Dr. Greybeard, prior to deciding on his course of action, elects to consult with the pharmacist on duty about the proposed order. He asks his question in the secure pharmacy chat room used by all hospital pharmacists. A responding pharmacist recommends an alternate antibiotic formulation. Dr. Greybeard then proceeds to modify the CDS recommended order based on his discussion with the pharmacist, selecting a new formulation from a list of orderables (catalog) presented to him. Upon filling the medication order, a pharmacy tech questions the dosage recommended by Dr. Greybread and seeks confirmation from the doctor prior to continuing with the medication dispense. The tech uses a VOIP text-to-voice messaging tool to call Dr. Greybeard’s his office phone with a brief message. When Dr. Greybeard does not answer his phone, the system escalates to an SMS message sent to his registered SMS-enabled mobile device. Upon receiving the text, Dr. Greybeard confirms that the dosage is correct by return texting “YES” and the tech proceeds to fill the order. The communication between the three providers is recorded and documented/linked to the patient’s file as a monitored conversation. | 
