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Y2K Syndrome: Year 2000 Situation in the Health Field
Dr. Jorge Raúl Rodríguez
Chief Director of the Year 2000 Sub-Commission
Argentine Society of Intensive Care
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As the new Millennium gets closer, our time to face the so called "Year 2000 Effect" gets shorter. This effect is a kind of nightmare that recalls a Sci-Fi movie, but is sound reality. The risk that not only computers, but all electronic systems that work with chips will be altered, is extremely high. Chips are so small and usual in machines and equipment currently used in home, shops, and factories, that the problem is underestimated. For instance a TV can have around 50 chips, while a plane probably has from 500 to a thousand. Towards the end of 1999, there will be from 25 billions to 30 billions chips in use in the whole world. Chips are present also in diverse systems and equipments, for example: cash registers, systems of companies and bank entities, traffic lights and other traffic systems, communications, control systems of manufacturing processes, robotics systems, cars, ships, planes, trains and modern subways, defibrillators, pacemakers, other kinds of medical equipment, and of course PCs, etc.
The list of equipments and systems with chips is endless. Is this problem a fantasy created by computer specialists? I transcribe the opening words from one of the lectures by Peter de Jaguer, one of the most important figures in the field, and who knows most about the subject in the world : " ...my role today, is not to entertain you, neither to amuse you, not even that you might get to like me. I believe that you will bear in mind some of the things I will say, or perhaps you will not even like the way in which I say certain things. But my only purpose here is just that, when you leave, I hope you will check your systems in order to verify that what I have told you is true. I don't even think you will believe what I tell you. As a matter of fact, I would prefer you to be extremely skeptical. Because someone who is a skeptic keeps asking the question "prove it to me, prove to me that this is a problem". Of course, there will be some cynics in the audience. There's nothing I can do. Cynical people made up their minds before entering the room, and why they are here wasting their time, I don't know...That is not a prediction, is a remark. That is how your systems are written currently. It is too easy to prove. All you have to do is go to a system, enter 00, press enter or put the clock forward to 01/01/2000 to see what happens: the systems will fail, and the computers will stop. All the applications of a computer will stop? Of course not. Some people had enough knowledge to do things the right way..."
The purpose of the current paper in not just to issue information about the problem, is to ask you to become aware as a professional of this problem and to allow yourself the benefit of doubt. Once you have read this article, only each one of you will be the performers with the ability to change this reality.
Source of the Year 2000 Compatibility Problem
The problem of year compatibility arises from the first computers, manufacturers, and programmers that worked in groups. In this stage (we mean the 50s and 60s decades) programming and storing information was very expensive. Each space of memory to be filled cost many dollars, therefore being necessary to save. A way to do this at the time, was representing dates by two digits, keeping in the computer's memory only the information about the 20th century (period from 1900 to 1999). Programs were executed by pierced cards, and the two digits system allowed entering more information by cards. For example, January 17th 1967, was represented as 17/01/67. This saved both memory and budget. It was mistakenly believed that by the year 1999, the current systems would no longer be in use and the date problem would be solved for sure. Programming, and creation of BIOS and chips with the two digits model went on until recently. Conclusions on this modality are more than obvious. Just a few companies began, in recent years, to generate equipment and systems without this problem.
The Problem of Dates and Year 2000
We already know that most equipments, current integrated systems, PCs, and software represent dates with the dd/mm/yy format, that is to say two digits for the day, two digits for the month, and two more for the year. This implies that, for instance June 22nd 1960, is represented thus: 22/06/60. Systems are prepared to read the two digits format for years, and they suppose that the year always begins with digits 19.
The problem will rise when turning from December 31st 1999 to January 1st 2000. Systems will not recognize the year 2000, and because of the way they were programmed, they will believe themselves to be in year 1900. This will produce a data processing mistake that will influence on the system's performance, in processes which include calculations with dates, with several consequences: from a mere impression of a mistaken date, to a wrong calculation of an age that is, for example, part of a more complex equation, or a wrong estimate of the real time gone by between two commercial transactions.
This problem affects most computer technologies and electronic components. It includes not only computers, software, and applications, but it could also affect medical equipment, security systems, electric and electronic systems, refrigeration systems, communication systems, or any other equipment that has internally incorporated integrated circuits (chips or microchips) with logics sensitive to real time (date and time). Those processes or routines of programs that do not use dates directly for derived calculations, will be barely affected.
But why is the date format not changed, thus solving the problem? It is not so easy. A program usually has thousands and thousands of code lines, several of which can include operations with dates, too. In other words, dates are always used for some kind of calculation in most programs. Finding the lines with dates, is like finding a needle in a hayloft. A programmer must be employed to devote himself five or six days a week in full time to solve the problem, which is the right way, though financing is not always possible.
Checking each code line, cost between 1 or 2 dollars in USA in 1998. If a type program has from 100 thousand to a million code lines, the budget is extremely high, even in our country where costs are a 50% lower .
What Are the Consequences of This Problem?
According to different authors, consequences are varied. Supposedly, all equipments or systems that work with chips may be affected one way or another.
Saturday, January 1st, year 2000, 11:00 AM: you wake up in the new Millennium, try to take a shower and the water runs cold. There is no electric power, such a disappointment! You try to phone you relatives, but the telephone is not working very well. The TV cannot be turned on, the freezer of your refrigerator drips water on the floor. It is very hot, and the air-conditioning is out of order. You decide to pay a visit to your brother, but your state-of-the art car does not get started and there is no public transportation, etc. This parody was illustrated by Edward Yourdon in his book about the year 2000 problem. It may be farfetched, but possible depending on the geographic location we consider .
It is obvious that all equipments and systems we mention before could be affected somehow by this problem. The worst part of it, is that specialists have not been able until today, to anticipate the real extent and impact of the year 2000 problem.
What Are the Probable Consequences on the Health Area?
Those equipments that do not have chips and/or software compatible with the turning of year 2000, may display disruptions in some of its functions in the turning of the Millennium. This does not mean that all machines will be altered. This change in functions could be critical or not. To be critical, it has to compromise vital areas of the equipment, resulting in a bad assistance to the patient.
Some examples of critical operation problems are:
1. Ultrasound scans that estimate pregnancy time or fetal age mistakenly.
2. Pacemakers that stop operating or internal defibrillators that do not respond.
3. Tomographs or Resonators in danger of stopping operations.
4. Respirators that alter their function and therefore oxygenate and vantilate badly a patient, or directly stops working.
5. Automatic Intravenous Pumps that alter or end their infusion.
6. Monitors that deactivate their alarm or turn off their display.
7. Computerized Monitoring Stations that stop working.
8. Machines for pressure recording (Swan-Ganz, PIC, TAM, etc.) that do not operate properly.
There are hundreds of examples like these about critical machinery equipments, that may or may not alter their operation; it depends on the kind of machine, trademark, model and software version. There are large data bases on the Internet, where providers and equipments are shown, and whether or not they are compatible with the Y2K problem. A very complete database from the state of New South Wales, Australia, can be found in http://www.y2k.gov.au . The FDA data base is in http://www.fda.gov/cdrh/yr2000 and Canada government's data base is in http://www.hc-sc.gc.ca .
Governments and their health areas, have been legislating the steps to be followed in the problem that is our matter. In our country, by presidential decree, the Unidad Ejecutora 2000 (Executor Unit 2000) was created in 1997 (resolution 152/97). The Unit depends from the Secretaría de Función Pública (Public Works Secretary), and its responsibilities are to deal with the Y2K problem in Argentina, to support organizations in general to face up to this problem ( http://www.sfp.gov.ar/2000 ). The Ministerio de Salud y Acción Social de la Nación (National Ministry of Health and Social Service) has settled limits to solve the problem in resolutions 145 and 146 from February 1999. They state September 1st 1999 as a deadline for certifying medical equipment regarding compatibility with year 2000. (At the end of this article, the 145 resolution is shown in detail  , ).
Approach to the Y2K problem
Inside the approach to the year 2000 problem, it is necessary to make clear that now, March 1999, is too late to solve it totally, only contingency programs can be created to soften its impact in different areas . In order to approach the problem, the following steps must be taken into consideration:
1. Get to know the problem in all its range and deepen the knowledge on its effect on health areas. To achieve this, there is wide information available on the Internet, that we provide in detail in the section "Recommended Webgraphy".
2. To determine the areas most likely to be affected in a health center, critical assistance, and they are: critical care areas such as intensive care, specialized unit of critical patients recovery and coronary unit, care units and emergency, neonatology, operating theaters, labs, image diagnosis area, sterilization sector, mobile units. These areas are just a guide: each institution has to determine their own.
3. Inventory of elements, machinery, and equipment that can be affected. This topic includes listing all the existing machinery in the hospital, recording the following information: kind of equipment, trademark, model, serial number, software version with which the equipment operates, manufacturing date, manufacturer, distributor and technical support representative in Argentina. If you already have a certification regarding year 2000, a copy must be attached.
4. Once the listing is made, the corresponding certification must be required. It must be written, in official paper from the manufacturing or provider company of the equipment, and must have information about the machine, such as model, serial number, and software version.
5. Make an inventory of the computer systems of the institution, too: PCs, single working stations, nets, printers, storage equipment, scanners, etc., all computer equipment material. .
6. Determine if the systems are compatible or not with Y2K, a procedure that must be supervised by the systems department. To obtain such information there is a series of programs that test your PC, for instance, Ymark of NSTL ( www.nstl.com ), Ontrack Y2K Advisor ( www.ontrack.com ).
Depending on the results, programs must be planned to diminish or prevent the impact of year 2000 on these elements. These programs are called Contingency Plans. The most important step is to detect and classify critical equipment, that is to say, those with changes that compromise basic operation functions and alter the performance of the machine in a way that affects life or puts the patient at potential risk. At the end of this article you will find a transcription of a data base on high risk machinery from the University of Kentucky, USA ( http://www.mccs.uky.edu/y2k ). The latter will let you have an idea of the most risky equipments.
High risk areas in a model hospital:
1. Critical Care Areas
2. Emergency care unit
3. Organic transplantation
4. Highly complex surgery, such as Cardiac Surgery
5. Image diagnosis
6. Obstetrics Neonatology
7. Operating theaters
9. Sterilization Maintenance
10. Service provision
The first stage in a contingency plan, is to detect the most critical areas, those most affected by the problem. After listing medical and computer equipment, and obtaining compatibility certifications, a group of equipments that is not compatible with the turning of year 2000 is defined. This leads to trying to create solutions for those non compatible equipments. Basic solutions may be:
· Replacement by a compatible equipment. Indispensable machinery must be replaced first.
· Adjustment of the equipment to the turning of the century by changing hardware parts and/or software version.
· Use of an alternative equipment without problems with year 2000, with a similar performance.
· Use of an alternative plan for this incompatibility problem, without equipment.
In computer systems this implies changing or updating of BIOS, other boards, operative system, and other critical programs. One of the biggest problem arises with personal development programs, where thousands of font code lines must be updated, which is neither easy, nor cheap. Programs that are used in large scale, such as operative systems, office automation packages, image processing, data bases, etc., generally do not mean trouble since there are versions already compatible with Y2K available in the market.
As what regards hardware, a PC can be incompatible with year 2000 at three basic levels:
· RTC: the PC's Real Time Clock, it may or may not have been created to jump to year 2000 automatically.
· BIOS (Basic Input and Output System) basic software that provides life to the PC's motherboard.
· Operative System: the platform upon which the PC runs. It could be Windows, Unix, Linux, IBM's OS or Macintosh's MacOS, as they are the most usually used.
PCs could have several problems, from not recognizing year 2000, to not registering leap years (such as year 2000), or recognizing year 2000 but not being able to retain dates once turned off, etc. Given the frequency of use of 9 in software design by some programmers, there are also programs under risk of altering their critical functions on September 9th 1999 (9/9/99).
However, the biggest problem arises with biomedical equipments. Year 2000 compatibility varies according to kind of equipment, model, and trademark, serial number, and software version. The same machine may be incompatible with a GX2.01 software version, for instance, and totally compatible with the GX2.02 version. The task of making inventories and testing medical equipments must be done by bioengineers. Basically, the following should be tested:
· Automatic passage of the machine operating, to year 2000.
· Turning the machine on in a date in January 2000, turning it off, and turning it on again.
· Turning it on in leap years.
· Testing of other dates that the examiner may consider risky.
Critical functions of the equipment and its performance must be evaluated in each testing. These items will allow later to prepare a report and make a compatibility certificate. Compatibility certificates are the minimum requirement from the manufacturer or the official provider company. These certificates must be made in headed paper, and they must state clearly, type of tested equipment, model, serial and software, testing dates, kind of results, and the consequent certificate with the tests. They must be signed by the engineer who carried out the tests, and endorsed by the signature of the Company's President.
Do not forget to work out contingency plans to face up to possible problems in New Year. What kind of contingency plans can be prepared for an emergency? Let us see some examples:
· Intensive care unit's trolley for CPR, and defibrillator operating
· Trying to have electric or mechanical-pneumatic respirators for immediate use (e. g.: Non micro-processed Neumovent; LifeCare, Drager EV-800 y EV-801, Siemens 900C, etc.)
· I.V. drop-counting devices with flux regulators to replace infusion pumps
· One or two electrocardiographs that operate correctly
· Non digital, non modulated monitors to exchange for another
Legal Aspects of the Problem
The first step to prevent legal problems regarding Y2K and its implications, is using equipments endorsed for utilization in the turning of the century.
If you ventilate a patient on December 31, 1999, and after midnight the equipment presents a problem without being properly certified, you will be responsible as a last resort, to moral, human, civil, and criminal judgment. No one can avoid professional responsibility. However, if the same thing happens to you while working with an equipment properly certified as compatible with year 2000, the responsibility is automatically transferred to those who signed the certificate for the equipment. That is to say, that firstly you must have compatibility certificates for each electronic equipment in your Unit. Apart from this you must have alternative contingency plans for critical problems that may endanger the patient's life.
Just as I mentioned in the opening of this work, the latter only aims at making us aware of the year 2000 problem and its consequences. I hope I had achieved my goal. This is a serious problem, anyone who underestimates it will run their own risks. I have no more conclusions. Next year we will speak about it...Don't you agree?
To exchange opinions among all FVCC registered, the FVCC would like to invite you to take part in the Discussion Forum.
 Renato Bustos M. Año 2000 Terremoto Informático. Ed. Grijalbo. 1998.
 Peter de Jaguer. Secretaría de la Función Pública. Jueves 10/07/1997 (Public Works Secretary. Thursday, 10/07/99) Conferencia brindada en el Auditorio del Banco Hipotecario Nacional (Lecture given in the National Mortgage Bank Auditorium). http://www.sfp.gov.ar/2000
 Peter de Jaguer; Richard Bergeon. Año 2000: cómo sobrevivir a la crisis informática. Anaya Ediciones. Madrid, febrero 1998.
 Edward Yourdon, Jennifer Yourdon. La bomba de tiempo del 2000. Editorial Prentice Hall, 1998.
 Ministerio de Salud y AS. Resolución 145/99 (Health and Social Service Ministry. Resolution 145/99) ( http://www.inforeg.mecon.ar/txtnorma/55891.htm )
 Sobre equipamiento informático y crisis del año 2000 (About computer equipment and year 2000 crisis). Memorandum 2344-SS-99. Secretaría de Salud (Health Secretary). GCBA.
 William M. Ulrich; Ian S. Hayes. The year 2000 software crisis. Challenge of the century. Ed. McGarw Hill, 1997.
 Documento Informático sobre el año 2000. Anexos I, II y III (Computer Document on year 2000. Added clauses I, II, and III). - Dirección General Adjunta de Procesamiento Informático (General Associated Bureau of Computer Processing). Secretaría de Salud (Health Secretary). GCBA.
1. Secretaría de la Función Pública. Unidad Ejecutora 2000. (Pubic
Works Secretary from Argentina. Executor Unit 2000. http://www.sfp.gov.ar/2000
2. Food and Drug Administration. Data base with more than 4000 biomedical equipment manufacturers. http://www.fda.gov/cdrh/yr2000
3. Rx 2000 Organization.A whole organization devoted to researching the Y2K problem on health. http://www.rx2000.org
4. New South Wales Goverment Dada Base. http://www.y2k.gov.au
5. Center for Disease Control. http://www.cdc.gov
6. Canada Health Goverment Site. A very complete data base on equipments. http://hc-sc-gc.ca
7. University of Kentucky Data Base. Data bases and important articles from the U.K.Y. http://www.mccs.uky.edu/y2k
8. Site of the English Institute of Electronic Engineering. http://www.iee.org.uk/2000risk
9. US Government. CIO Council Committee on Year 2000. Official site of the USA Government about Y2K. http://www.itpolicy.gsa.gov/mks/yr2000
10. American Medical informatics Association. http://www.amia.org
11. Nellcor Puritan Bennett. http://www.npb.com
12. Siemens: http://www.siemens.com
13. Hewlett Packard. http://www.hp.com
14. Drager http://www.drager.com
15. Infrasonics. http://www.malindkroft.com
16. Intel Corp. http://www.intel.com
17. Microsoft Corp. http://www.microsoft.com
18. Action 2000 . http://www.bug2000.co.uk/ . Government sponsored site aiming to assist medium and smaller businesses .
19. Web site of Peter de Jaguer. Canada. - http://www.year2000.com/
20. Year 2000 FAQ. - ftp://www.year2000.com/pub/year2000/y2kfaq.txt . Frequently Asked Questions about the Year 2000 Computer Crisis
21. IBM Corp. - http://www.ibm.com/IBM/year2000/
22. Siemens (Healthcare) http://www.siemens.co.uk/ Siemens has issued a circular announcing their intention of giving a website with details of non-compliant equipment. The site will be available "in a few weeks"
23. Siemens Nixdorf http://www.sni.de/public/uk_sys/whatsnew/y2000_us.htm
24. Sun Microsystems http://www.sun.com/970416/cover/roadmaps/year2000.html
25. Year 2000 Technical Support Center http://www.software.ibm.com/year2000/
26. ICL http://www.icl.com/year2000/index.html
27. Intel http://www.intel.com/italiano/PROCS/support/year2000/index.htm
29. Oracle http://www.oracle.com/products/servers/rdb/html/y2000.html
30. Raytheon Engineers & Constructors http://www.raytheon.com/rec/autosys/y2kpg1.htm
31. Y2000Registry.Com. - http://www.y2000registry.com/ - "Official International Directory of Y2K Awareness for Public Companies"
32. UK National Health Service: http://www.imc.exec.nhs.uk/2000/
38. Royal National Institute for the Blind. Voluntary Agencies Link Unit. Telephone (UK) 0171 388 1266. Information to help blind and partially sited people and carers with Year 2000 problems in the home. For information for the disabled generally and an information pack see
39. Compaq http://www.compaq.com/year2000/
41. Microsoft http://www.microsoft.com/year2000/
43. Australia : http://www.ogit.gov.au/committees/yr2000.html [replaced by http://www.ogit.gov.au/year2000/yr2000.html 21 July 1998] Commonwealth Year 2000 Committee and related material
44. Canada: Department of Industry http://strategis.ic.gc.ca/year2000
45. Canada: Treasury Board Secretariat http://www.info2000.gc.ca
46. Denmark http://www.fsk.dk/fsk/div/aar-2000/
48. European Union / European Commission - http://www.ispo.cec.be/y2keuro/
Year 2000 and euro: IT challenges of the century (mostly information about other sites)
49. Italy - http://www.aipa.it/news/anno2000/anno2000.htmn Autorità per l'Informatica nella Pubblica Amministrazione. Gruppo di lavoro "Cambio data anno 2000"
50. Netherlands - http://www.fsk.dk/fsk/div/aar-2000/
51. New Zealand - Organization for Economic Co-operation and Development http://www.oecd.org/puma/ -
52. The Year 2000 Problem: Impacts and Actions: this report can be accessed by clicking on "On-line documents" http://www.united.org.nz/2000.htm
53. Draft legislation for comment http://www.nzcs.org.nz/y2k_news.htm
54. Y2K news from the The New Zealand Computer Society - http://y2k.dia.govt.nz/indexnf.htm
NZ Department of Internal Affairs
55. Spain - http://www.ctv.es/USERS/estrella/2000.htm - Text of a proposition by the Government Joint Commission for Science and Technology, and report of a debate.
56. Sweden - http://www.itkommissionen.se/itsite/pages/nyheter.htm
57. Official Government year 2000 site - http://www.wilsonwhite.co.nz/y2kleg02.htm - Government ordinance, effected February 1997 and applicable to all Swedish government departments
58. UK - http://www.ccta.gov.uk/mill/mbhome.htm
59. Central Computer and Telecommunications Agency - http://www.hsebooks.co.uk
Health and Safety Executive report on Year 2000 risks from embedded systems http://www.wilsonwhite.co.nz/y2kleg01.htm . Legislation (not enacted)
60. USA - http://www.fda.gov/cdrh/yr2000/ipyr2000.html U.S. Food and Drug Administration
http://www.comlinks.com/legal/s22.htm - http://www.comlinks.com/legal/s22.htm Year 2000 Information and readiness disclosure act http://www.tarlo-lyons.com/
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