Y2kThis year, most of the world is preparing to celebrate the year 2000 and the coming of anew millennium.
However, many businesses, manufacturers, banks and hospitals arequietly hoping for an uneventful new year’s transition. At midnight on December 31,many businesses will be anticipating what effects the millennium rollover will have oncomputer software and other equipment that contain a time sensitive chip called anembedded chip. Early computer programmers, in an effort to conserve limited memoryspace, programmed computers to read the year in only two digits. So computers read 15as 1915, and 02 as 1902, and so on. Thus, when the year 2000 arrives, many computerprograms might go from December 31, 1999 to January 1, 1900.
Some computers willcease to function, or ?crash?. Needless to say, if these programs control functions such aselectricity, airline travel, or communications, the results could be disastrous. Manycompanies and governments have spent countless hours and untold dollars makingsoftware Y2K (year 2 thousand) compatible. The consequences of not preparing for the Y2K problem could spell disaster forthe company involved. For example, a small Midwestern manufacturer encountered asimilar date-related problem in 1996 (a leap year) when the company did not realize thattheir entire computer network would be affected by the extra day in the year. When theyear 1997 turned over, all systems shut down.
This malfunction caused the liquidsolutions being produced to freeze, causing them to destroy the pipelines they ran through. This disaster cost the company over $1 million in new equipment. The catastrophe causedmassive delivery delays to their customers, and the company believes numerous customeraccounts were lost as a result. This is just a small example of what could happen whencomputer software and related equipment is not tested for Y2K compatibility. Now,imagine the confusion and disaster that could result from a similar incident occurring in ahospital–where lives, not inventory, are at stake.
?Code Blue 2000? is the term used to describe the possible breakdown of theworld’s hospital software and related medical devices. Most hospital organizations haveprepared themselves for any problems that might occur with their software and medicalequipment. It is the organizations that ignore the potential problem that will most likelyloose valuable patient information, and in extreme cases, have their ability to furnishadequate health care reduced. Major Hospital in Shelbyville, Indiana, has a team of computer scientists currentlytesting the hospital’s computer system’s software for Y2K compatibility. First, mocksystems are tested to determine what will actually happen when the year changes. Then,obsolete software and equipment is replaced with Y2K compliant equipment.
MajorHospital has spent over a half-million dollars on research of the Y2K problem. Thisresearch is extremely costly to an organization, but the alternative–ignoring theproblem–could be catastrophic. This report will cover the numerous ways the Y2K problem could affect hospitals. The first and most important area that will be reviewed is the manner in which the Y2Kproblem could affect patients. The Y2K problem could adversely affect the biomedicaldevices some patients rely on for life-sustaining purposes. Then, the potential problemson the clerical side of hospital administration will be explored; focusing on patients’medical records and accounts.
Finally, the possible adverse effects on utilities such aselectricity, gas, and water will be discussed. A hospital is a place that a person should feelsafe and secure. This report will describe the steps being taken by hospitals to ensure thattheir patients’ peace of mind and sense of security is unaltered. The Y2K problem is a concern for hospitals worldwide for a variety of reasons.
Perhaps the most pressing concern are the biomedical devices, which contain computersoftware, that many patients rely on. Some critical biomedical devices are pacemakers,fetal monitors, Magnetic Resonance Imaging machines (MRI’s), and heart defibrillators. One of the most important biomedical devices that could be affected by the Y2K problem is the pacemaker. A pacemaker is a biomedical, electronic device implanted inthe wall of the heart designed to detect irregular heartbeats and provide regular, mild,electric shocks that restore normalcy to the heartbeat. The pacemaker then records thetime an electric shock was administered; this information can then be downloaded to acomputer system and analyzed by medical personnel. Cardiologists use this information todetect patterns and irregularities in the patient’s heart rhythms.
If the software were torecord faulty times for the shock deliveries, the cardiologist could misinterpret the resultsand administer improper medical care. The results could be deadly for some patients. The Veteran’s Administration interviewed the top five pacemaker manufacturers togauge their awareness of the potentially hazardous Y2K problem. One company said theproblem would be corrected by mid-year; two companies stated the problem was alreadyunder control; and the final two companies were behind schedule in eradicate the problem. In addition to the pacemaker, there are several other biomedical devices that maycontain faulty software.
One such type of device is an anesthesia monitor. An anesthesiamonitor regulates the anesthesia’s effect on the patient during surgery. Another criticalbiomedical device is a fetal monitor. A fetal monitor helps examine the condition of thebaby while it is still being carried by the mother. Incubators, critical to a newborn baby’ssurvival, could also be adversely affected by the Y2K problem.
Other biomedical devices(and their functions) include MRI’s (produce computer-generated views of arteries,nerves, tendons, and tumors), infusion pumps (used in intravenous drips), and heartdefibrillators (emergency method of establishing a heartbeat). All of the aforementioneddevices contain embedded microchips critical to their functions. There are also intensivecare monitors that may not be Y2K compliant; these include heart monitors, bloodpressure monitors, and machines that provide additional oxygen and physical support. Finally, dialysis machines (help remove waste from a patient’s blood) and radiationequipment (x-rays, chemotherapy, etc. . ) are other critical pieces of medical equipment thatcould fail if the software controlling their functions is not Y2K compliant.
Major Hospital is currently working with all of their medical equipment vendors toensure that all biomedical devices are Y2K compliant. ?We are confident that outstandingpatient care will not be interrupted,? says Carol Hussman, information systems manager atMajor Hospital, ?and we are about 95 percent finished with all testing. ?One may think that in this day and age, with all of our technological advancements,that the Y2K problem would not be of concern to even the average computer user with afairly new system; much less a vital institution such as a hospital where thousands of ourloved ones lives hang in the balance. However, this is not the case.
There are stillhospitals in the United States that are not equipped to deal with the Y2K problem. Moreover, the U. S. is not the only place where the Y2K problem is causing difficulties. Infact, almost a third of computer-related equipment in Australian hospitals, includingcardiac monitors and drug distribution systems, have failed the millennium test.
The final aspect of patient care that may be affected is the mental health of thepatients. In a crisis situation, patients might panic; hospital staffs will have to be aware ofthis potential crisis. Major Hospital personnel are aware of this aspect of the Y2Kproblem and are focused on preventing any software problems that may lead to patientconfusion or panic. However, there are no specific strategies in place to handle possiblepatient disorder, other than by answering patient questions on an individual basis. The Y2K problem is not limited to biomedical devices, however.
This dilemmaeffects non-medical devices such as the personal computers used in record-keeping andaccounting. If the programs that are used are not corrected, many problems could arise. Even though some patient records are kept in paper form as a backup, most patientinformation, such as test results, medical histories, registration, and insurance informationare kept in computer databases. These databases, if left unchecked for the Y2K problem,could malfunction. Patient information is important to physicians and other hospitalpersonnel using the databases. It is readily available to them at the touch of a keypad.
Ifpatient information is inaccurate, it could result in detrimental care or incorrect medicationbeing administered to patients. This dilemma could be solved in one of two ways. One option hospitals have is toput all information on paper, which would be very time consuming and prone to causeerrors, or the database systems can be programmed to be Y2K compatible. In order toaddress the Y2K problem, President Bill Clinton signed into law the ?Year 2000Information and Readiness Disclosure Act. ? In a statement by the president released bythe Office of the Press Secretary of the White House, this law requires the shared?necessary information tools needed to overcome the Y2K problem.
? This will helphospital information systems departments acquire the knowledge necessary to reprogramnoncompliant systems. The personal computer problem not only affects the hospital records department,but also the purchasing, billing, and payroll aspects of the accounting department. The purchase of essential medical equipment and supplies could be delayed if clerical softwareis not brought into Y2K compliance. In addition to President Clinton signing into law requirements that hospitals andother businesses share information to help solve the Y2K problem, The Washington StateHealth Association (WSHA) also recommends steps for compatibility for insurance billing. According to Tom Byron, chief information officer of the WSHA, ?The Washington StateUniform Billing Committee (WSUBC) has adopted multiple resolutions concerningelectronic submission of Uniform Billing (UB-92) claims such as, (1) use of the MedicalFlat File, Version 5. 0, (2) all plans should be ready to accept the recommended format byOctober 1, 1998, (3) providers should submit claims in the recommended format byJanuary 1, 1999, (4) all plans should allow for a period of October 1, 1998 to March 31,1999 for providers to submit claims in either the recommended format or the currentformat, and (5) electronic formats not Y2K compliant should cease beginning April 1,1999.
If the laws enacted by the U. S. Congress and the president , and therecommendations made by the WSUBC are followed, the Y2K problem will likely havelittle or no affect on the clerical areas of hospitals. In addition to the patient care and clerical concerns facing hospitals with respect tothe Y2K problem, there is one other pressing concern for hospitals. Utilities are essentialto the everyday life most people are accustomed to. If the electricity goes out at home,most people just burn candles and wait, without much worry, for the lights to come backon.
However, losing utility service in a hospital could be much more than aninconvenience. Imagine having to go to the hospital on December 31, 1999. It could be more of aproblem than you think. All hospitals rely on electricity, gas, and water for their everydayoperations. A spokesperson for Major Hospital states that all methods have beenexhausted to comply with state and federal guidelines and suggestions regarding the Y2Kproblem.
The suggestions include, but are not limited to, obtaining a copy of the?Approach to the Y2K Problem?, distributed by the federal government. This approachsuggests a plan of attack and an inventory of all systems that might be affected. A teamshould be formed with a leader to assess the problems. This team should assess andprioritize possible problems. At that point, the team must prepare a list of all assessmentsmade. This leads the team to the testing phase of the operation.
After testing, correctionsshould be made, and a reassessment needs to be done. Utilities are just a small portion ofthe testing that will be done. Utility companies are spending more than $2 billion to test and prepare theircomputers and replace software in order to successfully meet the Y2K challenge. At thistime, there is no evidence that the Y2K problem will create power failures within thenationwide electrical power-service grid. Electric companies plan to have a dressrehearsal in September, 1999, to gauge how utilities will react to a simulation of the Y2Kscenario. The inability of some equipment and computers with date-sensitive components todistinguish the correct year after the year 2000 has now become a widely recognized andaccepted problem.
The utility company Cinergy began an active response to this dilemmain 1996 with a review of several million lines of computer software application code in acampaign to locate and correct date-sensitive fields. Most of that code has since beenexamined, corrected, tested, and returned to operation. All such remaining systems are onschedule for completion by March, 1999. Cinergy, like most owners of information systems, will be required to modifysignificant portions of its systems to accommodate new local, state, and federalrequirements brought about by the Y2K problem.
During 1997, Cinergy incurred costs ofapproximately $8 million. Maintenance or modification costs will be absorbed as theyoccur, while the costs of new software will be capitalized and amortized over thesoftware’s useful life. For example, at Hawaiian Electric Company (HECo), the Y2K project teamidentified significant problems with its energy management system (EMS). EMS is the?brain? of the power distribution system at all electric companies. This system is used toremotely control transmission system breakers, coordinate power generation schedules,compensate for large transmission line breaks, and provide protection against voltage, andcurrent and frequency transients. HECo and their EMS system vendor determined thatEMS would crash on the rollover to January 1, 2000.
This would have, in turn, resultedin HECo’s transmission network crashing, and by default, a major power outage and lossof all generating capacity. Besides medical devices, embedded chips are ?hard wired? into other pieces ofequipment that may be critical to patient services or hospital operations. This equipmentis often the responsibility of the vendor, not the hospital. These systems include 1) firealarm systems, including detection, sending/ receiving, and suppression units, 2) securitysystems, including sending/receiving units, video and surveillance systems, and badgereaders, 3) telecommunications equipment, including telephone switching equipment,emergency call management systems, pagers, and cellular phones, 4) buildinginfrastructure, including HVAC, energy management and lighting controls, emergencygenerators and lighting, uninterruptible power supplies, and elevators. Major Hospital isamong a number of the world’s health care providers that will participate in every effort tominimize any and all malfunctions related to the Y2K problem.
Gas companies are contacting their suppliers and service providers to determinethe status of their year 2000 compliance projects and will be developing contingency plansif their efforts do not meet certain goals. An inventory of computer systems, embeddedsystems, and resources has been developed and prioritized according to the importance tothe continuing operation of the companies. It is anticipated by gas companies that thistesting, and any required modifications to systems, will be completed by July, 1999. Major Hospital uses gas for heating and lab equipment. However, Major Hospital isunlikely to be affected by a gas outage because gasoline-powered electric generators willtake over in the event of an outage and run most systems.
Wastewater and sewage treatment facilities are highly automated and contain year2000-vulnerable embedded chips. Also, emissions monitoring and control systems dependon year 2000-vulnerable embedded controls. Malfunctions due to Y2K problems couldlead to accidental pollutant-filled releases and emissions that could endanger localresidents. In August, 1998, a malfunctioning computer in Boulder, Colorado was blamedfor water main breaks that cut service to over 40 homes, flooded basements and garages,and turned city streets into raging rivers. A computer controlling water pressure gaveinaccurate readings, prompting a city worker to open the mains.
Some residents andbusinesses were left without water for over a week. Major Hospital staff have preparedfor a water shortage. They have stocked up on bottled water, just as every other hospitalhas done. However, bottled water will only last so long.
In the event of a prolongedwater shortage, such as the one in Boulder, Major Hospital personnel will be faced withpersonal hygiene and medicine issues. Patients must be bathed on a daily basis andwashed off completely. It is difficult to comprehend a hospital as an unsanitaryenvironment; where doctors must ?scrub? repeatedly to reduce the risk of infection andpatients must be kept free of germs. Medicines are sometimes mixed with water to formtheir completed structure. This crux could alarm the many patients who depend on thesemedicines.
The sewage treatment plant in Shelbyille, Indiana that services Major Hospitalstates that the plant is already Y2K compliant. The faculty and staff at Major Hospital is extremely confident that when the newmillennium arrives, it will not be accompanied by any significant problems or catastropheswith regard to malfunctioning utilities. If any problems do surface, Major Hospital hasassured its community and its patients that the problems will be minor in scope and will bequickly and efficiently dealt with. As has been discussed in this report, the Y2K problem is a vast and complex issuethat must be dealt with by hospitals.
Virtually every facet of hospital care is affected bythe Y2K problem. Patient care, clerical software, and utilities are three major aspects ofthe hospital organization that, if left unchecked for Y2K compliance, could causeconfusion, sickness, and even death among hospital patients. Worst case scenarios involvemalfunctioning pacemakers, improper medication being dispensed, and unusabledefibrillators in emergency situations. The Major Hospital staff, like most other hospitalstaffs, continues to work diligently to ensure that whatever malfunctions occur are minor. It is difficult to predict the scope of the Y2K problem and the possible severity ofrelated malfunctions when the most knowledgeable computer experts disagree on theseverity of the problem.
According to Alastair Stewart, a senior Year 2000 advisor withinformation technologies market watcher Giga Information Group, the Y2K computerdate bug will not cause an ?embedded systems Armageddon? as some have feared. ?Itmay rain, but the sky won’t fall. ? Giga recently called for a ?common-sense approach? tothe Y2K threat. Some projected scenarios have Y2K failures toppling civilization. Forexample, in one sequence of falling dominoes, embedded track switching controls willcause railroads to fail to deliver coal to power generation plants. As a result, electricutilities–which have Y2K problems of their own–will shut down.
As the power grid goesdead, telephones will stop working. Without communications the interlinked banks andinternational finance structures begin to fall and, ultimately, so does civilization. ?Can you hear the four horsemen galloping off in the distance?? remarked Stewart. ?It’s easy to scare people with talk about The Great God Teowawki. ? ?Teowawki?stands for ?the end of the world as we know it,? Stewart explained.
Just as some downplay potential Y2K problems, others offer substantial evidencethat the Y2K problem is for real. Mike Wedland, a noted software expert and author ofnumerous computer software guides, produces the following examples for consideration:U. S. Social Security computer programmers have identified 30 million lines of codethat need to be changed to reflect the correct date after the year 2000. Some 400programmers have been working on this problem since 1991. As of June, 1997 theyhad corrected only 5 million lines.
The Internal Revenue Service has identified 100 million lines of code that need to bechanged in their computers to fix Y2K problems. They have only found about 300programmers and they are just now getting started. An estimated 65 percent of the businesses in the U. S that need to correct the problemhave done nothing so far. Regardless of whether the Y2K problem is all hype or a catastrophe waiting tohappen, hospitals must prepare for the worst. While businesses deal in profits and stocks,hospitals deal in human beings.
When peoples’ health and lives are at stake it is best to beaggressively cautious. It appears that most U. S. hospitals have a firm understanding of theconsequences of not being Y2K compliant, and are dealing with the issue accordingly.Technology Essays