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Paul Barach, MD

JAMA. 1999;281:862.

Modern medicine would not have been possible without the 20th-century technological revolution. It is ironic, therefore, that this technology may pose significant problems to patients by the end of this year. The year 2000 problem (Y2K, as it is called) exists because mainframe computer programs were originally created to read only the last 2 digits of the year field in data, the first 2 digits being an implicit "19." So, when the year 2000 is entered on older software or systems, it will be read as 1900. This flaw may potentially wipe out data, prevent computers from starting up, and lead software programs to make faulty calculations.

Virtually every aspect of the medical profession depends on computer systems hardware, software, and microchip-embedded medical devices. Health care professionals rely on these systems to treat patients, handle data, monitor vital functions, select medications, document patient care, and handle administrative functions. In medicine, this problem could have devastating results since it could affect patient care.

Respirator-dependent patients without adequate respiratory support, malfunctioning cardiac support balloons in cardiac-crippled patients, and vital drug pumps going awry are just a few of the examples of the problems we could face. Other less life-threatening but potentially serious administrative aspects of Y2K include Medicare coding and billing. The Health Care Financing Administration just announced that it will delay implementation of its Medicare voluntary residency reduction program until it has addressed the Y2K problem.

Medical device manufacturers must immediately disclose whether or not their products are Y2K compliant. The Food and Drug Administration has received Y2K compliance information from only 11% of the 16,000 medical device manufactures worldwide. Assessing the status of the year 2000 problem is difficult not only because the inventory of the information systems and equipment that will be affected is far from complete, but also because the consequences of noncompliance for each system remain unclear. Most of the organizations that have thousands of these devices do not have the expertise and resources to test these devices properly and will have to rely on the manufacturers for assistance.

In an effort to address this problem, the American Medical Association has developed a national campaign entitled "Moving Medicine Into the New Millennium: Meeting the Year 2000 Challenge." The campaign, which will launch in July, will include educational seminars and a dedicated Web site. This site will serve as a communications clearinghouse, providing up-to-date information about the Y2K bug, as well as recommendations to solve specific problems. In addition, the National Patient Safety Foundation has made a concerted effort to increase public awareness of the year 2000 hazards.

What can you as a resident do to raise awareness and prevent patients' being harmed? Every resident should ask the chief of service and hospital administration if the medical equipment has been checked for Y2K failure and, if it has not, seek assurance that there is a correction plan that will be implemented in the near future. Ensuring compliance is vital to the health care needs of our patients.

Resident Representative, AMA Council on
Long Range Planning and Development
Boston, Mass

Prepared by Ashish Bajaj, Department of Resident and Fellow Services, American Medical Association.

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