By Anne Federwisch,OTR
Illustration by Malcolm Garris/PhotoDisc
December 15, 1998

Don’t expect healthcare facilities to usher in the year 2000 with gusto. Enthusiasm for the end of the second millennium may be muted by contingency plans to deal with the "Y2K" problem, caused by the inability of computers to recognize the two digits "00" in a date as the year 2000. Date-sensitive computer operations could malfunction or shut down if computers become confused about whether it’s 2000 or 1900—and that could adversely affect patient care.

Exactly what the scenario will be in hospitals on Jan. 1, 2000, no one can say for sure. But if not remedied, Y2K could affect electronic patient records, medical devices, billing systems, automatic pharmaceutical dosage calculations, and even supply inventory, some experts say. While no one is predicting Armageddon, it probably won’t be business as usual.

"It’s not the end of the world, but what will happen is you’ll just have to limp along," said Harry Rhodes, a professional practice manager with the American Health Information Management Association. "Some of it is going to be [an] inconvenience." But where decisions depend on information in an inaccessible medical record, the patient could be at risk, he said.

What’s the problem?

The problem stems from programmers’ decision to use a six-digit date field (such as 12-07-98) rather than an eight-digit one (such as 12-07-1998) to save space in computer memory, Rhodes explained. So the year 2000 is expressed as "00." In some systems, software might interpret the year as 1900 and shut down because of a perceived 100-year lag in maintenance. Or the computer might not be able to calculate a patient’s age for the correct pharmacy dosage, because the interpreted date of 1900 is ostensibly before the patient was born.

To correct the problem, programmers must change the software to definitively recognize the year 2000. Many software vendors and medical device manufacturers have devised solutions, but healthcare organizations need to take the time to implement those fixes and test the results, said Ken Kleinberg, a research director with Gartner Group, a Stamford, Conn., information technology advisory firm.

Can we fix it?

"Health care tends to be about a year behind most other leading industries," Kleinberg said. He estimates that a mid-sized organization needs 30 months to fully address the Y2K glitch. That includes prioritizing systems that need to be fixed, testing both in-house and vendor fixes, and developing and practicing contingency plans. "We think that the majority of health care will not finish in time," he said.

The American Hospital Association is more confident. Using information from a recent survey, the AHA estimates that approximately 90 percent of hospitals will complete their year 2000 solutions before Jan. 1, 2000.

Yet even organizations that consider themselves at the forefront of Y2K readiness are bracing for the historic calendar change. Len Bourget, the year 2000 project manager for the Veterans Health Administration, which oversees U.S. Department of Veterans Affairs facilities, thinks that his organization is one of those at the head of the curve. He said that the VA’s information system required very few alterations because it was written in a programming language that uses three digits for the year. Bourget estimated the total cost of revising the system at under $1 million. In contrast, the Veterans Benefits Administration, which uses a different computer system, is spending about $26 million on repairs, he said.

But Bourget is still cautious about the year 2000. "I think that we will find some surprises. I think there will be things that we have overlooked or not anticipated," he said. Many could involve services and supplies beyond the VA’s scope of influence, such as billing systems and medical devices, he said.

Medical device downfalls

The VA has headed an aggressive effort to compile data from medical device manufacturers concerning what effect—if any—Y2K will have on the equipment. Last summer, Sen. Christopher Dodd, D-Conn., publicly berated the Health Industry Manufacturers Association (HIMA) for its members’ lack of cooperation with government efforts to develop a database of medical devices’ Y2K compliance. (A Y2K-compliant device will not malfunction simply because of the date.)

While some concern for medical devices may be warranted, the frenzied focus on their supposed shortcomings may be a case of media hype, according to Bernie Liebler, HIMA director of technology and regulatory affairs. "A lot of people seized on devices that have critical functions, but they didn’t necessarily know how those devices worked," Liebler said. "In many cases, there’s nothing that has anything to do with year 2000 dates."

For example, patients and clinicians do not need to fear that pacemakers will malfunction because of the date change, he said. "It doesn’t matter what date it is," Liebler explained. "Your heart beats the same on your birthday as it does on Saturday or Sunday or Wednesday. The date has nothing to do with [the pacemaker’s] functioning."

What should you know?

As healthcare facilities inventory their equipment and carry out changes, clinicians need to be educated about their employers’ efforts. "Most clinicians are not aware of the problem," said Laurene West, RN, a year 2000 consultant and an adviser to Rx 2000 Solutions Institute, a nonprofit healthcare information year 2000 clearinghouse based in Minneapolis. "There needs to be a mass education process."

Ignoring the problem won’t make it go away, she said. Nurses need to take responsibility for understanding how the Y2K problem will affect them. "We’re at a point where there’s so much information that no nurse or physician should say, ‘I didn’t know anything about this.’ "

Clinicians should start by asking their employers questions about what Y2K efforts are under way and how quality of care is going to be maintained in the event of computer and equipment malfunctions, said Michael Stewart, a spokesperson for the American Nurses Association. Questions might include:

Nurses and other health professionals need to get involved in contingency planning as well, Stewart said. "Healthcare organizations should develop contingency plans, and registered nurses, as primary providers, should be at the core of developing those plans since they’re going to be implementing them," he said.

Rhodes said that employees who started with the organization before systems were computerized could be valuable on contingency planning teams. "They can say, ‘In my day, before we had a computer, this is what we did,’ " he explained.

Patients are likely to ask clinicians for reassurance as well, Kleinberg said. "There’s going to be a large public relations component," he said. "Everybody’s got to take some responsibility for functioning in a PR capacity."

Being alarmist does no good, Stewart said. "It’s also equally foolish to assume that there simply won’t be any problems and that everything will be corrected with no problem," he said.

The time to act is now, Kleinberg said. If your facility has not started remedying the Y2K problem, insist that it start immediately. "Everybody likes to watch a train wreck, but we’re all riding on this train," he said. "We all have to do our part."

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