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Senate finds health care system may be unprepared for computer glitch
Even infection control departments with fully updated office computers and software should be wary of a rippling effect if the so-called Y2K "millennium bug" adulterates data or disrupts services in less prepared hospital departments or connected facilities. Such downstream disruptions may be the primary impact for many ICPs, who have become increasingly reliant on computer-driven surveillance, laboratory and patient information.
"The main problem for ICPs is not their own house, but all the other people that they rely on. ICPs rely on the rest of the hospital for information," says Joe Harr, MBA, director of information technology at the Association for Professionals in Infection Control and Epidemiology (APIC) in Washington, DC.
A recent U.S. Senate report singled out health care as the most unprepared of the major economic sectors to deal with the infamous computer glitch. While not specifically addressing infection control, the report outlines potential problems and disruptions that could affect ICPs increasingly dependent on computer data to perform their jobs. The impact on ICPs will vary depending on the level of individual facility and program preparedness, including data dependence on other health care networks or systems that may be suspect, experts advise Hospital Infection Control.
The problem is essentially that old two-digit software dating systems in many computers may not discern between the year 2000 and the year 1900 on Jan. 1 of next year. (See box, p. 58.) That could set off potential equipment failures in computers and biomedical devices, creating a domino effect throughout interconnected systems, the Senate report warns. Y2K problems may lock up a computer or microprocessor, cause obviously incorrect dates or other data, or could "produce invalid data that will not be detected until much later, forcing users to correct a range of accumulated errors while searching for the source of the problem," according to the Senate report. (See report highlights, p. 60.)
In addition to ensuring related departments like clinical laboratories will be Y2K-compliant, ICPs should check that such critical business tools as cell phones and pagers are going to function when they report to work on Monday, Jan. 3, 2000, Harr reminds. As a general approach to the Y2K issue, many hospitals are sending out letters to their vendors asking them to provide certification they are year 2000-compliant, he adds.
"We’ve gotten quite a few of them because we happen to be on vendor lists for quite a few hospitals," Harr says. "That kind of worries me, because that tells me they are just sort of taking a blanket approach. If they were taking a look at the vendor and what the vendor supplies, they would figure out that what APIC supplies is not Y2K-dependent."
Indeed, the Senate report found that many hospitals are relying solely on producers of medical devices to certify their Y2K compliance. "Based on known inaccuracies of some producers’ compliance certification, this could be a serious mistake," the report states. The committee emphasized that the health care industry "lags significantly in its Y2K preparations compared to other key economic sectors, and because of limited resources and lack of awareness, rural and inner-city hospitals have particularly high Y2K risk exposure."
The report says the health care industry trails other sectors in handling the Y2K problem in terms of managerial attention, technical resources available, financial resources committed, and remediation monitoring. Moreover, even though the pharmaceutical segment is among the most prepared sectors in health care, companies that rely on overseas suppliers may face disruptions. Some 80% of the basic ingredients used for drug products come from other countries, the report notes.
"I don’t believe the health care industry’s lack of preparedness will necessarily mean loss of life, but it could seriously impact care for millions of Americans dependent on prescription drugs and regular medical treatments to stay healthy," says Sen. Robert F. Bennett (R-UT), chairman of the special committee, which issued the report on March 2, 1999.
The Senate report drives home the immediacy of the problem and underscores the need for ICPs to assess their own programs and seek answers from information specialists at their facilities about interconnected databases, notes Patti Grant, RN, BSN, CIC, infection control professional at RHD Memorial Medical Center and Trinity Medical Center, both in Dallas.
"If you haven’t already been approached, you need to immediately call," Grant says. "Almost every aspect of my surveillance is computer-generated in one form or another. With patient data systems, I think all of us — even if we don’t realize it — are getting some form of computerized report."
Grant has been actively involved in Y2K compliance efforts at both hospitals, particularly because she sometimes needs computer access to information at one hospital while working at the other. Personal computers (PCs) at the facilities were checked for Y2K compliance more than a year ago, but a few months ago she found that a software program used to collect surgical site infection data at both hospitals was not year 2000-compliant, Grant says.
"Two months ago, they upgraded the system, and consequently I am five weeks behind at both hospitals because there has been a large learning curve," she says. "But we still have time to address these [issues] and be proactive, and not do everything after Dec. 31, 1999."
Beyond the desktop PC and biomedical devices, the Senate report also warns that Y2K problems could disrupt basic utilities in hospitals that use microprocessor controls to control air handling systems, power, and water.
"It would be back to the days of Florence Nightingale if any of that malfunctioned," says Grant, who reviewed the Senate findings for HIC. "As an infection control professional, you may want to get with your director of plant operations, for example, and ask if everything is year 2000-compatible. Don’t take things for granted."
The consensus message from both the Senate report and from those looking specifically at the Y2K implications for infection control appears to be that the situation warrants neither panic nor complacency.
"The effects of Y2K, although potentially serious, are probably going to be for infection control a very rare event," says Robert Garcia, MT, CIC, assistant director of infection control at Brookdale University Hospital and Medical Center in Brooklyn, NY. "Overall, the problems that may occur would probably be inconveniences, but not disasters in the majority of cases."
Of those ICPs who have computers, many may have older hardware and software that may not be Y2K-compliant, Garcia notes. That may mean problems if databases or other programs used for infection control records are date-sensitive.
"Most infection control departments have some records of this nature," says Garcia, who reviewed the Senate report for HIC with Marvin Shuldman, director of biomedical engineering at Brookdale. For example, sterilization equipment that generates dated reports may fail to apply correct dates.
"These printouts are used as a record of correct processing and are therefore permanent records used for regulatory review," Garcia says.
Lab computers may be affected, but Garcia does not expect any major problems with testing systems and monitoring of patients’ results.
"I would not anticipate [problems] since the systems are designed by major national companies who would have been looking for Y2K abnormalities for a long time," he says. "Medical record systems may be one area where there may be problems. Hospitals usually do not replace these systems very often and therefore may be [using] versions created prior to envisioning year 2000 problems. These records are often accessed by infection control."
Indeed, one approach for ICPs trying to assess the impact of Y2K problems on their programs is to determine what dated medical data they frequently access, advises Tracy Gustafson, MD, a health care computer software consultant with Epistat Systems Inc. in Richardson, TX.
"[ICPs] can expect to be affected pretty quickly if any of the systems they collect data from are not Y2K-compliant," he says. "It’s not life or death like some computers in the hospitals that control biomedical devices. Those are certainly on a higher order of risk, but still it would be naive for infection control people to say, It is not my problem; I don’t have to worry about it.’ It’s everybody’s problem, and you can’t ignore it if you handle dates. And they do."
The dates that often are critical to ICPs include the admission date of the patient, procedure dates that involve any surgery, the date an infection was reported, culture dates from laboratory computers, and follow-up dates postdischarge to see if an infection occurred, he says. Also important to ICPs are dates that relate to placement of medical devices like central lines and ventilators, particularly if those dates are used to calculate infection rates by device-days.
"Those are the dates they use regularly and have to be correct for them to do their job," he says. "Most of those, it turns out, are kept on other systems. They need to check with the systems that they collect data from. In most hospitals, that is limited to admissions, surgery, and the lab. If they are convinced that those three systems are completely up to date, then the only thing they have to worry about is their own software they are using for infection control."
At particular risk for Y2K woes are hospitals that are using custom-designed data collection systems developed specifically for their facility more than five years ago, he says.
"Those are the ones I think are really at some risk [because] those systems are very likely to have been written at a time when nobody was worried about Y2K," Gustafson says. "I think it is fair to say [those ICPs] are sitting on a time bomb. You won’t be able to run reports; you want be able to trust the reports you do run."
Another problem that may surface in infection control departments is use of old "hand- me-down" computers, he says.
"They get a lot of old computers; people pass them down and they get handed off to infection control," he says. "If you have a computer that is over five years old, it is probably not Y2K-compliant itself."
There are software upgrades available to fix Y2K problems, but the best option for ICPs who find their office equipment is outdated may be to lobby for a new computer, he adds. That may be preferable to getting on the list for an in-house software upgrade, particularly because many departments will be reporting computer concerns as the year wanes and the scramble ensues for 11th-hour corrections, he warns.
"You can pretty much predict the second half of this year is going to be taken up with putting out fires," Gustafson says. "Infection control doesn’t have a fire [in the sense] that it will cause the hospital to shut down. But it could have a serious impact on [ICPs], and they need to take care of themselves."
For example, back up all program data files to ensure all your valuable information is archived, he advises, noting that it may be wise to start a separate data set for the year 2000. Similarly, ICPs may want to heighten suspicion of data collected from other systems as the year change nears and for a few months thereafter.
"It has been a great advance and a big convenience over the last 10 years that networks have grown, but the price of that is a lot of computers depend on getting data from another computer in a certain way or format," he says. "We’re having to pay that price now with Y2K."
1. United States Senate Special Committee on the Year 2000 Technology Problem. "Investigating the Impact of the Year 2000 Problem." March 2, 1999. Web site: http://www.senate.gov/~y2k/