It's after midnight on New Year's Eve. Can your surgeon buzz through the security door on your hospital floor in case of an emergency?
Maybe not. Electronic security controls have computer-activated codes and personal identification numbers that are time- and date-sensitive. Come Jan. 1, 2000, they will need to have been reset to recognize the year 2000, or they won't work.That's just one of the grim scenarios facing hospital staffs as they brace for the so-called Y2K problem, the inability of computers to differentiate between the years 1900 and 2000. The glitch is threatening to shut down computer systems nationwide, but hospitals may be more at risk than other industries as they face the costly and complex task of modifying their computers.
"We as an industry have been slow to recognize the ramifications of information systems, because patient care is the name of our game," says Timothy Zinn, president of Zinn Enterprises, a Chicago computer-consulting firm for health-care providers. Only 23 percent of 301 hospitals surveyed last fall by Zinn and PricewaterhouseCoopers LLP, the accounting and consulting firm, had integrated Y2K upgrades in their administrative computer systems and tested the modifications, Mr. Zinn says.
Computers -- to a degree easily taken for granted -- have become the lifeblood of health-care delivery. Doctors and nurses rely on a web of interconnected computerized administrative systems to schedule patients, keep records, monitor treatment and medications, order supplies, track prescriptions, analyze diagnostic tests and record results. All are sensitive to time and date. Critical devices such as operating-room anesthesia, defibrillators, heart-bypass machines, cardiac monitors and infusion pumps also use microchips to sound alerts for scheduled maintenance -- or else shut down.
The top priority has been getting suppliers to certify that equipment critical to life support won't crash. "The good news is that there aren't that many things that fall into that category," says Dr. Joel Nobel, president of ECRI, a Plymouth Meeting, Pa., health-services-research organization that evaluates medical technology for hospitals. "And the better news is that there are alternatives and work-arounds for all of them."
Sarasota Memorial Hospital, Florida's second-largest hospital, with 833 beds, is testing all its critical-care equipment itself and making sure it has manual backups in place, says Victoria Weingart, program director for technology assessment. That will mean placing respiratory bags within easy reach of every ventilator in use. Drip rates on intravenous infusion pumps can be set and monitored manually, if necessary. "We go back to the old way," Ms. Weingart says.
At many hospitals, that will mean beefing up staff by canceling vacations for the first two weeks of January, discharging all but the most critically ill patients and canceling all elective surgeries. "We will have a skeleton patient load," Ms. Weingart says, "but we'll have a full staff."
The broader question for most hospitals isn't whether their high-end medical devices will work but how long they will be able to handle possible disruptions of basic services, such as electrical power and water supply, and deliveries of essential supplies, such as surgical gowns, medication and food. Hospitals, more than most industries, depend on outside suppliers for daily operations, and many of those vendors have their own Y2K problems to resolve.
"We're more concerned about external factors than internal equipment at this point," says Tom Lenkowski, chief financial officer at the Southwestern Vermont Medical Center, a 125-bed facility in Bennington. The hospital's power company, Central Vermont Public Service Corp., is unable to guarantee that power supply won't be disrupted. All hospitals have emergency power generators -- the problem is lining up enough diesel fuel to handle a prolonged outage.
"We have agreements for a seven-day supply," says Mr. Lenkowski, "but no guarantee afterward."
A spokesman for Central Vermont said the utility expects to be ready by Jan. 1 but can't be certain that other companies in its supply network will come through.
Patients never see many of the most basic hospital services that depend on computers. The water they drink has been purified in treatment systems that have date-and time-sensitive monitors. The temperature, humidity and air flow in their rooms are regulated by microchip control sensors. Fire alarms have date-sensitive microchips to automatically dial local fire departments in an emergency.
"These can really shut an institution down," says Dr. Nobel of ECRI. All interconnect to other systems. A hospital's elevators may be programmed to override a Y2K glitch, he says, but they will still stop automatically if a fire alarm goes off. Hospital administrators at the 200-bed Pocono Medical Center, in East Stroudsburg, Pa., are bracing for that possibility by placing emergency gurneys in all their stairwells.
Not surprisingly, the cost of getting ready for everything that might go wrong is adding up. The 5,000-member American Hospital Association estimates that the total will come to $8.2 billion nationwide by Jan. 1. Nearly 25 percent of all hospitals surveyed by Zinn and Pricewaterhouse anticipate dedicating 15 percent to 25 percent of their operating budgets to Y2K-related contingencies this year.
"When you spend that kind of money, you spend money you would have used for other technology," says Judith West, vice president in charge of administrative services at the 125-bed Westerly Hospital in Westerly, R.I. At two area medical centers Sarasota Memorial now has under construction, getting ready for the year 2000 is eating up half of the $1.5 million initially earmarked for new diagnostic equipment.
And the cash squeeze could get worse. The federal agency responsible for reimbursing hospitals and physicians, to the tune of $330 billion annually, under the Medicaid and Medicare programs is struggling to patch together its own vast computer network. The agency has 50 million lines of computer code that must be assessed for Y2K compliance. As of last June, according to the Government Accounting Office, fewer than a third of the agency's "mission critical" computer systems had been renovated. And none had been validated or implemented.
Federal Health Care Financing Administration Chief Nancy-Ann DeParle told a House committee last month that her agency is making headway and payments will be on time. But at Sarasota Memorial, which serves a large population of Medicare patients, Chief Financial Officer Dale Beachey has his fingers crossed.
Keeping the hospital running costs $900,000 a day, with half of that paid by Medicare and Medicaid reimbursements. Unless HCFA reimbursements come through on time, he says, "you'd be dipping into cash reserves almost immediately."