Members of the group working on the healthcare project of Y2K:

•  Leah Gabel (lgabel@indiana.edu)
•  Jennifer Schaeffer (jnschaef@indiana.edu)

I. Introduction

The year 2000 poses potential risks in every area of our lives. Even though it is still unclear as to what exactly will or will not happen when the date rolls over, definite precautions and action must be put in place to prepare for the worst. One area in which many people will be affected by the risks and problems of Y2K is the healthcare industry. There are many different aspects to which the healthcare industry is related. The most important component of the healthcare industry is the patients because these are the people that need to be assured security of safety and health by the industry itself. According to the Senate Report there are 50 million Americans that are dependent on prescription drugs alone in the healthcare industry (37). Panic and uncertainty can erupt if people that are dependent on the healthcare industry are not convinced that the healthcare industry is, or are taking proper precautions to become prepared for Y2K.

Another concern within the healthcare system is the ever-present embedded chip. To clarify, “embedded chips are non-programmable microcircuits that are ‘hard wired’ into other pieces of equipment that may be critical to patient services or hospital operations, many of which include date calculations in their programming logic (Goldberg et al; 1).” Embedded chips are distressing to the healthcare industry because if the chips fail, they can cause devices such as life-support systems to fail (Y2K Center, 1). Therefore, many lives will be in danger. True, patients are the biggest worry; however, in order to ease the patients, other factors need to be addressed. These other factors related to the healthcare industry have been divided into four specific areas:
· Individuals of the Healthcare Industry: Patients, Doctors and Nurses.
· Healthcare Institutions: Hospitals and Nursing Homes
· Equipment and Supplies: Necessary for survival in a medical view and necessary for daily business interaction)
· Billing and Liability

Key organizations within these aspects of the healthcare industry include:
· HCFA: The Health Care Financing Administration is a federal agency that administers Medicare and Medicaid to patients.
· Rx2000 Solutions Institute is a non-profit organization that has been developed to deal with solely Y2K problems within the healthcare industry.
· GAO : The General Accounting Office is an investigative unit within Congress that monitors issues regarding financial flows of the public.

Research has been done by all of these organizations, and they have been addressing the importance of being prepared for failures caused because of Y2K. The impact of Y2K, if unprepared, could be devastating to the healthcare industry both from a medical and business standpoint.
 
 

II. Individuals of the Healthcare Industry

Q: How are the threats of Y2K going to affect the individuals that are dependent on the healthcare system?

A: The purpose of the healthcare industry is to provide services and treatment for medically dependent patients. Patients as well as their families trust trained individuals, such as doctors and nurses to ensure their safety and health. The pretentious threats of Y2K can cause the disruption in the area of needed security among patients and their families.

Of the many concerns among patients, one of the most noteworthy is the possible disturbance of needed services, like the availability of prescription drugs. As said before, 50 million Americans are dependent on prescription drugs. Many factors are included in the ordering, receiving and distributing of prescription drugs to patients. Patients are not as worried about the process of receiving their drugs, the just want to be assured that they will be able to have their medicine available to them at the necessary time. If other systems, specifically those run by computer are not cooperating during the turn of the century, there is a huge threat that patients will not be able to receive their prescription drugs.

Another threat is on the minds of the individuals within the healthcare industry. This is the threat that Americans that depend on the life support or biomedical devices. Here again we see that patients, doctors and nurses is directly linked to computer systems. The patients’ health and possibly lives are threatened if the healthcare industries are not prepared for the budding risks of Y2K.
 

Q: How are the threats of Y2K going to affect the individuals that work within the Healthcare Industry medically and professionally?

A: There are also concerns among those that manage the healthcare industry. Nurses of one hospital have expressed their concern of the nonchalant attitudes of the administrators and the seriousness of Y2K (Stockyard). According to the Center for Y2K and Society, from a business aspect, healthcare professionals are concerned with maintaining proper financial accounts of patients (1-2). “Year 2000 failures by providers or payers could result in late, miscalculated or rejected claims for payment (Goldberg et al; 1).” Unfortunately, these concerns cannot be addressed by every healthcare professional because of the lack of financial backing that is available to them. On a medical and personal aspect of Y2K, the individuals that work within the healthcare industry are threatened by the failure of the embedded chip which could possible interrupt the maintenance of adequate patient care, administering drugs, and giving tests.
 
 

III. Equipment and Supplies

Q: Will equipment be prepared and ready for the threats of Y2K?

A: Healthcare equipment is at great risk of failure at the turn of the century because of the number of devices that contain the embedded chip. Embedded chip systems that should be tested for the Year 2000 vulnerability include: medical equipment, including infusion pumps in intravenous drips, heart defibrillators, pacemakers, intensive care monitors, MRIs, CAT scans, dialysis, chemotherapy, radiation and laboratory equipment, radiology and other diagnostic systems; monitoring and control systems including environmental and safety equipment such as fire alarm systems, including detection, sending, receiving, and suppression units; security systems, including sending and receiving units, video and surveillance systems, and badge readers; telecommunications equipment, including telephone switching equipment, call management systems, pagers and cellular phones; and building infrastructure, including HVAC, energy management and lighting controls, emergency generators and lighting, interruptible power supplies and elevators (Goldberg et al; 1). These devices definitely affect both the medical side and the professional side to the healthcare industry.

According to the Executive Director of the American Society for Healthcare Engineering (ASHE), 20% of the medical equipment has failed tests for Y2K (AHA News, 2). Unfortunately, there was not any reference to which equipment failed, but the problem still lies within technology. The problem with this is that the information on equipment capability in correlation with Y2K is in the hands of manufacturers that are aware of the risks Y2K and its potential interruptions with specific equipment. One advantage that manufacturers have right now is that they are having contractors assess them on their Y2K readiness (AHA News, 2). This helps to ensure that manufactures are taking necessary precautions to the threats of Y2K. The question that still remains when dealing with medical equipment is whether the embedded chip can be fixed or changed in some way to prevent the disruption of healthcare service to patients. In June of 1997, the Center for Devices and Radiological Health of the Food and Drug Administration informed medical device manufacturers that ‘some computer and software applications currently used in medical devices, including embedded microprocessors, may experience problems beginning January 1, 2000. These problems are due to their use of two-digit fields for date representations.’ Therefore, it is vital for these devices to be tested to see if there are going to be problems after 1999 (Goldberg et al; 1).
 

Q: Will supplies be adequate and available for expectant patients?

A: Supplies are also in a vulnerable position due to threats of Y2K. The patients receive their medical supplies from the institutions themselves, therefore healthcare institutions are the first to be hit with a problem in supplies….whether it is a shortage or complete loss of available supplies. According to Gary North, 80% of the necessary materials to produce drugs are imported to the United States. Therefore, there is a large concern about oversea countries and how they are preparing for Y2K (1). Obviously, if countries that are not ready are the ones that supply the US their drug supplies, and then the US will not be receiving their supplies, making them unavailable for patients. Although, according to the Senate Report, the drugs that people normally require will be available as long as institutions do not order excess amounts of the drugs in advance (41). The pharmaceutical industry is also active in Y2K preparedness in assuring patients that they will be able to supply their necessary drugs. Therefore, the amount and availability of supplies are going to depend on whether or not people are wise in their decision making in ordering, stocking and distributing the supplies properly.
 
IV. Healthcare Institutions

Q: How is Y2K going to affect the institutions that are responsible for ensuring the health and safety to their patients?

A: “Health care facilities will be exposed to operational disruptions caused by failures in computer systems, embedded chips, business dependencies, and public infrastructure (Goldberg et al., 2).” Here we can see that the embedded chip is the main threat to all areas discussed thus far, especially in hospitals because all of their patient and business records are in a computer system. According to the Center for Y2K and Society, hospitals are reporting Y2K readiness (a report that the embedded chip has been fixed with a compatible system) more locally and within their institution, rather than nationally (2). This becomes consequential because some statistics do not show full representation of all institutions being questioned. According to the President’s Council of the Year 2000 Conversion, the Rx2000 Solutions Institute conducted a survey that shows that only 40% of all healthcare providers are Y2K ready. Fortunately, 66% of healthcare institutions are implementing contingency plans to secure their role in the healthcare industry. Yet, a problem stands with these statistics in that an uncertain number of people did not respond to the survey. The Rx2000 Solutions also states that 15% of the institutions have not taken any action in preparing for possible risks (35). Therefore, this leaves some discrepancy in determining exactly who and how many healthcare institutions are in fact Y2K prepared. According to the Health Care Financing Administration (HCFA), of 423 managed care organizations, only 89 are Y2K ready without exception (President’s Council, 36). For all industries, replacing old equipment with Y2K compatible equipment is very expensive. This raises a major concern for rural and inner city hospitals because they do not have the financial means to invest in such equipment (Senate Report, 38). Smaller and private physicians’ offices also play an important role when providing for their patients, yet they see problems with their financial capabilities to prepare for potential failures as well.

Another institution that is concerned about the pretentious threats of Y2K is the larger nursing homes. Because of their lack of preparation, the threat that medical equipment (devices) will fail in correlation with electrical outages. According to the Senate Report, there is no real evidence on how nursing homes are preparing for Y2K or how they are going to deal with various situations like patients and electricity (40). Therefore, there are large gaps in just how prepared the nursing homes are for Y2K. The lack of evidence is troublesome for patients and their families of nursing homes. Questions are then raised in regard to the operation of nursing homes. For example, if there is a power outage, what will happen to a person needing dialysis? Since there will be no heat, how will the patients be kept warm? Where will the nursing homes find running water? According to the Center for Y2K and Society, there is little visibility of nursing homes in regard to Y2K (2).  Hence, nursing homes still remain a large concern for the healthcare industry.
 

V. Billing and Liability

Q: Are providers prepared for the potential problems they may face with billing systems and their customers (patients)?

A: A problem with the billing system is that health claim forms are entirely dependent on the entire hospital or, healthcare institution. Therefore, the billing systems are going to be affected by Y2K. This is the case unless of course readiness is accomplished. Special attention has been directed to the Medicare and Medicaid Systems. According to the Health Care Financing Administration (HCFA), “if healthcare providers fail to address their Y2K issues, they may be unable to bill Medicare or other payers and as a result they will not be able to maintain the cash flow and services (1).” Therefore, Medicare could not pay for elderly patients, which is a great loss for such individual patients. According to the Senate Report, the HCFA also states that 8 states are in high risk of failure, 25 states are in medium risk, and 17 states are in low risk. Yet, the states that are in low risk are doing more to be prepared, than the states that are in high-risk failure (39). States provide Medicaid to people who cannot afford medical treatment. Consequently, if the states that are in high-risk of failure for threats of Y2K are not prepared by the time Y2K occurs, many patients will not receive the treatment that the state offers for financially deprived people.

Under the subject of liability, it is a fact that lawsuits will follow the year 2000. “Hospitals and their key decision-makers may face malpractice claims, personal injury and wrongful death suits, actions against directors and officers, enforcement of licensing, accreditation and other regulations, and for publicly-held corporations, shareholders suits (Goldberg, 3).”  However, the Y2K Act was recently mandated to protect businesses from lawsuits from customers that are affected by the computer malfunctions. Yet, it does not include personal injury claims and wrongful death claims resulting from Y2K disruption (Modern Healthcare, 1). Being liable for someone else’s life is a huge responsibility. Thus, when something can be done beforehand to prevent disaster, it should be done. This creates a problem in risks that the healthcare industry must face and therefore, it makes it even more necessary to take action in being prepared for the turn of the century.
 

VI. Sources

· “Investigating the Year 2000 Problem: The 100 Day Report.” Senate Special Committee on the Year 2000 Technology Problem. Sept. 22, 1999. The report is located on the Monroe County Y2K Action Group web page at the link: http://www.senate.gov/~y2k/documents/100dayrpt/. It addresses the readiness of the industry, an analysis on what is being done, and what is not being done. The report is a government publication that is fairly recent, and is the primary contributor to our project.

· “Healthcare.” President’s Council on the Year 2000 Conversion. Aug. 13, 1999. This is located on: http://www.bluemarble.net/~y2k/3rdquarter/ypcy2000a.html. The government report gives recent statistics and analysis of healthcare and Y2K problems. The report contributes a substantial amount of information to the project.

· “HCFA Fact Sheet: Medicare and Medicaid Year 2000 Compliance.” Health Care Financing Administration (HCFA) web page http://www.hcfa.gov July 27, 1999. The source is located at http://www.hcfa.gov/facts/fs990727.htm. It provides an analysis on the status of Medicare and Medicaid and explanation of what needs to be done and what is being done to prevent the pretentious threats of Y2K. The HCFA is a government publication that provided a large amount of information to the project.

· “Y2K and Health Care.” Center for Y2K & Society. Fall 1999. This source was located at http://www.y2kcenter.org/about/index.html. This source also provides a substantial amount of information for the project. The source offers testimony focusing on maintaining a functioning healthcare industry throughout a possible disruption. It also includes explanations about different devices that can contain the embedded chip. The Center is an organization that helps advocate Y2K preparation and participation.

· “Millennium Buggy.” Catherine Quayle, the American Hospital Association (AHA) new report. The source is located on EBSCOhost. The home page of AGA is http://www.ahanews.com. It provides information on how the industry is ready for Y2K and mentions possible problems that might arise at the turn of the century. The AHA news offers information for healthcare administration and other professionals. However this source presents a small amount of information for the project.

· “Y2K Law Causes Glitch for Providers.” John Morrissey, Modern Healthcare. Aug. 2, 1999. This source is located on EBSCOhost, and the home page for modernhealth is: http://www.modernhealth.com Modern Healthcare is a news source that provides an abundance of information to healthcare executives and administrators every week. This source provides excellent explanations for us for our liability section. The information makes an informative contribution to our report. The author of the source has written several issues focused on the Y2K issue and has several years of experience with information processing information.

· “80% of Raw Materials for U.S. Drug Industry Are Imported.” Gary North. April 4, 1999. This source is located at http://www.graynorth.com/y2k/detail.cfm.4416. Gary North is an historian and therefore looks at Y2K from an historical view. He definitely expresses the magnitude of the problem. He received his information from government reports and professional opinions to support his stance and opinion on Y2K. This source provides links on several issues pertaining to healthcare industries are facing now and at the turn of the century. It provides informative information for the project.

· “Concerns for Hospitals and Y2K.” Steven H. Goldberg. Sept. 1997. This source is located on Alta Vista web page at http://www.comlinks/legal/gold1.htm There is detailed explanations of the problems and risks that hospitals and bill providers are facing if not prepared for the pretentious threats of Y2K. This source provides a substantial amount of information for the report.
 
 

VII. Suggestions

· One suggestion for hospitals and nursing homes is that they have a back-up emergency generator. This will hopefully take over when electricity fails and provide power to necessary equipment, electricity and water.
· The healthcare industry also needs to find alternative ways to conduct daily activities. These could include hiring more staff, acquiring help for the community, and seeking support from across the continent.
· It is highly recommended that hospitals remain in close contact with other hospitals and institutions in case certain equipment or supplies are needed or fail.
· The most important thing for the healthcare industry to do is to become aware of all-possible failures and disruptions as soon as possible. Then the industry can continue to correct the embedded chip tribulations and develop contingency plans.
· Thorough contingency plans need to be developed and put into action throughout the healthcare industry. Patients, families, doctors, nurses, administrators, accountants, etc. need to be prepared for the worst, but hope for the best. Action within the healthcare industry needs to be organized before the turn of the century suddenly turns.
 
 

VIII. Is Y2K a normal accident?

With respect to the healthcare industry, the Y2K incident is not a normal accident. One reason that it is not a normal accident is because it is not unexplainable. We know for the most part that major problems with devices and computers will come from the embedded chip. A problem of date conversion can be solved by failure of the chip to convert. The possible problems that may occur out of Y2K will most likely happen if the healthcare industry does not prepare. Therefore, the situation becomes an incident rather than an accident. The healthcare industry will have known what the risks were there for failure, but perhaps nothing was done or done in time.

True, it is possible that there could be a series of ordinarily unrelated events that could take place when Y2K occurs, however throughout our research, we found that most, if not all systems in the healthcare industry are related in some fashion. Each individual part depends on another to succeed. If one thing should happen to fail, most likely something else will fail or become complicated in some way. These would not be considered unrelated event, hence Y2K is not a normal accident.

Blame can also be allocated on behalf of the healthcare industry and Y2K. The main point here is that people have been warned about the pretentious threats of Y2K. They have been advised by numerous agencies and professional to become prepared, otherwise disaster is potential to strike. Hence, Y2K is not a normal accident.
 
 

IX. Predictions

· We have found that the healthcare industry is inadequately prepared for Y2K. This is a serious problem, because many individuals and institutions are slowly taking action to become prepared, if taking action at all. With the little amount of time that is left, if the healthcare industry does not commit to becoming organized and prepared, expect to see serious failures in the healthcare industry when the date rolls over.
· Pharmaceuticals have been reporting to healthcare institutions to avoid stockpiling on drugs. The information of whether or not pharmacies, hospitals, or nursing homes are stockpiling is not available, yet the possibility still exists. We predict that if institutions do begin to stockpile, somewhere a hospital or individual is going to have a shortage of drugs. This is because one area could get more than another and this could result in a panicked rush for drugs.
· It has been stated, that lawsuits will be acted upon after Y2K. This will result in conflict between institutions, and professional and their patients. With only 40% of healthcare providers ready (President’s Council, 34), this will mean that 60% of the industry will have some type of problem (Senate Report). Unless, the industry becomes equipped in preparation for Y2K, there are going to be some very angry and perhaps distressed people.