allowing cover to fax prescriptions from one's emr

[Guest guest]

i would not have someone fax prescriptions to a pharmacy "in my name" or from my emr. that's putting your liability in someone else's hands. LLAnnie Skaggs wrote: Hmmmmm…Take call for eachother…That’s an interesting idea Jean. I never really considered it before, as I never “thought outside the box” enough to even consider someone out of the area as a back up for calls… I don’t very often really get in a situation that requires a back up, though someday I might actually take a vacation. I do have a colleague in town (not an IMP, but solo) who has

agreed to see patients if needed when I am gone. She is a nice gal, and I don’t have a great deal of reason to distrust her, but I have been unwilling to let her have access to my EMR, on the oh-so-unlikely chance that she would decide to send letters to all my patients inviting them to come see her if she had access to all my data… But now, someone in, say, Maine, is far enough away that my patients are not going to leave me to go there, no matter how much they like the Maine doc….so I would not be so nervous about giving online access to my emr…. With a virtual desktop connection and passwords, a doc in a remote location could see a patient’s chart, and could also fax prescriptions to local pharmacies in my name. Still does not address the issue of what if the person really needs their lungs listened to…..but would be OK to cover about 90% or more of calls that come in, at least as a temporizing measure…. I’m going to ponder this some more. What does everybody else think? Annie Re: Re: IMP practice call failureThanks for the virtual wall of support and feedback. You guys are so wonderful. As Brady pointed out in his usual pithy way some timeago, although I am solo, I am definitely not alone.I just hate it when the really old, young, or vulnerable fall throughthe cracks.I can't help perseverating somewhat about those extra 12 hours of hypothermia. I am sure that is generally not good for you at age 87.Of course I know I should take vacations, but - oy vey! there can be aprice to pay.I think I need to get my home phone number out of the public eye. I gaveout that number before, in case my cell phone was off while I was at home,and in case of cell phone failure, but now think I need to change

that. Certainly children answering the phone is another place where messagescould disappear. I think I also need to add that line to my answering machines/messages that instructs people to please call 911 if this is a medical emergency. (It seemed blatantly obvious/alarmist to me before,but I guess it is not.) I wonder if I should look into a onebox phonesolution, even though it sounds expensive and somewhat complex, but would I haveto remember to forward it everytime I move my physical location? Soundslike I could easily screw that one up! Sounds like I also need to review how tocontact me with patients during the first (and subsequent visits). Ithink the contact me emergency sheet is a good idea for a patient handout, Iam going to develop one.It's a process...Lynn__________________________________________________________The average US

Credit Score is 675. The cost to see yours: $0 byExperian. http://www.freecred<http://www.freecreditreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOTERAVERAGE> itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOTERAVERAGE

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[Guest guest]

I

don’t share in a call group anymore, but when I did, on weekends I would

be taking call for a dozen family docs and a couple NPs/PAs

and >99% of the calls were for patients I had never seen before, and often

whose charts were locked up in some building I had no key to, even if I was

willing to drive 30 miles to another town to look. I just had to do the best I could, and

not infrequently phoned in prescriptions for new problems because that was the

best I could do under the circumstances and that was the “standard”. I think they still do it that way.

Now why, just because of state licensing

issues, would it be better for patients to have a local doc with no access to

info treat them over the phone, than it would be for in Maine to talk to

them on the phone, while she had access to see their entire chart on line to

treat them, or if based on the info in the chart she can identify people who

really should go to the ER or UTC?

I’m not arguing that there may not be

laws against such over state lines, but thinking just in terms of what is

commonly done, and what is better for the patient, I would vote for looking

at the chart over LMD with no info except what the patient tells him…

Just musing,

Annie

Re: Re: IMP practice call failure

Thanks for the virtual wall of support and feedback. You guys are so

wonderful. As Brady pointed out in his usual pithy way some time

ago,

although I am solo, I am definitely not alone.

I just hate it when the really old, young, or vulnerable fall through

the

cracks.

I can't help perseverating somewhat about those extra 12 hours of

hypothermia. I am sure that is generally not good for you at age 87.

Of course I know I should take vacations, but - oy vey! there can be a

price

to pay.

I think I need to get my home phone number out of the public eye. I gave

out

that number before, in case my cell phone was off while I was at home,

and

in case of cell phone failure, but now think I need to change that.

Certainly children answering the phone is another place where messages

could

disappear. I think I also need to add that line to my answering

machines/messages that instructs people to please call 911 if this is a

medical emergency. (It seemed blatantly obvious/alarmist to me before,

but I

guess it is not.) I wonder if I should look into a onebox phone

solution,

even though it sounds expensive and somewhat complex, but would I have

to

remember to forward it everytime I move my physical location? Sounds

like I

could easily screw that one up! Sounds like I also need to review how to

contact me with patients during the first (and subsequent visits). I

think

the contact me emergency sheet is a good idea for a patient handout, I

am

going to develop one.

It's a process...

Lynn

__________________________________________________________

The average US Credit Score is 675. The cost to see yours: $0 by

Experian.

http://www.freecred <http://www.freecred/>

< http://www.freecred

<http://www.freecreditreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

> itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

ERAVERAGE> itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOTERAVERAGE

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[Guest guest]

I am not in any call groups any longer either. I just take call

for myself 24/7. I frequently go to San Diego where my parents, who

are in their mid 80s, live. From where

I live in Tulare, it's about 300 miles, and I just cover my own calls

from there by cellphone. I can get into my EMR from away if I can get

on-line, and I can fax Rx's and check records if I need to. In fact, I

went there this weekend. I got one call over the weekend. My stress

level is so much better than when I was in a 6 doctor call group with

high practice volume docs! I would stress out so much anticipating the

upcoming night or weekend on call that even the 5 days off was not

enough to mentally recover.

The only problem I still have is that I'm on the hospital staff,

so if I have a patient in house when I leave, or I get an admission

through the ER, I do have a problem. We have a back up ER call

system that we get paid for 2 times a month and I've asked several

of the people in that ER back up system if they would mind if

one of my patients came in while I was gone to do the admission

and follow them until I get back. Most have said it was fine, since

they are on call anyway, and they get paid by the hospital, plus

if my patient has insurance, they can also bill the insurance. We

don't have any full time hospitalists at our facility.

Caldwell

Tulare, CA

>

> Hmmmmm...Take call for eachother...That's an interesting idea Jean. I

> never

> really considered it before, as I never " thought outside the box " enough

> to even consider someone out of the area as a back up for calls...

>

> I don't very often really get in a situation that requires a back up,

> though someday I might actually take a vacation. I do have a colleague

> in town (not an IMP, but solo) who has agreed to see patients if needed

> when I am gone. She is a nice gal, and I don't have a great deal of

> reason to distrust her, but I have been unwilling to let her have access

> to my EMR, on the oh-so-unlikely chance that she would decide to send

> letters to all my patients inviting them to come see her if she had

> access to all my data... But now, someone in, say, Maine, is far enough

> away that my patients are not going to leave me to go there, no matter

> how much they like the Maine doc....so I would not be so nervous about

> giving online access to my emr....

> With a virtual desktop connection and passwords, a doc in a remote

> location could see a patient's chart, and could also fax prescriptions

> to local pharmacies in my name. Still does not address the issue of

> what if the person really needs their lungs listened to.....but would be

> OK to cover about 90% or more of calls that come in, at least as a

> temporizing measure....

>

> I'm going to ponder this some more. What does everybody else think?

> Annie

>

> Re: Re: IMP practice call failure

>

> Thanks for the virtual wall of support and feedback. You guys are so

> wonderful. As Brady pointed out in his usual pithy way some time

> ago,

> although I am solo, I am definitely not alone.

>

> I just hate it when the really old, young, or vulnerable fall through

> the

> cracks.

> I can't help perseverating somewhat about those extra 12 hours of

> hypothermia. I am sure that is generally not good for you at age 87.

>

> Of course I know I should take vacations, but - oy vey! there can be a

> price

> to pay.

>

> I think I need to get my home phone number out of the public eye. I gave

> out

> that number before, in case my cell phone was off while I was at home,

> and

> in case of cell phone failure, but now think I need to change that.

> Certainly children answering the phone is another place where messages

> could

> disappear. I think I also need to add that line to my answering

> machines/messages that instructs people to please call 911 if this is a

> medical emergency. (It seemed blatantly obvious/alarmist to me before,

> but I

> guess it is not.) I wonder if I should look into a onebox phone

> solution,

> even though it sounds expensive and somewhat complex, but would I have

> to

> remember to forward it everytime I move my physical location? Sounds

> like I

> could easily screw that one up! Sounds like I also need to review how to

>

> contact me with patients during the first (and subsequent visits). I

> think

> the contact me emergency sheet is a good idea for a patient handout, I

> am

> going to develop one.

>

> It's a process...

>

> Lynn

>

> __________________________________________________________

> The average US Credit Score is 675. The cost to see yours: $0 by

> Experian.

> http://www.freecred <http://www.freecred <http://www.freecred/> />

> < http://www.freecred

> <http://www.freecred

> <http://www.freecreditreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

> > itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

> > itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

> ERAVERAGE> itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOTERAVERAGE

>

> _____

>

> Check out the all-new Yahoo! Mail beta

> <http://us.rd.

> <http://us.rd.yahoo.com/evt=43257/*http:/advision.webevents.yahoo.com/m>

> yahoo.com/evt=43257/*http://advision.webevents.yahoo.com/m

> ailbeta> - Fire up a more powerful email and get things done faster.

>

[Guest guest]

Wow,

you get paid by the hospital to be on backup call? It is written into our hospital

by-laws that we will take backup call as part of being on staff. It is about

every couple of months I guess, but I sure don’t get paid for it!

Re: Re: IMP practice call failure

>

> Thanks for the virtual wall of support and feedback. You guys are so

> wonderful. As Brady pointed out in his usual pithy way some time

> ago,

> although I am solo, I am definitely not alone.

>

> I just hate it when the really old, young, or vulnerable fall through

> the

> cracks.

> I can't help perseverating somewhat about those extra 12 hours of

> hypothermia. I am sure that is generally not good for you at age 87.

>

> Of course I know I should take vacations, but - oy vey! there can be a

> price

> to pay.

>

> I think I need to get my home phone number out of the public eye. I gave

> out

> that number before, in case my cell phone was off while I was at home,

> and

> in case of cell phone failure, but now think I need to change that.

> Certainly children answering the phone is another place where messages

> could

> disappear. I think I also need to add that line to my answering

> machines/messages that instructs people to please call 911 if this is a

> medical emergency. (It seemed blatantly obvious/alarmist to me before,

> but I

> guess it is not.) I wonder if I should look into a onebox phone

> solution,

> even though it sounds expensive and somewhat complex, but would I have

> to

> remember to forward it everytime I move my physical location? Sounds

> like I

> could easily screw that one up! Sounds like I also need to review how to

>

> contact me with patients during the first (and subsequent visits). I

> think

> the contact me emergency sheet is a good idea for a patient handout, I

> am

> going to develop one.

>

> It's a process...

>

> Lynn

>

> __________________________________________________________

> The average US Credit Score is 675. The cost to see yours: $0 by

> Experian.

> http://www.freecred <http://www.freecred <http://www.freecred/> />

> < http://www.freecred

> <http://www.freecred

> <http://www.freecreditreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

> > itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

> > itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

> ERAVERAGE> itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOTERAVERAGE

>

> _____

>

> Check out the all-new Yahoo! Mail beta

> <http://us.rd.

> <http://us.rd.yahoo.com/evt=43257/*http:/advision.webevents.yahoo.com/m>

> yahoo.com/evt=43257/*http://advision.webevents.yahoo.com/m

> ailbeta> - Fire up a more powerful email and get things done faster.

>

[Guest guest]

Well it's actually a fairly new thing here. I started here in

1983. The ER backup call was always mandatory as a condition

of being on the hostpital staff, and non-reimbursed until about 2

years ago. You were allowed to opt out at age 60.

They decided to make call voluntary about 2 years ago and felt

they needed to make it reimbursed in order to attract

enough volunteers. It seems to be working, as they have not had

problems getting people to volunteer to be on the schedule. They

were basically following the lead of a nearby somewhat larger

hospital which is one of our hospital's major competitors and only

a few miles away. So they were afraid of losing doctors who would

drop off the staff because of the non-reimbursed ER backup and send

their patients to the other hospital. I'm not sure what the impact

has been on the hospital financial picture, but it seems to be

surviving so far.

From my standpoint, it makes it much more palitable to

admit " self-pay " patients. And when they turn out to actually

have insurance in a few cases, it doesn't seem too bad at all.

The regular check did help me when I split off from my former

group a while back and started my own solo office. Also when

Medicare held my payments for 3 months when I changed my tax

ID no. I just moved out of my former building over this past

Christmas week into a new building

that was a former dentist's office. When I notified Medicare of the

address change, they have again been holding my payments for

over 8 weeks. So the ER call check has really helped keep me afloat

(barely).

I wish I could get retroactive pay for the 22 years I did

it for free!

Caldwell

Tulare, CA

> >

> > Hmmmmm...Take call for eachother...That's an interesting idea

Jean. I

> > never

> > really considered it before, as I never " thought outside the

box " enough

> > to even consider someone out of the area as a back up for

calls...

> >

> > I don't very often really get in a situation that requires a

back up,

> > though someday I might actually take a vacation. I do have a

colleague

> > in town (not an IMP, but solo) who has agreed to see patients if

needed

> > when I am gone. She is a nice gal, and I don't have a great deal

of

> > reason to distrust her, but I have been unwilling to let her

have access

> > to my EMR, on the oh-so-unlikely chance that she would decide to

send

> > letters to all my patients inviting them to come see her if she

had

> > access to all my data... But now, someone in, say, Maine, is far

enough

> > away that my patients are not going to leave me to go there, no

matter

> > how much they like the Maine doc....so I would not be so nervous

about

> > giving online access to my emr....

> > With a virtual desktop connection and passwords, a doc in a

remote

> > location could see a patient's chart, and could also fax

prescriptions

> > to local pharmacies in my name. Still does not address the issue

of

> > what if the person really needs their lungs listened to.....but

would be

> > OK to cover about 90% or more of calls that come in, at least as

a

> > temporizing measure....

> >

> > I'm going to ponder this some more. What does everybody else

think?

> > Annie

> >

> > Re: Re: IMP practice call failure

> >

> > Thanks for the virtual wall of support and feedback. You guys

are so

> > wonderful. As Brady pointed out in his usual pithy way some

time

> > ago,

> > although I am solo, I am definitely not alone.

> >

> > I just hate it when the really old, young, or vulnerable fall

through

> > the

> > cracks.

> > I can't help perseverating somewhat about those extra 12 hours

of

> > hypothermia. I am sure that is generally not good for you at age

87.

> >

> > Of course I know I should take vacations, but - oy vey! there

can be a

> > price

> > to pay.

> >

> > I think I need to get my home phone number out of the public

eye. I gave

> > out

> > that number before, in case my cell phone was off while I was at

home,

> > and

> > in case of cell phone failure, but now think I need to change

that.

> > Certainly children answering the phone is another place where

messages

> > could

> > disappear. I think I also need to add that line to my answering

> > machines/messages that instructs people to please call 911 if

this is a

> > medical emergency. (It seemed blatantly obvious/alarmist to me

before,

> > but I

> > guess it is not.) I wonder if I should look into a onebox phone

> > solution,

> > even though it sounds expensive and somewhat complex, but would

I have

> > to

> > remember to forward it everytime I move my physical location?

Sounds

> > like I

> > could easily screw that one up! Sounds like I also need to

review how to

> >

> > contact me with patients during the first (and subsequent

visits). I

> > think

> > the contact me emergency sheet is a good idea for a patient

handout, I

> > am

> > going to develop one.

> >

> > It's a process...

> >

> > Lynn

> >

> > __________________________________________________________

> > The average US Credit Score is 675. The cost to see yours: $0 by

> > Experian.

> > http://www.freecred <http://www.freecred <http://www.freecred

> <http://www.freecred/> /> />

> > < http://www.freecred

> > <http://www.freecred

> > <http://www.freecred

> <http://www.freecreditreport.com/pm/default.aspx?

sc=660600 & bcd=EMAILFOOT>

> itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

> > > itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

> > > itreport.com/pm/default.aspx?sc=660600 & bcd=EMAILFOOT

> > ERAVERAGE> itreport.com/pm/default.aspx?

sc=660600 & bcd=EMAILFOOTERAVERAGE

> >

> > _____

> >

> > Check out the all-new Yahoo! Mail beta

> > <http://us.rd.

> > <http://us.rd.

>

<http://us.rd.yahoo.com/evt=43257/*http:/advision.webevents.yahoo.com

/m>

> yahoo.com/evt=43257/*http:/advision.webevents.yahoo.com/m>

> > yahoo.com/evt=43257/*http://advision.

> <http://advision.webevents.yahoo.com/m> webevents.yahoo.com/m

> > ailbeta> - Fire up a more powerful email and get things done

faster.

> >

>

[Guest guest]

I am actually somewhat surprised myself that it is so far working as

well as it is. A few years ago, I too would not have thought it

would work to make the call voluntary.

I've been here for 23 years. The staff has changed a lot in that

period of time. The older docs and administrators of the WWII

generation would never have bought into the concept, but they are

all gone now. We have a bunch of new people now from a younger

generation. I'm somewhere between.

I think there is somewhat of a trend to this voluntary call idea at

least in California. As I mentioned in prev. post, there is a

nearby hospital about 8 miles away that went to a voluntary system a

couple of years before we did, and many of the docs are on the

staff at both hospitals.

There are an couple of articles here about a study done by the

Calif. Medical Association about ER Backup services in Calif.

http://www.csus.edu/calst/government_affairs/reports/Emergency_Room_O

n-Call_Coverage.pdf

http://www.usc.edu/schools/sppd/research/healthresearch/images/pdf_re

portspapers/On%20Call%20Physicians%20At%20CA%20Emergency%20Depts.pdf

Our administrator feels that he tries to work closely with

doctors. I think there was some pressure to match what the

other hospital was doing in order to keep them happy. We also have

2 physicians on our board of directors, who ultimately were

the ones that approved the reimbursement, although it

was the Medical Staff By-Laws that had to be changed to remove

the requirement for ER backup as a requirement of staff

membership. The administrator really had no power to stop the

Medical Staff from changing the By-Laws, but without the

reimbursement from him and the board of directors, I'm sure it

would not have worked. Only time will tell how it all works out

in the longer run. There is bound to be an effect on the

The main issue we have actually had is not the idea of the

call being voluntary or the idea of reimbursement itself, but

rather the relative value of taking call for one specialty

vs. another, i.e. is a pediatrician night on call equal to

an F.P. or an Internal Med? Our surgeons have agreed to take 10

nights on call a month, but we only have 2 on active staff, so

the hospital has been paying to get a locum tenans to take

the other 10 days of the month.

Caldwell

Tulare, CA

> > > >

> > > > Hmmmmm...Take call for eachother...That's an interesting

idea

> > Jean. I

> > > > never

> > > > really considered it before, as I never " thought outside the

> > box " enough

> > > > to even consider someone out of the area as a back up for

> > calls...

> > > >

> > > > I don't very often really get in a situation that requires a

> > back up,

> > > > though someday I might actually take a vacation. I do have a

> > colleague

> > > > in town (not an IMP, but solo) who has agreed to see

patients if

> > needed

> > > > when I am gone. She is a nice gal, and I don't have a great

deal

> > of

> > > > reason to distrust her, but I have been unwilling to let her

> > have access

> > > > to my EMR, on the oh-so-unlikely chance that she would

decide to

> > send

> > > > letters to all my patients inviting them to come see her if

she

> > had

> > > > access to all my data... But now, someone in, say, Maine, is

far

> > enough

> > > > away that my patients are not going to leave me to go there,

no

> > matter

> > > > how much they like the Maine doc....so I would not be so

nervous

> > about

> > > > giving online access to my emr....

> > > > With a virtual desktop connection and passwords, a doc in a

> > remote

> > > > location could see a patient's chart, and could also fax

> > prescriptions

> > > > to local pharmacies in my name. Still does not address the

issue

> > of

> > > > what if the person really needs their lungs listened

to.....but

> > would be

> > > > OK to cover about 90% or more of calls that come in, at

least as

> > a

> > > > temporizing measure....

> > > >

> > > > I'm going to ponder this some more. What does everybody else

> > think?

> > > > Annie

> > > >

> > > > Re: Re: IMP practice call

failure

> > > >

> > > > Thanks for the virtual wall of support and feedback. You

guys

> > are so

> > > > wonderful. As Brady pointed out in his usual pithy way

some

> > time

> > > > ago,

> > > > although I am solo, I am definitely not alone.

> > > >

> > > > I just hate it when the really old, young, or vulnerable

fall

> > through

> > > > the

> > > > cracks.

> > > > I can't help perseverating somewhat about those extra 12

hours

> > of

> > > > hypothermia. I am sure that is generally not good for you at

age

> > 87.

> > > >

> > > > Of course I know I should take vacations, but - oy vey!

there

> > can be a

> > > > price

> > > > to pay.

> > > >

> > > > I think I need to get my home phone number out of the public

> > eye. I gave

> > > > out

> > > > that number before, in case my cell phone was off while I

was at

> > home,

> > > > and

> > > > in case of cell phone failure, but now think I need to

change

> > that.

> > > > Certainly children answering the phone is another place

where

> > messages

> > > > could

> > > > disappear. I think I also need to add that line to my

answering

> > > > machines/messages that instructs people to please call 911

if

> > this is a

> > > > medical emergency. (It seemed blatantly obvious/alarmist to

me

> > before,

> > > > but I

> > > > guess it is not.) I wonder if I should look into a onebox

phone

> > > > solution,

> > > > even though it sounds expensive and somewhat complex, but

would

> > I have

> > > > to

> > > > remember to forward it everytime I move my physical

location?

> > Sounds

> > > > like I

> > > > could easily screw that one up! Sounds like I also need to

> > review how to

> > > >

> > > > contact me with patients during the first (and subsequent

> > visits). I

> > > > think

> > > > the contact me emergency sheet is a good idea for a patient

> > handout, I

> > > > am

> > > > going to develop one.

> > > >

> > > > It's a process...

> > > >

> > > > Lynn

> > > >

> > > > __________________________________________________________

> > > > The average US Credit Score is 675. The cost to see yours:

$0 by

> > > > Experian.

> > > > http://www.freecred <http://www.freecred <http://www.freecred

> > > <http://www.freecred/> /> />

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