Hospital Catches the Millennium Bug Discussion

Hospital Catches the Millennium Bug Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Hospital Catches the Millennium Bug Discussion Hi there, Please answer the following questions using the attached materials below. No outside source can be used. Please write about three single spaced page. One question per page. Thanks! Temple University MIS 535 Hospital Catches the Millennium Bug Discussion Based on the facts presented in the case, how far had Fetcher-Allen progressed in these steps by June, 1998? ( Explain your reasoning supported by specific evidence from the case study. ). Hospital Catches the Millennium Bug Discussion How likely is it that Fletcher-Allen would have achieved full-year 2000 compliance by December 31, 1999? ( Explain your reasoning. ) At the end of the case, Sadlemire observes, “This project sometimes plays second fiddle to other projects that I believe are less critical.” What “other projects” do you think he is referring to here? What advice would you give Sadlemire to help him address this issue of conflicting priorities? case_3_hospitalcatchesmilleniumbug_a.pdf Hospital Catches the Millennium Bug Discussion. A Hospital Catches the “Millennium Bug” By Janis Gogan Introduction Bob Sadlemire completed the minutes of the May 1998 meeting of Fletcher Allen Health Care’s Year 2000 Steering Committee, and headed out for a lunch meeting with his boss, Mary Kay Boudewyns. Before walking up the hill to the Burlington, Vermont restaurant, he paused to take in the serene sight of Lake Champlain. Refreshed, he walked on, his thoughts turning to the upcoming June meeting of the Patient Care and Systems Improvement (PCSI) committee of the Board of Trustees, in a few days (Exhibit 1). Sadlemire would have 15 minutes to brief the committee on the status of the hospital’s Y2K project. Sadlemire — an employee of Jennings Consulting, Inc. – had been assigned to Fletcher-Allen as its Y2K Project Coordinator, on a contract that ran from July 1, 1997 through July 1, 1999. While much had been accomplished, he was quite concerned that the project was not proceeding forward as fast as necessary. How Hospitals Caught a Millennium Bug Many computers, databases, applications software, and embedded microprocessor controls were coded (as long ago as the sixties and as recently as the nineties) with two-digit year fields. This choice would process the year “2000” as “00,” causing problems. All but the smallest of organizations, in virtually every industry, were affected by this so-called “millennium bug,” and Gartner Group estimated that it would cost $600 billion to fix systems affected by it. The year 2000 problem affected software (operating systems, transaction processing and decision support applications, vendor packages, user-developed applications, etc.), computing hardware (desktop, midrange and mainframe systems) and embedded microprocessors that control devices ranging from everyday equipment such as elevators and thermostats to specialized medical devices such as heart defibrillators and infusion pumps. Year 2000 compliance projects were comprised of the following steps: ? ? ? ? ?Temple University MIS 535 Hospital Catches the Millennium Bug Discussion Hospital Catches the Millennium Bug Discussion. Inventory: identify hardware and software that might give rise to Y2K problems. Analysis: examine code for date fields, and determine which ones need to be fixed. Remediation (conversion): alter the code for Y2K compliance Testing: ensure that altered code produces correct results. Migration: put the new code into production Boston attorney Steve Goldberg1 stated: “Unrectified, Year 2000 failures could compromise patient care, disrupt core business functions, and create substantial liability exposure.” He explained that the Y2K bug “… could scramble chronological patient histories and schedules for lab tests, admissions, surgeries, and office appointments. New perishable goods could be rejected by automated inventory systems as being 100 years old. Current accounts could be canceled because receivables were thought to be 100 years overdue. Equipment with computerized maintenance or calibration schedules could be taken out of service automatically… Even if a hospital takes care of its own Year 2000 problems, it may still experience business interruptions if third parties upon which it depends fail to do so. Health care systems cannot function effectively without reliable support from medical insurance payors, claims clearinghouses, banks, and suppliers of hundreds or thousands of other goods and services, all of which are potentially vulnerable to Y2K failures.” In addition to fixing the Y2K bug in software, hospitals had to ensure that medical instrumentation and facilities would not be affected. The United States Food and Drug Administration (FDA) sent a June, 1997 letter to medical device manufacturers, notifying them of their obligation to determine whether their devices were at risk of failure2. An article in the December, 1997 issue of Health Devices discussed the potential effects of the Y2K problem on equipment performance and hospital liability issues, and concluded: 1 2 The letter is posted at http://www.fda.gov/cdrh/yr2000.html. 1 “Hospitals should press to have remedies implemented without charge for any equipment that is still marketed and/or still supported by the supplier. If suppliers will not waive their fees, hospitals should pursue the following actions: (1) withhold any ongoing agreements they may have with the supplier, (2) refuse future purchases from that supplier and seek an alternative, Y2K-compliant supplier, and (3) report a supplier’s refusal to cooperate to ECRI (a non-profit health care research organization and Collaborating Center of the World Health Organization).” In January, 1998 the U.S. Department of Health and Human Services wrote to medical device manufacturers, requesting product year 2000 data that would be posted at the FDA web site. Temple University MIS 535 Hospital Catches the Millennium Bug Discussion A May 1998 FDA document urged manufacturers “to use this mechanism to communicate the status of their products that are affected by the Year 2000 date problem to public and Government purchases and users of these products3.” It added: “… Device manufacturers must evaluate their entire lines of medical equipment and software, not just currently produced or supported products, to identify and assess problems that could result from inaccurate date representation. This assessment should take into account date errors that might lead to device failure, such as failure to provide diagnosis or patient treatment, date misrepresentation leading to incorrect records which might impact future treatment, or any process affected by the Year 2000 date problem that, if not corrected, has the potential to present a risk to health. Should the assessment indicate a risk to patient or public health by medical equipment unable to correctly process dates, device manufacturers must report corrective action taken in accordance with Section 806 (21 CFR 806), the regulation requiring reporting of device corrections and removals…” An example of manufacturers’ data as reported on the FDA site is provided in Exhibit 2. Despite the high exposure of health care organizations to year 2000 risks in systems, devices and facilities, a Gartner Group survey revealed that 88% of U.S. hospitals were “aware” of the year 2000 problem but, as of late 1997, had not yet launched a project to inventory, assess and remediate their systems and equipment. Background: Fletcher-Allen Health Care Fletcher Allen Health Care (FAHC) was founded in 1995, in a merger of the 500-bed Medical Center of Vermont, 83-bed Fanny Allen Hospital and practice groups of 250 University of Vermont Medical School faculty. Fletcher-Allen’s 4,800 employees (including 560 medical staff, 1000 nurses, 370 other caregivers) and 500 volunteers serving a catchment area comprised of 850,000 people in 13 Vermont counties and 6 New York counties. In more than 50 separate facilities they handled 22,000 in-patients, 150,000 outpatients, 45,000 emergency-room visits, and 573,000 physician-office visits each year, with operating expenses of about $330 million4. The main campus was adjacent to the University of Vermont College of Medicine Burlington campus. These hospitals had long used a set of custom applications, coded in assembler — HIS (Hospital Information System); most were developed in the seventies and ran on an IBM mainframe computer. To address the problem of outdated, incompatible systems, and to enable new forms of technology-enhanced patient care,Temple University MIS 535 Hospital Catches the Millennium Bug Discussion a $17 million “Basic Infrastructure” initiative was underway, comprised of several ambitious components: ? ? ? ? Upgrade Burlington network, with new personal computers and Internet access. Integrate patient registration, enrollment, scheduling, eligibility and referral applications and provide links to an integrated billing system. Develop new Patient Data Repository (first step toward an integrated medical record). Develop new Care Management Information System. Fletcher-Allen was also developing a $13 million Regional Information Network, including providing participating caregivers with workstations equipped with Internet access, video conferencing, enhanced electronic mail, and an ambitious expert system for diagnosing, assessing, and managing patient health. These 3 4 The database, containing some manufacturers’ year 2000 data, is at http://www.fda.gov/cdrh/yr2000/year200.html. Source: http://www.fahc.vtmednet.org/facts.htm as of July 8, 1998. 2 “telemedicine” investments would extend the reach of Fletcher-Allen’s specialists to patients and caregivers located in rural areas5. CIO Bill Montgomery commented in a budget document: “Health care could dramatically improve because of more timely care, reduced duplicative services, dissemination of knowledge, care delivery provided as close to the home or work as possible, and reduced travel costs by patients and families…” In 1997 and 1998, Fletcher-Allen was recognized by a leading health trade publication as being in the “top ten” of telemedicine programs in the United States. When Bob Sadlemire started in summer 1997, Fletcher-Allen was organized in 11 Health Care Services teams (e.g., surgery, pathology, etc.) and five Key Support Process Teams: Key Support Process Teams VP Financial Services Clinical Support Services People and Systems Services Information Services C. Hindes D. Burke P. Kerr A. Wyman Facilities Services D. Ayres Budget, Mgt. Accounting, Patient Financial Services, Analysis Health Information Mgt., Health System Access, Risk Mgt./Safety Human Resources, Quality, Education and Development Technical Support,Temple University MIS 535 Hospital Catches the Millennium Bug Discussion Customer Support, Business Systems, Clinical Systems, Applications Development Facilities Services, Materials Management In spring 1998 the team-based structure was altered and some executive positions re-organized (Exhibit 3). A new CEO, William Boettcher, was to start July 1. A Board of Trustees press release (April 29, 1998) stated: “… We are addressing major challenges in health care delivery that have affected employee morale and our public image. With the naming of Bill Boettcher as chief executive officer today, we look forward to a period of stable leadership that will help the organization move forward.” Fletcher Allen Information Systems Mary Kay Boudewyns was responsible for five major systems projects, one of which was the Year 2000 compliance project. The other four projects under her direction were: 1. 2. 3. 4. Migrate Fanny Allen hospital information system (on IBM AS 400 computer) to Medical Center platform. Convert an old payroll application to MVS. Replace many old HIS applications for patient admitting, billing, managed care, and medical records with Unix-based applications from IDX, running on an Alpha6 server. Convert the mainframe (MVS) payroll and human resources applications to a Unix-based Peoplesoft package, which would run an IBM RS6000 midrange computer. The first two projects made it possible to shut down computers on which old systems operated. These applications were then to be replaced by projects 3 and 4 (client/server implementations). The IDX project, a major undertaking implemented by consultants from a large firm, “went live” in October, 1997, five months late. The Peoplesoft conversion was “on track,” per Boudewyn, for completion by January 1, 1999. Joe Mack, hired as director of clinical systems in January 1998, was managing a large project to migrate nursing scheduling, pharmacy and other clinical applications (part of the old HIS system) to a Meditech package, and also projects to implement an integrated surgical application (ORSOS), a nurse scheduling system (ANSAS) and a radiology system (IDX Rad). The Year 2000 Project is Launched Boudewyns asked Jennings Information Systems Consulting, Inc. (hereafter, Jennings) to help prepare a year 2000 project plan. One manager questioned her selection of Jennings, asking, “Why not bring in a major consulting firm, one with a track record in this kind of work?” She replied: 5 6 For further information, see “Fletcher-Allen Health Care: the Telemedicine Initiative,” by J.L. Gogan and P.J. Guinan. The Alpha computer was developed by Digital Equipment Corporation, which was subsequently acquired by Compaq. 3 “I prefer to work local when possible. On the IDX project there were issues of accountability and ownership. Bob Sadlemire will be seen as an extension of our staff, not some large consulting firm telling us what to do. That’s key; the people who execute a project need to feel like they own it.” Boudewyns felt Sadlemire’s previous experience on a Y2K team at an insurance company (where he worked for 16 years before joining Jennings) was impressive.Temple University MIS 535 Hospital Catches the Millennium Bug Discussion Sadlemire explained that the Y2K bug was “contagious” in that it could affect systems that linked Fletcher Allen with its suppliers and payors, and it would also affect many areas outside of IS control, such as facilities, medical devices, and departmental systems. When Sadlemire started on a full-time basis in August 1997, Boudewyns told him: “This is a complex environment, with many different platforms. The merger brought together three different cultures, three different philosophies, three different sets of values. We have not had solid tools and processes for resource allocation, system development, and project management. We’re making progress in these areas now, but I have a full plate of projects involving a wide range of applications. That’s why I need you to oversee the year 2000 effort.” Sadlemire offered to brief senior management on Y2K issues shortly after he came on board, but was unable to get a meeting on their calendars. “They were just too busy dealing with the many challenges of creating a viable new health care model via the merged organization,” he recalled. Sadlemire next attempted to compile an inventory of Fletcher Allen’s hardware, systems software, and applications software. Although a comprehensive inventory did not exist, it was not too difficult to compile an up-to-date listing of the 107 administrative and clinical applications (Exhibit 4) supported by Alan Wyman’s Information Services organization. In fall 1997, Sadlemire polled IS managers about each of 107 IS-supported applications: Impact of System Failure –What would the impact be on four critical aspects of the hospital: ? ? ? ? Patient Care: How will patients be effected, in quality or timeliness of services? Financial: How will the Year 2000 effect such functions as billing, A/P, payroll? Employee: How many effected? More people needed to perform manual functions? Legal: What’s our exposure for being sued if certain services are interrupted? Confidence of Y2K Solution – What is your confidence level that the stated Y2K solutions will be implemented before system fails? It’s well documented that most significant IS projects are late; many are never finished. Are you confident that systems deemed compliant by the vendor will work, or should they be tested? We are looking for your objective view of the stated Y2K plan! Viability of Contingency – Are viable backup procedures or contingency plans in place? Opinion on Overall PriorityTemple University MIS 535 Hospital Catches the Millennium Bug Discussion –Your opinion on the value of this system to Fletcher Allen. Sadlemire felt this exercise helped highlight key systems, but did not lead to a detailed risk assessment, because the group agreed that all 107 applications supported by the IS organization needed to be analyzed. Boudewyns told him at least as many applications were also supported by clinical and administrative departments. Getting an inventory of departmental applications proved difficult. Sadlemire wanted to meet with the 40 departmental managers and their direct reports, to brief them on Y2K issues and distribute an inventory and risk assessment questionnaire. (Exhibit 5). Since at that time no organization chart listed individuals reporting up to vice presidents or clinical directors, Sadlemire had to “do some digging” to find out who to contact. He spent much of fall 1997 meeting with these managers and instructing them on how to fill out the questionnaire. The initial product of this effort was discouraging. “As a result of not getting top-down buy-in, the response rate was not what I hoped for,” Sadlemire commented. “It has been very difficult to compile the information, because people aren’t giving this aspect the time and attention that is needed.” 4 In fall, two IS employees were assigned to work with Sadlemire. One helped to compile the inventory of departmental applications and helped users identify remediation and testing options for these applications. Another helped the Technical Support group compile an inventory of desktop hardware and software packages. To ensure broad participation, Sadlemire and Boudewyns formed a Year 2000 Task Force, which met once per month for about two hours, starting in December 1997. They agreed on four objectives: 1. 2. 3. 4. Review the status of key projects within each of eight task areas (see below). Recommend and support solutions to project issues, including making recommendations to allocate resources necessary to ensure the timely completion of key Y2K initiatives. Raise awareness throughout the organization on the importance of the Year 2000 project. Review the project status with key individuals within the organization. The Year 2000 Task Force included the following individuals: IT Organization Boudewyns: Business Systems Buermann: Desktop apps Eary: Technical Fraser: Telecommunications Harris: Applications Development Mack: Clinical Systems Sadlemire: Year 2000 Coordinator Spencer: Year 2000 team Wyman: IS Kanter: Year 2000 team Clinical/Admin. Departments Allard: Audit Carroll: Surgery Donehower: Nursing Irving: Facilities Morgan: Laboratory Parrish: Nursing Simmons: Temple University MIS 535 Hospital Catches the Millennium Bug Discussion Budget Stanislas: Medicine A Steering Committee, chaired by CIO Bill Montgomery, first met in March 1998, and Sadlemire briefed the hospital’s leadership on year 2000 risks and issues. Each of eight task areas had one or more “owners,” who were accountable to achieve compliance on all systems or devices in that domain. The tasks and “owners” were: IS supported Application Systems: Technical: hardware and software tools: Telecommunications: Independent (departmental) applications: Clinical equipment: Non-clinical equipment and facilities: Suppliers, Payors Wyman Wyman Fraser Ayres (Administrative Support Services) Hindes (Financial Services) Leible (Materials Management) Novak and Wilson (Operations) Hindes, Novak, Wilson Ayres Leible, Tolzmann (Provider Relations) The Steering Committee agreed to meet once a month. Members were to provide a written status for each major initiative at each meeting, including “changes to the actual timeline, completion of major milestones, and identification of major issues.” Minutes and a monthly status report were to be sent to senior management, and “status not reported by members will be so stated in the monthly report to management.” Sadlemire told the Steering Committee about his difficulties in compiling inventories of items that needed to be analyzed for potential year 2000 problems. By late fall he had identified 150 departmental applications, but he believed that many more had not yet been reported to them. He told the steering committee: “A lot of applications out there aren’t that meaningful in the scheme of things, so I’m not too worried. Still, there may be some small systems that are of critical importance. We have to find them, identify date-sensitive code in them, and fix them.” 5 Sadlemire met with Boudewyns once a week to apprise her of progress on the Y2K project. In one such meeting, he compared Fletcher Allen to the insurance company where he previously worked: “There’s more diverse hardware, operating systems, and programming languages here than at my old company, where 85% of applications were on a mainframe. There, … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10