Kathleen Davis knows all too well the extent of information system improvements needed to bring BroMenn Healthcare up to date in 1999. But she'll just have to wait until 2000.
"Right now we do not have clinical documentation. We do not have a radiology system. Those are things we would be working on now if it were not for the year-2000 problem," says Davis, hired last June as chief information officer of the Bloomington, Ill.-based two-hospital system.
A year or two ago, healthcare senior executives across the country began recognizing the role of information systems in shaping a strategy for successfully integrating delivery systems (Feb. 23, 1998, p. 70).
But just as organizations were set to add new applications to improve clinical processes and to get the most value from their networks, date-related computer programming flaws arose in their existing systems, wresting the resources.
"We can't move ahead, and I would like to move ahead," Davis says. "A majority of projects we are working on are year-2000-related." And some projects are stop-gap measures rather than foundations for the future, she says.
One vintage core computer system at BroMenn should be replaced by newer technology, becoming the centerpiece of a strategic plan to make financial and clinical data more accessible and useful.
But for now, Davis says, managers are stuck with installing "an interim solution" to get past the much-publicized problem known as Y2K-the threat of computerized confusion resulting from systems' inability to recognize the year 2000 in dates.
There isn't time to issue a call for alternatives to the older system powering the main activities at BroMenn and to get the new systems up and running this year, she says.
Progress delayed. Other healthcare systems may be further along in addressing their future needs, but Y2K is overshadowing project priorities everywhere, industry observers say.
"We definitely are seeing an impact, but it falls into different categories," says Scott Decker, vice president of information services at VHA, an Irving, Texas-based alliance of 1,750 healthcare organizations.
CIOs at member institutions report they are spending more on computerization but mainly for upgrades of existing software, personal computers and the infrastructure holding things together, Decker says.
It's a much different story for plans hoping to tame the next frontier. "New, large strategic capital projects are definitely on hold," he says.
That observation is confirmed by MODERN HEALTHCARE's ninth annual executive survey of information systems trends.
The Y2K drain on resources has slowed clinical-care improvements, the analysis of clinical treatment costs and the growing sophistication of physician practices, according to the survey.
The survey was co-sponsored by the integrated healthcare consulting practice of PricewaterhouseCoopers and by Zinn Enterprises, both based in Chicago.
More than 40% of respondents indicate they have put at least one information systems initiative on hold pending completion of all Y2K-related activities (See chart, p. 42).
Respondents were least likely to postpone the basic electronic underpinning of integration-high-speed computer cables, computer-network upgrades and other infrastructure required before innovative software can work across a healthcare organization.
Most often delayed were projects to install clinical information systems, considered the key to fulfilling the cost-containment and quality-improvement promise of integrated delivery systems.
Medical deferment. Delayed demand for clinically oriented information systems will hit hardest at companies that specialize in medical software or decision-support areas, observers say.
VHA, which has struck deals with vendors to promote selected types of software for integrated delivery systems, is seeing Y2K's effects on certain vendors of clinical data repositories and clinical records for physician practices, Decker says. "It's those kinds (of vendors) that are really nervous about this year."
With providers scrambling to buy upgraded or replacement systems to fix Y2K problems, clinical vendors may have trouble justifying their products as priorities. "They're competing for some tough dollars," Decker says.
They wouldn't have to compete if their customers had any real choice in the matter. Despite all the spending to replace or retrofit systems, senior executives still see clinical initiatives as the top priority in bringing order to their diverse operations.
That difference between what providers are saying and what they're doing underscores the impact of Y2K in decisionmaking, says Tim Zinn, president of Zinn Enterprises, a Chicago-based healthcare technology consulting firm.
Asked for up to three "hot button" priorities for developing an integrated delivery network, respondents ranked clinical information systems and the underlying clinical communication infrastructure higher than financial applications, patient accounting and other choices (See chart, this page).
Looming just behind clinical needs in priority, however, was Y2K compliance.
"Overall, Y2K is driving everything," Zinn says. But down the road, executives realize they need to know how their institutions are practicing medicine, he adds.
The chance to modernize. As long as they have to tackle the millennium compliance imperative, however, many organizations are turning it into a positive. With savvy planning, the Y2K effort can double as an opportunity to retool and standardize core operational systems.
"I think we've gained more than we've lost on Y2K," says Kari Cassel, CIO of UAMS Medical Center, the patient-care network of the University of Arkansas for Medical Sciences.
Although Y2K preparation will delay some clinical projects at the Little Rock, Ark.-based provider network, it hasn't halted other key initiatives, such as investing in telemedicine, Cassel says.
And software upgrades and hardware replacement projects are not only remedying Y2K concerns but also enabling the medical center to run more-sophisticated clinical software, says Bob Sterling, the network's Y2K coordinator. The previous hardware couldn't handle that level of sophistication, he adds.
Projects under way include a $1.3 million upgrade of 4,000 PCs to accommodate the Windows 2000 operating system when it is available next year, Cassel says.
It's part of a just-completed strategic plan that includes ongoing upgrades of communications networks and key transactional computers, called servers. That plan also includes telemedicine expansions for physician consults and the addition of a clinical data repository, an outpatient clinical information system and a system for medical student registration.
The university had approved spending $15 million or more for a new financial information system, including a general ledger, human resources management and materials management, Cassel says.
But the project was delayed by more-pressing priorities. It wasn't the only initiative affected by limited resources.
Another project to provide utilization management and case management also was postponed. And a home healthcare system contract that officials were ready to sign last fall seemed headed for indefinite delay until last week, when the funding was approved.
Cassel says it's difficult to say whether the delays are related to Y2K or budget constraints. The home health delay, for example, was "definitely a budget problem. But how much has Y2K affected that budget?"
Waiting room. A clearer casualty of the Y2K crunch is a bid to extend clinical documentation and electronic patient records to a half-dozen outpatient facilities on the UAMS medical campus.
Since August, physicians at a family medicine clinic and a primary-care facility have responded well to a pilot project implementing a system from MedicaLogic, Cassel says.
Nevertheless, the strategic plan calls for opening up bids, making Hillsboro, Ore.-based MedicaLogic compete with others for a networkwide implementation that also includes a cancer center, an eye institute, a center on aging and other outpatient clinics.
The final resolution will likely be delayed until Y2K tasks are completed, Cassel says.
At Covenant Health System in Waterloo, Iowa, basic technology considerations also are delaying some clinical improvements.
Plans for a clinical data repository, part of a five-year information technology plan that's in its second year, were delayed because of the Y2K imperative, says Andrew Huff, senior vice president of support for the three-hospital network.
Building backbone. However, other building blocks of that strategic plan have been moved up by the Y2K issue, says Huff. One example: a $300,000 laboratory system upgrade capable of running in a multihospital environment.
Typically vendors iron out their products' programming flaws in the most recent version of the software, which also is the most advanced. As a result, "we do have a better lab system that happens to be year-2000 compliant," Huff says.
The system was installed early last fall at Covenant Medical Center in Waterloo, and it was expanded by year-end to two outlying hospitals: Mercy Hospital of Franciscan Sisters in Oelwein, Iowa, and Sartori Memorial Hospital in Cedar Falls, Iowa.
As important as clinical information management is, Huff says, it must take a back seat to "putting a basic backbone in place to allow us to conduct business."
Projects to put that backbone in place include establishing PC networks, putting 80 physicians in 12 locations on the same computer server and giving physicians access to orders and test results from network hospitals and ancillary facilities.
"Y2K is just one more criterion for prioritizing your budget," Huff says. Regulatory and safety issues always move to the top of the list, he says. And in 1999, biomedical devices will move to the forefront for safety reasons-with Y2K problems as the underlying cause.
The cost of Y2K compliance hasn't even been quantified, because all the measures taken have been part and parcel of improvements to the computer network. "We're getting more than compliance; we're getting an upgraded product," Huff says.
Covenant spent $3 million on information system initiatives in fiscal 1998 ended June 30, and it will spend about the same amount in fiscal 1999. Overall, the healthcare system anticipates spending $12 million over five years.
Getting on the schedule. Products in demand for Y2K compliance will be added to vendors' implementation schedules only when hospitals make firm commitments that they will be ready to receive them by a specific date. "If we're not ready to go, they'll see us next year," Huff says. Software implementations take months, and neither vendors nor providers have time to stand idle.
That pressure to decide doesn't always result in a system that resolves Y2K issues and improves technology, says Lawrence Pawola, a healthcare consultant with Chicago-based Sheldon I. Dorenfest and Associates.
For example, one healthcare client with an old Y2K-flawed physician practice management system decided to switch to a Y2K-compliant system sold by the company that already supplied most of the core hospital software applications. "It was purely a replacement because of Y2K reasons," Pawola says. "It was not a strategic advancement for information systems in that organization."
Sometimes strategic advancement is not an option, however. When Kathleen Davis took over at BroMenn, she realized some mission-critical software applications required immediate replacement or upgrades. Time constraints led her to make the best of an outdated system.
BroMenn's Oacis StatLan clinical-order-entry system, developed a decade ago, could store data for only 30 days. The contract for its core administrative information system, called Precision Alternative, was due to expire in 2000.
BroMenn didn't even consider a much more complex offering from Oacis. It decided to renew the Precision contract for financial software and to solve the clinical order problem by buying an accompanying Precision module. The vendor, McKesson HBOC, isn't even selling the orders and results components of the decade-old system to new customers-but the choice affords at least a six-month window of data and gives physicians access to the data in their offices, she says. It also fills the expediency bill: Both product components are free of Y2K flaws.
The financial component of the updated software system is scheduled to be up and running this month. But even with the time saved by staying with the Precision line, the order-entry component won't be in operation until October.