How hospitals can avoid the biggest healthcare communications mistake How hospitals can avoid the biggest healthcare communications mistake

Many healthcare organizations struggle with delayed patient care, frustrated providers, and potential HIPAA breaches as a result of their outdated paging systems, which often rely on one-directional, unencrypted messaging for communications.

Many hospitals believe that pagers provide an ‘insurance policy’ that smartphones don’t: cellular networks go down but paging networks don’t. Based on this logic, many healthcare organizations keep their pagers. This is the biggest mistake that healthcare IT departments make.

Why? Because the everyday premium for the pager ‘insurance policy’ is too high for healthcare organizations to bear. Healthcare organizations should diversify their risk portfolio by using secure messaging for their everyday operational needs and re-purposing pagers for backup needs and critical communications for emergency staff. By embracing this strategic business and risk management policy, healthcare organizations can improve overall care coordination and patient safety and satisfaction while still being adequately prepared for communications emergencies.

Read this paper to:

• Learn about the reality of the declining wireless paging market • Gain a comprehensive comparison of wireless paging and secure messaging services • Create a business case for replacing pagers within your healthcare organization by examining the productivity and opportunity costs of the pager ‘insurance policy’ How hospitals can avoid the biggest healthcare communications mistake

Pagers in context Paging is used to Wireless paging methods include: encourage Paging type Use case communication, but One way numeric Users usually receive a number which they can then call to request further information. pager recipients Page recipients cannot send responses to typically need to use a any pages they receive. different Two-way numeric Users usually receive a number which they can then call to request further information. communication Page recipients can also send short medium to actually responses to pages they receive. respond to their page. Two-way alphanumeric Users receive a numeric or alphanumeric string which usually includes a short message, an email address, or a return phone number, which they can use to request further information. Page recipients can also send a short alphanumeric message from a web page provided by the paging service, or send an email to a pager email address.

Wireless paging has served an important purpose, providing urgent notifications for people to act on. However, paging services lack the functionality and depth of other communication mediums because pager communications provide limited context for recipients to act on. Pager communication is typically used to inform recipients that another person needs to speak with them, that there is a need for their services, or that new information is available that impacts their work. Receiving a page requires an immediate response to confirm receipt and learn the context of the page. Pager recipients typically respond with a return phone call, a return message, retrieving more information from a computer, or going immediately to a designated place to get further information. Paging is used to encourage communication, but pager recipients typically need to use a different communication medium to actually respond to their page, unless they are using a two-way pager which can only send a simple text response. Receipt notifications and audit trails can only be provided by two-way paging methods. One-way pages are sent blindly, without any knowledge of receipt of the page by the recipient, unless they take action and respond. How hospitals can avoid the biggest healthcare communications mistake

The value of the The advent of smartphones has caused consumers and businesses to rethink how they communicate effectively. Smartphones have the ability to connect a smartphone or smart voice call, support a text chat, receive and reply to email, access Internet or intranet based data, and record or share pictures and videos. The value of the device is the increased smartphone or smart device is the increased communication capability and communication the contextual richness users can add to their messages, within a single platform. With smartphones, messaging is no longer a one-way, ambiguous capability and the text string - messaging it is a two-sided, contextual conversation that can convey complete meaning, allowing users to send, respond, and act on contextual richness messages more effectively. users can add to their The impact of smartphone technology has been devastating to wireless paging, driving major market contraction – over 60 million subscriptions at the messages, within a peak in 1991 to less than 6 million today1 – resulting in consolidation of single platform. providers and a significant rationalization of the wide area network infrastructure. Wireless paging has rapidly gone from a generic solution in a very broad communication market to an esoteric solution in specific niche markets. The amount that wireless paging vendors are investing in pager device technology and the wide area network infrastructure has diminished to mostly maintenance of service level. It is increasingly dwarfed by the investment of the smart device, cellular and unified communication infrastructure vendors and service providers.

The myth of wireless paging Wireless paging vendors have reacted to this market shift toward smartphone technology and secure messaging services by re-assessing the limits of pager technology, infrastructure, and market reach. Wireless paging companies are now strategically positioning their solutions as ‘critical messaging’ services to target their market niche. The value proposition of their service is not driven by the quality of the messaging they provide – it is entirely based on the network characteristics of wireless paging infrastructures. Wireless paging companies claim that the architecture of wireless paging networks make them more reliable than the broadband cellular networks smartphones use. Wireless paging companies subsequently market their services by highlighting that the simplicity and reliability of wireless pager solutions allows wireless paging to survive disaster scenarios by relying on a separate communications platform that continues to function when other communication technologies fail.

1. Where Pagers Haven’t Gone Extinct Yet, Fortune, Verne Kopytoff, July 16, 2013. How hospitals can avoid the biggest healthcare communications mistake

One wireless paging vendor2 argues that wireless paging is a superior Wireless paging’s communications choice because, since 2000, there were seven instances when wireless paging services were available, but cellular networks were “lowest-common- overloaded. This argument implies that extreme circumstances justify the choice of wireless pager technology over cellular services for critical denominator” messaging. This is an accurate, but flawed approach because it is a “lowest- argument implies that common-denominator” argument, implying that one should sacrifice the significantly higher value proposition that cellular and Wi-Fi networked users should sacrifice smartphones bring to all communications3, critical or otherwise, in order to ensure operation during a rare disaster event. Based on similar logic, the significantly higher hospitals would use their backup generators all the time, because of the rare likelihood that the main power supply fails. value proposition that

What happens when, for whatever reason, the wide area network goes down? cellular and Wi-Fi Contrary to what the wireless paging vendor would like you to think, this does networked happen4, and for hours at a time. The only alternative provided by the wireless paging service is to deliver users’ messages via SMS text or email. This smartphones bring to backup mechanism defeats the purpose of paging: to solicit an immediate response. If the wide area network goes down and users do not have communications in contingency services in their package, then all pages sent during the network order to ensure outage are lost. This can be devastating to business. operation during a rare Despite these concerns, wireless paging for critical messaging is still relevant in a few niche applications, like emergency service personnel, medical disaster event. personnel, information technology support staff, and petrol refineries5.

The reality of smartphones The advent of smartphones has caused organizations to rethink how they communicate. Most people have a personal cell phone that has transformed their personal communication. This phenomenon has begun to influence users’ expectations of their professional communication services. Regardless of whether a person carries a company-supplied pager, if they also carry a personal smartphone, they inevitably choose to default to their smartphone for their communication needs.

2. The Not So Secret Life of Paging, Spok, 2013-2014 3. Wireless Communications, Andrea Goldsmith, Cambridge University Press, 2005 4. The Great Galaxy 4 Satellite Pager Disaster, Courtney Macavinta, CNET NEWS.COM, 5-20-98 5. The Decline of Pager Technology, Dave Donnelly, Greg Park, Ludwig Reimmer, Grace Wood, Dartmouth Tuck, 2008 How hospitals can avoid the biggest healthcare communications mistake

Since smartphones are Knowing someone’s personal cell phone number has opened up access possibilities that pagers cannot compete with. You can call, text, and send not solely reliant on data as attachments. If a person receives a call on their cell phone, they can choose to answer it or let it go to voicemail. If the person who is calling does one network, with not want to wait for a voicemail response, they will send a text hoping that the careful planning and a recipient will respond immediately. Senders can attach documents, photos, or video clips, to better convey the context of their message, and improve the well thought out likelihood of an engaged response. network strategy, Critically, if a smartphone is in a location where the cellular coverage is weak, but there is Wi-Fi available to which it has access and permission, then even if organizations can a voice call may not be able to get through, text and data are always available. Since smartphones are not solely reliant on one network, with greatly reduce their careful planning and a well thought out network strategy, organizations can risk of outage. greatly reduce their risk of outage. Most organizations today have, or are in the process of implementing, an enterprise unified communication infrastructure, where audio/web/video conferencing, presence/IM and mobility are all carried on both wired and wireless networks across their facilities. Many companies offer Voice-Over-Internet-Protocol (VOIP) options to employees on mobile so that when they cross the threshold of the enterprise their smartphone switches from cellular to VOIP on the Wi-Fi network.

The healthcare communications business challenge Personal privacy and security are paramount in healthcare. Professional conversations in healthcare are related to a patient’s personal healthcare information (PHI) which the Health Insurance Portability and Accountability Act (HIPAA) laws protect. Unencrypted pagers and generic smartphone texting or SMS texting, with or without attachments, are not secure. This problem has introduced the need for all healthcare communications to be secured.

Mobile communication in healthcare is primarily focused on clinical communications coordinating patient care, some of which is critical, i.e. code calls. But all functions – medical, operations, IT, and administrative – in the hospital require some form of mobile messaging. Some messaging needs are urgent, requiring immediate action, but most healthcare communications just require responses in a timely fashion. A scientific study6 at one hospital has shown that two-thirds of pager messages sent to on-call residents are not urgent and of those, two-thirds again, interrupt an important patient care activity.

6. An Observational Study of Hospital Paging Practices and Workflow Interruption Among On-Call Junior Neurological Surgery Residents, Journal of Graduate Medical Education, Dec. 2012 How hospitals can avoid the biggest healthcare communications mistake

Healthcare institutions are very driven by three key objectives – to enhance Secure messaging patient care, ensure patient safety, and protect PHI – as governed by the Department of Health and Human Services, the Center for Medicare and applications for Medicaid Services, the Joint Commission National Patient Safety Goals, and the HITECH Act. Achieving these three key objectives is directly tied to a smartphones are hospital’s bottom line, through earning government incentives, ensuring specifically designed reimbursement, avoiding penalties, and reducing the overall cost of care. Secure messaging technology has been developed as a communication to protect privacy platform across workstation, tablet and smartphone in order to help hospitals achieve these objectives in an increasingly mobile world. while enabling all of

Secure messaging applications encrypt all communications sent between the best attributes of stakeholders, isolate message data when it is on a device, and remove it if a device is lost or stolen. Secure messaging applications for smartphones are smartphone specifically designed to protect privacy while enabling all of the best communication. attributes of smartphone communication.

Another scientific study7 shows that when secure messaging on smartphones are deployed to inpatient medical teams along with pagers, 85% indicate higher overall satisfaction with secure messaging over pager communications. No participants indicated a reduction in satisfaction. Feedback concluded that smartphones with secure messaging platforms are better equipped to communicate clearly and better designed to integrate into clinical workflows.

Patient care quality and patient safety are directly related to the amount of care coordination caregivers can achieve through communication, ensuring timely access to actionable and meaningful information. Secure messaging services’ integration with hospital directories and scheduling systems to facilitate quick connection to key stakeholders. Interoperability with Electronic Health record (EHR) programs enable access to vital information and fast, centralized care team coordination to provide better care to patients. Integration with clinical information systems, at both enterprise health record (EHR) and departmental (LAB, RAD, CARD, PATH) levels, provides the needed context to increase the efficacy of important care coordination messaging, improving patient care and enhancing clinical workflow efficiency.

7. Smarter Hospital Communication: Secure Smartphone Text Messaging Improves Provider Satisfaction and Perception of Efficacy, Workflow, Journal of Hospital Medicine 2014; 9:573–578. V C 2014 How hospitals can avoid the biggest healthcare communications mistake

For every stakeholder Secure messaging for productivity and security Healthcare institutions can choose to make a prudent communications that can benefit from a decision by embracing secure messaging on smartphones. Embracing secure messaging does not mean that there isn’t a place for a niche solution like more advanced wireless paging. Hospitals and healthcare systems can decide to embrace a communication blended communications policy of paging and secure messaging by evaluating their current wireless paging system’s total capabilities and solution or requires determining which clinical workflows would benefit most from smartphone messaging capabilities. secure mobile The goal should not be to entirely replace or remove wireless paging from the communications, hospital. First, understand where it is most effective as a primary mobile healthcare messaging device and where it can be replaced by secure messaging on smartphones to better address the hospitals key drivers. Next is to identify organizations can the stakeholders where critical messaging is a necessity. Re-purpose existing wireless pagers to users where basic unsecure messaging is all that is deploy a secure needed, these include transporters, housekeepers, security, and facilities. For those that require critical messaging, like code teams, IT staff, and emergency messaging response personnel, if they do not already carry a wireless pager as a primary smartphone app, like device, deploy them one as a backup. Imprivata Cortext. For every stakeholder that can benefit from a more advanced communication solution or requires secure mobile communications, healthcare organizations can deploy a secure messaging smartphone app, like Imprivata Cortext, in accordance with the hospital’s mobile device management (MDM) protocol.

Medical staff and patient care services are the stakeholders in healthcare who can benefit the most from the context-rich communications smartphones and secure messaging services provide. Medical staff and patient care services are the stakeholders who struggle the most with the lack of information and content pagers provide – information that is required for improving patient care. With the drive to coordinate care across all aspects of a patient’s hospital journey, from home, to ambulatory, to acute care, caregivers need to securely manage the increased communication required from phone calls, text messages, alarms, and notifications.

Secure messaging applications offer a secure platform for clinical collaboration via text and voice and deliver clinical notifications like consult requests, critical LAB results, medical imaging reports, orders, patient care alerts and alarms, and the tools to effectively triage and respond. By focusing secure messaging platforms to the use cases that introduce the most challenge to caregiver performance and satisfaction, hospitals will return significant positive patient care, quality, and safety outcomes. How hospitals can avoid the biggest healthcare communications mistake

The future of healthcare communications is clear. Provider initiatives for coordinating care require a new approach that enables caregivers to securely communicate and collaborate in a more meaningful way to improve patient outcomes. Secure messaging platforms, like Imprivata Cortext, open up new opportunities for healthcare institutions to address the key drivers impacting their business of providing cost-effective, secure, and safe patient care.

Imprivata Cortext Imprivata Cortext® is the secure communications platform for healthcare that enables healthcare organizations to replace pagers, improve care coordination, and increase provider and patient satisfaction. Imprivata Cortext is exclusively endorsed by the American Hospital Association (AHA) for the Secure Messaging category and recognized by KLAS as the category leader for Secure Messaging.

Imprivata Cortext enables healthcare organizations to:

Replace pagers and outdated technologies. Organizations can eliminate inefficient workflows caused by outdated technologies such as pagers and overhead paging systems with an easy to use secure messaging platform.

Improve care team coordination. Providers can use a single platform for group communication across multiple sites, both inside and outside the hospital.

Secure patient health information. Imprivata Cortext is HIPAA-verified by a 3rd party audit agency and backed by a Business Associate Agreement.

Providers no longer need to decide between speed of communication and legal risk.

To learn more about Imprivata Cortext, or to schedule a demo visit www.imprivata.com/secure-communications. About Imprivata

Imprivata® (NYSE: IMPR), the healthcare IT security company, provides healthcare organizations globally with a security and identity platform that delivers authentication management, fast access to patient information, secure communications, and positive patient identifcation. Imprivata enables care providers to securely and efficiently access, communicate, and transact patient health information to address compliance and security challenges while improving productivity and the patient experience.

For further information please contact us at: 1 781 674 2700 or visit us online at www.imprivata.com

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