So often, we take for granted the things that need our attention the most. This certainly is true of ophthalmology’s aging computer systems. Most doctors are concerned about their software and hardware being outdated. But few of them are moving fast enough to take care of the problem – seemingly paralyzed by either a lack of information or a tunnel-like focus on medical economics and patient care.

In this two-part series, you’ll find advice on how to proceed with your computer system. This month’s article will look at what exactly can go wrong if you don’t make your office Y2K compliant now – and how you can still avoid practice mayhem in 2000 if you take the right steps as soon as possible.

Next month’s article will tell you how to upgrade your system by linking your billing and clinical areas, overcoming Windows-DOS communication problems, and strengthening your internal information stream.

The typical ophthalmologist is generally among the more proactive of physician specialists, so it’s puzzling that some still ignore the potent risks of the dreaded millennium bug.

In fact, for many, the Y2K bug may already have manifested itself. Some ophthalmologists who have tried to schedule patients beyond January 1, for example, know exactly what I mean: Entering year 2000 dates into non-compliant practice management systems will schedule the visit for 1900 or, worse yet, cause the system to shut down.

Just what are the risks? What can be done? What should come first? These were excellent questions 2 or 3 (or more) years ago; now they’re critical. The good news, however, is that it’s not too late to get answers and put them to use.

Until relatively recently, software was written in the now older COBOL and FORTRAN programming languages. To save space on pre-microchip punch cards, which had room enough for only 80 columns of data each, programmers signified years by using just the last two digits. So 1984, for example, would be indicated with "84." Problem: When a user keys in the year 2000, such systems will read only "00" and interpret the year as 1900. Tests have shown that many healthcare software applications respond to the "00" entry with something akin to "computer meltdown," rendering the systems useless.

Though no one is sure that each and every program will respond so dramatically, practices using non-compliant systems run the risk of malfunctions, including:

• disruptions and delays for all operations that depend on electronically transmitted data
• inaccessible patient records
• scheduling and patient recall woes
• failure of online communications systems
• reporting and reimbursement operations grinding to a halt – in short, any data that normally is transmitted electronically will be lost forever or lie dormant for an indeterminate and possibly detrimental length of time.

And the problem is not limited to computers. Any piece of medical equipment, particularly those built during or after the mid 1980s, most likely has some sort of microprocessor that depends on the accuracy of the date to function properly.

Erroneous information from this equipment could result in medical mishaps that might endanger the patient and destroy your good name. By some estimates, legal settlements associated with this or any kind of Y2K problem in health care could run into the trillions of dollars over the next 10 years.

To find out how prepared you are for 2000, you and your administrator will need to consider five areas of your practice:

• Computer information systems.
Hardware/software packages facilitate practice management, billing and scheduling, reporting and reimbursement, accounting, maintenance of medical records, and other administrative functions.
• Equipment.
This domain includes diagnostic and other devices used in the examination, monitoring and ongoing care of patients, as well as stand-alone personal computers, transcription machines, etc. Equipment required for emergencies should be your primary concern. Also important, but less so, would be equipment used for ancillary or secondary services.
• Office facilities
. Elevators, security systems and other components of the physical plant depend on microprocessors.
• Utilities.
How will Y2K affect your electricity, water and telephone? Although I’m reasonably sure public utilities will suffer few (if any) outages, you should check to make sure they have plans in place. Of course, phone service is important, but even more important is that your particular phone system be Y2K ready. If patients can’t get through, you’ve got problems.
• Your suppliers.
The Y2K bug has the potential to disrupt the flow of materials you need from outside sources. Much of the medical equipment you have uses parts manufactured overseas. Early next year, we may see shortages of replacement parts and medical consumables that could continue for up to 6 months, simply because not everyone in today’s world economy will be prepared for Y2K.

Check with all of your suppliers on the adequacy of their contingency plans. Will they stock enough of what you need to get through the first few weeks of the new year? If not, have your staff plan inventory accordingly. (See "If Your Vendor Leaves You Stranded" at the end of this article.)

Once you’ve assessed potential problem areas in your practice, identify what you can do to avoid shortages or disruptions. Inventory all items within the categories of computer information systems and equipment (and facilities, if you own your own plant) that have even the slightest potential of exhibiting a Y2K problem. For example, at NovaMed, where I’m the vice president of information technology, we consolidated our inventory into a single database that let us evaluate the consistencies among all of our member practices.

As you progress with your inventory development, contact all respective vendors to determine their products’ Y2K compliance. By now, you should expect updated information and a clear picture of what will happen at the end of December.

If a vendor claims compliance, obtain the claim in writing. If a product is not compliant, find out from the vendor what will make it so. (Beware: even if a vendor promises to support corrective measures at no cost, time is still a factor. As the end of 1999 draws near, more physicians are updating their systems simultaneously. The personnel and resources you might need even for a simple upgrade are becoming more scarce.)

Avoid the temptation to test equipment on your own. Some who’ve tried have caused irreparable damage. You also risk voiding the warranty on equipment that employs a time stamp that must not, for legal reasons, ever be altered.

You may find out that certain vendors no longer exist, or that your equipment is so old that it can’t be upgraded. One of our ophthalmology group practices had an old operating system that the physicians completely replaced last year. The vendor had continued to support the product, but had since moved on to an altogether different operating system. So even though the practice still dealt with the same vendor, the product itself had no upgrade path.

All of this preparation can’t guarantee a glitch-free 2000. Be ready to run your practice manually, if you must. One thing about paper – it’s potential for Y2K problems is zero.

In my opinion, every practice should be prepared to use paper processes anyway. Computer systems can and will fail, but the practice must function. Here are some contingency plans:

• Start keeping paper records on billing and clinical activities.
Should there be any question or confusion in 2000 regarding expected reimbursements from 1999, you can present complete and accurate documentation to support your claims.
• Secure adequate cash flow for the first 2 to 3 months of 2000.
It’s prudent to sock away a couple of months worth of operating capital in case you need it.
• Conduct contingency training.
Don’t wait too long to begin this process. Start a program in the fall, so that your staff can respond to system outages and address any concerns your patients may express along the way.

Never to this day has a piece of computer software been 100% bug-free. What makes the Y2K bug unique, however, is that it will manifest itself in countless systems at precisely the same time. Your task, then – regardless of how late in the game it might be – is to mitigate the severity of the bug’s bite to the greatest degree possible.

And although your task will not necessarily end when the clock strikes midnight on December 31, 1999, it must begin sooner rather than later – lest the bug swallow you whole.

Next month: Linking your clinical area with your billing area and accomplishing other upgrades necessary for competing in the next millennium.

It boils down to this: If your vendor won’t support Y2K compliance – or can’t support it in time – you can’t buy a new system fast enough. If you’re uncertain about specific pieces of equipment, you need to decide whether or not to risk their continued use. The sooner you can start the process of replacing systems and equipment, the better.

Begin with systems whose disruption would make your business the most vulnerable. Concerned about cost? Consider that most of the systems in ophthalmology offices are due for retirement anyway. At NovaMed, we initiated a concerted effort back in 1996 to replace all of our core business systems – not for Y2K reasons, but to improve our access to information, reporting capabilities, scheduling and billing functions, and other administrative operations. We also made certain, however, that we were investing only in Y2K-compatible products.

We have vendor documentation from MicroMed, for example, that our new practice management system (now called NextGen EPM) is Y2K-compliant. In fact, one of the reasons we selected this system was that it was built with the latest Y2K-compliant software development tools. So, by default, the system components that we purchased then were among the latest and greatest available – and by year 2000, all of our practices will be using them.

A word to the wise: Regardless of all the documentation and assurance of Y2K compliance that you gather from your various vendors, check it all again before the end of the year. Even Microsoft continues to post new updates to its software and operating systems as it discovers previously undetected bugs in products it already has deemed Y2K-ready.

–Jon C. Thomas