The scene repeats up to 60 times a day in radiation oncology, where more than 12,000 patients a year come to The Emory Clinic for its high-tech ability to isolate tumors, calculate dosage precisely, and treat cancers of all types more effectively than ever. The linear accelerator, linked via computers to a CT scanner in a nearby room, is just one of the complex pieces of equipment that Emory physicist Ken Brooks and his colleagues in radiation oncology will carefully attend as the clock ticks toward the new millennium. But Brooks is concerned. He's well aware that without some software and hardware first aid between now and the end of this century, some of those computers may not know what to do when the clock strikes midnight to usher in the year 2000. Without some digital tweaking, the treatments will stop. The same goes for Brooks' pager, his telephone, computer, e-mail server, fax, and some of the 21 therapeutic devices that radiation oncology operates at four Emory Healthcare sites (the clinic, the Veterans Affairs Medical Center, Grady Hospital, and Crawford Long Hospital). |
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eep within The Emory Clinic, the young woman lies on a procedure table as it rotates in sync with the long arm of gray steel looming above her. Its monitor-like eye fixes a red laser light grid across her chest. A bank of terminals lining an adjacent space and connected to a series of five computers flashes her "prescription" to the linear accelerator inside, telling it exactly how much radiation to beam with pinpoint accuracy at its target: cancerous tissue in the woman's breast. At the technician's prompt, she holds her breath for a few seconds. A few soft clicks and quiet hums later, the tumor is irradiated, the surrounding healthy tissue minimally impacted, and unlike times past when breast cancer meant almost certain mastectomy, the breast remains intact.
Thousands of cancer patients come to The Emory Clinic each year for treatment using the Varian linear accelerator. At the heart of this device are hundreds of microchips programmed by complex software, all inextricably linked. |
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| The Varian Cliniac 2300CD linear accelerator symbolizes the ultimate in high tech at Emory, where, like many places in the world, faculty, staff, patients, and visitors have become increasingly dependent on technology at all levels. Computers not only help us diagnose and treat our ills, but do our work, plan our days, keep us in touch, pay our bills, cook our food, heat and cool our buildings, and get us to where we need to go - whether it's between floors or to outlying health centers.
For faculty and staff at Emory, computer-driven equipment is as much a part of our everyday lives as our alarm clocks and parking spaces. For the more than 2 million patients who come to Emory Healthcare annually, computers can mean the difference between life and death. We're not just talking about computers sitting on desks, but all systems and devices driven by computers or microchips. Systems such as the sprinklers at Emory Hospitals or the security systems at Yerkes Primate Center, which keep the animals in and unauthorized personnel out. Devices like kidney dialysis machines and ventilators that keep our critically ill patients alive. Specially coded chips run sophisticated Medicare, payroll, and supply-ordering software. Hardware and software store and retrieve student and patient records, calibrate intravenous fluids, and measure drug doses. Many of these systems and devices are dependent on programming and coding that are date-sensitive, sometimes in surprising ways. What would happen if the programming and coding in many of these systems or devices suddenly and simultaneously told them that the calendar had reverted back 100 years? What are the chances that they would malfunction or begin to operate in unpredictable ways? What are the chances that critical systems in everything from cars to aircraft to elevators to linear accelerators suddenly would be crippled? No, this is not some science fiction scenario dreamed up by a doomsday cult. Come January 1, 2000, there is a very real chance that millions of tiny pieces of silicon, which manage so much of our lives, may be unable to function properly. But the Woodruff Health Sciences Center is hoping that good planning and a lot of hard work will eliminate the chance of life-threatening or disruptive scenarios. The center has mounted an extensive proactive effort - including investing millions, marshalling a workforce of dozens of hardware and software experts, and making it a top priority - to correct the computer code at the root of all this angst.
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 n the information systems industry, a programming misstep in the way computer chips read dates is called the Year 2000 problem or Y2K. It stems from the fact that the year traditionally has been coded in computer chips with two digits instead of four, largely to save space. For example, 98 means 1998 and 75 means 1975. So when 2000 rolls around, the computer may read 00 as 1900 and start a chain of reactions that are at best problematic and at worst, unpredictable.
"We don't expect all applications relying on computers or imbedded chips with year 2000 problems to just stop working when the year 2000 rolls over," says Ron Palmich, chief information officer for the Woodruff Health Sciences Center, which includes Emory Healthcare. "Rather, what we may see is that they continue to operate, but produce incorrect results and information." It's a concern of enormous potential when you consider that less than 10% of all computer chips manufactured end up in computers. MRI equipment, microwave ovens, ambulances, pagers, radios, and telephones are but a few of the other places chips are found. The coding glitch is multi-layered as well: It's imbedded not only in hardware, but in operating systems, middleware (network software), and applications. And, the problem isn't just internal. Emory's hospitals do business with an estimated 6,500 outside vendors who supply more than 25,000 different items. For example, 70% of the world's insulin supply comes from one plant in Denmark, which has not finished its Y2K testing. Our hospitals' contingency plan, therefore, includes how to obtain insulin for patients if the current source can't deliver. A survey has been sent to outside vendors inquiring about their Y2K status. Vendors who do not respond will be recontacted, and it is anticipated that additional communications, including face-to-face meetings, will be necessary for vendors whose responses are inadequate or who are especially critical to the center's mission. To compound matters, more than one date has the potential to wreak havoc. The year 2000 is a leap year, unusual in that most century years are not leap years. Coding will be checked to ensure that it calculates this leap year correctly. Special attention also must be paid to dates ending in 9 because computer code uses the digit 9 to signify specific application actions, such as the end of a file. Specific dates throughout 1999 will be checked, including January 1, 1999 (the first time the year 99 will be read) and September 9, 1999 (the only time 9-9-99 appears).
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 ossible repercussions from the millennium bug won't end at least until 2001. End-of-the-year programs, such as those used in generating annual reports, may have been tested but will not actually run until the end of the fiscal or calendar year.
Insidious problems may build as the year progresses. "Programs may test within normal limits but could still be off just a hair," says Palmich. "Errors of this type will compound and by March, for example, a system could be really out of whack." Computers involved in forecasting may already be experiencing glitches. Palmich cites an example involving a grocery store chain that threw out an entire warehouse of food when its computers incorrectly noted that the expiration dates had passed. "The Y2K problem is an unprecedented business problem with an immovable deadline," says Palmich. "We know there are going to be problems. We want to ensure that they're inconveniences and not patient safety or business problems." An elevator that doesn't work, for example, is generally considered an inconvenience. It becomes a patient safety issue if there are no elevators working to transport critically ill patients to and from surgery. Similarly, it would be inconvenient if the National Institutes of Health couldn't pay Emory its grant money for a week. It would be a significant business problem if the NIH couldn't pay for a month or more. It is small consolation that every business, computer, and institution in the nation, if not the world, faces the same deadline with potentially severe consequences. The Gartner Group, an international information technology firm, estimates that 10% of mission-critical systems in the nation's health care organizations will break down because of failure to address Y2K. A Senate Special Committee on the Year 2000 Technology Problem found that about 80% of hospitals are analyzing the problem but only 30% have developed strategies. And glitches likely will translate into casualties: a British study predicts 600 to 1,500 deaths will be directly attributable to the Y2K problem in the UK - numbers some experts call conservative.
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 he year 2000's impact on Emory could be great or it could be minimal, but no one will know until we get closer to 2000. What we do know is that the health sciences center is vulnerable in the year 2000 transition because it is so vast (Emory Healthcare alone has more than 5,000 computers) and because many departments select and manage their own technology and outside vendors. It would be difficult, if not impossible, for one person or team to monitor every aspect of becoming Y2K compliant.
For example, Emory Hospitals use a "just-in-time" inventory system, which means they have only enough supplies on hand to last a few days. This system is efficient since the hospitals avoid costs of storing and maintaining large quantities of supplies, by using distributors as a virtual warehouse. However, such a system also means that Emory is vulnerable to Y2K failures in systems that are largely beyond its control. "The vast majority of our medical and surgical supplies, such as gauze and gloves, come from one distributor," says Lee Partridge, director of materiels management for Emory Hospitals. "We need to make sure our distributors are compliant with year 2000 issues well before 2000 gets here." Although the hospitals do not generally keep a lot in inventory, they're planning to stock a 30-day supply of critical items. "And, we will work with key suppliers to ensure we can place orders and receive supplies," Partridge says. Emory must also check all internal devices and systems - there are more than 15,000 in the hospitals, the clinic, and labs alone - to make sure they are Y2K compliant or that there is a plan to make them compliant. New machines are not exempt. "Just because a machine is new doesn't mean the chip inside meets Y2K standards," Palmich says. "We need to know if all our devices can handle the Y2K transition."
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n a system as large and as complicated as Emory's health sciences center, the logical way to deal with a problem of this nature is to develop overriding goals, cut the problem into manageable pieces, and dole out the pieces to those most familiar with the circumstances. In this case, that means giving the departments and schools the ultimate responsibility for their machines and systems. In management terms, that means having a centralized policy, with which everyone has to comply, and a decentralized implementation approach.
To do this, the process of becoming Y2K compliant is divided into information systems-related and noninformation systems-related components. The department of Information Systems (IS) is in charge of the overall plan for Y2K compliance, including managing a Lotus Notes database of all departmental Y2K compliance plans. Additionally, it is obtaining Y2K-compliant versions of current IS-supported software systems, testing and installing those versions, contacting hardware and software vendors to determine if their products are Y2K ready, and replacing systems as needed for the systems and applications that it maintains. The non-IS component covers systems and applications which are not supported by Emory Healthcare IS - including many desktop systems, databases, medical systems and devices, and service providers. Mike McCain, a Y2K consultant hired to manage the noninformation systems component, says that while top management takes this problem seriously and middle management is aware of it, "we need to build a greater sense of urgency throughout the enterprise. Now is the time to formulate our plans and start to execute them." To manage the large non-IS component, McCain and administrators of the hospitals and clinic have created a structure in which there are approximately 127 "plan owners," generally analogous to departments. The plan owners are in charge of identifying and correcting Y2K problems at the department level, contacting their vendors to ensure they are compliant, and creating contingency plans to enable Emory to continue operating in the event systems or suppliers fail. The schools of medicine, nursing, and public health as well as the Yerkes Regional Primate Research Center have individuals charged with developing their plans.
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 owever, much still falls outside of the responsibilities of plan owners.
"The health sciences center includes many researchers who have built and operated their own databases and networks. We're concerned that they become aware of the problem and take steps to become compliant," says McCain. "We don't want anyone to lose ten years of work." By September 1, every school and hospital and clinic department or division in the health sciences center was expected to have a detailed Y2K plan in the Lotus Notes database that outlines where the weaknesses are and what needs to be done to prevent systems from malfunctioning. The yeoman's job of assessing potential problems and guaranteeing compliance has been made somewhat easier by the fact that hospitals and their support systems are required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to keep detailed equipment inventories. "For example, we knew that Crawford Long had nearly 6,000 medical devices, excluding those in radiation and pathology," Palmich explains. "Of those, about 50% were not date dependent. The remaining 50% had to be tested. Of those, less than 200 had date failures. Some of these can be retired, some will be replaced as a matter of course before 2000, and some will simply have to be replaced. But having the inventory to start with was a great help." He adds that JCAHO also requires disaster contingency plans, such as alternative ways to get water or electricity should the main sources malfunction. "Our overriding concerns are for patient safety and business continuity and certainly we hope to protect the system from liability," says Palmich. "We are taking a due diligence approach and documenting as many of our activities as we can so we can prove it, just in case year 2000 proves to be a lawyers' paradise." Stephanie Maffett, assistant counsel in the office of the general counsel for Emory University, agrees with Palmich's priorities. "By focusing on patient safety and business continuity and adequately documenting actions, the health sciences center will go a long way toward exercising appropriate legal due diligence," she says. How well Emory handles the year 2000 rollover also has important public relations implications since hospitals are usually viewed as safe and secure. "If any glitches occur, that perception can be compromised," says Palmich. "If any problems occur at Emory's hospitals, they could damage our reputation."
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he planned phases and dates of completion of the compliance plan include the following:
"This intense evaluation process is really sanitizing," Palmich says. "It will help clean up lots of things. For instance, in our testing we've also uncovered problems not related to Y2K, such as deficiencies in the clinic's billing system that we're correcting. The problem is, everything is interrelated. Like links of a chain." And, like a chain, the Woodruff Health Sciences Center will only be as strong as its weakest link when the year 2000 rolls in. Only time will tell if the reinforcements are adequate, but Palmich and his staff are determined to make sure the center, indeed all faculty and staff, do everything they can now to ensure business as usual in the future. For Ken Brooks in radiation oncology - and his counterparts across the health sciences center - it's not a millisecond too soon to bring in those reinforcements. He's updating hardware and software now to make sure that the tools so critical to stopping cancer in its tracks work properly when the year 2000 rolls in.
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What kind of person would take on the challenge of containing the potentially explosive Y2K problem? Someone who is seasoned in computers, has experience with hard and fast deadlines, and can motivate hundreds of people to move in the same direction. Solid training for this job might include a stint as the individual in charge of computer systems for the Atlanta Olympics and membership on the team that put a man on the moon. That's Ron Palmich's resume. "Working on the Olympics and the Y2K problem are similar in that they both have fixed dates and there is no confusion on the objective," says Palmich, chief information officer for the Woodruff Health Sciences Center. "However, the Y2K problem is only one part of my job. You can't stop the world while you work this one out." Besides his Y2K responsibilities, Palmich must concentrate on other aspects of the job, including sorting out the health sciences center's complex computing needs. In response to strategic issues prioritized by the Lewin Group, an outside consulting agency, Palmich and his staff are now tackling such massive programs as electronic patient records and global patient registration. At his job for about two years, Palmich has compiled an impressive list of accomplishments, ranging from negotiating money-saving contracts with new vendors and bringing his programs in under budget to beefing up training and Information Systems' (IS) salary structure to make it more competitive with outside markets. He has also improved internal processes to make IS more responsive to its clients. Palmich earned a bachelor's degree in industrial psychology from the University of Washington and spent 37 years at IBM, working in all aspects of the business, from building hardware to marketing. "My education in industrial psychology has been a key piece in my career," he says. "It has been invaluable in being able to understand and motivate people." During his tenure with IBM, Palmich worked with Boeing on systems for moon landings and was part of the team that tested the Moon Rover. Commenting on similarities between getting computer systems ready for the Olympic Games and for Y2K, Palmich notes, "The Olympic Games were complex, but ultimately, they were games. If a newsperson doesn't have the results from an event in real time, it's a problem, but it's not life and death. Landing someone on the moon and helping Emory Healthcare with the Y2K problem can have much more serious consequences. |
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he success of Y2K compliance depends on all faculty and staff. The Woodruff Health Sciences Center has been divided into 197 areas with 127 plan owners. Each plan owner will create an inventory of machines, suppliers, and software that are date dependent, and will obtain written documentation from manufacturers and vendors providing assurance of each component's compliance. Plan owners will supply contingency plans just in case something fails.
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The plan owner does not develop all these lists, documents, and plans by him or herself, but will rely on individuals, such as yourself, to supply information. If you don't know who your plan owner is or what your department should be doing, ask your manager. Respond promptly to assignments that will make your department Y2K compliant. The schools of medicine, nursing, and public health and Yerkes Primate Center receive technical support for desktop and interdepartmental information systems from the Information Technology Department. The Information Systems Department supports medical systems and devices and outside vendors. The departments work together to prevent duplication of effort. So, when you are contacted to do your part, please take this seriously. It may not be apparent how the database on your PC affects others, but you at least want to ensure that your data will not be compromised. As Ron Palmich says, "If everyone does their part, this will be difficult, but doable." For further information on the management of Y2K, please refer to the Emory Year 2000 website. This site includes updates, tips, and a countdown clock to the year 2000.
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Copyright © Emory University, 1998. All Rights Reserved.
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Web version by Jaime Henriquez.