Patient Care at 12:01.01 on 01-01-2000
Patient - Physician Relationship
Part Three:
Providing Continuing Health Care in the Year 2000
Foreword: Thank God for the creation and sustained awesome evolution of the greatest computer of all time. On January 1st I will awaken with full electrochemical function and integrated communication ability with my cerebrum. We will all be without any Year 2000 concerns, at least for that moment in bed. I am pleased to inform you of the winner of the Y2K computer of the millennium contest: ----- The Human Brain
Y2K Compliance
Three criteria should be met before the computer system or physician's office is Y2K compliant.
(Before 01-01-2000)
1.) The computer must support the millennium date format ( mmddyyyy) ex. 01-01-2000.
2.) The year on the computer changes to 2000 on January 1st, 2000.
3.) The year 2000 is identified on the computer as a leap year 02-29-2000.
Year 2000 or Y2K Issue
From 12-31-99 to 01-01-2000
"OO" by itself means zero or none or the value of an empty set. The extra "00" means billions of dollars in repair costs to companies and individuals using computers.
The problem simply defined is determining how your computer system and all software programs chose to represent and manipulate digital time-related data. Hardware and software programmers believed that the hardware and software applications would be replaced way before the end of the Twentieth Century.
If you have spent hours investigating and carefully performing a strict inventory of all Electronic hardware, computer systems including the B.I.O.S. (Basic Input Output System), R.T.C. ( Real Time Clock), Operating System and Applications, Data Bases and Files and any Biomedical Equipment, then you are on schedule to complete the upgrade of a group or private practice office to an acceptable Y2K reliable compliance level.
PATIENT EVALUATION 01-01-2000
History and Physical Examination: ---- Reliable and Y2K Compliant
Diagnostic Tests---- Not Reliable or Y2K Compliant
Lab tests and X-ray 's -----Unsure on Reliability or Y2K Compliant Status
Medications and Pharmacy Supply ---- Not Reliable or Y2K Compliant
Surgical Treatments----- Not Reliable or Y2K Compliant
Rehabilitation Treatments----(Almost Acceptable)----Reliable and Y2K Compliant
Nursing Care-------Reliable and Y2K Compliant
PHYSICIAN OFFICE BUSINESS
FUNCTION
Immediate Concern January 2000: Medical Record
All Physicians understand the obvious Clinical need for quick access to a complete history of a patient's previous health care. Data always includes treatments and medications received in the recent past and preferably throughout the patient's lifetime. The medical and surgical care in January of the year 2000 will require old documents and means of adding to or creating new documents related to a patient's health care. Legal standards have been set by the Texas State Board of Medical Examiners and Texas Medical Practice Act for Maintenance of a Patient's Chart. Ease of chart accessibility and reliable transmission of all data and documents are required and expected by patient and physician.
1.) Paper Medical Records - - - - Reliable and Y2K Compliant
2.) Electronic Medical Records - - - - Reliable and Y2K Compliant
Both methods of document storage and access are used in 1999 and will be for years to come. There are multiple methods of chart maintenance and reliable storage in hospitals and physicians' offices. Each has to be evaluated by the physician and determination made as to the Y2K readiness of their system of medical records.
Confidentiality and Security and Privacy Issues related to the Patients' Chart:
These issues exist in both paper and electronic systems of medical record document creation, addition and storage.
INSURANCE CLAIMS AND ACCOUNTS RECEIVABLE
Insurance claims are processed by paper or through software programs currently in 1999. Electronic claims are sent to a regional computer center for proper formatting and transmission to third party insurance carriers or Medicare-Medicaid centers. Medicare requires a four-digit year to be placed on paper forms or the claim will not be accepted. After patient care has been rendered, the diagnosis is placed on the claim form ( paper or electronic) using Current Procedural Terminology (C.P.T.) and International Classification of Diseases, Ninth Revision (I.C.D.-9) codes. Payments received need to be maintained and secondary insurance carriers billed after a primary insurance carrier has reimbursed the physician. The insurance billing software or paper system has to have audit capabilities and ability to properly reference digital data of previous 1900 to 1999 years. Back up of the system to a paper file may be best unless strict guidelines and Y2K compliance can be identified and proven. Back up of data and then changing the computer date to 01-01-2000 may be necessary to prove the compliance of the software related to date management instructions residing inside the software application.
Year 2000 Solutions:
For all medical offices using computers, the most important clinical and preventive legal action taken by a physician in 1999 preparing for the year 2000 for a physician using a computer system in their office is keeping back up copies of their patient's medical records, patient accounts, business documents including financial and insurance data.
1.) Date Expansion
Simplified any date using two characters to represent the year, i.e., "99" needs to be changed to four characters, i.e., "1999".
This includes date related software instructions or date containing files B.I.O.S. or read-only memory ( R.O.M.), all files using dates, software programs, embedded control systems ( E.C.S.) within the entire computer, hardware and software.
2.) Windowing
The software programmers install date manipulation instructions which determine what the last two numbers or characters in the year represent.
A Pivot year is set such as "50". If the date entered is 01-01-00 then 01-01-2000 is assumed by the software program. If a year is entered 00 to 50 then the software assumes the year entered or referenced is 2000 to 2050. Years with higher numbers or characters, 51 to 99, when entered or referenced are assumed to be 1951 to 1999.
3.) Paper Back Up Files
Perhaps this is the best answer to maintain a contingency plan for the next year. Financial data, mortgage and loan papers, wills and legal papers, birth certificates, stocks, bonds and mutual fund certificates, credit card information and monthly statements, checking, savings and CD statements should be available. The U.S. Banking Association has recommended keeping at least two months of paper data before 01-01-2000. The burden of proof rests on the individual or physician in practice.
4.) Real Time Clock and the Basic Input Output System
Here lies the main problem faced by Y2K programmers. Both the R.T.C. and battery component on the computer and the PC's B.I.O.S., a memory chip on the computer's mother board with Read Only Memory (R.O.M.) need to be able to properly interact and supply date information for applications on the hard drive. This Date-Time Management function on your computer must work today and on 01-01-2000.
5.) Four Digit Year 2000 Compliant Software
Check and upgrade or replace computer software applications not in compliance. Check your data including spread sheets for Y2K problems of two character year data.
6.) External Suppliers beyond your control
If your computer system is Y2K ready and compliant then you have dealt effectively with internal office related medical-legal risk factors related to the year 2000. However, external suppliers of goods and services and information may cause separate external risks for the physician to deal with.
Legal effects and concerns related to Year 2000 compliance have erupted into a major income source for lawyers. Failure to provide medical records or administer community standard tests and treatments due to Y2K problems will lead to lawsuits. Finding replacements or upgrades for an E.C.S. or software or computer or Biomedical equipment can be difficult and at times not possible or expensive. Software and hardware vendors have used contracts with their customers shielding themselves from legal attack. Many software licenses have disclaimers and/or clauses limiting liability for Y2K issues. The statute of limitations for breach of contract nationally using the Uniform Commercial Code (UCC) is generally four years. Many companies will not fix or offer remedies to Y2K non-compliant products or data. Simply replacing old software programs and computer hardware and biomedical equipment is often recommended.
7. )Electric power supply is the key to solving this Y2K problem. Without wire, barbed and electric lines, the Southwestern United States would be almost uninhabitable. The T.U. Electric Company has graciously accepted an invitation to talk to the physicians today in Dallas regarding the capability to handle the Y2K issues. Many other industries have to also analyze their systems and prepare for the next century. The Nuclear Regulatory Commission will require by July 1, 1999 all nuclear power plants to be Y2K ready or apparently not be allowed to continue operations. The Telephone, Utility, Transportation industries have to prepare with the same concerns related to Y2K in order to allow Americans to maintain their standards of living. Leadership and social cohesion will be strained if all these industries are not Y2K compliant. Thankfully the issues are being addressed and expensive upgrades and replacement systems integrated. Contingency plans are being initiated. Remember the old saying of a parent needing to provide food, clothing and shelter for their children and family.
8) With the recent price reduction of PC's and server computers ----BUY A NEW ONE. This is cost effective and reduces the number of hours required to " patch or fix" the computer system. The patches can be complex and unreliable when integrated into your computer system.
9.) READ !!!
INTERNET Y2K WEB SITES
Most major companies have web sites addressing known Y2K issues with their products or data.
Compaq, Hewlett-Packard, American Megatrends, Zenith Data Systems, Microsoft, Apple, Corel, Sun Microsystems, T.U. Electric, Seagate are examples of sites with Y2K information on their products such as noncompliance, upgrades, service packs, etc . . .
Try:
http://y2k.gov
( As of 03-31-1999, 13 of 24 federal government departments of agencies were 100% Y2K compliant with mission critical systems. Other agencies are less ready perhaps 85% Y2K compliant estimated. The United Stated Navy will be the source of time and verification of any geographic position relied on by the federal government on after 01-01-2000.
http://year2000.com ( Reference sources)
http://fda.gov (F.D.A.)
http://fda.gov/cdrh/yr2000/year2000.html (Federal Government Y2K Biomedical Equipment Clearing House)
http://wdcy2k.org
(Washington, D.C. group of Y2K experts)
(Quicken information)
The unknown factors related to Y2K are the most anxiety producing. What will be the psychological and sociological effects of Y2K on our nation and internationally?
Basic Data Information
If time permits, I would like to reference operating systems and software application which had to be evaluated and altered in my home and in my practice of Neurosurgery. Also, basic information on data may be helpful with a glossary of terms.
The fundamental unit of data in a computer is the BIT. A bit has only two values 0 and 1. Electronic circuitry or electromagnetic fields can easily create a 0 or 1. In such manner 0 or 1 can be detected, manipulated and represented so that the computer hardware and software can see and use the data. A BYTE is 8 bits. One 8-bit byte can have 2* eighth power or 256 values. The American Standard Code for Information Interchange (ASCII) uses one byte per character. A B ; { + all are represented by a specific byte sequence of 0's and 1's.
Digital data means the numeric value of a data element or information. Analog data is simply information stored or transmitted in a physical or magnetic form likes the grooves on a record or magnetic tape. Computer hardware receives information in analog form and converts the data to a digital format. Software programs contain lists of digital instructions. The central processing unit (CPU) of the computer reads this data and then transmits or combines other groups of data in a specific method as per the software instructions. Data often enters into the computer through Input-Output (I/O) ports.
The Operating System controls the computer's hardware components function. The Operating System allows the interaction and integration of software applications with the computer's hardware components. The Disk Operating System (D.O.S.) configures your computer at start up using the AUTOEXEC.BAT and CONFIG.SYS start up files. The mouse will not work until a driver is loaded from these programs.
These operating systems at start up may not handle your computer's B.I.O.S. problems. Most R.T.C. are not able to recognize the rollover to the next century or year 2000 or use four character years. The B.I.O.S. will have to change the clock time data to a 4-character year. If the system clock or B.I.O.S. does not work properly a B.I.O.S. upgrade or use of a program such as Norton 2000 will need to be installed.
Window NT 4.0 requires the additional Service Pack 4 to be Y2K compliant. The server B.I.O.S. needs to be checked for Y2K compliance after Service Pack 4 is installed. Windows 95 requires a change in the short date format (mmddyy) to the long date format (mmddyyyy). This problem is quickly identified using software such as Norton 2000.
Apple computers like the Apple II series or IIC+ IICx purchased around 1984 to 1988 had no system clock. The operating system has to be upgraded to System 6.0 which handles even seconds well but only up to the date 02-06-2040.
Quicken applications have to use the Windowing technique to format and utilize the two digit year data. Older versions may have to be updated in order to compare budgets, etc...
Microsoft Excel Version 5 sold around 1995 may have been upgraded to Microsoft Excel 97 in Microsoft Office Suite 97. The two software applications use different languages: SQL for Excel 97 and Visual Basic for Version 5. Importing of files from Version 5 to Excel 97 can alter macros and make the data un-interpretable or you may see *** instead of 999.
Future Millennium New Medical and Surgical Treatments:
Examples:
1.) Stereotactic Computer Based Intra-operative MRI Use in Neurosurgery
2.) Embryo Research and Organ System Regeneration and Cloning
3.) Genetic Re-engineering
A.) Disease Prevention and Eradication
B.) Accelerated Iatrogenic Impact and Alteration of Human Chromosomes and Cloning
C.) Bone Graft and Cartilage Substitutes in Spine and Skeletal Reconstruction
Jerry V. Marlin, M.D., P.A.
Neurological Surgery
8220 Walnut Hill, Suite 604
Dallas, Texas 75231
(214)363-2587
FAX (214)363-6996
Web Site: http://dmismedical.com