Like clockwork: How Daylight Saving Time stumps hospital record-keeping

Nov. 9, 2018

Modern technology has helped medical professionals do robot-assisted surgeries and sequence genomes, but hospital software still can’t handle Daylight Saving Time.

One of the most popular electronic health records software systems used by hospitals, Epic Systems, can delete records or require cumbersome workarounds when clocks are set back for an hour, prompting many hospitals to use paper records for part of the night shift.

“It’s mind-boggling,” said Dr. Mark Friedberg, a senior physician policy researcher at RAND. In 2018, “we expect electronics to handle something as simple as a time change. “Nobody is surprised by daylight savings time. They have years to prep. Only, surprise, it hasn’t been fixed.”

Dr. Steven Stack, a past president of the American Medical Association, called the glitches “perplexing” and “unacceptable,” considering that hospitals spend millions of dollars on the systems, and Apple and Google seem to have dealt with seasonal time changes long ago.

Carol Hawthorne-Johnson, an intensive care nurse in California, said her hospital doesn’t shut down the Epic system during the fall time change. But she’s come to expect that the vitals she enters into the system from 1 a.m. to 2 a.m. will be deleted when the clock falls back to 1 a.m. One hour’s worth of electronic record-keeping “is gone,” she said.

Hospital staff members have learned to deal with it by taking extra chart notes by hand, but it’s still a burden, she said, especially if vitals change, or a patient needs something like a blood transfusion.

Although hospitals often avoid the software glitches by turning the software off and switching to paper charts, it’s far from ideal because hospitals have become increasingly reliant on electronic systems, said Stack, an emergency physician in Kentucky.

The one-hour pause slows everything down, which can cause patients to spend more time in emergency department waiting rooms, prompting some to go home before seeing a healthcare provider. That’s dangerous, Stack said.

Not all hospitals turn Epic off, however. At Johns Hopkins Hospital, providers who need to check patients periodically through the night use a workaround. They enter vitals at 1 a.m. and then when the clock falls back an hour later and they have to enter new vitals, they list them at 1:01 a.m. They leave a note that it’s an hour later, not a minute later. That’s how the Cleveland Clinic does it, too.

Other electronic medical records systems may require similar workarounds, said Jennifer Carpenter, vice president of IT clinical systems at University Hospitals in Cleveland, which uses several electronic medical records systems. Cerner, another major electronic medical records company, was unavailable for comment, but many hospitals planned for Cerner to be down during the time change, too.

Kaiser Health News has the full article

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