Last week, one of us here at BeckonCall grabbed the phone to get in touch with a physician’s office to clarify a question about insurance coverage for a recent minor procedure. Instead of the usual recorded message directing him to “press 1 for appointments, press 2 for billing,” etc., the machine clicked on after one ring and announced that the practice was closed for the day. And then, the office manager’s voice said, “if you are an existing patient and are calling with an urgent medical question, please call Dr. Smith’s pager at 555-123-4567, pager number 89.”
Make no mistake, we at BeckonCall are well aware of the prevalence of pagers in medical practices. Finding better ways to get in touch with physicians is literally our reason for existence. And indeed, we spend a lot of time talking about the use of legacy technology – like fax machines and pagers – in medical practices. Even so, it was a jolt for our colleague to hear, in the context of being a patient, that he was supposed to set off an irritating alarm screamed from a box on “Dr. Smith’s” hip. This is 2016, after all.
Pager use may be on the decline, but they’re not gone yet. Why? A Slate article published earlier this year by Dr. Allison Bond reviews some of the reasons. It’s a good read, so be sure to check it out. Briefly, though, Bond points to the simplicity of pagers (battery life, for example) and their reliability when receiving messages. She also notes that there is some pride when physicians and other providers are first given a pager, although she’s quick to point out that the novelty wears off in a hurry.
There are a number of other concerns medical providers and practices express when talking about switching away from pagers. Below are a few, as well as responses that might help break the inertia of technological stagnation.
Historically, pagers use networks that rely on a form of radio transmission instead of cell towers. As a result, pagers can be used in situations like natural disasters when the towers are down or networks congested. (Spok, which provides pager services, published a blog post in 2014 about how their system was used during the Boston Marathon bombing.) In general, however, the strength and reliability of cell service has reached a point where an on-call physician will receive messages almost instantaneously in most circumstances. Yes, there are times where being buried in the bowels of a hospital building might obscure service, but cellular providers have been increasing signal strength and adding towers (often on medical campuses themselves) to eliminate the problem. Additionally, most hospitals have on-campus Wi-Fi networks that allow for delivery of messages and, increasingly, calls, even in the absence of cellular signal. Therefore, messages or calls will arrive quickly. Additionally, they can be responded to on the same device with one touch instead of having to type in the number from the pager. Thus, while there are instances such as disasters or rural practices where pagers still have a slight edge, the majority of medical providers can let them go safely.
This is an understandable concern. No one wants to have an important work message lost in the shuffle of dinner plans and cat gifs. Smartphones include a few options that allow for separation between contacts to eliminate this problem. The most basic, and perhaps most effective, method is to use some shorthand to denote work contacts. Many people do this with a partner, listing them as “ICE – Joe Brown” so first responders know whom to call in case of emergency. The same thing can be done professionally, adding an asterisk to relevant names. A more elegant solution is to take advantage of the features of specific medical messaging and on-call management systems that run on mobile operating systems. In this way, all communications will occur through an app that is entirely separate from those used for personal purposes such as WhatsApp and iMessages. A good standalone app will be more than messaging, including features such as on-call scheduling, in-app callback, and advanced group chat options.
Pagers operate by receiving thousands of radio signals and then filtering out those that do not include the number associated with that specific device. They are remarkably secure. In general, though, communication via smartphone is considered HIPAA compliant. Regulations require “reasonable” effort to be made to protect patient information. Email and smartphones are listed as acceptable systems to use. Beyond that, however, messaging platforms and on-call scheduling tools built for medical practices are built for security. Encryption and other safeguards are put in place to cordon off any private data, regardless of the device on which it is read. No system is 100% secure, but smartphones are a well-established method for interacting with information covered by HIPAA. (as always, this blog does not provide legal advice. Please consult with a lawyer or your hospital’s compliance office to ensure all regulatory/legal requirements are being met.)
A pager can go weeks without changing the battery, more if it’s used sparingly. Smartphones, of course, require far more frequent charging, although battery life continues to improve. Additionally, portable chargers and cases with extra power are common. This is another area where tradeoffs need to be considered: a long battery life for a device that does one thing only, or a day-long charge on a pocked-sized computer that provides multiple forms of secure communication, scheduling, reference materials, and in some cases even the ability to view images.
Pager services cost an average of $9.19/month/device, and the devices themselves are only $30-$50 (not including likely volume discounts). Practice managers may feel this is reasonable for a reliable system, especially if they are concerned about subscription fees, as well as time and money required for onboarding, associated with on-call management platforms. However, there are enormous hidden costs associated with pagers. A 2013 study reported by CNN and Fortune suggested that over $8 billion is wasted annually by the US healthcare system through lost productivity associated with pager use. The same study estimated that patient discharge times could be dropped by 50 minutes by switching to more modern communication tools such as smartphones. If yours is a small, private practice, even a couple of minutes saved per patient could lead to increased productivity and added profitability. Additionally, the cost to switch is far less than you might expect. On-call management systems run as low as $50/month. That fee includes far more features than just the message alerts provided by pagers. Additionally, the good platforms have no setup fee. In terms of hardware, more than 80% of physicians were already carrying smartphones as of mid-2015. Many clinics have a “bring your own device” policy, so it makes sense to integrate workflows with existing technology wherever possible and save on additional hardware costs, low as they may be.
Ultimately, the decision to shift away from pagers comes down to whether it is more resource efficient to use a simple device that does one thing well and nothing else, or a more complete and powerful device that can integrate all functions with a few tradeoffs (e.g., battery life). The new healthcare landscape is such that any upgrades to provider workflows and more efficient patient care can improve outcomes and financial concerns. Consolidating communications with other processes onto one device is a great – and simple – place to start.
Questions about ditching the pager? Get in touch today!