Guest Post: Health Systems Need More than a Doc-to-Doc Messaging Solution 4/25/12

Travis, thank you for igniting such a lively discussion!

Going back to your original post of the growing list of companies focused on growing a network of physician users to enable secure doc-to-doc communication, and the expansion of the discussion around pagers and smart phones, here’s how I look at it.

Health systems don’t need a secure doc-to-doc messaging solution, which just adds to the fragmented communications clinicians put up with today. The industry needs a comprehensive clinical communications solution that includes secure messaging as a feature or component.

While physician-to-physician communication is important, a far greater frequency of communication occurs between nurses and physicians in the course of providing care. Therefore, any truly effective communications solution must incorporate nursing and all of the other clinicians responsible for care coordination.

Physicians are unique because they need greater flexibility in reliable mobile device technologies. For example, nurses in a hospital environment are mobile within the four walls of the hospital where they provide care during a given shift. Physicians, on the other hand, may be in Hospital A at certain times, and at other times they may be in Hospital B, their office, or in-between care settings, or at home.

For a physician, fewer devices means more convenience. In addition to convenience, physicians need reliability. Reliability has more to do with the communications process than it does with devices. All wireless devices will fail to receive a signal at some point.

For clinicians — physicians in particular — the solution requires technology-enabled processes that distinguish critical and time-sensitive communication from that which is non-critical and less time-sensitive. And for those critical, time-sensitive communications, those processes must anticipate and accommodate device failure.

If I’m carrying a pager and a smart phone, another clinician can contact me in at least one of five ways. They can (a) send me a page; (b) call me on my phone; (c) send me an SMS text message; (d) send me an e-mail, or (e) send me a text via one of myriad secure messaging apps.

The question is: which one of those modalities should I choose now ? And if the communication is critical and time sensitive, what is the process if there is no acknowledgement or response?

The realities are that cellular and Wi-Fi innovation and user adoption are growing and will continue to grow. Paging is dying and is becoming less reliable. The latter point is evidenced by continued decline in USA Mobility’s annual paging revenue (2011 down 14% vs. 2010); continued decline in its pager disconnects; and continued decommissioning of the company’s paging transmitters (13% fewer in 2011 vs. 2010).

I’d like to say something provocative like. “Paging will be dead in three years.” However, in all likelihood, it will still be around in some limited, niche capacity.

The question is, how do we best use and apply these different technologies and devices to enable reliable communication processes that truly help clinicians better coordinate care?


Terrell “Terry” Edwards is president and CEO of PerfectServe.

  • David Brooks


    Very nicely framed. I don’t think we’re going to see a single modality take-over all communication flow anytime soon. Furthermore, solutions that cater specifically to physicians or nurses or other niche segments continue to add to the overall fragmentation, as you mention.

    While there is no doubt ample opportunity to improve communications within the four walls of an organization – I think we will continue to struggle with this for years to come – I am increasingly interested to hear how organizations intend to support communication across organizations and across disparate technology infrastructure. Isn’t that, afterall, one of the greatest challenges before us?

    David Brooks

  • David, your question about the challenge in supporting communication across organizations and disparate technology infrastructures is key. The reason why it is so important is because of the interdependency between clinicians in these interdependent organizations. Trying to find an effective way to stitch the flow of communication and information across the continuum is a priority for us right now. Good observation on your part!

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