Along with stethoscopes and scrubs, pagers are one of those enduring signs of the medical provider. With rhe ubiquity of ultrasounds threatening the stethoscope, pagers may be the next indomitable sign to fall. TigerText, a HIPAA compliant text messaging app, has a lot of potential for improving how providers communicate with each other. The app also provides many benefits that a traditional pager cannot match. However, it will require a culture change before adoption spreads more widely.

Introduction

TigerText is a secure enterprise text messaging platform that meets HIPAA requirements for electronic communication. According to their developers’ website, more than 4,000 healthcare organizations are using it in some form. Tiger Text can be used by an organization to communicate protected patient health information, send media such as pictures and video, or send group texts to multiple providers.

At my hospital, we have been using TigerText since early this year, but use spiked in April when Anonymous attacked our network, forcing our paging system offline. TigerText was an easy and effective way to maintain communication although there was suspicion, never directly confirmed by patients or their families, that seeing providers using their smartphones instead of pagers would be seen as disrespectful or worse.

User Interface

The first time you set up Tiger Text, one logs in with their enterprise user name and password. The app downloads the directory used by the enterprise (if it is ActiveDirectory, LDAP, or eDirectory), enabling you to send TigerTexts via email to anyone in your organization or personal address book or directly via Tiger Text to those who have the app.

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The app opens to the main messaging page, which has a clean interface that is simple and intuitive to anyone who has used an SMS or Wifi based messaging app like like Apple’s “iMessages” or “WhatsApp.”  When starting a message, you can send to an individual or to a group. Texts can last up to 10 days (the duration can be set by your organization). In addition, you can forward messages and see if it has been delivered or if it has been read. You can also elect to send videos, photos, audio notes through Tiger Text – all HIPAA compliant.

When push notifications are enabled, the app will send you a notice that you have a new TigerText to review. Groups can be easily created with multiple members, which was extremely useful to my ward team as everyone from attendings to interns could communicate together. Tiger Text can also be integrated into EMR, although that was not something that my institution had enabled, and users can also log into the Tiger Text website to send and receive messages online.

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Tiger Text can be customized, both by the enterprise and the user. Either group can set how long to keep messages and whether to require a PIN to log into the app. Users can choose an avatar and alert sounds (there are a number of alert sounds, including a “growl,” fitting for an app called Tiger Text). Users can also set the the app to “do not disturb” or type out a status message when unavailable.

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Overall, the app functioned quite well — it did crash on occasion, but that was relatively rare. It did have some difficulty in differentiating between my personal and enterprise address book for people who were in both (usually this happened when my personal address book was accidentally selected in the messaging tab), but other than that it worked fairly seamlessly.

When in with patients, however, I did feel self-conscious using the app since it seemed I was checking my smartphone for personal use in front of families. Older providers and nurses who were not used to checking their phones frequently during the day also reported not liking to communicate with Tiger Text, especially for more urgent communication.

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There is also a Pro version, with a slightly different user interface that includes the ability to send files through the app. However, many of the features of the Pro version have been incorporated into the standard TigerText and the Pro version has not been updated in nearly a year. It is unclear from the App Store or from the TigerText website if the Pro version is still being updated.

Healthcare providers that would benefit from the app

  • Any healthcare provider who communicates PHI frequently.

Patients that may benefit from app

Unclear if there is patient communication functionality but, if there is, it can also enable better patient communication with their providers (e.g,. texting brief questions).

  • Price
    • The app itself is free, however enterprises must sign up for the app to be most functional
    • Ability to send texts containing PHI safely
    • Ease of use
    • Ability to communicate with groups of providers
  • Dislikes
    • Lack of common contacts list (i.e., lack of integration of personal and enterprise contacts)
  • Overall
    • Tiger Text has the potential to radically change how providers communicate, but like every culture change in medicine it will take time and a shift in attitudes about smartphone use on the wards.
    • I do think that it has made me more effective but it also made me more self-conscious about how I communicate, in particular using my smartphone around patients.
    • Overall, I would strongly recommend Tiger Text but perhaps with the caveat that it may take some adjustment before it is widely adopted.
  • Overall Score
  • User Interface

    Clean interface that is simple and intuitive to anyone who has used an SMS or Wifi based messaging app

  • Multimedia Usage

    You can also elect to send videos, photos, audio notes through Tiger Text – all HIPAA compliant.

  • Price

    Functionality is good in free version but requires subscription at enterprise level

  • Real World Applicability

    Real potential to improve clinical communication

  • Device Used For Review

    iPhone 5

  • Available for DownloadAndroidiPhone