Saanich News – Prying doctors from their pagers

In the fall of 2010, Ben Moore paced the halls of Victoria General Hospital as an worry-ridden dad whose newborn daughter was suffering complications. He lived outside of the neonatal intensive care unit for two months, and noticed – as a telecommunications engineer and a guy who owned a smartphone – that communication between patients, nurses and doctors seemed unnervingly outdated.

He had a lot of questions about his daughter’s condition. The nurse often paged the on-call doctor, and then waited for a call back. Doctors, to Moore’s surprise, still use beepers, a technology that largely vanished from common use a decade ago. 

“I was in the hospital with an iPad and I couldn’t believe they were trying to page a doctor,” he says. “It caused a lot of frustration and anxiety waiting (for answers).” 

Moore and his wife emerged from VGH with a healthy child and a nugget of an idea – to replace beepers with smartphone-based system, a device almost all doctors carry anyway. “Doctors say (pagers) work, that they’re reliable. They love the pager and they work where you can’t get a wireless signal,” Moore says, laughing at what he calls the “page and pray” system – medical staff send a page, and then pray the message gets through.

“Ninety per cent of doctors are carrying smartphones, but those aren’t being used for critical communication. Smartphones aren’t secure and they aren’t reliable.”

Moore, 37, who attended Claremont secondary before moving to Ontario, where he graduated from Waterloo University, launched the startup company SmartPager with his friend Mike Ferguson, a 30-year-old software engineer  who went through Mount Doug secondary, Camosun College and Vancouver Island University. Ferguson hears insider stories of awkward communication flow from his wife, a licenced practical nurse. “(Nurses) could call a pager number and wait for hours,” he says. “Sometimes (my wife) would call doctors at home, so the doctor would be pestered to no end.”

Prying prized pagers from the fingers of doctors might be a tall order, but Moore and Ferguson quickly recognized the lucrative and widespread potential for modern communication within medical fields. They established a base in Saanich at the DataTech Business Centre across from Reynolds high school, and have spent the last year developing the SmartPager app and back-end call centre software. In January, the system

launched with a team of surgeons in Phoenix, Ariz. The system allows medical teams to flow confidential patient information, discussion and diagnoses via texts, audio messages, and images on smartphones through a secure cloud network. It can persistently “page” the on-call doctor

until the message is read, or flip the query to the next doctor down the chain of command. It can even mimic the beep-beep pager as it exists now for diehard users.

“We want to make communication between patients and doctors as organic as possible, so that it’s effortless to get what you need,” Ferguson says. At the point the light bulb went on in Moore’s head, SmartPager wasn’t viable. Even a few years ago, pager signals could penetrate into the depths of dense hospital buildings, where cellphones networks died. Now almost all hospitals have reliable and widespread WiFi networks.

But the backbone of the system is its network security and reliability – SmartPager has to conform with onerous information privacy regulations, called HIPAA in the U.S. and FIPPA in Canada. Creating an app that transmits voicemails, texts and images between smartphones isn’t new, but creating one that meets security thresholds and has 99.999 per cent uptime is a high technical barrier.

For that, Moore and Ferguson teamed up with University of Victoria computer engineering professor Jans Weber through Mitacs-Accelerate, a federal program designed to fund research and development collaboration between industry and academics. Weber and a graduate student helped integrate security into the app and validated that the system conformed with HIPAA and FIPPA standards (the company says SmartPager is compliant with privacy laws in the U.S. and most of Canada, although not in British Columbia. Moore said they plan to install a dedicated SmartPager server in Vancouver to meet provincial law).

The encryption and communication protocols on the SmartPager system are as stringent as possible, Weber says, but balances the need for ease of use and quick transmission. “Overall this is where health care needs to go – more mobile, with better information and secure information flows.”

Nothing is foolproof, he notes, but the system is more secure than paper records that fill shelving in medical offices, and more secure than doctors sending patient information over unsecured texts or emails. “Health information systems have lots of concerns about privacy and security and how that information is maintained,”

Weber says. “We have to put this in contrast with paper records. There’s a lot of paper out there up for grabs, things potentially don’t get shredded, there’s no encryption on documents sent between a lab and a medical office.” Moore and Ferguson’s startup remains a small operation with another half- time employee in Saanich and two programmers out of Eastern Europe. But clients are coming to them – about 200 medical professionals are piloting or will pilot the SmartPager system, mainly out of the U.S., but also a few in Waterloo, Ont., and at Vancouver General Hospital. So far, the Vancouver Island Health Authority hasn’t come knocking. SmartPager’s largest client group involves about 85 doctors working out of the Centre for Orthopedic Research and Education (CORE) in Phoenix. CORE surgeon Dr. Jason Scalise says it wasn’t hard to abandon pagers.

The reliability of paging networks is eroding daily, he says, and that standard texting between doctors and staff presents a “grey area” in terms of what is allowed under HIPAA. “The entire paging infrastructure in the U.S. is physically failing,” Scalise says from his office in Phoenix. “If a page doesn’t get through, the recipient and sender would never know.

“We’ve transitioned to (texting) but we’ve got patience compliance issues. There is a debate on how OK it is to text patient information. It’s something that is a problem.” The SmartPager system allows his medical centre to track the 2,500 to 3,000 daily messages and log response times and information flow. “Sometimes we have people say they haven’t got a call back. This allows us to track that. This is going to be really helpful,” Scalise says.

“We want to make sure it works for our work flow. Then we will be pushing it on other doctors outside our organization so that if they need to get in touch, they can use SmartPager and not call a call centre to take a message, type it out and then send it to me.”

Doctors in Greater Victoria remain largely wedded to the “crude and antiquated” paging technology, as UVic’s professor Weber describes it.

Dr. Neil Boyle, a GP who works at Jubilee and Victoria General hospitals, agrees that the 30-year-old paging system is of dubious reliability, and said that pages can be easy to miss. Reforming that system, he says, is a low priority for health care providers, and would need to be replaced with something uncomplicated and easy to use.

In the meantime, many doctors routinely use their smartphones to text non-specific medical consultation information and surgery scheduling with other doctors, an imperfect but useful way to communicate, Boyle says. “No names or genders or anything sensitive,” he says. “We are certainly careful about what we send in messages.”

On the other hand, Boyle carries two different pagers and a cellphone, and says that pager beeps can be loud and intrusive while talking with patients. Having one catchall gadget would be a dream come true, but Boyle isn’t expecting that to happen any time soon.

“We all recognize there is a problem, but in the world of problems it’s not that big,” he says. “But if (a new system) saved me 15 to 20 minutes each day, it would be valuable given how full a day is.”

For more on SmartPager, see smartpager.net .