Table 1. Pros and cons of different secure messaging application tiers.

Tier level and applications	Pros	Cons
Tier 1 • HIPAACHAT • Tigertext free edition	• Secure communication platform • Inexpensive/free	• No functionality to help with workflow • Minimal functionality to improve communication • Might be difficult to get full adoption due to minimal functionality
Tier 2 • CareAware Connect (Cerner secure messaging) • Cores secure messaging • Epic secure messaging • Medisas • miSecureMessages (AMTELCO) • Mobile Heartbeat • TeamStitch	• Secure communication platform • Potentially easier to implement if you already use native system extensively (i.e., Cerner or Epic) • Some offer functionality to help with hospital workflow and communication • Well integrated with existing native system • Vendors may have been in the health care sector for long periods of time.	• Additional licensing costs for messaging functionality • Difficult to integrate across multiple different clinical applications • Less advanced functionality (system-dependent) • Unclear how vendors will prioritize support and development of messaging functionality compared with native application • Ability to customize or integrate with third party systems uncertain
Tier 3 • Cureatr • Doc Halo • Imprivata Cortext • PatientSafe Solutions • PerfectServe • Spok Care Connect • Tigertext enterprise edition • Voalte • Vocera • Zipit Wireless	• Secure communication platform • Intended to be integrated communication platform across entire health system. Solely dedicated to this area, offer good support. • Offers extensive functionality to help with hospital workflow and communication • Offers the highest functionality, including integration with electronic health records, laboratory, scheduling, nurse call alerts, monitor alerts, etc. • Most customizable to meet specific workflow needs or integrate with third party systems.	• Most expensive option • May require additional time/expense to integrate with other clinical applications to leverage advanced functionality Note: Vendors in this space are relatively new, and the market is evolving (uncertain which vendors will thrive with market maturation).