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Comment by mikecsh | Hacker News Reader

>> I'd wonder why

I'm a doctor, and whilst I despise carrying a pager it does have some benefits over more modern alternatives in some scenarios.

Mobile (cell) reception in hospitals is generally very poor and wifi connectivity is also generally poor. Trying to rely on either of those to deliver critical communication (e.g. bleeps to the crash team to respond to a cardiac arrest) is more unreliable than the hospital blasting a simple radio signal that any pagers within a few mile radius will always receive and decode appropriately.

For less critical communications (e.g. where you might bleep someone to contact them to a refer a patient to their specialty) there is a (slow) move towards messaging apps or email. These solutions do not yet have the immediacy and reliability of a simple pager for critical applications.

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I'm curious about the use of pagers in healthcare. I work in an industry that would love to have pagers for on call events, but service has proven unreliable (especially indoors) unless you build out your own dedicated wireless infrastructure for every building you are working in.

We have alternative secure voice/data communication, but they tend to either be bulky or have strict storage and carry restrictions.

Would love a small reliable pager system to carry on our person that would simply let us know to check in.

All of the pager architecture in the US seems to have disappeared in the marketplace.

Seems like it'd be a plausible (small) business idea. A $10 SDR stick with a piece of wire as an antenna is enough to pick up pager signals, and I doubt you'd need a much more advanced setup to transmit. A 100 or 400 MHz license in the US costs maybe $500 for a decade. Mounted at the right spot, you wouldnt need much power to cover a large area with a single transmitter, though basements are always going to be trouble.

> A $10 SDR stick with a piece of wire as an antenna is enough

That doesn’t sound like mission-critical levels of reliability.

My point was the technology is cheap - there are certainly better dedicated, inexpensive chips that could be used to make a simple wireless messaging system.

I'm curious what personal health information would be transmitted via a pager anyway? I assume a doctor would only need to know a room number and maybe code or chief complaint in the page?

I see other commenters mentioning some PHI is being shared via pagers and I am unclear what that may be ?

In my experience (UK) there is no personal information transmitted. There are two main types of bleeps:

1. Sending the number of a telephone extension you want the recipient of the bleep to call. For example, if I need a cardiology opinion, I will bleep the cardiologist with a telephone extension and wait for them to (hopefully) call back while I am still but he phone and before it is called by anyone else. This data is not sensitive. These are the types of bleeps which are being replaced slowly by asynchronous communication via apps

2. Emergency bleeps which are designed to alert a specific group of people on the arrest team to respond to an emergency. These usually work quite differently. Instead of 1:1 they are 1:many and usually carry a different alert tone, followed by a (generally poor quality) audio alert of the operator saying something like "paediatric cardiac arrest inbound to ED, ETA, 5 minutes". Again these carry no sensitive data.

Yeah from what I have heard from Canadian based doctors the pagers are used for almost identically the same as what you described for the UK.

Pagers get used for PII, and if somebody thinks it doesn't happen, they're simply confident that their experience is representative. It happens, and quite frequently, in Canada.

https://www.trendmicro.com/vinfo/id/security/news/vulnerabil...

Yeah what you linked me to talks about I believe the same case another user already linked to. It was more correct for me to say I was speaking more about the Ontario, Canada healthcare system as that is the one I work within. The healthcare systems are mostly run at the provincial level so it can be hard to talk about the countries healthcare as a whole as it can often vary province to province.

I’ve listened to pages in large Canadian cities in the past for fun. Pages at the local hospital often included patient names and diagnosis or analysis results.

Yeah from what it sounds like there were some incidents in the news in BC in 2019 and it sounds like a lot of hospitals may have adopted new procedures since then? Not sure if you've been listening to any recent ones?

It's kinda hard also to figure out which areas may be doing it and which aren't as the different provinces are kinda run independently.

Yes that was before 2019 so maybe it has changed now.

here's an article with examples: https://www.kansascity.com/news/business/health-care/article...

basically, they broadcast patient name, initial diagnosis etc

Weird, as the other commenter mentioned their's in the UK don't have patient information in them. In fact the medical professional I know in Canada have pagers that give essentially the same information about the UK commenters. It's either an extension to call, or for a code.

Maybe countries like the UK and Canada are more strict about personal health information and have kept personal info out of pagers? I know working in healthcare systems in Canada I would get in trouble even if I used a medical software to look myself up in it.

Here's a Canada example (apparently patient transport coordination, fixed after media attention): https://www.ctvnews.ca/health/pager-systems-used-in-healthca...

Ah, interesting. The only people I've actually talked to before about the pagers were from Ontario and the healthcare is mostly managed at the provincial level. So not sure if this was a problem in Ontario or not. I am sure at some point all the hospitals were doing this and eventually switched over to the new way that doesn't do this.

However being a 911 dispatcher for the EMS system here I can say that our radios are not encrypted and can be listened to online by anyone. We mention addresses, chief complaints, and anything else that may be relevant for the paramedics. Patient names would not be given over radios nor would other private info like if the building has an access code. Anything that is private like that is indicated to the paramedics by saying something like "call for access code". Then they call the landline and get the info that way.

In my opinion though, knowing addresses and medical conditions going on can still be a bit sensitive in nature. The police here recently switched to encrypted radios. It was nice sometimes to listen to the scanner, but at the same time it's understandable why it's less than ideal having open radios.

If you reread me, you'll find my "why" isn't "why use pagers", it's "why don't pagers implement even basic crypto"

Ah yes - sorry, I read that too quickly. The answer to that (at least limited to my experience of pagers in many UK hospitals) is that they don't carry any sensitive data at all.

There are a lot of other issues with them though. There are few companies supplying them so they are actually very expensive. Consequently in our publicly funded health service they are not replaced often and many are in a poor state with batteries held in by tape etc.

The main issues from perspective as a user is the synchronous model of communication that they enforce. Unless something is an emergency, it's an unnecessarily disruptive workflow.

There are usually a limited number of phones on a ward, which are usually very busy lines. Using pagers for routine communication means:

1. Physically move myself to a location with a phone 2. Wait for phone to be free 3. Call a number to send the bleep 4. Wait for a response (bearing in mind the recipient needs to be free, move to a phone, wait for that phone to be free, and call back) 5. Guard the phone from others using it until I receive the call 6. Hope that no one else calls the phone in the meantime

Bearing in mind that everyone is always busy in hospital this is a huge source of frustration and wasted time, hence the move towards secure messaging apps for these scenarios. Unfortunately these are mostly being built as silos rather than interoperable communication networks.

As mentioned above, for actually alerting a group of people to an emergency when you need an immediate response, pagers are still hard to beat.

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