Doctors urged to ditch pagers in favour of smartphones

When Ann Marie McKenna uses her iPhone to communicate with colleagues at work, she’s upsetting the long reign of another device – one that is virtually obsolete outside her industry.

Physician Jonathan Ailon uses a smartphone at St. Michael’s Hospital in Toronto, Sept. 9, 2012. J.P. Moczulski for The Globe and Mail.

Dakshana Bascaramurty, The Globe and Mail September 10, 2012

Dr. McKenna, a general internist at St. Michael’s Hospital in Toronto, thinks it is time hospitals joined the 21st century and ditched their pagers.

For those who don’t work in health care or the narcotics trade (or were born in the nineties), the pager is a portable electronic device that can be used to transmit short messages. In hospitals, nurses use them to send phone numbers to doctors, which the doctors are then meant to call. They’ve had remarkable staying power because of their simplicity.

For most people, the pager represents a sad, humorous relic of the past—a reminder of the primitive time before cell phones, Google, and the Twitterverse. But for doctors like me, pagers are still an important part of everyday life.

It’s estimated that about 85 percent of hospitals still rely on pagers for communication, and during a recent episode of post-call delirium, I wondered why. Allison Bond

But research has revealed deep flaws in the efficiency of the technology, which is why Dr. McKenna and other clinicians across the country are trying to make their institutions switch over to smartphones. They face a range of barriers, however, from a jump in cost to questions on how to protect patient information on devices that allow for much more sharing.

Still, Dr. McKenna thinks it’s time for a revolution.

Left to right (per your perspective, not radiologic left to radiologic right) I’m wearing my cell phone, the Peds Trauma pager, the Peds Arrest pager, the Peds Pain pager, and my own personal pager. Needless to say, I was on the Peds Anesthesia service at the time. From the underwear drawer.

“If the only information you get from a page is a four-digit extension you have to call back, you can imagine that dramatically interrupts your work flow and there’s no context to that page,” she said.

“They could be paging you to say, Your patient’s having chest pain, I think it’s a heart attack, or Your patient’s constipated, can you prescribe a laxative.”

On an afternoon at St. Michael’s, she scans through her iPad, which, with an app developed by Amcom Software, can trace all the communiqués between nurses and residents in internal medicine who are also using the app. The much evolved “pages” that nurses send can be rated high, medium or low priority so doctors know when an urgent response is needed. They can also include detailed patient information.

In one case, a nurse sends a text page to a doctor via the app: “Sorry to bother you. Patient asking for meds for restless leg syndrome. Order not in yet.”

Within a minute, the nurse receives an alert that the doctor has read the message and then, a few seconds later, a response by text, even though the doctor is making rounds at the time.

In a study, Dr. McKenna found that with pagers, nurses would wait more than six minutes for a response. However, when smartphones were used, allowing for text replies, the average response time dropped to 1.6 minutes.

A more pressing need for the switch stems from lack of accuracy with numeric paging.

When researchers at Sunnybrook Health Sciences Centre and Toronto General Hospital analyzed all the “pages” sent to their internal medicine residents during a two-month period in 2008, they found 14 per cent were sent to the wrong physician. About half of those were classified “emergency” or “urgent” pages. That could mean 4,300 misfires a year, with about 2,000 being high priority.

“It’s a failure-prone system that we’ve been using and we want to be able to increase the reliability of those communications from nurses to physicians,” said Robert Wu, a general internist at University Health Network in Toronto and research director at the hospital’s Centre for Innovation in Complex Care.

Funding the switchover is the biggest reason hospital staff aren’t communicating via smartphones, according to a survey of 600 health-care organizations in the U.S. and Canada conducted by Amcom Software last year.

Dr. Wu said it’s been a major barrier for adoption at his hospital. While pagers cost the institution $5 a month, equipping employees with smartphones and data plans would be in the neighbourhood of $60 to $80.

The solution to that in some hospitals, such as St. Michael’s, is adopting a bring-your-own-device approach. The cost of the app, in that case, is the same as the monthly pager subscription, Dr. McKenna said.

Another top concern of hospital administrators considering the switch to smartphones is how patient information will be protected.

Staff at hospitals sometimes stray out of more secure apps to communicate via e-mail or text message, neither of which are secure, said Brian Edds, the director of project strategy at Amcom Software, which developed the Mobile Connect app used at St. Michael’s Hospital and more than 100 others.

There are features in place to make Amcom’s app itself secure, though: information is encrypted when transmitted, users must enter in a password to log on to the system and, if a device is lost, the information stored on the app can be wiped remotely.

Still, some hospitals are content maintaining the status quo because pagers, though archaic, are reliable.

A spokesperson for the Winnipeg Regional Health Authority said no hospitals in the region had plans to trade in pagers for other devices.

In rural areas, a pager wins out over a smartphone since cell reception “can sometimes be sketchy,” said Trudi Beutel, a public-affairs officer with Vancouver Coastal Health, in an email. “Have you ever tried to make/receive a call from Tsawwassen, for example?”

Still, the Provincial Health Services Authority – the body that makes centralized decisions about hospital communication in B.C. – is looking at the smartphone model as a few individual clinicians experiment with them, said Barry Rivelis, the authority’s chief information officer.

At St. Michael’s, the pilot project is over but internal medicine staff have continued using the app instead of reverting back to their pagers. It has proven so efficient that soon it will be tested in the cardiology ward.

“The interruptions are still happening,” Dr. McKenna said, “but [doctors] are able to triage the message and decide if they want to deal with it right now.”

Source The Globe and Mail

The hospital pager: Out with the old or here to stay? McElroy L M, Gillett EZ, Nguyen C, Holl JL, Abecassis M, and Ladner DP. Clinical Liver Disease. (2016) 7: 29-31. doi:10.1002/cld.529 PDF

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Efficiency and Interpretability of Text Paging Communication for Medical Inpatients: A Mixed-Methods Analysis, Luxenberg A, Chan B, Khanna R, Sarkar U. JAMA Intern Med. 2017 Aug 1;177(8):1218-1220. doi: 10.1001/jamainternmed.2017.2133. No abstract available. Full text

Why do we still page each other? Examining the frequency, types and senders of pages in academic medical services, Carlile N, Rhatigan JJ, Bates DW. BMJ Qual Saf. 2017 Jan;26(1):24-29. doi: 10.1136/bmjqs-2015-004587. Epub 2016 Jan 6. Full text

Also see
Why do doctors still use pagers? Slate
90 Percent of Hospitals Still Use Pagers and Overpay to Maintain Legacy Technology Healthcare Informatics
Hospitals turning a ‘pager’ on data hardware The Boston Globe
Constant Connection: The Value of Pagers in the Hospital Spokwise healthcare blog
Another trip in the way back machine from the underwear drawer
WakeMed RapidConnect hospital app enables quick communication and helps ditch pager iMedical Apps
Medigram app allows HIPAA compliant group text messaging between doctors iMedical Apps