Pagers – There’s an App for That (Part 3) 4/23/12

Sorry to all those that think I’m beating a dead horse with this topic, but I think a lot has gone unwritten. Thanks to Trey Lauderdale of Voalte for his guest post last week on the subject. I also want to extend the invite to anybody else that has an opinion on the topic. Please e-mail me with you post (or thoughts for a post) on pagers and smart phone communications for healthcare.

Let’s start with a poll. I found this nifty company called Quipol that creates embeddable surveys. It’s free, easy, and allows for social connections to Facebook and Twitter. It only allows for "Yes"/"No" surveys so it’s slightly limited in robustness as a polling tool, but the simplicity makes it great. Give it a try. I’m curious how the results turn out.

I wanted to follow-up on Trey’s post and take a more holistic — as well as enterprise and administrative — view of smart phone apps meant to replace pagers. Trey is clearly of the opinion that healthcare communications, whether pager or smart phone, need to be driven by workflows and not technologies. That’s a good point.

Trey also hit on the fact that my question, pagers vs. smart phone apps, is really too broad. He broke pagers down into four categories: 1) in-house, 2) wide-area, 3) shared, and 4) personal.

I’m slightly confused about the categories. I imagine a shared or personal pager can be wide area or in-house, right? I guess these are really characteristics of pagers, or functions of pagers. In-house and wide-area are mutually exclusive. Shared and personal are mutually exclusive.

With that in mind, I’m going to flip it around and categorize pagers — and more generally, healthcare communications — into critical vs. non-critical. To me, this is the dividing line between whether a phone using Wi-Fi and a carrier network can be a pager. Sending a thank you for a referral or asking a quick question (curb-siding) about a patient who has already left an office is not critical. Sending a code/cor page is critical. Everybody gets this.

For each category above — and somebody please tell me if these categories / characteristics aren’t exhaustive — both critical and non-critical functions exist. If that’s the case, and assuming smart phones can’t be the only form of communication for critical messages, can we really replace any of these pager categories? Or can we just limit the usage to certain types of messages, remaining weighed down with an overcrowded waistline?

I’ve found data on my own, and seen data sent to me from others, that show results of trials or studies of smart phones in place of pagers. The results generally find users prefer smart phones, but not that smart phones were found to provide 100% of critical communications. Are there any hospitals that have 100% replaced pagers?

The power of phones over pagers is the ability to provide a richer communication experience. Phones and apps allow you to move a high percentage of communications off pagers. That’s good.

Are there solutions that determine if communications are critical or not, routing them accordingly? I think this is what Trey was touching on when he addressed clinical workflows. I think this is what PerfectServe does, though pagers are a node or preference and not replaced. PerfectServe is not replacing pagers, just trying to limit the use of them to when they are preferred by clinicians.

One other issue I wanted to bring up is the issue of administrative or enterprise tools for clinician communications. I realize that SMS and in-person communications aren’t really auditable, but don’t hospitals want secure clinical message access for audit purposes? If a physician downloads an app and gets the rest of the medical team to use it for team communication, what happens if an order discussed using the app doesn’t get entered and an adverse event results? I assume at that point the legal teams have an expensive fight over user agreements and terms.

I also wanted to follow-up on this series of posts with something on proper smart phone etiquette. One of the points raised in the comments — one I hadn’t thought of — is that a smart phone is more interrupting to a clinician than a pager. This is really an interesting paradigm. As we do more on our personal smart phones, both personally and professionally, we’re more distracted, less engaged, and seemingly less interested. I’ll post more about this growing problem next time.


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


  • DrM

    Completely anecdotal, but I gave up my pager after having my pages sent to my cell phone as a text message as well (a service many of the carriers provide), and had several instances where the text message arrived but the page never did. I don’t live in an area known for bad pager coverage either. It made me wonder how many pages people in our institution were missing, given that I’m not paged often (couple of times per week) and had several missing within a few months. No delivery notification is really pretty poor.

    Two other benefits cell phones have over really dumb pagers:
    – Cell phones, perhaps surprisingly, cost about the same as pagers. At our rather large institution (11k employees, ~1000 housestaff) we could get a BB for $150, but pagers cost us $300. Monthly service was almost comparable, although I don’t remember exactly (depended what kind of service). If you could send it to somebody’s personal cell, it was substantially cheaper.
    – I just wanted to emphasize how badly the pager infrastructure is falling apart. In our major metro area, our pager towers die about twice yearly, and it gets harder and harder to pay to keep them up, as the page system operators are all moving on to other related businesses rather than putting capital investment into paging infrastructure, just doing break-fix now. It will only be a couple of years before paging infrastructures die for that reason alone, unless hospitals are willing to support them on their own, and I don’t think that’s affordable.

    Right now, the only reason that our institution still kept pagers was that the penetration of cellular signals isn’t as good as pagers, so there are places in the hospital, and in various buildings that physicians work, where they have no service. If it wasn’t for that, they’d have ditched them already for the various reasons above.

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