Most physicians admit they pay little more attention to their office information systems than they do their home computers.
So it should come as no surprise that medical group practices may be among the U.S. businesses least prepared to cure the year-2000 computer bug.
Those who don't know much about this fin de siecle terror are not alone. Barbara Penatzer, an executive director at Superior Consultant Co. in Southfield, Mich., says only five of 150 medical group managers she recently queried said their information systems were year-2000 compliant. And those were practice managers savvy enough to attend a session on the "Y2K" problem at the Medical Group Management Association's annual conference last October.
"From what we have seen all over the country, physician practices have done little or nothing about the year-2000 problem, though they are starting to get alarmed about it," says Joel Ackerman, executive director of the Rx2000 Solutions Institute, a Minneapolis-based organization that promotes millennium-bug solutions for the healthcare industry.
Practices that demonstrate such casual concern about the problem might get a rude awakening early this year, Ackerman says. Those that schedule appointments up to a year in advance could experience a computer meltdown when they enter the 2000 date.
Here's why: Older computers have software based on programming languages such as COBOL and FORTRAN that once used punched cards to record data. Because each card had only 80 columns of data, programs were written to conserve space by using just two digits to signify the year, for example 69 to indicate the year 1969. So when someone enters the date 2000, the system reads it as 00 and assumes it means the year 1900.
While no one knows specifically how each piece of equipment will respond, tests at hospital systems have shown many programs go haywire at the sight of 00.
The results won't be pretty. Patient histories could be unavailable in an emergency. Medication errors could result from physician orders being mistimed. Physician offices could be unable to log onto healthcare organization networks, so requests for appointments or test data could be lost.
Perhaps worst of all, if a practice hasn't demonstrated due diligence in attempting to fix such problems well in advance of the millennium, lawyers may be lined up with subpoenas from patients-turned-plaintiffs.
"Everybody will be suing everyone else when something goes wrong," predicts Kenneth Kleinberg, research director with the healthcare division of the GartnerGroup, a Stamford, Conn.-based information technology consulting firm. "Patients will sue doctors and hospitals. Doctors will sue vendors and outside billing practices."
In surveying 15,000 companies in 87 countries last fall, GartnerGroup found 66% of all healthcare organizations will experience at least one mission-critical system failure in the coming year.
GartnerGroup also found 88% of 200 U.S. medical practices surveyed had done nothing about Y2K (see chart on page 39).
"If you are not scared about the year 2000, you really don't understand the problem," Penatzer says.
Too little, too late
The trouble is, it may be too late for a practice manager to adopt a new attitude, swing into gear and expect to solve the year-2000 problem in time.
Bill Finney, senior vice president and chief information officer at Health Alliance of Greater Cincinnati, an integrated delivery system, says: "If you haven't started now, probably you are not going to be able to make every device compliant by the end of 1999. Most of the mission-critical devices and systems can be made compliant, but there will be things you just have to let go until after the year 2000. You will have to decide what you can do without."
Making this harder, Kleinberg says, is the casual nature of many small group practices. "The typical scenario is a group of doctors who brought in a brother-in-law a few years ago to adapt some software to their business," he says. "The (applications aren't) well-documented. The doctors view their mishmash of PCs, network links, etc. as their 'computer system,' and they are loathe to invest in a new one."
Untangling the problem involves painstakingly analyzing thousands of lines of computer code. Also, microchips in many clinical devices may have a date problem. Many of these chips are buried beneath layers of circuitry. Some devices may fail in the testing and may not be reparable.
And practices can't test software on outdated hardware, so many will have to bring in consultants to analyze their systems.
Get in line, the experts say. "There are vendors out there who are telling people they won't be able to get to them for months. That's too late," Penatzer says.
Finding a solution
When Finney arrived at the not-for-profit Health Alliance from a post at the Mayo Clinic in fall 1995, he was confronted with a system trying to integrate six hospitals, outpatient facilities and Alliance Primary Care, a group practice that since has grown to 180 doctors at 48 locations.
"What we found in the practices was a lot more diversity in software as well as equipment than we found elsewhere in the system," he says. "Right now, Alliance Primary Care is a group of practices rather than a group practice."
Each practice site is unique in the types, brands and ages of its clinical devices, he says. "There were a lot of analyzers and a lot of pumps that were all over the place in terms of age and brand. Some of the vendors no longer existed, so we didn't have anyone to ask (about the date problem)."
Finney says he found the same problems with scheduling and billing programs.
Demonstrating how far in advance a business must start surveying devices and applications, Health Alliance began doing so more than three years ago. "And we're not done yet," Finney admits. "We have a target date of September (1999) for completing all the work. But some systems need to be done much sooner. For patient scheduling, we need to be compliant by June 1." Alliance Primary Care schedules 500,000 patient visits annually.
After cataloging all the systems and devices that were problematic, Finney's year-2000 team did a risk assessment based on how important an item was to the core mission of Health Alliance. If a device could fail and affect a patient's outcome, the team revamped it. If a device or system would only inconvenience providers, they put it on the back burner. And they took out of service some equipment that isn't used often.
The next task was contacting vendors to fix the problem. In situations where the practice had an ongoing maintenance contract, the vendor did the work at no additional cost, Finney says.
"Where vendors would not commit (to a solution), we went through a process of identifying whether the software or device was year-2000 compliant and whether we could fix it ourselves or simply replace it," he says.
Health Alliance's deep pockets made the whole process a lot easier. For billing, claims processing and other business processes, Finney's team installed across the network a new practice management system made by IDX Systems Corp. In one fell swoop, such systems became year-2000 compliant.
Health Alliance set aside about $2 million for the Y2K work that would not have taken place naturally through system integration, but the total cost may reach $10 million, says James Thomazewski, vice president and chief operating officer of Alliance Primary Care.
Those without such deep pockets can tap a growing array of sources for Y2K information and advice. Joining the Rx2000 Solutions Institute gives practices access to a huge database on problems and solutions in software and hardware. They can download a manual that will show them how to organize a Y2K program. They also can obtain sample forms for ensuring a vendor has certified a product as year-2000 compliant, which is critical for defending potential lawsuits.
Membership runs between $1,000 and $20,000 a year, depending on gross annual revenues.
Other databases on clinical devices include one jointly run by the Department of Veterans Affairs and the Food and Drug Administration and another one put together by hospital alliance VHA that is available only to alliance members and affiliated doctors.
Medical groups will find it more difficult to test devices than software, Kleinberg says. Computer software allows the source code controlling an operation to be called up and picked apart, but microchip programs are difficult to find, let alone cure. Often just getting to the chip and testing it can change the device's operation, causing problems rather than solving them, he says. Such a change may expose a practice to liability it might otherwise not have incurred.
"Usually, it's best to trust the vendor as long as they provide you with letters certifying compliance," he says.
The Y2K problem isn't just a computer glitch. Microprocessors could fail in elevators, telephone systems, security passes and supply chains, says Tom Kumura, a healthcare systems expert with Superior Consultant. "You really have to have some contingency plans, such as what to do if the elevator fails. You should keep manual bank statements and supply statements in case your links to the bank or your suppliers go down."
On Jan. 1, 2000, some physicians may find a nasty little surprise at their offices, Kumura says. "Sprinkler systems default to the 'on' position when they malfunction. You could have a few inches of water on the floor."
Physicians should be asking their building managers, lenders, hospitals and suppliers if they are year-2000 compliant, and they should get letters from each confirming this, he says.
Ignoring the problem
In conducting a recent informal survey of 15 group practices, Modern Physicianfound most practices aren't heeding such advice. Most wouldn't talk about the Y2K problem or referred a reporter to a computer vendor, saying "they handle it."
One director of a 40-physician multispecialty group practice in the Midwest who requested anonymity, said: "We have just started to look into this. I just came back from a conference where this was discussed. We are talking with some vendors and examining our options. Right now, it doesn't look good" for solving the problem in time.
Rx2000's Ackerman isn't surprised by such reticence. "One thing that has filtered down to the practices is they shouldn't speak publicly about their lack of preparedness. Such a quote would be strong evidence in a negligence lawsuit."
Already lawsuits have been filed over the issue, albeit by providers against vendors. Robert Courtney, a D.O. in Somerset, N.J., last fall filed the first of eight class-action lawsuits against Medical Manager Corp., alleging the company was selling noncompliant practice management software as late as November 1997, even though it was well aware of the year-2000 problem.
Tampa, Fla.-based Medical Manager settled six of the suits in December, including Courtney's, by paying claimants $1.5 million and making available a "patch" that makes the software Y2K compatible. The patch is now in final testing, a company spokeswoman says.
Todd Sloane is a Chicago-based writer and editor.