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THE CUTTING EDGE

Hospitals Treating Y2K Bug as Serious Ill

Replacing Affected Equipment Is Priority for Litigation-Conscious Health-Care Field

November 23, 1998|BARBARA MARSH | TIMES STAFF WRITER

A cardiac monitor stalls. An ultrasound device miscalculates the age of a fetus. A radiation-therapy machine deals a deadly overdose to a cancer patient.

These dire scenarios present real concerns for hospitals scrambling to prepare for the year 2000 and, with it, the threat of malfunctioning computer technology.

Many types of medical equipment that are used to diagnose, treat or prevent disease rely on calendar dates to run properly or stamp the time on a patient's chart. When the clock passes midnight on Dec. 31, 1999, experts predict, a significant, though unknown, number of systems could succumb to an internal flaw: They won't recognize the programmer's two-digit shorthand "00" for the year 2000 and, as a result, could make wrong calculations or shut down entirely.

Medical experts say most of the medical technology in hospitals here and elsewhere should work safely and that hazards to patients will be rare. But the thought of even a few incidents is enough to cause anxiety.

"You have to look at the numbers, and this makes me worry," says Dr. Kenneth W. Kizer, undersecretary of health for the Veterans Health Administration, which annually cares for about 3 million veterans at more than 1,100 hospitals, clinics and other facilities nationwide.

"How many patients are treated in America every day? About 3.8 million in a hospital or outpatient setting," Kizer says. "Those in intensive care, for example, are having hundreds to thousands of interactions with technology a day. Say there's just a tiny fraction of the devices or systems that don't work that could cause harm--the numbers are still bothersome."

Hospitals across the country are bracing for millennial problems of a scope and complexity that no one fully understands. Anything from a small $800 medication pump to a $1.6-million nuclear accelerator that kills tumors may be suspect. Two-digit dating errors may arise in the software or in an embedded chip.

Threats to patient safety raise the prospect of potentially huge hospital liabilities. Malpractice insurers are mulling over whether to cover any patient-related mishaps. And some hospitals have only a few months to make corrections because some date-related snafus will start showing up in January.

Hospital officials say they're focusing first on ventilators, heart-lung machines, cardiac monitors and other life-support equipment. They're also concerned about anything that's technically complex, such as CT scan machines, nuclear accelerators, ultrasound equipment, lab equipment and computerized linkups between equipment.

Unless the technology is debugged or replaced beforehand, some of this equipment will stall. Other items will keep working, with some possibly jeopardizing future care by stamping incorrect dates on patient records throughout the hospital.

Costs of Resolving Problem Are Huge

Ken Kleinberg of GartnerGroup, a Stamford, Conn., technology consulting firm, predicts the cost of trouble-shooting millennial software problems across all industries worldwide could total $300 billion to $600 billion.

He figures that the U.S. health-care system's tribulations could account for $10 billion to $20 billion. That excludes the costs associated with medical equipment. "Nobody [knows] those numbers," Kleinberg says.

For individual hospitals, the millennial challenge is enormous. For large hospital systems, equipped with tens of thousands of various machine makes and models, the job of locating a weak link is a mind-numbing task.

"It's an enormous project--much bigger than I expected," says Marc Beauchesne, a movie industry software developer hired last year to run Cedars-Sinai Health System's Y2K project.

Cedars' 1,000-bed hospital, research center and outpatient offices house as many as 20,000 pieces of equipment, he says. His handpicked team of a dozen technical specialists--including six biomedical engineers--has made its way through about 70% of the inventory. Thus far, they've turned up 1,700 pieces of clinical equipment with date-related problems.

Among them: Fifty-two defibrillators, which modulate irregular heart rhythms, won't work come Jan. 1, 1999. These defibrillators, worth a total of $350,000, could be fooled into working if they were reset using a bogus date, Beauchesne says. But Cedars-Sinai will replace them rather than run the risk of having an erroneous date on a patient's record lead to errors in medical care and potential legal liability.

"If you take an X-ray of someone's heart, for example, it must be dated appropriately so doctors can take the necessary action," Beauchesne says.

Beauchesne estimates that the cost of resolving Cedars' millennial problems in medical equipment will be $5 million.

For any hospital, recent changes in health care render the job difficult. Rising cost-cutting pressures by managed care have forced patients with less serious problems out of the hospital and into outpatient care. As a result, the typical hospital patient today is sicker than a decade ago.

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