The End of a Healthcare Communications Era

Goodbye, Pagers. Hello, Handheld Computers!

A healthcare provider uses a clinical smartphone to update records and communicate with colleagues from the patient's bedside.
by Wayne Miller
July 15, 2019

It’s official. According to the National Health Service (NHS), pagers will be considered obsolete in the next two years. (At least in the U.K.) Can you believe it?

If you can’t, it’s probably for one of two reasons:

1. You thought that pagers went the way of the pay phone around 1999.

2. You’re a millennial and don’t even know what a pager (or pay phone) is.

But the shocking truth is that many healthcare facilities are still using this outdated communications technology to reach doctors and clinicians.

According to this BBC report, the NHS “still uses about 130,000 pagers, which is about 10% of the total left in use globally.” That means that approximately 1.3 million pagers are sending messages to doctors and other clinical staff around the world as you read this.

Did your jaw just drop again?

There are a few reasons why pagers are still so prevalent in healthcare facilities, 30 years after their use surpassed their peak:

1. They can quickly alert and activate medical team members in an emergency.

2. Pagers use a dedicated network to send messages, making them highly reliable communication tools with minimal transmission delays.

3. They are lightweight and mobile.

However, there are just as many reasons – if not more reasons – why a pager should not be the first (or only) device a healthcare provider uses to initiate communications with other care team members, even in an emergency:

1. Pagers only facilitate one-way communication. Doctors and nurses cannot acknowledge pages or provide care guidance using pagers. They have to either find a fixed landline phone or use their mobile phones, if equipped with them, to call the person back.

2. The message has to be relayed through a third-party before it reaches the pager, delaying communications. Medical staff members have to pick up the phone to call either an automated line or dispatcher to voice the message they want distributed to doctors and nurses via the pagers.

3. Pagers are expensive, as UK Health Secretary Matt Hancock noted in the BBC story. The NHS is paying about £6.6m a year to manage its 130,000 pagers.

In my opinion, the cost of using pagers extends far beyond the infrastructure management expenses.

It can take minutes to page a doctor and receive either a return call or a resource at the bedside; minutes that some patients may not have. The cost of communication delays during the course of patient care, though hard to quantify, would likely far exceed any equipment sticker price.

Seconds matter in acute healthcare settings. Clinicians need mobile devices that allow for immediate and direct two-way voice and text-based communications. There should be no middle-man required to relay a message – human or otherwise. And staff should not have to use more than one device to share information with one another, whether in a written or verbalised manner.

That is why I am pleased to see in the BBC report that the NHS has been directed to “stop using pagers for communications by 2021 […].”

Simply replacing a pager with a smartphone-like device in a one-to-one swap will enable healthcare leaders to retain many of pagers’ benefits while delivering several new benefits:

1. Instantaneous communications: Clinical smartphones with push-to-talk (PTT) capabilities give staff the option to pick up the phone and, on the first call, reach the right doctor or nurse to simultaneously alert him or her to an issue and request guidance on how to handle the situation. Such mobile devices also allow for fast group text alerts that mimic pager notifications. The difference is that – with a mobile device – you don’t have to go through a dispatch agent to initiate that alert, which can save seconds to minutes. And you don’t have to know which number to dial, either. 

With the push of a button, you can initiate a secure call to a single “subscriber” in your facility’s centrally-managed call list, a pre-configured group of subscribers (such as your primary healthcare team) or even an ad-hoc group (ideal for reaching providers outside your core care team). Others can join the call later if needed. And, depending on the PTT software you select, you may have the option to select between barge calling (for urgent communications) and alert mode (for non-critical communication) or allow for priority call overrides, which allow certain team members to interrupt ongoing PTT calls of providers in an emergency situation.

Plus, smartphone-like devices enable you send group text alerts that mimic pager notifications. But, unlike a pager-based system, these text-based alerts can be sent to any wirelessly-connected mobile phone, tablet, 2-in-1 device, laptop or desktop running the right software.

2.  A single, secure data capture tool that also serves as a single, secure source of patient data (which you can be confident is up-to-date, up to the minute): Pagers aren’t the only legacy technologies that are long overdue for retirement. Fixed landline phones, fax machines, stationary computers and standalone cameras are among the archaic devices that some healthcare facilities are still using to capture and transmit data to care team members and back-office systems. Even more surprising is the volume of paper stock still used to manage admissions, patient charts, payroll, and other administrative filings. These silos – whether digital or manual – increase the risk of miscommunication and make collaborative care challenging.

Fortunately, a clinical smartphone can single-handedly replace all of those data capture and distribution devices without compromising data capture capabilities. If anything, this type of mobile device eases the data input process and improves collaboration since all team members are able to access and act upon the same set of accurate data without delay.

Unlike pagers, which can only receive an abbreviated, scroll-like alert, clinical smartphones can transmit multiple data points at once via multiple encrypted communication methods. For example, a doctor can view electronic health records (EHR) on the device’s screen while consulting with the bedside nurse on the device’s speakerphone to confidently recommend the best course of care for the patient. The nurse no longer has to track down the doctor to deliver a paper chart for review, which delays patient care.

Along those same lines, a doctor or nurse can document patient vitals, add detailed assessment notes or update the care plan in a patient’s record in real time while at the bedside so the doctor is making a care decision based on a patient’s current status. Things can change quickly in an hour or even a minute. He or she can also capture images of wounds or surgical repairs in the emergency room or operating room using the built-in camera so that a time-lapsed record is available to monitor a patient’s recovery. As one customer told me recently: “The [built-in] camera capture [tool] removes 5 extra steps, freeing up more time to be with our patients.”

Once a care plan is determined, the doctor or nurse can use that same mobile device at the bedside to securely order labs or prescriptions, document medicine or IV administration or even generate specimen collection labels, if connected to a mobile printer. The smartphone can even be used to remotely access and manage clinical devices such as infusion pumps.

Kassaundra McKnight-Young of Truman Medical Centers spoke a lot about these bedside benefits in her recent Stories from the Edge blog post and video interview.

3. Enhanced patient safety tools: Built-in barcode scanners enable doctors, nurses, pharmacists and other caregivers to scan a barcoded wristband to verify a patient’s identity before discussing sensitive information or administering care. Similarly, they can scan the barcodes on a patient’s wristband and the barcodes on an IV bag, prescription medication, medical device or other controlled items to verify the patient information matches up on both. Such medication, device and equipment scans also ensure compliance with insurance and regulatory directives set forth worldwide, such as the Falsified Medicines Directive and Unique Device Identification guidance in the U.K.

4. Real-time and remote monitoring of patients, personnel and assets: Built-in GPS technology enables clinical smartphones to serve as staff locators if they aren’t responsive to calls or texts. Pagers can’t tell you whether or not the provider received the message, much less where they are to try to physically track them down.

The smartphone’s built-in scanners can also be used to track and trace patients and equipment. Every time a patient or wheelchair is moved, for example, the porter can scan the patient’s barcoded wristband or wheelchair’s RFID tag to notate new locations. I spoke more about this in my last blog.

The mobile devices’ track and trace tools also assist with inventory management, which you can read more about here.

5. Clinical smartphones can streamline every administrative and patient care workflow: The value of this all-in-one mobile device is evident long before a patient is assigned a bed and long after the patient leaves the facility. Numerous customers have attested to this when sharing their clinical mobility stories, including Truman Medical Centers, Nemours Children’s Health System, BJC Healthcare’s Barnes-Jewish Hospital, Hexagone Neuilly, and this Dutch hospital group.

Unlike a pager, stationary computer or even paper-based intake process, a smartphone-like mobile device can be used to immediately verify insurance and triage patients from the waiting room and initiate the laser or thermal printing of patients’ barcoded wristbands. You don’t have to wait for a dedicated triage room to become available to initiate care.

Once a patient is ready to go home, you can present discharge paperwork on the device for digital signature and even print hard copies for the patient to take home if they prefer that over emailed instructions. In other words, clinical smartphones can even be used to complete nearly every healthcare workflow from patient intake to discharge.

(Although, I’d be remiss if I didn’t acknowledge that a larger-screen rugged tablet or 2-in-1 computer with a full-size keyboard may be the preferred device form factor for completing longer-form patient admission documentation that is filled to the brim with small font copy. The good news is that these rugged mobile computers can also connect with your communication systems to send and receive alerts as needed.)

And these are just a few of the benefits you will gain by adopting a smartphone-like device as your primary communication device when it comes time to say goodbye to your pagers once and for all!

So, don’t fear this change. It is one that will be for the better – for your patients and your providers.

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Ready to scope out a clinical smartphone to replace your pagers? Remember that not all mobile devices are appropriate for healthcare use. (And BYOD mobility strategies are not suitable for healthcare environments in most cases. My colleagues and I will talk more about this in upcoming blog posts, so stay tuned.)

While buying an enterprise-grade device should be part of your baseline requirements, it’s not enough to select a smartphone or tablet just because it’s enterprise-ready. Some consumer-grade devices claim to be enterprise-ready, but not all are properly designed or specifically equipped for healthcare applications.

Communication device reliability is clearly a concern in healthcare. That’s why pagers have survived so long in hospitals. But security, accessibility, longevity, usability and decontamination should be weighed just as heavily before investing in any smartphone, tablet, 2-in-1, barcode scanner or even printer.

I offered an in-depth analysis of these mission-critical considerations in this recent post. If you missed it, it’s worth the read given the implications of choosing the wrong device for patient care.

We’ve also developed a clinical mobility resource page and a free downloadable clinical mobility buying guide that can help to inform your device evaluation and selection process. I encourage you to check them both out.

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Wayne Miller
Wayne is the Zebra lead for Healthcare solutions and works to directly improve patient care, supporting partners and end users.












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