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Your Health and Y2K

August 31, 1998

Among life's few certainties is the passage of time. The year 2000 is coming, ready or not. Indeed, it is almost upon us. And equally as certain is that it will cause some degree of disruption in computer programs that require a date to function properly. Many of these programs were designed years ago, when computer memory was very expensive. To save space, years were abbreviated, so that 1970 became 70. The "19" was assumed. What will the computer think of the entry of "00?" According to the present programming in most of the country's older computers, this will be interpreted as 1900, not 2000. That will, we are told, present problems.

Will those problems effect the practice of medicine? Will it be dangerous to get sick in the year 2000? The problem, or potential problem, involves four components: the medical office, the medical facility, the medical device or machine, and general considerations.

The medical office is surely the least involved in possible Y2K snafus. Smaller medical offices may not have computers at all; and even in larger ones, computers are used primarily for patient scheduling, and billing. Some physicians may keep their patient's records on computer as well. The software involved is of recent origin, and the importance of a date for its proper operation is minimal. In any event, your doctor can examine you and prescribe the appropriate treatment regardless. He may be frustrated when he tries to use a computer to submit your insurance claim, but that's another problem. He might even resort to that hoary old method of collecting his fee from his patient (imagine!) and having the patient deal with his insurance company, or HMO, or PPO, or whatever. All in all, there shouldn't be a significant problem at the physician's office.

Medical facilities, such as hospitals or surgery centers, are more computer-dependent. Even here, however, the computer is not directly involved with patient care, but with such matters as scheduling, billing, inventory, purchasing, payroll, etc. Again, however, these computer programs may be recent enough to allow for the use of four digit year designations. It is conceivable, of course, that a facility might find itself so frustrated by scrambled data regarding payroll, and vacation times, for example, that some of its operations might be put on hold until the matter be resolved. Glitches in scheduling could cause mass confusion in admissions, or operating room schedules. Supplies could become scarce. One rumor currently making the rounds is that about fifty percent of all the insulin used in this country comes from a single foreign company. A problem with that firm's computers could obviously have great significance, but any failure of a hospital's computers to communicate with those of its suppliers could cause problems. Still, all this notwithstanding, if a medical facility is operational at all, your acute appendicitis attack should not prove fatal! The surgeon, the nurses, the operating room staff, and the medical equipment are there and will still be there whatever the computer can or cannot do.

Medical devices may be affected by Y2K, but the extent to which this is a problem is not clear. Do pacemakers, for example, have a Y2K connection? The answer appears to be "maybe." Some, I gather, have an imbedded chip that is date sensitive. If you have a pacemaker, you would be well-advised to contact your surgeon, or the maker of the device, to learn what significance, if any, Y2K may have for your heart. The matter is even murkier for other computerized medical equipment. The machines used in cataract surgery, for instance, contain computers. Whether the operation of these computers depends upon the correct date, however, is doubtful. As a physician who uses such a machine, I certainly do not program it with the date of the operation, nor does anyone else. I have a computer-containing machine at my office to determine the power of intraocular lenses to be inserted at cataract removal. When the machine is turned on, it asks, among other things, for the date. I have not attempted to insert "00" for the date, but if the machine balked, I could insert any date I pleased; the machine wouldn't know the difference, and it wouldn't effect its operation.

The most important considerations regarding the effect of Y2K upon medical practice will be the general ones: the availability of electrical power, telephones, and the like. Obviously, even the most dedicated individuals cannot work without these utilities. Again, your appendicitis attack could be treated, in an extreme case, with battery powered operating room lights, even if the hospital's or surgery center's auxiliary generating plants failed. But how about your heart attack? The monitor which sends a continuous EKG type signal to the nursing station may not be Y2K sensitive (or maybe it might!) but without electricity, it's moot. Obtaining proper medication from the supplier might be well-nigh impossible, at least on short notice, without telephone lines. Can drugs and equipment be flown to town if the airline computers are down? And while the staff might be willing to work without pay for a while, let's hope that some arrangement is made to pay them before you need their services. Of course, everyone else might be in the same boat.If traffic lights are computer-controlled, your ambulance ride to the hospital might be more dangerous than your illness, assuming you could call an ambulance!

It must also be realized that I do not know exactly what I am talking about. Neither, I gather, do at least some others who are concerned about this problem. The Y2K event will be anything from the end of civilization to a minor nuisance, depending upon the opinion you read. For a person such as myself, with limited computer expertise, the obvious question is never addressed: why, exactly, should the inability of a computer to recognize "00" as the year 2000 shut down the generation of electricity, (or the telephones, or the airlines?) Since electricity was in widespread use prior to computers, they obviously are not essential to its generation or distribution, although they may have made themselves so since their arrival on the scene. Aren't the older methods still available? And what does the Y2K problem have to do with telephone usage, or airline operation? I realize, of course, that these things involve computers, but why is the date so pivotal? The answers to these questions may be so obvious to computer-literati that they do not need presentation, but to the computer-illiterati, they are stumbling blocks. It seems apparent, however, that these general Y2K problems, however serious they might be, will be more troublesome in medical facilities--especially large ones, like hospitals--than in doctor's offices. If your health depends upon the proper function of devices like pacemakers, or respirators, you would be wise to check with someone knowledgeable about these machines before the next millennium.


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