Abstract: A server facilitates and tracks a request for a change in patient care from a nurse and a responsive directive regarding that care from a physician as a transaction. Upon completion of the transaction by the physician in providing the responsive directive, the server automatically compensates the physician for processing the request. The server can require acknowledgment from the nurse that the responsive message was substantively responsive before declaring a transaction complete and therefore before compensating the physician for the response. Each user, whether a nurse or physician, can specify both (i) a schedule of days and times the user is scheduled to be available and (ii) one or more alternate users to which matter should be referred in times at which the user is not scheduled to be available.