As one of the five largest public healthcare systems in the nation – and a medical safety net for Broward County – North Broward Hospital District faces a myriad of challenges and opportunities daily to maintain and enhance its flow of information electronically.

But according to Systems Development Director Glenn J. Fell, their challenges are not unique.

“Ours are probably no different than those facing other healthcare institutions … finding the resources (both capital and personnel) required to implement and maintain the many great technologies that are available today, balanced against other equally important uses for those same resources,” he says.

“Florida has some unique challenges,” he adds, “relating to attracting the key personnel needed to support a sophisticated IT infrastructure. Due to housing costs, property taxes, etc., we have seen this prevent people from moving here – while causing some people already living here to move out of the area.”

But Fell, and NBHD, are seizing the opportunities at hand.

“We have a clear path that we want to pursue relating to electronic medical records – or EMRs. This includes continued automation of clinical information so it is readily available to providers, implementing a medication administration process with automated safety checks, linking biomedical equipment electronically to the medical world, and increasing a clinician’s ability to perform their workflow electronically – to name a few.”

“All of which will improve efficiency, patient care and patient safety,” he adds.

In the last 20 years, technology has almost catapulted us into a new world, and that advancement has had a particular impact on Information Technology.

Fell says, “Improvements in wireless connections have afforded opportunities for point of care access that weren’t available in the past. The evolution of affordable, faster communication methods such as DSL, cable modems and data enabled cell phones now make remote patient record access a practical proposition for all providers – including access to clinical results and electronic images.”

He continues, “The Internet use by both providers and patients has exploded the access to a wide variety of knowledge content and has made the use of computers for ‘health’ related purposes commonplace among a significant percentage of the population.”

More accessibility translates to more efficiency – in a hospital setting, in the physician office … and even in the field.

“More data is becoming electronic every day, and more affordable methods to access that data remotely are available. For example, radiology images are now available to a physician electronically so that they can examine these from their offices or even from their homes. Not only can they see results sooner or without having to drive to the hospital, they can use the sophisticated tools that are part of the viewer program to quickly and easily manipulate the image.”

At A Glance
Glenn J. Fell
Director, Systems Development
North Broward Hospital District

How many years at North Broward? 17
Community (where you live): West Boca Raton
Family: Wife, son (19) daughter (21)
Education: Masters, Healthcare Administration.
What would you advise someone going into the medical IT field? It’s a very challenging field but with lots of exciting opportunities ahead. No two days are the same and it’s never boring. It’s stressful because there are always many more systems and technologies requested by users than you can deliver. That said, it’s very rewarding to see the positive impact on both providers and patients when you are able to provide new technologies

This is also a benefit in the office where physicians can see results as soon as they are available, which could lead them to make a treatment modification sooner and, ultimately, get the patient out of the hospital sooner – saving time, saving money.

The emergence of advanced electronic transmission has also impacted the pre-hospital arena. Some EMS units have the ability to transmit EKG data from the field.

“These go directly to our emergency rooms,” Fell says.

Other trends on the horizon?

“We’ve seen, of course, an incredible growth in the use of the Internet for medical information, but a more recent development in early pilot stages in some areas is it’s use by patients to communicate directly with their physicians and vice versa, leading to what is sometimes referred to as ‘e-visits.’ Some insurance companies are experimenting with reimbursement for things like this.”

“Also, the creation of health records beyond the walls of one institution is a trend now being explored in various communities. Regional Health Information Organizations (RHIO) or Health Record Banks (HRB) are terms describing some of these efforts – as well as patients contributing on-line to their own personal health records.”

Another trend is a move to greater “transparency.” This includes things like web sites where a provider’s outcome statistics are posted for the public, or “pay for performance” programs where providers are paid differently based upon various outcome statistics or their use of certain technologies.

Patient privacy is of paramount importance at NBHD – and everywhere, however.

Fell says, “As we expand beyond the confines of just one organization and towards a regional – or even national – health record, our challenges expand. Not only so we have the usual access security issues on a broader scope, but there is the added issue of patient identification. We need to have some ‘clean’ identification mechanism to assure that the right patient data being fed from different places gets associated with the right patient record. However, people have a concern about having a unique national identification number for health record purposes because of privacy concerns.”

And where does Glenn Fell see all of these trends heading?

“It depends on how far you want to go. Initially, we need to finish building the ‘electronic highway’ of clinical information so that all data is digital, in a format useful and accessible to the clinicians, and where basic clinical interaction and safety rules are automatically checked all the time.”

“In the electronic record world, physicians can use that data to provide faster diagnoses, prevent duplicate procedures, have easier access to clinical reference information and protocols – thereby enhancing the ability to react faster to a patient’s changing condition.”

Whatever the technological challenges, North Broward Hospital District is seizing them as opportunities. Whatever technological trends are seen on the horizon, NBHD is interpreting them and utilizing them to best benefit their patients, physicians and their entire health community.



2007 will be another challenging year for health care providers. We have a system of care in our country with which no one is happy. Misaligned incentives and flawed economic strategies have crippled our well-meaning system. So where are we going in 2007? I don’t have a crystal ball, but like many others, I have an opinion. Here is what I see as we look ahead.

No State Left Behind

As the federal government stalls under a lame duck congress, the weight of the uninsured is falling on our states. The timing is perfect for universal health care coverage initiatives. Massachusetts will require the state’s 6.4 million residents—including the 550,000 uninsured—to obtain health care coverage by July 1, 2007, and their new law will subsidize premiums for people earning below 300 percent of the federal poverty level. The Vermont Legislature in May created a comprehensive health insurance plan for uninsured residents under which the state provides premium assistance to lower-income individuals to keep premiums low. And the state of Utah is using a Medicaid waiver to provide primary care and preventive services to low-income adults who otherwise would lack health insurance.

Universal coverage is an option being seriously considered by virtually every state. Why? Because they are reacting to 46 million uninsured in our country and the reality of $1,000/month premiums for those fortunate enough to have private coverage. Reactive solutions are symptom-focused and fail to address system flaws. But this one is gaining a great deal of momentum.

The “Big Boys” Make the Plunge

IBM recently joined the myriad of healthcare technology vendors with plans in the coming year to develop systems to overhaul medical payments by using small personal devices to trigger financial transactions (Smart HealthCare Payment Systems) and will make the leap into the word of electronic medical records. The timing is good. 2007 will be a breakout year for physician adoption of electronic health records. The stars have aligned and the big boys are seeing dollar signs. Microsoft has finally rolled out the Vista operating system and freed up some intellectual resources. In addition, we will see more general acceptance by physicians of decision support databases that will facilitate evidence-based medical decision making.

Employer-Driven Health Plans

If providers won’t invest in health care, some employers say they will. Intel, Wal-Mart, and British Petroleum are creating a joint effort to provide their employees with portable electronic health records that they hope to link with records from hospitals and pharmacies. These three companies could be joined by several others in a CDC co-sponsored project intended to reduce medical errors and improve quality in a transparent environment that stresses performance data. Toyota is taking a different approach by building a health clinic for employees and dependents in its new factory in San Antonio. They will go a step farther than Wal-Mart and offer medical care, dental care, eye care and physical therapy services in addition to technology infrastructure.

The Medical Home Model for Primary Care

We have a daunting task before us. How do we provide high quality care to our aging population composed of chronically ill seniors with multiple and often complex medical conditions? The answer derives from the concept that medicine is now a team sport with primary care physicians serving as captains. Access to primary care in the form of a “medical home” is a concept essential to success. In addition to expertise in the chronic care model, these physicians will require the efficiencies that can only come from a systems approach supported by technology infrastructure.

Outcomes-Based Competition

Precursors for this concept abound—patient centered care, transparency, pay-for-performance, consumer-driven care and high performance networks. Through the work of groups like the Commonwealth Fund and thought-provoking books like Redefining HealthCare (by Michael Porter and Elizabeth Olmsted Teisberg), the next year will see more movement toward outcome-based competition. This is where we need to go for lots of reasons and our patients will provide the catalyst for this change as information about cost and quality becomes more available to them and more reliable. Physicians that embrace this concept now will reap the benefits while others are scrambling to catch up.

Hospitals Become Major Employers of Physician Providers

Hospitals are back in the physician employment business. This time, I think many of them will succeed. On the new list are not just primary care providers, but niche specialists (e.g., wound care, stroke centers) that support important hospital services. New physicians in training are being told that they can not be successful at starting and maintaining their own business. Most are looking for an employer that has the cash flow to support start-up and weather the lean times that may occur. The hospitals are getting the help they need from companies skilled in revenue cycle management and physician office systems. Early signs of success are encouraging.

The coming year will offer great opportunity for those who embrace change, create efficiencies, successfully implement technology and differentiate themselves based on quality. The rest will continue to swim as hard as they can against the rip current of “this is how we have always done it.” Sometimes it is not safe to go into the water.



When you see someone collecting canned food for the hungry, raising cancer awareness or providing home repairs to seniors, you will most likely encounter a HERO (Healthcare Employees Reaching Out), which boasts 2,344 volunteered employees from Memorial Healthcare System.

The premise of the program, which had its humble beginnings in October 2001, aims to match employees with volunteer activities and projects that meet their interests. One of HERO’s signature events is the “Adopt” a Child drive, which has provided more than 4,333 children with toys and backpacks in the past five years. Memorial HEROs also collaborate in one of the largest food drives called the “Souper Bowl,” which engages area Broward hospitals in a “friendly” competition aimed at collecting the largest amount of donated food. This year, Memorial employees donated 10,464 pounds of non-perishable foods, which were delivered to several pantries in the Broward area.

Memorial HEROs have participated in a variety of projects and events such as cleaning up beaches, bringing access awareness to the handicapped and notifying mobile home residents when hurricane warnings have been issued. In fact, HERO was highlighted together with other Memorial programs in the prestigious Foster G. McGaw Award for Excellence in Community Service, recently earned by Memorial Healthcare System.

“Some of our HEROs volunteer within our community all year long, helping with Girl Scouts, volunteering at their place of worship, serving meals at local food banks, museums, civic organizations and animal shelters. The list is as endless as their generosity,” said Steve Sampier, who oversees the HERO program and is the director of community services for Memorial Healthcare System.

This year, the HERO program expanded to include the LEAP Squad (Leaders, Enabling, Assisting and Promoting).

“They are the cheerleaders in our facilities, who promote and support HERO projects and events and are involved in details from planning to project execution,” said Lisa King, community volunteer coordinator for Memorial Healthcare System. “You will find them writing articles for newsletters, doing data entry, acting as team leaders at events, posting flyers and promoting employee participation. These dedicated volunteers go that extra mile by taking on a leadership role.”



As Americans, our passion for technology often leads us to confuse technological productivity with scientific advancement. Science applies an agreed upon system of knowledge to the understanding of fundamental principles and mechanisms that control and explain the natural world in which we live. Technology uses the knowledge generated from scientific investigation to design products that will better be able to serve specific functions. So it would seem that technology follows science.

Interestingly, what has evolved in the modern world of cardiovascular (and other) research is much more complex. Certain technological advances have not only enabled more advanced scientific investigation, but they have even changed the very nature of that investigation. For example, the advances in data-processing over the past several decades have been nothing short of phenomenal. Today’s hand-held devices have more processing power than the room-sized computer monsters of the past generation.

If we look, for example, at the field of genetic investigation, a major research interest here at the Florida Heart Research Institute, we see two rather remarkable developments. First, the ability to process and integrate enormous amounts of information in a rapid fashion led to the near completion of the Human Genome Project approximately a decade ahead of schedule. The genetic information regarding the human (as well as several experimental animal species) that is currently available in the public domain is enabling researchers to explore areas and ask questions not even accessible to earlier investigators. But the process is even more dramatic. Because huge quantities of information can be processed very rapidly, databases can be mined for associations that were not previously predicted. What does that mean? In classical scientific research, the investigator uses his observations of phenomena to generate a hypothesis. He then designs an experiment or series of experiments to test that hypothesis. The findings either prove or disprove or modify the hypothesis, while at the same time raising new questions to be explored. And so science marches on. Now, however, the scientist can take one huge set of data, like the human genome, and another huge set of data, such as a population with a known form of heart disease, replete with all sorts of clinical details, and bring the two together, looking for patterns of association. The results may be somewhat predictable. For example, when we use this technique and discover that there is an association between an abnormal heart rhythm and a mutation in the gene that codes for one of the proteins that sit in the cell membrane and determine the flow of ions (charged particles) across that membrane, we are not particularly surprised. That flow of ions is the mechanism by which heart rhythms are generated and maintained. However, determining which specific mutation(s) are associated with which arrhythmia would have been, without this technology, like trying to find a needle in a haystack. Moreover, other results, may have been completely unpredictable, such as finding an association between congestive heart failure and the genes encoding certain poorly understood cytoskeletal proteins, or even more mysterious genes which do not encode anything, but regulate the expression of other genes.

What is happening here? Not only is technology enabling scientific investigation but it is changing scientific method!! Now the power of the information which is being processed can generate the hypothesis, rather than vice versa. Perhaps in the area of informatics, this dramatic potential of technology to impact science can most readily be appreciated. However, there are other areas of evolving technology whose impact on scientific discovery is likely to be enormous. The exact nature of that influence is now only a matter of speculation. For example, what will happen when nanotechnology will soon enable us to evaluate living organisms on the subcellular level? To perhaps tell us which cells “sound” or “look” more like cancer cells? To “listen” to the communication between cells? What will be the impact when proteonomics can distinguish for us the specific modifications that certain cells make of certain proteins under certain conditions of health and disease? When noninvasive tests will be able to identify for us which atherosclerotic plaques will be the ones en route to rupture and cause a heart attack? And which ones can be reversed?

Between science and technology we are reminded of Humphrey Bogart’s classic line at the conclusion of Casablanca, “this could be the beginning of a beautiful friendship…”



The Health Council of South Florida Board of Directors is pleased to announce the appointment of Marisel Losa to President & CEO of the Health Council of South Florida (Council) and Vianca Stubbs as Vice President.

Prior to her position at the Council, Losa was the Program Director of Mission Services and St. John Bosco Clinic, Mercy Hospital. Losa is also known for her work in advocating for the establishment of the State of Florida Free Clinic Association. She graduated from Florida International University with a Masters in Health Services Administration.

Prior to her promotion, Stubbs was the Associate Director of the Council where she oversaw health care planning programs and community-based planning initiatives. Most recently Stubbs led a countywide effort to plan for a potential influenza pandemic in Miami-Dade County. She graduated from the University of Miami with a Masters in Public Health.