Dear Sir,
We read the letter by Saxena, et al.,[1] making an interesting and relevant point of periodic check-up of clocks on all computers in the radiology departments and highlighting the potential legal ramifications.
We fully agree with the authors and would like to add that this is critical for teleradiology practices providing opinions to clients spread across different time zones. Ours is a global teleradiology group providing radiology services to different continents, with the hospitals from the United States comprising a major chunk of the case load. As integral parts of the patient care records, the reporting times and time stamps of any communication must be synchronized with the local time zone of the client, else the relationships between on-site medical documents and the radiology procedures become incomprehensible. This is also a potential source of medicolegal liability. To complicate things further, the United States and some other countries follow a practice of advancing the clock by 1 h near the start of spring to maximize the use of early daylight, which is referred to as daylight saving time (DST). Normal time is restored in autumn by setting back the clock. The DST changes can pose difficulties to local businesses and it is even more challenging for the service providers working from across the globe. We have personally faced a problem during our emergency teleradiology practice, wherein the time of communication with the doctor in a critically ill patient was incorrect in the report due to the computer clock not having been set back in autumn. Because of the computer clock not having been set backward by 1 h at the end of DST, the time of communication logged in the report was an hour later than it actually was, creating the appearance of delayed reporting in a critical time-sensitive study. In this case, no adverse outcome resulted and the problem was sorted out after our quality assurance team alerted us of the miscommunication. We have subsequently actively monitored the clocks on our computers, and a group mail is sent out to the entire team at the beginning and end of DST. Other measures such as automated report dispatch, wherein the software can adjust the time based on the location of the imaging study, and centralized communication via call center personnel have also been effective. The computer clocks are under the control of the administrative staff to prevent any inadvertent errors and subsequent confusion.
It is incumbent upon the technical staff and radiologists to ensure that time on computers and imaging equipment is checked periodically as part of the quality assurance process. This is important for all radiology practitioners and needs special attention in teleradiology offices.
Link for the publication: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3624746/
Kalyanpur,A, A.Agrawal. Synchronizing computer clocks: The challenge of multiple time zones in teleradiology. The Indian Journal of Radiology and Imaging. Volume 22, Issue 3. August 2012