Why Doctors Still Use Pagers

Holly May is a Consultant at Health Advances.

Despite the wave of innovative clinical apps for smartphones, iPads, and even Google Glass, the medical profession is not known as a bastion of modern innovation.

Case in point: physicians still carry pagers. One recent estimate cites 90%+ of hospitals still use pagers.

Conventional wisdom attributes the persistence of pagers in healthcare to the glacial pace of change in hospitals and clinics. According to this view, healthcare institutions are behind the times and reluctant to embrace new things, and that’s why we still fill out paper intake forms or fax medical records or call for lab results.

While this criticism of the healthcare industry rings true, there is another explanation: pagers fill a need that cell phone and smartphone technology fail to address adequately. In this view, novel products could fill this need in the future.

It’s the 21st Century, Why Pagers?

Pagers were first patented in the late 1940s for use in New York City’s Jewish Hospital and became a mainstream consumer device throughout the 1980s. Even though cell phones and smartphones have become widespread, these devices pose multiple unique challenges in medicine.

The main challenges posed by smartphones in medicine fall into three categories: technical, cost, and security.

TECHNICAL CHALLENGES

Transmission of critical or emergency messages must be reliable, yet cellular and wifi networks can be disabled due to catastrophes, natural disasters or even technical problems (looking at you, Blackberry*).
Recharging a phone takes time and requires electricity, which may not be available in emergencies.

COST

Rolling out smartphones is expensive: NYU Langone Hospital spent $10-20K to purchase equipment and data plans, develop applications and pilot 16 smartphones in the hospital.

SECURITY AND HIPAA

Data breaches put patient information at risk. For example, >90% of US hospitals experienced a data breach in 2012 and 75% of hospitals are not sufficiently securing devices with patient data. Dealing with these HIPAA violations is very expensive.
Potential unprofessional behavior by staff jeopardizes hospital records. Nurses have been disciplined for discussing patient situations on Facebook or posting photos of unusual x-rays. Arming healthcare personnel with smartphones creates liability.
Texting, a promising communication method, does not leave a message or audit trail, is not encrypted, and autocorrect may result in transmitting an erroneous message with grave clinical implications. One violation can result in a fine of $50,000 and repeat violations can lead to $1.5 million in fines in a single year.

There are plenty of other obstacles that smartphones pose. Important clinical messages get mixed up alongside personal messages and content in the inbox. Texting apps may not integrate with the hospital’s central database for contact information, and a user may not receive texts if the phone is in active use during a voice call.

On the flipside, pagers offer several key benefits:

Reliable networks, ensuring transmission of messages even in emergencies
Strong signals: cell sites might cover 10-15 miles, while a pager transmitter can cover 150 miles, enabling communication in rugged and rural locations
Designed solely for transmitting critical messages; a user does not have to sort out the critical messages from the barrage of texts, emails, and video content present in one’s inbox
Recharging is as simple as popping in another AA battery
No storage of patient data
Inexpensive

What does this mean for health tech innovators?
It’s no doubt that smartphones are invaluable to the practice of medicine — instantaneous access to the world’s medical information, the ability to manage patients remotely, and stay in touch with patients and families are all major advancements.

But the reasons smartphones haven’t displaced pagers are surprisingly rational. Digital health entrepreneurs and EHR vendors must recognize that pagers play a key role in medicine. The persistence of these old-school devices is not only an analogue for the slow pace of adoption of communication technology in medicine, but represents the opportunity for new products that specifically address the unique challenges in healthcare settings.

Potential winners
We may not need SnapChat for Doctors, but we need an easy to use, encrypted, secure texting tool for medical staff that comes pre-loaded with clinical vocabulary. This could enable medical professionals to communicate about drug dosing and test results and could be a big winner. In addition to health systems building their own tools in-house, a lot of companies are already pursuing this space: TigerText, Cortext, MediGram, and HIPPOmsg just to name a few.

Across the digital health ecosystem, companies that understand the unique challenges faced by medical institutions and can develop and implement a compliant and sensible mobile device strategy could see support from hospital administrators and clinical staff.

Sources:
1. http://www.wnyc.org/articles/wnyc-news/2012/jun/04/pager/
2. http://www.greenbook.org/marketing-research.cfm/smartphones-invade-healthcare-28384
3. http://pewinternet.org/Commentary/2012/February/Pew-Internet-Mobile.aspx
4. http://nakedsecurity.sophos.com/2013/01/03/hospital-data-breaches/
5. http://mobihealthnews.com/12503/why-doctors-pagers-still-trump-smartphones/
6. http://www.aaos.org/news/aaosnow/aug12/managing5.asp
7. http://www.informationweek.com/healthcare/mobile-wireless/texting-app-looks-to-improve-hospital-wo/240008612
8. http://www.tigertext.com/
9. http://www.cortext.com/
10. https://www.medigram.com/
11. http://hippomsg.com/

* Blackberry has a history plagued with network disruptions and blackouts. Most notably, in 2011, Blackberry endured a three-day blackout that interrupted email and Internet services for tens of millions of frustrated users.