embedded processors, registries aim to inform users about devices that have a problem calculating dates, the status of any corrections, the time frame and procedure for fixing the glitches and alternatives to equipment that is unfit to operate in 2000.
The registries are attracting manufacturers who want to help get the word out, but database sponsors also are hunting down status reports on specific devices. They often work from inventories supplied by hospitals and other providers.
Because manufacturers are at varying stages in determining whether their products have problems-and if so, what will be done about them-the registries will continually expand and update their status reports. "This is not a static environment," Holden says.
Varying versions. Beyond those basics, registries differ somewhat in information gathering for their databases, customization and accessibility of the data, and fees.
VHA, an alliance of 1,600 hospitals and healthcare organizations, started a service early this year using a database and reporting format developed by Keane, a Boston-based information technology company prominently involved in year-2000 planning and project management.
As of mid-May, the database had more than 10,000 entries from 3,000 businesses reporting the status of their products in four categories: information technology, biomedical devices, facility-management equipment and computer interfaces.
VHA has 30 organizations committed or on-line, and another 75 are investigating participation, he says. The users contribute their complete inventories to the database, which are matched with product information on file and reported back to the providers.
If there's no information on file about a listed item, the alliance asks the manufacturer. That inquiry process broadens the database while answering a specific question, Holden says. Once customers have submitted their inventories, they get updates automatically as new information comes in.
VHA is charging fees based on the size of the organization and its sign-up date. Fees will increase as 2000 approaches, because the database will increase in size and value, Holden says. It's more expensive to help larger organizations because they have more data and more vendors to contact, he says.
The database started out as an alliance service. It has been opened up to non-VHA organizations out of "a corporate responsibility to be a good citizen to all members of the healthcare industry," Holden says.
Members only. The Premier alliance, by contrast, is readying a registry that will be available exclusively to its members for free, says David Natale, chairman of the San Diego-based organization's Y2K Task Force.
In development since February, the database began with information gathered from 300 Premier biomedical and imaging technicians who manage and maintain medical equipment at more than 150 member sites. That information is being supplemented by manufacturers' statements about their products, Natale says. Premier also is prevailing on suppliers under contract with its group purchasing unit.
The database is expected to be available by July 1 to alliance owners and affiliates through a password-protected entry on Premier's World Wide Web site.
In Wallingford, Conn., an information technology unit of the Connecticut Hospital Association is getting ready to take its database nationwide in cooperation with the American Hospital Association, says Jennifer Jackson, CHA general counsel and vice president of clinical services (See Outliers, p. 52).
The state association's Community Health Information Management Exchange is compiling a master inventory of medical equipment using information from the Food and Drug Administration and information from manufacturers and other sources.
Database employees are entering equipment-status information from manufacturers and refining software so the database can generate reports by manufacturer, type of device and other headings.
The effort has focused first on a short list of healthcare's "most essential equipment," such as automatic pumps, defibrillators and pacemakers, Jackson says.
Like VHA participants, customers will be able to submit inventories to match information on file and get updates. The CHA will charge a onetime fee ranging from $5,000 to $20,000 for unlimited use through 2000. The fee will be based on each hospital's expenses as recorded by the AHA's latest hospital statistics report.
Exceptions to the fee schedule are the 70 CHA members, which contributed a total of $450,000 to develop the registry, Jackson says. Of those CHA members, 32 are acute-care facilities that currently are submitting their device inventories. By the end of the month, the AHA expects to complete a mechanism by which state associations across the country can participate, she says.
The independent. A not-for-profit corporation formed expressly to help healthcare organizations with year-2000 computer problems has operated a supplier information clearinghouse since October 1997 and a registry that contains more than manufacturers' statements.
Through mid-May, the products database of Rx2000 Solutions Institute tapped the results of tests conducted and contributed by health plans and hospital networks, says Gary Setterberg, the institute's executive vice president.
The institute also chases down information on suppliers for its customers. Besides determining product readiness for the year 2000, it offers a separate assessment of suppliers' capacity to stay in business and serve their client bases in the new millennium.
Fees are based on healthcare organizations' gross revenues and range from $1,000 to $20,000 a year, Setterberg says.
Customized searches for specific equipment in subscriber inventories cost more, beginning with an upfront $4,000 fee plus a charge per supplier investigated. A subscriber with 100 suppliers to track and update, for example, would pay an extra $4,500, he says.
The products database has accumulated about 60,000 test results, with 16 health plans and provider networks subscribing and another 22 in the process of signing up.