 The time period leading up to January 1st 2000 will be the most challenging ever for those in society who rely on computers or electronic devices as fundamental aids to their professional duties. Many people in the computer industry have begun to fear what will happen to computers after midnight on December 31st 1999. Computers which keep a record of the date in their internal electronic clocks could interpret the year 2000 as the year 1900 because only the year's last two digits are stored in memory. Many system critical programs on computers rely on internal calendar and timekeeping functions. Some computers could simply carry on working, others might display error messages and simply be put to normal by entering the date in a full four digit format. The biggest fear though is that some critical computers and programs essential to business and the maintenance of the infrastructure of nations could become disabled. In the areas of computing technology used by health and emergency services this could prove to be a serious issue that potentially could lead to loss of life. Those branches of healthcare that do not necessarily rely on electronic or computing technologies to diagnose patients or assist in their recovery will see an increase in the demand for their services, especially those provided by alternative and complementary practitioners. Practitioners and their governing bodies need to be prepared for a time where they will be called upon to provide backup to the conventional services of health bodies such as the UK's National Health Service (NHS). In association with this they will need to address the outcome of major shifts in the purchasing patterns of consumers of healthcare services towards alternative and complementary medical treatments. Current surveys of health services reveal that technology failures and breakdowns in administrative structures within conventional healthcare will increase as a direct result of computing or electronic equipment falling foul of year 2000 date processing problems, or as is said in computer circles, not being 'Year 2000 compliant'. When computers were first being developed and needed to record date information about events that they were working with, the computers programmer's would store the year part of the date in the computer's memory as a two digit number rather than four digits to save space in memory, which in the early days of computer development was very expensive and so had to be utilised efficiently. This meant that the year '1998' would be stored as '98', the computer automatically assuming that the century digits were '19'. A problem with this method of storing dates has surfaced in the last few years, especially with some older computers. The year '2000' would be stored as '00'. The computer would interpret the year as '1900'. Dates that were entered say a week before the year 2000 would have '99' as the year. As 2000 came round and the year became '00' the data entered the week before would now appear to have been entered 99 years in the future! As awareness of this apparently trivial issue increased it came to be known as the 'Year 2000' problem or 'Y2K' bug but also has been referred to as the 'Millennium Bug'. Many modern computers now store the date in full four digit format and the problem no longer arises. However older or 'legacy' computers as well as microchips used in many electronic devices may still have this bug. When dates become represented incorrectly, computers may produce meaningless information, random errors or even fail altogether. Nowhere is this most difficult to detect than in microchips embedded in electronic devices or within 'embedded systems'. Their use and presence now pervades practically every aspect of our lives. Use of Microprocessor Based Systems in Healthcare Of particular concern to the subject matter of this report are computer and electronic systems within hospitals, General Practitioner surgeries and Pharmacies. The concerns begin with basic necessities such as systems which supply
water or electricity. A failure in these can initiate a chain reaction
of problems which eventually will affect every facility that contributes
to the efficient functioning of a hospital or clinic. Consider the following
scenarios,
The Cost of Addressing the Year 2000 Issue As can be imagined, hiring technical staff to check computers and other electronic devices in hospitals room by room, bed by bed is going to be a mammoth task. Project management has to ensure that no thumbnail microchip critical to healthcare is left unchecked. The costs of ensuring that Y2K compliance is achieved are immense. In studies of hospitals in the US, a typical example of the scale of checking needed can be provided by looking at the efforts of a hospital such as St. Joseph's in Hamilton, New Jersey. St. Joseph's has some 3000 bio-medical devices that must be checked for Y2K compliance. This figure jumps to 10,000 when devices used by its research facilities are included. Even low tech mechanical equipment such as the hospital's ventilation system needed $40,000 to be upgraded. John Downs Coordinator of the Y2K team at the hospital says that, "I personally do not care if the parking system does not work and we're not charging the three bucks. If I have time, I will worry about something like that. What my concern is those critical applications. Nothing can impact patient care. Period. There's no ifs, ands or buts about it. That must be done." Sir John Bourn, head of the UK's National Audit Office reported to Parliament on 15 May 1998 in his report 'Managing the Millennium Threat II', that "..some parts of the NHS remain at risk of failing to meet the NHS deadline of 31st December 1998 for all critical systems to be ready and fully tested or contingency plans in place" There was limited information available at the time about compliance in the field of General Practice. In the report it was indicated that GP's as a body were likely to have difficulty in achieving compliance. Sir John called for the NHS to assure themselves that the medical services provided by GP's were not disrupted. In estimates provide by the National Audit Office it was thought that projects to manage Y2K problems in the NHS could amount to £170m with additional costs for GP services being £60m costing a total of £230m. Caution was proposed though as these figures were at the low end of estimates. In conventional businesses similar projects for organisations that provide services of the scale offered by the NHS and GP's would cost as much as £850m. Ongoing estimates continue to enlarge these figures and final costs for the NHS and GP services alone in the UK could amount to nearly a £1billion if not more. The UK's Prime Minister, Tony Blair, recognised the scale of the problem and on the eve of promising £3billion to address the governments internal departments' Y2K issues, said that "Every organisation must put in place contingency plans in case failures
occur in it's own systems or in other people's"
Paragraph 17 of Sir John Bourn's reports on the National Audit Office's survey of Y2K compliance in the NHS and states, "Inadequate resourcing increases the risk of failure, and the single largest area of concern raised in response to our survey was about the difficulties they anticipated in providing adequate resources. The NHS Executive have warned that the cost of skilled assistance on year 2000 projects is increasing and availability is reducing. This will put further pressure on year 2000 project budgets to the extent that external assistance is required." But the method of allocating resources within the medical services has not been well thought out by some. For example Bart Gilbert, director of clinical engineering at Robert Wood Johnson University Hospital in the US states, "A lot of the equipment we use is machinery that does things that we used to do manually. When things break we go back to the way we used to handle them and the patients are fine". The problem with returning to the manual methods used historically is that you're going to need the staff to carry them out. Either existing staff will have to be given an increase in their workload or extra personnel are going to be needed. It all adds to the budget to address the Y2K issue. In the UK were there is a shortage of such staff and a disenchanted body of nurses and doctors that are already overloaded with duties. Additional duties that arise out of Y2K faults in the thousands of medical devices in each hospital could prove to be the straw that breaks the NHS's proverbial back. Implications for Alternative and Complementary Medical Practitioners. There are many individuals in the Alternative and Complementary medical fields that are qualified in conventional medicine either as nurses or doctors. This vast reserve could provide the additional staffing requirements in hospitals come the year 2000. However the critical problem of having working diagnostic and patient management equipment available will still be present. Without such working equipment, quality of patient care will reduce and recovery times will increase. This trend will lead to a situation where demand for medical services will exceed supply due to delays imposed by Y2K faults or lack of available working medical equipment. Alternative methods of diagnosis may need to be introduced which do not rely on electronic devices. In addition, new methods of patient management will need to be implemented to process patients more effectively. The prime area for acquiring such resources is amongst alternative and complementary medical practitioners. Historically, practices such as Homeopathy, Acupuncture or Herbal Medicine do not rely on computerised equipment or electronic devices either to diagnose or to treat patients. An issue arises from this option though. This issue is the time taken by such practitioners for initial consultations. Typically this can be anything from one to three hours. Due to Y2K issues in conventional medical services there is likely to be an increase in the number of new patients requesting alternative and complementary medical healthcare. This could lead to a decrease in the availability of a practitioner for existing patients. However this commitment to a significant initial consultation period is usually offset by the reduction in the probability of the patient returning with the same problem. Therefore rates of supply and demand are likely to rise initially but will soon equalise. The Need for Caution in Integration with Conventional Medical Services Currently many bodies within Alternative and Complementary medical fields are working towards making respective treatments more accessible for the public through the NHS. Clearly if there are likely to be administration problems even before the provision of such services then it would be unwise to integrate them until the NHS and GP services are fully Y2K compliant. In addition to there being a need for NHS and GP services being Y2K
compliant there will be a need for any practitioners of bodies within alternative
and complementary medicine to also be Y2K compliant. The issue of Y2K problems
is not likely to be as manifest amongst this category of individuals. However
it is imperative to recognise that as far as the Y2K bug is concerned there
only needs to be one computer that is not compliant that when connected
to a computer network which is linked directly or even indirectly to a
critical healthcare computer system may cause possible administrative chaos
to arise. Even computers used in private by practitioners could produce
inaccurate reports which when absorbed into larger pools of computer information
could cause a cascade of errors to the point where quality of patient care
and management will deteriorate. All Practitioners need to ensure that
their computer equipment is Y2K compliant.
Further information about how to prepare computer systems to become Y2K compliant is given at the end of this report. In the meantime those who work in the alternative and complementary medical fields need to recognise that the search for the availability of quality healthcare that is not susceptible to Y2K problems could be accompanied by a shift in attitudes by the public that technology based medicine is unreliable. The public may feel that any modes of treatment not relying on technology in diagnosis or patient care may become a more sensible option to have faith in. It is conceivable that members of the public could be involved in a huge migration from a desire to be treated by conventional medicine to a need to receiving care from alternative and complementary medical practitioners. If public faith migrates en masse to disciplines such as Homeopathy, Acupuncture, Spiritual Healing or similar modes of treatment that do not rely in principle on computerised or electronic equipment then the subsequent effect on those individuals' mental, physical and emotional states is inevitably going to lead to major shifts in the very nature of society. The Y2K problem is not limited to computers systems of Health and Welfare
organisations. It is present in the fields of Finance, Defence, Law, Transport,
Public Order not to mention Government itself and every private computer
user. All these areas which have not become Y2K compliant within the next
year are likely to have breakdowns in their infrastructure that could affect
the well being of every human being alive. Each one of us has to respect
the fact that the Y2K issue is something that we need to take responsibility
for. The well being of every one of us after the year 2000 is going to
depend on what actions we take between now and then.
(1) The government's Action 2000 and Millennium Bug Campaign have been specifically set up to address Y2K issues raised in the UK. UK Action 2000 Hotline (2) Managing the Millennium Threat II, Report by the Comptroller and Auditor general, HC 724 1997/98, 15 May 1998, ISBN: 0102962987. Copies of the above report are available from, The Publications Centre The Stationary Office Bookshops, (Many additional local offices exist in the UK) The Parliamentary Bookshop, (3) The Health & Safety Executive have guidelines for managing Y2K problems in safety critical areas. 'Health & Safety and the year 2000 problem' and 'Safety and the year 2000' can be obtained from, Major sites that provide background and updates to the year 2000 issue are 1. UK Government Millennium Bug Campaign http://www.open.gov.uk/bug2000World Wide Web Year 2000 sites Legal and management. http://www.y2K.comBBC Education http://www.bbc.co.uk/education/cdb/bug/index.shtmlHealth and Safety Executive (HSE), "Health and Safety and the year 2000 problem". http://www.open.gov.uk/hse/year2000.pdfNews items and reports referred to in this report are:- 2. New Jersey Online & The Times, March 16 1998, Mark
Perkiss.
3. BBC News, Monday March 30 1998, Science Correspondent, David
Whitehouse
4. BBC News, Tuesday May 5 1998,
5. The Hamilton Spectator, May 7 1998, David Akin.
6. BBC News, Friday May 15 1998,
7. Chicago Tribune, Wednesday June 17 1998, Jon Van.
Ijaz Rasool was born in 1966 in Pakistan. He has been resident in London since 1970. He is a scientist with a BSc in Astrophysics, obtained from Queen Mary College at the University of London and a MSc in Computer Modeling of Molecular and Biological Processes from Birkbeck College's Crystallography Dept. also at the University of London. He has been a lecturer at complementary medical colleges and universities for several years presenting classes on the Scientific Foundations of Complementary Medicine and the recently developed science of Consciousness Studies. He is a Co-Facilitator of the Energy Medicine Group of the Scientific & Medical Network. Currently he is providing specialist technical support for the computer databases of major Fortune 1000 companies. .  (c) 1993-1998,Ijaz Rasool, All Rights Reserved. Last updated  |