April 16, 1999

Somewhere between panic and doing nothing are steps psychiatrists can take to ensure their computer systems won't crash on January 1, 2000. Because most computer systems were programmed with two-digit years, 00 could be interpreted as 1900 instead of 2000, causing errors in electronic billing, patient medical records, and other information systems.

Assurances of Y2K readiness notwithstanding, segments of the health care industry appear to be slow in making the necessary Y2K repairs. A special Y2K U.S. Senate committee interim report revealed last month that more than 80 percent of doctors' offices were not Y2K compliant, and 64 percent of the nation's 6,000 hospitals still have serious Y2K problems.

Bertram Warren, M.D., chair of APA's Committee on Information Systems, told Psychiatric News that most psychiatrists appear unprepared. "Many of us are using older programs for billing and can't afford paying $20,000 to replace them with newer Y2K-compatible systems."

Warren recommended that psychiatrists keep hard copies of their computerized billing and patient records in case their systems malfunction when the year 2000 dawns.

The Health Care Financing Administration (HCFA), which administers Medicare, has advised providers who submit claims electronically that they must change from six-digit to eight-digit codes for service dates and birthdates by April 5; otherwise, their claim forms will be rejected.

A HCFA spokesperson told Psychiatric News that 70 percent of the agency's systems that handle Medicare claims were Y2K compliant at press time, and the remainder would be compliant sometime this month.

According to Karen Trudel, director of HCFA's Division of Health Care Information Systems Standards, 58 percent of hospitals submitting Medicare Part A claims have converted to the eight-digit code, and 98 percent of providers submitting Part B claims have met the eight-digit requirement. However, most physicians use billing companies to submit Medicare claims, so the 98 percent figure may not accurately reflect providers' Y2K readiness.

APA Chief Information Officer Charles Killian told Psychiatric News, "The complexity of the Y2K problem grows exponentially as psychiatrists' activities extend beyond their desktop computers to office networks and electronic data exchanged with other organizations."

The exception to the Y2K problem is MacIntosh computers because they were programmed for the next century, he noted.

Killian said the Y2K problem impacts these five components of IBM or IBM-compatible desktop computers:

• The hardware that boots the computer when the power is turned on


• The operating system such as Windows


• Software such as word-processing, spreadsheet, and e-mail programs


• Stored data about a patient or practice


• Data sharing with other systems such as those of HCFA or a managed care organization

Killian explained that the hardware layer has the basic input/output system (BIOS) that sets the system's date and time clock. BIOS provides this information to the operating system and software programs.

"If there is a problem here, each successive layer of the system is at risk and data entered in spreadsheets, accounting systems, scheduling, and payroll systems are suspect," said Killian.

To fix this problem, the PC must be audited and repaired or replaced.

To assess Y2K compliance, Killian suggested using software programs such as Check 2000 PC, which was rated the best Y2K product by InfoWorld magazine, he noted. In some cases, manufacturers will provide a way to repair the existing BIOS. If it cannot be repaired, then it must be replaced, said Killian.

He noted that a recent purchase of a computer, software, or operating system is no guarantee against Y2K problems, however, because some Pentium machines are not Y2K compatible.

The operating system provides information to the other components, he explained. "Unfortunately, the standard product of most common operating systems, including those sold in the past year or two, are not fully Y2K compliant. This means each layer is at risk."

To find out whether the operating system is Y2K compliant, Killian recommended visiting the manufacturer's Web site, which in most cases is Microsoft.

Software programs vary in how they deal with dates. Between two-thirds and three-fourths of all Windows programs have a problem related to storage or manipulation of certain types of dates such as leap year or the year 2000, estimated Killian. Psychiatrists should identify all their software programs and consult the manufacturers to determine whether the version they use is Y2K comptabible. Most of the popular programs can be checked by Y2K risk-assessment software such as Check 2000 PC, noted Killian.

Data about billing or patient histories have often been entered into desktop computer applications using two digits for the year. Software programs make assumptions about the century when calculating differences in dates, explained Killian.

"The assumption that a two-digit year can be expanded to a full century such as 2000 may be erroneous unless the 21st century was programmed when the software was developed," he said.

"Since this is largely an automated function, errors can occur without the user being aware of it. In database or spreadsheet applications, which allow the user to define the date field, the field should be expanded to allow for four digits."

Killian added, however, that "even when data were entered with four digits, they can become corrupted when exchanged with other applications that are not fully compliant. This is the issue HCFA faces in claims submissions and why [HCFA is] trying to bring all claims submissions into compliance."

To limit exposure to computer applications that may not be Y2K compliant, Killian suggested that psychiatrists ask intermediaries they deal with such as billing companies whether their computer systems are compliant. If not, physicians should have a contingency plan for billing such as having claim forms available.

In addition to installing assessment software, psychiatirsts can check Y2K compliance of their desktop computers by consulting their computer maintenance contractor or local computer vendor for help in assessing and renovating the system, said Killian.

Killian plans to have Y2K information available this month on APA's Web site at that will include hyperlinks to useful Y2K resources on the Internet. He invited members to e-mail their suggestions on useful Web sites to Webmaster@psych.org.

Killian also recommended the following Web sites for Y2K computer-compliance information:

• Check 2000 PC software: www.easirun.com.au/NZ/check2000.html


• Microsoft's Y2K operating system information: www.microsoft.com/year2000/>


• HCFA provider and agency Y2K fact sheets: www.hcfa.gov/y2k


• AMA Y2K resources including sample equipment checklist and HCFA Y2K requirements: www.ama-assn.org/not-mo/y2k/ (AMA members can also access Y2K guidelines and a Y2K forum, and attend regional seminars.)

The text and legislative status of a bill that would allow the Small Business Administration to guarantee loans to fix year 2000 computer problems is posted at ; search on S.314.