The American Health Information Management Association (AHIMA) and the American Medical Informatics Association (AMIA) announce their support for legislation introduced by Congressman David Wu (D-OR) to ensure a trained work force capable of innovating, implementing, and using health communications and information technology (IT). The proposed legislation would authorize the National Science Foundation to award grants to institutions of higher education to develop and offer educational and training programs for healthcare workers and professionals in applied health and medical informatics.

“We are very pleased to see this legislation being introduced. Health IT cannot be effective unless those who use it to perform their duties are properly trained,” states Linda Kloss, MA, RHIA, AHIMA’s CEO. “Without a plan to train healthcare workers at all levels of healthcare delivery, the goal of an improved, interconnected healthcare system may never be met.”

“This bill will not only provide the funding necessary to develop the current work force; it will also help improve the curriculum in academic programs to increase the number of students who pursue studies in fields related to healthcare informatics,” adds Don E Detmer, MD, MA, President and CEO of AMIA.

AHIMA and AMIA have been focused on developing the information management and informatics work force for some time. In recent years AHIMA has addressed work force issues by advancing an agenda for electronic health information management (e-HIMR), creating a virtual educational laboratory to provide training for students, and developing a framework for education that encompasses the new roles required by the electronic workplace. AMIA has been a core resource for academic programs in medical and nursing informatics. In 2005 AMIA created the “10×10” program, which aims to realize the goal of training 10,000 healthcare professionals in applied health and medical informatics by 2010. Dr. William Hersh, Director of the “10×10” program at the Oregon Health and Science University (OHSU) was pleased to serve as an expert source of information for Representative Wu and his staff as they crafted legislation to address the training needs of the nation’s health work force.

In 2005, AHIMA and AMIA hosted the first-ever summit to develop strategies to address work force challenges related to electronic health records (EHRs) and a nationwide health information infrastructure. The summit produced targeted recommendations for preparing the existing health work force to use technology tools and to ensure a sufficient number of well-qualified health information specialists to achieve effective health IT transformation. The recommendations included federal support for health IT adoption and training, and legislation to increase funding for education programs.



When talking to physicians and case managers recently about determining prognosis on potential hospice patients, Noemi Sanchez, senior representative for VITAS Innovative Hospice Care® of Broward County, would ask them to consider their overall caseload and point out the patients who probably would not survive through spring of 2007. These are the patients, she told them, who would benefit from a hospice referral to VITAS today.

One of Noemi’s daily challenges is clarifying a common misconception about hospice: that it is for patients who are imminently dying.

Hospice is for any patient who has an incurable disease and is expected to live for a period of less than six months. The earlier the patient is referred, the fuller the scope of care and the better the patient’s quality of life. Early referrals can expect:

  • Effective pain and symptom management
  • Care delivered wherever a patient resides
  • An interdisciplinary team caring for patient and family
  • Medications, equipment and supplies related to the terminal diagnosis provided at no cost to patient or family and delivered directly to the patient’s home
  • 24-hour care when a patient needs an inpatient level of service but wishes to remain at home
  • Telecare(sm) services—instead of frantic after-hour calls to 911; VITAS’ Telecare is a virtual emergency room, staffed to answer questions or dispatch a nurse 5 p.m.–8 a.m.
  • Ongoing education for patient and family, so they know what to expect throughout the progression of the disease
  • Psychosocial support for patient and family, including grief and loss counseling

Another common hospice misconception Noemi dispels is that patients must have a DNR in order to be referred to hospice. This is not true. Hospitals that understand hospice know it can:

  • Reduce Average Length of Stay
  • Reduce mortality rates
  • Reduce average cost per case for terminally ill patients.
  • Educate case managers and hospital staff about clinical criteria for hospice appropriateness
  • Avoid unnecessary hospitalizations
  • Assist discharge planning by coordinating delivery and providing all medications, equipment and supplies
  • Provide important statistics regarding individualized hospice utilization by facility or physician, enabling hospitals to monitor and control length of stay and dollars spent on patients who are terminally ill
  • Educate ER physicians and staff in identifying patients making the shift from chronic to terminal disease, thereby reducing ER crowding and freeing staff to care for patients who are critically ill or injured.

“We are a resource,” concurs Holli Hallmark, VITAS’ senior director of clinical services development. “Every day we work with case managers or discharge managers so they can plan ahead. We get people home sooner with the right equipment and we leave beds for patients requiring aggressive treatment.”

Finally, how can hospice help physicians? Noemi says:

  • We reduce calls to the physician’s office from patients and their families.
  • We encourage physicians to follow their patients to provide continuity of care, and we answer questions regarding billing Medicare Part B for those services.
  • We answer questions about whether patients meet clinical criteria for hospice referral.
  • We educate physicians on prognosticating survival, discussing advanced directives and “breaking bad news.”
  • We answer frequently asked questions regarding nutrition, hydration and innovative ways to approach pain and symptom management.

When speaking about patients who cannot be cured by medical treatment, Noemi tells physicians, “You never have to say, ‘There is nothing more that I can do.’”

She suggests telling your most challenging patients and families—today—that “There is a great benefit available to you called palliative care. It provides everything needed to manage your symptoms and keep you comfortable. Palliative care focuses on the quality of your life, and this is the care I believe is best for you at this time.”



Overcoming the challenges of today’s job market with new employee-focused initiatives

If there is any single factor impacting healthcare recruitment and retention in South Florida more than most, it is cost of living. This seemingly insurmountable hurdle is making all of us think more creatively about our approach to attracting new employees and keeping experienced employees in a rewarding work environment.

Florida’s high cost of living, especially home prices, is having a dual effect. It is preventing some new healthcare workers from relocating to South Florida, while simultaneously pushing current workers out. Employees who cannot obtain the American dream of home ownership here are willing to relocate to get it.

In addition, high energy costs are forcing job seekers to reprioritize their job criteria. Commuting time and distance has become a large factor in a potential employee’s willingness to accept a position. That’s bad news for South Florida employers who used to count two or three counties as a potential source for local employees.

On top of the unique challenges facing South Florida, our industry also must contend with the national trend of less supply coupled with a growing demand for healthcare professionals, especially among nurses. Across the country, we are seeing RN vacancies remain high at 35-40 percent. Meanwhile, the number of employees voluntarily terminating from positions within their first year of employment is up, making recruitment that much more expensive.

At Cleveland Clinic Florida, our short and long-term growth goals make employee recruitment and retention a top priority. With just over 100 physicians currently on staff, our medical support team totals 1500. In order to grow by some 50 percent in the next year, and then ultimately reach a physician staff of 200 within five years, our management team is focused on overcoming the challenges that lie ahead.

Already Cleveland Clinic Florida has found the use of employee referral programs to be a positive recruitment tool. They’ve helped pull in new job candidates who are difficult to reach through traditional employment advertising, while offering existing staff an added financial incentive. It’s a win-win situation.

We have harnessed online recruiting tools, such as CareerBuilder.com and Monster.com, to effectively reach out to larger pools of potential new hires in a broader geographic area. The competitiveness of these services, however, makes it very important to fine tune compensation packages. In addition, utilizing our own online job posting site at www.clevelandclinic.org continues to be an important driver of job candidates.

The diversity of healthcare career opportunities and long-term demand in the industry is a potential draw for many job seekers. The first half of the challenge is to convert these individuals to potential healthcare professionals, while the second half of the challenge is to retain them.

Several factors play into that ongoing challenge, including compensation, benefits, work environment, employer reputation and job flexibility. As the desire to attain work/life balance has gained greater attention among employees, job flexibility has become a very important negotiating tool.

Cleveland Clinic Florida is tackling the retention question with a new initiative focused on our nursing staff. We’ve improved our orientation to better meet new staff needs, and we have developed a less cookbook-approach that caters to the individual. We have created a stronger, more comprehensive preceptorship program that allows us to focus not only on our “orientees” but also the preceptors or trainers.

By providing education, needed tools and applications, and ensuring consistency with our training staff, we achieve a dual benefit. First, we are making an impact on retention and in the facilitation of high quality caregivers that have been oriented to an environment that stresses the importance of education. Secondly, we remain focused on our main goal of putting the Patient First.

As an academic medical center, Cleveland Clinic Florida also offers many unique ongoing educational programs in-house that support career development. We encourage nurses to have a voice in the design and refinement of clinical care model delivery systems. These opportunities are appreciated by employees looking for career advancement and fulfillment.

At the end of the day, our employees remain our best recruiting tool and are instrumental in creating a work environment that motivates and inspires all of us. Understanding their goals and dreams and responding with employee-focused initiatives is one way that healthcare institutions in South Florida can respond to today’s recruitment and retention challenges.



The sounds of music lilt through the halls of the inpatient unit at the C. W. Gerstenberg Hospice Center in West Palm Beach. “Oh what a beautiful morning,” sings a trio of volunteers to a patient as her family looks on. Inside the kitchen, Dorothea Stein–also a volunteer– hurriedly grills chicken as part of her daily lunch preparation for hundreds of patients, staff, and volunteers. Upstairs, stacks of medical records are being processed by Jacky Cummings and Chick Wachtel, also volunteers. “We feel like we’re giving back. It makes a tremendous difference for patients and families,” Wachtel said. Meantime, volunteers are visiting patients and helping families throughout Palm Beach County.

Brian and Paula Gould are pictured with their volunteer canine, Dusty. The Great Dane is certified in Pet Therapy.
Photo credit: Walt Stearns

The singers plus Dorothea, Jacky and Chick are a few of the more than 650 volunteers who provide support to Hospice of Palm Beach County programs at the organization’s six inpatient units, the John J. Brogan Horizons Bereavement Center or wherever patients reside. Volunteers often work one-on-one to provide comfort and companionship to patients in their home, skilled nursing or assisted living facility. Others provide respite care to allow a patient’s caregiver time outside the home. Volunteers do clerical or administrative work. Others work in the kitchen, the Resale Shops, or medical records, accounting or community development departments. Interfacing with staff or working closely with patients, they gave more than 55,000 hours last fiscal year. To say their role at Hospice of Palm Beach County is crucial is an understatement.

What is it that makes so many give of themselves to Hospice and why? For many, volunteering is a way to say “thank you” for the care Hospice of Palm Beach County provided to a loved one. One volunteer shared, “There is no better way for me to show my appreciation and repay Hospice for its care, concern and compassion. We’re a very special support group,” he said. Volunteer Ruth Goldstein’s brother-in-law, friend, and husband were all Hospice of Palm Beach County patients. “I figure if I can help people in any way, I want to do that,” she said. For others, volunteering gives them a sense of satisfaction. Volunteer John Gash sings to patients twice a week. ” What do we get out of it?” he asked. Patient happiness and joy,” he said.” Another volunteer expressed a sentiment felt by so many. “I’ve done many things in my life, but this is the best. This is the top. I love it. I love what I do. I’ve heard people say it comes back tenfold. It does. It really does,” she said

The volunteers are led by Dee Johnson, Manager of Volunteer Services. “They’re a valued part of our team,” Johnson said. “They play a critical role in us reaching our mission. We couldn’t possibly operate a program caring for more than 1,050 patients a day without volunteers providing an extra hand,” she said. Despite the high number of volunteers, Johnson says there is still a need for more. “We could always use more help and more volunteers with expertise in various specialties—including but not limited to computer graphics, medical records, scanning, and more.”



There have been tremendous advances in healthcare technology and medicine over the last decade, some of which have been truly “awesome”. However, what these advances are depends on who you speak to (patient, physician, nurse, engineer, etc.) and how you define “greatest” (financial, efficiency, outcome, etc.) Because of this diversity, I will describe some of the successful advances that have had a significant impact in patient benefit and are either already available or close to being introduced. While some of these advances have been listed by other prominent sources, the list below is based on my professional opinion, as a physician and healthcare executive.

The Cleveland Clinic announced about six months ago what it perceived to be the top 10 innovations that would positively impact healthcare in 2007. Of the 10 advances cited, I would consider 4 of them to be truly “awesome”. These include:

1. Left Ventricular Assist System (LVAS): This is the first implanted heart assist device that can sense when to increase or decrease the rate of blood flow. This device allows patients with severe heart failure awaiting a transplant, to feel and breath better and be mobile and not “tied to their bed”.

2. Endografting: This is a minimally invasive repair technique that has been used to treat diseases, such as abdominal aortic aneurysms, which previously could be treated only with major surgery.

3. Ranibizumab: This drug that was approved one year ago, treats a form of age related macular degeneration that accounts for 90% of all blindness from the disease. Macular degeneration is a chronic disease of the eyes caused by the deterioration of the central portion of the retina, known as the macula, which is responsible for focusing central vision in the eye. Age related macular degeneration affects about 200,000 people in the US and accounts for 12% of all cases of blindness.

4. Cancer Vaccines: One of the cancer vaccines developed is the HPV vaccine to prevent cervical cancer caused by human papillomaviruses. This vaccine was approved by the FDA in mid-2006.

Other significant advances over the past decade include:

5. Telemedicine: Combining high speed networks and high resolution images has allowed x-rays to be read by a radiologist nowhere near where it was done, to have consultations done over computer lines with full audio and video, and to even have critically ill patients remotely managed by physicians miles from the patients bedside. Many of these technologies are still in their infancy with exciting growth still to come.

6. Computational Model of HIV Infection: Discovered in 1996, this model, provided guidance in the development of multi-drug therapy for AIDS contributed to the dramatic decline in AIDS mortality over the last five years.

7. Automated External Defibrillator – These devices have been used by Paramedics since 1982. It was not until 1997 that they began to appear commonly in public places and in 2002 were approved for home use. These devices decrease the time it takes to restart a heart after a heart attack and therefore improve a patient’s survival and brain recovery significantly.

Finally, the British Medical Journal recently published a list of the 15 greatest advances since 1840. Of those 15 advances, only Evidence Based Medicine, occurred in the past 15 years. Evidence Based Medicine, which was listed at Number 8, involves making use of the current best evidence (such as medical research studies), along with a physician’s clinical experience, to make decisions about patient care. While the term was coined in the early ’90s, the concept has been evolving ever since.

As the US continues to try to reign in healthcare costs, provide healthcare to all its citizens and improve healthcare quality to truly be “the best in the world”, we thankfully will continue being significant innovators and developers of healthcare advances and technologies that will make our health and our lives that much better.