I’ve reported about the growing list of new and established companies that are getting into the secure clinical communications arena. A friend sent me a link to another new startup that’s out to replace pagers with smart phone apps. I felt like I had to write something on the exploding space.
When people outside of healthcare see doctors carrying pagers, I imagine most think it’s pretty outdated and ridiculous, especially when they see that same doctor respond to a page using the iPhone in their pocket. When people see a doctor carrying three pagers (I’m thinking of a general surgery resident I used to live next door to for this example) they are even more shocked.
Personally, I’ll always associate pagers with the marijuana dealer at my high school and those stupid numeric codes people used to use, like “143″ for “I love you.” Cell phones caught on when I was in college, not high school. I didn’t grow up with a physician parent, so that might have changed my perspective.
The point is that replacing pagers with smart phones — especially now that ~80% of physicians have them — or tablet apps seems a lot like low-hanging fruit. Creating an app to securely exchange messages isn’t trivial, but it’s not exactly building a tricoder or analyzing all that big data, either. Because of this, we’re seeing more and more companies launching apps to enable physicians to securely communicate. Here are some startups I’m familiar with.
TigerText. Basic secure, HIPAA-compliant messaging. The app looks a little like typical SMS, but with additional features, like deleting messages before being read and getting notified when a message is read. TigerText is new, but has raised over $10 million in the last two years.
Doximity. A slightly different angle on secure communications. Doximity has been called the LinkedIn for doctors and offers more features than just secure communication, which Doximity calls DocText. Doximity is initially going direct to physicians to sign up. Part of the company’s plan for revenue includes premium packages for health systems to use Doximity for clinical communication, so I imagine it will be out selling to hospitals and systems in the near future, maybe once it hits some user target.
Medigram. I heard about this one recently. It is part of the well known and successful Y Combinator. As far as I can tell, this is purely a smart phone app for secure communication with colleagues, just like TigerText. It is in beta with Stanford Hospital and two other Stanford-affiliated hospitals.
DocBookMD. The unique angle to this company is that it’s working with medical associations to claim big user numbers. It just raised $2.2 million and is founded by two doctors, which provides a nice story for selling a platform to physicians: “We feel your pain.”
DocHalo. I know very little about this one, but I like that it is charging for use ($2.99-$9.99 depending on role – practice doc, resident, student). I’m a fan of early revenue for startups. It does secure communication and seems to be pitching itself as a tool for handoffs and signout.
PerfectServe. This isn’t really a startup and has success selling its solution to hospitals. It’s also not just a mobile app — it’s a platform for directing calls to the appropriate person using the appropriate device (one option is mobile phone/app). It’s a much-improved version of the call sheets people use now to find and contact people. I included it here because I like it and it is starting to promote how many physician users it has, which I think signals a move beyond purely an enterprise offering to a broader network for physicians to connect with one another.
What’s my prediction? Totally replacing pagers is not really a simple thing, despite the obvious potential benefits of unifying communication onto a device that physicians are already carrying. Guaranteeing connectivity and timely message delivery are not hallmarks of today’s consumer mobile devices and networks. I have an iPhone and wouldn’t trust its connectivity with my life, let alone somebody else’s. There are technical reasons why pagers are more reliable — especially inside a hospital — than a smart phone app.
That said, how many pages are really critical? A patient crashes and the nurse calls a code, or a cor depending on your facility. That’s critical. Paging a team member to get the overnight events is not. Paging a team member to sign out is not. Paging an intern to order a test is not. Paging the team because pizza arrived is not. Paging an outpatient doc on a Saturday for a patient question is not, although patient advocates might disagree with me. I define “critical” as requiring a response instantly, as in somebody needs you to bang on his chest or shock him or see if he needs a cath or thrombolytics.
I think we can move 97% (that’s arbitrary) of messaging away from pagers. The 3% of truly critical messages need something better than an iPhone app, especially if that app is installed on a personal device. And then there is the situation with a major emergency, like an natural or human-made disaster. In times like those, cell phone networks are notoriously poor performing and we likely need a backup, reliable system in place. That system, until something better is invented, is the pager. So pagers still have a place, even if we can replace much of their use.
For further reading, Amcom has a pretty good paper outlining the issues with moving from pagers to smart phones for all clinical communications. I think the key points are having an audit trail and policies around communication to assure it is clear all staff how and what is to be used to communicate.