Daylight saving time stumps EHRs: 5 things to know

For many Americans, daylight saving time offers an extra hour of sleep. But for hospital staffers, it poses an annual problem, as some EHR systems haven't figured out how to handle the time change smoothly, according to Kaiser Health News.

Here are five things to know:

1. Some hospitals shut down their Epic EHR in advance of daylight saving time, since the system may delete records when clocks are set back an hour, KHN reports. These hospitals might revert to paper records for part of the night shift, meaning they can't access previous clinical notes or test results.

"It's an hour where you're flying sort of blind," said Mark Friedberg, MD, a senior physician policy researcher at the Rand Corp. "Nobody is surprised by daylight savings time. They have years to prep. Only, surprise, it hasn't been fixed."

2. One intensive care unit nurse in California told KHN that the hospital she works at doesn't shut down its Epic EHR during daylight saving time, although she now expects any vital signs she enters from 1 a.m. to 2 a.m. to be deleted when the clocks fall back to 1 a.m.

She said hospital staffers address this challenge by taking extra chart notes by hand, but it can still be a challenge if a patient's vitals change or if a patient needs a procedure, such as a blood transfusion.

3. Providers at Johns Hopkins Hospital in Baltimore told KHN that they implement a workaround for daylight saving time for patients who need periodic check-ins. They enter vitals at 1 a.m., and then again an hour later at 1:01 a.m., after the clocks fall back — at this time, they enter a manual note that the 1:01 a.m. entry is an hour later, not a minute later.

Peter Greene, MD, chief medical information officer at Johns Hopkins Hospital, said that the workaround didn't pose a major challenge for his team. "I don't disagree with the sentiment that we would like health IT systems to be much more sophisticated, … [but] this particular aspect is not one that has caused us a lot of trouble."

4. However, Steven Stack, MD, a past president of the American Medical Association, said these glitches remain "perplexing" and "unacceptable." He noted that a one-hour pause can slow down patient care at inopportune times, such as if a patient is left waiting for a longer period of time in an emergency department waiting room.

He argued that consumer technologies — such as those offered by Apple and Google — have figured out how to deal with these seasonal time changes, while EHR vendors have not.

5. Epic spokesperson Meghan Roh provided the following statement to KHN: "Daylight saving 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."

Other EHR systems — such as Cerner — also require similar workarounds, according to KHN. The publication said Cerner was unavailable for comment.

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