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Adventures in telephony

The transition from pagers to more modern devices is full of ups and downs. 

Pagers are outdated and healthcare workers are turning to their own smartphones to communicate, opening up potential issues, industry experts say.

Joanne Foster, lecturer in Queensland University of Technology’s faculty of health, predicts pagers will eventually be phased out and thinks that’s a good idea. “They’re a bit of a relic of the past,” she says. “[Nurses] really need to have access to a mobile device that can enable them to access any sort of patient information and data at the point of care.” She adds that if smart devices are used appropriately, they make for better care.

“A lot of nurses are using their own smartphones,” Foster says, “and oftentimes these are personal items, so therefore the aspect of security, confidentiality and legality when maintaining data or information on those personal devices is a bit of an issue.”

Even so, Foster says, healthcare workers should be using these devices increasingly – despite threats on unsecure networks – as they allow for access to data at the point of care.

For now, though, pagers are still widely used. Dr Tony Sara, director of clinical information systems at South East Sydney and Illawarra Area Health Service, proposes a solution.

“There is a move in some hospitals to use wi-fi phones for a defined area that provide the capacity to have both the functionality of a phone and the functionality of a pager,” Sara says. These devices can provide more efficiency than pagers, as they allow users to make and take calls.

Foster also supports the use of this technology. “That’s got to be the way to go – they have to be able to link into whatever the organisation’s access is,” she says, adding that it’s then the organisation’s responsibility to ensure there is appropriate security surrounding data transfer.

And it’s easier than ever to introduce such devices, Sara says. “As we move more in the electronic medical record and we’re looking at point-of-care devices, both BYOD and ones we supply, then we’re having to put wi-fi in,” he says. “So there is an increased capacity to host wi-fi phones.” But he says you couldn’t justify putting wi-fi in unless it’s for point-of-care devices.

“Issues of functionality, efficiency and infection control … would be reflected in wi-fi phones,” Sara says. However, she explains, the wi-fi handsets would avoid some issues personal smartphones pose, as staff’s personal cost of use would be eliminated and there would be fewer interruptions from external calls.

“It’s likely to make it easier for the nurses to contact [others] rather than just sending a page,” Sara says. “It will tend to provide more timely and more relevant, appropriate care if the nurses can speak to the young doctors immediately, rather than sending a message on a page to ring an extension. It’s likely to decrease tensions and increase productivity, efficiency and communication, so I think it’s likely to be a positive development.”

There are still cost issues, however, and cash-strapped budget managers will need to make decisions based on their own views on productivity.

Many organisations don’t upgrade to these sorts of tools, despite the fact staff want them, Foster says, explaining that this is why workers often start using their own devices. These habits start early, she says, with many nursing students bringing their smartphones into wards so they can access information straight away.

“A lot of the health organisations or departments really need to look at that and they need to get up to speed a lot more with the use of technology,” she says.

Whilst there are hygiene concerns, Foster says those same issues are there for everything used in healthcare and workers often at least pay attention to the cleanliness of new devices, as opposed to those frequently used.

As an example of what’s already in use, Sara points to the phones in St George Hospital’s radiology department. “They put them in because they perceived [the system] would be quite advantageous and it is,” he says. “They’ve shown that in a defined area, like in the X-ray department, it’s a plus.”

Whether this would be the case for professionals who are running around wards is unclear, he adds. “It’s potentially positive for a defined geographical area,” Sara says. “For an entire hospital, it’s less clear.”

Case study – St George Hospital radiology department

Back in 1996, the radiology department in St George Hospital replaced a paging system with digitally enhanced cordless telephones (DECT) as wireless PABX extensions.

Director of radiology, Dr Derek Glenn, says the decision was made because there was a lot of overhead paging, which was becoming irritating to staff. “In terms of [usage], alphanumeric pagers belong in the 1980s and should have stayed there,” Glenn says, adding that a voice solution also eliminates telephone tag.

“The whole idea of putting a phone on the belt of people, as opposed to a pager, is that if the person is inaccessible for whatever reason they can forward the call to voicemail,” he explains.

He says putting phones on belts mostly worked. However, “There were some issues around longevity of the handsets and the handsets were expensive for what they were.”

Since then, technology has advanced. “When mobile phones first started to become popular, NSW Health made some sort of token effort to try and dissuade people from carrying their mobile phone everywhere, which completely didn’t work,” Glenn says. “If you look at NSW Health staff, you will find pretty much 90-plus per cent of the people wandering around the hospitals at the moment have a smartphone with them.”

Since everyone was using the phones, Glenn wanted to emulate digital, cordless handsets by using voice over internet protocol (VOIP), via a wi-fi network.

The hospital obtained inexpensive software to achieve this but it didn’t work properly. “We couldn’t get this emulation on the smartphone to control the voicemail, so we lost voicemail capacity – that was crippling for us,” Glenn says.

Battery life was a problem, too. “Leaving a smartphone roaming around with wi-fi all day trying to do VoIP didn’t work; it flattened the battery within four to six hours,” he says.

And there were other issues; staff weren’t able to stay on the line and there was no slick cell handover.

At that point, Glenn decided it wasn’t working and began looking for alternatives. The department bought a system to replace its DECT gear with the latest standard – DECT over IP. “That basically fixed the problems,” Glenn says. He says this gave the department’s staff use of a smart handset, though it is not as ‘smart’ as a smartphone.

“It gave us battery life all day and it completely fixed the cell-to-cell roaming problem,” he says. “We no longer had call dropout when people walked from one end of the department to the other.”

Glenn says departments should give everyone a phone, saturate the system with handsets and back it all up with voicemail.

The emergency department in St George is planning to install voice over wi-fi. “It’s a dedicated handset and allegedly it fixes those problems that we were having with the battery life and the cell-to-cell handover,” Glenn says; however, he adds it has not been demonstrated to work properly yet.

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