[Discuss] How Daylight Saving Time Messes With Hospitals

[Rich Pieri]

Lots of articles about this over the weekend, and they all quote the
same line about how handling a time change is simple and easy.

Fact is, it's anything but simple or easy when it comes to medical
records. Here's an example: what time were you born? If your birthday
for a given year falls between the second Sunday of March and the first
Sunday of April or between the last Sunday of October and the first
Sunday of November then you're probably wrong because the days for
daylight savings changed in 2007. Your times are off by about 1 hour
unless you accomodate that change or your place of birth and your
current location do not honor daylight savings time.

Multiply that by many hundreds of millions of patient records across
many years of patients' lives, many locales and time zones and
timekeeping changes, and inconsistencies across different
record-keeping procedures, and you have a bonafide nightmare.

Is there a solution? I don't think so short of doing away with daylight
savings. Epic have been at this for almost 40 years. If it were
possible and viable I think they'd have figured it out by now.

[Mike Small]

Post by Rich Pieri
Lots of articles about this over the weekend, and they all quote the
same line about how handling a time change is simple and easy.
Fact is, it's anything but simple or easy when it comes to medical
records. Here's an example: what time were you born? If your birthday
for a given year falls between the second Sunday of March and the first
Sunday of April or between the last Sunday of October and the first
Sunday of November then you're probably wrong because the days for
daylight savings changed in 2007. Your times are off by about 1 hour
unless you accomodate that change or your place of birth and your
current location do not honor daylight savings time.
Multiply that by many hundreds of millions of patient records across
many years of patients' lives, many locales and time zones and
timekeeping changes, and inconsistencies across different
record-keeping procedures, and you have a bonafide nightmare.
Is there a solution? I don't think so short of doing away with daylight
savings. Epic have been at this for almost 40 years. If it were
possible and viable I think they'd have figured it out by now.

If database programmers would only always use UTC for their storage
format and translate as necessary for presentation it wouldn't be so
bad, but I guess in your example case it's too late now.

Maybe you'd like this article if you haven't seen it already:
http://naggum.no/lugm-time.html

[Rich Pieri]

On Tue, 06 Nov 2018 23:20:08 +0000

Post by Mike Small
If database programmers would only always use UTC for their storage

If hospitals and doctors from the 2000s and 1990s and 1980s and 1970s
and 1960s and 1950s and... only always used UTC for their records...
but they didn't.

Post by Mike Small
format and translate as necessary for presentation it wouldn't be so
bad, but I guess in your example case it's too late now.

It's not just my example case. An EMR system today has to accomodate
not only data today but data spanning the entire lifetimes of patients
with all of the inconsistencies of different paper records and
procedures and EMRs and timekeeping. And it's impossible to unify
because the information needed to unify those records does not exist,
never did.

[Bill Ricker]

Date/time calculations not using a library accessing the historical
TZ/DST data in Olsen TZdata file is erroneous.
Alas for future dates, one can't even assume the TZ spec won't change
between now and then, as it can be undone by politicians, witness
Morocco cancelling DST with two days' notice recently.

Post by Mike Small
If database programmers would only always use UTC for their storage
format and translate as necessary for presentation it wouldn't be so
bad,

Right on.
If a Date-Time isn't marked with explicit TZ indicator (including DST
status indication ) it better be implicitly Zulu or it is buggy data
already.

Post by Mike Small
but I guess in your example case it's too late now.

yeah, should have fixed that in 1999 ...

Post by Mike Small
http://naggum.no/lugm-time.html

Interesting

Post by Mike Small
If hospitals and doctors from the 2000s and 1990s and 1980s and 1970s
and 1960s and 1950s and... only always used UTC for their records...
but they didn't.

If they at least annotate 2018 Nov 4, 1:30 AM EDT vs Nov 4, 1:30 AM
EST, and also 1972 October 29, you're good, you can use TZdata to
validate and convert UTC for storage.

If they failed to note TZ during that hour because the hospital never
moves so they don't need a TZ the rest of the year on paper, well
yeah, it's ambiguous data -- and banning DST in the future won't fix
your ambiguous historical data. And our modern systems can require
recording of the TZ/DST in effect at time of
admission/birth/time-of-other-service at point of data capture going
forward, so you get no value from banning DST.

(Although most people who SAY they want to ban DST, particularly in
N.E., actually mean they want to abandon Winter time and move
permanent summer time, UTC-4, which would be DST-less AST.)

Post by Mike Small
It's not just my example case. An EMR system today has to accomodate
not only data today but data spanning the entire lifetimes of patients
with all of the inconsistencies of different paper records and
procedures and EMRs and timekeeping. And it's impossible to unify
because the information needed to unify those records does not exist,
never did.

Yes, you have data ingest problem when pulling in old paper records
and records sent over in incomplete exchange formats from other
systems.
Ambiguous data that wasn't properly cleaned at the time will always be
ambiguous.
Unless you borrow a timemachine and kill Ben Franklin so the idea of
DST never spreads, you can't fix that. (I think he did more good than
harm, so I recommend against it.)

OTOH, TimeZones were created for the convenience of the Railroads and
their passengers, and welcomed by the financial markets, and DST was
promulgated for the convenience of Little League and out-door chores
like lawn mowing (before power mowers it took longer). They were never
welcomed by farmers, who worked can-to-can't and milked the cows at
the same sun-time -- and customers thinking time changed rankled them!

Today, the digital financial markets handle TZ differences between
LON, NYC/BOS, CHI, SF, TOK, and HK markets without difficulty -- and
we trade around the clock. Boston's small stock exchange could go on
Atlantic time without discouraging volume; opening "floor" trading an
hour before New York might actually attract volume.

As more and more parks and ballfields have flood lights, does DST buy
us anything that wouldn't better be addressed by WFH and Flex Time?
No. Flex time reduces congestion and would encourage bicycling later
in the year.

If we wanted to join India and Newfoundland as rebels, we could even
split off N.E. as a half-hour timezone based on our local meridian, or
adopt permanent DST by joining NB/NS/PEI as AST (but without ADT/DST).

20 years ago either permanent DST (=AST year round) or half-hour zone
would not have been practical because network TV only recognized 2 TZ,
ET & PT, but with streaming/binging/DVR today, would anyone care if
GoT came on an hour "later" in Boston just as it is an hour "earlier"
in Chicago today?

[Mike Small]

Post by Bill Ricker
If we wanted to join India and Newfoundland as rebels, we could even
split off N.E. as a half-hour timezone based on our local meridian, or
adopt permanent DST by joining NB/NS/PEI as AST (but without ADT/DST).

If we join Newfoundland in taking a half hour offset we should also
start celebrating Guy Fawkes day like they do. I'm sure people around
here would love a good bonfire.

Post by Bill Ricker
20 years ago either permanent DST (=AST year round) or half-hour zone
would not have been practical because network TV only recognized 2 TZ,
ET & PT, but with streaming/binging/DVR today, would anyone care if
GoT came on an hour "later" in Boston just as it is an hour "earlier"
in Chicago today?

Well, there's still the late night shows. Sure you can time shift them,
but somehow it's just not the same. I grew up on Atlantic time and
staying up for Letterman was a special little rebellious indulgence. And
then there's sports. People like to watch with others in bars and so
on. It's hard in Boston to stay late in bars, what with transit not
running very late and with so many people having to live so far away
from the affordability problems. On the other hand maybe fans would like
the idea of being in a different time zone than NYC just because.

[Daniel Barrett]

Post by Rich Pieri
Multiply that by many hundreds of millions of patient records across
many years of patients' lives, many locales and time zones and
timekeeping changes, and inconsistencies across different
record-keeping procedures, and you have a bonafide nightmare.

I'm all for precision in hospital record keeping in general, but in
this specific example (birth time off by 1 hour), is there any
compelling need to know the precise time of someone's birth? I can't
think of a single time in five decades that I've been asked for it,
except maybe by a particularly anal astrologer.

--
Dan Barrett
***@blazemonger.com

[Rich Pieri]

On Wed, 7 Nov 2018 20:52:41 -0500

Post by Daniel Barrett
I'm all for precision in hospital record keeping in general, but in
this specific example (birth time off by 1 hour), is there any
compelling need to know the precise time of someone's birth? I can't
think of a single time in five decades that I've been asked for it,
except maybe by a particularly anal astrologer.

Don't get hung up on the specific example. It's an example. Substitute
the times that medications are administered if it makes the example
more relevant to you. It's the same problem: when did something happen.