Y2K causes concern for teleradiology usersQuestions arise over importance for different applicationsNew Year's Day is months away, but teleradiology vendors and end users are already suffering hangover symptoms from dealing with the year
Questions arise over importance for different applications
New Year's Day is months away, but teleradiology vendors and end users are already suffering hangover symptoms from dealing with the year 2000 (Y2K) compliance of their teleradiology systems.
End users are spending a lot of time trying to determine if their teleradiology system is Y2K-compliant and to establish what steps and how much money will be required to fix the problems. And vendors are finding their technical and marketing resources diverted from new clinical developments to solving Y2K problems. Even vendors with fully Y2K-compliant systems are spending countless hours strategizing about how they will interface to non-Y2K-compliant devices made by other companies.
Y2K problems in teleradiology systems can arise in one or several areas. Some computers, particularly those over five years old, have basic instruction operating systems (BIOS) that cannot accommodate dates beyond 1999. This problem can be resolved in PC-based teleradiology systems by getting an updated version of BIOS from the computer manufacturer or purchasing a newer PC that will not only be Y2K-compliant but will also display and process images much faster.
The computer's operating system can be another problem. Fortunately, newer operating systems like Windows 98 and Windows NT with Service Pack 4 are fully Y2K-compliant or have patches available to handle Y2K problems.
The next issue is the teleradiology software. While all teleradiology vendors offer Y2K-compliant software, there is a problem with legacy teleradiology installations in the field. Many of the older software versions were not written to handle four-digit date information, leading to Y2K errors in the date of examination (DOE) or date of birth (DOB) fields of the patient headers.
Since the release of earlier versions of software several years ago, software vendors may have changed operating systems and/or released newer teleradiology versions with additional clinical features. The older versions may no longer be supported, and as a result, users seeking Y2K compliance may have to purchase a later version of the vendor's software. That can be very expensive if each workstation has to be upgraded; generally speaking, the older the software, the more expensive the upgrade will be. Most vendors are offering these customers discounts to upgrade, however.
Other hardware and software elements of teleradiology systems can also be affected by Y2K. Many teleradiology systems employ framegrabbers to capture images from video-based host systems such as a CT or ultrasound scanner, while other systems use direct digital image capture boards. If the host units are not Y2K-compliant, the date recorded on the image could be incorrect, creating confusion about the information entered in the teleradiology patient header. To solve this problem, either the scanner must be replaced or its manufacturer must provide a Y2K- compliant software update.
Teleradiology users do not have many sources of advice on how to gauge the impact of Y2K. The American College of Radiology does not plan to update its teleradiology standards to include Y2K issues, according to Dr. Charles Kelsey, a member of the ad hoc committee on teleradiology for the Reston, VA-based society. The ACR has, however, cautioned its members to be aware of Y2K issues and to take appropriate action if required, since physicians are ultimately responsible for providing safe and efficacious patient care.
To determine how teleradiology customers are preparing for Y2K, the Howell Group of Gilroy, CA, is conducting a survey of users. Findings from an initial survey of 20 sites revealed a wide variation in how end users view the necessity of Y2K compliance in teleradiology. About half of the surveyed sites use teleradiology for on-call applications, while the other half employ the technology in a centralized reading environment. In addition, two have teleradiology systems interfaced with a PACS network.
A moot point
Overall, the majority of respondents said that as long as the teleradiology system continues to operate, a superficially confusing DOB or DOE is not likely to be a critical issue. Many teleradiology users are confident that their current procedures and some common sense will make the impact of an incorrect DOB or DOE a moot point.
"If I can't tell the difference between a six-month-old baby and a 100-year-old man, I've got bigger problems than Y2K," one radiologist said.
The survey results did show some interesting levels of concern among the teleradiology segments, however. Of the on-call teleradiology users, fewer than half knew if their teleradiology systems are Y2K-compliant. Users who did realize that their equipment is noncompliant were evaluating what path they would take to obtain Y2K-compliant software. Interestingly, a significant number indicated they would stay with their existing non-Y2K-compliant software if costs to upgrade proved excessive.
Nearly all respondents from both the on-call and centralized reading groups said they were unsure of the Y2K-compliant status of the modality scanners interfaced with the teleradiology systems. They also indicated that, given the prohibitive cost of upgrading or replacing these host systems, protocols would have to be developed to double-check DOB/DOE information.
Not surprisingly, a high percentage of end users employing teleradiology for centralized reading indicated that their teleradiology system is Y2K-compliant. With cases being transmitted from a remote site to a centralized site for primary interpretation, having the correct DOB/DOE data is more important to these teleradiology users.
In general, noncompliant users reading a higher volume of cases appear more likely to plan upgrades to Y2K-compliant teleradiology software. The smaller volume practices, however, will be less likely to upgrade if it involves significant cost. They seem more likely to develop protocols to ensure that the correct DOB/DOE is provided to the interpreting radiologist.
While stand-alone teleradiology users held mixed opinions concerning the importance of Y2K compliance for DOB/DOE information, respondents with integrated teleradiology and PACS networks reported a strong need for full compliance. Their major concern is that inaccurate dates could be imported from the teleradiology system to the PACS and contaminate the patient records.
--By Richard Howell, principal of the Howell Group (firstname.lastname@example.org)