- The Washington Times - Monday, December 13, 1999

Patients at Fairfax, Va., Hospital shouldn’t see any glitches in their health care when the clock strikes midnight Jan. 1.
The hospital’s parent company, Inova Health System, has spent millions of dollars to inoculate itself against the millennium bug, a programming glitch that could cause problems in computers when the year changes to 2000.
“We’re taking a zero-tolerance approach. We really haven’t found any unexpected problems,” said Terry Hsu, who runs the computer systems for Inova. The health system has 1,407 beds in five of the region’s hospitals.
But while Inova’s staff is tidying up loose ends and stray technology, officials at other area medical facilities are more worried. District of Columbia General Hospital is still testing its main computer. Some private city clinics haven’t prepared at all and hope to ride out the date change as best they can.
“They don’t all know what they need to do,” said Robert Cosby, executive director of the Nonprofit Clinic Consortium, which represents 12 clinics serving patients in the District.
There may be no problem at all. But time and money are the best indicators of whether hospitals, clinics, doctors, insurance companies and government health care agencies trip over the calendar change or glide into 2000.
Well-heeled hospitals have been preparing for years, spending millions of dollars and scheduling repairs with regular maintenance. But hospitals and medical clinics with less money had to put off repairs and now find themselves scrambling to outrace problems or hoping they can manage.
The year-2000 computer problem stems from a memory-saving shortcut years ago in which software programmers devoted only two spaces in a date field to designate the year. That older software assumes the year always will begin with the digits “19.”
If technicians don’t carefully reprogram and test affected systems and replace calendar-sensitive computer chips embedded in some equipment the computers could shut down or malfunction when they “read” the digits “00” as meaning 1900 and not 2000.
As a result, hospitals and other medical agencies have been testing computer systems, replacing medical devices, installing new software, rewiring facilities and even checking building systems like elevators and heating systems all to keep patient care running smoothly.
Hospital officials say they don’t expect critical systems to fail. They have worked with manufacturers to ensure that equipment like dialysis machines and defibrillators which have electronic chips embedded in them won’t stop working for patients who can’t survive the interruption.
Government agencies have been working with providers and insurance companies to ensure that the financial conduits that pass the money to keep doctors and hospitals in business won’t clog in the new year.
With less than a month to go, government officials say the industry has addressed most problems, but concerns remain.
The Senate Special Committee on the Year 2000 Technology Problem said rural and inner-city hospitals, doctors offices and nursing homes had “high exposure” to problems caused by the date change. Other officials agree.
“We’re concerned that providers just don’t know where they are,” said Gary Christoph, chief information officer for the Health Care Financing Administration, which runs the federal Medicare program, reflecting on concern about doctors offices and nursing homes.
Fred L. Brown, chairman of the American Hospital Association, denies it’s a problem.
The Senate panel feels “they do not have all the resources in terms of financial resource but in reality 87 percent are hooked in with other institutions through alliances” and larger systems that provide ample help, he said.
Nursing homes will be ready, said Tom Burke, a spokesman for the American Healthcare Association, which represents the nation’s 17,000 medium-term health care facilities. Delays in reporting data account for the low rating, he said.

Those who have

Suburban hospitals are among the best prepared. Since early 1998, most have been replacing, upgrading or junking equipment they need to run their businesses and care for their patients. It’s an expensive job.
Inova decided to prepare for the millennium bug while it was going through a computer upgrade, which cost $30 million over three years. The health care system brings in $1 billion a year.
MedStar Health, the region’s largest hospital group, has spent $20 million rooting out the millennium bug since 1997, Dr. Alton Brantley said. He is in charge of computers for MedStar, which formed earlier this year through the merger of D.C.-based Medlantic Health Group and Baltimore’s Helix Health System.
MedStar owns Washington Hospital Center and National Rehabilitation Hospital in the District and Harbor Hospital Center, Good Samaritan, Union Memorial, Church and Franklin Square hospitals in Baltimore.
Mr. Hsu, having worked to eradicate the bug at Inova since February 1997, said the group is 99 percent done fixing all equipment related to patient care. The remainder is scheduled to be fixed or replaced by Dec. 31. He expects only nuisance problems, such as medical equipment displaying the wrong date but working normally.
Inova owns Fairfax, Fair Oaks, Mount Vernon and Alexandria hospitals and Fairfax Hospital for Children.

Those who have not

However, hospitals and clinics with less money have found themselves scrambling.
D.C. General, which planned to be ready at the late date of Dec. 1, now expects to be finished testing its main computer system by the end of this week, said Earl Cabbell, executive vice president.
“When you’re dealing with a couple million lines of code, you find things,” said Fitzgerald Hoskins, who oversees the hospital’s computer system.
The Nonprofit Clinic Consortium, which represents 12 nonprofit clinics in the District, has been unable to line up a contractor to solve the problem.
“There’s no consensus on specific needs,” said Mr. Cosby, the consortium’s director. The risk isn’t immediate or directly involved with health care, he said. It’s mostly from persistent glitches that slow operations or interfere with billing and payments.
“The billing is important because if the cash stops flowing, then systems start to back up in lots of ways,” he said.
The District has asked the federal government to chip in $75 million toward year-2000 problems across the city, including D.C. General’s plans to replace patient monitors in intensive care, antiquated computer wiring and switches, voice mail and paging systems, and 623 personal computers.
“Funding is a critical issue,” said Bill Wild, who heads D.C. General’s millennium bug effort. While all the federal money hasn’t come through, the District has given the hospital and other city agencies money to pay for fixes, against the expected federal funding, other hospital officials said.
The District’s chief technology officer, Suzanne Peck, charged with leading the city’s campaign against the bug, says the District will be ready.
“All systems repairs are tracking to schedule, but if any function in any system fails, contingency planning is complete. We’re creating and testing an extensive group of backup plans for mission-critical agencies, so if there are any interruptions, we’ll have extensive backup plans in place.”
She said she expects the District to find the money it needs to complete the job.
“This is one of the most important projects the District has. The necessary funding I believe will be available to us,” she said.

Linking up

One of the big issues facing hospitals is that they, suppliers, insurance payers and their computer systems are more integrated than ever, said Margaret Anderson, director for policy for the D.C.-based Center for Y2K & Society.
A doctor who prescribes a drug at the patient’s bedside can set off a chain of electronic transactions. The nurse enters it into a computerized system, the pharmacy fills the order, the patient is billed, the hospital inventory revised and patient history updated.
“You can get an answer from one vendor that all equipment’s OK, but that doesn’t mean it will be OK when working with other vendors,” she said.
Trabian Shorter, a roving computer troubleshooter for D.C.-based Meyer Foundation, which gives grants to nonprofit health care, arts and science organizations, agrees.
“One thing we’ll find out is how interconnected we all are,” he said.
The District already saw evidence of that in 1970, when a computer error struck the newly computerized patient accounts department at George Washington University Hospital, according to John Gochenouer. He wrote about his experience as a supervisor there in the Futurist magazine.
After a computer operator at the hospital mistakenly entered the wrong date in the new system, the computer began calculating the age of patient bills from 1900 70 years earlier. This led it to print 10,000 notices of legal action on overdue bills that weren’t overdue.
The patients who received notices including two Supreme Court justices, the U.S. attorney general, ambassadors and Cabinet members responded with a deluge of phone calls that jammed the hospital’s accounts office and shut down an entire quadrant of the District’s telephone grid. The accounts office took their phones off the hook until AT&T; threatened the hospital controller with legal action.
“Only a few errors will bring major disruptions,” Mr. Gochenouer wrote.
Hospitals across the nation, afraid of just that, are canceling their employees’ leave to make sure they will have enough doctors and nurses on hand. That goes for computer professionals like MedStar’s Dr. Brantley.
“I feel comfortably prepared and cautiously optimistic, but continuously on guard for issues,” he said. “I’m going to be on site. We would rather be there than not be there. There’s always the problem that something’s left unfinished.”
Holy Cross Hospital in Silver Spring, Md., has tested its computers repeatedly and laid plans in case power, phones, water and supplies are cut off, said spokesman Mike Hall.
“We wanted to display a worst-case scenario [of] how you maintain critical systems,” he said.

The money supply

Another area of concern for hospitals and clinics is money. The income they need could be vulnerable if the millennium bug strikes the connections between health care facilities, private insurers and government agencies like the Health Care Financing Administration.
HCFA, which oversees Medicare, Medicaid and the State Children’s Health Insurance Programs, processes 807 million Medicare claims worth about $211 billion each year. Medicare and Medicaid are federal programs administered by the states that pay for the health care of the elderly and poor, respectively.
HCFA’s computer systems and those managed by its contractors have passed rigorous testing, said Mr. Christoph, who runs the agency’s networks. But the providers filing claims concern him.
“We’re not sure that they’re capable of generating a claim we can get into our system,” he said. “We don’t have a good handle on how many are ready.”
If some processors can’t file claims, it could shut off cash flow to providers on tight margins, according to congressional and federal health officials.
In a July survey conducted by the Department of Health and Human Services, of which HCFA is a part, more than 70 percent of Medicare fee-for-service hospitals surveyed said their billing systems and medical records systems were year-2000 compliant. About 27 percent said their medical equipment was ready.
Medicare managed care organizations were doing slightly better, the health department said.
Medicaid systems in Maryland and Virginia, as well as 15 other states, are judged low-risk, according to the agency, which runs Medicare. The District’s Medicaid program, which annually pays out about $900 million for about 125,000 residents, has been behind schedule and rated medium-risk.
The issue is most acute for clinics, which operate on tighter budgets. They depend on the District’s Medicaid program and have watched nervously as its rating stuck firmly in the high-risk category until mid-November, when it was upgraded to medium-risk.
“We have tested it and it has passed,” said Donna Folkemer, chief of the policy unit of the D.C. Department of Health’s Medical Assistance Administration, which processes Medicaid claims.
The D.C. Medicaid program expects to finish upgrading its system by Dec. 20, said Yohannes Birre, who supervises the computer system.
But hospital officials remain concerned.
“I have a far greater sense of comfort with Blue Cross,” said MedStar’s Mr. Brantley. “It’s a matter of the size of the organization.”
The District uses a few small contractors to handle its managed care payments. But smaller contractors are less likely to be able to afford the technical resources to deal with the computer problems, he said.
D.C. Medicaid officials say that whatever happens, they will keep the cash flowing.

Stocking up on drugs

Health care officials also are stocking up a little bit more on drugs, some of which are critical for patients, such as those with HIV or diabetes. But they also express concern about hoarding, which could make supplies less available.
There have been stories of hoarding, said Miss Anderson. She says those hospitals that are taking one to two weeks’ extra supply are acting responsibly.
“The biggest concern we have is are there going to be some supply chain difficulties around late January, early February if the public gets into panic buying and depletes pharmaceuticals,” said Inova’s Mr. Hsu.
The industry should be able to keep the supply flowing, according to the industry and the President’s Council on Year 2000 Conversion. In fact, the Senate Special Committee on the Year 2000 Technology Problem recently said the industry is at low risk for problems.
“Most of the large pharmacies have tested and they believe they’re compliant,” Dr. Malson said. “They urged us nationally not to hoard and thus create a shortage.”
The president’s commission has recommended that hospitals buy their usual supply.

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