Why the *Beep* Do Doctors Still Use Pagers?

The anachronistic pager still lives on in healthcare. Here’s why, and what it will take to leave them behind.

A patient has taken a turn for the worse, and the doctor needs to be notified. What to do? For decades, the way we reach out to doctors has remained the same: paging them. Even through the rise of the internet, the smartphone revolution, and the mass adoption of electronic health records, the pager has endured.

One of the pioneers of paging systems, Sherman Amsden, began researching pagers because he was dissatisfied with the frequency that doctors checked in on his popular call forwarding service. His Doctor’s Telephone Service, later called Telanswerphone, was a big hit when it was introduced in New York in 1924. Calls to a doctor’s office after hours would be forwarded to an operator, who would transcribe and sit on the messages until a doctor called later to retrieve them. But what if some clinical news couldn’t wait? Amsden dreamed of a radio system, broadcasting only to doctors with dedicated receivers. He finally realized his dream in 1950, when his New York City broadcasting antenna reached a doctor golfing 25 miles away. But the service was expensive, and every doctor received every signal — they’d have to wait and listen for their own unique code to learn if they had, in fact, been paged. The service didn’t take off.

Instead, in another part of New York, Al Gross was developing a paging system of his own, for Brooklyn’s Jewish Hospital. Gross had already developed walkie-talkie technology in World War II, and in 1949 he adapted this two-way radio technology for one-way telephonic signaling. His patent actually predates Amsden’s technology, but the FCC didn’t approve his telephone transceivers until 1958.

It was Motorola that coined the term “pager” and introduced the Pageboy in 1964. This first commercially successful pager had a rechargeable battery but no screen, and no ability to store messages. The only notification that a message had been sent was a single tone, hence their eventual moniker: the beeper. Doctors who heard the beep would call a pre-arranged number, usually the hospital operator, to hear the message.

Voice pagers proliferated in the 1970s. After the tone, a recorded snippet would play, instructing the doctor on where to go or whom to call. This was considered progress. LCD screen technology didn’t come along until the 1980s to help restore quiet after the beep. The number of pagers in the US crept past 3 million in the early 80s, and exploded to 22 million by 1990 as wide-area paging technology was adopted, and people began using pagers outside of work.

The 90s also saw the rise of 2-way pagers with QWERTY keyboards, from Motorola and a company called RIM that would rename itself Blackberry. American pager penetration peaked at over 60 million in the 90s, but began to decline as mobile phone technology became smaller and more affordable.

Still, pagers have persisted in their original home — the medical field. Paging networks have more broadcast power than cell networks (so they can reach those basement call rooms where the radiologist is lurking). These networks are also more reliable than cell or wifi networks that can easily become overloaded, or inoperable, during an emergency. Another 90s development — HIPAA — meant that text messages with patient information could lead to liability. Paging for a voice conversation was viewed as more secure, even if less efficient. Pagers are also cheaper than cell phones. And so, even though US pager usage is down more than 90% since its heyday 20 years ago, the medical field keeps beeping.

Finally, pagers are facing the technology that could ultimately make them obsolete, even in healthcare:

Secure texting apps like TigerText and Cureatr leverage the power of the ubiquitous smartphone, or PC on the web, to engage in text (and media)-based conversations. Texts are less disruptive than pages to voice calls, and providers can review past correspondence or carry on simultaneous conversations about multiple patients with multiple parties.

EHR-based “ticklers” — Providers ordering a blood test or radiology scan can flag it, so when a result is available, their phone (or smart watch) gets a notification. One such system, EurekAlert, was recently shown to improve ED disposition time.

Health Information Exchanges offer Clinical Event Notifications (CENs) to subscribers, Health Homes and managed care services. When a high-risk patient shows up at an affiliated clinic or ED across town, a CEN is sent to a care manager, nurse or physician’s email inbox (or, you guessed it, a smartphone app). From there, the care team can reach out to those caring for the patient, to arrange prompt follow-up or reduce redundant testing. Evidence suggests CENs can reduce utilization and costs of care.

Medicine’s adoption of pagers in the mid-20th century demonstrated ours was a field on the cutting edge. But in 2017, consumer technology has long since surpassed these devices. Continued reliance on pagers is emblematic of broader problems in US healthcare — bureaucratically inflexible adherence to dated practices, with dissatisfied stakeholders nonetheless unable to agree on a way forward. Perhaps mounting evidence of security, efficiency and savings with new smartphone-based messaging can achieve what the embarrassment of anachronism has not and consign pagers to the past.

Originally published at www.telemedmag.com.