In this edition of the CommonTime podcast, we examine the role of pagers in clinical and emergency environments. Our team also answer the question: can smartphones replace pager systems? To do this, we take a look at some of the most common objections, as well as the facts about how intelligent paging systems have developed over the years.
As Vodafone seeks to wind down its pager business, this is the perfect opportunity for organisations to see what else is on the market and understand how non-pager based solutions could benefit response times, auditing & more.
Smartphone vs Pager Transcript
Chris: Hello and welcome to the second edition of the CommonTime podcast. Today, we're going to be talking about whether or not smartphones can replace pagers. To help me in that conversation, I am joined by Andy Brinkworth, Matt Bracewell and Ben Burt.
So the first question I have for you guys is: why are we talking about this today? Why is this so relevant right now?
Andy: I think there are a number of reasons from our perspective, but more important, nationally. Vodafone have just announced that they are ending support for their pager service. Vodafone are one of only two players in the pager market, but have now announced that they are withdrawing from that, leaving only a single point to get paging services from.
I think people are understandably worried about what they are going to do. Is it going be a monopolised market now? I think there is an education that needs to happen - to explain that there are alternative choices for them.
Chris: So why are pagers still being used today? What makes them so common?
Matt: Well there's a history behind them. They've grown from radio into the telephone network with copper wires and so on. Then they got all teched up with jazzy LCD screens and my understanding of them operationally is that it's an object that somebody who needs the functionality can pick up and take with them. It's the physical embodiment of responsibility I suppose. You clip your pager on, then you go out and do your duty.
Andy: And that comes back to the images in the late 80s of yuppies wearing pagers on their belts through to now, the modern image of a nurse or a doctor in a hospital environment. The chances are if you're going to look at stock art of these people, they probably would have a pager on them.
Ben: It's an established piece of technology as well. People understand it. In a pressured environment such as a hospital, it's important that people have something which is simple to use. They need to recognise when it's making a noise. Anything else could be considered to be a distraction.
Andy: But equally, if you're in that environment and a doctor receives a page, then you would almost forgive them for looking at it because it must be important if it's on a pager.
Matt: Again, it's a recognised symbol - a beacon - of responsibility.
Chris: What would you say some of the common objections are to why pagers can't be replaced by smartphones and what would you say to some of those objections?
Matt: Well the first one has to be inertia, hasn't it? That's the key thing to any change - just inertia. Pagers work. Why would they not work? But given the technology I guess there are coverage restrictions. I don't know how far pagers can reach, especially in terms of depth. If you're in the morgue, four to five stories down would you still get coverage? I don't know.
Andy: But pagers are reliant on towers so you are going to get blind spots as a result of that. Now, they are classed as a very robust technology - but everything has some form of weakness. And so, I think some of the objections that smartphones will come up against include those who say: we use this technology, we know it lasts for a very long time. It just works. Why replace it? Pagers are still an option. I think it's human nature to try to avoid that change for something that is deemed to be so critical.
Matt: I guess that also, someone who objects to replacing pagers may not be aware of some of the benefits of moving forward. I mean, why would we ever move away from the humble C90 cassette tape?
Ben: Also, from a technological perspective - something that has been in place for so long (20 odd years), will have had a lot of the technical problems ironed out. Issues will have been resolved and they will have reached a point where the people understand how they work. They'll be able to work in most places.
Andy: I think the area where people are saying there is a lot of fear at the moment is around services being withdrawn in those places which need critical responses. It's clinical staff, ambulance crews, first responders, mountain rescue, or the RNLI - those are people we are hoping have our back all of the time. And so, it's very easy to spread panic about what happens if we change something that they have.
But, as we've seen, things have to move on. Matt raised a point there about the C90 cassette. You can't buy a car with a cassette player anymore. Even old cars have had those ripped out and replaced with CD players. Media has moved on from the cassette through to a disk, to different types of disk that can quickly access files, through to hard disks and now streaming.
If you go back 20 years and said that one day we will be streaming over the internet, people would look at you and say, "What's the internet?" But after that they'd say, we've got physical media, we won't be streaming things. But it's happened. The service that Apple Music and Spotify offer is incredible now. You use it without any worry at all. But getting there in the first place is quite a wake up call.
Matt: A similarity with pagers is that disks were the last of the analogue media, and pagers are very much the last of the analogue medium aren't they. They're like a big stick which you can send through the building to poke somebody, maybe give them a number to call (or a limited message). It's one way traffic.
Ben: Would it be fair to say that mobile technology has a bit of a stigma associated with it? It's not really considered to be a part of system critical applications.
Andy: I think it's very easy. The use of mobile is widely considered to be Facebook, Angry Birds (or whatever the latest game is), other social media and then instant messaging platforms. There's a view that mobile phones are making it so that people don't have to interact with each other. So yes, there is a stigma. But if you look at the other things that those devices can do, I think that's where there needs to be more education.
You've got more computing power in your pocket than we used for the space program in the 60s to get people to the moon. In fact, you've got more computing power in a calculator than the space program. With all that processing power, imagine what you could do with it. I think that's the key thing - what is possible. And there's so much.
Ben: And the time and investment and even brainpower that goes into the protocols behind the messaging systems are just incredible. Things like Whatsapp and Facebook need a huge amount of investment to make them reliable, resilient and scalable.
Chris: Is there an element of cost at all that might prevent people from ditching the pager and using smartphones instead?
Matt: One of the things about the pager system is that it's completely dedicated. So from an accountant's point of view you can imagine that if he's got a requirement to create some paging functionality - then this is hardware, these are the batteries and this is the software that lives within it, it's all accountable.
A smartphone based solution is more nebulous. Are we going to allow people to use their own devices? It's a bigger and more complicated question.
Andy: You could even take it back to the concept of ownership. Who owns the devices? Who owns the apps that are on the devices? Who owns the licence for the apps that are on the devices? You need to answer those questions.
In terms of cost, the truth is that most people who are carrying a pager will most likely have a smartphone. So, where's the additional hardware cost? Maybe you have to improve what's there but actually the cost of hardware is coming down. So hopefully the cost can be offset against other benefits that you'll get from the system.
Matt: You'd also hope that because a smartphone is an open device, you've got competition in that market. Whereas, presumably, the pager systems will tend to be more proprietary and, probably, much more expensive than the sum of their component parts I would imagine.
Chris: Something you mentioned there Andy was that the benefits of using a smartphone should outweigh the costs of using them. So, what are some of those benefits - as opposed to using pagers?
Andy: I think if you look at the potential journeys when somebody needs to use a pager: they are going to input a number. Let's assume there are speed dials to make it quick. Then you need to input something into your phone, or talk to somebody who can input something into a system, which is then going alert somebody with a pager, somewhere, that something needs to happen.
Hopefully at this point, and let's assume that we're in a hospital, a consultant now has a buzzing in their pocket, beeping and an LCD screen with text. They'll then be hotfooting it back to wherever they need to get to. However, that's relatively dumb. Later on, you might be coming down to say - did you not get my page?
If you were to look at what's possible, you can still perform all of those functions because you have a console which can still write those messages and you can still broadcast those messages out to tell people to get to the emergency department. But maybe I can't get to the emergency department because I'm dealing with an emergency where I am now. If I can inform you that I'm not going to be attending, you now have a chance to get somebody else there in the appropriate time. Then there's an audit trail to show that's what happened.
From a responsibility & liability point of view, I've got something that I can go back through and say: here's a sequence of events that happened, as a result of a particular incident. And that, in itself, is valuable. Unfortunately we live in a blame culture, so it's becoming more and more necessary for the people we rely on to have our backs to have audit trails to back up the decisions that they make. And I think that's something that can really be improved.
Ben: I think another advantage has to be the flexibility. Andy made the point earlier about having a computer in your pocket and the possibilities that can bring. I think it's quite common when you work with technology to introduce a computing system somewhere and you almost kind of cross a threshold where that in itself will start to generate new ideas.
With something specific and fixed like a pager, you aren't going to get that kind of engagement with the device and think of the possibilities. With a smartphone you can introduce new software to open up all kinds of new possibilities for healthcare.
Andy: You can already see that with the pager. The modern pager has got a flashing light and an LCD display. The first ones never had an LCD display. So someone has already thought, how can we make this better? But, nobody actually says it's time for it to move out of the way, or move on to something completely different.
If you go back to the Nokia 3310, it was a great phone which had great battery life. You could rely on it for making calls, you could play snake - but you couldn't do what we take for granted now from the devices that we have.
Ben: Of course any kind of upgrade to a pager device relies on you building a pager with a flashing light or an LCD screen. With a phone, you just need to update the software to add new features and new functionality.
Matt: I think the paradigm shift, as well, is that in a page scenario you're communicating to a pager. In a smartphone environment, you are communicating with a known person and you don't care what the device is. Somebody will be logged in or not. Pagers get handed around, which is really kind of 19th century technology. It's a case of, now you have the baton.
Andy: We prefer the term conch here.
Chris: If we were to look at the question we started off with. Can smartphones replace pagers - what's the key thing you would want people to take away from this conversation?
Andy: Yes, they can.
Matt: Also, for those people who are in charge of pager systems - it's an opportunity for them to look at the benefit they can bring in the summoning of their staff or their use. What extra can be bought? Is it appropriate to send a photo of an incident to somebody? Do you want multiple choice responses? Do you want free text responses? Or can you bump your page onto somebody else because you're not available? All of those sort of exciting - well not terribly exciting - ideas. But from where they are, they are rich and exciting opportunities.
Andy: But you are going to be able to start gathering data that you wouldn't otherwise be able to get. As soon as you have got data, you've got a level of value. When you've got that data, you can start to push it into some of the new stuff that can be done with cognitive services.
I'll go back to it... artificial intelligence. Actually, this helps you add massive benefits. You can start looking at patterns, you can start looking at response times and modeling things for the future as well. You can also start looking at behaviours as well. We've talked about pagers here, within a clinical environment.
But if it were a national emergency, then knowing where people are, whether or not they're going to be available for maybe an hour because of their location - then you can send an alert to them to let them know they need to come back or hand over their responsibility to someone else. Or, you can start modeling past situations as well because you have the data. Surely that has to be a benefit?
It's very difficult to put a value on that benefit because when it comes to life and death, it can be invaluable.
Ben: If you think, as well, that a mobile device is built to communicate with other devices, you introduce the possibility of wearable tech, new phones etc. Who knows what kind of equipment and sensors will be available in a few years time. These are devices an intelligent pager system could readily connect to and bring back information.
Matt: Ultimately, a pager is the start of a journey for somebody, into another important task. The chances are, in that task they will certainly be communicating with other people and probably other things. So a smartphone based pager type system is the start of a workflow. It's difficult to cost, but the impact could be enormous.
Chris: Just to bring it back to something you said earlier - this is an opportunity for people in charge of these systems. With the state of the market now, as Vodafone looks to wind down its pager business, this is the perfect opportunity for people to take stock and look at what else is out there and see what might be available to them.
Matt: Absolutely, I don't think that in the history of economics there have been many companies with a monopolistic position that have decided to lower prices.
Ben: I would agree with you there.
Chris: I think that brings us to the end of the podcast. I would like to that Andy, Matt and Ben for joining us today. Thank you for the discussion around smartphones and their role in hopefully replacing pagers in the future. Also, thank you to everybody listening and we hope to see you again in a few weeks.
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