The keys to being prepared for Y2K: Planning, planning, and more planning
The keys to being prepared for Y2K: Planning, planning, and more planning
Check medical equipment; set up a contingency plan
Editor’s note: As the clock ticks toward the new millennium, physician practices should make sure their information systems and medical equipment will be working in the year 2000 (Y2K). Last month, we examined the steps you should take to ensure that your computer software and hardware will survive the transition from New Year’s Eve to New Year’s Day. In this issue, we take a look at medical equipment and supplies, payers, and what other practices are doing to prepare for Y2K.
If your practice hasn’t started getting ready for the year 2000, you’d better start now. Come the millennium, you could lose access to your patient records, experience medical equipment failures, face a shortage of critical supplies, or be held accountable for harm to your patients.
A U.S. Senate committee report released Feb. 28 estimated that 80% of the nation’s 800,000 physician offices had not yet upgraded their computers and other equipment to make them Y2K-compliant.
"It does appear that doctors are a bit late in the game. The message we are trying to send is that being a little later than other industries isn’t the problem, but failing to get started can have dire consequences," says Jim Kalyvas, JD, a partner in Foley & Lardner law firm in Los Angeles and a speaker at the American Medical Association’s Year 2000 Advanced Regional Seminars, held earlier this year.
Small glitches can cause large problems
Even if you feel your practice is totally in compliance for Y2K, you still need a contingency plan to deal with unexpected problems, says Joel Ackerman, chief executive officer of RX2000, a nonprofit clearinghouse on the millennium bug for health care providers in Minneapolis.
"Any kind of glitch in the system, even if it involves small items, can have significant ramifications for your practice," he says. (For tips on what to consider when designing a contingency plan, see p. 52).
The bad news is that if you haven’t already started planning for the year 2000 and implementing those plans, you’re already behind. The good news is that because of the work already done on this issue in other industries, there is a lot of accumulated knowledge that will allow you to jump-start your efforts, Kalyvas notes.
"However, I want to emphasize that the key is to jump-start it now and get the effort under way. If practices haven’t started, they’re going to have to aggressively push it," he adds.
How much the Y2K problem will affect your practice — and how much it will cost you — depends on how much you rely on technology.
"Corporations are spending millions of dollars, but I don’t see that in the cards for any doctors’ offices. They could spend $50,000 for staff time and upgrades, or it could go much higher," Kalyvas says.
Expenses can mount up
But if a practice relies on a practice management system that’s not Y2K-compliant, it probably will have to outsource the billing and record keeping until a new system is installed. That’s simply because there may not be enough time to shop for a new system and have it installed. This expense could run in six figures, Kalyvas adds.
"It can get expensive very quickly depending on what your practice is and how responsibly the vendors you work with have responded," he says.
Even if your practice uses paper records, documentation, and billing, you still need to take steps to make sure you’re not at risk in the new year.
"There are emerging standards of care in year 2000 compliance. If a physician doesn’t take those steps, it’s just like performing surgery without taking all the proper steps. If something goes wrong, the doctor will be held accountable," Kalyvas says.
For instance, if a piece of equipment you use for diagnosis, monitoring, or treatment fails, you could be held liable — even though you aren’t the equipment manufacturer — unless you have been diligent in checking the equipment for Y2K compliance. (For a list of some medical devices and other equipment that may be affected by the millennium bug, see box, above right).
That’s why you need to establish a diligence trail including paper and other documentation showing you made every effort to ensure the equipment is Y2K-compliant. (For steps you should take to ensure compliance, see related article on p. 51.)
If you sign any new contracts with insurers between now and the first of the year, you’re going to have to assure the payers your systems are Y2K-compliant, reports Robert Goldstein, chief executive officer of the Browne-McHardy Clinic in Metairie, LA.
"All the contracts that are coming across my desk require us to warrant that we are compliant and to indemnify the plans against the risks associated with not being compliant," he says.
The year 2000 problem arose because computer hardware and software use a six-digit field to represent dates, with the "19" in the year being assumed. When the year 2000 rolls around, some computers will read "00" as "1900." Computer software and hardware are likely to be affected if they are more than a few years old. (For information on how to check out your computer equipment, see Physician’s Managed Care Report, March 1999, pp. 33-35.)
However, any biomedical device that has a microchip in it also can be affected. According to the Food and Drug Administration, more than 100,000 medical products in more than 1,700 categories could be affected by the Y2K problem.
Only a small percentage of biomedical equipment has an electronic component, and only a subset of that will have any problems, says Gayle Finch, director of the officer of information technology analysis and investment for the Department of Health and Human Services in Washington, DC.
"Most biomedical equipment tends not to have a Y2K compliance problem, but for the machines that do, it can be a big problem," she adds.
If your equipment is 10 years old, you can assume that the embedded chip won’t be Y2K-compliant, adds Jaren Doherty, Y2K program manager at the National Institutes of Health in Bethesda, MD.
With more recent equipment, you need to check it out and get assurances from vendors that it is compliant, he adds. (See above for a list of steps to follow when checking equipment compliance.)
The experts predict that some small equipment manufacturers may go out of business rather than going to the expense of making their products compliant. You should be prepared to deal with this contingency.
Kathleen Quinn, RN, MBA, director of practice management services for the Health Service Foundation of the University of Virginia in Charlottesville, reports that some of her vendors of used equipment were unable to verify Y2K compliance for their products. The health system was forced to find other suppliers for those products.
Utilities, elevators, communications equipment such as interoffice telephones and pagers, and fire alarm systems in your office building all can directly affect your ability to practice medicine.
After you have checked and rechecked everything, consider an audit by an outside agency.
"The next step for us is going to be having an outside firm come in and double-check our compliance," reports Goldstein.
Don’t confine yourself to checking only the systems in your own office. Make sure the vendors and payers you rely on will be able to function on Jan. 1. (For more about payers and their Y2K readiness, see related article on p. 53).
The AMA recommends setting up a triage system for dealing with Y2K issues. Here are some steps to take:
• Evaluate everything you do on a daily basis that relies in any way on a product or service that might not be Y2K-compliant.
• Decide which failures could cause the most harm to your patients or could cause the most harm to your business.
• Put them in order and start working down the list.
• If an item isn’t compliant, decide whether you’re going to get it repaired or replace it.
• Save noncritical items until last.
• Come up with a contingency plan in case a particular piece of equipment or system doesn’t work.
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