The year 2000 may pose practice-threatening problems for the unwary dentist.
John R. Vaselaney, DDS
Traditionally, New Year`s Eve is an occasion to celebrate, maybe even to forget about the office for a few hours. But New Year`s Eve 1999 will be different. Many people will be waiting anxiously to see how their computers and systems welcome the new century.
Unless this is your first Year 2000 article, you already have seen the litany of dire predictions: airplanes and elevators plummeting to earth, shutdowns of everything from traffic lights to life-support systems, even worldwide financial collapse.
Whether or not you believe those doomsday scenarios, it is undeniable that some businesses could be seriously affected as their systems (or the systems of their key business partners) either shut down or become riddled with errors. Businesses and professionals may sustain losses. Some may even go out of business due to Year 2000 problems.
The health-care industry certainly is not exempt from these problems, nor is dentistry, in particular. Will the Year 2000 issue have an impact on your practice? Yes! Are there steps you can take to prepare? Yes! Is there plenty of time? No! The clock is ticking and one thing is certain. This deadline will not be extended.
What is the Year 2000 issue?
It refers to the fact that many existing computers and systems can`t recognize the Year 2000 because they use only the last two digits of the year to record dates. They assume that the first two digits always are "19," so "1998" appears simply as "98."
This works fine until the computer hits "00." It reads that either as 1900 or not at all. In either case, there`s a problem. A system that can recognize and use dates that fall after 1999 is said to be Year 2000-compliant.
What kinds of problems might occur?
Year 2000 failure can result from incorrect, future date calculations. This could be happening now. If a system (such as a patient-recall system) uses future dates and any part of that system cannot recognize the years beyond 1999, errors can occur. The computer could shut down, or worse, those errors could spread throughout the system, corrupting everything they touch.
One of the first widely publicized examples of a Year 2000 problem was caused by future dates. A produce market was stunned to discover that its new computerized cash-register system collapsed whenever a customer tried to pay with a credit card that bore a post-1999 expiration date. Note that the system did not simply reject the card; it shut down, making it impossible for the store to serve its other customers.
Do I need to prepare for the Year 2000?
Virtually everyone needs to prepare for the Year 2000. If you do nothing, you probably will regret that decision. The Year 2000 is not just a computer issue, since computers are essential to most businesses and many professions.
To prepare for the Year 2000, you need to consider how the particular issues raised by mainframe and personal computers, by electronic interfaces and by embedded systems might affect your practice. In addition, check with the manufacturers, distributors, and vendors who provide your practice with equipment and products that could have date-related problems to make sure that they are Year 2000-compliant. Vendors providing services to your practice should be contacted to determine if they are going to be able to continue to serve you without errors or interruptions in the Year 2000.
How might it affect my practice?
The Year 2000 issue won`t change the way you do things, such as preparing teeth, finishing composites, or cementing crowns. However, it could affect how long it takes to get the burs to prepare the teeth, the composite for the restoration, or the cement for the crown. Benefit checks from your patients` insurance plans may be delayed. Some electronic devices that are essential to patient care may not function properly due to the Year 2000 issue`s effect on their internal design and function.
As we delve deeper into this issue, let`s examine the various systems that may be affected by the Year 2000 issue and the effects each might have on your practice.
Interfaces
A major aspect of the Year 2000 issue is interfaces. It is likely that some or all of your computers are connected to servers to form a Local Area Network (LAN) within your office. Additionally, your computers may interface with outside computers and systems (ones you don`t control). For example, your computers may exchange files with computers controlled by insurance companies, suppliers, banks, accountants, or payroll-processing services. You may be linked to computers at your employee-benefits provider, at multiple practice locations, or in other ways. Even if your applications and systems are all Year 2000-compliant, your data could be corrupted by non-compliant data coming from one of these outside sources.
The amount of coordination required to achieve Year 2000 compliance within these electronic interface networks is a challenge. All participants need to become Year 2000-compliant, then they need to test and coordinate their fixes with each other to make sure they still are compatible.
Even if you don`t interface electronically with external entities, their Year 2000 readiness still could affect you. What if a key supplier suddenly crashes on January 1, 2000, and can`t provide an essential product? What if your bank can`t post your electronic deposits to your account? To what extent will their problems affect your practice?
Practice-management software
Most offices currently use some form of practice-management software to enhance the efficiency of the practice, from both patient flow and business perspectives. These software systems, usually run from either a LAN server or a single personal computer, can vary greatly in their operational design and the platform used. Some are DOS-based, while many use a Microsoft Windows interface. Others are based on a different operating system altogether.
Regardless of how your system operates, it is used to perform many diverse functions. It tracks production, revenue, accounts receivable, and patient visits. It coordinates your insurance processing, from estimating benefits to printing forms to flagging overdue payments. It manages patient flow in your practice with its appointment scheduling, recall notice, and general database capabilities. Perhaps your system is used for other purposes, too.
With all the functions your practice-management software performs, are you prepared to run your business without it? If it`s not Year 2000-compliant, you`ll be facing that task two Januarys from now.
If your practice-management software is so old that your vendor is no longer in business, it`s a good bet it`s not Year 2000-compliant. Newer software systems that run on Microsoft Windows 95 are more likely to be Year 2000-compliant than older systems that run from a DOS prompt or an earlier version of Microsoft Windows. Yet, that`s still no guarantee you`ll be problem-free.
Some noncompliant, practice-management programs can be fixed by the selling vendor or by a capable consultant if you have the right to make changes to the program. Some programs can be updated with newer, compliant versions of the same program. Other systems may not have any available fix and will need to be completely replaced. And even if your software is Year 2000-compliant, your computer hardware might not be. That`s why it is imperative that you contact both your software and hardware vendors as soon as possible and inquire about the Year 2000 issue.
Other computer software
The good news is that many of the popular over-the-counter PC applications sold by major companies like Microsoft are either Year 2000-compliant now or will be in their upcoming versions. In other words, your software may be Year 2000-compliant already or, if it isn`t, the upgrade to make it Year 2000-compliant will be inexpensive and easy to implement. Compared to checking mainframe code line by line, this is a relatively painless solution. The key is finding out the Year 2000 status of your most crucial software so you can be ready in time. Check the Year 2000 status of the software you use now and the status of the most likely replacement version.
Virtually any type of software can have a Year 2000 problem. Database, spreadsheets, accounting, scheduling, and billing programs are the most obvious ones to check, especially if they are crucial to your work.
Even if your software is compliant, you still need to check your individual applications. (By "individual applications" we mean your spreadsheets, your databases, your reports - any files, macros, or templates that you have set up in a particular way.) Many of these individual applications are designed in ways that aren`t entirely Year 2000-compliant.
For example, if you have an application (let`s say an accounting program) that displays years in a two-digit format, it may continue to display years in a two-digit format even after the underlying program has been reprogrammed to accept four digits. You need to be aware of how your system handles dates in every application so you can make informed decisions about whether or not to change it.
How new should your software be? Some experts say you shouldn`t trust anything made before 1997. If you are using off-the-shelf software that is so old its manufacturer no longer supports it (or the manufacturer itself no longer exists), there is a very good chance it has a Year 2000 problem. You need to either evaluate and test it thoroughly or replace it. In any case, you should test all of the software you use, regardless of its age, to make sure that it will function properly in the Year 2000 and beyond.
Computer hardware
In addition to software, many computers have a hardware problem with their internal system clock and Basic Input Output System (BIOS). Every PC has one. Some internal clocks can`t recognize the year 2000 because of the BIOS chip. This is critical because PC programs that use dates usually look to the system clock for the current date. Even if your practice-management software and other programs are working properly, you still may have problems if your computer cannot generate post-1999 dates because of its BIOS chip.
If your computer is more than a few years old, there is a good chance it has a BIOS problem. Even some newer computers have this flaw. Your best course is to check with the manufacturer, especially before you buy any new computers.
Embedded systems
Computer devices used to control, monitor, or assist the operation of equipment or machinery are called embedded systems. Often, an embedded system is a single, tiny chip buried deep in a machine that performs only one function; it signals the need for periodic maintenance, for example. Virtually every office relies on machines that contain embedded systems.
The first step in preparing your embedded systems is an inventory. Date-sensitive processors are built into everything from elevators to fax machines. Many devices such as telephone exchanges, heating and ventilating systems, cellular phones, security systems, electronic vaults, electronic door locks, and video equipment may contain embedded chips that perform a timing function. Other examples include systems that perform data acquisition, monitoring, diagnosis, and time-keeping functions.
In some cases, an embedded system will interface with a stand-alone or networked computer. An office computer that is completely Year 2000-compliant might fail if it receives erroneous data from a non-compliant device.
Obviously, non-compliant embedded systems have the potential to thoroughly disrupt your practice. How many patients would pursue treatment in a building without a functional heating system during January weather? How productive could your practice be if your phone system went down?
Some reports have speculated that the performance of certain patient-monitoring devices that record date and time, such as pulse oximeters and automatic blood pressure and pulse machines, may be affected by Year 2000 issues. A malfunction in such equipment could result in serious consequences for your patients.
To obtain information about embedded systems in your equipment and their compliance, contact the manufacturer of each device.
Mainframes
Most dental practices don`t use mainframe computers, but the mainframes of other businesses can affect your practice. Mainframes are the big, centralized machines that form the computing infrastructure backbone of most large companies. More than a few medium-size companies have mainframes, too, and many more rely on the services of data-processing vendors who use mainframes.
You may hear the term "legacy systems" used in reference to mainframes. These machines often are the direct descendants of systems developed more than three decades ago. In those days, memory was extremely expensive and any technique that conserved memory was adopted. Writing years as two digits is just one example.
Today, some components of those old mainframe systems still are running. Fixing them for the Year 2000 takes a combination of renovation and replacement. Because most of these systems use components supplied by vendors, converting them requires close coordination between the user of the mainframe and the vendors. After the system has been readied, it must be thoroughly tested. Overall, checking and renovating mainframe software is a complicated and time-consuming process.
Even if you don`t have a mainframe, you still may have a mainframe problem if your practice relies on businesses that use mainframes. Some examples of potential mainframe users are outside processing services (like a payroll processor); insurance companies processing patient benefits; and dental suppliers that manage orders, inventory, and shipping on a mainframe system.
Planning around problems
All the uncertainty about what will happen on January 1, 2000, and beyond should have you thinking of ways to minimize the impact on your practice. One of your contingencies should be to have enough clinical supplies on hand to weather the potential delays faced by suppliers.
January 1, 2000, falls on a Saturday. Even if you`ve done extensive testing, consider going into the office to test systems and equipment before you open for business in the new year. If there are computer problems, you may be able to prevent them from compounding into larger business problems. Your diligence in further testing patient-care equipment might actually prevent an injury to a patient.
In all cases - whether your concern is interfaces, practice-management programs, software, hardware, embedded systems, mainframes, vendor dependencies, or all of the above - the single biggest part of your Year 2000 preparation process likely will be testing.
Will Year 2000 failures and the harm they may cause be covered by insurance? Coverage, if any, will depend on the terms of your particular policy and the specific facts of the claim. In addition, no coverage exists for Year 2000-related exposures on many types of policies as currently written. The best protection against loss is to assess the problem as it relates to your own computing devices and correct it.
If you have not yet begun to prepare for the Year 2000, start now. There are many qualified resources available to help you, but they will become increasingly scarce as the deadline approaches. Remember, literally every computer-dependent business on earth has the same deadline for this project.
The Year 2000 issue is serious. It needs to be resolved and it can be. If we all pay attention to it now and do what needs to be done, we can fix it and get back to taking care of patients.
This article should not be construed as legal advice or a legal opinion on any factual situation. Its contents are intended only for general information.
Year 2000 Survival Guide
Computer Age Dentist, a California firm that sells practice management software, has some suggestions for keeping you in a tranquil state of mind at midnight on December 31, 1999. Their ideas are in the "Survival Guide for the Year 2000."
The guide is distributed free of charge to dentists. To obtain a copy, call (800) 426-8927.
A Year 2000 Checklist
So how should you begin? Here is a simple outline of the steps to follow:
* Get started now. Rank tasks in terms of how critical they are to patient care and the livelihood of your business. You may not have time to address all possible issues, so tackle the most significant ones first.
* Raise the awareness of everyone in your office and assign one or several teams to tackle the various tasks.
* Inventory all of your systems, equipment, and facilities that may be affected and assess their compliance status.
* Assess the compliance status of your suppliers and business affiliates, especially when there are electronic interfaces involved.
* Identify your core business functions and procedures.
* Develop a compliance strategy and create a detailed plan.
* Create a contingency plan.
* Identify and prioritize resources that will help you get ready.
* Contact all of your suppliers and business affiliates, and document their responses.
* Thoroughly test your systems.
