Why the hospital pager withstood the test of time | Hacker News Reader

Why the hospital pager withstood the test of time

healthtechmagazine.net

44 pointsrbanffy45 comments

I work in a hospital; the system I'm in finally deactivated our physical pagers last week.

One thing that I really liked about pagers was the social element. If I receive a page to a physical pager while talking to a patient, they have no question about whether the incoming message is of a clinical nature. In contrast, when I get a message and glance at my phone, it's not possible for them to know. I'm sure they give me the benefit of the doubt, but with a pager that wasn't necessary.

Set a custom notification tone for whatever app or number "pages" you. Make it sound like a pager.

Thanks, that's a good idea.

My mother is a GP (in Australia). Many times I have interrupted one of her consultations with a patient by calling her. She tells me she is with a patient and keeps the conversation brief. I’ve never experienced that from the patient’s viewpoint, but I wouldn’t be upset at the doctor if I did. I’m a parent too, if my kid was calling me I’d be inclined to pick up just in case it was something serious.

Last time we took our son to see the paediatrician, he spent 5 minutes on the phone talking about another patient-the hospital called him to ask what to do about some seriously ill infant. That didn’t bother us at all.

What you are saying totally makes sense. A phone call is a brief, observable interruption where you can sort of follow along with how close it is to ending.

The issue with getting rid of pagers is that it means people are now texting using a special app, rather than calling. (I should have been more clear about that detail.) I think that staring quietly at your phone is a little bit more fraught than answering a page or a call.

I totally agree. I am checking my phone in patient rooms all the time now to look at epic messages in case they are urgent. I have to say the good ole days of pagers were much better.

Pagers are also popular among people who work in secure areas (in the sense of national security, e.g., at national labs) because they are one-way so you can bring them inside; they receive information but cannot transmit it out.

Do they submit the pager for validation every time they clock in then? Seems like the perfect vector otherwise.

Keep the pager in the secure area. Turn it on when you enter, turn it off and hand it back in when you exit.

Also, I’ve been to places where they do things like “no external laptops; however you can bring your phone in-we will cover the camera with security tape, and check the tape on the way back out”. Obviously that is not what they do for classified stuff, but not everything sensitive is classified (indeed, some governments have a category “sensitive but unclassified”). And some private sector entities copy aspects of public sector security, but rarely to the same extreme, which can produce similar rules.

They don't allow laptops but they allow phones?

Yes, that was their policy. I won’t say their name, but it was the headquarters of a major financial services firm in South Korea

One of my Korean colleagues had this theory-senior executive ranks in Korea are dominated by former military officers, and as a result the corporate culture is heavily influenced by the military - including an obsession with countermeasures against corporate espionage. In practice, I don’t they were doing anything worth spying on, while the extreme security rules were a big burden on developer productivity

That is even more baffling then that they’d fail to see a phone with tape on it poses the same risks as the laptops they ban

a friend told me about a facility that didn't allow phones. Then there was an active shooter incident and they changed the rules afterwards.

I believe the rules are aimed to keep people with clearance from being foolish, risky, or bending the rules, not to prevent dedicated spies. I don't think they're getting patted down.

Dumb question: how do these work? Specifically, how does the network know where to transmit the page, and whether to stop retransmission (if the pager is offline when originally paged).

It doesn’t, one-way really does mean one-way. Pagers are broadcast over an entire region. Regions can be as small as metro areas or as large as the continental United States.

True one way pagers only receive if they're on at the time a page is sent out. Think a radio with a transcriber, if it's on when the page is sent it records it and plays it's notification sound. There are two-way pagers that could respond to and acknowledge pages.

I am wondering that too. Do they detect/record location like mobile phone towers do?

How could a one-way device do that?

this is crazy because i bet pager encryption isn't particularly strong

The biggest concern in these environments isn't information reaching the people inside - it's those people extricating that information (intentionally or otherwise). So having a system where e.g. some scientist's family can tell them they need to call right away is super helpful and not a huge security risk because they have to go through the process of leaving before they can actually contact them. There's no [obvious] way to MITM the pager and get it to extricate any data.

"The T5 supports message encryption using the industry standard AES?128* encryption algorithm. Each device is programmed with a unique key. Messages are encrypted as they enter the Spok network and are sent over the air to the device where they are decrypted for display to the user."

https://pagersdirect.net/collections/alpha-numeric-pagers/pr...

However, there seem to be other weaker links in that chain (like the email that's being sent to the host).

You might be interested in the 9/11 pager intercepts (https://911.wikileaks.org/)

The encryption isn't too much of an issue, you're usually just paging a phone number or a code like '911' from your family who otherwise have no other way to reach you.

Unfortunately they're used in hospital settings where patient information inevitably winds up getting transmitted in the clear.

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

I'm talking about this

> Pagers are also popular among people who work in secure areas (in the sense of national security, e.g., at national labs)

That’s what I was talking about as well. A pager is the only mobile communication device allowed in those spaces so it’s impossible for a family member to contact you when you’re walking around otherwise.

Still might be useful to an adversary.

that's interesting, because it means you can't track the recipient either.

I am a hospitalist and we still occasionally use pagers, but they are not reliable like people assume. Dropped/missed pages happen, probably at about 1-5% frequency. The battery life is great but still my phone can be recharged and is much less wasteful with battery use.

There is a major trend to transition to hipaa compliant text messaging apps which work much better and efficiently. Some are built into EMRs.

When "100% working no matter what" is a core requirement - military, medicine, etc - you should expect slow technological change and lots of maintenance of the current status quo until it becomes untenable.

We still use pagers for emergency response alerting (Victoria, Australia). It's a dedicated, reliable alerting system that ensures the alert goes out between the emergency call takers and first responders.

It's reliable partly because it's so basic - it's a "one-way" broadcast network, and only operates at 1200bps (IIRC). They're not trying to build a network to serve hundreds of Mbps over duplex data connections so everyone can download their favourite cat pics. The network is built to cover 98% of the state by area, mobile networks cover less than that by population.

As a volunteer unit, we use mobile apps to augment our response (ie, hit green on our phone to indicate we're responding, red if you're not), but the primary alerting system is still the pager. The amount of people that turn their pager off then act surprised when they miss an alert because they don't get the difference is fun though.

When I’ve had to be oncall, I’ve always preferred pagers to SMS or phone apps. It’s a pain in the ass to keep my phone on me at all times and not be able to silence it. If I ever have another job that requires oncall I will probably buy a cheap Android burner and expense it rather than using my personal phone.

Interesting, had a pager in the early 90s and worked in a hospital. But it was used primarily for picking up extra shifts and occasional friend communication.

Was a small, clear motorola that I was proud of and so kept it for years. Believe I got rid of it finally ten years ago and regret a bit now.

At one point tried coming up with a numeric code to text the alphabet for short texts but it was difficult as you can imagine. :-p

My friends and I all got these in high school a year or two before mobile phones become commonplace:

https://www.youtube.com/watch?v=WuBXphPuEuk

They came with a little codebook and kids would extend with their own codes. EDIT: It also came with a voicemail that you could access with a freecall so you could leave each other voice messages too.

It was pretty awesome.

Nice. In the side bar it had mine, though it didn't have a blue tint:

https://www.youtube.com/watch?v=V9dxWf0yoj4

I work for a hospital and we just phased out our pagers this past year for some staff. Honestly, I am glad they are gone. I hated carrying the extra device. But I see the advantage for physicians. Pagers absolutely work everywhere.

U can ease drop on this systems today with free software, a cheap antenna, and a rtlsdr.

Pagers continue to live in hospitals in part because they work where cellphones won’t. Hospitals have cellular and Wi-Fi dead zones, particularly in spots where walls have been built to stop X-ray exposure. Pagers get the same kind of range as an FM radio station, and signals go to multiple satellites instead of just one, as cellphones do.

Also stay charged for a lot longer.

About a month on a aaa I recall. Independent of how many texts were received it seemed. Guess it had to amplify and demodulate every bit of noise that broke squelch.

I recall reading somewhere (IIRC it was a Motorola patented method? Probably expired by this point) that one brand / com method involved a stead, slow / long sequence at the start of the analog signal expressly as _the_ thing that terminals woke up on, started to process on, and then could go back to sleep right away if it wasn't a device match.

"Selective calling" - or selcall.

It's still very very very widely used in Fire and EMS - listen to any scanner and you'll hear "tones" "dropping" before any dispatch. Motorola Quik-Call is most common around here (there's a sample at this page called 'Tone and voice paging example') - https://en.wikipedia.org/wiki/Selective_calling

In my area, by and large (smaller volunteer departments might just have a 'department' tone), each dispatchable unit has a unique tone (usually two separate tones) and the pager is programmed with a decoder, "if I hear X Hz for x ms, followed by Y Hz for y ms...". Then we will have 'utility' tones, that may not dispatch a unit, but provide information. For example, here a medical call is likely toned as:

[engine tone] [generic tone for private ambulance company] [ems utility tone]

so you'll get a stream of six tones (well, the utility tones have slightly different rules, so our EMS tone is "beep beep beep" while our Fire tone is "hilo hilo hilo".

There can be problems with the current hybrid state of things, though. Here in my county, dispatch is supposed to use the new phone app method AND tone notifications so that Ye Olde Radios still work. But they don't always remember to do both ...

Very helpful, thanks!

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