Tired of carrying around pagers, doctors at Emory University hospital wanted to receive pages on their BlackBerries, iPhones and Androids. After all, the pager seemed like a relic compared to today's smartphones running cool apps and trading tons of messages over a beautiful touch screen.Many doctors wondered why the IT department couldn't just flip a switch and send pages to cell phones. "There's lots of underlying issues that have to be worked out," says Jay Flanagan, senior manager of the messaging team at Atlanta-based Emory University.Flanagan knows all about the pages-to-cell phone swap. He's midway of a three-year journey to retire some 6,000 pagers, mostly used by medical staff at the university's hospital. So far, 850 users are in the piloting phase of the program.What's taking so long? Flanagan must deal with a host of issues, such as spotty carrier coverage on campus, messaging reliability and device-replacement policies. Meanwhile, many of the technical hurdles are still being worked out by the university's paging vendor, Amcom Software."[Smartphones] are a kind of tidal wave going across the medical community," says Chris Heim, CEO of Amcom. "We're making a substantial increased investment in Amcom Mobile Connect to the tune of a million dollars over the next couple of years."Notoriously adverse to new technology, doctors have made an about-face when it comes to smartphones. Last year, market researcher Manhattan Research reported that 64 percent of U.S. physicians own smartphones. This figure will jump to 81 percent in 2012, predicts Manhattan. Expect to see doctors walking around with a stethoscope and smart mobile device.Super Smart SmartphoneAt Emory University hospital, doctors love their smartphones. One of the most popular iPhone apps is Epocrates (free), a mobile drug reference resource. Other medical reference apps are also now at a doctor's fingertips.Technically speaking, smartphones have many advantages over the pager. For starters, smartphones have built-in encryption making them more secure than pagers. Another key advantage: Smartphones can both send and receive messages whereas a pager only receives messages. This means that the smartphone can let IT know if a message was received and even opened.Also, if a smartphone is out of coverage, the message will be delivered as soon as the smartphone gains coverage. An out-of-coverage pager, on the other hand, won't receive the original message. "With pagers, it's kind of fire and forget," says Heim. "You're sending it out there and hoping it was received."Smartphones give IT an audit trail of every outgoing message. Since hospital pages tend to be emergencies, it's critical to know if a doctor received the page or not. If not, the hospital can decide to send a message to another doctor. Additionally, patient case reviews have access to the turn of events from a messaging standpoint.Reliability, Reliability, ReliabilityNevertheless, pagers have proven to be reliable technology over the years while new-fangled smartphones still have quirks to work out. Given the importance of hospital pages, can smartphones pass the reliability test?"My biggest concern was the reliability across all the different types of carriers and phones," Flanagan says. "No matter what kind of device, doctors must get the message. Many pages are time sensitive for critical patient situations, so there must be fast delivery."In the service-level agreement with Amcom, Flanagan specified that a message must be received by the smartphone in less than 30 seconds.Flanagan and Heim also had to figure out ways to make sure doctors hear the alert on their smartphones. Pagers are always attached at the hip where doctors really can't miss them. But smartphones tend to find their way into purses or be left on desks. Even worse, a smartphone usually lets out a single ping to indicate a message that often goes unnoticed by the owner.So Amcom built in some features to mitigate these problems. Amcom's paging system, Mobile Connect, lets administrators override settings. A message marked urgent will have an audible tone (even if the phone is on silent mode) that keeps ringing until someone acknowledges it.The Long Coverage CoughFlanagan says he could move everyone off pagers tomorrow\u2014if everyone was on Verizon. Reliable multi-carrier coverage is the problem that pushes pager-replacement programs years out.It's not that Verizon is better than AT&T (although by many accounts, it is) or Sprint or T-Mobile. Rather, Emory University's system is already set up on Verizon. Verizon coverage has been thoroughly tested throughout the hospital. There's even a Verizon rep on campus ready to hand out replacement phones in case a phone becomes damaged.Thus, Emory University guarantees delivery of messages to Verizon smartphones. For other carriers, most notably AT&T, which has an exclusivity arrangement with the iPhone, it's a different story. Currently, messages aren't guaranteed but they'll need to be over the next couple of years."In some cases, you don't have the cell phone coverage by carrier across every area of the hospital," Heim says. "So you have to build fail-safes into the software. If this message doesn't get through, can you communicate this via a second method and get it over to that smartphone?"Both Flanagan and Heim will be working through these kinds of issues in order to ensure messaging reliability for all carriers and devices. "The myth is that tomorrow I'm going to switch 100 percent of my users to smartphones," Heim says, "and that's not going to happen."iPhone, Heal ThyselfThis summer, Apple released the much-hyped iPhone 4, and people (including doctors) lined up to get one. A few weeks later, reports of antennae problems surfaced, followed by slow reaction from Cupertino. The media dubbed this "antennagate," which prompted Apple CEO Steve Jobs to call a press briefing and give a half-hearted mea culpa.At the time, Amcon was working on its iPhone piece for Mobile Connect and Flanagan was readying the iPhone for the pilot project. Reliability being the central issue at Emory University's page-to-cell program, antennagate couldn't have been good news.Like everything Apple, antennagate proved to be more hype than truth. Nevertheless, it was a sobering reminder that smartphones are still in their infancy compared to the venerable pager. "It's something we're just going to have to deal with," Flanagan says. "Doctors want their BlackBerries, iPhones and now Androids."Another issue that has cropped up: Smartphones tend to break more than the hardy pager. (Check out 5 Strange Ways iPhones Die: Insurer Hears it All.)If a pager breaks, Flannagan would immediately give the doctor a spare pager. Quickly getting a new iPhone with the doctor's same cell number, however, isn't so easy. "We're working on policies right now on how best to do that," he says.If all else fails, Flanagan can always return to the tried-and-true pager, right? Nope. That exit has been shut, says Flanagan. Virtually everyone in the 850 pilot program told Flanagan, "We don't ever want to see our pagers again," he says. Tom Kaneshige covers Apple and Networking for CIO.com. Follow Tom on Twitter @kaneshige. Follow everything from CIO.com on Twitter @CIOonline. Email Tom at email@example.com.