Healthcare Paging: It’s a Perception, Not a Device

By Jason Stanaland

Critical messaging and communication are important in a hospital environment and are key to employee and patient safety. Communications occur between doctors and nurses, patients and employees, and many other groups working together throughout the hospital. For a long time, paging has been the backbone of this communication. It has been the glue that has held communications together. When all other methods of communication have failed, whether by technical failure or lack of acknowledgment, paging has often been what people have used. For a long time, one-way paging fit well in the healthcare communications environment.

There are several key reasons pagers have worked. Paging systems are reliable, redundant, secure, fast, auditable, and low in cost.  Paging systems also support ensured disaster recovery capacity and common capcodes, offering the ability to send a message to a single address and have it received on many devices simultaneously.

In addition, communication on pagers has also offered an environment for people to interact that is separate from all other communications media, such as email, text messaging, and instant messaging (IM). This unique environment represents important, hospital-related messages only.  No texts from friends, moms, or kids – just messages related to the job.

Pagers have also offered the ability for critical messages, such as code blue (heart attack), to emit a different tone than other messages, indicating to the receiver of the message that this particular notification was of the highest priority.

All of these functions are still relevant today when planning and developing new paging systems in healthcare environments.  With mobile messaging (paging, text messaging, and mobile instant messaging), there is a need for a type of communication that is reliable, redundant, secure, fast, auditable, and capable of group messaging from an enterprise level.  I call this type of mobile messaging, “paging.”  To me, paging is no longer a device, an infrastructure, a messaging protocol, or a method of transport.  Paging is a perception.

There are three important things to consider when designing paging solutions for today:

Ensure Reliable and Quick Delivery to Any Device: We must ensure that we accommodate all of the traditional requirements for paging systems when we are considering “paging” on a smartphone.  Using a mobile messaging solution, such as Amcom Mobile Connect, affords several compelling opportunities:

  • Reliability and redundancy of “paging” on a smartphone supporting a messaging system that is capable of seamlessly failing over between messaging platforms, such as BlackBerry Enterprise Server (BES), short message service (SMS or Google Push), and networks (cellular and Wi-Fi).  This is similar to the system reacting and recovering in the way that the human body does, by using alternate resources and repairing broken parts when necessary.
  • Secure paging to smartphones can use encrypted SMS, BES, or other protocols.
  • Cellular paging offers full two-way messaging and auditing, affording users the ability to maintain full text conversations that can be archived for auditing purposes.  This provides both accountability and protection for employees.
  • Data push technologies helps save on ongoing costs, as SMS charges are not required.
  • Under normal conditions, cellular messaging, even using SMS, is faster than an in-house paging network.  (This is from my observation and empirical studies, not assumptions.)
  • Due to message retries, I’ve found that cellular messaging is more reliable in many cases and requires less in-house coverage to be successful.
  • Smartphones do not offer a “common capcode” technology that is widely supported on phones in the U.S. (such as SMS-CB in Europe), but rather rely on software-based, one-to-one serial messaging.  At first glance, this seems like it would be a major pitfall of a cellular messaging solution. However, serial messaging actually offers a strong benefit, as it has more flexibility to send messages to more targeted groups.  By automating these groups and updating some business practices, serial messaging can become more of a strength than a limitation.

Ensure That Important Hospital-Related Messages Standout: This is key to “paging” and is why paging is a perception.  The receiver must perceive the message with the same priority as the sender intended.  Priorities are important in healthcare communications, and we must designate between patient-related pages, normal hospital-related pages, and critical/time-sensitive pages.  These messages need to offer different screen pops, alert tones, colors, or reminder tones to communicate the level of importance to the receiver.  This becomes, in a sense, a tone of voice for the message.

Consider New Strengths of Smartphone Capabilities: On a smartphone we can integrate other applications, Web services (such as weather alerts or RSS feeds), built-in cell phone functions and features (like calling, email, instant messaging, Web, camera, or GPS), middleware (nurse call, lab systems, and fire alarms), and location-based services (for presence, status, and location-based messaging).  Tablets offer another dynamic to this in terms of integration with patient charts and enhanced video content.  At this point, the possibilities are endless.

Not all of what I have mentioned is offered by a single solution today, but things are certainly headed in that direction. You can’t directly compare the cost of “paging” to pagers with “paging” to smartphones.  If you just look at the cost, smartphones will be more expensive, and pagers will win out.  But, if you weigh the cost and the demand as you would with any economic assessment, you might find a different outcome.  The demand along with the ROI provided by increasing capabilities for smartphones is rising, and the demand and ROI for pagers is decreasing.  The cost for pagers can only go up as the demand continues to shrink, while cost of operations remains static. The cost for smartphones will go down over time as demand continues to grow, providing more revenue to cellular providers and driving the increases in supply and lowering consumer costs.

At Emory, we approach new technologies with a bit of caution in practice; in healthcare, we must sometimes be conservative.  However, our thoughts are forward-looking with communications technology, and we are eagerly awaiting the future, as it is quite near.  I predict that pager devices and networks will soon enough become a relic, but paging, as a perception, will remain a part of healthcare communications environments.

Jason Stanaland is with Emory University. The Emory Office of Information Technology supports a hybrid paging system which includes pagers and cell phones, but it is migrating away from pagers, with an eye on healthcare technology trends.  

[From the August/September 2011 issue of AnswerStat magazine]