Contributed by Ben Berkowitz

One of the things that Americans pride themselves on is having the best health care system in the world. Complaints about managed care aside, American health care truly is a cut above global standards. And of course, no one doubts how crucial an effective health care system is for a nation's survival, which is one of many reasons that Medicins Sans Frontieres (Doctors Without Borders) just won the Nobel Peace Prize. But many people have not stopped to think about health care and how it might be affected by Y2K, a 'bug' not even modern medicine can cure.

The Food and Drug Administration (FDA) has put an incredibly positive spin on Y2K. To hear them tell it, nothing will happen of any negative consequence on January 1 in anything relating to food, medicines, or medical equipment. Similarly, the Department of Health and Human Services (HHS) reports that as of October 1, all of its systems are operating in fiscal year 2000, and there have been no interruptions of data flow or services.

Predictions of happiness and total compliance, however, often should be taken with the same grains of salt that predictions of gloom and doom are considered with. Both the FDA and HHS are entirely confident in themselves and their regulated systems. Then again, the Chicago Tribune was entirely confident about Dewey defeating Truman in 1948.

A report relased November 10 by John Koskinen, the director of the President's Council on the Year 2000 Conversion, said that fully 50% of local 911 emergency call centers are not Y2K compliant. The danger is obvious: whether or not the rest of the health care industry makes it through Y2K in one piece, that readiness will not matter if people can not get to the hospital in the first place.

The Health Care Financing Administration, or HCFA, is in charge of administering Medicare and Medicaid. Its website lists the certification status of its internal systems. Of the systems listed, eight mission-critical systems have no listed compliance date. In the absence of other information, it is reasonable to assume that this means the systems are not yet compliance-certified. When eight mission critical systems are not ready 100 days from Y2K, another reasonable assumption is that there may well be a problem.

Since the United States has no formal national health insurance, the health care system in this country is highly de-centralized. In fact, American health care is a highly complex, heavily layered web of companies, government agencies, physicians, hospitals, and other service providers. Literally millions of people have daily jobs that have some pertinent function in providing people with health services. The problem with getting the 'health care industry' compliant is that very interconnectedness. A Y2K failure in just one computer at just one company's office could have a profound effect on thousands of people, depending on the company.

The section of the Senate Special Committee on the Year 2000 Technology Problem 100 Day Report that deals with Health Care is perhaps its most cautious. The report recommends, among other things, that people not make use of hospitals around the new year 'except in cases of acute need.' Further, the report says that there has been no organized, institutional contingency planning for patient safety related to Y2K. In short, the report raises serious concerns about readiness for private doctor's offices, biomedical equipment, and government billing systems. While most people would not mind if their monthly Medicare bill did not come, they would certainly mind their doctor not having working phones or EKG machines.

If the hospitals are not Y2K compliant, the problems could be enormous. In a telling article titled 'What about Y2K?,' Randy Alcorn of Eternal Perspective Ministries, relays the story of what happened when one person tried to make an appointment for January 2000 in a Pennsylvania hospital. The computer network that scheduled patient appointments at three hospitals and 75 clinics in the state shut down as a result. In mid-September, the state of California did a Y2K readiness drill on its hospitals. While the system performed admirably, Kirsten Schneider of Sutter General Hospital in Sacramento said in the September 17 Los Angeles Times, 'It's going smoothly, but not perfectly.' This included a failure of the system to be able to read how many hospital beds were available in a five-county area in southern California. Nonetheless, the general consensus is that of all the places to be on January 1, Y2K, a hospital may be one of the best.

The one health care segment most ready for Y2K is the pharmaceutical industry. In fact, the industry was singled out for special praise in the Senate report as being a leader in Y2K preparedness among American businesses. However, as with any multinational industry, there are still concerns about the ready availability of supplies from foreign manufacturers. Pharmaceutical companies have gone to great lengths to ensure that the necessary components are on hand to keep making medicines after January 1. The industry is hopeful that these measures will be prove to be unnecessary.

For more information on health care in the Year 2000, please click on the following links:

Government Links

Office of Statewide Health Planning and Development This site has many links to activities and support services that 'address key issues of access, cost, and quality of healthcare for all Californians.'

Federal Y2K Biomedical Equipment Clearinghouse This web site provides information and guidance to medical device manufacturers, healthcare providers, researchers, and the public. The site includes a searchable list of biomedical equipment and their Y2K compliance status. 'Compliance', in this case, means that the device will function 100% as intended, in that the date change will not adversely affect the device?s operation. The database will allow you to search for any specific item of biomedical equipment, and determine its compliance status, and the effect of a 'non-compliance'.

Year 2000 Healthcare Outreach Workgroup Provides an 'Assessment of State Health Agencies in the U.S.' This assessment is based on self-reported data from states collected December 1998 though February 1999, but limited by the non-response of 50% of the states and territories. The degree of compliance is also fairly high at 77% on average. Of greater concern are the 33 responses of 'unknown' with the greatest concentration (14) in the area of local public health agency readiness. Finally, the lack of contingency plans for 68% of the respondents plus the indication that there is no intent to develop a contingency plan by 18% of respondents is of significant concern.

Department of Health and Human Services This is HFCA's (Health Care and Financing Administration) Y2K project page, with links to news releases, Medicare-specific information, and other government links.

Millenium Status of Medicare Claims Related Standards Specific information regarding to special requirements HCFA will have for the medical assistance programs administered by the states.

Industry Links

American Medical Association Statement of the American Medical Association to the Special Committee on the Year 2000.

Rx2000 Solutions Institute This site houses comprehensive listings of vendor compliance, industry links, and data about health care's Y2K readiness.

Electronic Data Systems Provides a system where you can see if hundreds of thousands of products are ready for the Year 2000.