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If it ain't broke don't fix it, may apply to a many aspects of life but it certainly won't be applicable to your computer on December 31, 1999. One of the hottest topics that may impact the business of health care and the method that we receive compensation for our services is the famous "millennium bug" also known as the year 2000 problem or the "y2k."

What's the problem?
The problem is that some large offices and research computers were programmed long ago to treat the year filed in a date as a two-digit number-that is, 1998 is stored as "98." The computer just assumes that the first two digits of the year are "19." This programming peculiarity, by the way, was not the fault of stupidity or laziness. Memory space in early computers was expensive and limited. Consequently, early programmers (before Pentiums and gigabytes) were constantly using shortcuts and tricks to reduce memory usage. Reducing a four-digit year to a two-digit number was considered an act of genius 20 years ago.

Why is this important?
The year 2000 problem not only affects large computers in a few companies, it also affects personal computers (PCs) and any software application with a two-digit year instead of a four-digit field. This may include accounting software, computer operating systems, programs that run VCRs, time-controlled vaults, and other date-dependent electronic equipment and programs. Everything from patient records to equipment on board ambulances relies on date-sensitive microchips. Even minor failures, if duplicated across the whole country, could cause injuries and even many deaths. The health care profession is particularly vulnerable because the electronics in some of the technology used to treat patients can produce injury and harm patients. In addition to our usual malpractice concerns, law suits related to y2k will not only involve the software vendors but the providers may also be held liable for damages.

However, now with electronic submission of bills and credit cards that extend into the 21st century, a two-digit year will not be sufficient. If your computer sees a date of service charge on 1150, it may decide that you submitted a charge in January 1900 and assess 100 years of delinquent charges! Chances are you won't be granted the windfall for this submission. More likely, your charge will be "kicked out" and returned to you requiring you to resubmit your bill and you will experience just one more delay in receiving your reimbursement. Multiply this by hundreds and thousands of claims and you can easily see how physicians will experience losing millions of dollars in payments from insurers.

Who is affected?
"Y2k" is a huge problem for large practices, hospitals, the government and insurance companies that use huge, antiquated mainframe computers.

At the present time very few physician's offices have addressed the y2k problem. According to a recent survey only 23% of hospitals have started to look for solutions to y2k. As a result, a panic or feeding frenzy may be taking place in a few months as hundreds of hospitals and thousands of physicians' offices are looking for that quick fix. It will be like to trying to find an electrician or a contractor after a hurricane hits your community. There will be a greater demand than the "y2k fix-its" available.

What to do?
Your office manager can easily check this out today by manipulating the system clock on your PC to 11:55 p.m. December 31, 1999, and waiting five minutes to see what will happen. What you'll most likely find, according to computer experts, is that all of your software will glide smoothly into the new century. If not, contact your software provider, and they will almost certainly offer you an upgrade that will put the "manage" into the year 2000 problem.

Next, if you are considering buying a new software program, make certain that the program is year 2000 compliant. The Information Technology Association of America's (ITAA) provides certification of approval for those programs that are year 2000 compliant. ITAA allows vendors to submit their program to a third-party for evaluation of the year 2000 process. According to Bob Cohen, vice president of ITAA, the approval process focuses on a number of different areas, including assessment, quality management, technical approach and testing. Bottom line-make sure your new program contains the ITAA 2000 compliant seal of approval. When you submit a request for a proposal, be sure to ask that the vendor to provide assurance that the new program is year 2000 compliant.

I am aware of several practices that have contacted their software vendors about the y2k problem and did not receive a reply. According to the Gartner Group (Stamford, CN), at the end of 1997, only 25% of the software vendors from all industries had answered letters or inquiries from customers about the y2k problem. Any vendor that does not have an answer regarding the y2k problem, will probably not be very effective and helpful after you have purchased the program and you need service and assistance for bugs or problems with the program.

The short-term solution, which is more technically complex, simply postpones the problem by YY years by modifying the date routine so that 1900 is added to the YY field if YY is >30. However if YY is <30 then 2000 is added to YY. For example, if 01 was typed into the computer in the year field this would be read as 2001. If 29 was entered, then the year would be interpreted as 1929. This is only a short-term solution as the pivot date will need to be changed in the year 2030 again.

To complicate matters, older computers have an added problem. They have a special hardware chip called a BIOS, which among other things, tells the computer what time, day, month, and year it is. Since the chips contain a built-in program, they can't be reprogrammed and can't recognize dates past December 31, 1999. This means the chips will read the year as 00 and conclude it is January 1, 1900. Others, because of the manufacturing design, may default to the year 1980 or 1984. The only way to solve the problem is to remove the chip and replace it with a correctly programmed one.

However, there is some good news: Most new computers have a flash memory chip that can be reprogrammed to be year 2000 compliant. But, a new chip may not be the answer to all the problems. Even if you have changed your computer's BIOS internal clock to January 1, 2000, there is no guarantee your applications will accept the new date.

What to do? First, check the instructions that come with your PC, or contact your vendor to find out if your hardware is year 2000 compliant. If you want to check for yourself, you can run a test. Change the setup data in your computer to December 31, 1999, a few minutes before midnight, and see what happens when the date changes to the new year. Does it say January 1, 2000, or January 1, 1900, or some other default date? (To change the setup data, check your computer hardware instructions or contract your vendor.)

Next, run another test to see how your software will dealt with the new date. This could include running some date-sensitive applications (e.g., expiration date of credit cards) with test information. You may find the date is not a problem, or you may discover some files get saved to a default date. You can check with your local software retailer to confirm which software is compliant.

Help can also be found on the Internet: free software (called freeware) is available to help run tests. To get such software, search for the following programs on the Internet (key word: freeware): DOSCHK, 2000Test, 2000Fix, and Year2000. Websites that offer assistance to the health care industry include: http://www.rx2000.org/ and http://www.kanbay.com/

Solutions
More and more health care software vendors are offering programs that will address the y2k problem. Some vendors are using the new software programs and y2k solutions as a selling point to attract new clients and customers. Other vendors are offering upgrades that will correct the problem in order to avoid customers from abandoning their existing programs. Finally, some customers are using the problem as an excuse to drop a program and buy a new program with more bells and whistles and year 2000 codes.

How much does it cost to fix y2k?
The English health care system estimates the costs of fixing the y2k at 500m pounds. The Gartner Group estimates the cost of fixing the y2k problem will be $300-$600 billion worldwide. Individual practices are paying $15,000-$150,000 to make their practices y2k compliant. That figure will only get larger as the year 2000 approaches.

Some vendors are providing y2k fixes gratis or at no charge to those customers that have software maintenance agreements. Another method of vendors is to bundle the fix into updates that contain additional features besides the y2k fix and charge for the updates. At the present time nearly 30% of vendors are charging a few for y2k solutions.

So if you want to have a happy New Year on December 31, 1999, make certain that you address the y2k now and avoid the rush that will certainly occur. If you make your practice y2k compliant now, the champagne you drink will be for celebrating not for dulling your feelings of anxiety and panic that await you in the office on January 2, 2000. Happy New Year!

Last year the stock exchange in Brussels was shut down for two hours because of Y2K - related problems with the futures software. In those two hours, lost commissions totaled $1 million - and the problem was relatively minor and easily fixed. There have been already more than 10,000 similar - and similarly costly - Y2K instances reported in the United States alone. A tiny glimpse into the doomsayers' future as provided in May, 1998 when a communication satellite died and millions of people were thrown into panic when their cellular phones wouldn't operate; technology is great when it works and cataclysmic when it doesn't.