Modern technology has helped medical professionals perform robot-assisted surgeries and sequence whole genomes. But hospital software still can’t handle daylight saving time.
Epic Systems, one of the most popular electronic health records software systems used by hospitals, can delete records or require cumbersome workarounds when clocks are set back for an hour – prompting many hospitals to opt for paper records for part of the night shift.
And it happens every year.
“It’s mind-boggling,” said Dr. Mark Friedberg, a senior physician policy researcher at RAND. In 2018, he said, “we expect electronics to handle something as simple as a time change.”
“Nobody is surprised by daylight saving 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 these systems, and Apple and Google seem to have dealt with seasonal time changes long ago.
Epic was founded in 1979. But some hospitals have used the electronic systems longer than others.
Carol Hawthorne-Johnson, an intensive-care-unit 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 vital signs she enters into the system from 1 a.m. to 2 a.m. Sunday 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 have learned to deal with it by taking extra chart notes by hand. But it’s still a burden, Hawthorne-Johnson said, especially if vitals change, or a patient needs, say, a blood transfusion.
Hospitals often avoid the software glitches by turning the software off and switching to paper charts. But it’s far from ideal, because hospitals have evolved to become increasingly reliant on electronic systems, said Stack, an emergency physician in Kentucky.
“When (electronic medical records) work, it’s wonderful,” he said. But when the system is turned off, doctors can’t use it to access patient records or order tests. Whiteboards are a thing of the past, and some staff members aren’t comfortable with paper records after relying on electronic records their entire careers.
“It’s an hour where you’re flying sort of blind,” Friedberg said.
The one-hour pause slows everything down, which can cause patients to spend more time in emergency department waiting rooms. Some go home before seeing a health care provider. That’s dangerous, Stack said.
Not all hospitals turn Epic off. At the Johns Hopkins Hospital in Baltimore, 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.
“I don’t disagree with the sentiment that we would like health IT systems to be much more sophisticated,” said Dr. Peter Greene, chief medical information officer at Hopkins. But there are plenty of other problems he’d like to see fixed first.
“This particular aspect is not one that has caused us a lot of trouble,” he said.
Other electronic medical records systems may require similar workarounds, said Jennifer Carpenter, vice president of IT clinical systems at University Hospitals in Cleveland. University Hospitals uses several electronic medical records systems.
Many hospitals use Cerner, another major electronic medical records company. Those hospitals plan for Cerner to be down during the time change, too.
Cerner was unavailable to comment. A spokeswoman for Epic, asked to comment on the glitches and workarounds, provided a statement.
“Daylight saving time is inherently nuanced for health care organizations, which is why we work closely with customers to provide guidance on how to most effectively use their system to care for their patients during this time period,” Epic spokeswoman Meghan Roh said. “We’re constantly making improvements and looking for opportunities to enhance the system.”
Friedberg said hospitals are often locked into their electronic medical record systems because they’ve invested so much money in them. It would cost even more to convert and transfer the records into a new system. As a result, he said, there’s little incentive for software companies to improve their products.
“I shudder to think,” he said. “What does it do with leap years?”
Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.