In many sectors, pagers are a technology that came and went with the '80s and '90s. With the advent of cellular phones, and then smartphones, the simple alarm-plus-message functionality became obsolete quickly.
In medicine, however, pagers are still ubiquitous. Most hospitals and medical settings use pagers as their main form of communication, primarily because they are viewed as low-risk communication tools. However, despite pagers being the more common choice, they're not necessarily the better choice. Pagers cost US hospitals $8.3 billion in 2013: $3.2 billion through lengthy discharge processes and $5.1 billion while clinicians wait for patient information.
The evidence shows that we may be reaching a crisis point regarding the viability of using pagers in medicine:
- With so many providers at different parts of the continuum of care, and with so many handoffs within a given case, pagers can't keep up with care coordination.
- In an age of increasing malpractice suits, having no record of communications or responses is riskier than ever.
- With pay-for-performance, rather than pay-for-service, being today's touchstone, it is no longer sustainable to be wasting time or money with an antiquated technology.
As usual, it is the providers themselves -- particularly the nurses -- who are taking matters into their own hands and finding efficient ways to communicate whether regulations or administrations support them in doing so. Hospitals are seeing a de facto Bring Your Own Device (BYOD) situation and 67% report nurses are using their smartphones to support clinical communications and workflow. According to research by Logicalis, the phenomenon is even more common in high-growth markets (like Brazil and India): almost 75% of users in these countries used their own devices at work, compared to 44% in places like the US.
Why can't pagers support medical collaboration and coordination of care like smartphones can? Benjamin Kanter, chief medical informatics officer at Palomar Health, explains:
"The message is only one piece of the puzzle. You've got to provide context and you've got to be able to create action. Most secure texting systems don't take that into account."
When medical providers come to us for advice on how to coordinate care and collaborate without running afoul of hospital regulations or HIPAA, we acknowledge that it can be tricky. That's why we recommend the following:
- Don't ignore HIPAA. While we do applaud the persistence of medical providers who just "get the job done" and use their own smartphones as necessary, we caution our colleagues to not use text messaging, email, or their regular camera roll as none of these are HIPAA-secure. The penalties are too great to risk it.
- Be willing to go first. Sometimes a provider will be ready to use iClickCare for medical collaboration but hesitate because their institution doesn't already use it (even if it's allowed). If we're going to change medicine, we have to be willing to lead the charge -- first an individuals, and then as a community.
- Be realistic about the complexity of your communication. Popular messaging services don't incorporate the use of photos, videos, archiving, and consults with any provider. Communicating is great, and a great start, but the reality is that our medical collaboration demands more than a text message to really accomplish the communication and coordination we need.
For our rundown of telemedicine options, pros, and cons, click here:
Image courtesy of hades2k on Flickr, used under Creative Commons rights.