Paging Dr. Hacker: The Hidden Dangers of Using Pagers in Healthcare

Mack Jackson Jr
7 min readFeb 4, 2024

By: Professor Mack Jackson Jr.

In the fast-evolving landscape of the healthcare industry, securing messaging data stands at the forefront of priorities, mainly when dealing with the delicate nature of Patient Health Information (PHI). As digital communication technologies become increasingly integral to healthcare operations, data breaches and unauthorized information access loom, presenting complex challenges to safeguarding patient confidentiality and ensuring adherence to stringent regulatory frameworks like the Health Insurance Portability and Accountability Act (HIPAA). This dynamic shift underscores a critical juncture for healthcare providers, compelling them to reassess and fortify their digital communication strategies with robust security measures. Protecting sensitive patient data reflects a commitment to patient trust and privacy and aligns with the legal and ethical obligations that define the modern healthcare landscape.

The Prevalence of Insecure Communication

Despite the surge in secure communication technologies, a considerable number of healthcare organizations persist in their use of dated systems like pagers. The Healthcare Information and Management Systems Society (HIMSS) Analytics report underscored this trend, revealing that over 200 hospitals across the United States still predominantly utilize pagers to facilitate communication among physicians and nurses. This enduring reliance is primarily attributed to prevailing misconceptions regarding their cost-efficiency and operational effectiveness. Such a steadfast adherence to obsolete technology breeds operational inefficiencies and significantly heightens security risks for healthcare providers, mainly because pager communications lack encryption. This issue exposes sensitive patient information to potential unauthorized access, undermining the confidentiality and integrity of patient data. This scenario accentuates the pressing need for the healthcare sector to reevaluate its communication infrastructure, prioritizing the adoption of modern, secure, and efficient alternatives to safeguard patient information against emerging cybersecurity threats.

The Risks to Patient Health Information (PHI)

Leveraging unsecured communication channels in healthcare settings significantly elevates the risk of PHI breaches, directly compromising patient privacy. Such breaches infringe on confidentiality and bring hefty financial repercussions for healthcare organizations under HIPAA regulations. This issue is further magnified, considering that studies reveal that 96% of physicians utilize smartphones, showcasing a vast potential for integrating secure messaging solutions. Physicians’ widespread use of smartphones underscores an opportunity to shift away from traditional, less secure communication methods like pagers towards more secure, encrypted messaging platforms. These platforms can offer robust protection for sensitive information, ensuring compliance with privacy laws and safeguarding against the financial and reputational damage associated with data breaches. This transition aligns with the technological trends among healthcare professionals and represents a proactive approach to enhancing patient data security in an increasingly digital healthcare environment.

Statistics Highlighting the Problem

The reliance on pagers within the healthcare sector, which is diminishing at a rate of approximately 11% annually, highlights a gradual yet reluctant shift toward adopting more secure and efficient communication technologies. This cautious pace of change is particularly alarming when considering the financial implications and security vulnerabilities inherent in the continued use of paging devices. Notably, with large healthcare organizations incurring annual expenses exceeding $200,000 to maintain pager services, the economic burden is far from negligible. This situation is further complicated by the security risks of transmitting sensitive patient information via unencrypted channels. The juxtaposition of escalating costs and heightened security risks amplifies the critical necessity for healthcare providers to expedite their transition to secure messaging platforms. These platforms promise enhanced protection of patient data through encryption and offer potential cost savings, advocating for an urgent reevaluation of communication strategies within the healthcare industry to prioritize fiscal responsibility and safeguard patient privacy.

Tools Used by Hackers Exploit Pagers

Hackers utilize low-cost tools and specific know-how to intercept and decode data transmitted via pagers, exploiting traditional pager systems’ inherent lack of security. One primary tool in their arsenal is the Software Defined Radio (SDR), which can receive and decode radio frequencies, including those used by pager systems. Hackers can easily capture and read unencrypted pager messages from a distance by employing an SDR and investing as little as $20 for a dongle. This vulnerability is because pager communications are typically not secured with encryption, allowing anyone with the right equipment and technical knowledge to intercept messages. This method of data interception poses significant risks, including the exposure of sensitive information such as patient details, operational data, and potentially even passwords communicated via pagers in various industries, including healthcare and critical infrastructure sectors.

POCSAG (Post Office Code Standardization Advisory Group) is a digital coding standard for sending data to pagers. The British Post Office (now Royal Mail) developed the protocol in the 1970s to support wireless data communication services, particularly for pagers. POCSAG is widely used for its simplicity and reliability, enabling long-range transmission of numeric and alphanumeric messages.

FLEX is another paging protocol developed to improve the limitations of earlier systems like POCSAG. In the early 1990s, Motorola introduced FLEX, which was designed to offer higher data throughput and greater capacity, supporting numeric and text messages. It operates at various baud rates, allowing for more efficient spectrum use and better device battery life. FLEX’s robustness and flexibility have made it popular for paging and other wireless messaging systems worldwide.

Frameworks like POCSAG and FLEX, which are open standards for paging, have fostered a vibrant community around free and open-source decoding software. This accessibility enables hobbyists and professionals to explore and innovate within digital communications, enhancing interoperability and security practices. The availability of these open-source tools not only democratizes access to sophisticated decoding capabilities but also encourages collaborative improvements and the sharing of knowledge across the global tech community.

Concerns Over PHI and Data Exposure

The apprehension surrounding the exposure of Patient Health Information (PHI) is primarily due to the inherent risks associated with transmitting sensitive data over unencrypted communication channels. These channels, lacking robust security measures, are susceptible to interception by unauthorized individuals equipped with the necessary technical skills and tools. Such breaches violate patient privacy and risk significant patient harm, including identity theft, financial loss, and potential health risks from misusing medical information. This vulnerability transforms every piece of transmitted patient data into a potential liability, underscoring the critical need for healthcare providers to adopt secure communication practices that include end-to-end encryption to safeguard patient information against unauthorized access. The security gap highlights a pressing issue in healthcare information technology, necessitating a shift towards more secure communication methods to protect the confidentiality and integrity of patient data.

The Solution: Secure Messaging Apps

In response to the risks posed by unsecured communication practices, healthcare providers are increasingly adopting secure messaging applications. These apps offer end-to-end encryption, ensuring only intended recipients can read the messages. They also comply with HIPAA regulations, providing features such as message accountability (with delivery and read receipts), remote wipe capabilities in case of device loss, and the ability to transmit PHI securely.

Secure messaging apps not only enhance the security of patient data but also improve communication efficiency within healthcare settings. They eliminate the one-way communication limitation of pagers, allow instant information delivery, and reduce the time physicians spend waiting for critical patient data. With the cost of secure messaging apps being significantly lower than the ongoing expenses of pager use, healthcare providers stand to gain financially and operationally by making the switch.

Implementing Secure Messaging Solutions

For healthcare organizations considering the transition to secure messaging apps, selecting solutions explicitly designed for healthcare environments is crucial. These apps should offer compliance with HIPAA and other relevant regulations, ensuring that all communication meets the highest standards of privacy and security. Additionally, healthcare providers should seek out solutions that integrate seamlessly with existing IT infrastructure and clinical workflows to ensure that the adoption of secure messaging apps enhances, rather than disrupts, patient care and operational efficiency.

The urgency of safeguarding messaging data within the healthcare sector cannot be overstated, mainly because of its profound implications for patient confidentiality and the integrity of medical operations. As the industry shifts from traditional, less secure communication tools like pagers, the need to rapidly adopt secure messaging solutions becomes paramount. This evolution is about embracing new technologies and signifies a more profound commitment to ensuring the highest patient care and data protection standards. Secure messaging platforms offer a robust shield for Patient Health Information (PHI), enhance operational efficiency, and ensure adherence to stringent regulatory frameworks. Moreover, this transition indicates the healthcare industry’s proactive stance toward leveraging digital innovations to foster a secure, efficient, and compliant communication environment. By integrating secure messaging applications, healthcare organizations demonstrate a dedication to protecting sensitive patient data and position themselves at the forefront of digital healthcare transformation. This commitment is essential in building trust with patients and stakeholders, affirming that patient privacy and data security remain paramount in our increasingly digital world.

About the Author

Mack Jackson Jr. is the CEO of Vanderson Cyber Group. In the age of global cyber threats, Vanderson Cyber Group helps businesses protect themselves from cyberattacks by teaching them cybersecurity awareness. Vanderson Cyber Group uses state-of-the-art practices in security policy development and comprehensive employee training. One of the essential services is phishing simulation and compliance training, which keep employees up-to-date on the threat landscape. Vanderson Cyber Group also provides resources for cyber insurance, managed services, and legal representation. For more information, visit: http://www.vandersoncybergroup.com or http://mackjacksonjr.com

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Mack Jackson Jr

Mack Jackson Jr, is a cybersecurity speaker, TV host, and author. He brings increased awareness to his audiences on cybersecurity and cybercrime protection.