Fort Lauderdale, Fla.-based North Broward Hospital District had primed its information systems to survive a Y2K disaster.
During the past three years, it had worked out an off-site recovery plan for computer disasters with help from a company specializing in such things.
A state-of-the-art, millennium-ready data center had backup features and redundant storage of information. The healthcare system had systematically removed points of possible failure from the interconnected network of four hospitals and 40 ambulatory sites, including physician offices, clinics and ancillary facilities.
To control temperature in the data center-crucial in the heat of southern Florida-a modern water-cooled air-conditioning system had been installed.
Wait a minute. Water-cooled?
That could be a hitch. The healthcare system had generators for electric power and pagers and wireless phones for communication, but a disruption in the main water supply could force the data center to shut down.
And that shutdown could have negated all the best-laid plans for computer readiness, says Karen Ondo, vice president and chief information officer.
By thinking things through systematically, North Broward helped identify that weak link and other problems that weren't part of the narrower hunt for Y2K viruses but could still have serious effects.
Identifying the vulnerability in the air-conditioning system allowed managers to look for a contingency, and they found one: a capped well on the campus where the data center is located. The well will be uncapped and connected to the air-conditioning structure as an emergency water source, Ondo says.
Contingency plans are nothing new in places where natural disasters strike. "Hospitals have to have some kind of plan already in place, and we call it our hurricane plan," Ondo says.
When a hurricane watch becomes a warning, standard practice includes obtaining supplies for a few extra days from the local healthcare warehouse operator, increasing the water supply and staffing up for the strain on patient-care operations.
Disaster plans are good places to start planning for consequences of Y2K problems, but the plans must be adjusted for assumptions that won't apply under the unique conditions imposed by the millennium, says Bob Relph, divisional vice president in the Clearwater, Fla., office of Superior Consultant Co.
If software doesn't work, he says, it can't be backed by software with the same glitch. If a ventilator fails, it can't be replaced by another ventilator with the same faulty microchip.
And when disaster hits one hospital, Ondo says, it likely can't count on help from other hospitals if the whole county or state is having similar problems.
In December, North Broward conducted a three-day retreat on millennium contingency planning that included an analysis of how it differs from other disaster plans. Facilitated by the healthcare contingency planning solutions division of IBM Global Services, the healthcare system's executives and key employees identified special problems they could face and made fiscally important decisions, Ondo says.
For one thing, they decided to keep a 100% supply level on hand for five days. That's two days more than would be ordered from the Baxter Value Link warehouse before a hurricane.
In addition, "we're looking at making sure we have five days of water at each site," she says. Hospital personnel will fill gallon containers, "putting them in rooms and lining halls with them."
North Broward also decided it had to be more liquid in its investments to free up more cash, especially for a payroll of $8.9 million paid twice a month to about 6,000 employees.
Those decisions carry a cost. "You really take a hit on your budget" by taking ownership of five days of supplies in a just-in-time operation, Ondo says. The system also loses the difference between long-term and short-term returns on money.
But employees must be paid, especially when so much is asked of them. And the supplies will be used, diminishing the effect on the materials budget over time, she adds.
The costs of payroll and supplies contribute to a Y2K preparation expense that North Broward estimates to be between $11 million and $22 million. That includes the strategic plan, legal due diligence, tests of all medical devices, upgrades and replacements of medical equipment, and extra pay for employees working on Y2K projects.
On the revenue side, North Broward began in mid-1998 negotiating arrangements for prospective payment on managed-care contracts as they came up for renewal, Ondo says. In a Y2K crisis, "we fully expect to bill; what we're concerned about is their ability to pay."
If there are problems on either side, cash flow will keep coming based on the previous three months' total reimbursement, and the contract partners will "tidy up later" when actual billing can be concluded for that period of prospective payment, she says.