Abstract

Today, millions of people are allocating millions of dollars and man hours to fix the Y2K bugs in their systems. A bug that originated due to the forgetful nature of humans and what they thought, at the time, was efficient. The Year 2000 Bug affects millions and millions of computers and logic devices worldwide. If a device keeps track of the date in any way, then it is affected and its proper functioning might be jeopardized. This essay explores the ways that the Millennium Bug affects the healthcare industry; specifically it focuses on the Dartmouth-Hitchcock Medical Center in Hanover, New Hampshire. The methods that DHMC is using in its race to become Y2K compliant will be explained, concentrating in both their efficiency and utility. Furthermore, this paper analyzes the possible impacts that other industries might have on the healthcare industry and how they might impact on DHMC's Y2K readiness. Finally, conclusions are drawn that discuss the status of the DHMC plan to become Y2K compliant and whether or not it will be, according to the authors, Y2K ready on the early morning of January 1st, 2000.

Contents
 

1. Introduction
2. Background information
3. Y2K and its effects on the Healthcare Industry and DHMC

i. Safety of Patients
ii. Safety of Employees
iii. Issues of Severe Financial Impact
iv. Issues of Business Continuation
v. Litigation and Legal Fallout

4. DHMC's General Plan to become Y2K Compliant

i. DHMC Y2K Team Structure
ii. DHMC Y2K Proposed Timeline

5. DHMC's Plan in action

i. Departments and their compliance plan
ii. Facilities and their compliance plan
iii. Biomedical and their compliance plan
iv. Information Services and their compliance plan

6. Other industries and their impact on DHMC's Y2K readiness

i. Utilities
ii. Supply Shortages

7. Educating the users at DHMC
8. Summary
9. Acknowledgments
10. References

1. Introduction

Some science fiction novelists have focused on what could happen if humans gave computers too much power. In their novels many of them speculate that computers will simply eradicate or dominate the human race after a computer revolution. Artificial Intelligence is, in most of the cases, blamed for this mishap; after all, why did humans have to make computers so smart? Today all over the globe a war is being fought against computers; but unlike in science fiction, the computers have no idea that they are fighting in this war. They are simply doing what they were programmed to do: store data in an efficient way. In this paper, we will explore the Millennium Bug and its effect on the healthcare industry. Furthermore, we will focus on the possible problems and solutions that a major healthcare provider, like the Dartmouth-Hitchcock Medical Center, should be ready for and implement to triumph in their battle against the Y2K problem.

Although this paper concentrates on a major institution, its contents is of extreme importance to smaller providers. They will be able to shape the solutions and suggestions provided to their specific needs. Specifically this paper addresses the Year 2000 problem; its possible consequences on the healthcare system; how DHMC has confronted the bug; and finally how other institutions might affect the ability of DHMC to deal with Y2K related issues.

This paper is divided into 8 sections. In the next section we briefly describe the Year 2000 problem as well as introduce some background information about the healthcare industry and the Dartmouth-Hitchcock Medical Center. In the 3rd section we discuss the possible problems that could arise from Y2K related malfunctions in the medical industry and at DHMC. In section 4 we focus on the general plan of action devised by DHMC to resolve the Millennium Bug. The following section, section 5, analyzes the implementation of DHMC's general plan; it explains, in great detail, the achievements and solutions that have been undertaken. Section 6 exhibits the ways in which other industries might incapacitate a hospital to fully be Year 2000 ready. In section 7, we discuss the means by which DHMC is educating its users about Y2K related issues. Finally, in the last section we draw conclusions in accordance with the readiness status of DHMC for the millennium change.

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2. Background information

The war we are fighting against computers is due to a bug that programmers and system designers planted in their systems. Today's impressive size of memory and data holding devices allows users to store information without really paying attention to the misuse of a few bytes. Decades ago, however, a few bytes here and there made the difference between having more free hard drive space and having to buy a new one. Punch cards were only 80 characters wide, so saving a character or two would be very significant [Jagg99]. Saving storage space also became a very big concern when programming ROM (Read-Only Memory) chips. These chips provide the computer with the necessary information to "boot up," or start up. When looking at possible places that will save you some valuable space, designers and programmers thought that it was unnecessary to store a date as February, 1st 1999 or even 02011999, when 020199 will be sufficient; after all we all know that '99 simply stands for 1999. That was the flaw, we mistakenly assumed that computers would be able to figure out what was meant by these two digits. A very common idea among computer programmers at the time was that these machines that they were designing would not last until the year 2000. At the rate the computer industry was growing, they were sure that replacements would come along in time. These two approaches have generated one of the biggest problems humanity has faced in recent history. Any logic device with a date dependency might not function correctly as December 31st, 1999 rolls into January 1st, 2000. The Year 2000 problem could cause a computer to think, on New Year's Day 2000, that it is 1900 and not 2000. Some computers might even refuse to start up after the year 2000. Yet another problem arises on February 29th, 2000 which is a leap day that many systems weren't programmed to take into account.

Determining who is to blame is an impossible task to undertake. In all reality it was the lack of a standard among computer programmers and designers that allowed the doomed practice of shortening the date to continue through out the years. It was Boeing, in 1993, one of the first to notice some mistakes when orders with seven or more years in advance were placed. In the years to come even more problems kept arising, from not working credit card machines, to drugs being marked with expiration dates of 1900. As a matter of fact, a study conducted in 1998 showed that more than 40% of those organizations surveyed had experienced some sort of Y2K related problem [Jagg99]. Ever since then many efforts have been made to make organizations and businesses aware of the Year 2000 bug and to correct the associated problems before the fateful date comes around.

The healthcare industry is one of the many critical areas in which this problem must be resolved. The excellence of care at most American hospitals is due, in a great manner, to the automation of an extensive list of functions. From patient records to life support machines, computers and other logical devices play a vital role. It is this automation, however, that puts the healthcare industry at the greatest risk. Being unable to process insurance information, might degrade the level of care offered to a patient. A misinterpreted dosage order by a computer or biomedical unit could cause the death of a patient. It is common knowledge in the healthcare industry, that if someone does not do their job properly, the consequences could be catastrophic. Because of their importance, all organizations in the healthcare providing cycle, from private practices to insurance companies, must comply with Year 2000 requirements. If they do not, they are putting human lives at risk.

In one issue of Center View, the newsletter of DHMC, Sherry Calkins says, "Because the year 2000 Computer Bug is one that has significant impact on computers, medical devices and other equipment that utilize computer chips, it's an issue that has great importance to DHMC [Calkins99]." This is very evident in their committment to solving the problem as it relates to the medical center.

The Dartmouth-Hitchcock Medical Center is part of the Hitchcock Alliance, which groups more than ten smaller hospitals and other medical centers in New England. There are four institutions that make up the DHMC, the Dartmouth Medical School, founded in 1797; Mary Hitchcock Memorial Hospital, 1893; The Hitchcock Clinic, 1927; and finally the Veterans Administration Hospital, which opened its doors in 1938 [DHMC-W]. On July 25th, 1997 the DHMC uncovered the need to be Year 2000 compliant and on December 15th, 1997 it had its Y2K project managers' kickoff meeting.

The DHMC was worried of the possible effects that this Y2K bug could have on them. The first department to notice any mishaps was the financial department. This caught the attention of the board and a Y2K committee was born. The committee's purpose, at first, was to determine the scope of the problem and to develop a plan of action to solve it. In a recent issue of Center View, the newsletter of DHMC, Sherry Calkins says, "Because the year 2000 Computer Bug is one that has significant impact on computers, medical devices and other equipment that utilize computer chips, it's an issue that has great importance to DHMC [Calkins99]." This is very evident in their committment to solving the problem as it relates to the medical center.

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3. Y2K and Its Effects on the Healthcare Industry and DHMC

There are a multitude of different problems that the Y2K bug introduces to DHMC and to hospitals in general. Probably one of the hardest parts of preparing for the year 2000 is trying to figure out every possible thing that could go wrong as a result. The problems are extremely wide ranging and often hard to quantify. To name a few, patient safety, staff safety, equipment failure, financial impact, business operations, and resulting litigation are all very important issues. Next, all of these problems must be itemized and prioritized to give a clear picture of not only what needs to be solved, but what needs to be solved immediately and what can wait. Some items are designated 'mission critical' systems in that without their compliance, critical functions of the hospital would not be able to continue service. At the Dartmouth-Hitchcock Medical Center, they have prioritized four main categories of problems as follows:

1. Issues of patient health and safety.
2. Issues of employee, visitor, and all personnel safety.
3. Issues with potentially severe financial impact.
4. Business operational issues affecting multiple areas.[DHMC99]

In addition to these areas of concern, we will talk about the possible litigation and legal fallout of the Y2K problem and how they can and will affect the medical center, as well as how DHMC is preparing for failures by their various providers that they might not be able to prevent like power outages and materials shortages.

The hospital is a place where people to go to be cured, to heal their wounds, and to feel better. This being the main focus of the facility, it is fitting that their number one priority concerning the Y2K is the safety of their patients.

As far as patients go, the most important category of equipment that could cause problems for them is the biomedical equipment. Some of these machines are directly responsible for the well being of many patients. This type of equipment can have potentially disastrous effects on a patient in the event that malfunctions occur and they begin to operate incorrectly. One possibility deals with IV monitors. These monitors determine how much of each constituent drug is pumped into an intravenous needle, and how fast. Some of these machines are date sensitive in that after certain times or dates, the doses change. This can cause major problems if drugs are administered incorrectly.

Some more systems or machines that can have Y2K issues are x-ray machines, defribulators, pacemakers, and anything else that could affect the condition of a patient [DHMC99]. Other systems that affect the health of a patient aren't quite as obvious as the biomedical equipment. Record keeping, for instance, is extremely important in many cases. For instance, doctors need to know if someone is allergic to certain drugs if they are going to prescribe them, and if the record keeping system breaks down due to Y2K issues, there would be little access to the information they need.

This is another important category that includes all failures that could jeopardize the well being of everyone else associated with the hospital. A major concern is the physical plant of the hospital.

All of the hospital's utilities must be able to function properly including water, power, and ventilation. Without the precious commodities of water and power, most of the hospital would be shut down, and many normal tasks would take much longer than usual. These functions are all very important to the operation of the hospital, and the facilities department is taking great care to make sure that none of this equipment will produce problems at the turn of the century.

Transportation and other vehicular devices are also being checked and rechecked for any Y2K vulnerability. Cars, trucks, and the helicoptor are all very potentially dangerous machines when not functioning properly. Also, elevators and similar equipment must all be designated compliant if they will be used after December 31st.

Financial impact is very important to any business enterprise, and a hospital is no exception. There is a wide range of financially related problems arising from the Y2K bug. The first one on many people's minds is financial record keeping and payment procedures. Improper or failed operation of computer driven payment systems could cause immense damages [DHMC99]. Joel M. Ackerman, Founder & Executive Director of Rx2000 Solutions Institute, a healthcare Y2K information resource, said "The [health care] industry is almost totally dependent upon the electronic exchange of information with insurers and claims processors, physician practices, laboratories and affiliated institutions [Ackerman99]." If this system breaks down, payment claims could cause immense financial damages. Issues with the Medicare and Medicaid system could also be a humongous stumbling block for the proper operation of the medical center. As we learned from the CS 99 Y2K presentation concerning the U.S. Government's Y2K readiness, the departments that handle Medicare and Medicaid have been receiving very low Y2K compliance grades, and the failures of these systems could delay payment to many hospitals and downgrade the services that they will be able to provide.

Another issue that must be discussed is the failure of extremely expensive equipment. Being one of the most advanced, if not the most advanced facility in New Hampshire and the Upper Valley, DHMC is home to a host of very expensive high-tech and state-of-the-art equipment [DHMC99]. If Y2K issues cause these machines to malfunction or in some way be ineffective, it may present a large cost to the hospital to repair or replace these important articles.

DHMC has allotted almost it's entire computing budget to fixing the Y2K problem, a figure that tops $12 million [DHMC99]. This is just a small fraction of the possible cost that not fixing these problems would have caused.

Dartmouth Hitchcock Medical Center is a twenty-four hour, seven days a week fully operational facility. In this catch-all category, DHMC lumps together all of the various areas in which Y2K problems could cause an interruption in normal business operating procedures [DHMC99]. The first of these is the information systems of the hospital including employee records, patient records, mainframe systems, and all the other standard workstations used every day by employees. The communication systems used by the medical center are also part of this category. Paging systems, telephone operation, and email are all possibly susceptible to Y2K issues, and must be tested and made compliant.

From DHMC's point of view, there should not be any legal fallout that will affect them directly. From the people we talked to and the information we've gathered, DHMC plans to be completely compliant by the year 2000, and if their remediation plans do not finish in time, their contingency plans will take effect. If everything goes according to plan, the will not be responsible for any legal damages.

However, the Year 2000 Problem is all about unforeseen difficulties, and DHMC is taking no chances. Just as they have contingency plans for all of their equipment, they also have a legal contingency plan.

Many insurance companies are currently demanding that their clients make 'the best possible effort' to be Y2K compliant in order to assure coverage. In talking with their underwriters, officials with DHMC determined that they need to have an auditing company come in to assess their Y2K efforts [DHMC99]. The purpose of the auditing company is an assurance that DHMC has done its best in combatting Y2K problems. This standardized assurance lifts the burdens of liability from the hospital and makes their insurance companies more confident in providing coverage.

If things were to go wrong with machinery and cause injury to patients, employees, or visitors, the legal battle to follow would be extremely complex. Many interdependencies would exist. The manufacturer of the machine would have a stake, as well as the hospital and the injured party. In many situations, the Y2K problem is going to create a tangled web of legal action.

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4. DHMC's General Plan to Become Y2K Compliant

DHMC's plan is highly decentralized. It has a central group of people in charge of the entire project, but this group is small, and the various departments take on most of the responsibility. There is no huge central group that is going to solve the problem on its own. Instead, each department implements a plan of their own to inventory, develop a compliance or remediation plan, implement their plans, and verify Y2K compliance first for all of their mission-critical items, and second for their non-critical systems. This division of labor is critical to their plan because of the huge scope that the medical center encompasses.

"The DHMC Year 2000 Project encompasses computer hardware, supported software, interfaces, network, facilities, medical equipment, and supplies for Mary Hitchcock Memorial Hospital (MHMH) Lebanon Campus and The Hitchcock Clinic (THC). The project also includes DHMC-supported Information System hardware and software at the Northern New England Regional Clinics and the Northern New England Outreach Clinics. These areas are responsible for their non-IS systems, including facilities, medical equipment, and supplies, as well as for any non-standard computer hardware and software. The Lebanon Campus consists of The Medical Center, LaBombard Road, Community Health Center, and the offices located at Colburn Hill, Hanover Building 37 and Building 50.[DHMC-W]"

The number of unique hardware, software, interfaces, network, facilities, medical equipment, and supplies items was found to be ## after the inventory stage of the DHMC Y2K Project. This high number also illustrates the large scope of the project.

DHMC has a focus of creating both remediation plans and contingency plans. Each department is charged with first coming up with a plan to identify, repair or replace, and test each unique piece of equipment. They are also required to have a contingency plan in case unforeseen failures do occur in order to keep the hospital running efficiently, effectively, and safely.

4: i. DHMC Y2K Team Structure

The DHMC Year 2000 team is heirarchically structured with a few different layers that we discuss in this section.

Peter Johnson is the chief information officer of the hospital and Year 2000 Chairman. "The Year 2000 (Y2K) Chairman is responsible for the overall Year 2000 compliance strategy, budget, and policy for DHMC. He also is the liaison between DHMC and partners and alliances. [DHMC99] "

Under him is the Year 2000 Steering Committee, comprised of Ken Spence, Ron Sliwinski, Rick Nothnagel, Ernie LeBlanc among others. "The Year 2000 Steering Committee members include the Year 2000 Chairman, Year 2000 Compliance Coordinators, the Year 2000 Project Coordinator, the IS Year 2000 Coordinator, and Internal Audit. [DHMC99] " The steering committee coordinates the departmental compliance efforts, progress, and costs, and reports these items to the DHMC Information Systems Department.

Connie Durham has a special post as the Year 2000 Project Coordinator. "The Year 2000 (Y2K) Project Coordinator is responsible for consolidating, monitoring, and tracking the Year 2000 inventory, plans, progress, and issues of the Y2K Compliance Coordinators for these major areas: Information Systems (IS), Materials Management, Medical Equipment, and Facilities. The Y2K Project Coordinator consolidates information from Department Directors about individual Departments and communicates that to the appropriate Y2K Compliance Coordinator and the Y2K Steering Committee. [DHMC99] "

The next level down is the departmentCompliance Coordinators. "A single contact point and controller of Year 2000 strategies, plans, tools, vendor letters, and other documents in each of the following areas:

1. Information Systems - Ernie LeBlanc
2. Materials Management - Jim Fawcett
3. Facilities - Rick Nothnagel, Steve Cutter
4. Medical Equipment - Lee Winslow

These coordinators have responsibility for managing and providing Year 2000 remediation expertise, communications, training, and resources. They also maintain the master inventory for enterprise-wide products and services. [DHMC99] "

The structure extends into all of the departments with the Department Directors and Department Liaisons. Department Directors are responsible for the proper functioning of their departments despite the Y2K problem. They are in charge of developing their department's remediation and contingency plans, and of making sure these plans are implemented. They report compliance progress and associated costs to the Y2K Coordinator. Department Liaisons are responsible for coordinating the compliance efforts, and for reporting progress and costs to the Department Director.

This chart is the proposed timeline provided by the Y2K Steering Committee for each of the various departments. The timeline is divided into four stages: Inventory, Assessment, Remediation, and Testing. DHMC started preparing for Y2K in 1997, when they had their first presentation on the problem. They hope to be completely compliant with all remediation and testing finished as well as contingency plans developed by September of 1999 [DHMC99].

Inventory -- Before 1999

As the chart shows, all departments were expected to have an inventory of all of their equipment that possibly could have Y2K problems completed during 1998. At this point they wanted to have a comprehensive list of all hardware, applications software, operating systems, embedded systems, and data records divided by the departments. DHMC completed this goal on time. The next step was to assess all of this equipment and determine solutions for making the equipment compliant as well as contingency plans should the equipment fail to comply [DHMC99].

Assessment -- 1998 - April, 1999

Different departments were alotted different time periods for the assessment stage, and most of the departments are still involved with this stage of the plan. Criteria that they based the length of time for assessment included number of unique devices, available trained staff, accessibility of equipment, and importance of equipment [DHMC99]. Obviously they expected mission critical systems to be taken care of first in order to assure the business continuation of the medical center.

The purpose of DHMC's assessment phase is to determine the scope, size, and priorities of the Year 2000 issues. During assessment, the departments determine what is to be done with each piece of equipment. They first determine if date information affects the functioning of the device. Many of the hospital's devices are declared compliant very easily because of the fact that they don't even have date-sensitive functionality. After this observation, the machines that are date sensitive must be declared compliant or non-compliant. For this, the departments often have to contact the manufacturer of the device. Most manufacturers are being extremely helpful and straightforward with information regarding their equipment. However, problems arise when either the information on a device is unavailable or if the manufacturer has since gone out of business. In these cases, DHMC's FAQ (frequently asked questions) manual gives the following advice:

Q: What if my vendor has gone out of business?

A: Short-term: test the application or data for Y2K compliance. Consider replacing the application. Even without Y2K issues, the application may need enhancements in the future. You may want to define a manual process as a contingency. [DHMC99]

As we can see, DHMC is doing a thorough job of exploring all of the possibilities that they must take into account concerning the Y2K Problem and their solution to it.

Remediation -- January, 1999 - August, 1999

The remediation phase includes the repair or replacement of all devices. It's placement in the timeline differs greatly from one department to another. Again, this depends greatly on availability of staff, and sheer numbers of equipment that must be remediated. For instance, the Medical Equipment department has by far the most unique items that must be tested, hence it has the longest remediation period, however, the testing period runs almost concurrently [DHMC99].

Many different strategies will be used for remediation. Some solutions are as simple as manually setting a machine's clock back to the year 1993. Other systems must be entirely replaced. Many times, vendors will release a patch that they claim will make their product Y2K compliant, and much of the remediation phase involves acquiring these patches and installing them [DHMC99].

Testing -- February, 1999 - September, 1999

As Connie Durham told us in an interview, "We're taking nothing for granted. If we haven't tested it fully, we don't call it compliant." Testing is an extremely important component of DHMC's Y2K Compliance Plan. It does not matter at all if a manufacturer has stated that its products are Y2K compliant, the departments at DHMC are testing everything.

Testing at DHMC will run concurrently with remediation to save time and money. It's no use installing a patch and then waiting months to test it just to find out that the patch doesn't work properly, so DHMC is testing as they go. They want to make sure that every step of their remediation plan has resulted in a compliant piece of equipment.

Some testing methods that departments are using are as simple as setting the clock ahead to 11:58 PM December 31st, 1999, waiting 5 minutes, and attempting to reboot a system. Other testing methods are much more in depth, including the testing of biomedical equipment that can have profound impact on the health of a patient [DHMC99].

Testing is at the heart of the Year 2000 Plan for DHMC, and they are taking it extremely seriously.

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5. DHMC's Plan in action

This decentralized approach to fix the problem, suggested by the general plan, is the most efficient way to solve the problem. In order to prove this statement we will provide the calculations, figure 5.1, made by the Y2K Steering Committee as to how long the process might take. (This calculation does not include the time that would be spent on creating an inventory of the devices, just the time that it will take to have a fully Y2K compliant system.)

It would require too many resources to create a team of experts that will simply go around and test both the hardware and the software to guarantee its compliance. Hence, by having each department do their own assessment of their problems, we will not only be saving time, but also money. It will save money because, the rates at which the department's help will be paid is at most 1.5 the current rate of pay; if an outside contractor is hired, the payment rates will be much higher. Although the same amount of time will be spent, no matter who does the testing, it is the quickness at which the job is finished that is critical in this case. It will take a team of experts longer to be able to test all the devices; this same task could be performed in much less time if all the departments conduct their own testing. All that is needed is a small number of people who organize and direct the effort. In order to ensure that this solution would succeed, the Y2K Steering Committee and the Y2K coordinator, Connie Durham, divided the DHMC into five different areas, that each will have a compliance coordinator. These five areas are Departments, Facilities, Biomedical, Informational Services, and Materials.

All devices will be categorized according to their make and importance to the functioning of the hospital. Figure 5.2 contains a list of "Standard devices." That is, a list of devices that are known to be Y2K compliant and that the Computer User Support will have to deal with in case of other sort of malfunction. Some other devices have been added to this list since it was first envisioned. These late additions were due to the lack of knowledge by the Y2K Steering Committee of their compliance. A system that was not recognized by the Committee was given a Non-Standard status, which meant that the department had to test its compliance. Figure 5.3, contains a list of Standard Applications, this are applications that DHMC Computer services certifies as Y2K Compliant. This procedure allowed for stricter compliance assurances. Critical devices were those "that are essential to the department's operation, and that their failure could result in death, injury, severe financial loss, or legal liability to the institution or the department" [DHMC99]. Important devices are those that "are important to [the] department but are not critical" [DHMC99]. Not important are "items not important to [the] department" [DHMC99].

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5: i. Departments and their compliance plan
 

The compliance plan for all departments mandates that each one must conduct inventory of hardware, software, medical devices, and facilities equipment, including Y2K compliance if known and its priority [DHMC99]. Then the department coordinator must develop and implement compliance plans for departmental systems. A department's inventory then goes to the Y2K Coordinator, who compiles them as well as their status.

In order to aid the departments in their quest to test for compliance in their systems, the Y2K Steering Committee provided guidelines for testing both Non-Standard hardware and software. This plan was given to all department liaisons and it can also be accessed on the web at the Computer User Support Y2K site. (This plan is of outmost importance to the departments testing plan, but its text will not be included on this paper due to its length, please refer to the web site mentioned above, or look at our copy.) Figure 5.4, includes a sample compliance and remediation plan for all the departments.

This approach works with extreme efficiency; it uses the most knowledgeable person about a system the system's user as the source of information regarding the possible problems and fixes available. It is important to also notice that the departments part of the division is the one where most of the problems will arise. Due to the wide variety of hardware and software that the departments use one could assert that this part of the five divisions is the one of most time.

The Y2K, Steering Committee at the Dart mouth-Hitchcock Medical Center, has done a fabulous job with the departments. A total of 2, 482 unique devices were reviewed. For example if you have two Power Macs 6100 Laptops and five Power Macs 7100, you will only have two unique devices. Figure 5.6 indicates that the departments at the DHMC, are right on schedule and that will finish their compliance tests possibly before the deadline of August of 1999.

Even though this approach is very effective, it must be implemented properly. The testing should be implemented very carefully, pin-pointing hardware problems are not as complicated as determining date conflicts on databases and other programs. It lays in the Department Coordinator's hand to develop and implement an appropriate and effective compliance plans. He or she must also communicate promptly with the medical and facilities coordinators so that those devices get counted into the proper inventories and are tested accordingly.

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5: ii. Facilities and their compliance plan
 

The facilities compliance plan is very different to that of the departments. All devices from elevators to boiler rooms must be reviewed to determined whether they could be affected or not by the Y2K problem. This has proven to be a very arduous task; nevertheless it was implemented right on time. The assessment phase of all facilities devices was finished at the beginning of February of 1999; its schedule due date was the end of February of 1999. They have done an outstanding job at accomplishing their goals, considering that there were a total of 4, 711 unique items to review, of these only 720 could be affected by Y2K related issues, figure 5.9.

Facilities encountered 7 devices, figure 5.10, that were not Y2K Compliant; one of which, an O.R. Krueger System, is a critical device. For these devices there were options that could be taken as solutions to the problem, figure 5.11. Although most of them simply require a software update, in the case of the Ultrasonic Washer, a new PC motherboard has been ordered for replacement with the current one. A computer and keyboard will be fully replaced on the spring of 1999. The O.R. Krueger System, a critical device, will be manually adjusted to 1993 on 12/31/99, and it will have to be adjusted again on 2/28/00 to allow for a leap year.

This solution, does solve the problem with the O.R. Krueger System, however, it raises many ethical questions about the possible problems that this could generate. If the in charge individual forgets to reset the unit at some point in the post 2001 period, the critical nature of this device could lead, in the case of failure to various unpredictable problems.

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5: iii. Biomedical  and their compliance plan
 

Perhaps one of the most critical parts of this Y2K effort at the DHMC is that of assessing the compliance of all biomedical devices. The devices in this area are what we would consider the most important and critical of all devices. Not only do the patients lives depend on them properly working in order to survive, but also the hospital as a whole will be unable to achieve its most basic goal, that of saving lives, if these devices do not function correctly.

Medical devices most have their assessment phase completed by March of 1999. Currently they have reviewed most of their equipment, figure 5.12. Although most of the devices reviewed are unaffected by Y2K related problems, figure 5.13, the review phase is not over at this moment. There are also some solutions being brought forth already, and all the reviewed devices have been tested, yielding an unusual high percentage of devices to fix, figure 5.14.

The Biomedical Engineering Department had over 5, 000 individual items, making its inventory a very time consuming task. Careful planning and data gathering techniques, however, allowed the department to be doing well above expectations. A giant database was developed in order to safeguard all of these information and too easy the communication barriers that could arise in a project of this magnitude.

All their non-compliant equipment, if unfixable, will be replaced with newer and compliant units. This effort is being budgeted for a total of $6 million. The biomedical area is by far the largest block of the Y2K budget [DHMC99] This does not only shows its importance to the hospital as a whole, but it also shows how careful the hospital is being in their "take no-chances approach."

Since the hospital will be the only place that can not stop its basic operations of caring for the sick, the biomedical area must be the area were the most weight is placed. They must be compliant and extremely sure of it by the due date. In the case of Y2K chaos, the hospital will fall back on their biomedical devices in order to provide care for the injured. No risk can be taken; a non compliant device can not, even by mistake, be used on an ill person. If this fatal mistake is made, the hospital will go from the business of saving lives to the one of taking them.

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5: iv. Information Services and their compliance plan

Informational Systems is the one department that depends the most on vendors to solve their Y2K related conflicts. They are in charge of all of the communication related problems at the DHMC. From pagers to internet services via a satellite dish, the IS effort is perhaps the most painful one. In some few instances, code has had to be rewritten on some systems to make them Y2K compliant.

Currently in their remediation phase, IS has contacted all vendors of its equipment to ensure Y2K compliance. All the vendors have been prompt and forthcoming with Y2K compliance information and remedies for their systems. However, side problems have surfaced from the equipment that currently works with the Fujitso F9600 telephone switches, which are Y2K compliant, but the computers that are connected to them, mostly 286s, 386s, and 486s, are not compliant. To solve this specific problem the DHMC must replace all of them with new Pentium PCs at some point during 1999. Also patch installs to satisfy Y2K compliance for the Fujitso Automatic Call Distribution System, the Centigram Voice Mail system, and the AIS Paging Encoder, will be installed by the vendors at a given price tag.

All network routers and other network equipment is Y2K compliant. As well as the e-mail program used by the hospital, BlitzMail. An update, however, to BlitzMail 2.1 has been required to all of its users. IS Coordinator, Ernie LeBlanc, is confident that all communication services will be Y2K compliant by the proposed deadline of May, 1999.

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6. Other Industries Impact on DHMC's Y2K Readiness
 

Another category of problems that will affect DHMC in the year 2000 is the possible failure of other businesses, institutions, suppliers and providers to acquire Y2K readiness. DHMC could be totally Y2K prepared in its own facilities, but the breakdown of supply chains and utilities could still cause them problems. In this section we explore some of these possibilities.

6: i. Utilities

The three utilities that will affect DHMC the most are water, power, and communications [DHMC99]. DHMC is always ready for these type of problems however, and has contingency plans to allow business continuation in the event of failures of any of these systems. Generators are in place that would power the hospital in the event of a power failure. It makes no difference to DHMC whether these outages occur due to storms or due to computer errors, they must be prepared for them at any time, not just December 31st, 1999.

Supply shortages are one frightening possibility presented by the Y2K problem. As we learned from the CS 99 presentation on Y2K and the manufacturing industry, we learned that if any part of a supply chain is hit hard by the Y2K problem, the whole chain can be stopped, and the end users may not receive the products they need to continue functioning.

Some agencies, including Joel Ackerman's Rx2000 are predicting drug shortages caused by Y2K failures in the drug manufacturing supply chain [Ackerman99]. Whlie many hospitals have large supplies of necessary drugs, a disappearance of certain items on the market could cause major problems for patients that desperately need certain drugs. While pharmacies may have their facilities completely Y2K compliant, problems could arise anywhere in the supply chain of pharmaceutical production that would delay or eliminate certain products from being made and shipped properly to health care institutions nationwide.

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7. Educating the users at DHMC

Since the departments will have the hardest time dealing with the testing of their Non-Standard devices, all departments' directors and some other members of the staff must attend mandatory educational sessions. These sessions will aid in educating the other members of the department. It is through this decentralized system of education that the Y2K Steering Committee will be able to educate the whole DHMC by educating a smaller group, which can in turn educate those in his or her own department.

There will be a total of six, one hour and a half sessions on topics such as, Non-Standard Computer Hardware and Y2K Testing, FileMaker Pro and Y2K testing, and Excel and Y2K [DHMC99]. These classes will be offered during February and March of 1999.

The Y2K Steering Committee has made sixteen presentations in the last two years about Y2K related topics. Six of them have been in January 1999. These six presentations have been given at the Department Directors Y2K Review. During every meeting progress reports are given, and if new issues have arrived they are brought forward.

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8. Summary

The Y2K problem has caused a great deal of confusion and uncertainty in the world and in the healthcare industry. At DHMC, the greatest concern is the safety of its patients, followed by the safety of its employees. Other concerns include issues of severe financial impact, business continuation issues, and legal fallout. DHMC has taken proactive motions to avoid these problems, and they hope to be immune to the Y2K Bug with the help of their own vaccine, a strong plan that will guarantee their business continuation through to the next millenium.

Through the four stages of inventory, assessment, remediation, and testing, DHMC will have catalogued every piece of equipment with any sort of Y2K weakness, developed a solution for dealing with the problems arising from this equipment's possible malfunction, replaced or repaired the device possibly with the help of the manufacturer, and tested its proper functioning in a realistic post-2000 environment, all by September, 1999. This impressive undertaking is being accomplished by an intelligent, decentralized plan, in which all departments take responsibility for their operation into their own hands and solve their own problems. We believe that DHMC will be ready for the Year 2000 based on the information that they have provided us and the information that we have sought on our own.

The only issues that could have an impact on DHMC's operations will be issues outside of their control. For instance, the possible drug shortages that are being predicted by some could have serious consequences for hospitals and medical centers throughout the country. DHMC has contingency plans even for some of these emergencies including power outages and other disasters.

All things considered, DHMC should be very prepared to enter the Year 2000, and is a strong example for other medical centers to follow as the year approaches.

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9. Acknowledgements

We would like to thank the complete DHMC Y2K Steering Committe for all their support and aid. Specially, we will like to thank Connie Durham, the Y2K Coordinator, for all the time she donated to our inquiries and requests. Also, thank you very much Peter Johnson, Vice-President of Informational Services, for allowing us to conduct this research at the DHMC. Finally we will like to thank Professor Kotz for coordinating this whole effort and allowing us to see beyond the Year 2000.

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10. References

[Ackerman99] Joel M. Ackerman. Presentation to the U.S. Senate Special Committee on the Year 2000 Technology Problem. Available at http://www.rx2000.org/data/y2k_us_senate.htm, Visited on March 1st, 1999.

[Calkins99] Sherry Calkins. "What's Happening with the Year 2000 Computer Issue at DHMC?" Center View, 6-7. January 1999.

[DHMC99] Information About the Dartmouth-Hitchcock Medical Center that was obtain from research conducted at the DHMC and the use of their 4 Volume Folders about their Y2K Compliance. Connie Durham is the keeper of the folders, February 19, 1999

[DHMC-W] Information About the Dartmouth-Hitchcock Medical Center. Available at http://www.hitchcock.org/pages/PhysGuide/DHMCinfo.html, Visited on February 20, 1999.

[Jagg99] Peter de Jager. Y2K: So many bugs... so little time. Scientific American, 280(1):88-93, January 1999.