This year, most of the world is preparing to celebrate the year 2000 and the coming of a new millennium. However, many businesses, manufacturers, banks and hospitals are quietly hoping for an uneventful new years transition. At midnight on December 31, many businesses will be anticipating what effects the millennium rollover will have on computer software and other equipment that contain a time sensitive chip called an embedded chip. Early computer programmers, in an effort to conserve limited memory space, programmed computers to read the year in only two digits. So computers read 15 as 1915, and 02 as 1902, and so on. Thus, when the year 2000 arrives, many computer programs might go from December 31, 1999 to January 1, 1900.

Some computers will cease to function, or crash. Needless to say, if these programs control functions such as electricity, airline travel, or communications, the results could be disastrous. Many companies and governments have spent countless hours and untold dollars making software Y 2 K (year 2 thousand) compatible. The consequences of not preparing for the Y 2 K problem could spell disaster for the company involved.

For example, a small Midwestern manufacturer encountered a similar date-related problem in 1996 (a leap year) when the company did not realize that their entire computer network would be affected by the extra day in the year. When the year 1997 turned over, all systems shut down. This malfunction caused the liquid solutions 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 caused massive delivery delays to their customers, and the company believes numerous customer accounts were lost as a result. This is just a small example of what could happen when computer software and related equipment is not tested for Y 2 K compatibility.

Now, imagine the confusion and disaster that could result from a similar incident occurring in a hospital-where lives, not inventory, are at stake. Code Blue 2000 is the term used to describe the possible breakdown of the worlds hospital software and related medical devices. Most hospital organizations have prepared themselves for any problems that might occur with their software and medical equipment. It is the organizations that ignore the potential problem that will most likely loose valuable patient information, and in extreme cases, have their ability to furnish adequate health care reduced.

Major Hospital in Shelbyville, Indiana, has a team of computer scientists currently testing the hospitals computer systems software for Y 2 K compatibility. First, mock systems are tested to determine what will actually happen when the year changes. Then, obsolete software and equipment is replaced with Y 2 K compliant equipment. Major Hospital has spent over a half-million dollars on research of the Y 2 K problem. This research is extremely costly to an organization, but the alternative-ignoring the problem-could be catastrophic. This report will cover the numerous ways the Y 2 K problem could affect hospitals.

The first and most important area that will be reviewed is the manner in which the Y 2 K problem could affect patients. The Y 2 K problem could adversely affect the biomedical devices some patients rely on for life-sustaining purposes. Then, the potential problems on the clerical side of hospital administration will be explored; focusing on patients medical records and accounts. Finally, the possible adverse effects on utilities such as electricity, gas, and water will be discussed. A hospital is a place that a person should feel safe and secure. This report will describe the steps being taken by hospitals to ensure that their patients peace of mind and sense of security is unaltered.

The Y 2 K problem is a concern for hospitals worldwide for a variety of reasons. Perhaps the most pressing concern are the biomedical devices, which contain computer software, that many patients rely on. Some critical biomedical devices are pacemakers, fetal monitors, Magnetic Resonance Imaging machines (MRIs), and heart defibrillators. One of the most important biomedical devices that could be affected by the Y 2 K problem is the pacemaker.

A pacemaker is a biomedical, electronic device implanted in the 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 the time an electric shock was administered; this information can then be downloaded to a computer system and analyzed by medical personnel. Cardiologists use this information to detect patterns and irregularities in the patients heart rhythms. If the software were to record faulty times for the shock deliveries, the cardiologist could misinterpret the results and administer improper medical care. The results could be deadly for some patients. The Veterans Administration interviewed the top five pacemaker manufacturers to gauge their awareness of the potentially hazardous Y 2 K problem.

One company said the problem would be corrected by mid-year; two companies stated the problem was already under 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 may contain faulty software. One such type of device is an anesthesia monitor. An anesthesia monitor regulates the anesthesia effect on the patient during surgery.

Another critical biomedical device is a fetal monitor. A fetal monitor helps examine the condition of the baby while it is still being carried by the mother. Incubators, critical to a newborn babys survival, could also be adversely affected by the Y 2 K problem. Other biomedical devices (and their functions) include MRIs (produce computer-generated views of arteries, nerves, tendons, and tumors), infusion pumps (used in intravenous drips), and heart defibrillators (emergency method of establishing a heartbeat). All of the aforementioned devices contain embedded microchips critical to their functions.

There are also intensive care monitors that may not be Y 2 K compliant; these include heart monitors, blood pressure monitors, and machines that provide additional oxygen and physical support. Finally, dialysis machines (help remove waste from a patients blood) and radiation equipment (x-rays, chemotherapy, etc... ) are other critical pieces of medical equipment that could fail if the software controlling their functions is not Y 2 K compliant. Major Hospital is currently working with all of their medical equipment vendors to ensure that all biomedical devices are Y 2 K compliant. We are confident that outstanding patient care will not be interrupted, says Carol Huss man, information systems manager at Major 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 Y 2 K problem would not be of concern to even the average computer user with a fairly new system; much less a vital institution such as a hospital where thousands of our loved ones lives hang in the balance.

However, this is not the case. There are still hospitals in the United States that are not equipped to deal with the Y 2 K problem. Moreover, the U. S. is not the only place where the Y 2 K problem is causing difficulties. In fact, almost a third of computer-related equipment in Australian hospitals, including cardiac 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 the patients. In a crisis situation, patients might panic; hospital staffs will have to be aware of this potential crisis. Major Hospital personnel are aware of this aspect of the Y 2 K problem and are focused on preventing any software problems that may lead to patient confusion or panic. However, there are no specific strategies in place to handle possible patient disorder, other than by answering patient questions on an individual basis.

The Y 2 K problem is not limited to biomedical devices, however. This dilemma effects non-medical devices such as the personal computers used in record-keeping and accounting. 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 patient information, such as test results, medical histories, registration, and insurance information are kept in computer databases.

These databases, if left unchecked for the Y 2 K problem, could malfunction. Patient information is important to physicians and other hospital personnel using the databases. It is readily available to them at the touch of a keypad. If patient information is inaccurate, it could result in detrimental care or incorrect medication being administered to patients. This dilemma could be solved in one of two ways. One option hospitals have is to put all information on paper, which would be very time consuming and prone to cause errors, or the database systems can be programmed to be Y 2 K compatible.

In order to address the Y 2 K problem, President Bill Clinton signed into law the Year 2000 Information and Readiness Disclosure Act. In a statement by the president released by the Office of the Press Secretary of the White House, this law requires the shared necessary information tools needed to overcome the Y 2 K problem. This will help hospital information systems departments acquire the knowledge necessary to reprogram noncompliant 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 software is not brought into Y 2 K compliance. In addition to President Clinton signing into law requirements that hospitals and other businesses share information to help solve the Y 2 K problem, The Washington State Health Association (WSHA) also recommends steps for compatibility for insurance billing. According to Tom Byron, chief information officer of the WSHA, The Washington State Uniform Billing Committee (WSUBC) has adopted multiple resolutions concerning electronic submission of Uniform Billing (UB-92) claims such as, (1) use of the Medical Flat File, Version 5. 0, (2) all plans should be ready to accept the recommended format by October 1, 1998, (3) providers should submit claims in the recommended format by January 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 current format, and (5) electronic formats not Y 2 K compliant should cease beginning April 1, 1999. If the laws enacted by the U. S.

Congress and the president, and the recommendations made by the WSUBC are followed, the Y 2 K problem will likely have little or no affect on the clerical areas of hospitals. In addition to the patient care and clerical concerns facing hospitals with respect to the Y 2 K problem, there is one other pressing concern for hospitals. Utilities are essential to 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 back on. However, losing utility service in a hospital could be much more than an inconvenience. Imagine having to go to the hospital on December 31, 1999.

It could be more of a problem than you think. All hospitals rely on electricity, gas, and water for their everyday operations. A spokesperson for Major Hospital states that all methods have been exhausted to comply with state and federal guidelines and suggestions regarding the Y 2 K problem. The suggestions include, but are not limited to, obtaining a copy of the Approach to the Y 2 K Problem, distributed by the federal government.

This approach suggests a plan of attack and an inventory of all systems that might be affected. A team should be formed with a leader to assess the problems. This team should assess and prioritize possible problems. At that point, the team must prepare a list of all assessments made.

This leads the team to the testing phase of the operation. After testing, corrections should be made, and a reassessment needs to be done. Utilities are just a small portion of the testing that will be done. Utility companies are spending more than $2 billion to test and prepare their computers and replace software in order to successfully meet the Y 2 K challenge. At this time, there is no evidence that the Y 2 K problem will create power failures within the nationwide electrical power-service grid.

Electric companies plan to have a dress rehearsal in September, 1999, to gauge how utilities will react to a simulation of the Y 2 K scenario. The inability of some equipment and computers with date-sensitive components to distinguish the correct year after the year 2000 has now become a widely recognized and accepted problem. The utility company Cinergy began an active response to this dilemma in 1996 with a review of several million lines of computer software application code in a campaign to locate and correct date-sensitive fields. Most of that code has since been examined, corrected, tested, and returned to operation.

All such remaining systems are on schedule for completion by March, 1999. Cinergy, like most owners of information systems, will be required to modify significant portions of its systems to accommodate new local, state, and federal requirements brought about by the Y 2 K problem. During 1997, Cinergy incurred costs of approximately $8 million. Maintenance or modification costs will be absorbed as they occur, while the costs of new software will be capitalized and amortized over the softwares useful life. For example, at Hawaiian Electric Company (HECo), the Y 2 K project team identified 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 to remotely control transmission system breakers, coordinate power generation schedules, compensate for large transmission line breaks, and provide protection against voltage, and current and frequency transients. HECo and their EMS system vendor determined that EMS would crash on the rollover to January 1, 2000. This would have, in turn, resulted in Heco transmission network crashing, and by default, a major power outage and loss of all generating capacity. Besides medical devices, embedded chips are hard wired into other pieces of equipment that may be critical to patient services or hospital operations.

This equipment is often the responsibility of the vendor, not the hospital. These systems include 1) fire alarm systems, including detection, sending/ receiving, and suppression units, 2) security systems, including sending / receiving units, video and surveillance systems, and badge readers, 3) telecommunications equipment, including telephone switching equipment, emergency call management systems, pagers, and cellular phones, 4) building infrastructure, including HVAC, energy management and lighting controls, emergency generators and lighting, uninterruptible power supplies, and elevators. Major Hospital is among a number of the worlds health care providers that will participate in every effort to minimize any and all malfunctions related to the Y 2 K problem. Gas companies are contacting their suppliers and service providers to determine the status of their year 2000 compliance projects and will be developing contingency plans if their efforts do not meet certain goals. An inventory of computer systems, embedded systems, and resources has been developed and prioritized according to the importance to the continuing operation of the companies.

It is anticipated by gas companies that this testing, and any required modifications to systems, will be completed by July, 1999. Major Hospital uses gas for heating and lab equipment. However, Major Hospital is unlikely to be affected by a gas outage because gasoline-powered electric generators will take over in the event of an outage and run most systems. Wastewater and sewage treatment facilities are highly automated and contain year 2000-vulnerable embedded chips. Also, emissions monitoring and control systems depend on year 2000-vulnerable embedded controls. Malfunctions due to Y 2 K problems could lead to accidental pollutant-filled releases and emissions that could endanger local residents.

In August, 1998, a malfunctioning computer in Boulder, Colorado was blamed for 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 gave inaccurate readings, prompting a city worker to open the mains. Some residents and businesses were left without water for over a week. Major Hospital staff have prepared for a water shortage.

They have stocked up on bottled water, just as every other hospital has done. However, bottled water will only last so long. In the event of a prolonged water shortage, such as the one in Boulder, Major Hospital personnel will be faced with personal hygiene and medicine issues. Patients must be bathed on a daily basis and washed off completely. It is difficult to comprehend a hospital as an unsanitary environment; where doctors must scrub repeatedly to reduce the risk of infection and patients must be kept free of germs.

Medicines are sometimes mixed with water to form their completed structure. This crux could alarm the many patients who depend on these medicines. The sewage treatment plant in Shelbyville, Indiana that services Major Hospital states that the plant is already Y 2 K compliant. The faculty and staff at Major Hospital is extremely confident that when the new millennium arrives, it will not be accompanied by any significant problems or catastrophes with regard to malfunctioning utilities. If any problems do surface, Major Hospital has assured its community and its patients that the problems will be minor in scope and will be quickly and efficiently dealt with.

As has been discussed in this report, the Y 2 K problem is a vast and complex issue that must be dealt with by hospitals. Virtually every facet of hospital care is affected by the Y 2 K problem. Patient care, clerical software, and utilities are three major aspects of the hospital organization that, if left unchecked for Y 2 K compliance, could cause confusion, sickness, and even death among hospital patients. Worst case scenarios involve malfunctioning pacemakers, improper medication being dispensed, and unusable defibrillators in emergency situations. The Major Hospital staff, like most other hospital staffs, continues to work diligently to ensure that whatever malfunctions occur are minor. It is difficult to predict the scope of the Y 2 K problem and the possible severity of related malfunctions when the most knowledgeable computer experts disagree on the severity of the problem.

According to Alastair Stewart, a senior Year 2000 advisor with information technologies market watcher Giga Information Group, the Y 2 K computer date bug will not cause an embedded systems Armageddon as some have feared. It may rain, but the sky wont fall. Giga recently called for a common-sense approach to the Y 2 K threat. Some projected scenarios have Y 2 K failures toppling civilization. For example, in one sequence of falling dominoes, embedded track switching controls will cause railroads to fail to deliver coal to power generation plants. As a result, electric utilities-which have Y 2 K problems of their own-will shut down.

As the power grid goes dead, telephones will stop working. Without communications the interlinked banks and international finance structures begin to fall and, ultimately, so does civilization. Can you hear the four horsemen galloping off in the distance remarked Stewart. Its 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 Y 2 K problems, others offer substantial evidence that the Y 2 K problem is for real. Mike Wetland, a noted software expert and author of numerous computer software guides, produces the following examples for consideration: U. S.

Social Security computer programmers have identified 30 million lines of code that need to be changed to reflect the correct date after the year 2000. Some 400 programmers have been working on this problem since 1991. As of June, 1997 they had corrected only 5 million lines. The Internal Revenue Service has identified 100 million lines of code that need to be changed in their computers to fix Y 2 K problems.

They have only found about 300 programmers and they are just now getting started. An estimated 65 percent of the businesses in the U. S that need to correct the problem have done nothing so far. Regardless of whether the Y 2 K problem is all hype or a catastrophe waiting to happen, 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 be aggressively cautious. It appears that most U. S. hospitals have a firm understanding of the consequences of not being Y 2 K compliant, and are dealing with the issue accordingly.