As we enter “heart month” 2010, and with the healthcare debate fresh in everyone’s mind, it is important to reflect upon two remarkable facts: 1) despite continued and remarkable advances in scientific knowledge and therapeutic capability, cardiovascular disease remains the leading killer of men and women in this country and increasingly throughout the entire world; and, 2) perhaps in no other sphere of human disease (except, arguably, injury due to trauma) does human behavioral choice play such a major role in disease initiation and progression.

Years ago, when speaking about risk factors for cardiovascular disease, we used to distinguish between “modifiable” and “non-modifiable” risk factors. However, upon more careful reflection, the distinction is somewhat misleading. For example, hypertension, lipid abnormalities, cigarette smoking and physical inactivity are all potentially modifiable. Age, family history and diabetes were viewed as non-modifiable. Upon more careful examination, it may well be that age per se is not the core issue—i.e. that the physiology of aging, a very poorly understood phenomenon in and of itself, somehow promotes or accelerates the atherosclerotic process. Although that may certainly be true, we have very little evidence in this area. What we do know, however, is that age represents the length of time an individual has been living with the disease. Atherosclerotic vascular disease is a complex process that progresses over years. Autopsy studies dating back to the Korean war demonstrated that one fifth of ostensibly healthy young Americans in the 1950’s already harbored evidence of the early states of the atherosclerotic process in their aortas.

The evolution of that process into a clinically significant event, such as a heart attack, may, depending upon a given person and the complex milieu of risk factors, take any number of years. In fact, even in the presence of disease in an individual with a genetic predilection, a clinical event may never occur. Therefore, the most compelling contribution of age to risk is the length of exposure to disease. If other risk factors are rigorously controlled, disease progression may be slowed, arrested or even reversed sufficiently to protect a given individual from a clinical problem. Likewise, one can clearly see that while one can do nothing with current medical technology to alter one’s genetic predisposition (assuming that future studies will continue to tease apart the complex array of genetic markers for this multifactorial disease process) to cardiovascular disease, one may be able to accomplish a tremendous amount through control of known risk factors to help protect the genetically “at risk” individual from a clinical problem. Lastly, although we used to think of diabetes as somewhat of an unpreventable disease, the current epidemic of obesity is bringing with it an inexorable rise in the incidence of insulin-resistance “Type II” diabetes. Currently 33% of adults are obese, 29% exhibit signs of prediabetes and 7.7% have diagnosed diabetes. Alarmingly, almost a third (31.9%) of children aged 2 to 19 years are also overweight or obese. We are currently seeing the tip of the iceberg.

The news from the “modifiable” risk factors is far from optimal as well. High rates of men (25%) and women (20%) continue to smoke, despite that fact that this risk factor is synergistic with the others. Unlike the risk of cancer, which is cumulative, much of the risk of cardiovascular disease recedes immediately upon cessation of smoking. One third of adults have hypertension, while only two-thirds of these are being treated, and less than one half are meeting currently recommended therapeutic goals. Approximately one sixth of the adult population has elevated serum lipids, but less than half are receiving lipid-lowering therapy. Among adolescents, 31% of females and 18% of males recently reported no vigorous physical activity within the previous 7 days, while 59% of adults report engaging in no regular vigorous activity.

Discouraging? Perhaps. But the “full” half of the glass teaches us that the potential for improvement rests largely in our own hands. It is for this reason, the Florida Heart Research Institute, while pursuing an aggressive and innovative program of scientific research, balances these efforts with an active program of screening and education, especially in currently underserved high risk populations. It is only through translating our scientific knowledge into individual and community awareness through education that we can begin to harvest the benefits of our knowledge and reduce the incidence and danger of this lethal disease.



Given the complex, health-related challenges that often burden the elderly, delivering healthcare tailored to their needs can be daunting. On the other hand, the Miami Jewish Home and Hospital for the Aged has cared for the elderly in such a focused way since its inception in 1945. Today, this institution stands out as the most comprehensive, not-for-profit, geriatric healthcare center in the Southeastern United States.

“When you walk onto this campus, you enter a rare care-giving environment for older people. Our system of care supports those who live independently and those needing different levels of medical care and support,” said Fred Stock, Chief Operating Officer and Executive Director.

Older adults who live independently with some support reside in 98 modern, tastefully designed studios and one-bedroom suites in the Irving Cypen Tower. Here, they access recreational, emotional, physical, and medical support unavailable in the community.

As the elderly age, they may need a higher level of care and choose to live in the Hazel Cypen Tower, an assisted living facility consisting of 92 apartments for residents who prefer to live independently, but who require a certain level of physical care. “Older people who live here don’t need to be in a nursing home, because they are not sick. But they do need a level of care they cannot get in an independent setting,” said Stock

A major clinical situation may create the need for greater supervision in the 462-bed nursing home on the campus of the Miami Jewish Home and Hospital for the Aged. Specialized units attend to the needs of dementia patients and residents whose clinical needs require specialized medications, more monitoring, and greater medical and registered nurse supervision. The home is fully accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO).

“Some patients in the nursing home require only short-term care following a broken hip or knee. Some may have cardiac issues requiring rehabilitation. Currently, about 30 to 40 such patients participate in the rehabilitation program on average for 30 days, and then return to the community to be assisted with home-care services,” said Stock.

In February 2004, the home launched a service that accommodates patients suffering from extremely complex medical conditions – pulmonary problems, for example – who may need to continually be on a ventilator. The home currently serves the needs of 15 residents requiring this level of medical care.

With few facilities serving patients this way in Miami-Dade County, the service addresses a major underserved need in the area and complements the work of hospitals in the region. “Besides the medical and nursing staff serving this ventilator unit, we provide the services of a full-time social worker and recreational therapist to assist patients,” Stock emphasized.

The ventilator service underscores the role of the Miami Jewish Home and Hospital for the Aged as a resource for Dade County and southern Broward County. “We take a holistic approach to patient care in a comfortable environment. We take these people out of bed and put them in wheelchairs so they can be outside. The quality of life that we provide on a long-term basis for people who are so clinically complex is much greater than they could find in a hospital,” he said.

According to Stock, the home offers a level of nursing, medical, social work, recreation, and rehab services that few other nursing homes can match. The home employs a medical staff of three, full-time physicians and four, full-time nurse practitioners.

Just as important, the staffing ratio at the home consistently exceeds the per-patient nursing ratios mandated by the State of Florida. “The state ratio for certified nursing assistants is 2.6 hours of nursing care per resident. We run between 2.8 and 2.9 hours for certified nursing assistants. For LPNs and RNs the state ratio is 1 hour of care per resident. We run at about 1.26 hours of care,” Stock said.

In an industry that suffers from high staff turnover, the Miami Jewish Home and Hospital for the Aged prides itself on the longevity of its staff. Stock attributes this to hiring the best people and offering them an unparalleled wage and benefit program. In fact, he anticipates that by July 2004, the home will be one of 11 nursing homes out of 700 in Florida to be designated as meeting the Florida Gold Seal standard.

A stable staff assures that the home will continue to serve the aged with high-quality continuum of care as it has now for nearly 50 years.

Fred Stock may be reached at (305) 751-8626 or at fstock@mjhha.org.



In an effort to provide support, encouragement, and resources to the Boatswain Bay Presbyterian Church community members and those served by the Church throughout the hurricane rebuilding period, The Doug Williams Group, Inc., Miami, is spearheading relief efforts. The support of this Grand Cayman community will be accomplished through pastoral support, medical support donations, material donations, labor teams, and prayer teams. All administrative costs are being privately funded; therefore, 100% of all donations and donated materials will directly benefit members of this Grand Cayman community.

Financial Donations: Checks should be made out to Old Cutler Presbyterian Church and designated as follows: Boatswain Bay Presbyterian Church Hurricane Relief. Mail to The Doug Williams Group, Inc., 8900 Southwest 107th Avenue, Suite 302, Miami, Fl, 33176.

For more information, please contact the effort’s full-time relief coordinator, Kenia Pol, at The Doug Williams Group, 305-598-9880, or e-mail Relief@TheDougWilliamsGroup.com



In today’s healthcare market, physicians have been desperately seeking a solution which will address their reduced reimbursements and increasing costs. Medical Office Software is pleased to announce a solution to help physicians increase their revenue by utilizing technologies which streamline their processes and billing procedures.

MOS has been a leader in the sales and installation of computerized solutions for physicians in South Florida since 1984. These solutions have improved the physician’s efficiencies in the billing, collecting and electronic filing of claims, using the latest technologies available. They are known for providing first-class service and support to thousands of users in South Florida for the financial accounting systems they have developed.

In an effort to provide physicians with a comprehensive clinical solution (Electronic Medical Records) MOS has partnered with MedcomSoft, a leading supplier of EMR software throughout the United States. Ken Barnes, Vice President of Sales & Marketing, has spearheaded MOS’s EMR division over the past year-and-a-half. Barnes explains, “We have done our research over the past year and evaluated many different systems. We felt that MedcomSoft Record is the most comprehensive software solution available in today’s marketplace. This solution fit all of the needs to fully automate the clinical side of a physician practice. In addition to the clinical aspect of the product, it also has a fully integrated practice management (financial) component built into it as well. It automatically does the correct coding and fully documents the visit. This full documentation is designed to prevent and defend frivolous lawsuits and also provides the physician the government-mandated documentation for billing and HIPAA regulations.”

Based in Toronto, the designer, MedcomSoft Inc., develops and markets software solutions that change the way the healthcare industry captures, manages, and exchanges patient information. Powered by MEDCIN, MedcomSoft Record has one of the largest numerically codified medical vocabularies in the world. By using MedcomSoft Record, healthcare providers can record patient data using an easy point-and-click system. It reduces the time and effort required to produce documentation compliant with today’s rules and regulations, and is able to reduce costs and risks—all of which result in better quality of patient care and increased billing productivity. True efficiency can only occur by implementing a fully integrated automated solution. MedcomSoft Record is a comprehensive software solution that enables healthcare providers to use one single platform to achieve automation of the majority of the tasks required for the management of their patients and practices. This includes an Advanced Integrated Practice Management System, an Electronic Medical Record System, an Order Entry System, a Document Management System, a Referral & Authorization Management System, MedcomSoft Portable Chart, and a variety of integrated tools for clinical decision support, coding and compliance checking for medical necessity.

Regarding the software, Barnes said, “Not all EMR solutions are equal. Very few systems in the marketplace currently utilize a codified medical vocabulary. This technology does not rely on text-based phrases and allows for direct correlation of patient outcomes. In the future, all EMR solutions will eventually use a numerically coded standard in order for the systems to seamlessly speak to each other. MedcomSoft is one of the few companies that has developed the system from the ground up to this standard. This puts them years ahead of the competition and will eliminate the need to replace the system in the future for a system that adheres to the new standards.”

Physicians need to be aware that HIPAA addresses the need for computerized electronic medical records, and there are current initiatives to develop guidelines that all physicians will be required to adhere to in the future. EMR systems will certainly rapidly replace the paper-based systems that 90 percent of physicians use today. Physicians will find that deployment of these solutions will provide a direct impact to the amount of time they will have to practice medicine. By significantly improving efficiencies within the practice, EMR solutions typically reduce the physicians’ workload by hours each day. Physician practices will also benefit from the reduction of rapidly increasing overhead costs that have had a direct impact on their profitability. As a leader in healthcare automation, MOS will provide your practice with a turnkey solution of hardware and software that will enable you to take control of your practice’s profitability again.



Broward General has launched its Expansion and Renovation Program, a $163 million initiative to expand the existing facility to meet and anticipate the needs of Broward County residents for decades to come.

Targeted for completion in 2005, the multi-phase expansion brings a new era of access and convenience to the state-of-the-art healthcare services Broward General delivers. In addition to new construction totaling 480,000 square feet, there will be extensive upgrades to most of the services on the Broward General campus. The beautiful new environment provides for improved patient flow and greater efficiencies for staff and physicians.

“The New Broward General” will feature state-of-the-art surgical suites, new critical care units, a new outpatient imaging center, private rooms and The Heart Center of Excellence. There will also be an expanded Trauma Center and Emergency Department with separate areas for children and adults. The latest technology available, from advanced diagnostics to internal and external communication, will be integrated throughout the entire facility.

Just steps away from the hospital’s main entrance, a seven-story parking garage provides ample parking for patients and visitors. Additionally, the new hospital structure will provide a focal point for outpatient care, with convenient access to pre-admission testing, outpatient surgery, radiology and other diagnostic services. Separate entrances will be designated for The Heart Center of Excellence, the Comprehensive Cancer Center and the Chris Evert Children’s Hospital.

Across the street from the main campus, a new medical office building will be constructed. A walkway over Andrews Avenue will offer safe access between the parking garage, the hospital facility and the medical office building. In 2004, the first Ronald McDonald House in Broward County opened on the Broward General campus.