Y2K worry? Computer compliance isn’t the only 2000 problem out there
No water, no electricity: Could this really happen?
In little more than a year from now, you could be examining workers by kerosene lamp, your medical equipment may be disabled, and your computerized employee health records could be in shambles, all because of a once-in-a-millennium phenomenon known as Y2K.
The abbreviation generally refers to the potential "Year 2000" computer crisis, a gargantuan global glitch resulting from attempts to save scarce and expensive computer storage space. In the 1960s, when computer memory was very costly compared to today, programmers saved memory space by using only two digits to code years, such as "98" for 1998. Simply put, unless those programs are changed, they will interpret the year "00" as 1900, not 2000.
Repercussions for the health care industry involve more than just computer system failures. Because many critical medical devices and pieces of equipment contain embedded chips that include date calculations in their programming logic, they also may be vulnerable to Y2K problems. Electrical power systems, too, could fail for unknown lengths of time.
Employee health practitioners may think none of this affects their operations, or that their hospital is taking care of all potential problems in a timely manner, but experts warn that EHPs need to learn about Y2K, ask questions, and take appropriate action. (See list of Web sites, p. 143.) And they say you need to do that now.
Understanding the complexities of the Y2K problem
You might have to be a computer guru to understand all the complexities of the Y2K problem, but EHPs need ask only a few basic questions to ensure a smooth transition into the 21st century, says Tracy Gustafson, MD, a pediatrician-turned-hospital software and statistical consultant who is president of EpiStat Services in Richardson, TX. However, you need to start asking those questions "yesterday," he emphasizes.
While most hospital information systems (IS) departments have been working to eliminate Y2K problems throughout their facilities, don’t assume your problems are solved, says Gustafson, who also is head programmer for a vendor of hospital employee health software.
"Employee health may be lower on the totem pole, and therefore nobody has exactly thought which data are still good and which might have to be thrown out," he says. "It’s not the end of the world, but you could lose all the data in your system and have to start over from scratch. Nobody wants to do that."
Employee health services are date-intensive departments, he adds, and many of those dates are beyond the year 2000. For example, employees might already be scheduled for tests or vaccines in the first few years of the next century, but the computer may read a 2005 date for a tetanus shot as 1905. Employee health software also must be capable of accurately subtracting one date from another. An employee who was born in 1965 will turn 35 in 2000, but if the computer is not Y2K-compliant, it would subtract 1965 from 1900 and calculate the employee’s age as -65 or possibly just 65.
Gustafson says EHPs must find out from the IS department not only if their computer systems are Y2K-compliant, but also if the method of compliance is compatible with other hospital computer systems with which it must communicate, such as personnel or human resources. The problem also can occur if a microcomputer used in the EHS doesn’t use the same operating system as the hospital mainframe.
"This is where the rub comes in," he says. "There’s more than one way to be Year 2000-compliant. Two different computer systems in the same hospital may both be compliant, but perhaps not in the same way, and then they won’t be able to communicate."
The ideal method of compliance is for systems to use four-digit years, such as 1998, instead of the two-digit 98, which solves the date recognition problem. However, another means of achieving compliance involves a 100-year "window" that allows dates to be recorded and recognized accurately for the window selected, such as 1940-2039. Numerous technical distinctions are involved, but EHPs merely need to know if their system’s method of compliance is the same as that of other systems it depends upon for data.
Besides questioning the in-house IS department, EHPs should contact vendors if their software was purchased rather than developed internally. Gustafson suggests asking vendors if the software is Y2K-compliant, and if so, again ascertain if the method is the four-digit year or the 100-year window.
He points out that some software companies have gone out of business in recent years. If an EHS is using an unsupported product, "get rid of it fast," he says.
Jennifer Jackson, RN, JD, general counsel and vice president for clinical services for the Connecticut Hospital Association (CHA) in Wallingford, says speed is essential for investigating all possible Y2K problems in hospital departments.
Hospital computer systems often are "home-grown," and every hospital should be in the process of a complete Y2K assessment of all its computer systems, says Jackson, who oversees the CHA’s Y2K efforts and has represented the American Hospital Association on Year 2000 issues.
"Hospitals are aware of the fact that this involves not just patient records and billing systems, but employee records also," she says. "There are a great many date-dependent records in occupational health and human resources, so those systems need to be assessed for Y2K."
Most facilities have Y2K coordinators who head up Year 2000 assessments, and EHPs should contact that coordinator immediately if they have not done so already, she adds.
Take responsibility for getting answers
Mary Amann, RN, MS, COHN-S, occupational health services manager for AT&T in Chicago and a health informatics instructor at the University of Illinois, agrees that EHPs must be responsible for ascertaining their system’s Y2K compliance rather than assuming their hospital’s IS department has taken care of it.
"As we have found in a lot of health care environments, attention is focused primarily on those [departments] that are the revenue-generating parts of the organization, and sometimes internal support systems are left to fend for themselves," she says. "But there is a huge [Y2K] issue with surveillance and health care workers in surveillance programs. Most employees who work in a health care setting are in programs where they need to be immunized, examined, tested, trained, notified, and tracked on a regular schedule as required by law or by hospital policy."
Because surveillance is longitudinal and long-range, scheduling often takes place well into the next millennium, says Amann, who also coordinates the Internet Learning Center and teaches informatics for the Atlanta-based American Association of Occupational Health Nurses.
"If systems aren’t capable of successfully wrapping around the dates and associated information into the year 2000, I’m afraid that information will be lost and surveillance interrupted," she states. "The message for occupational health program managers is they need to talk directly to vendors, whoever developed their system — whether internal or external — to be sure a Year 2000 fix has been done. Just because a system is integrated with the hospital system, they should not assume the problem is taken care of."
How will you function without power?
In addition to Y2K computer problems, EHPs also must prepare for other Year 2000 dilemmas threatening hospitals: power failures and nonfunctioning biomedical equipment.
"A lot of people think the issue is only a computer problem, but they don’t recognize there are embedded digital chips in just about everything that we use. Occupational health managers need to know what everyone else needs to know: We may not have power — local or regional — for a period of time, because the national power grid switches are embedded with date chips," says Nita Brassard, RN, MS, information manager for clinical systems and quality assurance manager in information services for The New York Hospital-Cornell Medical Center.
Brassard, who also is in charge of Y2K contingency planning and business continuity for the hospital and was its employee health nurse manager until a few months ago, can well imagine the problems employee health departments might face at the turn of the century.
While medical equipment failure is not life-threatening in employee health as in some other hospital departments such as critical or intensive care, equipment such as audiometry and spirometry machines also contain embedded chips and therefore may not work.
And if power failures hit United States cities, "it doesn’t matter what we fix because if we’ve got no power, we’re dead," Brassard says. Hospitals have generators for disaster situations, but no one knows how long the power might be out. If generated power becomes necessary for days, it might not be available to all areas of the hospital, especially those not directly involved in patient care activities.
"Everyone is trying to do something about [Y2K problems], but the issue is are there enough people and is there enough time? You have to be prepared for the worst," she adds.
Employee health department managers need to develop a contingency plan for how they will function without computers, without medical equipment, without water, and without power, Brassard advises. She warns that a department’s contingency plan cannot be developed by the hospital’s IS personnel.
"Most IS people don’t know how a clinic is run, so it has to be done by the department manager," she emphasizes. "You are the only one who can develop that plan."
Health care-related Y2K information on the Web
Information on possible Year 2000 (Y2K) computer problems abounds on the World Wide Web. Sites range in tone and scope from pure hysteria to reasonable projections and solutions. Following is a list of several useful Web sites related to the health care industry, as well as to the Y2K problem in general. While the information does not pertain exclusively to occupational health departments, it is nonetheless pertinent for all hospital personnel managing a department to be aware of what might lie ahead for your institution.
Health Care-related Sites
The American Hospital Association
http://www.aha.org
Click on "Year 2000 Resource Center"
Georgia Hospital Association
http://www.gha.org
Click on "Year 2000 Y2K"
Ontario Hospital Association
http://www.oha.com
Click on "Year 2000 Public Information"
RX2000 Solutions Institute
http://www.RX2000.org
An information clearinghouse related specifically to health care
General Y2K Sites
Giga Information Group
http://www.gigaweb.com
Scroll down, click on "Year 2000: A Real-Time Question and Answer Session."
Year 2000 Information Center
http://www.year2000.com
North American Electric Reliability Council
http://www.nerc.com
Go to "Select a topic" and click on "Year 2000"
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