Why doctors’ pagers still trump smartphones

By: Brian Dolan | Aug 11, 2011        

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Doc_PagerMore than 80 percent of physicians in the US now have smartphones. About a third have tablets. Despite the aggressive adoption rates of these devices many physicians still carry pagers. Yes, plenty of healthcare-specific messaging services are now available for physicians with smartphones, and we cover the launch of these services at MobiHealthNews. Is it really time to move away from the pager? Ted McNaught, President of Critical Alert Systems, the third largest paging carrier in the United States, argues that smartphones aren’t up to snuff when it comes to critical messaging. I invited McNaught to make the case for pagers despite the rise of smartphones in healthcare settings — here’s his take:

By Ted McNaught, President, Critical Alert Systems

New smartphone paging apps are promising emergency medical personnel the same fast, reliable service as pagers. But before you retire your pager, remember that smartphone apps are only as reliable as the cellular or WiFi network they operate on. A comparison of cellular and paging networks and devices shows important differences that can dramatically impact the reliability and speed of critical messaging, as well as patient and public safety.

First and foremost, when using a smartphone paging app, your critical messages will be delivered on a cellular system. Those are the same networks that are notorious for dead zones, dropped calls and poor in-building coverage. Cellular systems were not designed for the delivery of critical messaging. In fact, most cellular carriers provide a disclaimer and caution users not to rely on their system for the delivery of critical messaging.

During many major disasters in the United States over the past 10 to 12 years, local cellular systems were quickly overloaded or disabled — proving virtually useless for emergency communications. Consider the aftermath of the tragic tornado that struck Joplin, Missouri on May 22, 2011. The cellular systems in that area were off line for up to four days.

However, even though the paging transmitter and antenna on top of St. John’s Regional Medical Center were blown off the building, Midwest Paging’s simulcast network delivered uninterrupted critical messaging when it was needed most. The surrounding transmitters continued broadcasting critical messaging to medical personnel inside the hospital, as well as first responders throughout the Joplin area.

Unlike a cellular network that sends a message from only one site at a time, a paging network sends the message over every transmitter in the network at exactly the same time. This is called simulcast technology, it’s unique to paging and is significantly more reliable than the cellular networks used by smartphones.

Paging systems also have the unique capability to set up a common group address in any pager so that the same message is sent and received at exactly the same time to as many people as needed in a group. Stemi and Code teams are generally set up this way. Smartphone apps can’t do that. Mass message delivery with cellular networks can result in different delivery times for each device, often measured in minutes that can be critical for emergency responders.

Paging networks also outperform cellular networks when it comes to broadcast power. Paging systems have up to seven times the power of cellular networks, translating into better signal penetration in buildings and more reliable message delivery. A single paging transmitter site typically covers 176 square miles, while a typical cell site covers only 10 to 15 square miles. Pager systems typically provide better coverage in rugged and remote terrain than cellular networks.

While new smartphone paging apps tout single device convenience, smart phones have several drawbacks that limit their reliability for critical messaging. The smartphone interface can require users to take a number of steps to read a critical message, which can be difficult during emergencies. Busy medical professionals don’t need complexity with their critical messaging device. With a pager, critical messages do not compete with e-mails, text messages, streaming video and other information received by a smartphone. Pagers are easy to use and solely designed to meet the demands of critical messaging.

Power failures often coincide with a crisis, making it difficult or impossible to recharge a Smartphone. And, having a smartphone tethered to a charger on a regular basis just isn’t practical during emergency situations. The disposable battery in a pager generally lasts 3 to 4 weeks and is easily replaced. WiFi and Bluetooth enabled cell phones may provide redundancy, but they also significantly cut back on the phone’s battery life. If you forget to enable those features, you may not receive your critical messages at all even when the cellular system is working perfectly just outside the building.

If you’re still not convinced that trading your pager in for a software app is a bad move, then you should know that smartphones that operate on our nation’s largest cellular network utilizing CDMA technology can’t receive messages or texts when in use on a call. Imagine a critical care physician missing a message in a life or death situation just because they took a phone call. And, after upgrading your smartphone software, some messaging apps may not continue to work as they did before. Lastly, don’t forget that many smartphones are also subject to malware and virus attacks.

Consider all the facts, and the consequences, before you trust your critical messaging to a smartphone app and the cellular network.

Ted McNaught is President of Critical Alert Systems, the third largest paging carrier in the United States. Ted has worked in the paging industry since 1986, was the founding President of the American Association of Paging Carriers and currently serves on the Executive Committee, as well the Enterprise Wireless Association’s Board of Directors.

  • http://pulse.yahoo.com/_ON2Q3PFLNA6D7X45KFWMIQOTVY Eric Z

    If you need to send a page from an Android phone, check out this application: https://market.android.com/details?id=com.a1pager.lite&feature=search_result

    Works with a few major pager networks!

  • Medical Alert Systems

    Great blog, i am very glad that medical alert system have present in our life. It is becoming a part of our life.

    For more Info visit: http://www.medicalalertsystemblog.com

  • Richard Tanler

    Well Said!   The rush to do everything on a smart phone is producing some Apps that don’t make much sense…to me…some are “cool” but in the end we need technology that is Geeklessly Simple, reliable and affordable.  That is not always possible with the smartphone.

  • Judit

    With all due respect to Critical Alert, using old technology on disappearing devices and shrinking networks is like riding to work on a horse vs. in a car with airbags, air-condition and music on a highway! …Now, you may like riding a horse better but it’s inefficient in today’s world.

  • Craig

    Judit clearly does not understand the difference between the technologies, in fact I doubt very much whether she really understands how even cellular works even though she sells an application (which she did not disclose) which she promotes as a paging replacement on smartphones.  I will not rehash Ted’s comments but those who understand both technologies thoroughly would never risk their critical messaging on cellular.

  • Judit

    I obviously touched a very sensitive issue here if Craig
    makes it a point to personally attack me. My statement included only facts. The
    fact is that Traditional Pagers use OLD technology. The fact is that Pager
    device manufacturers are disappearing. The fact is that the network-coverage is
    shrinking due to consolidation of transmitters. The fact is that when you are
    out of coverage with traditional pagers you lose the message and the sender has
    no clue as to the status of that critical message.

  • Linda

    And, the fact is the latest crisis in Indiana just reinforced the need for seperate networks for emergency notifications in crisis situations. 

    http://www.wishtv.com/dpp/news/local/marion_county/cell-networks-jammed-after-fair-tragedy .

  • Craig

    Judit read it again, that was not a personal attack, merely a statement of facts. Paging might be a technology that has been around a while however if you knew your technological history you would know that by some definitions it is actually a newer technology than cellular.  To write it off as an “old” technology merely highlights your bias and ignorance of the reality of how technology development works. Using that argument one might suggest that wind power is irrelevant given it uses technology, windmills, that has been around for centuries.  These arguments are somewhat redundant however given that the more important fact is that the two technologies are quite different and paging still features functions that cellular just cannot match and is unlikely to ever do so, certainly not in the foreseeable future.  

    As an engineer who works with both technologies everyday ( and in fact builds products that use both technologies) I know the advantages and disadvantages of both.  No emergency services person who understands both technologies would ever consider cellular for critical messaging.  History has shown time and time again that cellular is not suited to emergency messaging; Indiana is just one more example. Your argument regarding coverage also belies the fact that in very few places in the world does cellular coverage ever exceed that of paging and whenever there is a requirement to extend coverage it can be done easily and cheaply with paging compared with cellular which is orders of magnitude more expensive to increase coverage for.   In emergency messaging, paging also relies on the fact that rarely are less than several people receiving the same message simultaneously, something cellular cannot do reliably.Cellular is provided by carriers whose primary concern is commercial compared to paging where in a large number of cases the paging network infrastructure are actually owned by their emergency services end users whose primary concern is the delivery of critical information fast and reliably.To also suggest that pager manufacturers are disappearing belies the fact that there are currently at least 14 manufacturers that I can think of just off the top of my head, many of whom are still developing and extending the functionality of the technology.

  • Craig

    Oh, what a surprise, cellular system fails again in an emergency!!


  • Smartphoneuser

    Craig, when there is nothing else to say, spreading fear is the last resource! Reading the CNN article that you attached I see that the Cellular network did NOT collapse. Yes, the VOICE channels were congestioned but the DATA channels worked well. That is exactly the reason that Smartphone paging should use the DATA channels. Also, the internet worked well, so if the Smartphone Paging uses Wi-Fi, in addition to Cellular data, the service reliability is very high.

  • http://www.unleashed-technologies.com Michael Spinosa

    I am 

  • http://www.unleashed-technologies.com Michael Spinosa

    I am very late to this old article and came upon it as I was actually curious why many of the mid wife’s and pediatrician’s still carry pagers. As a career technologist I must admit I see the undeniable truth in this blog post. Thanks for this post. I can’t say we don’t all pray for the reliability that the pager networks carry and as technology progresses we will eventually see it fold into the phone.

    It doesn’t look like that day is today however :). I’m glad to know the reach I have to those that I would need to potentially save my children’s lives in the case of an emergency.

  • DanielHsu2

    Bluetooth has nothing to do with receiving messages or emergency alerts

  • John Smith

    Actually, the real reason they keep using pagers is because it is more efficient to do so. They operate on a different frequency which penetrates better than cell signals. It’s rudimentary technology which is ideally suited for emergency responses. The more fancy the technology, the more ways it can fail. Hospitals don’t want fancy, they want reliability, they want a doctor to know he is needed somewhere and they want him to know immediately and not miss the message because of no signal. The example of horse is actually incorrect. Its more like a staircase and elevator. In case of emergency you cannot use the elevator. You want reliability. Hospitals work in perpetual emergency mode.

    When paging systems receive a message they transmit it through every tower at a frequency which penetrates the deepest corners of buildings. Reliability.

    When cell phones reach that point, I am sure people will shift. But THEY ARE SIMPLY NOT RELIABLE ENOUGH FOR EMERGENCY USE.