Like clockwork: How daylight saving time stumps hospital record keeping

Modern technology has helped medical professionals do robot-assisted surgeries and sequence whole 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 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, adding that 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 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 these electronic systems longer than others.

Carol Hawthorne-Johnson, an ICU 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 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 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 as comfortable with paper records because they've relied 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, prompting some to go home before seeing a health care 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.

"I don't disagree with the sentiment that we would like health IT systems to be much more sophisticated," said Dr. Peter Greene, Johns Hopkins chief medical information officer. 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."

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 plan for Cerner to be down during the time change, too.

When asked to comment on the glitches and workarounds, Epic spokeswoman Meghan Roh provided the following statement:

"Daylight savings time is inherently nuanced for healthcare 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. We're constantly making improvements and looking for opportunities to enhance the system."

But Friedberg pointed out that hospitals are locked into their electronic medical record systems because they've invested so much money in them. And it would cost even more to convert and transfer the records into a new system. As a result, there's little incentive for software companies to improve their products, he said.

"I shudder to think … what does it do with leap years?" Friedberg wondered.