The ‘millennium bug’ puts computers in jeopardy of year 2000 problems
The millennium bug’ puts computers in jeopardy of year 2000 problems
Major recoding may be needed to avoid disaster
There’s a bug in your future. Whether it brings you just a minor sniffle or comes on like a flesh eater depends on how well-prepared you are for it.
Under a worst-case scenario, the "millennium bug," as it’s being called, threatens to make the computer systems you rely on totally worthless when the year 2000 rolls around. Experts warn that without immediate attention, this bug could rob you of your ability to verify insurance, to bill, to schedule patients, or perhaps even to operate your electronic bedboards.
The cause lies deep in the codes of your computer systems — the "logic" they use to route and store data, conduct claims and billing, and produce the data your hospital or health system relies on for outcomes measuring, benchmarking, and contracting.
Some computer systems, especially older ones, are not coded to handle data relating to the year 2000. They can calculate a wide assortment of comparative and analytical data for years that begin with "19," but the numerals 2000 are a foreign language to them.
"The nature of the problem is that the majority of software packages written today won’t recognize the year 2000, making those dates that begin in 2000 listed as 1900 files," says Bob Dimmitt, a medical applications consultant with Networked Medical Systems, a health information consulting company in Houston. "In the financial world, this will be a total disaster, and in the health care field they may not even be able to boot their systems. They certainly won’t be able to access their patient files."
Because most hospitals are computer-dependent, the problem affects virtually all operations. But, says Dimmitt, "The people who will be pulling their hair out are those involved in reimbursement. From the date of admission, date of discharge, reimbursement, date of service, billing, and claims. It’s on the financial side and use-of-information side" that the problem will be felt most profoundly.
The good news is that if your information services department is on the ball, it probably is speeding ahead with the necessary fixes. But if it’s not, or if you rely on outside vendors, there’s cause for concern.
"If these people are saying it isn’t a problem, then really be worried, because it is," says Peter A. Kraus, CHAM, systems liaison manager in patient financial services at Emory University Hospital in Atlanta. But don’t panic, he adds. First you need to determine how much of this bug is "media hype" and how much is real. "It’s a problem, a technical problem, and there are a number of fixes to it. You have to pick the right one and do it," he adds.
Be alert to problems not only in your own computer systems, but outside systems you rely on, says Kraus. An obviously critical link is Medicare claims.
Computer systems used by insurance companies, and insurance verification companies also can be affected, Kraus warns. For instance, insurance companies look at dates of eligibility for specific coverage. If the computer calculates that a policy in effect for two years was taken out in 1996, the computer knows that that policy will still be in effect in 1997. But if that same two-year policy is taken out in 1999, a flawed software system may not recognize that the policy is still good for the year 2000.
The problem will be more severe for hospitals that have developed their own computer systems over the years, so-called legacy systems, says Michael G. Eckstein, president and chief executive officer of PSIMED, a health information consulting company in Santa Ana, CA.
"So many hospital systems in this country are home-grown and the people who wrote the codes didn’t do a good job of documentation, so you’re talking about spaghetti code," he says.
Adding to the problem is the fact that the people who built these systems may not be around anymore. These systems are basically functional, but "deep in the bowels" there are codes that link the various information to your databases, he adds.
"In the typical acute care hospital, there are between 30 and 40 totally independent, unrelated data streams flowing through the institution at any time, and each one of them can have this very, very serious problem," Eckstein adds.
If you’re among the fortunate, a good information services department and conscientious vendors will solve the problem. But some experts also caution against totally turning the solution over to your technical people. Much of the responsibility for pinpointing potential problem areas rests on non-technicians — including access and business office managers — who understand the data implications of the problem.
To help prevent a problem becoming a crisis, experts offer these recommendations:
1. Prepare a plan.
Form a broad-based task force of people — including those familiar with access functions — who can identify which systems may be in jeopardy. System users should be involved to ensure all of the complex configurations of the systems are considered, says Eckstein.
"You have to create a task force to say, Here’s where it will impact us, not only on the inpatient side but also the outpatient, and not only on receivables but also cash flow, and this is where it’s going to impact the employees.’"
This task force should be prepared to spend four to six months doing an analysis and complete review of all the coding systems in an institution, and preparing a plan to remedy the problems.
Change won’t be cheap
"Not only are you talking about putting your current systems in suspense and running parallel systems while the codes get fixed, but you’re also talking about this being a people issue, an information flow issue, a business operations issue, and a money issue, and all of those have to be addressed in the plan," says Eckstein.
He notes that a complete overhaul of your information systems could require an outlay of $1 million or more, meaning the plan will have to be reviewed and approved by the executive upper echelon.
2. Do an audit.
Part of the plan should be to do an audit of your software systems. "Try to input data in the year 2000, and set the date in the computer at 2000 and see how the system responds," suggests Dimmitt. "It may not even accept it."
Remember that you have to look at each software system. And once you have gotten each computer system to accept the year 2000 date, you have to ensure that all the software packages are updated to accept that date. Along with determining whether you can input year 2000 data, you must also determine whether the data already in your databases can be manipulated in the ways you want to use it. "You have to take it both ways," says Dimmitt.
Eckstein suggests you make sure the audit includes use of what is called a "tracer file," which can locate all date-oriented information flow.
If you’re a large hospital or widespread health system, be prepared for a shock when you start looking at the number of data systems you have, says Peter de Jager, a speaker and consultant on the year 2000 problem, who is based in Brantton, Ontario, Canada. He notes that one bank he’s familiar with initially estimated it had 92 information systems that would be affected. After completing an audit, the bank discovered more than 190 systems were affected.
3. Recode your systems.
A key question is who will do this. Be leery if someone suggests using your own systems people, says Dimmitt. He estimates that a complete overhaul of system date codes could take more than a year of concentrated work. Can your information services department handle such a heavy extra workload while performing its normal duties?
If your system is of the store-bought variety, call the vendor and see what they plan to do to check out and resolve any problems. (For tips in dealing with vendors, see story below.)
Are there any shortcuts to solving this mess? Probably not, says Eckstein. "If you’re talking about 5,000 acute care hospitals in the U.S., remember that if you’ve seen one, you’ve seen one. There is no duplicative system configuration that you can point to as a model. Everyone is going to have to fight this out for themselves."
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