Will your information systems survive as we head for the year 2000 crisis?’
The new millennium may pose a threat to your data systems
The new millennium. It has a nice ring to it. A once-in-a-century opportunity to close out the old and start afresh. Provided, that is, it doesn’t bring total chaos and disruption to your health information systems.
Unless you start taking action soon, the technology that records, stores, and analyzes the data that are so crucial to your hospital will be in jeopardy. Some of those data will be meaningless; some you may not even be able to access.
In some circles, this is called the "millennium situation." Others are more urgently calling it the "year 2000 crisis." Whatever term you eventually subscribe to, the disruption to your operations could be catastrophic, experts warn.
The cause is imbedded deep in the codes of your computer systems the "logic" they use to route and store data and do the calculations your hospital needs for benchmarking and outcomes measuring, contracting, claims, and billing.
The problem is that many 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 "2000" is unrecognizable 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."
If there is good news, it is that the problem will manifest itself mainly with data, not patient care, he says. "The people who will be pulling their hair out are those involved in reimbursement," he continues. "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. For patient care, I think it would be negligible."
The impact this will have on the HIM field is hard to calculate and may depend on how advanced your information system is, says Cheryl Berthelsen, PhD, RRA, associate professor of health information management at the University of Mississippi Medical Center in Jackson.
The fact that many hospitals are technologically behind the times may prove to be a blessing, she says. In some cases the fix may be as simple as calling your vendor. In other cases it may be considerably more complex. Even if your systems are inadequate, the clock ticking toward the year 2000 can serve as an impetus for information managers to upgrade their systems. (See story, p. 19, for Berthelsen’s suggestions on accomplishing this.)
The problem will be more severe for hospitals and health systems that over the years have developed their own information systems, 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 code didn’t do a good job of documentation, so you’re talking about spaghetti code," he says. The problem is compounded because the people who built and modified these systems may not be around anymore. These information systems are basically functional, but "deep in the bowels" there likely are problematic 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 serious problem," Eckstein adds.
While the basic dilemma involves technology, experts say the solutions start with hospital professionals outside the information systems department. Much of the responsibility for pinpointing problem areas rests on people including health information managers who understand the data implications of the problem.
To rescue your hospital from the crisis, experts offer these recommendations:
1. Prepare a plan.
Start by forming a task force composed of health information people, systems people, and a broad group of others who can identify which systems may be in jeopardy. Don’t leave it up to the "techies," warns Eckstein. System users should be involved to ensure all of the complex configurations of information systems are considered.
"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.
"Not only are we 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.
Allow time in the plan for executive-level approval, says. A complete overhaul of your information systems could require an outlay of $1 million or more, meaning the top echelon of your administration will need to review and approve the plan.
2. Do an audit.
The plan should include 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 them. "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 Brantton, Ontario, Canada-based speaker and consultant on the year 2000 problem. 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 impacted.
3. Recode your systems.
A key question is who will do this. If anyone suggests using your own systems people, you might be wise to discourage that. Dimmitt 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 and resolve any problems.
But, warns Dimmitt, "Occasionally you’ll come across a vendor who is biased. They may not want to admit they haven’t addressed the problem. They’ll say, No, we don’t have a problem. We’re addressing that.’ If you go to an independent consultant, they’ll be able to tell where you’re system is, what the various software packages can do, and research the vendors to get the real story."
If the hospital is lucky, some software vendors can solve problems with a simple upgrade to a new version that recognizes the 2000 date, or they can add what are called "patches" to fix the problem temporarily. "But if you’re talking about a major code rewrite, you have to build a major fire under your vendors," says Eckstein. "If you’re beholden to everybody who’s a vendor, and you don’t have access to the codes yourself, you’re pretty helpless. This could take over a year, and that’s being conservative."
Also keep in mind that the larger vendors likely will concentrate on their larger customers, he adds. "If you are a client of SMS [Shared Medical Systems] or HBO & Co., the question is where you are on the pecking order."
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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