Telehealth and the use of Texting in Medicine

Today I had the delight of pondering about Texting as a supplement or even replacement of the Paging system within the medical workflow.


Current workflow: Doctor* carries pager > Nurse* (or some person from department X) pages Doctor > Doctor returns page with Phone call > The person accountable for the Page must be near the phone to receive the call > Communication ensues…

*This “Doctor” and “Nurse” could easily be swapped with other hospital staff or personnel: “Technician”, “Physicist”, “Nurse manager”, etc.

Scenarios: Could happen anytime of day (dinner, weekend, middle of the night!) in any location (cafeteria, bathroom, on top of Doctors head as he/she is sleeping)

Pagers, an obsolete technology in today’s smart-phone saturated world, is used only by doctors, lawyers and possibly drug dealers – not that I know too much about this 🙂

In terms of Pager types, there are all sorts of pagers: Numeric, Alpha numeric, Two way pagers. Will these soon be replaced by Text messaging? Not without some real consideration of the human factors involved in this Current Workflow.

The Human Factors

Physical – pagers are cheap, easily to carry, difficult to lose – they have a tendency to stick out like an ugly thumb. They scream, vibrate and do all sorts of alarming things to instil fear in the beholder.

Psychology – “This is the way it’s done”. But let me ask the question: How was it done before the Pager was invented? And once the pager was invented, how long did it take for the hospital system to adopt that technology?

Safety-critical psychology – Pagers offer a safe-guard in that the messaging system must be two way. If the proper protocol is followed. There will be someone to answer the page. Both parties are now talking to each other and we know who is liable for what.

Team behaviour – Currently this is the two-way communication mentioned above. The returned phone call will likely reduce miscommunication that could easily occur with a one-way or even two-way text message.

Organizational Issues – Again, using pagers is the way it’s currently being done – so why fix something that isn’t broken? It’s not really about fixing as much as it is about improving! If text messaging was employed, think how easily data from the SMS (simple messaging service) can be tracked! The hospital organization can benefit from the added data (who is texting who, who answers the message, how are messages being sent/received, etc). Furthermore, imagine what could be revealed (errors & behaviours) from the collected data! That being said, a well-thought out policy or organization would have to be put in place to regulate that reporting information.

Political Issues – The IT policy around use of cellphones and other mobile devices is currently being laid out in the US at a federal level. For this top down regulation to take effect, it could be tricky to enforce the idea of text messaging as a replacement for paging. Canadians are slower to implement solid IT policies around the use of mobile devices in healthcare. From my perspective, it seems like the residents and staff already text each other instead of speaking on the phone. Less intrusive, more informative and collegial. Although texting is not accepted formally but it appears that it is common and frequent!

So inarguably, humans have evolved to include texting as an accepted form of communication. As an Human Factors/IxD/UX enthusiast, I feel this could be a task for us user experience designers. Organize this evolved “texting” behaviour, adapt it to the hospital folk and workflow and come up with a solution on how to structure an SMS paging system that can address all levels of human factors…not an easy design or change-management battle to say the least!

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