Meet Dr. Don Fitch: Small Town Icon and MAFP’s “Family Physician of the Year” for 2011

If Hollywood’s Central Casting put out a call for the ideal family physician—one who was devoted to his patients, his family, his community, his calling as a healer, and who consistently exhibited such traits as unlimited patience, a sense of humor, superb listening skills, and enthusiasm—the search would stop with Dr. Donald Fitch.

The Escanaba family practitioner is—and always has been—that kind of doctor: The kind of physician Baby Boomers will remember from the movies they watched as kids. The cinema doctor who was a friend of the family, frequent guest for dinner, compassionate dispenser of care and wisdom, golf partner, and community leader—someone who was there to rejoice with at the beginning of a new life, and to shed a tear with when one ended.

Dr. Fitch is the family physician we all wish we had, and that so many residents in Escanaba in Michigan’s Upper Peninsula are glad they did have.

So it’s no surprise that Dr. Fitch, who recently retired after 49 years of serving patients, is a natural choice for the MAFP “Family Physician of the Year” for 2011.

The philosopher Pascal said that “the strength of a man’s virtue should not be measured by his special exertions but by his habitual acts,” and Dr. Fitch’s colleagues, neighbors, friends, and patients would agree. Throughout the years that he practiced family medicine and led his life in this small town, they’ll tell you that he habitually exhibited the virtues of the Eagle Scout and Boy Scout leader that he is.

Dr. Fitch’s Escanaba and Upper Peninsula friends and colleagues universally describe him as “caring, committed, enthusiastic, patient, dedicated, humorous, one-of-a-kind, an icon, respected, dependable, kind, strong, loyal, compassionate, a small town hero, humble, always positive…” Even what others might view as a tiny fault could really be seen as a virtue. “He was always running a little late because he never cut anyone off when they wanted to tell their story,” says a co-worker. “He always made time to listen.”

Dr. Frederick Hoenke, vice president and medical director for Marquette General Health System, who’s known Fitch for more than 15 years, says he spent some time thinking about all the positive adjectives he could use to describe his friend. “There are so many it’s ridiculous.”

He refers to Dr. Fitch as “the last of a breed that you won’t likely see again—a truly dedicated, small town family physician. I think of him as the epitome of a small town hero like George Bailey in the film ‘It’s A Wonderful Life.’”

The big difference between the two is that— unlike George Bailey, who was itching to get out of Bedford Falls to make his mark on the world— Dr. Fitch wholeheartedly embraced small town life.

A native of Minneapolis, Dr. Fitch obtained his medical degree from the University of Michigan. He met his wife, Paddy, on a blind date in the 1950s. They married in 1960 and headed west, where the young physician served a stint with the U.S. Public Health Service before a new opportunity came knocking. A friend and colleague, Dr. Ramond Hockstad suggested that Fitch join him in putting a practice together in Michigan’s Upper Peninsula.

With a population nowadays of just over 13,000, Escanaba seemed like heaven on earth to the young Fitches, who enjoy the great outdoors. It’s a place where a couple can raise a family, work hard, and make a difference in the lives of the people who live there.

That’s exactly what they did, launching Doctors Park Family Physicians in 1962, and then building a practice that over the years has served thousands of patients and generations of families. The Fitches—who raised three sons, Bob, Russ and Gordy— were also instrumental in bringing a YMCA to the community, active in Boy Scouts, and long-time members of the First Presbyterian Church.

Over the years, Dr. Fitch was also an active member of the Delta County Medical Society, a Diplomate of the American Board of Family Practice, and a member of both the Rampart Board of Directors and the Home Health and Hospice Advisory Board of the Marquette General Health System.

In recognition of another of his passions—helping kids—Dr. Fitch received the Boy Scouts’ Hiawathaland Council’s Hall of Leadership award in 2010. More than 7,000 leaders are nominated nationally and only 300 are chosen for this recognition.

Both Dr. and Mrs. Fitch agree that Escanaba proved to be the ideal place for them. “We were so at home here immediately—it just sold itself to us,” Dr. Fitch recalls. “The best part of living here is the people. They’re wonderful to work with and be with. It’s always been that way.”

After almost a half century of serving the community as a family physician, Boy Scout leader, colleague, friend and neighbor, Dr. Fitch has made a lasting impression on generations of folks in his small town.

His pastor, Scott White, remembers a few years ago when the church hosted a missionary who came up from one of the Pacific Islands. He had poor sight because of cataracts. “Dr. Don—you could just see the wheels spinning in his head, laying out a plan,” says White. “Don gave him a lot of care to get him ready for surgery and to promote his cause within the medical community. The missionary got his sight back and the community was overjoyed to be of help.”

The fact that he was a small town family practitioner didn’t mean, however, that Dr. Fitch wasn’t a forward-thinking medical professional, always keeping abreast of advances in medicine and technology.

“He and his partners brought what we now consider as health care reform to this area—looking at the population as a whole, proactively addressing wellness, disease prevention, and management of chronic conditions—these were things Dr. Fitch was doing back in the 1960s,” says Dr. Thomas Noren, chief medical officer at Marquette General Health System & Superior Health Partners. “The only thing they didn’t have then was the information technology infrastructure that we have now that allows for better connectedness among providers.”

Dr. Noren, like so many others who’ve found themselves in his orbit, has a special place in his heart for Don Fitch.

As a senior medical student at the University of Michigan, Dr. Noren was intent on becoming a surgeon, but a 10-week externship with Doctors Park Family Physicians in 1973 changed his career trajectory. “During the time I worked with Dr. Fitch, I saw a man who was the portrait of integrity. He was compassionate, a brilliant physician and a tireless mentor—just a superb human being.”

In fact, Dr. Noren saw in Dr. Fitch everything he aspired to be as both a physician and human being. So much so that, after he completed his residency at the University of Colorado, he returned to Escanaba and practiced medicine for 11 years at Doctors Park. “I’ve continued to try to emulate him in the 38 years I’ve known him,” he says.

In “It’s A Wonderful Life,” George Bailey needed the help of a fledgling angel to show him how each man’s life touches so many other lives. Dr. Fitch doesn’t need additional guidance to know the difference he’s made in the lives of the patients he’s treated, the friends he’s made, the colleagues he’s mentored, the Boy Scouts he’s influenced, and his children, seven grandchildren, and beloved wife. Most have already told him so.

“Don is really a sterling example for younger physicians of what you can make of a career and a life,” says Dr. Hoenke. “You always hope that your life is going to matter. Don Fitch’s has. This man will leave a legacy for this community that’s second to none.”

It sometimes seems like we’re losing control of medical care, not to the traditional culprits, those cookbook-generating government agencies, but to a new culprit, our own EMR’s, EMRs paid for with our own hard-earned dollars, lured as we were by promises of increased practice efficiency and cash handouts for “meaningful use,” EMR’s steadily and insidiously altering the way we practice medicine, first by helpfully writing our patient notes, notes which are increasingly imbued with extraneous data, becoming pathetically impossible to decipher and unhelpful in the clinical setting, then by adding laboratory ordering templates, making it simple to order a multitude of expensive, recurrent labs with a few simple keystrokes, leading to a blizzard of data impossible to comprehend except for those nifty little graphing tools provided, then by re-writing multiple prescriptions for us with one keystroke, prescriptions the patient may not need and have no intention of filling, an intention unknown to the us, spending as we do most of our time pecking away at the computer keyboard, searching for screens, selecting data points, and deleting those pesky alerts about allergies or potential contraindications, alerts which are habitually ignored as a consequence of information overload, all this instead of interacting with or even looking at the warm body in front of us which is commonly referred to as a patient, an unfortunate creature not made from silicon, but from carbon, a creature increasingly bewildered by the complexities and mysteries of the medical care system, but nevertheless increasingly inclined to complain about his unhappiness with his interactions with his physician when given the opportunity by way of exit surveys as he leaves the hospital. 1

This will not do. We cannot allow this new technology, challenging as it is to deal with and important as it is to the future of medicine, to interfere with our relationship with our patient who is depending on us and needing us to give him a personal touch of care and encouragement. While realizing that computers are here to stay, while struggling with the steep learning curve involved in dealing with then, we must daily seek to tame this beast to the service of our patients. Preoccupation with silicon-based issues (computer glitches and the like) must not lead to the neglect of the carbon based (i.e. patient) issues that are our primary reason for being. Here are some ideas: 

DO:  Write an assessment at the end of your note with your own hand, expressing your summary of what is going on with patient and what you intend to do about it. This will enable other attending physicians, now and in the future, to use your note to help with ongoing care that they provide. 

DON’T: Write, under “assessment”: the words, “as above”

DO: Talk to and look at the patient periodically while you are dealing with the computer. Tell him what you are doing, and why.

DON’T: Ignore the patient for long periods while typing, leaving the patient disconnected with his doctor, free to make up his own mind about what you are doing, perhaps imagining that it has little or nothing to do with him.

As always, you, my carbon based readers, are welcome to add additional ideas by way of letters to the editor.

_______________

1 I’m compelled to point out that this rather long sentence is nonetheless intelligible because it is written by a human, not a computer. You won’t see computer-generated text in this publication while I live.

Meaningful use requirements will go through three stages over the next several years. Stage 1, focuses on the use of a certified EHR and the demonstration of performance measures to CMS.  Stages 2 and 3 will set higher goals for quality and further encourage the use of electronic health information to improve health care quality. The staged approach was created to give health care providers and EHR technology companies time to gradually build their capacity to meet these requirements. 

Stage 1
Stage 1 sets the baseline for electronic data capture and information sharing.  Stage 1 meaningful use criteria require the use of a certified electronic health record (EHR) and demonstration that the EHR is used to meet objective and measure requirements.  Meaningful use includes a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs.

For eligible professionals, there are a total of 25 meaningful use objectives.  To qualify for an incentive payment, 20 of these 25 objectives must be met.

• There are 15 required core objectives.
• Must choose 5 out of 10 objectives from a menu set of objectives.
• In addition, eligible professionals must report on 6 clinical quality measures:  3 core quality measures and an additional 3 from a set of 38. There are no thresholds for these quality measures; providers only need to submit them to meet the requirement.

For eligible hospitals and CAHs, there are a total of 24 meaningful use objectives. To qualify for an incentive payment, 19 of the 24 objectives must be met.

• There are 14 required core objectives.
• The remaining 5 objectives may be chosen from the list of 10 set of objectives.
• In addition, eligible hospitals and CAHs must report on all 15 of their clinical quality measures.

Stage 2
Stage 2 meaningful use criteria, expected to be implemented in 2013, will continue to expand on this baseline and be developed through future rule making. It is expected that the proposed rule will further encourage the use of health IT for continuous quality improvement; for example, the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results. 

Stage 3
Stage 3 meaningful use requirements are expected to be implemented in 2015. The proposed rule will focus on sustainability of the program through improvements in quality, safety and efficiency that improve health outcomes. 

Please go to www.mceita.org or www.hhs.gov/healthit/ for more information on meaningful use.

Third-year medical student Leanne Lawwell is no stranger to primary care advocacy. She has been a champion for family medicine since the beginning. From the start of medical school Lawwell has been interested in local and national health care issues related to primary care.

“As health policy is receiving so much attention at the national and state levels, now is an extremely important time for our voices to be heard,” Lawwell said. “I believe that talking with our elected officials about how health policy affects primary care physicians is necessary in order to ensure that our future patients will have access to the best health care that we can offer them.”

Because of her dedication to the advancement of family medicine, Lawwell was the most recent recipient of the AAFP Foundation’s James G. Jones, MD Student Scholarship award to attend the Family Medicine Congressional Conference May 9-11, 2011 in Washington DC.

The purpose of the conference is to educate participants about family medicine’s legislative priority issues and how to effectively lobby. Participants are then given an opportunity to put those skills to use during visits with federal legislators and their staffs.

Upon return from the Conference, Lawwell has the following to say about the trip:

Which session was most beneficial and why?

I found the breakout session on Evidence for New Models and Centrality of Primary Care and the Primary Care Training Panel to be most beneficial because both of these sessions presented evidence that clearly illustrated the value of family physicians and the importance of increasing the primary care work force.  Although I was aware that the United States is facing a shortage of primary care physicians, it was very informative to see data from the Graham Center and the COGME Report.  Attending these sessions provided me with evidence-based information regarding family doctor-to-patient ratios, the recommended and actual percentages of primary care physicians in the work force, the cost effectiveness of primary care, the allocation of GME funding, and the percentage of medical students choosing to go into primary care fields.  It was particularly interesting to learn that there is a direct correlation between the primary care to specialist income ratio and the percentage of medical students choosing primary care residencies.  As a medical student, I found that the information I learned during these sessions was extremely helpful in preparing for the visits with my legislators.  By incorporating data from these sessions into my conversations with them, I believe I was able to more effectively communicate the value of family physicians and the importance of supporting legislation aimed at increasing the primary care workforce.

How will you use the information learned at the Conference?

As a medical student going into family medicine, I plan to use the information I learned during the Congressional Conference to continue to advocate for family physicians at both a state and national level. After attending the conference, I feel much better prepared to effectively communicate the value of family physicians to my legislators. I plan to attend my state chapter’s advocacy day again next year and to use the knowledge I acquired during the Congressional Conference to encourage my elected officials to support legislation that increases reimbursement for primary care services, funding for primary care training, and allocation of GME funding to community-based primary care residency programs.  I also hope to have the opportunity to follow-up on the meetings during the Congressional Conference by meeting with some of my national officials stateside.  As an active member of the Family Medicine Interest Group at my medical school, I would also like to use my experience at the conference to encourage other medical students at my school to advocate for family medicine.  I have talked with the staff of my state chapter about organizing a state advocacy day specifically for medical students and I am planning to work to arrange that next fall after the new academic year begins.  Finally, I hope to attend the Congressional Conference again next year and I will encourage other medical students from my state who are interested in family medicine to attend as well.

Any other comments about your experience?

I would like to thank the Board of Trustees of American Academy of Family Physicians Foundation for allowing me the opportunity to attend the Congressional Conference as a James G. Jones Student Scholarship Recipient.  I sincerely appreciated having the chance to acquire a better understanding of the important legislative issues affecting family physicians, especially payment reform, increasing the primary care workforce, and allocation of GME funding to community-based residency programs.  The information I learned during the conference was very helpful in preparing me to talk with my elected officials in Washington D.C. and I plan to continue to use this information to advocate for family medicine in the future.

Practice Transformation Institute (PTI) Partners with Michigan Academy of Family Physicians Foundation to Present Courses on the Patient-Centered Medical Home, Organized Systems of Care and Accountable Care Organizations

Classes are Part of MAFP’s Transformation University

Monday, June 6, 2011 – Troy, Mich. – Practice Transformation Institute (PTI), Michigan’s leading non-profit provider of customized learning for the Patient-Centered Medical Home and other primary care transformative issues, and offering Continuing Medical Education credits that result in sustainable, transformative improvement, announces it will offer two courses for the Michigan Academy of Family Physicians (MAFP) Foundation as part of the Foundation’s Transformation University.  The courses are Designing and Building a Patient-Centered Medical Home and Organized Systems of Care & Accountable Care Organizations: Nuts, Bolts and Strategies for Family Physicians.

Designing and Building a Patient-Centered Medical Home is designed to give family physicians and their practice teams the understanding and tools necessary to develop and advance the Patient-Centered Medical Home (PCMH) model.  At the conclusion of the course, participants will have an action plan that outlines the key initiatives necessary to support PCMH development, ultimately leading to state and national accreditation.

Organized Systems of Care & Accountable Care Organizations: Nuts, Bolts and Strategies for Family Physicians, is designed to give participants a thorough introduction to the Blue Cross Blue Shield of Michigan PGIP Organized System of Care model and the CMS Accountable Care Organization model, both driven by the national healthcare reform movement.  At the conclusion of the course, participants will have an understanding of the key initiatives that must be undertaken to support the development of an Organized System of Care (OSC) and an Accountable Care Organization (ACO).

Both programs provide up to six CME credits and will be facilitated by PTI presenters Ewa Matuszewski, Jodi Root, MBA, Mary Beth Bolton, MD, and Ginny Hosbach, RN, MSN.  PTI is accredited by the Michigan State Medical Society and endorsed by MAFP as an approved provider of training programs for its more than 3,000 physician members.  Designing and Building a Patient-Centered Medical Home and Organized Systems of Care & Accountable Care Organizations: Nuts, Bolts and Strategies for Family Physicians will be offered simultaneously on the following dates and locations:

• Wednesday, July 13; 8:00am to 3:00pm; James B. Henry Center in Lansing
• Wednesday, August 3; 8:00am to 3:00pm; Somerset Inn, Troy
• Wednesday, September 28; 8:00am to 3:00pm; Courtyard Marriott, Grand Rapids

Cost is $100 per participant or $249 for up to three practice team participants and includes meals. To register, go to www.MAFP.com or contact Trish Marsh at 800.833.5151 or marsht@mafp.com.

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About Michigan Academy of Family Physicians (MAFP)
The Michigan Academy of Family Physicians (MAFP) is the state’s largest specialty physician association. With more than 3,000 members, MAFP is dedicated to assisting family physicians and their practices as they work to ensure high-quality, cost-effective health care for patients of all ages. Visit us on the Web at: http://www.mafp.com 

About Practice Transformation Institute (PTI)
Practice Transformation Institute, a 501(c)(3) tax-exempt organization, is Michigan’s leading provider of CME and IACET accredited experiential learning programs for the Patient-Centered Medical Home and other primary care transformation initiatives.  PTI is a founding partner of the Mackinac Learning Collaborative, a learning community linking Michigan physicians with their peers to rapidly test and implement meaningful, sustainable change within their physician practices. PTI also runs the Physician’s Training Center in Madison Heights. To learn more about Practice Transformation Institute or the Mackinac Learning Collaborative, please visit www.transformcoach.org.

Wednesday, June 1, 2011 – Lansing, Mich. – A first-of-its-kind physician organization has been created specifically to help Michigan family physicians implement the widely popular Patient-Centered Medical Home (PCMH) model. The new organization, called Michigan Family Physicians Care, was created in a unique partnership between the Michigan Academy of Family Physicians (MAFP) in cooperation with Medical Advantage Group. The first statewide academy of family physicians to lead the charge, MAFP wanted to ensure their membership the opportunity to stay on the leading edge of medicine and technology while helping patients stay healthier longer.

“We are the only state academy of family physicians to do this so far,” said Mark Dickens, CEO of MAFP. “The MAFP Board of Directors is to be congratulated for their visionary concept.”

Michigan Family Physicians Care (MFPCare) will consist solely of family physicians who will share information about best practices, quality and efficiency, as well as help them seek opportunities that recognize, reward and incent family physicians for performance excellence.  MFPCare will provide reporting and analytic services, in-office consultation on PCMH, and technology adoption through their collaboration with Medical Advantage Group (MAG).  MAG is a consulting and management services company, providing similar services to more than 50 physician organizations and 5,000 physicians in Michigan.

“We view this decision as a significant moment in MAFP’s history and want all members to know about this. We are hoping that throughout this process, increased transparency will occur and family physicians will evaluate what they are and are not getting from their current arrangements,” said Dickens.

“We are pleased to welcome Michigan Family Physicians Care,” said Larry Schwartz, MAG’s CEO. “We look forward to a long relationship that benefits both organizations.”

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About Michigan Academy of Family Physicians (MAFP)
The Michigan Academy of Family Physicians (MAFP) is the state’s largest specialty physician association. With more than 3,000 members, MAFP is dedicated to assisting family physicians and their practices as they work to ensure high-quality, cost-effective health care for patients of all ages. Visit us on the Web at: http://www.mafp.com.

About Medical Advantage Group (MAG)
MAG is a consulting and management services company providing support to over 50 physician group clients and 5,000 physicians statewide. MAG’s expertise prepares physicians and their practices to maximize efficiency and increase the quality of medical care. MAG is owned by the Michigan State Medical Society, The Doctors Company and approximately 250 independent Michigan physicians across the state. For more information, contact us at:(517) 336-1400. Visit us on the Web at: http://www.medadvgrp.com/.

GET MOVING. STAY SAFE. WEAR A HELMET.

FREE Bike Helmet Giveaway

Thursday, August 11 from 2 – 7 pm on the Capitol lawn, Downtown Lansing.

Michigan family doctors care about your child’s safety. Bike riding, skateboarding inline skating, and riding a scooter are good ways to have fun and get lots of exercise. But even really good bike riders, skaters, and boarders crash. One wrong fall is all it takes to wind up with a serious head injury. That’s why family doctors want you to wear your helmet when you ride – especially one that fits properly.

Parents & Children: Register for a free bike helmet here or contact Sara Hollander at hollanders@mafp.com or call 800-833-5151.

Family Physicians: Join your fellow family doctors giving away 500 free bicycle helmets to children in the Lansing area. Physicians, staff, family and friends are all welcome! If you are interested in volunteering, please contact Sara Hollander at hollanders@mafp.com or call 800-833-5151.

On March 31, 2011, the U.S. Department of Health and Human Services (HHS) released proposed new rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).

Under the proposal, ACOs – teams of doctors, hospitals, and other health care providers and suppliers working together – would coordinate and improve care for patients with Original Medicare (that is, who are not in Medicare Advantage private health plans). To share in savings, ACOs would meet quality standards in five key areas:

• Patient/caregiver care experiences
• Care coordination
• Patient safety
• Preventive health
• At-risk population/frail elderly health

The proposed rules also include strong protections to ensure patients do not have their care choices limited by an ACO.

During the public comment period, the American Academy of Family Physicians and the Patient Centered Primary Care Collaborative (PCPCC) have offered suggestions:

AAFP Comments

In a May 20 letter, the AAFP submitted formal regulatory comments to the Centers for Medicare and Medicaid Services regarding the proposed Medicare Accountable Care Organization (ACO) regulation. While supportive of ACOs as a concept, the letter voiced concerns that the Medicare ACO program as currently proposed will fail to offer the potential benefits of better care for individuals, lower per capita costs for Medicare beneficiaries and improved coordination among physicians. To improve the final Medicare ACO regulation, the AAFP offered several recommendations including urging that CMS:

• Permit primary care physicians to participate in multiple Medicare ACOs;
• Broaden its payment method beyond the current, traditional Medicare fee-for-service for ACO participants by employing a variety of payment approaches;
• Offer greater flexibility so small- to medium-sized primary care practices will be able to participate more readily;
• Specify that the Medicare ACO governance structure must utilize primary care physicians in the top leadership positions; and
• Outline quality reporting requirements for the full three-year program while significantly reducing the number of required quality measures.

In a May 25 letter, the AAFP responded to the Federal Trade Commission and US Department of Justice on the proposed antitrust enforcement policy regarding the Medicare ACO program. This second AAFP letter outlines antitrust barriers to physician collaboration and encourages FTC efforts that enable primary care physicians to contract with all insurers on level playing fields. The letter also expresses concern that the revised policy only applies to groups integrating after March 23, 2010 and that the “rule of reason” analysis applies only to the three-year Medicare ACO program period instead of a longer timeframe.

PCPCC Comments

The PCPCC has composed a letter in response to the Proposed Rule on Medicare Shared Savings Program and Accountable Care Organizations; RIN 0938-AQ22 asking participating organizations to consider signing.

Stay current and proficient in family medicine’s core curriculum. Prepare for your board exam. Do both with one powerful tool, FP Comprehensive.

FP Comprehensive features:

• Five years of FP Essentials full-text monographs
• Easy-to-navigate review of 17 family medicine topics
• 1,600 Board style questions and answers in 18 practice tests

Order your 2011 FP Comprehensive CD-ROM at www.aafp.org/getfpcomp or call 800-275-2237.

AAFP/MAFP members pay just $235. Special discounts available for CME subscribers, third-year residents and new physicians. Credits can be purchased for an extra fee.

DOWNLOAD GUIDE

Electronic prescribing is rapidly becoming a standard of practice with about one-third of office-based prescribers (over 230,000 by the end of 2010) actively e-prescribing. E-prescribing is just one aspect of a broader transformational movement within healthcare. The direction the industry is moving is toward more appropriate alignment of financial incentives to lead to a more patient-centered, coordinated, and accountable model of care delivery. Health information technology is widely viewed as an important tool to support healthcare financing and delivery reform and lead to higher quality and more effective cost management.

This Clinician’s Guide to E-Prescribing describes the new environment, one where the federal government is making significant financial investments to encourage the widespread adoption and meaningful use of electronic health records, and addresses the implications for physician practices and e-prescribing. In particular it describes:

• Details regarding the financial incentives available to physicians through these incentive programs – in particular – those available through the HITECH Act, and the concept of “meaningful use” as it relates to this incentive program.
• Upcoming requirements for the use of e-prescribing that doctors will face in 2011. In particular, the Medicare Fee Schedule for 2011, published in November of 2010, which describes how the failure to use of e-prescribing in 2011 will be used to determine payment reductions in all physicians claims paid out in 2012 and 2013.
• Recent Drug Enforcement Administration rule changes that now give prescribers the option of prescribing controlled substances electronically. Related requirements demonstrate compliance requirements for prescribers. This rule addresses one of the key remaining barriers to e-prescribing and will likely lead to more adoption and use of the technology once the healthcare industry takes the appropriate steps to be in compliance with its requirements.
• Recommendations to help clinicians become successful, meaningful users of e-prescribing as a key step in eventually becoming meaningful users of EHRs. This includes the major steps that should be followed, the issues to expect and how to address them, as well as practical tips for successful deployment of e-prescribing.

This guide also includes a number of Appendices designed to offer additional tools and information to support adoption and use of prescribing technology. This includes a Buyer’s Guide, frequently asked questions, and an extensive list of additional resources that may be helpful to physician practices at varying stages in this journey.