Dr. Robert J. Snyder, a podiatric physician and surgeon for more than 30 years and leading wound care specialist, joins the faculty at Barry University’s School of Podiatric Medicine. Snyder began his new role as a professor and director of clinical research this January.

Snyder joins Barry from private practice at University Hospital in Tamarac, FL, where he is director of the Wound Healing Center. Snyder, who serves on the editorial advisory boards of Ostomy Wound Management and WOUNDS and reviews articles for the New England Journal of Medicine, will teach student doctors about wound management, limb preservation and research at Barry.
 


2011 has barely begun and healthcare is already a hot topic. The implementation of electronic health records (EHRs), new HIPAA policies, and the upcoming transition to ICD-10-CM/PCS is enough to keep health information management (HIM) professionals busy. However, in the HIM field, more change is always on its way. Whether there are coding updates, technology innovations, or new legislation, staying educated and current on industry trends and the latest HIM news is critical to working as an HIM professional.

Education in the HIM field dates all the way back to 1934 when HIM professionals were known as medical record librarians. The first graduating class was only five students, all women. But now in 2011, there is a diverse group of almost 25,000 students studying HIM across the country and abroad.
 
Those first five HIM students in 1934 were true pioneers in the field, and as we fast-forward to the present it is clear that their legacy has lived on. Education has become a core component of the HIM field. HIM professionals recognize that while years of industry experience are invaluable, experience alone is not enough. It is no substitute for the steadfast dedication to life-long learning that has become fundamental to the success of HIM professionals.
 
What does this mean for HIM professionals today? Employers are now looking for more than just on-the-job experience. Taking advantage of continuing education opportunities—such as attending meetings, participating in distance learning programs, or speaking at a conference—not only demonstrates an enthusiasm for learning but also a true desire to succeed. Even experienced professionals are often surprised how much they can benefit from the plethora of education opportunities that are now available.
 
Earning a new credential also illustrates a commitment to the field and long-term career goals, and catches an employer’s eye. With the emphasis on education, employers value credentials now more than ever. According to a survey by the American Health Information Management Association (AHIMA), AHIMA credentials were highly esteemed and influenced hiring and promotion practices.
 
The findings from the employers surveyed across a variety of healthcare settings showed that with all things being equal, 68 percent of employers report choosing a credentialed candidate over one who is not, and 53 percent prefer credentials when promoting their employees.
 
Employers also understand the importance of employees maintaining their credentialed status. Over 94 percent believe credentials must be kept current, while 84 percent report their organizations financially support maintenance activities. The results also showed that employees who participate in continuing education activities each year and maintain their credentials are typically more respected and earn higher wages.
 
There has never been a more exciting time to work in the HIM field and these fast and furious changes are not likely to stop soon. To keep up, HIM professionals must be constant in their efforts to remain industry leaders and true agents for change. Staying educated or earning a new credential assures not being left behind—and with all this excitement who would ever want that?


Over the years, I have been continuously amazed at the number of physicians, nurses and other health providers who leave the "bedside" practice to pursue other careers within the healthcare industry. Some providers take hospital-related administrative positions while others accept roles in various types of healthcare entities. Regardless of where they go, it is critical that they have sufficient management skills to successfully assume their new responsibilities. Of course, it would be easy, but expensive and time consuming, to obtain an executive MBA. However, there are alternatives such as “certification” courses, programs of varying length which provide new knowledge in specific areas. I believe that most of us need some form of additional education if we are to be successful in our future healthcare environments.

Looking back, I wish there had been a program of management study when I made the transition from clinical doctor to VP Medical Education at Orlando Regional Medical Center and later when I started Sterling Healthcare. Being a Chemistry major in college and graduating after 3 years, I had no time for even basic business courses. I had to learn about business while “on the job.” Healthcare has become very complex and effective leaders need to be well versed in many areas. This is true for hospital department heads, physicians with busy practices, physician owners of ASCs, managers of diagnostic centers, medical entrepreneurs, hospital board members; and the list goes on. Every day I encounter situations where business and leadership training would have made a big difference in the outcomes.
 
One need look no further than the headlines to find a perfect example of how lack of understanding can turn a situation from bad to critical. While we are all aware of the crisis at Jackson Memorial, this situation is not unique among safety-net providers across the country. In most cases, the severity of the health system’s problems are not initially understood by their Boards. For example, Board members need to understand the difference between Gross Charges and Net Revenue. Understanding how to make the calculation accurately may make the difference between making and losing money. At Jackson Memorial, board members were shocked to learn that the methodology that had been used previously had been incorrect and thus what was perceived to be a $40 million dollar loss, turned out to be a $244 million loss. The hole to be climbed out of suddenly got a whole lot deeper.
 
This past year, I was asked to serve as a financial advisor in a bankruptcy of a chain of diagnostic imaging centers. The debtor repeatedly told the Judge that there was $4 million in accounts receivables. I looked at a Date of Service reports from the billing company and immediately realized that the actual “collectable” receivable balance was in fact $1.1 million. As a result of my analysis, I was able to convince the bank, the secured lender in the case, to take a substantial reduction for settlement of their claim. Once again, fully understanding the numbers and the methodology made a very big difference!
 
Recently, a hospital that my firm consulted for decided to seek “critical access” designation. Such designation had financial as well as operational implications for the hospital. Many members of the Board of Directors thought it was a good idea only because they had been told so by the company that had been hired to manage the hospital. Given the fact that the average daily census was 4-5, on the surface, it seemed like this was the right concept at the right time. What was not taken into consideration was the fact that the family practitioners and the internists on the hospital’s medical staff did not want to admit patients of those who might have otherwise been admit-able. Another option for the Board, had they had more knowledge of the complexities of the situation, would have been to delay the “critical access’ designation and focus on recruiting additional physicians. Many physicians today are seeking to become employees of hospitals. As such, hospital leaders need to understand all of the issues physician/provider employment involves. Treatment of physicians as “independent contractors” versus actual W-2 employees may create greater liability for the entity. Leaders should be familiar with the history of the independent contractor issues and the IRS, as well as the 20 common law tests and Section 530 relief/exemption from the rules. Once that issue is determined, there are a variety of ways to compensate physicians. Knowing up front, which have been successful and which have failed will impact the success of the entity’s employed physician model. In addition, understanding the difference between the hospital‘s governing body and the medical staff by-laws will help tremendously.
 
Perhaps the most difficult areas for new healthcare leaders are budgeting and strategic planning. Most physicians in their 50’s and beyond never had to use Excel, yet I don’t know how anyone would be able to prepare a budget without using it in today’s environment. Knowing how to read financial statements and understanding billing, collections and the accounts receivable/cash flow cycle is critical to building a healthy practice. All too often I encounter practices with little understanding beyond their current bank balance. These days one must not only understand the concepts, but also the technology. Such skills are invaluable to any rising healthcare leader.
 
Use of technology includes instant communication with Blackberrys and other smart phones, implementation of electronic medical records, as well as online appointment scheduling and prescription refills. Proper use of these technologies can make a big difference in the efficiency and effectiveness of a physician’s practice. I recently consulted with a busy cardiology practice where lots of time was lost searching for charts that were misplaced around the office. Staff was not answering phones and scheduling appointments because they were away from their desks chasing charts. The practice has since implemented an EMR system which has eliminated those problems. In addition, front office staff communicates with the doctors and medical assistants via e-mail and messaging to laptops and smart phones to convey patient messages and to alert them about important information, in real time, without leaving their desks. Both appointments and patient satisfaction are up as a result.
Finally, marketing of healthcare has also taken on new dimensions. It used to be that we relied solely on referrals, and written messages. Today practices have websites, doctors participate in Webinars, advertising and direct mail are more prevalent, and branding, while underappreciated, is beginning to take hold in medicine. Physicians need to be more creative to stand out in the crowded field. This extends not only to attracting patients, but also to recruiting staff. Today you are just as likely to see ads for employees on Craig’s list as you are in JAMA.
 
Given all of the issues we currently and will encounter in the future, the question is how to provide current and emerging healthcare leaders the tools they need to succeed. The good news is that there are a multitude of educational offerings today to fulfill virtually every need. In addition to an MBA, a number of universities have courses on weekends which can lead to certification or if for-credit can transfer to degree programs. Professional development extends beyond the clinical setting and organizations need to value leadership skills the same way we value medical training. Learning management, leadership, and business skills is no different than keeping up with one’s specialty. Things change and evolve. What is important is dedication and commitment to change and evolve as well.


Nursing education faces many challenges as a result of the population’s increased cultural diversification. It is very important to prepare skill and culturally competent nurses to provide care in the both urban and rural areas (Rutledge. C., 2008). In the United State it has been projected that by 2015 about 40 % of adults and 48% of children will be from racial and ethnic minority groups (Department of Health and Human Services (DHHS), 1999). The percentage of culturally diverse students at Miami Dade School of Nursing has been increasing during the last decade. The nursing student population at Miami Dade Medical campus consists of Hispanic 1,311 (56.1%), Black Non Hispanic 634 (27.1%), White Non- Hispanic 276 (11.8%), and Other (7.5.0%). The total enrollment of full and part-time students consists of 2,338 for 2009. How can educators meet their needs?

The healthcare delivery system and higher education have expressed a great concern regarding patient safety, cultural competence and the quality of patient care in our diverse population. Nehring (2008) identified the following patient care needs, patient safety and quality of care, nursing faculty shortage, increased technology to deliver healthcare, patient acuity, decreased hospital stay, decreased availability of clinical sites, decrease funding for orientation, and introduction of high complicated technology with which to deliver health care. Patient care needs require that the nursing educators seek creative ways to resolve these challenges and develop new and better nursing practices. The use of simulation for hands on practice, nursing skill competency, and critical thinking skills will increase patient safety outcomes and improve student’s cultural competence.
 
Simulation technology such as high fidelity simulation, Personal Response System and Virtual soft ware can be use to address these concerns and others such as improving student patient communication and communication with the healthcare team. Students can become familiar with other cultures and biases in a non threatening environment. Videotaping and role playing of diverse cultural patients during a simulation activity is an excellent tool for the faculty to provide feedback to the student. Nursing students in a diverse cultural needs help in the acculturation process and understanding that healing goes hand in hand with cultural beliefs and life styles.
 
Human Patient Simulators has been identified as an effective teaching strategy in many areas of the health care field (Bearnson & Walker, 2005; Nehring & Lashley, 2004). Simulation has been beneficial to science, healthcare field and the educational arena. The purpose of simulation is “to replicate some or nearly all the essentials aspects of the clinical situation so that the situation may become readily understood and managed when it occurs for real in clinical practice” (Morton, 1995, p.76). Advances in technology both in the educational and healthcare settings provide many opportunities to enhance the learning of the nursing student. The use of high fidelity patient simulation in nursing education has been described for specific fields of practice, including critical care (Rauen, 2004), community health (Brady, Molzen, Graham, & O’Neill, 2006), pediatrics (Lambonton,2008), nurse anesthesia (Fletcher, 1998, O’Donnell, J., Dixon, B., & Palmer, L., (1998). Rauen (2004) emphasized this technology’s; ability to enhance critical learning skills in nursing students through the use of high-fidelity patient simulation. Preparing and ensuring the competence of novice student nurses in code management, critical thinking, decrease stress and anxiety will result in patient safety outcomes, pain and suffering and decreased health costs.
 
During the last three years I have provided multiply training workshops to the nursing faculty and the surrounding community. The faculty evaluation reflected the need for simulation activities to supplement the problem with decreased clinical sites, to improve student, patient and healthcare communication interaction. Simulation equipment in a diverse culture is an excellent tool for the future of nursing education.


The University of Miami (UM) Miller School of Medicine’s division of hospital medicine, Jackson Memorial Hospital’s (JMH) internal medicine residency training program, and the UM-JMH Center for Patient Safety (CPS) have joined forces to provide safer patient care through a novel approach: A standardized curriculum for teaching invasive bedside procedures.

Trainees (interns, residents, and fellows) have long performed procedures such as lumbar puncture (spinal tap), thoracentesis (removal of fluid from the chest cavity), and insertion of central venous catheters (long IV catheters used in acutely ill patients), among others. Historically, they learned how to do this through the “see one, do one, teach one” apprenticeship model. This has resulted in the delivery of care by trainees, at times unsupervised by a skilled physician, which may lead to preventable complications. We sought to improve patient care by devising and implementing a practical training program.
 
Joshua D. Lenchus, DO, RPh, FACP, FHM, associate program director of the JMH medicine residency and associate director of the UM-JMH CPS, developed and launched this simulation-based, blended approach to procedural performance. Implemented in July of 2007 as a component of the training program, his team has trained nearly 750 learners, across a variety of specialties. A multi-disciplinary group of faculty serves as volunteer instructors, and sessions last from two to four hours, depending on the procedure. Dr. Lenchus has recently opened the instruction for trainees and attendings of other institutions.
 
To date, he has demonstrated that such training increases participant knowledge base and technical skill, improves self-reported confidence and competence, and, most importantly, decreases iatrogenic procedural complications, thereby providing safer patient care, at a cost savings to the institution. The results of this training program have been reported in professional journals such as the Journal of the American Osteopathic Association and Medical Teacher.