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Can an on-call physician specialist's refusal to come to the emergency room lead to a malpractice case? Although some jurisdictions have considered the on call agreement between a physician and his/her hospital enough to establish a physician-patient relationship between the patient in the emergency room and the on call doctor, most courts rule along the lines that if the doctor never provided any care, treatment or advice concerning the patient's condition, the requirement of establishing a physician-patient relationship had not been met.

Washington - Dermatologists who have lagged behind in embracing technology need to be aware that the federal government is pressing forward with an initiative launched by the Medicare Modernization Act of 2003 (MMA) to implement a national system of electronic prescribing.

In a report to Congress released in April, Health and Human Services (HHS) Secretary Michael Leavitt said three electronic prescribing standards tested in an e-prescribing pilot project sponsored by the Centers for Medicare and Medicaid Services (CMS) are capable of supporting transactions in Medicare Part D.

HHS said the standards involve transactions that will provide physicians with patients' formulary and benefit information, medication history and the fill status of their medications.

The report also found that, with some adjustments, e-prescribing could work successfully in long-term care settings.

Some of the initial e-prescribing standards tested by the pilot project were found to have potential, but HHS says they still need further development if they are to be adopted. They include standards to convey structured patient instructions, a terminology to describe clinical drugs and messages that convey prior authorization information.

Pilot specifics, findings

The pilot project, conducted in cooperation with the Agency for Healthcare Research and Quality (AHRQ), selected five pilot sites operating in eight states to test initial standards to determine if they were ready for widespread adoption.

The sites were Achieve Healthcare Information Technologies, LLP, Eden Prairie, Minn.; Brigham and Women's Hospital, Boston; Rand Corp., Santa Monica, Calif.; SureScripts, LLC, Alexandria, Va.; and University Hospitals Health System, Cleveland.

The report to Congress said that a shift to electronic prescribing systems could avert more than 2 million adverse drug events annually, 130,000 of which are life-threatening. It said e-prescribing also has "enormous potential to create savings in healthcare costs, through reduction of adverse drug events and improved workflows."

The study estimated potential savings of $27 billion a year in the United States.

Congress mandated the establishment of standards for the electronic transmission of prescriptions and other information for covered Part D drugs prescribed in the new Medicare drug program. Although physicians are not required to write prescriptions electronically, if they do, they must use the adopted e-prescribing standards.

Support, compliance

Under the MMA, prescription drug plan sponsors, Medicare Advantage organizations offering Medicare Advantage-Prescription Drug plans and other Part D sponsors must support and comply with electronic prescribing standards when communicating with prescribers who want to use e-prescribing technology.

According to HHS, the use of interoperable health information technology will benefit individuals and the healthcare system as a whole in "profound" ways including:

In 2006, the Certification Commission for Healthcare Information Technology (IT) certified the first 37 ambulatory - or clinician office-based - electronic health record products. The commission's seal of approval is awarded to products that meet the established criteria for functionality, security and interoperability. Certification encourages adoption of health IT by assuring providers that their systems can be a part of the future of health IT, according to HHS.

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