Despite high interest and hopes, the clinical adoption of new mobile technologies such as smartphone apps and wearables for health care has been modest. While some clinicians and clinics are of course using the newest connected devices and apps, most would report they don’t regularly use mobile health technology yet. But they actually do. The vast majority of clinicians have been using mobile health technology for decades without even realizing it. Understand the success of this hidden mobile technology offers insights into how and why clinicians adopt technology as well as why they have been slower to adopt apps and connected devices.
The shrill beeping of a pager is a familiar sound to every clinician. These connected mobile devices have survived and thrived since the 1950s even with the birth of the Internet, rise of cellular phones, advent of smartphones, and development of wearables. The majority of clinicians continue to use pagers today, and pagers are a familiar sight in any health care setting from a rural clinic to a major metropolitan teaching hospital. While there are many reasons for the continued ascendency of pagers, three factors are worth focusing on in understanding what today’s apps and connected devices can learn from the successfulness of pagers. Pagers are simple to use, reliable, and facilitate but do not seek to replace or “disrupt” human interaction.
Pagers are easy for everyone to use. From a junior medical student to an experienced clinician, everyone knows how to use a pager. Their simplicity makes them easy to learn to use in a few minutes. Because they are so simple, it is easy to use almost any type of pager on almost any network. Hospitals may have different policies about when to use a pager, but the core technical functionality and use remains nearly the same anywhere in the world.
Contrast this with today’s sea of smartphone apps that offer ever more intricate and complex functionality. Some are so complex to use that it is difficult to even understand what the intended functionality is. Many apps can now collect real-time patient symptom data that is so complex that entire research fields are being developed to make sense of this new stream of information. Clinicians’ want to the best tools to provide the best care for their patients — and sometimes the simplest tools are the best.
Pagers also have a reputation for being reliable. While not perfect, clinicians can count on pagers to deliver information no matter where they are in the hospital or community. Contrast this with today’s apps that have minimal regulations or standards — let alone reliability data. With many apps often updating every few months, what may have been a reliable app can potentially completely change after a single update. On a more fundamental level, papers have tremendous reliability because of their low power consumption. A single battery can often power a pager for at least one month. Smartphone apps for health care on the other hand increasingly demand more battery resources as they become more complex and draw on more sensors such as the phone’s GPS and camera. While smartphone apps and watches will soon stop functioning without power, pagers can reliably keep chirping away.
Finally, pagers offer a simple functionality that aims to enhance communication rather than disrupt or replace it. Given the limited screen space of most pagers, anything beyond a simple reminded or request cannot be fully communicated via pager. Thus, most pages end with a phone number or pager number to call back and continue to the conversation. In effect papers are facilitating conversations between health care providers, sometimes patients too, and encouraging rather than replacing direct contact and interaction. This is in contrast with many apps today that seek to automatically manage responsibilities and contacts. Others aim to encourage more screen time and less face-to-face time among health care teams. While there is always a trade-off between efficiency and personal communication, pagers seem to have found a good balance for the health care field.
Mobile technologies like smartphone apps and wearables hold tremendous potential for health care — but can benefit from looking at the success of older connected technologies. This article is not meant to suggest pagers are the optimal technology, rather the aim is to underscore several of the principles that have made pagers so successful: simple to use, always reliable, and facilitating instead of replacing direct communication. Health care apps will continue to evolve — perhaps one day even replacing papers — but, for now, pagers still remain health care’s most utilized mobile technology.
John Torous is a psychiatry fellow and editor-in-chief, JMIR Mental Health.
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