Year 2000 problems pose a threat to your most vital medical devices
Year 2000 problems pose a threat to your most vital medical devices
Preparation is critical to keeping your equipment running
At the stroke of midnight when 1999 trips over into the year 2000, everyone is hoping that the biggest crash will be the Big Apple descending in Times Square in New York City. But a growing number of experts are concerned there will be other less noisy but more dangerous crashes - such as your ventilators, infusion pumps, and telemetry equipment.
Technology experts around the world are literally racing the clock to quantify the problems and devise solutions to what some predict could be a disastrous bite from the millennium bug in the year 2000. Simply stated: Some of the sophisticated equipment in your ICUs may not work.
Until relatively recently, most of the attention has been directed at the massive mainframe computers that store hospitals' patient, billing, and administrative information.
But now there is increasing concern about the medical devices that ICUs rely on for patient care, says Joel Ackerman, executive director of Rx2000 Solutions Institute in Minneapolis. The nonprofit institute was formed to help the health care profession deal with this situation.
Previously, the most serious problem was thought to be larger computer systems that contain codes specifying the date, which typically have a MM/DD/YY format for month/day/year. Thus, devices driven by microchips would read Dec. 31, 1999 as 12/31/99. However, many computers, especially older ones, aren't equipped to recognize that a YY reading of 00 stands for the year 2000. Instead, they may read it as 1900. The result, experts say, could be that the computers could produce inaccurate information or just totally shut down.
Solutions are costly and time-consuming
The solution for correcting the larger computers is expensive and time-consuming; however, it is feasible, if you can hire enough computer programmers to go over the millions of lines of code in large systems and make the needed corrections.
But the medical devices that you and your patients depend on may present an even more daunting task, says Ackerman. With larger computer systems, programmers can actually see the codes; with medical devices, they can't.
"The focus has been on administrative, and to some extent, clinical information systems, but medical devices were virtually ignored until about nine months ago," says Ackerman. "There wasn't an understanding that the chips - and the processes they control - would be a problem. That whole area is emerging quickly, and information is coming out on a daily basis. Now it's starting to look like anything that has a chip, even if it doesn't do date processing, can be a problem."
One rule of thumb: be suspicious of everything that is digital, says Marion Powell, RN, year 2000 compliance coordinator with Egleston Children's Health System in Atlanta. "Anything that's digital has a chip, and the chip can have date-related functions. With some it's apparent, such as devices where you can set a date and a date is needed. But others don't show a date, and even with them, you could have a problem."
How extensive the problem could be is largely guesswork. A British panel has estimated that up to 1,500 hospital patients in Great Britain could die there as a result of the year 2000 (Y2K) problem. A U.S. poll on that issue conducted by the Rx Solutions Institute found that more than 80% of respondents believe that problem could result in patients' deaths. (See chart, above left.)
Ackerman says he recently heard from a large East Coast medical center that discovered it would have to replace all of its telemetry equipment. He also says another institution advanced the date on one of its ventilators beyond year 2000 and discovered it would not work. It also could not be readjusted to the current date.
Could you already be too late?
What is certain, the experts say, is that if you and your information service people aren't already moving to correct the problems, you're behind the eight ball. (For the key elements of a year 2000 compliance program, see related story, p. 39.)
With the Y2K deadline only about 20 months away, time obviously is critical. Your medical device vendors can provide you with vital information, but don't rely on them for all the answers, says Ackerman. He adds that one survey found that when people queried vendors about their products the response rate was only 25%, and only 3% of the responses were accurate. Another survey found only a 7% response rate.
The problem is compounded because it's impossible to assume all medical devices - even the same models manufactured by the same companies - are comparable, explains Powell. "Just because you have several identical pieces of equipment, they may not have identical chips. Maybe the manufacturer ran out of one kind of chip and purchased another kind from another vendor. The only way to be 100% [certain] is to test everything."
Egleston is currently testing between 8,000 and 9,000 medical devices, a process that Powell doesn't expect to be completed until July 1999, which would give her six months of contingency time.
It's also impossible to rely on the date a product was manufactured as a guideline for its compliance, says Ackerman. Newer devices are less prone to problems than older ones, but he says that even last year some personal computer manufacturers were selling equipment that was not Y2K compliant.
One way to avoid problems is using contingency planning, says Powell. "You have to have manual procedures in place for all of your critical systems and equipment. Make sure you have contingency plans for supplies so you won't run out or in case transportation systems don't function the way the should," she says.
This planning should include having full staffing, perhaps even extra staffing, on hand at midnight on Dec. 31, 1999. All critical equipment should be monitored visually and plans should be in place for responding if a piece of equipment fails.
Countdown to New Year's Eve
You may also want to consider going into a semi-emergency mode that New Year's Eve. Powell says that Egleston plans to go into a holiday-period procedures, meaning keeping its census as low as possible with only the most critical patients remaining. Extra staffing also will be in place to handle any needed switches to manual procedures.
Consider the other critical details, and the complications rise. For instance, many elevators will be affected by millennium problems; will you be able to get patients to surgery or more vital equipment from one floor to another?
And, of course, there are elements you can't control. Will your local utility companies, such as the power company, have made all of their equipment year 2000 compliant?
It may even take three to five days after the year 2000 begins for most of the fallout to be evident, but Powell anticipates any problems with medical devices will become apparent at midnight. That's why she's not planning to be out on the town celebrating: "Oh boy! You know where I'll be."
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