Critical Questions Surround New Critical Messaging Options

By Ted McNaught

October/November 2011

Hospital call centers are facing some important choices regarding how they deliver critical messaging. New smartphone paging apps are promising emergency medical personnel the same fast, reliable service as pagers, and SMS may appear to offer a simple messaging solution for call centers. While medical professionals may like carrying only one device – and call centers may appreciate the possibility of receiving an acknowledgement – there is one important factor to consider before you encourage your staff to retire their pagers. Remember smartphone paging apps and SMS are only as reliable as the cellular or Wi-Fi network on which they operate.

We need to look no further than the aftermath of the tragic tornado that struck Joplin, Missouri, on May 22, 2011. The cellular systems in that area were off line for up to four days. However, even though the paging transmitter and antenna on top of St. John’s Regional Medical Center were blown off the building, the paging system’s simulcast network delivered uninterrupted critical messaging when it was needed most. The surrounding transmitters – thanks to the higher transmission power inherent in paging networks – continued broadcasting critical messaging to medical personnel inside the hospital, as well as first responders throughout the Joplin area.

A comparison of cellular and paging networks and devices shows important differences that can dramatically affect the reliability and speed of critical messaging, as well as patient and public safety.

Cellular Networks Cannot Reliably Support Critical Messaging: When using a smartphone paging app or SMS, your critical messages will be delivered on a cellular system. Those same networks are notorious for dead zones, dropped calls, and poor in-building coverage. Even the best smartphone paging app is quickly undermined, if not rendered ineffective, by these common cellular network problems.

Cellular systems were not designed for the delivery of critical messaging. In fact, most cellular carriers provide a disclaimer, cautioning users not to rely on their system for the delivery of critical messaging. Some technically aware hospital administrators even require medical personnel to sign a waiver if they choose to receive their critical messaging through their smartphone instead of a pager.

What happened in Joplin is not unique. During almost every major disaster in the United States over the past decade, local cellular systems were either quickly overloaded or disabled, proving virtually useless for emergency communications. In those circumstances, medical professionals who rely on a smartphone paging app or SMS for critical messaging may become unreachable just when they are needed the most.

Paging Networks Uniquely Qualified for Critical Messaging: For hospital call centers, the top priority is to ensure that critical messages are received immediately. Unlike a cellular network that sends a message from only one site at a time, a paging network sends the message over every transmitter in the network at exactly the same time. This is called simulcast technology; it is unique to paging and is significantly more reliable than the cellular networks used by smartphones.

Paging systems also have the distinct capability to set up a common group address in any pager so that the same message is sent and received at exactly the same time to as many people as needed in a group. A hospital’s STEMI and code teams are generally set up this way. Smartphone apps and SMS can’t do that. Mass message delivery with cellular networks can result in a “daisy-chain” of different delivery times for each device, often measured in minutes that can be critical for emergency medical personnel.

Paging networks also outperform cellular networks when it comes to broadcast power. Paging systems have up to seven times the power of cellular networks, translating into better signal penetration in buildings and more reliable message delivery. A single paging transmitter site typically covers 176 square miles, while a typical cell site covers only 10-15 square miles. Pager systems typically provide better coverage in rugged and remote terrain than cellular networks.

Single Device Convenience Is a Perception: While new smartphone paging apps tout single device convenience, smartphones have several drawbacks that limit their reliability for critical messaging. The smartphone interface can require users to take a number of steps to read a critical message. This can be difficult during emergencies. Busy medical professionals don’t need complexity with their critical messaging device. With a pager, critical messages do not compete with emails, text messages, streaming video, and other information received by a smartphone. Pagers are easy to use and solely designed to meet the demands of critical messaging.

Power failures often coincide with a crisis, making it difficult or impossible to recharge a smartphone. And, having a smartphone tethered to a charger on a regular basis just isn’t practical during an emergency. The disposable battery in a pager generally lasts three to four weeks and is easily replaced. Wi-Fi and Bluetooth-enabled cell phones may provide redundancy, but they also significantly reduce the phone’s battery life. If you forget to enable those features, you may not receive your critical messages at all, even when the cellular system is working perfectly just outside the building.

If you’re still not convinced that trading your pager in for a software app is a bad move, then you should know that smartphones that operate on our nation’s largest cellular network utilizing CDMA technology can’t receive messages or texts when in use on a call. Imagine a critical care physician missing a message in a life or death situation just because he or she took a phone call. And, after upgrading your smartphone software, some messaging apps may not continue to work as they did before. Lastly, don’t forget that many smartphones are also subject to malware and virus attacks.

Paging technology, SMS, and the new smartphone paging apps can all play important roles in critical messaging for healthcare professionals. However, during dire times when reliable, immediate communication is paramount, it is irresponsible to rely exclusively on the cellular network, smartphone apps, and SMS.

Consider all the facts, and the consequences, before you encourage your clients to use a smartphone app or SMS for critical messaging.

Ted McNaught is president of Critical Alert Systems, the third largest paging carrier in the United States. Ted has worked in the paging industry since 1986, was the founding president of the American Association of Paging Carriers, and currently serves on the executive committee, as well the Enterprise Wireless Association’s Board of Directors.