Pagers — There’s an App for That 4/11/12

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When people outside of healthcare see doctors carrying pagers, I imagine most think it’s pretty outdated and ridiculous, especially when they see that same doctor respond to a page using the iPhone in their pocket.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.

Travis Good is an MD/MBA involved with health IT startups. More about me.


  • Abe Frohman

    A very good take on smartphones versus pagers, though you only touched on one of the most critical differences between the two: Pagers signals get through to far more places – including in the special environment of hospitals – than cell signals. As you indicated, I wouldn’t trust my life to a cell phone, but would to a pager.

  • Terri

    Travis, don’t forget Extension, Inc. on your list of secure messaging options, and it is auditable as well.

    I agree pagers will always have a niche space of need. It’s not your grandma’s pager anymore either! Pagers are more sophistocated in their abilities today with the types of systems and of notifications and alerting they can receive.

    I read the “paper” you referred to. More of the same really, Extension can do that too. One note of interest. Blackberry seems to be pushing hard now to become the physician’s phone of choice. Are Amcom and Blackberry partnering in efforts. The last paragraph in the paper would suggest that. Now that’s interesting to know.

  • Margalit Gur-Arie

    Not sure another app is what’s needed.
    How about a dual device? Maybe Blackberry or Apple can make a medical version of their phone that can connect to the paging networks, so you have the best of both worlds in one device. It doesn’t seem like a big deal, but I’m probably wrong.

  • Sam Stern

    It is important to keep in mind that hospital communications encompasses more than just texting and paging, and that smartphones can be an overall solution to inefficient communications in the hospital. Mobile apps have the ability to integrate voice calls and alarms with texting, placing all three components of hospital communications in one device. This enables nurses and clinicians to communicate more efficiently at the point-of-care.

    As for the reliability of smartphone in a hospital environment, the Voalté solution runs on the hospital’s secure Wi-Fi network, eliminating the dependence and lack of reliability of a cell network.

    Thanks for bringing this important topic to light.

  • Dave Dillehunt

    I think you missed a major point. Because traditional paging technology is dying, and customers are leaving in favor of their smartphone texting apps, the industry is now milking what revenues they have left and are no longer repairing/replacing damaged/failing paging towers/equipment. As a result, paging coverage is rapidly deteriorating. This is now causing more people to abandon that technology, further worsening the problem.

    While cellular coverage is sketchy as well, technologies that send out through both cellular and wi-fi are a good start and probably provide better coverage than the current (worsening) paging coverage.

    Our physicians (and others) are now demanding something other than paging (beeper) systems. Personally, I predict that paging will be gone within 36 months.

  • Laura

    The facility where I work has been struggling with this very issue, recognizing that the pager companies seem to be on the decline. They envisioned a Blackberry solution and installed cell phone antennae within the facility since cell coverage on the underground floors and in shielded areas was horrendous and coverage in other areas was spotty. Coverage in the building is better but still erratic in some places (e.g. The bathrooms). And when the distributed antennae are out for service it’s a problem. (Just got a message from our help desk that ours will be out all weekend.) Coverage outside our facility is even more erratic as we have many cell phone dead zones in our area.

    Even when I am not on duty in the building, there are times that the on call person needs to get in touch with me about a patient and the beepers are great for that regardless of where I happen to be.

    Beeper technology has definitely improved over the years. The ability to provide a text based message through the beeper has been a big advance over the simple numerical messages or the old style beepers that would just alert you to call a switchboard for a message. And the smartphone integration would be an additional advance. But only if the reliability issues noted above can be addressed.

    The idea of Blackberry moving into this as a niche space is not very compelling. Even though our facility has given us Blackberries for free with the idea of switching to Blackberries for ‘paging’, the functionality and usability of the Blackberry compared to iPhone and Android is dismal. For awhile we all carried our beeper, our Blackberry and our personal phone. But now we just forward the Blackberry to our personal phone and carry it along with the beeper to give the best mix of functionality and reliability.

    One final benefit of the beeper is that it is much less interuptive when engaged in an important conversation or procedure. You can quickly glance at it without having to get engaged in a phone conversation or without having to type in a security PIN to access a text message on a locked down phone or without having to listen to a voice mail. It’s also easy to hand off to someone else if you’re scrubbed, for example, whereas smartphones are much more personal (and when the facility mandates access PINs another person can’t access messages anyway without in appropriately sharing the PIN).

    Bottom line: I love my iPhone, but when it comes to reliably contacting physicians I’d still put my money on beepers…

  • Ron

    Our organization looked at this some months ago (eons in Silicon Valley time) and the problem we encountered was latency of text messaging via cell. Not good when trying to reach a Trauma Surgeon timely. Internally we also looked at SocialText secure texting within our own walls and considered publishing. Essentially secure Twitter platform.

  • EM

    There is an app for sending a message from an Android smartphone to a pager and you only need to be connected to wifi or cellular network.

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