November 7th, 2018
Technology has made managing daylight saving time a lot easier. Phones and computers adjust for daylight saving time automatically, so we don’t even have to remember to set our clocks back! But for many hospital systems, technology has not solved the problem.
As Kaiser Health News reports, the common electronic medical record system EPIC does not handle daylight saving time well. When clocks are set back an hour, the system deletes records that were entered during that hour, so clinicians have to make backup notes on paper so they don’t lose vital information.
In a recent article in The New Yorker, surgeon and public health researcher Dr. Atul Gawande describes how his hospital dealt with the time glitch:
“The only solution was to shut down the lab systems during the repeated hour. Data from integrated biomedical devices (such as monitoring equipment for patients’ vital signs) would be unavailable and would have to be recorded by hand. Fetal monitors in the obstetrics unit would have to be manually switched off and on at the top of the repeated hour.”
How is it that an EMR system created in 1979 still does not adjust for a time change that happens twice a year? One would expect this ability to come standard for software that costs hospitals tens of millions of dollars.
Like many aspects of health care, the “market” for EMRs has many failures, which precludes system improvements. While there are many different types of EMR systems created by different companies, competition has not made EMRs much better, because once a hospital chooses an EMR they are effectively “locked in” by the enormous financial investment.
Another EMR market failure is that the administrators in charge of choosing and implementing an EMR system are not the same people who will be using them. Doctors may be consulted in the EMR decision, but in the end, EMR systems are designed as a tool for billing.
In Gawande’s piece, Gregg Meyer, chief clinical officer at Partners HealthCare, claims that EMRs are not for the doctors, they’re “for the patients.” However, EMRs still haven’t made patient records as widely available as promised. A recent study in JAMA found widespread noncompliance with patient record regulations among the countries “best” hospitals. Only 53% of hospitals allowing patients to get access to their complete records, and many did not disclose the estimated cost, or cited a higher cost to accessing records than is recommended according to federal regulations.
EMRs have significant potential to improve patient care and make clinicians’ jobs easier. But until we raise our expectations of EMR usability and provide stronger incentives for EMR companies to meet these expectations, we will likely have to deal with glitches like daylight saving time for many years to come.