> first component (prefix) of the identifier is a sortable timestamp > values generated are practically sequential These statements aren’t strict enough to be relied on. Maybe you have engineered the hell out of your distributed clock scheme, and your IDs actually are completely monotonic, which is great. But you probably haven’t done that, which means conflicts will surely happen and you must handle them gracefully.
In other words: Sorting by millisecond-or-so is just as good as sorting by picosecond in most situations. The reason you have to deal with conflicts gracefully isn't particularly because timestamps can be imperfect.