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EPtalk by Dr. Jayne 11/5/15

November 5, 2015 Dr. Jayne 2 Comments

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A shout-out to representative Steve King of Iowa for attempting to inject some Midwestern common sense into the Meaningful Use chaos. His “Putting Patients and Providers Ahead of Compressed Regulatory Timelines Act of 2015” would sunset meaningful use penalties and rebate 2015 penalties back to providers and hospitals. It doesn’t have a realistic chance of passing, but I applaud him for trying.

I mentioned last week that I’ll be attending the AMIA meeting. During my email cleanup, I happened to come across an invitation to a pre-symposium educational session and registered for it. It was lucky that I did my cleanup when I did because the session was the following morning. The late registration caused a couple of hitches in accessing the session, but the team at AMIA still got me connected in time.

I’ve attended a lot of conferences, but appreciated the ability to get some solid recommendations for first-time attendees. One of the pieces of advice that surprised me was their openness with attendees dropping in and out of sessions and following the “buzz” on social media.

One conference I attended last year required attendees to declare their intentions weeks in advance under the pretense of predicting room sizes. In reality, they were using the attendee information for target marketing in advance of the conference. They also had some pretty aggressive door-checkers who scolded attendees for leaving sessions or trying to enter ones already in progress. I understand minimizing disruptions, but I would rather people move to another session where they may learn something than to sit in a session where they don’t find value.

Now that I have more information on the meeting, I can spend my free time putting together my social schedule. There are several networking events planned, including one called WINE (Women in Informatics Networking Event). How can you go wrong with a draw like that? Unfortunately, a couple of my favorite San Francisco-area colleagues will be out of town while I’m there, but that gives me an excuse to look for new and exciting things to do in my free time.

Also in the email clean-up, I found a direct marketing piece from Pfizer about October being Gaucher Awareness Month. Although Gaucher disease only affects 50,000 – 100,000 people worldwide, it has a disproportionate impact on people of Ashkenazi Jewish heritage (one in 600) and medications are available for treatment that can make a dramatic difference for patients. Unfortunately, it’s extremely expensive (cost was $150,000 per patient per year when it first launched in 2012) despite its obvious benefit. I’ve never actually seen a patient with Gaucher Disease (treated or otherwise) as compared to other more prevalent conditions, so it seems an odd choice for a direct marketing piece.

I also found yet another email from Doximity asking me to review the residency program where I trained. I’ve been deleting these for several months. When it first launched in 2011, Doximity tried to brand itself as the LinkedIn for doctors. I’m not sure how successful they’ve been, but I suspect they’re somewhat struggling for relevancy.  I laughed, though, when I read the body of the most recent email, where they asked me to review the program because “choosing a residency program is one of the biggest decisions new physicians face in their careers” and “reviews help medical students find the right training program.” Thankfully, the program where I trained bears no resemblance to what it looked like when I was there. There have been tremendous changes to graduate medical education in the last decade and frankly anything I write would be wholly irrelevant to anyone considering the program today. I’d think that a company that is supposed to understand physicians would have a better handle on this.

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A reader contacted me about how hospitals handle Daylight Saving Time. “Our hospital claims that every hospital in the US that deals with Daylight Saving Time turns off their EHR from 1:00 to 2:00 a.m. so there are not duplicate orders, meds, notes out of order, etc. For 15 minutes prior and 15 minutes after — a total of 90 minutes — we have “Zombie Hour” every year for DST. No medical care happens in the system for one hour. Is this your experience? That if you are an unlucky soul that hits the ED from 1:00 a.m. to 2:00 a.m. on November 1 that you do not exist for 90 minutes? Isn’t there a better way? Use UTC or GMT time for meds and timestamps? I cannot imagine that EHR vendors and ONC did not think of this when it has come up before. Help me understand this.”

I was a bit puzzled by this because it hasn’t been a factor in any hospitals where I’ve worked. I double checked with one of my former hospital colleagues and our system handles timestamps in UTC but uses an adjustment for the display, whether regional standard time or regional daylight time. I polled a couple of colleagues at other systems, though, and several of them have Zombie Hour. The reader named a specific vendor in his email, which surprised me that they would not have a better solution than dropping to paper. I’d be interested to hear from vendors how they handle this issue. In the meantime, I found this NIST document on DST rules.

How does your facility handle DST? Email me.

Email Dr. Jayne.

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Currently there are "2 comments" on this Article:

  1. The systems with which I’m familiar use UTC for data storage and time comparisons. The problem is with the display. Imagine a nurse walks into a patient room at 12:55am EDT. There is an indication on the MAR that a med is due at 1:00am EST. While the nurse is in the room, he might as well give the med that he incorrectly thinks is due in 5 minutes. In reality, the med isn’t due for 1 hour and 5 minutes.

    Sure, there are ways around this. Display alerts to the user, or display durations instead of timestamps. But this is just one example.

    Most people “in real life” are asleep, so they never think about the logistical nightmare that involves repeating an hour on the clock. It may not be good, but I can understand why your reader’s hospital has taken this approach.

  2. I’m only familiar with Epic, but they do not need to shut down. Most likely you’ll need to shut down certain interfaces and downstream systems that can’t cope with it.

    What happens is that you’d be duplicating timestamps. You could use UTC to store it, but how would you convert it (or display it) back when you need to figure out when it happened on your local time? How do you report it to downstream systems that don’t use UTC? You have two distinct UTC times corresponding to the same regional time so how do you tell them apart? You could call them before DST and after DST but that’s not standard so it won’t be understood by anything but a human (if that). If everybody decided to use UTC we’d be fine, but then again we could just get rid of DST.

    You’ll end up dealing with a bunch of cleanup and workarounds during that repeated hour and that’s why most organizations just *choose* to be down. It’s not a technical problem so it can’t be solved via technical means. You can’t legislate into a mess and complain that technology can’t take you out of it. It’s like legislating that 2+2=5 and then complain when the math doesn’t work.







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