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Readers Write: Pagers Cost Hospitals Billions Each Year

May 22, 2013 Readers Write 10 Comments

Pagers Cost Hospitals Billions Each Year
By Larry Ponemon, PhD

5-22-2013 8-12-29 PM

Earlier this month, the Ponemon Institute released a study titled “The Economic & Productivity Impact of IT Security on Healthcare” that aims to quantify the impact that the use of pagers and other outdated communication technologies has on healthcare. The research reveals that communication in healthcare lags behind other industries, in large part because of the perceived security and compliance risks associated with the use of smartphones and other modern technologies.

As a result, outmoded communication systems waste clinicians’ time, limit patient interaction, lengthen discharge times, and lead to significant industry-wide economic loss.

The healthcare industry is facing some challenges in trying to balance the convenience benefit of new technologies with the need to keep patient health information protected at all times. While the implementation of electronic medical records and other new technologies is designed to improve efficiency and enhance patient care, it also has the potential to introduce risk, so IT departments must ensure that these new systems meet security and regulatory compliance requirements to keep private information protected.

As organizations struggle to strike this balance, the use of pagers and other outdated communications technologies continues as the status quo, in large part because of the perceived security and compliance risks associated with the use of smartphones and other modern technologies.

To quantify the impact this has and try to understand the scope, we surveyed 577 doctors, nurses, hospital administrators, IT practitioners, and other healthcare professionals. Overwhelmingly, respondents agreed that the deficient communications tools currently in use decrease productivity and limit the time doctors have to spend with patients. They also recognized the value of implementing smartphones, text messaging, and other modern forms of communications, but cited restrictive security policies as a primary reason why these technologies are not in use.

This study revealed that the use of pagers and other outdated communication technologies decreases clinician productivity and increases patient discharge times, collectively costing U.S. hospitals more than $8.3 billion annually.

According to our findings, clinicians waste an average of about 46 minutes each day due to the use of outmoded communication technologies. The primary reasons cited are the inefficiency of pagers, the lack of Wi-Fi availability, the inadequacy of e-mail, and the inability to use text messaging. On average, we estimate that this waste of clinicians’ time costs each U.S. hospital more than $900,000 per year. Based on the number of registered hospitals in the US, this translates to an industry-wide loss of more than $5.1 billion annually.

We also found that similar deficiencies in communications lengthen patient discharge time, which currently averages about 101 minutes. The majority of respondents said about half of this time could be eliminated if modern communication technologies were allowed. Specifically, 65 percent of survey respondents believe that secure text messaging can cut discharge time by about 50 minutes. Again, based on the number of registered hospitals in the U.S., we estimate that this ‘idle time’ during the discharge process costs more than $3.1 billion in lost revenue per year across the healthcare industry.

One of the primary reasons why smartphones and other newer technologies have not yet been adopted on a broad scale is the perceived security and compliance risks this would create. As a matter of both best practices and complying with HIPAA regulations, healthcare IT administrators are charged with keeping clinical systems and private health information protected at all times. As with other industries, we see that the reduction of risk often comes at the sacrifice of the convenience and productivity benefits of newer technologies.

For example, native SMS text messaging is not encrypted and therefore cannot be used to transmit private health information. Many hospitals have a policy forbidding the use of texting despite the fact that research like ours clearly demonstrates the value it would have on both clinical workflows and patient care. In fact, the majority of respondents to our survey said HIPAA compliance requirements can be a barrier to providing effective patient care. Specifically, HIPAA reduces time available for patient care, makes access to electronic patient information difficult, and restricts the use of electronic communications.

There is clearly a tension between giving caregivers access to the best possible technology to do their job effectively and ensuring that security and compliance requirements are met. Unfortunately we see that the pendulum seems to swing in favor of the latter, and while it is absolutely necessary to ensure security and patient privacy, clinician productivity and patient care suffer as a result.

One of the takeaways from our research is that healthcare professionals—both clinicians as well as IT staff—seem to understand these challenges and the benefits of deploying more modern communication technologies. For example, 74 percent of survey respondents said secure text messaging either has replaced pagers or will replace pagers within the next two years at their organization.

This is encouraging, and we think research like this will help the healthcare industry realize that the cost of implementing new, modern communication tools will be just a fraction of the economic and productivity costs of continuing to rely on pagers and other outdated technologies.

Larry Ponemon, PhD is chairman and founder of Ponemon Institute of North Traverse City, MI.

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Currently there are "10 comments" on this Article:

  1. Larry,
    Good points. Outdated cumbersome pagers are only one issue. There are a myriad of other hand held devices such as scanners, patient ID, and communication devices that need to come together. I saw are really good solution at HIMSS13 offered by Patient Safe Solutions called Patient Touch – Mobile Care Orchestration. They bring all these tools together in one device. Their web site is patientsafesolutions.com

  2. So all we need to do to save billions of dollars is get rid of those evil pagers? Really? This reminds me of the now discredited Rand study that predicted how much money the nation was going to save by implementing Electronic Medical Records. That study was funded by EMR vendors. This one, not surprisingly, was apparently commissioned by Imprivata, a company that presumably has developed a solution to this pager scourge that threatens the healthcare industry.

    I have a pager and a smartphone. In my opinion the pager is easier to “wear” when I have scrubs on. It is arguably easier for a circulating OR nurse to pick up the pager and respond to a message than it would be for her to figure out how to open a text message on several different brands of smartphone.

    I can get text messages on my pager and return the calls at my convenience. What difference does it make if the text message arrived on my antique device or my iPhone?

    Clearly, communication in Healthcare can and should be improved – and technology can certainly play an important role in that regard – but to suggest that the pager is what is holding us back clearly defies credulity.

  3. Larry
    Their is inherent bias in the survey question.
    Q14a. As a result of current methods of communication, how much time
    is wasted waiting for patient information (each day per clinician)?

    Couldn’t the word spent be substituted for the word wasted?
    What is meant by wasted?

    The calculation assumes that the wasted clinician time is equal to zero productivity on the part of the clinician.

    Is the average clinician actually losing 46.2 minutes per day of productivity? Are they not moving on to the next task while they wait for the information, then coming back to the task when the information is available?

    Why are the reasons for waste limited to Pagers, Email, WIFI, Text messaging not allowed, personal mobile devices not allowed? Why aren’t these clinicians looking for the information in the EHR if they have one?

    What types of patient information are they waiting on?

  4. We have about 800 pagers that are failing and need to be replaced due to poor performance. We have been researching mobile apps that use smart phones and tablets as user devices as we know that they are the devices our users prefer. These applications also provide additional mobile capabilities such as clinical workflow, messaging, voice, rounding, task management and a whole new next generation of mobile capabilities that should address the many process issues that our clinicians deal with. So for about the same size in form factor, we should be able to replace most of these old legacy pagers with mobile devices that run contemporary applications that address todays contemporary healthcare communication needs. We can’t promote any one vendor as their are several that look promising and address all our security and privacy concerns. Lets hope that vendors get this right so that we are not dealing with issues 5 years from now like what we are dealing with on our EMR.

  5. As a major fan of Larry Ponemon’s work, appreciate his thoughtful article. San Francisco AMC CMIO’s rationale for use of pagers with high-tech phones was “rescue teams take trolley ride to get to Codes and pagers only failsafe technology” hard to argue.

    Was compelled by Frank Poggio reply. Based on HIStalk alone, Frank is one of the smartest (most authentic) guys in the room (industry). His high praise for Patient Safe Solutions is de facto validation of their concept.

    RNs pay huge price (time, stress) for disjointed IT and communications that inhibit, not enable, care. We see new innovative RN solutions by a few EMR vendors and promising new entrants like Patient Safe Solutions who require tight integration with EMRs. Vendor dynamics – more than technology – could drive (long awaited) next generation of nursing IT…hopefully in the right direction. It’s time.

  6. I’ll add one that is costing major health systems a fortune…Faxing and USPS. Additional cost will be incurred when the HITECH modifications to HIPAA go into affect.

    Independant Primary Care Physicians and Specialist are WAY TOO dependent on Faxing and the US Postal Service to receive results and reports (usually for billing purposes). Even offices that have fax servers and EMRs still want documents routed to them via Byzantine distribution rules. Send H&Ps to this number, results to this number, and can you mail my operative reports to my billing office. Seriously?

    My organization mails 600 reports or results every day and faxes another 8000 every day. I’m still working on calculating the labor, material, and telecom costs for this but I can tell you it isn’t cheap!

    Further we have electronic means to distribute all of this document however we are receiving dozens of requests a week to change me back to fax…or change me back to mail.

    I hope that by demonstrating how much this dependance on 40 year old technology (fax) and centuries old technology (USPS) is costing the organization I can get the organization to take seriously deploying better electronic distribution methods that my…god help us cost a little more money.

    We need a national study analyzing the US healthcare industry’s dependency on faxing and how much that is costing providers, hospitals, insurance companies, etc.

  7. At the end of the day some practices want that fax for lab results. I see a lot use that as a cross reference against the electronic results so they are sure they didn’t miss something. Working in healthcare it, we all have seen something fail to transmit or fall to an in monitored task queue.

  8. @Bruce–You are so right. Faxing has to (somehow) die in healthcare IT. It will take some slog for everyone to agree on standards (secure e-mail, HL7 flying around everywhere, HIEs, all of the above?) but it will be necessary.

    And I’m someone who brought faxing to one of my sites and was really loved for it. They were mailing everything before me!

  9. I carry a pager and a personal smartphone. I’ve carried a hospital supplied blackberry (with a different cell phone carrier) in the past. Although the beeper is ineffective if more than 100 miles out of range, it is generally more reliable than the iPhone and certainly much better than the blackberry, each of which have numerous cell tower dead zones in our hospital vicinity (a major suburban region).

    Bidirectional text messaging is a major plus, but people are also tempted to use cell phones to call directly. This can be extremely disruptive to patient encounters and to thought processes, Typically, other people’s idea of an emergency requiring phone contact is not the same as my idea of an emergency. Routine administrative issues are much better handled by email, nonurgent phone messages by secure email, quick bidirectional messages by texting and requests to call back (for more complex discussion) by texting or beeper, with beeper as a better ultimate backup (at least in our area).

    Anyone who thinks text messaging isn’t already used (secure or not) is delusional. This doesn’t mean that HIPAA is being violated as you don’t need to transmit identifiable pt info to quickly communicate the gist of a patient’s status to a close colleague who has already been apprised of the key issues.

    Finally, I’d be very skeptical about better messaging speeding up discharges. People don’t call back rapidly for a whole slew of reasons, not just because beepers are slow and asynchronous. Usually it’s because they are in the middle of doing something else! Telling an overworked and overwhelmed doctor to respond to messages about discharges more quickly won’t help speed the process until the doctors are first given more time to complete their work and fewer patients to juggle. And that would likely improve discharge times even with beepers…

  10. The way in which these questions were structured to arrive at the conclusion that pagers cost hospitals billions is disingenuous to the industry and designed to favor the sponsor of the study.

    Every wireless technology has its strengths and weaknesses. In my experience of working with thousands of clinicians to eliminate waste in clinical communications, the cause of that waste is rarely about any particular technology or contact modality – it is always about the process.

    Clinical communication processes are inherently complex and all mobile technologies – pagers, texting apps, smartphones, etc. – by themselves are inadequate unless they are deployed in ways that improve the accuracy and reliability of the process.

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