Replace pagers. Improve physician accountability

Replace pagers with clinical communications platforms to improve physician accountability

In a recent article written by Providence Community Health Center’s CMO, Dr. Andrew Saal wrote that his hospital needed to replace pagers to improve physician accountability. By using pagers, physicians had and continue to have a readily available crutch –  a crutch they could use to explain why they did not respond to patient requests or to explain why they did not respond to colleagues requests. And while there was no way to verify if these statements were excuses or valid explanations, the result was the same. In the moment of need, the on-call physician could not or did not respond.

What also comes to light in this instance is that if a hospital is to run efficiently, on-call must be accountable. The hospital must have a reliable clinical communications platform. Otherwise, too many important calls can fall through the cracks. Additionally, physicians need to be accountable when they are on-call and when their patients need them.

Why hospitals need to replace pagers

Pagers have many faults, not least is their inefficiency which costs the average hospitals $1.75 M per year in inefficient communications and can impede critical clinical workflows.  Pagers lack critical functionality. Effectively, the reason to replace pagers focus in on the following seven points:

• Pagers are not encrypted: Pagers do not provide encrypted communications. Without encrypted communications, HIPAA compliant messaging is extremely difficult in a healthcare setting. Communications on pagers must be extremely limited and non-descriptive if doctors are to use them and not violate HIPAA regulations.
• Pagers can be hacked: According to a recent case study, a U.S. based hospital had their pager communications hacked and red by outside parties that forced the hospital to register the violation with the Department of Health and Human Services
• Pagers only have high priority pages: Pagers typically don’t have low versus high priority messaging. In a world where all you have is a hammer, every page looks like a nail.
• Pagers have a limited range: This limitation goes to the heart of physician accountability as outside of the few square blocks neighboring a hospital, a physician often won’t receive their intended page.
• Pagers don’t enable two-way communication: Pagers can often only receive pages but not initiate or further communication. This flaw further highlights the lack of accountability perpetuated by pagers. If physicians cannot delve into a request, they often are left with partial and incomplete information.
• Pagers cannot escalate alerts: For pages that are critical, there is frequently the need to bring in expertise or assistance of other professionals. Traditional pagers don’t permit this level of communication to occur.
• Pagers don’t allow attachments: Successful healthcare diagnoses and effective treatments typically require test results and imaging. However, traditional pagers are incapable of facilitating this necessary level of communication.

Secure physician communications like that provided by OnPage’s platform do permit physicians to exchange encrypted attachments and messages. Additionally, physicians are able to escalate alerts and communicate in a robust manner – all capabilities which run opposite to the limited functionality of pagers.

Secure physician communications improve accountability

When hospitals replace pagers, they are able to improve physician accountability. Here are aspects of clinical communication platforms that improve accountability.  

• Audit trail: As noted in the previous section, physicians are often not accountable because their pagers are unable to receive messages in many parts of the hospital as well as beyond the few blocks surrounding the hospital. Consequently, if the answering service or a colleague tries to page a physician, the physician can easily not hear the page or easily ignore it.

If hospitals replace pagers with secure messaging platforms like OnPage however, answering services and colleagues can actually see if the physician who is being sent the message has received the alert. This assurance enables senders to know that their message has been received and if it has been read.

• Presence information: Clinicians are at times known to be “digitally missing in action”. That is, the clinician who is supposed to be on-call does not have their device operational or logged-on so they cannot be reached.

Secure messaging platforms however allow the sender (either the on-call service or a colleague) to see if the practitioner to whom they are sending the message is actually logged-in. This characteristic of secure messaging platforms improves accountability since if the physician is not logged onto the application he or she can easily be called and told that they need to log in.

• Accountability is increased with alerting. Higher possibility of reaching colleagues: It sometimes occurs that when a physician is paged they are either unable to respond to the alert or do not hear the alert. Unfortunately, this inability of pagers to provide persistent alerts makes it easy for alerts to be forgotten or missed entirely.

Secure messaging platforms however provide persistent alerting that continues for several hours if the practitioner does not immediately respond to the alert. With this persistent alerting component, physicians are inevitably more accountable to colleagues because they can neither forget nor avoid their colleague’s need for help.

Transmitting patient information over an unsecured network is inviting a HIPAA disciplinary action or fine. It is incumbent upon all physicians to comply with HIPAA  and use HIPAA compliant messaging in order to be accountable to the demands of HIPAA. This level of accountability is ensured with secure physician communications.

Conclusion

Eliminating the use of pagers in healthcare will significantly improve physician accountability.  As noted throughout this whitepaper, pagers enable physicians to miss critical messages and potentially violate HIPAA statutes. It is incumbent upon healthcare facilities to make physician accountable to their colleagues and their patients. In order to achieve these ends, physicians and hospitals must end their relationship with pagers.