Goodbye Pagers, Hello Clinical Texting ― How to Make the Transition Painless

Nicole Pajer

June 02, 2022

Despite the consumer shift from pagers to cellphones and smartphones, paging has remained a communication staple among healthcare professionals.

But that's changing. More and more hospitals are replacing pagers with clinical texting systems that allow clinicians to send and receive patient-care messages using smartphones.

"This is a trend we see happening all over in medicine," says Joy Lee, PhD, a research scientist at Regenstrief Institute and assistant professor of medicine at Indiana University School of Medicine.

These messages could be team communications ("I saw the patient you wanted a consultation for in room X") or, say, an update on a patient's blood sugar level. "It's a lot of informational transactions that would be happening in healthcare anyway," Lee says. "It's just now happening over smartphones rather than pagers."

Still, the transition to texting can overwhelm healthcare workers and raise privacy concerns for patients. As more institutions roll out texting systems, Lee and other researchers are investigating the impact on communication among medical teams.

Working Out the Kinks

Lee and a team of experts surveyed hospitalists and nurses about their experiences with clinical texting. While study participants spoke favorably of texting, they cited more frustrations than benefits, the researchers found.

Things they liked included ease of access, the ability to send pictures, and having a record of conversations. On the other hand, they complained of receiving too many texts, trouble navigating the app, and confusion about how and when texts should be used ― like, which communications are (or are not) text-worthy and whether emojis are appropriate.

"Texting isn't new to most of us in our everyday lives. But in terms of being used in the hospital setting, these norms haven't really been set," Lee explains. "People haven't had focused discussions about when texting is appropriate, what type of texting is more convenient, and what [type] is annoying. Because of that, there's some tension among users."

To make texting more effective, Lee recommends medical facilities create guidelines for use ― for instance, clarifying what is appropriate to send by texting and whether using an emoji, such as a thumbs-up, would be an apt shortcut to signal confirmation.

Tackling Privacy Concerns

Clinical texting is not done through standard SMS texting but rather through a special messaging platform that has safeguards to ensure confidentiality. "That's one of the advantages it had over pagers," says Lee. "It's a secure platform that only verified users could have access to."

Still, texting is not without risk. Messages can remain on devices indefinitely, creating a major concern if a doctor's phone is lost or stolen. If private health information falls into the wrong hands, it could lead to identity theft or public embarrassment should the information be leaked.

That's why health staff must be trained to use a secure app and take proper safety precautions with their phones, says Andrew Mahler, vice president of privacy and compliance at CynergisTek, a cybersecurity firm serving the healthcare industry.

One smart practice is to keep a patient's personal information as vague as possible in texts, says Mahler. "Do you really need to use a patient's full name? Or is there a reason to text a patient's address or social security number?"

It's important to find ways to promote patient care without using identifying information and to develop clear guidelines, Mahler says. "Having accessible material that healthcare providers can use to really understand what the boundaries are is vital."

The Switch to Clinical Texting

Despite the challenges, clinical texting has plenty of pros, Lee notes. "With pagers, for instance, you had to call back a number to then talk to the person," Lee says. "So it had an extra step."

Mahler agrees: "Clinicians can very quickly text their colleagues with information on patients that can really help save lives and help patients get better."

The system just needs some fine-tuning, Lee says.

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