Year 2000 Computing Crisis: Action Needed to Ensure Continued Delivery of
Veterans Benefits and Health Care Services (Testimony, 04/15/99,
GAO/T-AIMD-99-136).

Pursuant to a congressional request, GAO discussed the Department of
Veterans Affairs (VA) year 2000 readiness, focusing on: (1) VA's ability
to deliver benefits and health care services through the turn of the
century; and (2) the readiness of automated systems that support such
delivery, the compliance status of biomedical equipment used in patient
care, and the year 2000 readiness of the pharmaceutical and
medical-surgical manufacturers upon which VA relies.

GAO noted that: (1) VA continues to make progress in its year 2000
readiness; (2) however, key actions remain to be performed; (3) for
example, the Veterans Benefits Administration and Veterans Health
Administration (VHA) have not yet completed testing of their
mission-critical systems to ensure that these systems can reliably
accept future dates--such as January 1, 2000; (4) also, VHA has not
completed assessments for its facility systems, which can be essential
to ensuring continuing health care; (5) in addition, neither VA nor the
Food and Drug Administration have implemented GAO's prior recommendation
to review the test results for biomedical equipment used in critical
care/life support environments; (6) further, VHA's pharmaceutical
operations are at risk because the automated systems supporting its
consolidated mail outpatient pharmacies are not year 2000 compliant; (7)
VHA does not know if its medical facilities will have a sufficient
supply of pharmaceutical and medical-surgical supplies on hand, because
it does not have complete information on the year 2000 readiness of
these manufacturers; and (8) it is critical that these concerns be
addressed if VA is to continue to reliably deliver benefits and health
care.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  T-AIMD-99-136
     TITLE:  Year 2000 Computing Crisis: Action Needed to Ensure
	     Continued Delivery of Veterans Benefits and Health Care
	     Services
      DATE:  04/15/99
   SUBJECT:  Y2K
	     Computer software verification and validation
	     Strategic information systems planning
	     Systems compatibility
	     Systems conversions
	     Medical information systems
	     Medical equipment
	     Embedded computer systems
	     Veterans benefits
	     Health care services
IDENTIFIER:  Y2K
	     VBA Beneficiary Identification and Record Locator
	     Subsystem
	     VA Compensation and Pension Benefit Payment System
	     Treasury Financial Management System

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TESTFMSEAL.eps GAO United States General Accounting Office

Testimony Before the Subcommittee on Oversight and Investigations,
Committee on Veterans' Affairs, House of Representatives

For Release on Delivery Expected at 9: 30 a. m. Thursday, April
15, 1999

YEAR 2000 COMPUTING CRISIS Action Needed to Ensure Continued
Delivery of Veterans Benefits and Health Care Services Statement
of Joel C. Willemssen Director, Civil Agencies Information Systems
Accounting and Information Management Division

GAO/T-AIMD-99-136

  GAO/T-AIMD-99-136

Page 1 GAO/T-AIMD-99-136

Mr. Chairman and Members of the Subcommittee: We appreciate the
opportunity to participate in today's hearing on the readiness of
the Department of Veterans Affairs (VA) to deliver benefits and
health care services through the turn of the century. We will
focus on the Year 2000 (Y2K) readiness of automated systems that
support such delivery, the compliance status of biomedical
equipment used in patient

care, and the Y2K readiness of the pharmaceutical and medical-
surgical manufacturers upon which VA relies. In discussing
biomedical equipment and pharmaceutical products, we will also
share with you information on the Food and Drug Administration's
(FDA) Y2K efforts. 1 In brief, VA continues to make progress in
its Y2K readiness. However, key actions remain to be performed.
For example, the Veterans Benefits Administration (VBA) and
Veterans Health Administration (VHA) have not yet completed
testing of their mission- critical systems to ensure that these
systems can reliably accept future dates-- such as January 1,
2000. Also, VHA has not completed assessments for its facility
systems, which can be essential to ensuring continuing health
care. In addition, neither VA nor FDA have implemented our prior
recommendation to review the test results for biomedical equipment
used in critical care/ life support environments. Further, VHA's
pharmaceutical operations are at risk because the automated
systems supporting its consolidated mail outpatient pharmacies are
not Y2K compliant. Finally, VHA does not know if its medical
facilities will have a sufficient supply of pharmaceutical and

medical- surgical supplies on hand because it does not have
complete information on the Y2K readiness of these manufacturers.
It is critical that these concerns be addressed if VA is to
continue reliably delivering benefits and health care. Key Actions
Remain to Ensure That VA Can Deliver Benefits and Health Care Into
the Next Century

Like many organizations, VA faces the possibility of computer
system failures at the turn of the century due to incorrect
information processing relating to dates. The reason for this is
that in many systems, the year 2000 is indistinguishable from
1900, since the year is represented only by 00. This could make
veterans who are eligible for benefits and medical care appear
ineligible. If this happens, the issuance of benefits and the 1
Biomedical equipment refers to both medical devices regulated by
FDA and scientific and research instruments, which are not subject
to FDA regulation.

Let t er

Page 2 GAO/T-AIMD-99-136

provision of medical care that veterans rely on could be delayed
or interrupted.

As we reported last August, 2 VBA had made progress in addressing
the recommendations in our May 1997 report 3 and making its
information systems Y2K compliant. It reported it had renovated 75
percent of its mission- critical applications as of June 1998. At
the same time, VHA reported it had assessed all and renovated the
vast majority of its missioncritical information systems. Despite
this progress, VBA was making limited progress in renovating two
key mission- critical applications-- the compensation and pension
online application and the Beneficiary Identification and Record
Locator SubSystem. And, except for its Insurance Service, VBA had
not developed business continuity and contingency plans for its
program services-  Compensation and Pension (the largest),
Education, Loan Guaranty, and Vocational Rehabilitation and
Counseling-- to ensure that they would continue to operate if Y2K
failures occurred. VHA's Y2K program likewise had areas of
concern. For example, although VHA's medical facilities had
hospital contingency plans, as required by the

Joint Commission on Accreditation of Healthcare Organizations,
they had not yet completed Y2K business continuity and contingency
plans. To address these areas and to reduce the likelihood of
delayed or interrupted benefits and health care services, we
recommended that VA  reassess its Y2K mission- critical efforts
for the compensation and pension online application and the
Beneficiary Identification and Record Locator Sub- System, as well
as other information technology

initiatives, such as special projects, to ensure that the Y2K
efforts have adequate resources, including contract support, to
achieve compliance in time;  establish critical deadlines for the
preparation of business continuity

and contingency plans for each core business process or program
service so that mission- critical functions affecting benefits
delivery can be carried out even if software applications and
commercial- off- the2 Year 2000 Computing Crisis: Progress Made in
Compliance of VA Systems, But Concerns Remain (GAO/AIMD-98-237,
August 21, 1998). 3 Veterans Benefits Computer Systems: Risks of
VBA's Year 2000 Efforts (GAO/AIMD-97-79, May 30, 1997).

Page 3 GAO/T-AIMD-99-136

shelf (COTS) products fail, including a description of resources,
staff roles, procedures, and timetables needed for implementation;
and  ensure rapid development of business continuity and
contingency plans

for each medical facility so that mission- critical functions
affecting patient care can be carried out if software
applications, COTS products, and/ or facility- related systems and
equipment do not function properly, including a description of
resources, staff roles, procedures, and timetables needed for
implementation. 4

VA Continues to Make Progress VA has been responsive to our
recommendations. For example, VBA reassessed its mission- critical
efforts for the compensation and pension online application and
the Beneficiary Identification and Record Locator Sub- System, as
well as other information technology initiatives. It also
reallocated resources to ensure that the Y2K efforts had adequate

resources, including contract support, to achieve compliance. In
addition, VBA completed a draft business continuity and
contingency plan in January 1999 for its core business processes,
as well as a related planning template for its regional offices.
The plan provides a high- level overview of the resources, staff
roles, procedures, and timetables for its implementation. It
addresses risks, including mitigation actions to reduce the impact
of Y2K- induced business failures, and analyzes the effect on each
business line of a number of potential Y2K disasters-- such as
loss of electrical power, loss of communications, loss of data
processing capabilities, and failure of internal infrastructure.
According to VBA, the plan, which it expects to test this August,
is an evolving document, to be revised and updated periodically
until January 1, 2000.

VBA's plan makes no reference to contingencies for the failure of
three of VBA's benefit payment systems-- Compensation and Pension,
Education, and Vocational Rehabilitation and Counseling. However,
it is currently developing a payment contingency plan for these
systems and expects this to be completed in May 1999. A VBA
official told us that the payment contingency plan should have
been referenced in VBA's business continuity and contingency plan
and will be in future versions. The current plan also does not
contain the designation of an information technology security

coordinator and a physical security coordinator-- individuals that
VBA acknowledges are essential to the agency's Y2K efforts-- with
responsibility 4 GAO/AIMD-98-237, August 21, 1998.

Page 4 GAO/T-AIMD-99-136

for ensuring overall security for VBA's network and web site and
backing up data storage before, during, and following January 1,
2000. This type of information will be necessary if security-
related failures occur. According to VBA, it expects to designate
these individuals by August 1999. VHA has also made progress in
developing business continuity and contingency plans for its
medical facilities. Last month, VHA issued its Patient- Focused
Year 2000 Contingency Planning Guidebook to its medical facilities
describing actions they can take to minimize Y2K- related
disruptions to patient care. The guidebook discusses how the
facilities

should develop contingency plans for each major hospital function-
- such as radiology, pharmacy, and laboratory-- as well as each
major support function-- such as telecommunications, facility
systems, medical devices, and automated information systems. The
guidebook also contains examples of plans, policies, and solutions
for problems that a medical facility may face and provides Y2K
templates describing the areas a facility should address by
specific hospital function. VA provided this guidebook to the
medical facilities early last month and expects the facilities to
use it to prepare their individual business continuity and
contingency plans, set to be completed by April 30. The guidebook
stresses that these plans should be tested and suggests that the
medical facilities begin testing in June. The guidebook addresses
external emergency preparedness as well as internal operations.
Specifically, it discusses three functions that medical facilities
should perform in order to ensure that potential external hazards
are considered and planned for. These are (1) performing an
assessment of hazard vulnerabilities-- that is, the types and
kinds of Y2K problems that are anticipated within the community,
(2) conducting an inventory of community resources-- people,
money, clinical space, supplies, and equipment-- available to
address these hazards, and (3) closing the gap between
vulnerabilities and capabilities by putting into place measures
that will mitigate potential disruptions in critical services by
developing new working relationships with various government
agencies, non- VA health care organizations, and vendors of
critical supplies. In addition to implementing our
recommendations, VA continues to make

progress renovating, validating, and implementing its systems. On
March 31, 1999, VA reported to the Office of Management and Budget
(OMB) that the department has renovated and implemented all of the
mission- critical applications supporting its 11 systems areas. As
shown in table 1, VBA has six of these areas, and VHA has two.

Page 5 GAO/T-AIMD-99-136

Table 1: Reported Status of VA's Mission- Critical Computer
Systems Areas and Their Applications

a Of this total, 316 applications were renovated and two were
replaced. Source: VA. We have not independently verified this
information.

Testing of Mission- Critical Systems Not Yet Complete Complete and
thorough Y2K testing is essential to providing reasonable
assurance that new or modified systems will process dates
correctly and will not jeopardize an organization's ability to
perform core business

operations. 5 Because the Y2K problem is so pervasive, potentially
affecting an organization's systems software, applications
software, databases, hardware, firmware, embedded processors,
telecommunications, and Component/ office (number of systems)
Systems areas Number of applications

renovated or replaced

Veterans Benefits Administration (6) Compensation and Pension 30

Education 24 Insurance 3 Loan Guaranty 19 Vocational
Rehabilitation 4 Administrative 27

Total 107

Veterans Health Administration (2) Veterans Health Information

Systems and Technology Architecture 105 Veterans Health
Administration Corporate Systems 95

Total 200

National Cemetery System (1) Burial Operations Support System/

Automated Monument Application System 1 Reengineer 1

Total 2

Office of Financial Management (2) Personnel and Accounting

Integrated Data 8 Financial Management System 1

Total 9 VA total 11 318 a

5 Year 2000 Computing Crisis: A Testing Guide (GAO/ AIMD- 10.1.21,
November 1998).

Page 6 GAO/T-AIMD-99-136

interfaces, the requisite testing can be extensive and expensive.
Experience is showing that Y2K testing is consuming between 50 and
70 percent of a Y2K project's time and resources. According to our
Y2K guide, to be done effectively, testing should be planned and
conducted in a structured and disciplined fashion. Our guide
describes a step- by- step framework for managing Y2K testing,
which includes the following key processes:

 Software unit testing to verify that the smallest defined module
of software (individual subprograms or procedures) continues to
work as intended.  Software integration testing to verify that
units of software, when combined, continue to work together as
intended. Typically, integration testing focuses on ensuring that
the interfaces work correctly and that

the integrated software meets requirements.  System acceptance
testing to verify that the complete system-- that is, the full
complement of application software running on the target hardware
and systems software infrastructure-- satisfies specific

requirements and is acceptable to users. This testing can be run
separately or in some combination in an operational environment
(actual or simulated) and collectively verifies that the entire
system performs as expected.

According to VBA and VHA officials, their testing criteria were
based on their software development life cycle guidance documents.
They said that upon completion of software unit and integration
testing, a system is considered Y2K compliant. They said this type
of testing had been completed for all of their mission- critical
systems.

As of March 31, 1999, neither VBA nor VHA had completed systems
acceptance testing-- which requires that each system be tested,
including full forward- date testing, on a compliant platform--
for all their missioncritical systems. Specifically, according to
VBA officials, the agency had completed systems acceptance testing
for half of its mission- critical systems-- Insurance, Loan
Guaranty, and Vocational Rehabilitation and Counseling. According
to VBA's March 1999 draft test plan, systems acceptance testing of
the Compensation and Pension and most of the Education systems was
to start in mid- April 1999. According to a VBA official, one of
the reasons for the late systems testing was that the IBM platform
at its Hines, Illinois, data center was not made Year 2000

Page 7 GAO/T-AIMD-99-136

compliant until the compiler 6 was upgraded in February 1999.
According to VBA, the Compensation and Pension and most of the
Education systems will be future- date tested throughout April.

VHA also plans to begin system acceptance testing of its mission-
critical systems this month and complete it this June. According
to VHA officials, they could not perform this type of testing
before March of this year because VHA did not have a separate Y2K-
compliant test environment to

isolate the testing from the hospital systems in use. In addition
to testing of individual systems, end- to- end testing of multiple
systems is also critical. End- to- end testing, as defined in our
test guide, verifies that a defined set of interrelated systems,
which collectively support an organizational core business area or
function, continues to work as intended in an operational
environment, either actual or simulated. For example, in order to
successfully process a compensation benefit

payment to a veteran, VBA's Compensation and Pension System must
work correctly with its Beneficiary Identification and Records
Locator SubSystem, Treasury's Financial Management System, the
Federal Reserve System, and financial institution systems.

VBA and VHA plan to conduct end- to- end testing between now and
this July. VBA is defining end- to- end testing as verification
that core missioncritical business functions, including benefit
payments and vendor and payroll payments, process correctly. The
interfaces between VBA's benefits system and Treasury's Financial
Management System are to be tested in May. VBA also plans to test
transactions that interface with VHA systems,

such as information related to veteran eligibility. VHA is
defining end- toend testing as verification that core mission-
critical business functions, including patient- care transactions
and vendor and payroll payments, process correctly. Once these
tests are completed, VBA and VHA plan to conduct a business
process simulation during the July 4, 1999, weekend. This
simulation of day- to- day work at VA is to include users at the
VBA

regional offices and VHA test laboratories, who will simulate
various transactions and process them through a set of
interrelated systems necessary to complete a core business
function. VBA expects to pretest the

business process simulation during May. 6 A compiler is a computer
program that converts human- readable source code into a sequence
of machine instructions that the computer can run.

Page 8 GAO/T-AIMD-99-136

Assessment of VHA's Facility Systems Not Yet Complete

VA's facility systems are essential to the continued delivery of
health care services. For example, heating, ventilating, and air
conditioning equipment is used by hospitals to ensure that
contaminated air is confined to a specified area such as an
isolation room or patient ward. If computer systems used to
maintain these systems were to fail, any resulting climate

fluctuations could affect patient safety. Despite their
importance, VHA has not yet completed its assessment of facility
systems. As of February 28, 1999, VHA medical facilities reported
that they had assessed 55 percent of their facility systems.
According to VHA's Director of Safety and Technical Programs, the
remaining 45 percent have not been fully assessed primarily
because (1) facility systems tend to be a combination of unique
elements that have to be separately assessed for compliance-- a
time- consuming process-- and (2) VHA is still awaiting

compliance status information from facility system manufacturers.
VHA has not established milestones for completing its assessment
and implementation of compliant facility systems. To help ensure
that sufficient time remains to complete these activities, we
recommend that VHA consider setting such deadlines.

In the event that facility- related systems and equipment do not
function properly due to Y2K problems, VHA medical facilities will
need to ensure that they have business continuity and contingency
plans addressing how mission- critical functions affecting patient
care will be carried out. According to VHA's Director of Safety
and Technical Programs, most of its

facility systems have some kind of manual override or reset that
will allow them to continue functioning after a Y2K problem. He
agreed, however, with the importance of developing contingency
plans that fully document continued delivery of essential services
in the event of a facility system failure. VHA medical facilities
expect to have individual business continuity and contingency
plans completed by April 30.

On April 14, 1999, VA informed us that its February 28, 1999,
report contained an error. The corrected numbers for facility
systems at the end of February were 91 percent assessed and 9
percent not assessed.

Page 9 GAO/T-AIMD-99-136

Biomedical Equipment: Additional Status Information Available, But
Test Results Not Reviewed

The question of whether medical devices such as magnetic resonance
imaging (MRI) systems, x- ray machines, pacemakers, and cardiac
monitoring equipment can be counted on to work reliably on and
after January 1, 2000, is also critical to VHA. To the extent that
biomedical equipment uses embedded computer chips, it is
vulnerable to the Y2K problem. Such vulnerability carries with it
possible safety risks. This could range from the more benign--
such as incorrect formatting of a printout-- to the most serious--
such as incorrect operation of equipment with the

potential to adversely affect the patient. The degree of risk
depends in large part on the role the equipment plays in a
patient's care. Additional Biomedical Equipment Status Information
Available

Last September we testified before this Subcommittee that VHA was
making progress in assessing its biomedical equipment, but that it
did not know the full extent of the Y2K problem with this
equipment because it had not received compliance information from
398 manufacturers (26. 7 percent). 7 According to VHA, as of March
16, 1999, the number of nonresponsive manufacturers had been
reduced to 126 (8.5 percent). 8 As shown in table 2, about 19
percent of the manufacturers in VHA's database

of suppliers had at least one biomedical equipment item that was
either noncompliant or conditionally compliant.

7 Year 2000 Computing Crisis: Leadership Needed to Collect and
Disseminate Critical Biomedical Equipment Information (GAO/T-AIMD-
98-310, September 24, 1998). 8 According to VHA, 101 of the 126
letters sent to manufacturers were marked return to sender.

Page 10 GAO/T-AIMD-99-136

Table 2: Status of Manufacturer Responses to VHA as of March 16,
1999

a For inclusion in this category, 100 percent of the
manufacturer's products had to be considered compliant. b For
inclusion in this category, only one of the manufacturer's
products had to be considered noncompliant. c For inclusion in
this category, the manufacturer had to have no noncompliant
equipment, no equipment pending, and at least one conditional-
compliant item.

d For inclusion in this category, the manufacturer had to have no
noncompliant equipment and at least one equipment item pending. e
For inclusion in this category, VHA had to have no compliance
information from the manufacturer. Source: VHA. We did not
independently verify these data.

To identify specific biomedical equipment in the inventories of
VHA's medical facilities that still require Y2K compliance status
information from manufacturers, VHA's Chief Network Officer sent a
letter to the directors of VHA's 22 Veterans Integrated Service
Networks (VISN). This letter requested that they (1) review VHA's
list of manufacturers that have yet to respond and compare it with
a list of manufacturers from whom their medical facilities still
require compliance information and (2) indicate the equipment item
that the facility owns for each manufacturer. According to

VHA's Y2K project director, as of mid- March-- with 135 of 147
medical reporting sites-- 47 biomedical equipment items involving
35 manufacturers were identified as still requiring compliance
status information. The

project director told us that VHA medical facilities have been
instructed to replace or eliminate equipment in their inventories
for which they do not know the compliance status by June 30.
According to VHA's February 1999 status report on medical devices,
medical facilities estimated that the total cost of renovations
will be about $41 million. Category Number of

manufacturers Percentage of manufacturers

Compliant manufacturers a 816 55.2 Noncompliant manufacturers b
126 8. 5 Conditional- compliant manufacturers c 156 10.5 Pending
manufacturers d 29 2.0 Manufacturers merged or bought out 226 15.3
Nonresponsive manufacturers e 126 8. 5

Total 1,479 100.0

Page 11 GAO/T-AIMD-99-136

We have previously reported that most manufacturers citing
noncompliant products listed incorrect display of date and/ or
time as the Y2K problem. 9 According to VA, these cases do not
present a risk to patient safety because health care providers,
such as physicians and nurses, can work around the problem. Of
more serious concern are situations in which devices depend on
date calculations-- the results of which can be incorrect. One
manufacturer cited the example of a product used for planning
delivery of radiation treatment using a radioactive isotope as the
source. An error in calculating the strength of the radiation
source on the day of treatment could result in a dose that is too
high or too low, which could have an adverse effect on the
patient. Other examples of equipment presenting a risk to patient
safety identified by manufacturers to FDA include hemodialysis
delivery systems; therapeutic apheresis systems; 10
alphafetoprotein kits for neural tube defects; 11 various types of
medical imaging equipment; and systems that store, track, and
recall images in chronological order.

To track the compliance status of its biomedical equipment, VHA
uses a monthly status report on medical devices based on
information provided by the VISNs. According to the February 1999
report, approximately 426,000 of 531, 000 medical devices in VHA
medical facilities are compliant. Of the remaining devices, 86,452
were identified as conditional- compliant or were not assessed for
Y2K compliance because the manufacturers certified that the
equipment contained no software or embedded chips, and 19, 073
were reported as being noncompliant. Of the noncompliant devices

identified, 15,621 are to be repaired, 1,582 are to be replaced,
757 are to be used as is, 255 are to be retired, and 858 are still
awaiting a decision on the remedy. According to VHA's Chief
Biomedical Engineer, most of the noncompliant devices identified
incorrectly displayed date/ time. As we reported last September,
FDA was also trying to determine the Y2K compliance status of
biomedical equipment. 12 Its goal is to provide a 9 Year 2000
Computing Crisis: Compliance Status of Many Biomedical Equipment
Items Still Unknown (GAO/AIMD-98-240, September 18, 1998). 10 Such
equipment allows therapeutic apheresis, which refers to the
exchange or purification of blood plasma. Therapeutic apheresis is
recognized as a successful treatment for more than 40 autoimmune
diseases. 11 Devices that use computer calculations of gestational
status to help assess the risk of neural tube defects in the
fetuses of pregnant women. 12 GAO/AIMD-98-240, September 18, 1998.

Page 12 GAO/T-AIMD-99-136

comprehensive, centralized source of information on the Y2K
compliance status of biomedical equipment used in the United
States and make this information publicly available on a web site.
At the time, however, FDA had a disappointing response rate from
manufacturers to its letter

requesting compliance information. And, while FDA made this
information available to the public, it was not detailed enough to
be useful. Specifically, FDA's list of compliant equipment lacked
information on particular make and model. To provide more detailed
information on the compliance status of biomedical equipment, as
well as to integrate more detailed compliance information gathered
by VHA, we recommended that VA and the Department of Health and
Human Services (HHS) jointly develop a single data clearinghouse
that provides such information to all users. We said development
of the clearinghouse should involve representatives from the
health care industry, such as the Department of Defense and the
Health

Industry Manufacturers Association. We recommended that the
clearinghouse contain such information as (1) the compliance
status of all biomedical equipment by make and model and (2) the
identity of manufacturers that are no longer in business. We also
recommended that VHA and FDA determine what actions should be
taken regarding

biomedical equipment manufacturers that have not provided
compliance information. In response to our recommendation, FDA--
in conjunction with VHA-- has established the Federal Year 2000
Biomedical Equipment Clearinghouse. With the assistance of VHA,
the Department of Defense, and the Health Industry Manufacturers
Association, FDA has made progress in obtaining

compliance- status information from manufacturers. For example,
according to FDA, as of April 5, 1999, 4,251 biomedical equipment
manufacturers had submitted data to the clearinghouse. As shown in
figure 1, about 54 percent of the manufacturers reported having
products that do not employ a date, while about 16 percent
reported having daterelated problems such as incorrect display of
date/ time. FDA is still awaiting responses from 399
manufacturers.

Page 13 GAO/T-AIMD-99-136

Figure 1: Biomedical Equipment Compliance- Status Information
Reported to FDA by Manufacturers as of April 5, 1999

Note: Total number of manufacturers = 4,251. Source: FDA.

FDA has also expanded the information in the clearinghouse. For
example, users can now find information on manufacturers that have
merged with or have been bought out by other firms. In
collaboration with the National Patient Safety Partnership, 13 FDA
is in the process of obtaining more detailed information from
manufacturers on noncompliant products, such as make and model and
descriptions of the impact of the Y2K problem on products left
uncorrected. 13 The National Patient Safety Partnership is a
coalition of public and private health care providers, including
VA, the American Medical Association, the American Hospital
Association, the American Nurses Association, and the Joint
Commission on Accreditation of Healthcare Organizations.

Page 14 GAO/T-AIMD-99-136

Review of Biomedical Equipment Test Results Lacking

We reported last September that VHA and FDA relied on
manufacturers to validate, test, and certify that equipment is Y2K
compliant. 14 We also reported that there was no assurance that
the manufacturers adequately addressed the Y2K problem for
noncompliant equipment because FDA did not require medical device
manufacturers to submit test results to it certifying compliance.
Accordingly, we recommended that VA and HHS

take prudent steps to jointly review manufacturers' compliance
test results for critical care/ life support biomedical equipment.
We were especially concerned that VA and FDA review test results
for equipment previously determined to be noncompliant but now
deemed by manufacturers to be compliant, or equipment for which
concerns about compliance remain. We also recommended that VA and
HHS determine what legislative, regulatory, or other changes were
necessary to obtain assurances that the

manufacturers' equipment was compliant, including performing
independent verification and validation of the manufacturers'
certifications.

At the time, VA stated that it had no legislative or regulatory
authority to implement the recommendation to review test results
from manufacturers. In its response, HHS stated that it did not
concur with our recommendation to review test results supporting
medical device equipment manufacturers'

certifications that their equipment is compliant. It believed that
the submission of appropriate certifications of compliance was
sufficient to ensure that the certifying manufacturers are in
compliance. HHS also stated that it did not have the resources to
undertake such a review, yet we are not aware of HHS' requesting
resources from the Congress for this purpose. More recently, VHA's
Chief Biomedical Engineer told us that VHA medical facilities are
not requesting test results for critical care/ life support
biomedical equipment; they also are not currently reviewing the
test results available on manufacturers' web sites. He said that
VHA's priority is determining the compliance status of its
biomedical equipment inventory and replacing noncompliant
equipment. The director of FDA's Division of Electronics and
Computer Science likewise said FDA sees no need to question
manufacturers' certifications. 14 GAO/AIMD-98-240, September 18,
1998.

Page 15 GAO/T-AIMD-99-136

In contrast to VHA's and FDA's positions, some hospitals in the
private sector believe that testing biomedical equipment is
necessary to prove that they have exercised due diligence in the
protection of patient health and safety. Officials at three
hospitals told us that their biomedical engineers established
their own test programs for biomedical equipment, and in many
cases contacted the manufacturers for their test protocols.
Several of these engineers informed us that their testing
identified some

noncompliant equipment that the manufacturers had certified as
compliant. According to these engineers, to date, the equipment
found to be noncompliant all had display problems and was not
critical care/ life support equipment. We were told that equipment
found to be incorrectly certified as compliant included a cardiac
catheterization unit, a pulse oxymeter, medical imaging equipment,
and ultrasound equipment.

VHA, FDA, and the Emergency Care Research Institute 15 continue to
believe that manufacturers are best qualified to analyze embedded
systems or software to determine Y2K compliance. They further
believe that manufacturers are the ones with full access to all
design and operating parameters contained in the internal software
or embedded chips in the equipment. VHA believes that such testing
can potentially cause irreparable damage to expensive health care
equipment, causing it to lock up or otherwise cease functioning.
Further, a number of manufacturers also have recommended that
users not conduct verification and validation testing. We continue
to believe that rather than relying solely on manufacturers'

certifications, organizations such as VHA or FDA can provide users
of medical devices with a greater level of confidence that the
devices are Y2K compliant through independent reviews of
manufacturers' compliance test results. The question of whether to
independently verify and validate biomedical equipment that
manufacturers have certified as compliant is one that must be
addressed jointly by medical facilities' clinical staff,
biomedical engineers, and corporate management. The overriding
criterion should be ensuring patient health and safety.

15 An international, nonprofit health services research agency.
This organization believes that superficial testing of biomedical
equipment by users may provide false assurances, as well as create
legal liability exposure for health care institutions.

Page 16 GAO/T-AIMD-99-136

VHA Pharmaceutical Operations Also Face Y2K Risks

Another critical component to VA's ability to deliver health care
at the turn of the century is ensuring that the automated systems
supporting VHA's medical facility pharmacies and its consolidated
mail outpatient pharmacies (CMOP) are Y2K compliant. VHA reported
that in 1998, it filled about 72 million prescriptions for 3.4
million veterans, at an estimated cost of about $2 billion. About
half of the prescriptions were filled by the over 200 pharmacies
located in VA's medical centers, clinics, and nursing homes. These
pharmacies rely on the pharmaceutical applications in the Veterans
Health Information Systems Architecture (VISTA) for (1) drug
distribution and inventory management, (2) dispensing of drugs to
inpatients and outpatients, (3) patient medication information,
and (4) an electronic

connection between the pharmacies and the CMOPs. Y2K failures in
these applications could impair the pharmacies' ability to fill
prescriptions. The remaining 50 percent of VHA's prescriptions are
filled by seven CMOPs, geographically located throughout the
United States. These facilities are

supported by automated systems provided by one of two contractors-
SI/ Baker, Inc. and Siemens ElectroCom. 16 For example, the CMOP
electronically receives a prescription for a veteran through the
medical center. The prescription is downloaded to highly automated
dispensing equipment to be filled. The filled prescription is then
validated by a pharmacist who compares the medication against a
computerized image of the prescribed medication. Afterward, the
prescription is packaged and an automatically generated mailing
label is applied for delivery to the veteran. Finally, the medical
center is electronically notified that the prescription has been
filled. Because of the reliance on automation, the CMOPs' ability

to fill prescriptions could be delayed or interrupted if a Y2K
failure occurred.

VHA has determined that the automated systems supporting its CMOPs
are not Y2K compliant. Specifically, neither of the systems
provided by their contractors are Y2K compliant. According to the
Y2K coordinator for the SI/ Baker facilities, failure to make the
SI/ Baker systems Y2K compliant may delay the filling of
outpatient prescriptions. The SI/ Baker systems are used by three
of VHA's CMOPs-- Hines, Illinois; Charleston, South Carolina; and
Murfreesboro, Tennessee; they handle about 58 percent of all
prescriptions filled by CMOPs. In contrast to the SI/ Baker
systems, according to a contractor hired by the CMOPs that use
these systems, 16 These include operating systems, databases, and
pharmacy fulfillment application software.

Page 17 GAO/T-AIMD-99-136

failure to make the Siemens ElectroCom systems Y2K compliant may
result in delays in processing management reports for
prescriptions filled, but not the actual filling of prescriptions.
Although the CMOPs plan to replace their noncompliant systems with
compliant ones, these systems are not scheduled to be implemented
until mid- to late- 1999. As shown in table 3, the earliest
estimated completion date for implementing a compliant system is
June 30, 1999, while the latest is December 1, 1999. This leaves
little time to address any unexpected implementation problems.
Table 3: Schedule of Estimated Implementation Completion Dates and
Current Daily Workload by Consolidated Mail Outpatient Pharmacies

a Siemens ElectroCom automation. b SI/ Baker, Inc. automation.
Source: VA.

Given the late schedule for implementing compliant systems, it is
crucial that the CMOPs develop business continuity and contingency
plans to ensure that veterans will continue to receive their
medications if these systems are not implemented in time or fail
to operate properly. As of March 31, VA had not completed a
business continuity and contingency plan for the CMOPs. The Y2K
coordinator for the Siemens ElectroCom system has been tasked with
developing this plan, which is to be completed by the end of this
month. Further, VA did not include the CMOP systems in its
quarterly reports of mission- critical systems to OMB. According
to VHA's Y2K project director, VHA considered the CMOP systems to
be COTS products and, therefore, Location

Estimated completion date Current daily workload

(prescriptions filled)

West Los Angeles, California a June 30, 1999 15, 000

Bedford, Massachusetts a June 30, 1999 15, 000 Dallas, Texas a
June 30, 1999 14, 000 Leavenworth, Kansas a July 31, 1999 16, 000
Charleston, South Carolina b September 1, 1999 23, 000
Murfreesboro, Tennessee b September 30, 1999 38, 000 Hines,
Illinois b December 1, 1999 21, 000

Page 18 GAO/T-AIMD-99-136

did not report them as mission- critical systems. Given the
criticality of these systems to VHA's ability to fill
prescriptions at the turn of the century, we believe VA should
reassess this decision, reporting CMOPs as missioncritical

to VA top management and OMB to help ensure that necessary
attention is paid to and action is taken on them. VA Taking Action
to Determine Y2K Readiness of Pharmaceutical and

Medical- Surgical Manufacturers VA, like other users of
pharmaceutical and medical- surgical products, needs to know
whether it will have a sufficient supply of these items for its
customers. Therefore, it has taken a leadership role in the
federal government in determining whether manufacturers supplying
these

products to VHA are Y2K- ready. This information is essential to
VHA's medical facilities and CMOPs because of their just- in- time
17 inventory policy. Accordingly, they must know whether their
manufacturers' processes, which are highly automated, 18 are at
risk, as well as whether the rest of the supply chain will
function properly. To determine the Y2K readiness of their
suppliers, on January 8, 1999, VA's National Acquisition Center
(NAC) 19 sent a survey to 384 pharmaceutical

firms and 459 medical- surgical firms with which it does business.
The survey contained questions on the firms' overall Y2K status
and inquired about actions taken to assess, inventory, and plan
for any perceived impact that the century turnover would have on
their ability to operate at normal

levels. In addition, the firms were asked to provide status
information on progress made to become Y2K compliant and a
reliable estimated date when compliance will be achieved for
business processes such as (1) ordering and receipt of raw
materials, (2) mixing and processing product, (3) completing final
product processing, (4) packaging and labeling product, and (5)
distributing finished product to distributors/

wholesalers and end customers. According to NAC officials, of the
455 firms that responded to the survey as of March 31, 1999, about
55 percent completed all or part of the survey. The remainder
provided general information on their Y2K readiness status 17 This
term refers to maintaining a limited inventory on hand.

18 Many pharmaceutical manufacturers rely on automated systems for
production, packaging, and distribution of their products, as well
as for ordering of raw materials and supplies. 19 This
organization is responsible for supporting VHA's health care
delivery system by providing an acquisition program for items such
as medical, dental, and surgical supplies and equipment;
pharmaceuticals; and chemicals. NAC is part of VA's Office of
Acquisition and Materiel Management.

Page 19 GAO/T-AIMD-99-136

or literature 20 on their efforts. As shown in table 4, more than
half of the pharmaceutical firms surveyed responded (52 percent),
with just less than one- third (32 percent) of those respondents
reporting that they are compliant. Among the pharmaceutical firms
that had not responded as of March 31, however, were two of VA's
five largest suppliers. 21 The three large pharmaceutical
suppliers that did respond provided general information on their
Y2K readiness status, rather than answering the survey, and
estimated that they will be compliant by June 30, 1999.

Table 4: Status of Companies Surveyed by VHA as of March 31, 1999

a Estimated compliance status ranged from March 31, 1999 through
January 1, 2000; about 71 percent of pharmaceutical firms and 80
percent of medical- surgical firms estimated they will be
compliant by July 31, 1999. One firm responded that it will be
compliant by January 1, 2000. Source: VA. We did not independently
verify these data.

Table 4 also shows that 54 percent of the medical- surgical firms
surveyed responded, with about two- thirds of them (166) reporting
that they are Y2K compliant. All five of VA's largest medical-
surgical suppliers have

responded. Specifically, two reported being compliant, two
reported they would be compliant by June 30, 1999, and the
remaining supplier did not report an expected compliance date. On
March 17, 1999, NAC sent a second letter to its pharmaceutical and
medical- surgical firms, informing them of VA's plans to make Y2K
readiness information previously provided to VA available to the
public through a

web site ( www. va. gov/ oa& mm/ nac/ y2k). VA made the survey
results available on its web site on April 13, 1999. The letter
also requested that 20 This includes annual and quarterly
financial reports required by the Securities and Exchange
Commission for companies listed on the New York Stock Exchange. 21
On April 14, 1999, a NAC official told us that of the two
suppliers that had not responded as of March 31, one responded on
April 12, and the other responded on April 14.

Responses Pharmaceutical Medical- surgical

Y2K compliant 65 166 Will be compliant by 1/ 1/ 2000 or earlier a
90 70 Provided no compliant date 50 14

Total number of responses 205 250

Non- responses 179 209

Total number of firms surveyed 384 459

Page 20 GAO/T-AIMD-99-136

manufacturers that had not previously responded provide
information on their readiness. NAC's Executive Director said that
he would personally contact any major VA supplier that does not
respond. On a broader level, VHA has taken a leadership role in
obtaining and sharing information on the Y2K readiness of the
pharmaceutical industry. Specifically, VHA chairs the Year 2000
Pharmaceuticals Acquisitions and Distributions Subcommittee, which
reports to the Chair of the President's Council on Year 2000
Conversion. The purpose of this subcommittee is to bring

together federal and pharmaceutical representatives to address
issues concerning supply and distribution as they relate to the
year 2000. The subcommittee consists of FDA, federal health care
providers, and industry trade associations such as the
Pharmaceutical Research and Manufacturers of America (PhRMA), the
National Association of Chain Drug Stores, and the National
Wholesale Druggists' Association. Several of these trade
associations have surveyed their members on their Y2K readiness
and made the results available to the public. However, the
information is not manufacturer- specific or as detailed as VHA's
survey results.

FDA's Y2K Efforts for Pharmaceutical and Biological Products
Industries Were Initially

Focused on Awareness FDA's oversight and regulatory responsibility
for pharmaceutical and biological products 22 is to ensure that
they are safe and effective for public

use. Because of its concern about the Y2K impact on manufacturers
of these products, FDA has taken several actions to raise the Y2K
awareness of the pharmaceutical and biological products
industries. In addition, it is thinking about conducting a survey
to determine the industry's Y2K

readiness. One of FDA's actions to raise industry awareness was
the January 1998 issuance of industry guidance by the Center for
Biologics Evaluation and Research (CBER) on the Y2K impact of
computer systems and software

applications used in the manufacture of blood products. In
addition, as shown in table 5, FDA has issued several letters to
pharmaceutical and biological trade associations and sole- source
drug manufacturers. 22 Biological products include vaccines,
blood, and blood products.

21 GAO/T-AIMD-99-136

Table 5: FDA Letters to Manufacturers Regarding Y2K

Source: FDA.

Further, on February 11, 1999, FDA's director of emergency and
investigation operations sent a memorandum on FDA's interim
inspection policy for the Y2K problem to the directors of FDA's
investigations branch. The policy emphasizes FDA's Y2K awareness
efforts for manufacturers. It states that FDA inspectors are to
(1) inform the firm of FDA's Y2K web page (URL http:// www. fda.
gov/ cdrh/ yr2000/ year2000.html), (2) provide the firm with
copies of the appropriate FDA Y2K awareness letter, (3) explain
that Y2K problems could potentially affect aspects of the firm's
operations, including some areas not regulated by FDA, and that
FDA anticipates that firms will take prudent steps to ensure that
they are not adversely affected

by Y2K, and (4) provide firms with a copy of FDA's compliance
policy guide Year 2000 (Y2K) Computer Problems. In addition, FDA
and PhRMA jointly held a government/ industry forum on the Y2K
preparedness of the pharmaceutical and biotech industries on
February 22, 1999. The objectives of this forum were to (1) share
information on Y2K programs conducted by health care providers,
pharmaceutical companies, FDA, and other federal agencies, (2)
provide a vehicle for networking, and (3) raise awareness. On
March 29, 1999, FDA revised its February 11, 1999, interim
inspection policy. The revision states that field inspectors are
now to inquire about manufacturers' efforts to ensure that their
computer- controlled or datePage

Date FDA source Recipient Purpose

October 1998 Center for

Drug Evaluation and Research

Pharmaceutical manufacturer trade associations

To relay to members FDA's expectation that the pharmaceutical
industry would (1) make resolution of Y2K a high priority, (2)
ensure that production systems

were fixed and tested prior to January 1, 2000, and (3) urge
manufacturers to develop Y2K contingency plans. October 1998
Center for Biologics Evaluation and Research Biologics
manufacturer trade

associations Same as above. January 1999 Center for

Drug Evaluation and Research

Sole- source drug manufacturers Same as above. Also (1) noted that
the impact of Y2K on pharmaceutical safety, efficacy, and
availability merits special attention for firms who are the sole

manufacturers of drug components, bulk ingredients, and finished
products and (2) stated that pharmaceutical industry suppliers
must have Y2Kcompliant systems to protect against disruption in
the flow of product components, packaging materials, and equipment
to pharmaceutical manufacturers.

Page 22 GAO/T-AIMD-99-136

sensitive manufacturing processes and distribution systems are Y2K
compliant. Inspectors are to include this information in their
reports, along with a determination of activities that firms have
completed or started to ensure that they will be Y2K compliant.
Further, FDA inspectors may review documentation in cases in which
firms have made changes to their computerized production or
manufacturing control systems to address Y2K problems. The purpose
of this review is to ensure that the changes were made in
accordance with the firms' procedures and applicable regulations.
If inspectors determine that a firm has not taken steps to ensure
Y2K compliance, they are to notify their district managers and the
responsible FDA center. FDA's interim policy describes steps
inspectors are to take in reviewing manufacturers'Y2K compliance.
However, FDA stated that the primary focus of its inspections for
the remainder of 1999 will be to ensure that products sold in the
United States are safe and effective for public use and

comply with federal statutes and regulations, including good
manufacturing practice (GMP). 23 FDA officials explained that the
agency does not have sufficient resources to perform both
regulatory oversight of the manufacturers and in- depth
evaluations of firms' Y2K compliance activities. Nevertheless,
according to the March 29, 1999, memorandum, field inspectors are
to note any concerns they may have with a firm's Y2K readiness in
the administrative remarks section of their inspection reports.
These reports are to be reviewed by FDA district managers. If the
Y2K concern appears to present a serious problem to a firm's
ability to produce

safe, effective medication, the district manager can discuss this
issue with FDA's Office of Regulatory Affairs and determine a
course of action. However, FDA officials have stressed that the
agency cannot take any regulatory action toward the firm until a
Y2K- related problem affects a pharmaceutical or biological
product. Like VHA, FDA is interested in the impact of Y2K
readiness of pharmaceutical and biological products on the
availability of products for health care facilities and individual
patients. FDA's Acting Deputy Commissioner for Policy informed us
on March 24, 1999, that the agency is 23 GMP requirements include
federal standards for ensuring that products are high in quality
and

produced under sanitary conditions (21 CFR parts 210, 211).

Page 23 GAO/T-AIMD-99-136

thinking about surveying pharmaceutical and biological products
manufacturers, distributors, product repackagers, and others in
the drug dispensing chain, on their Y2K readiness and contingency
planning. In

anticipation of a possible survey, the agency has published a
notice in the March 22, 1999, Federal Register regarding this
matter. The Acting Deputy Commissioner said that potential survey
questions on contingency planning would include steps the
manufacturers are taking to ensure an adequate supply of bulk
manufacturing materials from overseas suppliers. This is a key
issue because, as we reported in March 1998, 24 according to FDA,
as much as 80 percent of the bulk pharmaceutical chemicals used by
U. S. manufacturers to produce prescription drugs is imported. In
summary, VBA and VHA continue to make progress in preparing their

mission- critical systems for the year 2000. However, key actions
remain to be taken in the areas of mission- critical systems
testing, VHA facility systems compliance, and CMOP systems
compliance. We also reiterate the need for VHA and FDA to take
prudent steps to ensure that the test results of critical care/
life support biomedical equipment are obtained and reviewed.
Finally, VHA needs information on the Y2K readiness of specific
pharmaceutical and medical- surgical manufacturers. Until this
information is obtained and publicized, VHA medical facilities and
veterans will remain in doubt as to whether an adequate supply of
pharmaceutical and biological

products will be available. FDA and the pharmaceutical and
biological trade associations can play key roles in helping VHA
obtain this information and publicize the results in a single data
clearinghouse.

In carrying out this assignment, we reviewed and analyzed VA's Y2K
documents and plans, comparing them against our guidance on Y2K
activities. We also reviewed and analyzed FDA documentation
relating to its Y2K efforts on biomedical devices and
pharmaceutical manufacturers. In addition, we visited selected VHA
medical centers, VA data centers, and VHA consolidated mail
outpatient pharmacies to discuss their Y2K activities, and
interviewed VA and FDA officials on those activities. We also
interviewed officials of the Emergency Care Research Institute
regarding their statements on biomedical equipment testing.
Finally, we interviewed selected private hospital officials about
their Y2K actions and 24 Food and Drug Administration:
Improvements Needed in the Foreign Drug Inspection Program
(GAO/HEHS-98-21, March 17, 1998).

Page 24 GAO/T-AIMD-99-136

pharmaceutical trade associations on their Y2K readiness surveys
of pharmaceutical manufacturers. Mr. Chairman, this concludes my
statement. I would be pleased to respond to any questions that you
or other members of the Subcommittee may have at this time.

(511266) Let t er

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