The UK's Health Service Told To Ditch 'Outdated' Pagers (bbc.com) 111
The UK's NHS has been told to stop using pagers for communications by 2021, in order to save money. The health service still uses about 130,000 pagers, which is about 10% of the total left in use globally. From a report: They cost the NHS about $8.6 million a year, because only one service provider supports them. Health Secretary Matt Hancock called them "outdated" and said he wanted to rid the NHS of "archaic technology like pagers and fax machines". However, many in the medical industry say that pagers are quick and reliable - especially in emergencies -- and proposed replacements have their own shortcomings.
Here is why pagers are so important (Score:5, Insightful)
They should keep the pagers, absolutely. The reason is this:
Pagers use slow transmission protocols that do not need a huge S/N to be properly decoded. That means pagers are going to work almost everywhere you would otherwise get an annoying "No Service" notification on your phone, such as elevators, parking garages, basements, and so on.
It would be a blunder of gargantuan proportions to stop using pagers for critical messaging. Just because the mobile carriers want to take over the pager spectrum for 5G doesn't mean it's the right thing to do.
Re:The only problem with pagers (Score:4, Interesting)
Re:Here is why pagers are so important (Score:5, Insightful)
130,000 of them for $8.6 million a year. What are they going to replace them with that costs only $5.5 per month and has the same reliability?
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Considering the low cost it doesn't make very much sense to try to fix something that isn't really broken.
I was at a billiards tournament a long time ago and near the end this woman had her pager go off while she was shooting she was concentrating so hard that the sudden sound and vibration scared the crap out of her and she screamed then fell forward onto the table. She was so embarrassed and the pager kept going off she could hardly fish it out of her pocket. Too bad it was before the smart phone, it woul
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Are you sure it was a pager? There are other devices that vibrate and can be controlled remotely, other than cellphones and pagers.
When was this?
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Go back to a paging system with speakers; "Dr. Kervorkian, please call 666" or the number displays on the walls.
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Those systems don't work when you need to call a specialist back in right now. Even a cellphone is significantly less reliable.
And, I'll bet those number displays actually cost more than 8.6 million a year.
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So design a new protocol, with new software, probably new hardware, an inefficient use of the limited spectrum, and oh by the way, it won't work, because attenuation is still going to absorb all of the energy. 25 MHz pager signals diffract and penetrate buildings exceptionally well. 600Mhz and up cell phone signals just don't.
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25MHz is a too long wavelength, use a 150MHz system - it works better through windows and corridors.
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The whole message would fit in one packet. You could retransmit multiple times, but I doubt you'd have room for FEC.
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How does the signal get to them when they're at dinner with their wife? There is a reason they have pagers on them at all times.
Re:Here is why pagers are so important (Score:5, Interesting)
hey should keep the pagers, absolutely. The reason is this:
Pagers use slow transmission protocols that do not need a huge S/N to be properly decoded. That means pagers are going to work almost everywhere you would otherwise get an annoying "No Service" notification on your phone, such as elevators, parking garages, basements, and so on.
Amazon made the transition from physical pagers to an app just a few years ago. Turns out that pager coverage and reliability isn't as good as you'd expect once you get down to only one vendor. Plus, in a disaster where thousands of pages get sent in a short time, you saturate the vendor's infrastructure and pages get delayed by tens of minutes.
The app also sucked at first, and most people on call used both, but within about 2 years it was more reliable on average than physical pagers, and they were lagely abandoned.
For those who don't know, Amazon cares very much about paging people. Paging doctors is merely a matter of life and death; while paging engineers when amazon.com is broke affects profit. Needless to say, far more money gets spent addressing the latter.
It is really cool though to see the machine work from the inside. When anything goes wrong anywhere that affects your ability to buy stuff on amazon.com, it takes less than five minutes before engineers representing dozens of teams are fully engaged with the problem, with most people checking in within 2-3 minutes. Problems are usually localized to one team, usually with an initial theory of cause, within about 10 minutes of the problem appearing. It's amazing to watch from the sidelines when you're not the one on the hook.
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The problem is that time you *are* on the hook, and that 5 minutes of Amazon.com downtime costs you your job and any prospect at future employment.
Oh, the job market for former Amazon engineers is very hot, no worries there. Almost no one likes working there, so people leave all the time.
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Amazon probably has WiFI hotspots and cell minirepeaters throughout their buildings, and fewer (unintentional) Faraday cages in their new er buildings. Also, less equipment giving off all other kinds of EM radiation. I mean, I don't doubt you could build a better system when you have the cash, but I'm sure Amazon spends more than $5.5/employee*/month on comms infrastructure.
*I'm ignoring the warehouse workers, etc. and focusing on the "pager level" group.
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Yup, the budget for waking up engineers at 3AM is "whatever it needs to be". But apps worked much better than I expected for people away from the buildings, where I had figured that pager coverage would be better. Turns out not so much, if you build aggressive retry in on the app side.
Interesting point though about paging people inside hospitals in arbitrary spaces. Of course, adequate WiFi repeaters is "just" budget, but there are other constraints as well.
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The problem is a public health system has to always think about expenses, so can't just budget "whatever it needs to be"
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The NHS is clearly claiming it's a financial issue, so I'd imagine the budget differences are pretty high. Although, I must say, with your "whatever it needs to be," I'm envisioning a helicopter going to pick up an engineer who is rock climbing on vacation. Like Tom Cruise in one of his movies.
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There is a distinguished engineer who flies in on a private plane, but then it's his plane. Amazon isn't wasteful like that, but they will do practical stuff like hiring a team just to make the paging app better. Like I said, it's not some petty matter of life and death, there are corporate profits at stake.
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The amazon app does not work in elevators, unless you installed an AP in your elevator shaft. Think 'faraday cage'. A lot of times people can be in elevators.
And yet you still get paged when the door opens. It's almost as if there was an unlimited budget to make it work well.
Pocsag/flex pagers have better coverage than shitty GSM and WiFi.
Works great on paper. Funny thing: monopoly pager companies aren't so great on upkeep. Plus, people know where their cell phone dead spots are, and can avoid them while on call, but are oblivious to pager dead spots.
The experiment was run. After a couple of years or improving the system, pages showed up faster and more reliably with the app.
Re:Here is why pagers are so important (Score:5, Informative)
Add to it that a pager also is fine when you have radio-sensitive medical equipment like EEG and EKG measurement equipment.
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They should keep the pagers, absolutely. The reason is this:
Pagers use slow transmission protocols that do not need a huge S/N to be properly decoded.
That is not a reason to keep using pagers. In fact every emergency service messaging protocol achieves what you described, including messaging based systems that run on the Airwave network or the proposed public safety LTE extensions.
It would be a blunder of gargantuan proportions to stop using pagers for critical messaging.
That blunder along with your doom scenario hasn't played out in other parts of the world where pagers have been abolished. What would be a real blunder is when the pager network dies as the hardware is well and truly beyond end of life. Keeping old radio equipment operational i
smart (Score:2)
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Sure, let's make our emergency services rely on something that's delicate that needs constant battery recharging to work.
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Actually, as others have pointed out, it sounds like an ideal app for what they're currently using. It's very cheap (maybe not as cheap as it used to be due to the lack of competition, but still much cheaper than any proposed replacements) and extremely reliable (in an application where reliability is the primary requirement). About the only reason anyone is coming up for retiring it seems to be, "But it's so OLD!"
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Sounds like a lot (Score:5, Insightful)
lots of advantages (Score:2)
Re:lots of advantages (Score:5, Interesting)
Most pagers I know of still use AA batteries. Why? Rechargables just don't last as long!
They literally will last for months on a single AA battery. A busy pager may last a month (one that's constantly beeping and vibrating). Off a single AA battery.
But one that isn't so busy can probably go up to a year on a single AA battery.
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There's still the better reception thing.
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Phone chargers aren't some specialised personal item, even the vast majority of phones now use the same standard types of charger. I'm sure in an organization the size of a hospital there will be other people with a compatible charger. Failing that, chargers are cheap so the hospital could supply some for staff who are expected to have their phones charged.
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But if the person already has a working smart phone, what's the point? They are going to keep the smart phone charged anyway. And if they are out of cell phone range in this day and age paging them isn't likely to be of much value. By the time they run back down the mountain to use the phone in the small town pub the emergency is over since some doctor near the hospital with a smart phone already responded.
Naw, you'd be surprised how crap cell phone coverage can be even in this day and age. Remember hospitals have to work even with degraded service, and if the cell tower near you goes down for some reason you may have 3 bars of 3G coverage for a while instead. Works fine, but go one floor down into the basement and you're at no signal (whereas a pager will get through fine).
That brings up the other importance: Eliminating common failure modes. If you only have one way of reaching your life-saving employee, de
Common failure modes (Score:2)
Encountered that at my work. Maybe not life saving, but they transitioned our network/computer help desk to VOIP. What happens when the network goes down?
I mean, we were aware of the issue, but we couldn't reach out to our higher level/vendor supports for assistance, or to our lower level customers to let them know that we were aware of the issue and working on it.
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What happens when the network goes down?
In that case the IT staff would be fully aware of the problem, and would get to spend their time fixing it rather than answering endless calls from users telling them what they already know.
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It's also the physical significance of the pager itself. You have *the* pager, you are *the* cardiologist on call until someone takes it from you.
Everyone at the hospital knows x415 will reach the on-call cardiologist's pager (or so says the sheet by every phone if they forget), they don't have to worry about how to navigate a complex system, or making sure you're set as on-call correctly. The person you relieved handed it to you as the sign you were on duty and they were off duty, so he/she isn't wondering
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Exactly so. It's not just medical use either. In a big industrial facility doing shift work, you would hand over the pager as part of the handoff between shifts. You were now responsible and accountable. A sizeable physical token is useful because it has meaning, much moreso than a purely electronic system such as a phone app.
Just trying to drive down Pager OEM stocks prices (Score:2)
Everybody and I mean EVERYBODY knows pagers are going to make a big come back in 2019!
The reason pagers are still alive (Score:3, Insightful)
Pagers don't emit cellphone-level radiation & electrical interference around medical devices.
Pages have a weak acknowledge capability. Meanwhile you can't leave your cellphone by a radio. The interference it causes to the radio is the same interference it may cause in a medical device. And it may not cause a malfunction that gets noticed. What if the morphine drop was increased by a random flipped bit.
Medical devices are not evaluated in cellphone conditions. And given that doctors work in the immediate vicinity of medial equipment it is a risk the hospital is not willing to take.
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Medical devices are not evaluated in cellphone conditions. And given that doctors work in the immediate vicinity of medial equipment it is a risk the hospital is not willing to take.
That was the same garbage they used to explain why cellphones couldn't be used on airplanes. Simply a convenient lie. Do we really think an aircraft could be brought down or redirected off-course just by some jackass in the cabin whipping out his cellphone or grandma forgetting to put it in airplane mode? Of course not. And if there actually was a chance, the liability rests with the carriers. They'd never tolerate that kind of risk -- they would replace or shield the affected equipment. Same for hospitals.
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The difference between planes and hospitals are large. For instance, one is on the ground and the other is in the sky. The other big difference: There aren't 200 people crammed into a hospital room all with their own electronics, just feet away from the avionics control circuitry.
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As someone who has worked with sensitive medical equipment, this is highly misleading. It's not always possible to effectively shield stuff. Strong microwave radiation can induce current in all sorts of devices; you've doubtless heard it affect loudspeakers. There are even more sensitive coils in many medical devices. Not turning phones off is a selfish thing to do. Why is your personal convenience more important than the primary function of a hospital?
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Re:The reason pagers are still alive (Score:4, Informative)
Traditional pagers are not un-common in US hospitals, but it depends on a number of factors. Reliability, vendor contracts, urban/rural, and plenty of other things. Doctors usually don't need smartphones moment to moment absent some other check-in app.
I used to work for an RTLS provider in hospitals that worked with a distinct radio protocol for telemetry tracking, and was running into problems at times converting to low-powered Bluetooth because there was a lot of other RF stuff running. There was a mobile interface to the data, but wired stations were always where the critical communication was happening.
The hospitals I know of that have moved away from traditional paging have simply replaced them with on-site paging -- same kind of system you'd have to know your table was ready at a restaurant, but souped up. People really only migrated if/when they felt the last remaining local pager service was on its last legs, since there was a capital cost and not much reason to switch otherwise.
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The modem, display drive and the forward error correction were implemented in software in a single 4-bit micro, the radio was the only other chip. Hence low price and power consumption.
The UK is very strong on "if it ain't broke don't
Deploy their own Paging system (Score:5, Interesting)
I have several customers in our area including hospitals that have their own private paging systems. The spectrum is licensed and dedicated to their use. The are only designed to work with-in their facilities, which in the case of hospital staff, is mainly where they need the quick response. Outside the facilities then standard phone calls, text messaging can be used to call someone in.
The major downside is the support of the infrastructure to keep the system running, but with regular maintenance it's not that big of an ask.
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If they are complaining about the cost of running pagers then they will not at all be happy with the cost of using ASTRO P25, though in the UK they'd be using the Airwave TETRA system.
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I'm assuming they could piggy back on their EMS / Fire / Police systems... I'm a Vol. FireFighter in the states and we have our own private radio network in the town that is backed up by a neighboring town and the county... beyond that we can transmit directly from the Hall if things went really sideways...
The UK is very different - Fire, Ambulance and Police systems are defined at a national level even though there are individual authorities. It's a smallish island so you want interoperability between different counties etc.
Re:Deploy their own Paging system (Score:5, Insightful)
The major downside is the support of the infrastructure to keep the system running
I think you've hit the nail on the head. The issue is that the equipment and expertise available to maintain a 1980s era network is dwindling. I used to work at a company who had the contract to maintain the local hospital's private pager network. I have no idea of the contract value, but they were the only game in town that had the knowledge to do it. There was literally no competition in the pager space around there. If they went tits up, the hospitals would have been screwed. I can see the desire to get away from a system like that.
Paging Dr. Allcome! (Score:2)
Paging Dr. Allcome!
Pagers vs SMS (Score:2)
This was a while ago (about 15 I would say) and I managed the IT service desk for a large bank. We used pagers and the ticket system paged on various events. They were necessarily cryptic but the intention was to let the right people know when stuff was going on. The CTO would get paged if email went down, that kind of thing.
It was the dawn of the not-so-smart phone era and the executives got them along with people getting their own flip phones and such. Texting was starting to build. It was a great new wor
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"SMS relied on email"
Was?
In a properly-engineering life-critical situation you'd have an industrial-quality 2g/3g modem device interacting directly with the cell network to send SMS (ideally located in the roof closet with a large antenna on it), but during the mid-2000's email-to-text was often seen as "good enough". Direct web submission gateways became an option, but SMTP whitelists did a pretty good job at handling issues where a provider's web gateway may be unreliable.
Of course, numeric pagers could reached with a Linux box,
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In this case the pager system is unlikely to get overloaded when there's a crisis or some other event where everyone is on their mobile phones.
The question isn't one of paging vs SMS. There are many alternatives. If anything they would probably switch to SDS messages over TETRA which is what the rest of the UK Emergency services already use via the Airwave service. But even if they did use the public infrastructure it doesn't mean doom and gloom. 3GPP Release 13 includes message and device level prioritization including device preemption. It's something we tested when we were looking to LTE to replace 2-way radio infrastructure and a completely ov
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I would politely listen to them and tell them (again) that SMS relied on email to get the messages to the towers. So just how I was I going to send a message that email was down if .. I used a system that depended on email to send messages?
That's not a law of physics, it's an implementation detail. SMS itself doesn't rely on email, nor do paging systems, though both can be used that way. I've been involved with paging both through TAP and through email, and with SMS both directly and through email.
Using pagers is cool because they don't depend on the cellular network, but it also sucks because using good ones which can ack a message is as expensive as cellular. But if you expect it to work even in an emergency while the cellular network may b
LPWAN (Score:2)
The pager service could technically be done much cheaper today by the use of LPWAN. This would enable easy competition between LPWAN providers.
Someone "just" has to fund the development of the new devices.
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Easier to sniff / log too.
No. LPWAN has encryption. It may not be amazing, but it's there.
The pager protocol on the other hand is entirely unencrypted. Any idiot with an SDR can spy on them. The devices are not designed with security in mind, so they are likely to have interesting vulnerabilities if someone sends them unexpected messages.
Security is actually the best reason to ditch the pagers as soon as possible.
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That's nice, but the chances that the NHS are using encrypted paging are pretty slim.
Also, proprietary encryption is always full of holes.
Story based on ignorance (Score:2)
Pagers are the near perfect answer to the needs of medical workers, and very affordable - $5.5/month per user, or about 20ÃÂ/day.
The devices are quicker, more reliable than cellphones, and as a mature technology, costs are fairly trivial.
This politician's entire argument is based on ignorance of the problem, the technology involved, and the low cost of the current solution - it needs to be replaced because it's 'ancient', nothing more.
Think NHS can build an 'app' and roll it out for less than $8.5
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If you are mining availability with Intel, you are doing it wrong - you need FPGAs!
Forget the App. (Score:1)
Why not just put the same hardware technology a pager uses INSIDE the phone? I'm sure Apple or Samsung could easily incorporate Pager radio silicon in their phones.
No?
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Handing Pager to next person - alternate? (Score:1)
Folks in hospitals and first responders that I know have pagers often hand the pager to the next person or whoever is filling in for them. This enables system/managment to simply page on-call pager and reach whoever has it. If switching to phonecalls, or phoneapp, then someone/thing has to be constantly updated to know who to contact.
There are a number of places where cell-phone are prohibited, but one-way incoming pagers are allowed. Switching to cell-phone/app would make those area dark/off-limits/blin
Reliable in emergencies... (Score:2)
I used to carry a pager for almost 15 years when I was part of our state emergency service in NSW.
The reason we still use them is because of coverage.
Pagers rely on radio transmitters that cover massive areas. They are not subject to emergency mobile signal shutdown during emergencies or congestion periods.
SMS (and email) is much more useful, and we use that as our primary mass communication tool to our members, however, for team leaders and officers we still use pagers as well.
I have had situations where a
next up (Score:2)
faxes!