Unexpected three weeks of downtime prepares hospital for Y2K problems
Unexpected three weeks of downtime prepares hospital for Y2K problems
Unplanned system failure helped spot areas to address
Many access departments are anticipating computer problems around the first of next year, but the Medical University of South Carolina in Charleston got an unexpected foretaste of the disaster scenario when its registration and billing system went down for three weeks last spring.
Unpleasant as it was, says Susan Pletcher, director of access services, the system collapse provided a kind of emergency drill for both her staff and her colleagues in other departments. As a result, the hospital developed new ways of preparing for both Charleston’s ever-present hurricane threat and the advent of the year 2000, she adds.
Losing the ability to register patients and bill via the computer "affected virtually everything in the hospital," Pletcher notes. "Housekeeping didn’t know who was discharged and which rooms were cleaned. Physicians couldn’t find the new admissions from the night before, and the labs didn’t know where test results should go. Charts continue to float into medical records [for which] staff can’t find the patient in the system."
Estimates of revenue lost during the April 1999 incident range from $500,000 to $1 million, she adds. "It was virtually a disaster," Pletcher says. "What really hurt the hospital in general was that we could not generate any bills for almost a month."
Exacerbating an already difficult situation, says Cindy Williams, manager of admitting, was the fact that information systems personnel kept changing their estimate of how long the system would be down. "On Tuesday night, when it happened, they thought it would be down 24 hours. Then they pushed it to Thursday, then they decided it would be a week. It kept getting extended."
The computer collapse was due to a hardware problem and resulted in a new server being added to the system, explains Pletcher. When the system came up briefly, registrars began entering information on the computer, only to have it go down again, Williams notes, thus making it impossible to retrieve the registrations they had just completed. Her overall advice to fellow access managers is, "Make sure you have a good policy on downtime’ registration.’"
She says the experience uncovered several key registration issues — applicable to any facility — in time to deal with them before Y2K:
• It’s impossible to see if a patient has a previous visit recorded in the computer system. "If you’ve already done it, you’re going to have to do it again," Williams says.
It’s important to remember that, because admitters can’t access the master person index to see if the patient already has a record, there will be many patients who will have two medical record numbers, Pletcher points out. "Keep a log of all registrations and be aware that, as soon as the system is back up, you need to go back and merge [any duplicates]." (See related story, p. 99.)
Institutions that issue plastic or laminated cards containing the person’s name and medical record number can avoid the problem if the patient has the card, she adds. "We don’t, so we had to make sure we had an ongoing list of patients with new numbers. It took a lot of time [once the system came up] because we had to transfer all the charges over to the permanent record."
• The paper forms now in use to manually register patients are not adequate. "It’s an iden tifying form like that used in any physician’s office," she says, "and doesn’t include certain things you need when you [later] put the registration in the [computer] system." The revised form includes fields for the medical record number and for the time of admission, for example.
"Other hospitals may have other fields they take for granted," Williams adds. "They need to take a look at that."
Some of the hospital’s inability to recoup lost revenue, Pletcher points out, was because staff were unsure of the exact time of admission or discharge and therefore couldn’t be sure insurance guidelines were met. "It’s difficult to bill for observation patients," she says. "We know how many hours to bill for, but there’s no automatic timing when the system is down."
Although the timing issue primarily involved observation patients, there also were inpatients for which it was difficult to establish a time of admission, Pletcher adds. "If the patient didn’t get in the system, it’s hard to go back and say, Did they get admitted at 10 p.m., or was it after midnight?’ If it was after midnight, we wouldn’t bill until the next day," she explains.
In such cases, she says, "we erred on the side of caution and billed for less time if we couldn’t be certain. It’s better to lose $1,000 than be fined $10,000."
• It’s crucial to have a direct line into the hospital information management (HIM) department. "We needed a place to go to verify the patient’s medical record number," Williams says. "We depended on personnel in that department, and so did staff in any other area where registration might occur." For that reason, Pletcher notes, the HIM department might need to add staff during times of potential crisis.
• Don’t pass paperwork along without making a copy for the admitting department. Plan on adjusting to a full-time paper system, Williams advises. "We had registrars making copies of everything in the patient accounting folder. Normally [registration’s copy] is in the computer." When the system goes down, it’s easy to overlook functions that the computer usually takes care of, she emphasizes. "You need to talk about all those things."
• There are going to be some things you won’t foresee. In her department’s case, the way newborn infants are registered presented an unexpected challenge, Williams says. "A mom in labor comes in, we register her, and it may be hours or a day later when the baby is born," she explains. "The information for registering the baby is dependent on the mom’s registration. Since you can’t look it up on the computer, you’ve got to physically find the mom’s paperwork."
To facilitate that process, Williams notes, her staff began filing the obstetrics account folders separately. "You have to keep looking to see if [the expectant mother] had the baby or went home [without delivering]."
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