Are you ready for Y2K? Here’s what you need to know
ED managers must be involved in hospital Y2K preparation and have contingency plans for failed equipment, reduced staff, shelter, and community violence
When it comes to Y2K, ED managers must be prepared for anything ranging from minor glitches to a full-fledged catastrophe, stresses Dallas Peak, MD, FACEP, clinical assistant professor at Indiana University School of Medicine. "There is no way to be sure of the potential impact of the Y2K problem on any hospital ED. There are simply too many variables," he explains.
Y2K problems will occur when the computer incorrectly subtracts 100 years from an entered, calculated, or displayed date. The computer interprets the date as somewhere around the year 1900 instead of 2000. "In billing, a typical problem might be rejecting a patient’s insurance because the computer thinks the insurance expired in 1901 (instead of 2001)," says Jonathan Teich, MD, FACEP, corporate director of clinical systems R&D at Partners Healthcare System in Chestnut Hill, MA.
Clinical problems may occur when a departmental computer rejects medications in the pharmacy or laboratories, thinking that they are almost a century past their expiration dates. "Follow-up appointment scheduling, management reports, and even patient discharges can fail if the computer thinks the date is well in the past," notes Teich.
Problems can also externally arise, such as important supplies being held up if the external supplier experiences Y2K problems, Teich says. "Finally, the psychological fear of Y2K problems, which is sometimes overblown by media coverage, can itself lead to problems if institutions hoard supplies in anticipation," he adds.
Knowing the time frame of the potential problems is a major advantage, Peak stresses. "Unlike other potential crises, with Y2K we have a definite time frame for the events to take place," he says. "Any ED manager would be wise to take the full measure of planning and consideration for these concerns."
There is a fine line between being smart and overpreparing, notes Brian Duggan, RN, MSN, clinical operations manager for information services at Carolinas Health Care System in Charlotte, NC. "We have all heard the examples of people building fortresses in the wilderness and stockpiling food," he says. "There are extreme reactions to be sure, but don’t go to the other extreme and be caught unprepared. All this is guesswork, because we really have no idea what will happen."
Here are some things to consider when preparing for Y2K:
Assess your liabilities. "You need to assess exactly where your risks lie. For example, you should know what hardware and software is at risk," advises Duggan. "Your internal risks include utilities, electricity, water, and medical supplies, such as medications, linens, and equipment. You also need to consider third-party risks." (See Y2K readiness checklist on page 39.)
Every ED should prepare to operate without restocking for at least one month, Duggan recommends. "Water and backup electrical sources are essential to the ongoing operations of an ED, so those need to be considered first."
Address personnel issues. "If there is a major disaster and people don’t have access to gasoline because of fuel rationing, how will you keep your ED staffed? Have a contingency plan, such as working with a reduced staff," says Duggan. "Realize that it’s not just the ED that needs to prepare. Your staff also need to take care of their own needs so that they’ll be there when you need them."
Address personal preparation, advises Duggan. "Employers are hesitant to intrude into people’s personal lives," he says. "But since the potential for the individual’s personal life intruding on the ability to work is so great, I think ED managers are obligated to step into that role. At least warn staff about things to be prepared for."
Make sure all ED personnel understand the attendance policy. "Ours is fairly hard nosed, and clearly states that even if there is inclement weather, you have to be at work, or it’s an unexcused absence. People should know what is expected of them in the event of Y2K problems," says Duggan.
Consider how to provide shelter to the community. Remember that Y2K happens in the middle of winter. If there are power outages, people may come to the ED," says Duggan. "In the event that the floors are full upstairs and people are basically going to the ED for shelter, you will need to feed a large number of people."
Plan for triage criteria. "If you have limited resources in terms of supplies and personnel, your triage criteria will have to change. You have to be prepared to handle that," says Duggan.
Prepare for security risks. "Consider what could happen, and prepare to handle that. Violence in the ED could increase, because it’s a natural outcome in the event of shortages of food and water," says Duggan.
Make sure disaster plans are strong. You need to have an effective disaster plan in place. "However, this is nothing different from what you should have now," Duggan says. "This is not a wasted investment if everything is okay with Y2K. But you do need to involve the whole community, including all EMS fire and police."
Disaster plans must be reviewed and revised to plan for shortages of water, electricity, and supplies, notes Duggan. Many things need to be considered.
Understand the domino effect. "While many of the critical information technology systems are already being corrected, they rely on various sources for information that may not be corrected in time," says Todd B. Taylor, MD, FACEP, an emergency physician at Good Samaritan Regional Medical Center and Phoenix Children’s Hospital in Phoenix, AZ, and past president of the Arizona chapter of ACEP. "This domino effect’ may cause even carefully redesigned systems to fail, from a lack of input from other systems that fail."
Equipment are important pieces of the system: elevators, helicopters, IV pumps, ventilators, monitors, radio equipment, and paging devices may be interdependent. "It may not just be a matter of your individual pager working correctly. If the the satellite in the sky decides not to work any more, you’ve just lost all connection," says Duggan.
Plan for other key dates. Y2K problems affect dates other than midnight on January 31, 1999. "Experts expect only about 8% of systems problems to occur at this precise moment," says Peak. "Many will occur before, and many for weeks to months after that date. A listing of the critical dates leading up to this time is available from many sources." (See list of helpful Web sites on page 43.)
Know impact on hospital systems. "Hospital main frame systems are notorious for being antiquated, and most are hardwired to the two digit date format. They will have to be completely replaced or seriously patched’", says Taylor. "One healthcare organization recently reported that of its $80 million budgeted capital expenditures for the next two years, more than half will be spent on becoming Y2K compliant."
Know which systems are likely to have problems. "Any system that relies on the date for routine maintenance scheduling may fail and refuse to work," says Taylor. "Such speculation has caused some to predict that equipment with built-in maintenance monitoring, such as cardiac defibrillators, phone systems, power generators, and several others, will refuse to work or will have to be tricked’ into working by setting an inaccurate date."
At a minimum, healthcare information systems that aren’t corrected will produce inaccurate dates for any computer generated information, Taylor says. "For instance, many hospital systems calculate age using the current date and the date of birth. After Y2K, almost everyone will have a negative’ age, and even someone born in 1899 would be calculated as 1 year old," he explains. "Will your hospital system simply ignore the negative’ age and go on, or will it simply refuse to work? Only time will tell."
Systems that perform "time and date" stamping will, at a minimum, be inaccurate (e.g., 00:01-January 1, 1900) and may stop working altogether if the information is used in any calculation, notes Taylor. "And don’t forget the hardware that runs these systems," he adds. "Even if the software has been updated, the hardware infrastructure may not be able to handle Y2K."
Consider all other systems. "Don’t forget about postal meters, fax machines, digital clocks and watches, automobile emission control systems, phone systems, and security systems," says Taylor. "The list goes on and on."
Address billing issues. First, determine if your billing company is updated, says Taylor. "Even if they are, are the carriers they deal with, including HCFA and Medicaid carriers, updated?" he asks. "HCFA recently asked its claims processors to sign contract amendments to include a Y2K guarantee. To date, no carrier has signed it." (See sidebar on HCFA’s action plan for Y2K on page 42.)
This may cause significant billing problems, warns Taylor. "How many of us can wait an additional several weeks for payment of claims while these carriers work out their Y2K problems? Will insurance policies suddenly expire’? Will bank deposits go astray and checks bounce?" he asks.
Some billing problems can be internally resolved, notes Duggan. "Some EDs use stickers on cards to charge patients, while others key it into a system. If you depend on that system for billing, you should find an alternative," he says.
Find alternatives to electronic patient care equipment. This is something people may not have thought of, but we are very dependent on IV pumps and electronic thermometers," Duggan notes. "There is no way you’re going to be able to pace somebody on a pacemaker [if there are Y2K problems], but you can use a glass thermometer or a manual drip IV."
Ventilators are a major concern, says Duggan. "If these go down, you’ll have an immediate patient care problem," he says. "The less fancy ones that don’t track dates are probably less likely to go down than the ones that do everything except change the patient’s gown," he adds.
Plan for alternatives to cleaning instruments. "We didn’t always have autoclaves to do clean instruments," Duggan notes. "Make sure you have chemical cleaning supplies to take care of your needs. If you aren’t able to use a floor waxer, you may have to switch to an old fashioned mop."
Be aware of personal PCs. "If you use databases for tracking patients, that is more likely to be on the PC level," says Duggan. "If there are reports you are dependent on, make sure administrators realize what you use the reports for and why you need them."
The ED needs to take responsibility for its own PCs, Duggan advises. "This varies widely depending on your facility. In some hospitals there might only be three or four PCs in the whole facility, while there is a monitor every few feet," he notes. "Whatever your situation, you do need to check those out for compliance."
The vendors of those packages are often the best source of help. "Very often there is a download from the Internet site to update the software," Duggan says. "From a hospital standpoint, the biggest liability is in the software that does the billing and manages orders and results. If it’s outdated, it will fail unless it’s been remediated within the last year or so. If it was purchased more than two years ago, it’s a pretty safe bet that there’s something non-complaint."
Be aware of your hospital’s plan to address Y2K issues. ED planning should be part of institutional planning, says Jonathan Teich, MD, FACEP, corporate director of clinical systems R&D at Partners Healthcare System in Chestnut Hill, MA. (See related story on getting the ED involved on page 43.) "The institution should have a unified plan for Y2K remediation, [which is] typically centered in the information systems or operations management department," he adds. "Y2K remediation involves verifying both locally developed and commercially supplied computer software to make sure that it is protected against these errors."
The process is not difficult but it can be time-consuming, and planning should have started by this time, says Teich. "There is a cottage industry of software test sites and Y2K-specific consultants that can assist in this process," he adds.
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