The pager is an ancient piece of technology by most standards, but much to the bafflement of many, we in medicine continue to use this device today. Why? Reliability. The pager shines brightest in large inpatient environments, where cell reception is often questionable. I’m not sure if cell signal just doesn’t penetrate through that much concrete or if there’s another reason, but I don’t know anyone who would consider their personal phone a reliable communication device when in a large hospital. Even WiFi is not always guaranteed (that’s an entirely different can of worms). On the other hand, if I page someone, I know that unless their pager is off or out of juice, they’re going to get my message. That’s reason #1 why making HIPAA-compliant messaging apps isn’t actually very useful: it negates the primary hardware advantage of a pager.
Here’s reason #2: pagers get handed off constantly. Many of the current batch of HIPAA-compliant messaging apps assume that I really care about messaging a specific person. Wrong. I don’t care about messaging a specific Joe Shmoe. I DO care about messaging whoever-is-currently-covering-that-service; whether that’s Joe, Moe, Doe, or another physician on their team is completely irrelevant to me. I should never need to know who’s on call that day; I should just be able to call the [insert service name]’s pager (which gets passed around on their end) so I can talk to whoever is responsible at that current time. For you software engineers: it’s kind of like the doctors’ equivalent of blackboxing.
To achieve this blackboxing with smartphones, a hospital would have to invest in one or both of the following:
- A ton of smartphones + plans, ideally one per team/service
- Employee(s) to keep track of everyone’s schedules (which change constantly) and maintain a database of the right person to message at all times.
…do you see now why people would rather just stick to our current paging system?
Let’s get into the nuts and bolts. When I page someone, I want to open a line of communication that, ideally, encompasses three components:
- My contact number.
- The message itself.
- An idea of how urgent the message is.
Classic paging systems only have 1. I send out my contact number, the person receives it, and then they call me back to get 2 and 3. Text paging systems, which are less common, have 1 and (sometimes) 2, but 3 is still lacking.
AFAIK, there is no paging system that conveys urgency; phone apps don’t address this either. This is more a hardware than software issue. Amazingly enough, no one seems to have figured out that it might be useful for a pager to occasionally do something other than continuously screech an ear-splitting pitch until you acknowledge it. This is a huge problem because by default, this means you have to assume the page is of high urgency, which dilutes true signal-to-noise ratio considerably.
Could we develop a new device with a tiered system of notifications?
- Low urgency: an LED light that blinks unobtrusively.
- Medium urgency: a short beep that repeats every 10 minutes.
- High urgency: what we currently have, i.e. unrelenting cacophony
What if we could eventually develop hooks into our EMRs? A normal lab gives a low urgency notice to let the hospitalist know things are ok, a slightly abnormal value gives a medium urgency notice, and a flagrantly abnormal value gives a high urgency notice. The possible applications with EMR integration are endless.
But first, we need a complete refresh of the pager. And it will not come in the form of an iOS or Android app. It will come in the form of a new piece of hardware that retains the reliability we need but comes with optimizations to its communicative abilities.