×

Welcome to the Slashdot Beta site -- learn more here. Use the link in the footer or click here to return to the Classic version of Slashdot.

Thank you!

Before you choose to head back to the Classic look of the site, we'd appreciate it if you share your thoughts on the Beta; your feedback is what drives our ongoing development.

Beta is different and we value you taking the time to try it out. Please take a look at the changes we've made in Beta and  learn more about it. Thanks for reading, and for making the site better!

Know What Time It Is? Your Medical Device Doesn't

timothy posted about 2 years ago | from the why-the-economist-rocks dept.

Medicine 290

An anonymous reader writes "A man with one clock knows what time it is, goes the old saw, a man with two is never sure. Imagine the confusion, then, experienced by a doctor with dozens. Julian Goldman is an anaesthetist at Massachusetts General Hospital in Boston. After beginning to administer blood-thinning medication during an urgent neurological procedure in 2005, Mr Goldman noticed that the EMR had recorded him checking the level of clotting 22 minutes earlier. As a result, four hospitals in the northeast had their medical devices checked, and found that on average they were off by 24 minutes. The easy solution that devices could have used since 1985? NTP."

cancel ×
This is a preview of your comment

No Comment Title Entered

Anonymous Coward 1 minute ago

No Comment Entered

290 comments

NTP and hospitals (-1, Troll)

Asksa (2646127) | about 2 years ago | (#40089499)

The easy solution that devices could have used since 1985? NTP.

Holy hell, what about no? There's a huge reason why hospitals try to keep off networks, especially public ones. Do you really want to connect all the timing devices in a hospital to an outside public server? Because running it yourself does no good, it can just fuck up all the devices in the hospital.

Sometimes the ideas non-thinking geeks come up truly scare me.

Run your own NTP if it matters (5, Insightful)

tepples (727027) | about 2 years ago | (#40089563)

Why can't the medical devices be hardcoded to use an NTP server on the hospital's LAN?

Re:Run your own NTP if it matters (1, Insightful)

Asksa (2646127) | about 2 years ago | (#40089623)

How would that change anything? It just makes all the clocks on the hospital go wrong when it starts to move to wrong times on the NTP server. Updating it from public sources is out of question too. Think about someone injecting completely wrong time to the hospital.

What about good old solution comparing separate clocks?

Re:Run your own NTP if it matters (5, Informative)

slimjim8094 (941042) | about 2 years ago | (#40089791)

Easy, get a GPS receiver and use its time. The point is that the times all need to be the *same* (so things that happen at the same time are recorded as such); accuracy is secondary. Even if every week or two some guy goes and fixes the clock on the server, that should be acceptable.

Re:Run your own NTP if it matters (-1, Troll)

internerdj (1319281) | about 2 years ago | (#40089897)

Yeah, I see that going over well... How does it keep time? Oh GPS. Don't worry, we aren't tracking you. No thanks, I'm going to get a second opinion.

Re:Run your own NTP if it matters (1)

internerdj (1319281) | about 2 years ago | (#40089949)

Please disregard. When I read medical devices, I was thinking things like my neice's insulin pump. Didn't read the summary carefully enough.

Re:Run your own NTP if it matters (5, Informative)

Kenja (541830) | about 2 years ago | (#40090153)

Even if your interpretation of what devices where effected was true, you would still be a crazy person. The act of receiving GPS signals can not be tracked. To track (for example) an insulin pump, you would need a TRANSMITTER in addition to a receiver.

Re:Run your own NTP if it matters (3, Informative)

Patricia (643) | about 2 years ago | (#40090167)

You should be a little less paranoid about GPS.

Just because you can find the time and your position using GPS doesn't mean someone can track where you are.
A GPS device is a receiver, not a transmitter.

GPS satellites constantly broadcast the time, and their location. A the GPS in the device takes this data from several (4+) satellites, does the math, and calculates the position.

For this to work the time has to be absolutely correct. So you can use the time to set your clock.

Without some sort of transmitter (like a phone with its data connection, or some sort of dedicated transmitter built into the same device) no one has any possibility of knowing where you are.

Re:Run your own NTP if it matters (2)

bmo (77928) | about 2 years ago | (#40090307)

Yeah, I see that going over well... How does it keep time? Oh GPS. Don't worry, we aren't tracking you. No thanks, I'm going to get a second opinion.

Modded insightful, even.

Protip: GPS receivers do not transmit. Unless you buy one that is attached to, you know, a transmitter like a cellphone.

Crikes.

--
BMO

Re:Run your own NTP if it matters (4, Insightful)

Z00L00K (682162) | about 2 years ago | (#40089835)

At least then all data logged will have a correct relation and timing of events can be managed if necessary.

If every computer has it's own time then it's impossible to get things straight about when did who do what. And that's critical if something happens and you need to figure out how to correct it so it won't happen again. Of course - it can also be used in the blame game.

And it's not a big problem for a hospital to use NTP if the source used is trustworthy. GPS receiver and/or a trusted NTP server on the net.

Re:Run your own NTP if it matters (1)

jeffmeden (135043) | about 2 years ago | (#40090005)

At least then all data logged will have a correct relation and timing of events can be managed if necessary.

If every computer has it's own time then it's impossible to get things straight about when did who do what. And that's critical if something happens and you need to figure out how to correct it so it won't happen again. Of course - it can also be used in the blame game.

And it's not a big problem for a hospital to use NTP if the source used is trustworthy. GPS receiver and/or a trusted NTP server on the net.

Don't bother, this guy clearly works in a private healthcare environment, given his complete disregard for *actually* improving the quality of care and instead his direct instinct to preserve his job and/or revenue stream. Anyone who takes more than a casual look at private healthcare can see that there are so so SO many ways to do things better that get completely ignored in favor of doing things the current way, or doing things in a way that makes it easy to dodge a lawsuit.

did I say that?

Re:Run your own NTP if it matters (0)

Anonymous Coward | about 2 years ago | (#40090189)

I take it you have never been to a hospital in Canada and waited a full day in an ER in a city where there is no emergency happening.

Re:Run your own NTP if it matters (2)

slippyblade (962288) | about 2 years ago | (#40090413)

Canada? At least there you'll get the treatment eventually. 4-5 hour waits with an empty ER are pretty common in my city. Phoenix, AZ

Re:Run your own NTP if it matters (5, Informative)

tqk (413719) | about 2 years ago | (#40089969)

How would that change anything? It just makes all the clocks on the hospital go wrong when it starts to move to wrong times on the NTP server.

You can have one local timeserver that syncs with external trusted servers (nist.gov). All of your local devices can sync with your local ntp server.

Updating it from public sources is out of question too. Think about someone injecting completely wrong time to the hospital.

NTP is *pull*, not push. We've had decades now to bulletproof NTP. It will be pretty easy to nail an NTP server down so it's only going to be serving NTP.

The medical and legal professions are the most IT challenged disciplines I've ever seen, but that may be largely due to excessive gov't regulation.

Re:Run your own NTP if it matters (0)

Chakra5 (1417951) | about 2 years ago | (#40090285)

The medical and legal professions are the most IT challenged disciplines I've ever seen, but that may be largely due to excessive gov't regulation.

You obviously have little experience in education.

....oh, and your politics are showing...IT challenge is related to gov't regulation how? And please do tell how this unspoken rational outweighs simply being cash strapped and crisis focused?....ok, not as sexy as knee-jerk rant against the "gob'met"...carry on with that

Re:Run your own NTP if it matters (0)

Anonymous Coward | about 2 years ago | (#40090599)

It does not fix the problem, the NTP server could have the wrong time. The local NTP server at my employer has been supplying the wrong time for at least two years.

Re:Run your own NTP if it matters (5, Insightful)

sjames (1099) | about 2 years ago | (#40090031)

In many cases, consistency between two clocks and moving at the correct rate is FAR more important than absolute correctness. For example, it hardly matters if the hospital's clocks all think it's Feb 3rd 213AD so long as you know that the patient's last dose was 3 hours ago. If the clock in the patient's room thinks it's an hour later than the one in the recovery room, that could matter.

Re:Run your own NTP if it matters (0)

Anonymous Coward | about 2 years ago | (#40090361)

"What about good old solution comparing separate clocks?"

Isn't that what an NTP cluster is all about? Irregardless, admining & monitoring time in one disecrete place, where you could compare it with outside verificaiton (and throw an error as opposed to allow injections) is probably easier than managing every clock by itself.

Re:Run your own NTP if it matters (-1)

Anonymous Coward | about 2 years ago | (#40090443)

Irregardless isn't a word. Thought you should know. kthxbai.

Re:Run your own NTP if it matters (1)

dgatwood (11270) | about 2 years ago | (#40090419)

It just makes all the clocks on the hospital go wrong when it starts to move to wrong times on the NTP server.

Including the clock in the hall. Everything but the doctor's watch. Therefore, for the most part, all of them would be self-consistent. The reason this was a problem is that the doctor nearly performed a medical procedure twice because one person was using one clock as a baseline and another person was using a different clock. If all the clocks use the same baseline, they will all be the same. It doesn't actually matter if they are right.

Also, if everybody's clocks were suddenly wrong, the odds of somebody noticing the problem quickly are much, much higher than if a single patient's clock is wrong.

Re:Run your own NTP if it matters (1)

nedlohs (1335013) | about 2 years ago | (#40090675)

Having everything on the same clock seems far better than having things on their own out of sync clocks.

Sure that one device says it did something at 1:15pm doesn't mean it actually did, but if another device says the current time is 2:15pm then it was an hour ago since they are both out of sync with the actual time by the same factor.

And of course whenever there's some sort of external check (a nurse looking at their watch) then to fix the device all the devices get fixed rather than just that one. So your NTP server is more likely to stay in sync with reality than any one device.

Re:NTP and hospitals (0)

Anonymous Coward | about 2 years ago | (#40089569)

Why not just use radio [nist.gov] instead?

Re:NTP and hospitals (1)

David_W (35680) | about 2 years ago | (#40089755)

Why not just use radio [nist.gov] instead?

Nice theory, although if the couple of "atomic" clocks I have around the house are any indicator, it's not a great plan. They only can pick up the radio signal at night (something to do with the ionosphere IIRC), and this in my house with windows in every room. In a hospital? Good luck...

Re:NTP and hospitals (1)

zlives (2009072) | about 2 years ago | (#40089965)

could be used to seed the local lan NTP server for hospital devices... even if it checks for error nightly, its bound to be off by a few micro seconds...

Re:NTP and hospitals (5, Informative)

macemoneta (154740) | about 2 years ago | (#40089585)

Holy hell, what about no? There's a huge reason why hospitals try to keep off networks, especially public ones. Do you really want to connect all the timing devices in a hospital to an outside public server? Because running it yourself does no good, it can just fuck up all the devices in the hospital.

NTP does not require access to public networks. Private time servers, usually GPS sourced via rooftop antennas, are very common.

Re:NTP and hospitals (2, Interesting)

Anonymous Coward | about 2 years ago | (#40090159)

I am just playing with one said GPS unit. US$50, plus USB/Serial cable, plus conversion chips. 4h work, less than US$80 in hardware. There are ready made units for around $400, with a rubidium standard if the GPS is not available.

Not having a time standard is beyond not acceptable.

Re:NTP and hospitals (0)

Anonymous Coward | about 2 years ago | (#40090177)

If the majority of hospitals haven't been doing this for at least a decade, our society is further behind then I've calculated.

Off to re-examine the long term progress chart ....

Re:NTP and hospitals (0)

Anonymous Coward | about 2 years ago | (#40090265)

Quite simple really.

http://www.evertz.com/products/560xMSC

Sad to think that your local broadcaster is working on more accurate time then your hospital.

Re:NTP and hospitals (4, Insightful)

Alan Shutko (5101) | about 2 years ago | (#40089587)

You don't need to connect to an outside server. You can easily run your own time source (GPS is really easy these days), or have the devices talk to a single internal server which then securely contacts outward. If they're off, at least they're all on the same time. It's really dangerous if everything is reporting different incorrect times.

Re:NTP and hospitals (3, Insightful)

Anonymous Coward | about 2 years ago | (#40089589)

The easy solution that devices could have used since 1985? NTP.

Holy hell, what about no? There's a huge reason why hospitals try to keep off networks, especially public ones. Do you really want to connect all the timing devices in a hospital to an outside public server? Because running it yourself does no good, it can just fuck up all the devices in the hospital.

Sometimes the ideas non-thinking geeks come up truly scare me.

No one said the NTP server had to be external. NTP is just a method to keep a bunch of clocks synchronized to an arbitrary master.

Sometimes the stupidity of non-technical and non-thoughtful people scare me.

Re:NTP and hospitals (2)

fuzzyfuzzyfungus (1223518) | about 2 years ago | (#40089595)

You could do an implementation of NTP on a closed network, with a local time source(compared to the rest of a hospital, an OK atomic clock doesn't cost that much, and a GPS timebase could be lost in a rounding error) with devices flagging anomalies in the NTP source and falling back on local quartz oscillators if needed.

It'd be more expensive than just having IT bring a patch cable; but there isn't anything about "NTP" that requires putting gramps' pacemaker on the internet...

Re:NTP and hospitals (0)

Anonymous Coward | about 2 years ago | (#40090245)

"Atomic clocks" can only sync at night. You don't actually think the atomic mechanism is built into the clock, do you?

Re:NTP and hospitals (1)

rb12345 (1170423) | about 2 years ago | (#40090479)

For the original poster, the local atomic clock would indeed be a real atomic clock, so your NTP master clock drift ought to be minimal even if you only sync nightly. Of course, it's far more likely that a couple of cheap GPS receivers would be used in practice. Other servers and desktop machines would sync time using NTP over the existing internal network.

NTP Is Just a Protocol, Not a Specific Server (3, Insightful)

eldavojohn (898314) | about 2 years ago | (#40089611)

NTP is just a protocol that you can implement. There are solutions that you can install internally that don't require internet access. Just stand up your own internal NTP server and have your own internal official time (possibly synced to something more authoritative). I agree with your sentiment about keeping sensitive medical equipment disconnected from the internet but with hospitals becoming more and more interconnected and not having their own physical infrastructure to do so, the internet looks like it's probably the best option. Yes, there are way to protect your traffic and all that but I must be pedantic and point out that NTP does not mean you must use the common servers available on the internet.

Re:NTP and hospitals (1)

bernywork (57298) | about 2 years ago | (#40089631)

*blink* how can running your own NTP server taking time from GPS "Fuck up all the devices in the hospital" ?

Re:NTP and hospitals (1)

hippo (107522) | about 2 years ago | (#40090381)

Easy - when the server NTP clock goes haywire then all the device synced to it will follow. It's unlikely but you can't rule out bugs in the NTP server. Better to have a clock that increments fairly accurately (quartz crystal in the device) and has an offset than a clock you can't trust.

If I'm on life support and getting fed a drug at a certain rate to keep me alive I would like that rate to be accurate. I don't care what time the machine thinks it is.

Re:NTP and hospitals (1)

khallow (566160) | about 2 years ago | (#40089683)

Holy hell, what about no? There's a huge reason why hospitals try to keep off networks, especially public ones. Do you really want to connect all the timing devices in a hospital to an outside public server?

NTP works on private networks too. Set up your own internal NTP service.

Because running it yourself does no good, it can just fuck up all the devices in the hospital.

I'm not sure what you're trying to say here. But it strikes me that having a common time seems to have more upside than down (at least for devices that need to have an internal time clock).

Re:NTP and hospitals (0)

Anonymous Coward | about 2 years ago | (#40089691)

Holy hell, what about YES.

Have an NTP server locally inside the hospital that maintains internal time, so that at least we know room 105 and room 106 are consistent within the same building. Then, set the server to sync up with a GPS satellite or some other source once a day, or even once a week. You might get a few seconds of drift between buildings over the course of the week, but none of the 24-minute BS.

Some of the thoughts non-geeks come up with truly scare me.

Re:NTP and hospitals (2)

King_TJ (85913) | about 2 years ago | (#40089713)

I don't get why people (like the parent poster) are blowing this up, out of proportion?

You don't have to expose all of the hospital devices/systems to the Internet, just to ensure they all have the same, accurate clock time!!

All you need is ONE device permitted to access the proper port for NTP protocol through a firewall, to set its own clock as the master, and then have it redistribute the date/time info to the remaining devices on the hospital's LAN!

It's not like the hospital doesn't already have Internet access and a firewall in place. They probably offer free wi-fi in the waiting areas, if they're half way modernized -- and even if not? They surely have Internet connectivity in place for at least a few needs.

Re:NTP and hospitals (2)

MightyYar (622222) | about 2 years ago | (#40089727)

There's a huge reason why hospitals try to keep off networks, especially public ones.

And yet device makers create equipment that requires their time to be set...

I can't help but wonder why they don't use a different report style. If you want to look at the log to see when the last event occurred, why not report in elapsed time? Like:
20 min ago: 10cc of supermed dispensed
40 min ago: 5cc of supermed dispensed
60 min ago: unit reset

Re:NTP and hospitals (2)

MightyYar (622222) | about 2 years ago | (#40090131)

I thought of another good solution - when the electronic reporting system polls a device, it should ask the device what time the device thinks it is, and then adjust the report from the device accordingly.

Older devices without either the option to report in elapsed time or the ability to tell you the current time would be a problem. You'd have to either ignore the timestamps until someone manually verifies the time - which would be a joke since everyone would just click "Verify" without actually looking at the device - or come up with some more-clever-than-me solution.

Re:NTP and hospitals (1)

JWSmythe (446288) | about 2 years ago | (#40090359)

    As I understand it (which may be incorrect) a lot of units that are timed devices, just reference themselves. If you set an IV pump to dispense #mg every 5 minutes, it doesn't check the time, it only waits for that interval to pass. You don't want every device to be network attached. If you're on 5mg morphine once every 5 minutes (60mg/hr), it would be rather bad if some network based exploit changed the reported dispensed fluid to saline, and changed the rate to 10mg/min (600mg/hr). It might feel good for the first minute, but unless you have a serious opiate tolerance, the next room you'll be sent to is the morgue.

    Someone who actually works with medical devices will probably clarify if that is or isn't possible.

    From what I saw in a recent hospital visit, not much of their equipment is networked. At least at the fairly "modern" hospital I was at. At least they had wifi available in the rooms. Unfortunately, they blocked everything but port 80 and 443, so I couldn't even VPN to my work network. I spent my stay giving instructions via my cell phone.

Don't be silly. (0)

Anonymous Coward | about 2 years ago | (#40089783)

You're right that you wouldn't want to use untrusted time sources. But that doesn't mean NTP is useless here.

If the various devices need to work together, they also need to have similar time. It doesn't even need to conform to universal time; it only really needs to be the same in the same hospital, and especially in sync with the wall clocks doctors and nurses look at. I'd also want an indication on each clock that it still runs, that it's not standing still, and if mains-powered needs to be on the emergency power-enabled grid, too.

A well-tuned central clock or three (not two, thank you) should help quite a lot already. What that is, well, it could be GPS or an atomic clock or a receiver to the local government radio time service or what-have-you. But it really doesn't matter much. Keeping time among the devices inside the hospital is quite valuable in and of itself already.

Re:NTP and hospitals (1)

JWSmythe (446288) | about 2 years ago | (#40089813)

    You're absolutely correct. It seems intuitive to us that all devices should be networked. An in-house NTP server would satisfy this time sync need. As we've already seen with many other things, even a machine with no network access can be compromised by another that does.

    I happened to be in a doctors office (out patient surgical suite) today. Everything had a sign-off sheet with it, where someone would check everything daily. Even the portable O2 tanks were checked to make sure they were full.

    If the time on the device is important, it would seem very important to have the time checked and set daily. That in itself could cause problems if they used an unsynchronized source, like the persons analogue watch. The solution is obvious though. Synchronize their watches to a known good source. Those should be abundant in most hospitals, as the PCs are usually network attached and can be synchronized to a good in-house time source. Pick one, and tell everyone "set your watch to this.", even if it's the timeclock in the break room.

Re:NTP and hospitals (1)

Anonymous Coward | about 2 years ago | (#40089815)

The Universal Time Clock broadcasts over shortwave radio and can be picked up anywhere in the US at, for example, 10000 MHz. "Atomic" watches and clocks use this (or other equivalent) signals to sync their readings.

No extra networking, receive only. For all the insane markup on medical devices, I'm sure this could be added without any significant expense - if it were deemed necessary.

As of yet, apparently it hasn't been necessary. But it can be done without NTP.

Re:NTP and hospitals (3, Insightful)

plover (150551) | about 2 years ago | (#40089831)

hospitals try to keep off networks, especially public ones

The sysadmins try, but fail. Most hospital networks and devices ARE connected to the internet in some way. Doctors want their access from the various desktop machines, of course, but many of the diagnostic machines offer things like "click this button to email the ultrasound pictures". So they do.

I was appalled to learn this a few years ago from a hospital sysadmin here on /. The thing he pointed out is that Doctors are Gods. If they say "This thing can email pictures? Well yeah, hook it up!" then the sysadmin has zero choice. Holes get punched in firewalls that should never have been punched, and the gear gets hooked up.

And because medical devices are certified only to work with a particular operating system at a particular patch level, they don't get upgraded unless the vendor comes out with a new certified patched OS. That means the ultrasound machine sitting on that cart might still be running Windows XP SP 1. It's crazy.

NTP would actually be the least of their worries. That's something they could more easily house internally.

Re:NTP and hospitals (2)

Lumpy (12016) | about 2 years ago | (#40089925)

" Because running it yourself does no good, it can just fuck up all the devices in the hospital."

IF your devices are set to "fuck up" when time changes, you are buying really low grade crap.

NTP server on closed network for hospital devices, it's source is a GPS timing signal. Zero internet access, provides NTP and a accurate time signal.

This is SOP in any secure environment.

Re:NTP and hospitals (2)

jeffmeden (135043) | about 2 years ago | (#40089931)

The easy solution that devices could have used since 1985? NTP.

Holy hell, what about no? There's a huge reason why hospitals try to keep off networks, especially public ones. Do you really want to connect all the timing devices in a hospital to an outside public server? Because running it yourself does no good, it can just fuck up all the devices in the hospital.

Sometimes the ideas non-thinking geeks come up truly scare me.

So the GPS synced clocks used to generate microsecond-accurate timing distributed via NTP for utility billing, high speed trading, and a million other mission critical (read: *beyond* life critical) things aren't good enough for your EMR tablet to update on once a day? Sure thing. Keep hiding under that table.

Re:NTP and hospitals (1)

kdemetter (965669) | about 2 years ago | (#40089945)

Who is talking about connecting to an outside server : just have one ntp server running in the hospital, and all devices synchronize to that.
Then at least all the devices in the hospital will be synchronized, which I guess is the most important.

Re:NTP and hospitals (1)

RogueLeaderX (845092) | about 2 years ago | (#40089993)

The easy solution that devices could have used since 1985? NTP.

Holy hell, what about no? There's a huge reason why hospitals try to keep off networks, especially public ones. Do you really want to connect all the timing devices in a hospital to an outside public server? Because running it yourself does no good, it can just fuck up all the devices in the hospital.

Sometimes the ideas non-thinking geeks come up truly scare me.

So the problem posited by TFA is that device clocks with the wrong times lead to improper treatment. The solution offered is a central time server utilzing the NTP protocol. You've stated that this can just fuck up all the devices in the hospital. (I'm assuming you're getting at the problem of a time server gone bad setting the wrong time for all devices in the hospital.)

So now we weigh the risk of improper treatment due to time differences between devices vs. the risk of an time server failure. To make that calculation we'll need to know the rate of improper treatment due to time differences and the rate of time server failure. TFA speculates that it's causing problems but provides no hard data. Similarly, I have no hard dat on NTP server failure.

So essentially our discussion is as follows:

Time differences between devices could be causing problems and NTP will fix this!

But, NTP could cause all devices in the hospital to get messed up!

Also, the sky could turn orange today!

(p.s. I'm guessing you've had bad experiences with inhouse NTP servers?)

Re:NTP and hospitals (1)

DragonWriter (970822) | about 2 years ago | (#40090339)

Holy hell, what about no? There's a huge reason why hospitals try to keep off networks, especially public ones.

Facilitating exchange via networks is a major purpose of an EMR system, so this isn't generally the case with EMR systems, or (transitively) with devices that interface with EMR systems.

Do you really want to connect all the timing devices in a hospital to an outside public server? Because running it yourself does no good, it can just fuck up all the devices in the hospital.

NTP inside the organization that is synced by one of the broadcast time signals (GPS, FM time broadcasts, etc.) from outside of the hospital would address this concern, if you really were dealing with a hospital that wanted no internet connection to the outside world.

Re:NTP and hospitals (0)

Anonymous Coward | about 2 years ago | (#40090383)

So host your own internal NTP server that's synced via GPS. That part is trivial and inexpensive.

The hard part might simply be getting medical devices to all speak TCP/IP, and all the risks of having medical devices connected to a network (even internal).

Re:NTP and hospitals (1)

ThunderBird89 (1293256) | about 2 years ago | (#40090551)

You know, as long as the devices in one hospital keep the same time, it doesn't really matter if that time is off by any amount. The important thing is to have all clocks in one building showing the same time, so that the correct elapsed time can be told with just a quick glance. In a medical context, that's usually more important than the current local time.

Neither do Android phones (-1, Troll)

Anonymous Coward | about 2 years ago | (#40089547)

Few people realize this, but Android phones don't keep time correctly [businessinsider.com]. They use GPS satellites for timekeeping, which was last updated in 1982, and since then there have been 15 leap seconds added. As a result, nearly all Android devices are 15 seconds too fast. Note that iOS compensates for this and shows the correct time.

Re:Neither do Android phones (3, Funny)

tscheez (71929) | about 2 years ago | (#40089663)

Oh noes!!! My android phone will make me 15 seconds early to any appointment!!!! I must therefore dump it and become and apple fanboy.

Re:Neither do Android phones (0)

Anonymous Coward | about 2 years ago | (#40089849)

Ah, but if they were lazy doing this, and clearly they were, what else were they lazy doing? It is easy to do the right thing, yet they (android developers) didn't..

Re:Neither do Android phones (-1)

Anonymous Coward | about 2 years ago | (#40090033)

Forgive me for expecting an expensive smartphone to properly do what mechanical clocks have been able to do for centuries. Of course, if the iPhone was 15 seconds off all the time while Android phones weren't, you'd no doubt be trashing Apple for it. If Google didn't care enough to tell time properly, what else did they slack off on?

Re:Neither do Android phones (1)

Fwipp (1473271) | about 2 years ago | (#40090559)

Ah yes, because mechanical clocks that are hundreds of years old automatically adjust for leap seconds.

Re:Neither do Android phones (2)

Lumpy (12016) | about 2 years ago | (#40090061)

It's better than being a rabid android fanboy you are now.

P.S. Nokia phones also did the 15 second adjustment. Google just figures it is not important and also get's its time from the cellular towers that just happen to get their signal from GPS.

Re:Neither do Android phones (1)

MetalliQaZ (539913) | about 2 years ago | (#40089669)

Different problem. The medical devices were all set inconsistently. The Android "problem" you describe may slowly diverge away from iPhones, but at least they are consistent.

That's what the proverb in the post implies: consistency is what matters.

PS: since when do cell phones take the time from GPS instead of the cell network? I'm pretty sure my phone synchronizes to Verizon's towers. I usually keep GPS disabled.

Re:Neither do Android phones (0)

Anonymous Coward | about 2 years ago | (#40089711)

Anecdotally - I just checked and my Nexus One was perfectly in sync with my MacBook synced to Apple's time server.

Android phones get their time from the carrier they are connected to, just like iPhones do in their default configuration. While the info about GPS clocks being off from "true time" may be correct, the information about Android phones being off by 15 seconds is incorrect.

Re:Neither do Android phones (1)

khallow (566160) | about 2 years ago | (#40089757)

As a result, nearly all Android devices are 15 seconds too fast. Note that iOS compensates for this and shows the correct time.

Then Android devices are not 15 seconds too fast. And GPS isn't either for that matter, you just need to know the offset and you're golden. An accurate clock and a precise, well known offset means you aren't too fast or too slow.

Re:Neither do Android phones (1)

jeffmeden (135043) | about 2 years ago | (#40090169)

Few people realize this, but Android phones don't keep time correctly [businessinsider.com]. They use GPS satellites for timekeeping, which was last updated in 1982, and since then there have been 15 leap seconds added. As a result, nearly all Android devices are 15 seconds too fast. Note that iOS compensates for this and shows the correct time.

Hmm. [looks at NIST synced PC clock] Hmm. [looks at android phone]

Nope, the two match exactly to 1 second. Unless for some reason my ordinary Android phone (of which over 15 million of this exact variety were sold) qualifies as outside "nearly all" android phones, you are spouting pure nonsense.

Re:Neither do Android phones (2)

bmo (77928) | about 2 years ago | (#40090415)

1. You don't know how GPS works
2. You don't know how network time is set
3. You don't know how atomic clocks work.
4. You don't know fucking anything about leap seconds and how they're handled by downstream users of GPS clock ticks.

Trollpost is troll.

--
BMO

How long did it take for cell phones to sync time? (0)

Anonymous Coward | about 2 years ago | (#40089561)

I recall in the mid 90s wondering why cell phones had local time rather than network time. My phone rarely showed "correct time" - now it does. For whatever reason, syncing time to "reality" has never been high on the list - this seems to be changing..

It won't help (3, Informative)

Gothmolly (148874) | about 2 years ago | (#40089579)

First, they will use Windows Active Directory for NTP because someone will say "it's authoritative for the whole network". And their clocks will be off.

Then they will run into config hell, and blaming that for clocks being off - they will load balance the domain controllers. Which is precisely what you're not supposed to do with NTP. And their clocks will be off.

Then, some small but relevant IT subgroup will secede, claiming that they need "real" NTP. "Network Security" folks are typical suspects here. So their clocks won't match the rest of the gear (which is still off, remember?)

If you have poor enough technology discipline that your clocks are 24 minutes off already, you're probably screwed.

NTP - wrong answer (2)

Animats (122034) | about 2 years ago | (#40089607)

Medical devices should not have Internet access.

Receiving time from a GPS receiver is much safer. That's a broadcast signal with a fixed message format.

Re:NTP - wrong answer (1)

Anonymous Coward | about 2 years ago | (#40089717)

Good luck with that in an MRI-rated room...

hint: Faraday

Re:NTP - wrong answer (1)

Lumpy (12016) | about 2 years ago | (#40090105)

Not a problem, as almost all GPS time sync devices are mounted on the roof. (Hint cement and rebar that hospitals are made of is bad for satellite reception)

I'm guessing you dont know much about network time sync devices and how they work. And the MRI machine has a funny cable that runs in to the control room that has the magical ability to bypass a faraday cage.

Re:NTP - wrong answer (1)

jeffmeden (135043) | about 2 years ago | (#40090219)

Good luck with that in an MRI-rated room...

hint: Faraday

hint: you don't need/want GPS in every fucking device, you need ONE GPS somewhere far away from your MRI (say, on the roof) since you have ethernet everywhere else in the entire building.

Re:NTP - wrong answer (0)

Anonymous Coward | about 2 years ago | (#40090389)

No luck really needed...stick a GPSR on the roof and pipe in the data via hard line. Cost issue more than anything I would guess.

Re:NTP - wrong answer (0)

Anonymous Coward | about 2 years ago | (#40089797)

Receiving time from a GPS receiver is much safer

Now there's another reason for the enemy to take out the satellites, or jam GPS. I'd prefer something a little less centralized. Even having IT maintain an NTP server might be too centralized. The IT people might not realize how important it was. Why not have a master clock in the room that sends out signals via Bluetooth? Then you just have one clock in the room to set, and you train staff to push the sync button before using a device. Use simple procedures that everybody can follow.

Re:NTP - wrong answer (1)

silas_moeckel (234313) | about 2 years ago | (#40090175)

Consider that they need not even setup a dedicated server, most core networking gear can provide authenticated NTP by itself with a battery backed up RTC with enough accuracy to keep within a few seconds a year. Consider that some of these devices already have a network connection to talk back to the EMR software anyways.

Setting up a whole new standard is foolhardy, setting up a RF based standard in a hospital setting is looking for trouble. Adding a procedure that needs to be done is just adding cost. It wont be just press the button it will be a 4 hour training seminar. How will you secure this? Will each device have a different dance to sync it's time?

Re:NTP - wrong answer (2)

dgatwood (11270) | about 2 years ago | (#40090515)

Now there's another reason for the enemy to take out the satellites, or jam GPS.

No, the server would go into free-run mode if it cannot receive a signal, and all of the clocks would be the same, just with a little bit of drift. And even if the servers went down, in the worst case, the devices would do the same thing, which means even in the worst case, you would be no worse off than you are now, and realistically, because NTP provides drift compensation statistics, they would probably drift far less than they do now, on average, even in the event of a complete failure.

Re:NTP - wrong answer (2)

King_TJ (85913) | about 2 years ago | (#40089821)

From my experience in hospital environments, radio reception is often VERY poor. You've got lots of metal in their construction that tends to block signals. Doubtful you'll have any luck receiving a time signal via GPS unless you plan on running antennas all the way up to the roof of the building.

As I posted already, NTP is a perfectly good way to solve this problem. You simply have ONE system designed to be your time server, which synchronizes over the Internet via NTP, and then all the firewalled off devices behind it that DON'T have Internet access can update their NTP time info from your local time server.

Re:NTP - wrong answer (3, Insightful)

Chris Mattern (191822) | about 2 years ago | (#40090235)

Better yet: this is not an application that requires microsecond precision--within a minute or two is fine, particularly as long as all the clocks agree with each other. Completely private network with a master NTP server that is updated by hand every week or so should work fine.

Re:NTP - wrong answer (1)

Z00L00K (682162) | about 2 years ago | (#40090063)

You can always set up a network with trusted only devices. It requires some work but it will pay off in the long run.

Re:NTP - wrong answer (1)

AmiMoJo (196126) | about 2 years ago | (#40090117)

I looked into this last year for a project and it is actually pretty hard to get an accurate time signal cheaply inside a building. NTP works but needs ethernet and TCP/IP, and either a cable or wifi (which means WPA authentication etc.)

GPS is very accurate but tends not to work well indoors, especially in rooms with no windows like most operating theatres. Around the world there are various low frequency time signals (DCF77, JYY, MSF etc.) but like GPS reception can be a problem. I live in the UK and DCF77 doesn't work in my house, and MSF only works in some rooms in some positions during quiet periods which is why most clocks sync in the early hours of the morning and then run on an internal oscillator all day.

FM radio stations broadcasting RDA supply the time with pretty good accuracy and reception is usually better than the above options and is available on multiple frequencies, but the decoder is not trivial.

The best option seems to be to broadcast your own time signal in one of the ISM (industrial, scientific, medical) bands. I use the 433MHz band synced to a GPS. For medical equipment I'd just make checking the clock part of the regular OR setup procedure.

Re:NTP - wrong answer (1)

tlhIngan (30335) | about 2 years ago | (#40090271)

Medical devices should not have Internet access.

So... don't. NTP works just fine on a private network. And you don't even need a proper time source, either. As long as everything ticks within a narrow boundary of time, it doesn't really matter if the master NTP server clock is off. If it's stable, the offset between it and the real time would be well known.

NTP's just a way to distribute the time. It doesn't have to be used to distribute exact time. As long as everything's ticking to the same clock, things are fine. Heck, they can have the same machine that does their slaved clocks be the NTP machine.

Depends on the purpose of the medical device (1)

sjbe (173966) | about 2 years ago | (#40090593)

Medical devices should not have Internet access.

That depends entirely on the purpose of the medical device. "Medical devices" covers a lot of products that serve a lot of different purposes. For some devices internet access would be pointless, for others internet access would be dangerous, and for still others internet access makes perfect sense. It depends entirely on what you are doing with it and what the risks are. There is nothing inherently wrong with hooking up a medical device to the internet, provided that the risks of doing so have been adequately addressed.

Receiving time from a GPS receiver is much safer.

Use of NTP does not require internet access. How the time is (securely) transmitted to devices is a separate issue than what protocol is used. You can use NTP on a network that is completely segregated from any other network and it works just fine.

News FLash.... (1)

Lumpy (12016) | about 2 years ago | (#40089865)

Most devices dont. In fact it's highly rare for a device to NTP sync.

Most building lighting control systems do not do a NTP sync. Security systems, etc... all rarely do this.

It sounds like that someone finally realized that clock drift happens and is shocked about it.

It should be part of the equipment checklist (1)

radionerd (916462) | about 2 years ago | (#40089915)

Don't they have checklists to make sure their equipment is working as expected? Even brain dead pilots like me check every instrument on the panel, every time I fly. If I'm betting somebody else's life on it, I check twice. I'm living proof that an idiot can set a clock within a few seconds. Every nurse I've ever met keeps a watch with a sweep second hand (for observing pulse rate easily). How hard can it be to compare it to a GPS receiver,, networked computer or short wave receiver from time to time? I keep my watch within a second or two of UTC by looking at my computer, listening to WWV on the short wave radio, or looking at a GPS receiver, it's good enough for celestial navigation, it's surely good enough for medicine ..... how hard can it be to check life supporting equipment from time to time?

Re:It should be part of the equipment checklist (0)

Anonymous Coward | about 2 years ago | (#40090145)

Most hospitals systems will have a couple of engineers on hand who probably do regular checks of the electronic medical equipment to put them through a standard battery of test cases, but those tests could be months apart for a single piece of equipment. Surgeons, nurses, anesthesiologists and other clinicians will notice if a device is obviously not working and probably wheel in a replacement, but I wouldn't be surprised if they don't do some sort of checklist to check things like the clocks before every procedure because they generally don't have the time and assume they are all accurate.

NTP is a PITA (0)

Anonymous Coward | about 2 years ago | (#40090093)

Every device has its own way of supporting various protocols. Microsoft doesn't even properly support it. Sure, the domain controller can go get time from a reliable source (best if it's Microsoft's time servers, thanks), but the damn things won't SERVE NTP. We just had a big brew over NTP support here because the damned clocking servers were off by 90 seconds. 1 minute a day by 2500 employees supposedly works out to about $1Million a year in overtime. I didn't bother with the math.

NTP, GPS, PTP all have problems (3, Interesting)

jcdr (178250) | about 2 years ago | (#40090127)

NTP have the problem of discontinuing his UTC timestamp while a leap second occur and NTP do not broadcast the actual UTC-TAI offset (historically because he broadcast UTC directly but this is now more a problem that an advantage). GPS and PTP broadcast (something very closely related to) TAI and a UTC-TAI offset, witch is the right thing to provides the precise actual time without discontinuity.

But all of them, NTP, GPS and PTP, have the problem of not broadcasting the historical leap second table, making the client of those protocols alone unable to safely compute a precise date in the past. I hope next NTP protocol will broadcast TAI, and that NTP, GPS and PTP will be able one day to broadcast the leap second table. I am certain that there is still some reserved bits somewhere in those protocol to make that working.

Re:NTP, GPS, PTP all have problems (4, Insightful)

dlakelan (43245) | about 2 years ago | (#40090281)

Look if the options are 24 minutes of random error or say 24 seconds of consistently biased error in all the devices in the hospital, I'll take the consistent bias any day. The point of all of this is so that a nurse walking into the room and seeing a blue lipped coma patient can determine things like how long has it been since the monitor whose leads fell off last recorded an accurate O2 saturation.

NTP (1)

BumpyCarrot (775949) | about 2 years ago | (#40090181)

In my experience, NTP is the easy solution that nobody uses. Because hey, it's only a clock, right? How hard can it be?

:/

Internet time sync is not the best way to go (0)

Anonymous Coward | about 2 years ago | (#40090223)

I think it could be done with a small device supplied by the medical device manufacturers. It would plug in at home or the office, or wherever the medical device user spends a lot of his or her daily time. It would then receive the time broadcasts either from GPS, or, even better, from the WWV radio time signal in Colorado. The small device could then push a standardized time format to the medical device via it's own short-range radio transmitter, perhaps triggered by a daily sync request from the implanted medical device. A larger-scale version of this could be available for hospitals and other medical offices to allow for easy time syncing of all medical devices. No need to plug into an internet connection, making it pretty secure, and it would be easy to test reception of the timebase signal, too: just add one of those self-setting atomic clocks, which also receive the WWV signal. If it syncs up, put the medical device time server near it to ensure timebase reception.

clocks (1)

dominator (61418) | about 2 years ago | (#40090427)

"A man with one clock knows what time it is, goes the old saw, a man with two is never sure."

That's why the sailor's adage is to take one clock or three to sea. With one, well, that's all you've got to go on. With two, you never know which one is right. With three, usually at least two agree.

Secure? (1)

eugene6 (2627513) | about 2 years ago | (#40090461)

NTP is secure, right? Nobody can jump on the hospital network and impersonate the NTP server(s) and set times incorrectly on devices, causing them to do bad things like produce false readings or overadminister drugs, yes?

Not so simple (2)

jklovanc (1603149) | about 2 years ago | (#40090473)

We are talking about medical equipment that would have to be certified by the FDA. That would mean that every GPS receiver and every implementation of local NTP would have to go through a rigorous and costly certification process. The following issues would have to be certified;
1. Is the device accurate.
2. How does the device interact with the software.
3. How does the device interact with every device receiving data. This is the hard part.

Secondly, is it even necessary? The issue seems to be that there is an offset between the clock on the equipment and actual time. How about at the beginning of the operation the doctor writes down all the times as stated on the medical equipment. If necessary these offsets can be applied later to normalize the times. This reminds me of the time when the US spent tens of thousands of dollars to build a pen that would work in zero gravity(it was pressurized with gas). When a cosmonaut was asked how they coped he said "In Russia we use pencil". Sometimes high tech just complicates the issue.

Bad administration is a major problem with this (4, Informative)

ChumpusRex2003 (726306) | about 2 years ago | (#40090481)

This is often a case of poor administration, perhaps more frequently than poor design.

For example, I was recently tasked with reviewing the performance of several hospitals in the diagnosis and treatment of stroke. Under national guidelines (UK) a patient with suspected stroke must have had a CT scan within 30 minutes of arrival at hospital, with blood-thinning treatment administered within 60 minutes (if appropriate).

The problem was that the times on the CT scanners were discrepant by +/- 45 minutes from true time - so the images were tagged with the incorrect time. Further, the CT viewing workstations had times up to 2 hours discrepant. The CT scanners were Windows or Gentoo depending on the manufacturer's preference. Similarly, the CT workstations were windows, and were all bound to the hospital domain.

The time discrepancies made my assessment very difficult - and I had to correct for each individual scanner, and assume that the clocks hadn't drifted over the 6 month period of the audit.

I also found several safety issues because of this - e.g. if it was 1am, and a patient had a CT scan, some workstations would be 2 hours slow, so would read 11 pm on the previous day. These workstations would refuse to load the CT scan because the files were filtered by "WHERE [StudyTime] NOW".

I raised a support issue with the workstation vendor who simply said "These are windows workstations. You should ensure that they are appropriately bound to your domain, and configured to sync with your time server or domain controller". So I called IT to configure this, "No way. These are medical devices, we can't change the configuration - and anyway, what will happen if the clock is fast, and the sync pushes the clock back, so that there are 2 occurrences on the same time. That would cause chaos. Even if the manufacturer supports it, there's no way we'll set it up". Of course, their concern doesn't actually exist, because most time sync algorithms (even on Windows) are clever enough to avoid "double time".

There was similar obstruction with the CT scanners. The vendors simply said - we support and encourage synchronisation with a time server. IT or the radiology administrators simply stonewalled the ideas. They refused even to correct the clocks on teh scanners - so the clocks are still wrong to this day (even more so, due to accumulated drift).

Of course, even if the time can be set right - there is disagreement as to how daylight-saving is managed. Some equipment, esp. older embedded kit isn't daylight-saving aware. Do you set it to Summer time or winter time? In most hospitals I've been in, it's been an inconsistent mixture - often with lots of clock drift added, so you can't actually be sure.

Just incompetence (2)

rickb928 (945187) | about 2 years ago | (#40090575)

When I had a hospital gig, we knew back in 1995 that time would need to be syncronized amongst all the servers etc. We ran a local time server synched to a Tier 1 NTP server which was fortuitiously about 180 miles away. It has since gone to restricted access, but it's nailed to the USNO, and is still a Stratum One server. I bet they still use it as reference.

But even in 1995, NetWare servers were well behaved and accept NTP, and we set workstation time on login. As other servers came on, we went through the inevitable 'my server is more accurate' and blew them off until the Sun server showed up,and they refused to use our NTP. Fine. Took two weeks to resolve a 300ms difference, and then I watched as they re-fixed the error and synched with the NTP server they initially refused to use. In fariness, it was not SUN engineers involved, but they were arrogant enough to qualify.

Time is important to networks.

We did not, however, have any way to manage time on 'devices', such as infusion appliances etc. I do NOT think of an EMR as a 'medical device'. Nor do I think of the EMR sytem that way either. But if time isn't being synched on your network, you got some other problems, I suspect, that are not making your work easier or efficient as a network admin.

My experiences with this... (1)

Anonymous Coward | about 2 years ago | (#40090633)

I have two devices in my house that I wish had some form of clock syncing: the range, and the Ademco VISTA-20P burglar alarm.

Slashdot seems to be able to read my mind. I propose one of two solutions, and I openly invite device manufactures to join in on this:

- NTP. The device would have an Ethernet port on it. I'd read the MAC address off the label, make a DHCP reservation on the router, then go into a very simple Web interface where I would select the time zone and DST rules.

- GPS: The device would have an F connector on it. There would be a (commercially available) GPS antenna on the roof with RG-6 running into the structured wiring cabinet. From there, a (commercially available) F splitter splits the signal out to the range and burglar alarm, which would use GPS coordinates to determine the DST rules in effect and set the time. Some simple programming at the pushbutton oven controls would let you set the DST rules for the next time Congress decides to screw with them.

Notice that I am leaving WWVB completely out of this; it's not exactly reliable. My Casio Waveceptor watch hasn't picked up a signal since 2011-07-26 (I live in Florida), and I have to take my WWVB clock off the wall and put it on a windowsill for several days to get a sync during the DST changes. In a local public building, they round up all the wall clocks and put them in a van parked outside overnight to sync them.

The burglar alarm is a particular pet peeve of mine, which seems to have its clock drift measured in hours. The control panel is wired into a communicator that has a SIM chip and uses AT&T's GSM network to send monitoring signals...the damn thing already has the hardware to sync its clock, so why can't it?

Load More Comments
Slashdot Account

Need an Account?

Forgot your password?

Don't worry, we never post anything without your permission.

Submission Text Formatting Tips

We support a small subset of HTML, namely these tags:

  • b
  • i
  • p
  • br
  • a
  • ol
  • ul
  • li
  • dl
  • dt
  • dd
  • em
  • strong
  • tt
  • blockquote
  • div
  • quote
  • ecode

"ecode" can be used for code snippets, for example:

<ecode>    while(1) { do_something(); } </ecode>
Sign up for Slashdot Newsletters
Create a Slashdot Account

Loading...