At this point, the world seems to be divided into two camps: those who believe that 1,999 years are enough for two millennia and those who believe that we're not quite finished with the second millennium yet. If, like me, you find yourself in the second camp, there's good news: You still have almost a whole year to prepare your practice for the 21st century. That's particularly good news because you have a busy year ahead. I've taken the liberty of making a small to-do list for you. (Think nothing of it. It's the least I can do.)

A short task list

Here's how to start getting your practice ready for the 21st century:

1. Identify, finance and install an electronic medical records system.

2. Build a comprehensive patient registry capable of tracking all patients with chronic diseases and all patients in need of preventive care.

3. Identify evidence-based clinical guidelines covering all major areas of clinical concern; set up systems to ensure that all care is delivered in accord with the guidelines or diverges from them only with good reason.

4. Gather enough information on your practice to know exactly how good the care you deliver is.

5. Collect comprehensive financial information about your practice — enough to tell you whether you're losing money on each service you provide and each contract you sign.

6. Incorporate rapid-cycle clinical quality improvement into all aspects of your practice.

7. Open access to the point where any patient who wishes to can get an appointment on the same day he or she calls — and see you on time.

8. Open multiple channels for communicating with your patients and consultants; learn to use telephone, fax and e-mail as effectively as possible.

9. Identify and take advantage of sources of “full-contact” interactive CME that requires your active participation and builds on the best insights of adult learning theory.

Maybe we should stop there. There's more, but that's probably enough for a year.

How ready are you?

It's not a long list. How good do you think the chances are that you'll get through it this year?

That bad, huh? Don't despair. At least you have lots of company. But if the idea of getting through the list in a year is ridiculous, don't let that make the list itself seem ridiculous. The tasks on this list are very likely to constitute the cost of admission to the 21st century for medical groups. You'll be able to make it some distance past 2000 without paying the cost of admission; after all, many family physicians are practicing today in what are essentially 1980s practices. But continued existence and success are not synonymous.

Tackle the list — or your own version of it. Start now. Take it one step at a time. Every step will take you in the direction of better care for your patients and a better life for you and your staff.