The iPhone was introduced in June of 2007...only 7 years, but it seems like a technological lifetime ago. When you think about the tremendous capabilities and efficiencies smartphones provide, it is amazing to think that pagers - yes, pagers! - are still in use in the majority of hospitals around the United States. Doctors and nurses are required to carry these surprisingly expensive devices (all in, the costs usually are around $8-9 per month per device) with them at all times even though they all have smartphones or tablets in the pockets of their lab coats. To find out more about why hospitals are stuck in 1988 when it comes to notification and collaboration technology and what can be done about it, I spoke with Gino Andreozzi, the VP of Healthcare Solutions at Mutare Software.
“Pagers present a lot of limitations in today’s hyper connected world, not the least of which is that all pager communication is one way,” explained Andreozzi. “A problem arises, a page is sent to a doctor or nurse with a phone number or a small amount of additional text information. Any included details are unencrypted, there is no closed loop reporting and no ability to acknowledge receiving the page without calling.” However, back in the day this simplicity and limited capability made a certain kind of sense in the heavily regulated world of healthcare where privacy is critical. According to Andreozzi, “There are a number of reasons pagers have held on in healthcare, long after they’ve disappeared everywhere else. First, their simplicity means that most pages result in follow up phone calls and phone calls meet HIPAA (health insurance portability and accountability act) regulations for security. Second, many hospitals have historically had spotty Wifi and cellular coverage. Hospitals had invested heavily in paging services that utilized their own dedicated portion of the bandwidth spectrum, so having wifi darkspots in the hospital basement was no big deal. Third, healthcare IT has generally moved slowly from the status quo and they have had pagers in place for a very long time, so inertia has set in.”
However, there are several trends that are conspiring to put the final nail in the pager’s coffin. First, doctors and nurses all have smartphones and are demanding change. They don’t want to walk around with more things attached to their belt and feel they already have all the communications and computing power they need to improve care with their mobile devices. Second, technology has come a long way. Wifi and cellular coverage in hospitals in now ubiquitous, LTE services penetrate buildings the same as pager signals and secure mobile apps with powerful encryption can eliminate privacy and compliance concerns. Third, the Affordable Care Act and Meaningful Use has shaken up healthcare IT and incentivized organizations to move aggressively to implement secure Electronic Medical Records (EMR) changing the industry’s perspective on what can be done to improve operational and clinical efficiency.
Three Reasons Pager Replacement Makes Sense for Hospitals
It seems that all that’s left now is to provide a solid business case for administrators and clinicians in order to move beyond pagers. According to Andreozzi, once you address IT’s concerns around security and HIPAA compliance (meaning how to encrypt data in motion and at rest on the device and on servers - as we discussed in this post), there are three primary benefits that seal the deal.
Clinical Efficiency and Improved Outcomes
By replacing a limited, one-way communications device with a secure, unlimited two-way communications platform in the form of a mobile app on caregiver’s personal devices, hospitals can significantly improve care coordination and caregiver workflow. “A simple example are lab results,” says Andreozzi. “With pagers, a caregiver might receive a brief unencrypted text notifying them that lab results for patient X are ready, or they might simply receive a number on their pager. They would need to interrupt what they’re doing - or wait until they had available time - to call in to obtain the details, or find time to login and check results on a workstation or even walk down to the lab directly. From there collaborating with team members is generally a manual process or, as is often the case, is handled in a non-HIPAA compliant fashion via text or email on the caregiver's personal mobile device. With a secure messaging platform, the full results can be sent in encrypted format directly to the care team and they are immediately notified by their secure app. They can take a quick scan and determine if it requires immediate response, acknowledge receipt, interact with the EMR and follow up and collaborate with other team members as necessary, all from within the app. What may have taken hours, now takes minutes.”
And it is not only lab data, we also discussed how an orthopedic hospital they work with is using secure mobile apps to share rich content like x-rays & MRI imagery. By sharing this data using their secure messaging app as soon as it becomes available, clinicians can speed collaboration with key team members and discuss results and next steps.
By moving to a secure mobile application, hospitals can save up to 75% over the cost of paging. It seems counter-intuitive that you would get a lot more technology for less cost, but pager infrastructure and per message regional and national coverage fees are expensive. Between the servers, the manpower (schedulers, vendors) the devices and the paging service itself, costs generally are two to three times higher per user than for a secure healthcare communications platform like Mutare’s. Mobile app based solutions take advantage of the caregiver’s personal devices and assume a BYOD strategy is in place (likely with an MDM - mobile device management solution) to ensure the devices are securely connected to the hospital’s network and meet organizational policy requirements.
Closed Loop Reporting
“Paging systems don’t close the loop,” explained Andreozzi. “All you can track is that the page has been sent. All interactions after that are lost.” With a secure bi-directional communications platform the interaction goes more like this:
Rich Information Sent > Received by Device > Opened > Acknowledged > Action Taken > Further Communications > Patient Record Updated > Event Closed
“By capturing all of that information and integrating it into the appropriate databases and EMR, hospitals have tremendous reporting capabilities that have never been available to them before.” This allows them to define best practices over time, identify errors that led to poor outcomes and define opportunities not only clinically, but operationally. Andreozzi shared a story about how a hospital they work with has extended the communications platform to housekeeping (yes, they have smartphones too!). Now housekeeping is notified immediately when a patient is discharged and the room is ready to be cleaned. When they finish cleaning the room, they click a button on the app and the Emergency Department is notified that a bed is available, cutting down on the amount of time people wait in the ER. “By seeing this type of closed loop reporting in action, hospitals continue to come up with creative ways to extend the reach of the platform to lower costs, improve outcomes and enhance patient satisfaction.”
With so many good reasons to replace pagers, don’t be surprised to see docs and nurses working their mobile devices next time you visit a hospital.