Ask any practicing clinician what they think about their pager and you’ll get the same response, “it sucks and I get PTSD every time it goes off”. You remember pagers right, the ubiquitous sign that you are either a drug dealer from the ’90s or a modern-day physician? Incredibly, those handy little one-way communication devices were first used in healthcare in NYC in 1950 and cost about $120 per month in 2017 dollars!
Pocket Radio Pages Doctor Night and Day, January 1951, Popular Science
How then is it possible that a recent study showed that nearly 80% of over 600 hospitalists surveyed are still using hospital-issued pagers?[i] Arguably the main reasons these are still in use are several-fold, among them is the fact they are provided by the institution, they’re low cost, the reliance on legacy paging software, directories and workflows, and their unquestionable reliability even in cellular/WiFi “dead zones”. Despite this, studies have shown that most received pages require a callback and are for non-urgent issues, rendering them basically a modern-day version of whack-a-mole[ii],[iii].
It is no wonder that in a reaction to the use of this one-way, antiquated “communication” tool, over 52% of those surveyed were receiving standard text messages for patient care at least once per day. This is, of course, knowing perfectly well that using standard text messaging is a clear potential for a HIPAA breach, as most of us in healthcare have fear of HIPAA breaches beat into us on a regular basis. Not surprisingly, however, 85% of hospitalists thought the benefit of efficiency outweighed the security risk of exposing patient information.
Despite the clear need for a modern-day pager replacement and a penchant for clinicians to use insecure, yet ubiquitous text messaging technology, only 25% of those surveyed had a secure text-messaging solution implemented in their organizations. Beyond that, only one-third of those solutions were being used by all clinicians.
And therein lies the rub. We all hate pagers, but we get them for free and they’re reliable; we text because it’s easy, more efficient; and we often know our colleague’s phone number. Why then don’t people use secure messaging, and if they have a secure solution available in their organization, why are two thirds not using it? The simple answer is the network effect. In order to have a valuable communication tool, everyone has to reliably be on the platform. Everyone (in healthcare) is on iMessage, that’s why people use it as the path of least resistance. In order to successfully implement a secure messaging solution in an enterprise, its use needs to be mandated from the top and continually reinforced at all levels. If only some users are on the platform, it is by default not the de facto communication tool and it will struggle to replace the incumbent, albeit outdated technology.
With the rise of smartphone adoption by healthcare providers, improvement of cellular and WiFi redundancy, and the ease with which secure messaging providers such as TigerText can integrate into LDAP, legacy paging applications and even the electronic health record, the life of the pager is thankfully waning. Providing modern healthcare providers with a secure messaging solution brings tremendous value in facilitating real-time, efficient two-way communication, accountability, never mind the risk mitigation of HIPAA breaches.
There is no question, communication can be better than it was nearly seven decades ago with the advent of the pager. Secure messaging applications, residing on our cherished mobile devices that are deeply part of lives and work, makes perfect sense. The key however in ensuring providers will be willing to give up their valued, yet despised ball and chain pagers and not devolve to standard text messaging is to provide a solution as easy to use as consumer text messaging applications, integrate it with existing HIT applications and workflows wherever possible and push as an organization to mandate its use.
Michael Docktor is a Pediatric Gastroenterologist, Clinical Director of Innovation, and Director of Clinical Mobile Solutions at Boston Children’s Hospital. He is also an advisor on TigerText’s Physician Council.
[i] O’Leary K, et al. Hospital-based clinicians’ use of technology for patient care-related communication: A national survey. J Hosp Med. 2017;12(7):530-535
[ii] Carlile N, Rhatigan JJ, Bates DW. Why do we still page each other? Examining the frequency, types, and senders of pages in academic medical services. BMJ Qual Saf. 2017;26(1):24-29.
[iii] Kummerow Broman K, Kensinger C, Phillips C, et al. Characterizing the clamor: an in-depth analysis of inpatient paging communication. Acad Med. 2016;91(7):1015-1021.