The Healthcare industry is subject to time accuracy regulations, standards and mandates in the areas of administration, patient care, record keeping, medical procedures and accreditation by the American Hospital Association, Joint Commission and other regulatory entities. Below is a reference list of regulations and standards requiring accurate timekeeping.
Certificate of Ambulatory and Inpatient EHRs, Final Security Criteria:
The system shall provide authorized administrators with the capability to read all audit information from the audit records in one of the following two ways: 1) The system shall provide the audit records in a manner suitable for the user to interpret the information. The system shall provide the capability to generate reports based on ranges of system date and time that audit records were collected. 2) The system shall be able to export logs into text format and correlate records based on time (e.g., UTC synchronization). See S7, S8.1 and S8.2. CMS Conditions of Participation for Hospitals §482.24
All entries in the medical record must be timed, date, and authenticated, and a method established to identify the author. The identification may include written signatures, initials, computer key, or other code. Authentication may include signatures, written initials or computer entry.
Section 11.10 sites measures designed to ensure the integrity of system operations and information store in the system. Such measures include: 1) validation; 2) the ability to generate accurate and complete copies of records; 3) archival protection of records; 4) use of computer-generated, time-stamped audit trails, 5) use of appropriate controls over systems documentation; and 6) a determination that persons who develop, maintain, or use electronic records and signature systems have the education, training, and experience to perform their assigned tasks.
Security and Electronic Signature Standards (2002) addresses the following policies, practices and procedures:
The HL7 EHR Interoperability Model (EHR/IM) establishes an industry consensus view of "What is EHR Interoperability?" It provides a reference list of characteristics of (and requirements of) interoperable EHR records.
2.7c: An Act occurs at a specific date/time and has an elapsed time – date/time consistent with a Master Clock System
The HL7 EHR Functional Model (EHR-S FM) specifies over 160 functions that may be present in an Electronic Health Record System. These include:
IHE's IT Infrastructure Radiology, Cardiology, and Patient Care Devices (PCD) Technical Frameworks identify the problem of inconsistent time.
|Problem||IHE Domain||IHE Integration Profile||Transaction||Actors|
|Inconsistent Time||Infrastructure, Radiology, Cardiology, Patient Care Devices||Consistent Time (CT)||NTP or SNTP, request/send||Time Client, Time Server|
Consistent Time (CT) Integration Profile provides a means to ensure that the system clocks and time stamps of the many computers in a network are well synchronized. This profile specifies synchronization with a median error less than 1 second.
The Joint Commission on Accreditation of Healthcare Organizations requires: Organizations to maintain complete and accurate medical records (RC.01.01.01). It also requires Documentation in the medical record is entered in a timely manner (RC.01.03.01). Provides guidelines for the appropriate authentication of medical record entries:
Joint Commission Elements of Performance
The Joint Commission and CMS Reporting of Core Measures for Hospital Quality Measures requires accuracy in documentation related to time sensitive data currently being reported for acute myocardial infarction include:
Timey care is also defined for surgical care, emergency department care, and stroke care.
Synchronized time is an important improvement tool as required by Chest Pain Center accreditation in two ways: as a Functional Facility Design practice and accurate performance metrics.
KEY ELEMENT #2: Emergency Assessment of Patients with Symptoms of ACS – Timely Diagnosis and Treatment Examples of measurements and procedures:
KEY ELEMENT #7: Functional Facility Design
The Joint Commission's Certificate of Distinction for Primary Stroke Centers requires the following measurements: