Trends in secure mobile communication technology use among hospitalists in North America, 2016–2021

Objectives: Structured communication is essential for hospital-based clinicians to effectively coordinate patient care. However, traditional one-way paging systems are an inefficient means of information transfer. In response to the limitations of paging systems, vendors have developed secure text messaging systems (STMS) that provide asynchronous, multi-way messaging between mobile devices. In 2016 we conducted a cross-sectional survey of a nationally representative cohort of hospitalists and showed that pagers were used more frequently than STMS for patient care-related communication. Despite the potential benefits of STMS, we know little about the degree of STMS adoption since that time. The objective of this study was to quantify how STMS use has changed over time. Methods: We re-administered our secure communication survey to the original cohort of hospitalists who responded to our initial survey, with a response rate of 25.4%. We used paired hypothesis tests to assess how hospitalist use and organizational adoption of STMS have changed since 2016. Results: In 2021, more respondents received messages primarily via STMS than they did in 2016 (n = 36 vs n = 14, difference in proportions 0.23, 95% CI 0.13–0.34, P<.001). Conversely, fewer respondents received messages via pager in 2021 than they did in 2016 (n = 21 vs n = 47, difference in proportions -0.27, 95% CI -0.38 to -0.17, P<.001). Conclusions: We found that STMS has overtaken paging as the most frequently used technology for patient care-related communication. In addition, many hospitalists use both STMS and paging systems, placing them at risk for communication overload. Public Interest Summary: Doctors working in hospitals still use pagers to communicate. However, paging (receiving a message on a pager and having to call someone back) is slow and can lead to errors. New text messaging apps have been developed to let doctors send secure texts on their smartphones, but when we surveyed hospital-based internal medicine doctors (“hospitalists”) back in 2016, there was very little use of this technology. Because there seem to be benefits to using secure texting over paging, we wanted to show how trends in use of secure paging are changing over time. Here, we repeated our initial survey on the same group of hospitalists. We show that secure texting is now more common than paging, but many hospitalists have access to both. We caution that having too many communication options could lead to communication overload, and we suggest that best practices to prevent this should be studied.