The delay, announced October 30, comes at the request of Congressional members, the FTC said. The rule was scheduled to go into effect November 1.

The announcement comes a week after the House of Representatives passed an amendment to the rule that would exclude certain businesses, including small healthcare, accounting, and legal practices. The House bill is currently in the Senate.

On the day FTC announced the delay, the US District Court for the District of Columbia ruled that the FTC may not apply the Red Flags Rule to attorneys.

This is the fourth delay for the rule, which was originally scheduled to take effect November 1, 2008. Industry groups, including healthcare providers and lawyers, have pushed for an exclusion, while others have complained that the rule lacked sufficient detail and guidance. The FTC has since been adding information and guidance online.

Long-term trouble can start during a brief check-in. A rushed or incomplete search of the organization’s MPI can cause clinical registrars to create duplicate patient records or even select the wrong record.

Faulty information entered at check-in streams straight through the system, risking treatment errors and leading to eventual billing problems. Entities that participate in health information exchange will export bad information into their networks.

Error-ridden MPIs also hamper an organization’s ability to understand its patient population and its own performance, both for internal and external reporting. Patient information spread across multiple records can distort measures of patient severity and overall risk of mortality. And correcting errors consumes time.

HIM departments often are the hub of identifying and mitigating registration errors. HIM staff sift through the MPI, merging duplicate records and  separating out information that has been overlaid into the wrong patient account.

But what HIM learns about the types of MPI errors occurring in patient registration may never be shared with that department. Because HIM and registration are typically managed through different departments, there can be an information exchange disconnect between the two areas. If registration staff do not know what they are doing wrong, how can they correct it?

Some facilities have instituted registration improvement programs, which can feature cross-department committees whose purpose is to reduce registration errors and clean up the MPI.

Providing Feedback to Registration

Not only do these registration improvement processes eventually reduce work for HIM, they also give vital feedback to registration staff about how their actions directly impact the medical record and patient care, according to Gwyndle Kravec, MBA, RHIA, CCS, director of HIM and privacy officer at Peninsula Regional Medical Center, based in Salisbury, MD. Peninsula instituted a registration improvement program that has greatly reduced MPI errors.

“I think this program heightens the awareness that this is an issue of data quality and that these [duplicate MPIs] do impact patient safety,” Kravec says. “When you heighten awareness of what the downstream effects are of having a duplicate medical record, then I think [registrars] are more conscientious of what they are doing. They want to get it right.”

Registration improvement programs can be simple or elaborate, depending on what investment a facility feels is appropriate to clean up its MPI and registration processes.

The HIM department at Christiana Care Health System, based in Newark, DE, has worked with the facility’s registration areas for several years to improve registration processes and reduce MPI duplicates and overlays. The initiative is an important part of ensuring health records are complete and accurate, says Kathy Westhafer, RHIA, CHPS, program manager for clinical information.

“We are looking for that MPI to really be the focus of how we identify the patient, that we have one record for the patient within the health system,” Westhafer says.

Each day a team of Christiana Care HIM professionals uses a clinical system tool that identifies possible MPI duplicates and overlays. A notification tool is also available for all staff to report possible duplicate MPI accounts. HIM staff investigates these suggested cases, merging duplicate MPIs or separating out information in overlay cases.

“That team is doing the research and determining if it is a situation where two people were merged inappropriately, in an overlay situation, or if it is really one person that has multiple records,” Westhafer says.

Because each ancillary area at Christiana Care conducts patient registration, duplicate and overlay MPI cases are compiled by HIM and separated by the specific ancillary area where the error occurred. Reports describing the circumstances of the error are circulated monthly to the various registration area managers. The information is used to create better registration processes as well as develop specific education for registration staff, Westhafer says.

Providing feedback to the registration departments is key to the facility’s MPI cleanup efforts. Instead of HIM doing cleanup work solely on the back end, registration now can use the information to improve accuracy on the front end, Westhafer says.

Since Christiana Care started its improvement processes, registration errors have been significantly reduced. A recent audit showed the organization’s MPI duplication rate accounts for fewer than 2 percent of all MPI records, a typical industry benchmark for MPI best practices, Westhafer says.

“We felt really good that the processes that we have put in place over the years seem to have worked,” she says.

Direct Training for Dramatic Results

In other organizations, HIM may have a more hands-on role in registration improvement efforts. At Peninsula, MPI duplication rates were so high that in 2007 the HIM department staff formed a committee and began direct education with registrars.

At that time, Peninsula’s registration staff was not taking enough time to accurately select or create MPI numbers. HIM staff struggled to fix the resulting duplicate accounts being entered into the system each day.

“We were processing 60 duplicates a week,” Kravec recalls. “Some of those were expected as part of our [trauma] registration process, but a majority of them were errors. So we had to get together because [the registration department] were not taking accountability. They were creating the error, and HIM was cleaning it up.”

The resulting committee, made up of representatives from HIM, patient registration, finance, IT, and labs, meets monthly to review duplication creation rates, discuss trends in registration data errors, and create new processes to correct the mistakes. A registrar is also invited to each meeting to discuss how a registration error occurred and how it could be prevented in the future.

Through the program, HIM collects all MPI account duplicates and sends them to the registration department manager. The registration manager uses the information for educational training in the department and monitoring which registrars are habitually creating errors. Under a disciplinary action program, a registrar who creates three duplicate MPI accounts within a rolling one-year time period is terminated from the organization. The policy holds registrars accountable for their mistakes and has helped reduce the number of errors committed, Kravec says.
 
Also, once a month the HIM operational manager will visit the registration department and conduct quality training with the registrars. The manager provides registrars the recent duplicate MPI rates and shares specific examples of recent registration errors that HIM has found. The HIM manager also observes the registrars at work, watching for any shortcuts that could lead to registration errors, Kravec says.

“There were so many errors and missing information in different records that we knew we needed to get something done,” Kravec says. “So we built in this ad-hoc way to do it where the HIM manager goes up [to registration] and does training on a monthly basis and brings true live examples where they registered a patient incorrectly.”

The registration improvement program has drastically reduced the number of MPI account duplicates at Peninsula.

In the first year of the program, MPI duplication rates dropped 23 percent from the previous year. By the end of the second year, rates had dropped 57 percent compared to rates before the improvement program was implemented.

“It is less resources I’m using, and my identity coordinator can certainly use their time doing better things than merging duplicate records,” Kravec says. “It is not just with one system—we have 17 downstream systems that it impacts. We have to coordinate and synchronize these merges so that patient safety is not impacted in a negative way.”

The registration improvement program at Peninsula is vital in keeping the duplication rates under control. It holds people accountable for their actions, Kravec says. “You do betterwhen you think somebody is watching,” she says. “Now if we stopped the program or stopped the [training] on these, I can see these numbers reversing.”

How Registration Errors Occur

The cause of registration errors varies from simple accidents to negligence.

The turnover rate for registration department employees is especially high in many facilities. With new employees regularly starting work, education on proper MPI creation is constantly needed, Westhafer says.

The rush to register patients can also affect error rates. At Peninsula, the emergency department has a policy that patients should be registered within two minutes so treatment is not delayed. Nearly 65 percent of Peninsula’s patients are admitted through the ED.

Registering a patient within two minutes is a lot of pressure, Kravec says, and with both patients and registrars in such a hurry, mistakes can easily be made. 

The most common registration error at Peninsula is misspelling a patient’s name when searching the MPI. Because of this, the MPI duplication committee has asked registrars to confirm at least three unique identifiers in a patient’s record—such as name, Social Security number, and date of birth—before assuming they have found the correct file.

Many registration mistakes can be avoided by requiring registrars to ask patients if they have ever been to the hospital before. “That is very simple, but there were some registrars that never asked that,” Kravec says.

Technological problems are partly to blame for some registration errors at Christiana Care. The facility’s registration system is nearly 20 years old and in dire need of upgrade, Westhafer says. “There are inherent problems with a 20-year-old system in that you are very limited in how you can search [for MPI records],” she says.

The organization has decided to replace the registration system, and Westhafer says staff is looking for a system that makes it easier for registrars to look up MPI records.

One guideline at Christiana Care contributes to duplicate records, intentionally. Registrars are instructed to create a new record if they cannot confirm they have correctly matched a patient to an existing record. “We have told registers, ‘when in doubt—unless you are positive—it is better for you to create a duplicate than it would be to choose somebody incorrectly,’” Westhafer says. HIM staff would rather merge a duplicate record than sort out patient information from an incorrect account, Westhafer explains.

Getting Started

Improvement programs do not need to be elaborate. Merely sharing duplicate creation rates with registration staff can help reduce errors. Registration management can use the rates to help develop new registration procedures, train registrars, and track improvement progress.

Facilities looking to create programs should first track their duplication rates. Identifying specific MPI issues will help organize a response to the problem. Next, they can create a project assessment and determine which facility departments would be affected by a registration improvement program. Contact those parties and invite them to help develop the project, Kravec recommends.

Regardless of how the errors occur, an important part of a registration improvement program is educating registrars about the impact their work has on the rest of the facility. Registration’s impact on patient care is a focal point of the education sessions HIM conducts at Peninsula, Kravec says.

Just educating registrars on the importance of finding the correct patient MPI during registration can have a positive impact on their work.

“Registrars didn’t have the full picture before this program,” Kravec says. “Now they have the full picture.”

Members may read all stories online in the AHIMA Body of Knowledge. Select features and practice briefs are also available publicly.

November-December 2009

Features

• Dispute Resolution: Planning for Disputed Information in EHRs and PHRs, by Lydia Washington, MS, RHIA, CPHIMS; Ethan Katsh, JD; and Norman Sondheimer, PhD
• Plan B: A Practical Approach to Downtime Planning in Medical Practices, by Cheryl Gregg Fahrenholz, RHIA, CCS-P; Lance J. Smith, RHIT, CCS-P; Kyle Tucker, RHIA, CCS; and Diana Warner, MS, RHIA, CHPS
• Converting MS-DRGs to ICD-10-CM/PCS: Methods Used, Lessons Learned, by Rhonda Butler, CCS, CCS-P, and Janice Bonazelli, RN

In Addition

• 75 Years of HIM Education, by Shirley Eichenwald Maki, MBA, RHIA, FAHIMA

Practice Brief

• Electronic Signature, Attestation, and Authorship (Updated)

Working Smart

• Fear Factor: Ambiguities in State Law Leave Some Providers Hesitant to Adopt EHRs, by Chris Dimick
• Genomics and HIM: Three Areas of Increasing Intersection, by W. Gregory Feero, MD, PhD; Selma Holden, MD; and Barbara Fuller, JD, RHIA, FAHIMA
• Medical Device Deliberations: Data Issues to Consider When Purchasing and Implementing New Devices, by Beth Acker, RHIA
• Communicating Security Efforts: Informing Consumers of Data Protection Programs Helps Build Trust, by John Parmigiani

Coding Notes

• FY 2010 Changes to the Hospital IPPS, by Kathy DeVault, RHIA, CCS
• Coding in Critical Access Hospitals, by Karen M. Kostick, RHIT, CCS, CCS-P

The amendment is intended to relieve the administrative burden on small businesses.

The Red Flags Rule, part of the Fair and Accurate Credit Transaction Act of 2003, requires “creditors” and financial institutions to develop and implement written identity theft prevention programs. As described in the rule, creditors are organizations that maintain consumer accounts that receive multiple payments or payments made in installments.

In full, HR 3763 amends the Fair Credit Reporting Act to exclude “any health care practice, accounting practice, or legal practice with 20 or fewer employees.” It also excludes any other business that the Federal Trade Commission, which oversees the rule, determines:

• knows all its customers or clients individually;
• only performs services in or around the residences of its customers; or 
• has not experienced incidents of identity theft, and identity theft is rare for businesses of that type.

The proposed amendment moved easily through the House. It was introduced October 8 and was voted on without debate on October 20. There were 400 votes to approve and no votes in opposition.

The House bill was received and read in the Senate and referred to the Committee on Banking, Housing, and Urban Affairs.

The Red Flags Rule was first scheduled to take effect November 2008. The Federal Trade Commission offered several delays to provide more guidance and give businesses more time to prepare.

Provider Burden or Consumer Protection?

Rep. John Adler (D-NJ) sponsored the bill. “The Federal Trade Commission went too far and went beyond the intent of Congress by considering non-financial, service-related industries to be ‘creditors’…,” he said in a floor speech before the vote.

“Its ruling would force thousands of small businesses to comply with burdensome, expensive regulations by forcing them to develop and implement an identity theft program.”

The American Medical Association also is opposed to inclusion of medical practices and has lobbied against it.

However, in a letter to the Senate committee chair, AHIMA argues that medical practices are already a target of identity thieves and that exempting them from the rule would motivate thieves to focus on them more.

AHIMA also noted that the bill has a much farther reach than might appear. Nearly half of physicians work in practices of six physicians or fewer, according to a 2008 report from the Centers for Medicare and Medicaid Services. At a time when medical identity theft and healthcare fraud are on the rise, the bill would exempt a large share of providers from having identity theft prevention programs.

In addition, the exemption would undermine efforts to raise awareness of identity theft and subsequent fraud within the healthcare industry, AHIMA wrote.

The Senate Committee on Banking, Housing, and Urban Affairs has yet to schedule discussion of the bill. With a full plate and the winter recess approaching, it is unclear if the committee will consider the House bill this year.

Updated Oct. 28

California law requires businesses and state agencies that have unencrypted personal information lost, stolen, or improperly accessed from their databases to notify affected consumers. However, the law does not specify what information the notification letters must contain.

Senate bill 20 would have ensured businesses include key information in their notices, such as the type of personal information breached, a description of the incident, the date it took place, and who to contact for more information.

The bill was vetoed, Schwarzenegger wrote in his explanation, because there is no evidence of a problem with the information businesses are currently providing consumers.

The veto does not dramatically affect state healthcare organizations, which beginning September 23 must meet similar requirements under federal breach notification laws. The federal laws require companies that handle personal health information to include specific information in breach notification letters, including date of the incident and the personal information breached.

However, the federal provisions—part of the American Recovery and Reinvestment Act’s HITECH section—only cover healthcare businesses, leaving California organizations such as banks and educational institutions open to include as much or as little information in their breach notifications as they deem appropriate.

Veto “Surprising”

Senate bill 20 was proposed by state senator Joe Simitian, who said it was necessary to ensure that victims receive the information they need to understand the problem and protect themselves from harm.

“This is one of the most surprising vetoes I’ve gotten while I’ve been here, over nine years,” Simitian said.

The bill had moved through the state legislature with strong support.

Simitian acknowledged that the majority of the notices that go out to consumers do contain adequate, helpful information. However, he said there have been instances of vague and meaningless breach notifications.

A survey of data breach victims included in a 2007 University of California-Berkeley School of Law paper found that 28 percent of those receiving a breach notification did not understand the “potential consequences of the breach after reading the letter.” Simitian cited this study as well as personal conversations with confused breach notification recipients to explain why legislation is needed.

The proposed additions to California’s privacy law would not break new ground. Several states have added similar breach notice requirements to their privacy laws, Simitian said. Setting notification requirements could also benefit businesses by spelling out their responsibilities. Having clear-cut requirements saves businesses from guessing at what they should do to be compliant.

While he feels the breach notification content requirements were not necessarily a bad idea, California-based healthcare attorney Reece Hirsch said he can understand why the bill was vetoed. Hirsch, a partner with Morgan Lewis’s FDA/Healthcare regulation practice, has helped clients draft many breach notifications. The breach notification requirements proposed in the bill are considered best practices in the field and already followed, he noted.

“Most companies responding to a security breach under the existing law would typically include the elements that are stated in senate bill 20,” Hirsch said. “Certainly there are consumer groups who have felt that these notices are maybe confusing, not as forthcoming as they should be.

“But by and large I am not sure that the elements that were specified in senate bill 20 would really affect a real change in the sorts of notices that consumers are seeing under the current California law.”

No Copy for the Attorney General

Senate bill 20 also called on businesses to send a copy of their breach notifications to the California attorney general if the breach affected more than 500 people. The provision was included to give law enforcement and the legislature a way to track privacy breaches across industries and identify trends, Simitian said.

In his veto message, Schwarzenegger wrote there was “no additional consumer benefit” to the provision because the bill does not require the attorney general to do anything with the notices.

“I thought there was a little irony in the veto message suggesting that we didn’t have evidence of the nature of the problem, and then going on to say ‘and by the way, why on earth would you want to have a place where there is a repository of this information,’” Simitian said.

Under state law that took effect January 1 of this year, healthcare organizations are already required to report breaches of any size to the California Department of Public Health, Center for Health Care Quality, which has power to investigate and fine organizations.

However, sending a breach notice directly to the attorney general could have increased an organization’s chance of being prosecuted, Hirsch noted. The federal breach notification provisions give attorneys general the power to enforce privacy protections and take enforcement action against healthcare organizations that have experienced a breach of protected health information.

Though the bill was vetoed, Simitian said he will have conversations with the California governor’s office on how to get the bill passed. He plans to reintroduce the legislation next year.

The Federal Content Requirements

Two federal laws govern breach notification. A rule promulgated by the Department of Health and Human Services governs HIPAA covered entities; a rule published by the Federal Trade Commission applies to noncovered entities such as personal health record vendors.

The rule governing covered entities spells out that breach notifications must:

• Be written in plain language
• Describe what happened, including the date of breach and discovery (if known)
• Describe the types of unsecured personal information involved in the breach
• Provide steps individuals should take to protect themselves
• Give a brief description of what the healthcare organization is doing to investigate, mitigate harm, and protect against further breaches
• Describe contact procedures for patient questions, including a toll-free telephone number

The rule currently exists as an interim final rule, meaning that it could be modified based on public comments. The comment period ends this Friday, October 23. The FTC law governing noncovered entities has similar content requirements, though it provides less detail.

The California bill would have required businesses to include two items in addition to what the federal laws specify:

• Contact information for credit reporting agencies
• A statement describing whether there was a delay in notification because of law enforcement investigations

• Sample project communication plan
• Sample project plan
• Sample project progress report
• Sample issues log

The online version also includes a list of communication aids that organizations may use in the transition to ICD-10-CM/PCS and a contact form for the major stakeholders leading the ICD-10-CM/PCS implementation.

As the practice brief notes, planning for the transition to ICD-10-CM/PCS is a multifaceted effort. Defining the organization’s data management plan will facilitate a smooth transition to ICD-10-CM/PCS and optimize its greater specificity.

The conversion project offered an early test of the General Equivalence Mappings and provides organizations with a process for converting their own applications to ICD-10-CM/PCS.

Rhonda Butler and Janice Bonazelli, senior clinical analysts at 3M Health Information Systems, offer an overview of the conversion in this early look into the upcoming November/December issue of the Journal.

In addition, while the industries looking for HIM knowledge continues to diversify, the greatest concentration of employment is expected to remain within seven industries that are today’s major employers.

What will change, however, is the breadth and depth of the competencies required to do the work. The fundamental knowledge of health informatics that may serve today, for example, won’t go a long way in 10 years, according to survey respondents.

Following are the top five competencies that respondents believe are required for health information management now and in 10 years, ranked by their current importance.

_______________________________________________________________ 

 _______________________________________________________________ 

The level of competency in privacy, health information literacy, and basic computer literacy are expected to remain relatively consistent. The skills that will gain increasing importance as health IT becomes more prevalent and sophisticated are health informatics skills in using electronic records and technical security.

The rank order changes, also. In 10 years, respondents believe that health informatics will be the most relevant competency required—higher than the current leading competency of privacy and confidentiality.

Respondents also identified a fast-emerging need for a softer skill—leadership and organizational communication skills. While just 43 percent of respondents consider it a relevant competency for HIM work now, 70 percent believe it will be necessary in 10 years.

Who’s Hiring?

Seven industries represent the greatest concentration of HIM employment, either employing HIM professionals directly or staffing roles that require HIM skills. Shown here are employer responses greater than 66 percent.

_______________________________________________________________

  _______________________________________________________________ 

HIM practitioners gave similar replies. Both employers and practitioners foresaw these same industries having the greatest demand in 10 years, also. The research delved deeper with practitioners, asking them to rate the level of education demanded in each industry in 10 years. Educational institutions, hospitals, consulting services, and government agencies are expected to be the most likely to require master’s degrees. Those with associate’s degrees in 10 years are most likely to find demand in hospitals and physician offices.

The survey consisted of 20 interviews with subject matter experts and a survey of practitioners, employers, and search firm recruiters. It was conducted for AHIMA by the American Institutes for Research. The survey covers a much wider range and depth of information than excerpted here. The full results will be available this fall from AHIMA.

What Are the Informatics Skills Related to the EHR?

In 2008 AHIMA and the American Medical Informatics Association published core competencies expected of a healthcare workforce that uses EHRs in its daily work. The recommendation originated in a workforce summit the two associations convened in the preceding year.

The competencies for health informatics skills using the EHR include the following:

• Create and update documents within the electronic health record (EHR) and the personal health record (PHR)
• Locate and retrieve information in the EHR for various purposes
• Perform data entry of narrative information
• Locate and retrieve information from a variety of electronic sources
• Differentiate between primary and secondary health data sources and databases
• Know the architecture and data standards of health information systems
• Identify classification and systematic health-related terminologies for coding and information retrieval
• Know the policies and procedures related to populating and using the health data content within primary and secondary health data sources and databases
• Apply appropriate documentation management principles to ensure data quality and integrity
• Use software applications to generate reports
• Know and apply appropriate methods to ensure the authenticity of health data entries in electronic information systems
• Use electronic tools and applications for scheduling patients
• Educational and training programs, healthcare organizations, and professions can use the core competencies matrix to:
• Support the design of in-service and on-the-job training programs for the current workforce
• Serve as a reference for healthcare workforce job descriptions
• Plan professional development activities
• Build specific professional competencies (after review and expansion by various health professions)
• Develop new employee orientation programs
• Improve formal health professional academic curricula

The matrix is described in the report “Health Information Management and Informatics Core Competencies for Individuals Working with Electronic Health Records.” The full matrix is available as an Excel spreadsheet.

The rule also proposes to:

• prohibit health plans from using or disclosing protected health information that is genetic information for underwriting purposes;
• revise the provisions relating to the notice of privacy practices for health plans that perform underwriting;
• make conforming modifications to definitions and other provisions of the privacy rule; and
• make technical corrections to update the definition of “health plan.”

The interim final rule applies GINA’s prohibitions on using and disclosing protected genetic health information for underwriting to all health plans subject to the privacy rule, rather than solely to the plans GINA explicitly requires be subject to the prohibition. It also proposes applying the prohibition on using or disclosing is genetic information for underwriting purposes to all health plans that are covered entities as defined by the HIPAA privacy rule.

CMS will accept public comments for 60 days.

Signed in 2008, GINA protects individuals against discrimination in health coverage or employment based on their genetic information.

Jill Burrington-Brown, who teaches in an online HIM program at Missouri Western State University, shares with her students the communication skills she has learned in a career that has covered a range of settings and roles.

Burrington-Brown, MS, RHIA, FAHIMA, has been an HIM director; managed quality improvement, medical staff, and risk management departments; taught; worked in a law firm; and for eight years, she was a professional practice manager at AHIMA. Communication skills may not be a chapter in standard HIM and health IT textbooks, but she assures her students that communicating well will fundamental to doing their jobs well.

Burrington-Brown really started to learn about communication when she began managing a risk management department that encompassed patient relations. Until then, she says, she hadn’t considered that people who are upset may not know exactly what they are upset about. “They just know they are upset,” she says. “They had a bad experience at your facility, and you had to find out what made that experience bad.”

The job taught her that “you really have to listen hard to people who are upset. Because what they’re complaining about is often not what they are really upset about.”

Many times, she says, once discovered, the fundamental problem turned out to be easy to fix. Often a patient call that began with a threat of litigation was resolved with an apology.

But one of the first things she learned from that job, she says, is what she didn’t know about communicating. Fortunately, the CFO she reported to was interested in the communication process and offered staff classes on better communication.

“That’s where I found out, too, that if you don’t agree on what you’re talking about, you could walk away from the table and have totally different ideas of what went on. Communication is much more basic than any of us believe it to be. It’s got to be at a level where everyone understands what the topic is.”

It may sound simple, but she assures her students that it requires conscious effort.

Being Open to Communication

She also has learned how important it is to be open to communication with staff and colleagues. That can be invaluable when difficult situations arise.

“You have to be approachable, because people aren’t going to tell you things you don’t want to hear,” she says. “And they have to—you have to get them to tell you those things.”

Working in a long-term care facility, Burrington-Brown once had to approach a staff member who appeared to be involved in billing misconduct. If something was wrong, she says, she wanted to find out about it from the staff member, not from the Centers for Medicare and Medicare Services.

When she left practice to begin teaching, Burrington-Brown didn’t simply take with her the communication lessons she had learned, she took the classes that her former CFO had taught for staff. “I said [to my class], ‘These are things you guys have to know if you want to go out into the healthcare world. You have to know how to communicate with people.’”

In the first class she taught, Burrington-Brown gave a two-hour lecture on communicating. “I came back the next time and several people in the class said, ‘We would like to have another two hours on that,’” she says.

Real-Life Stories

After working in risk management, Burrington-Brown worked in a law firm specializing in healthcare. It was an opportunity to test out her interest in law school. She didn’t stay in law, but the experience gave her a firsthand look at a wide range of cases that she took to later jobs and ultimately to teaching.

The firm handled six or seven hospitals in the Seattle area. “I got to look at all sorts of different cases and see what kinds of things happened, how they happened, and what legal principles were violated—some really great examples for students,” she says. “What could have been avoided with proper training? What was something that maybe couldn’t have been avoided?”

The experience provided her with more material for her communications lessons, too. The cases she reviewed contained “tons of examples of poor communication,” she says.
 
Of course, real-life stories also make teaching fun, she says. Students “can’t believe some of the stuff—I can’t believe some of the stuff—that has gone on.”

Many of Burrington-Brown’s students are beginning second and third careers, and so they bring their own career experiences with them. “I have several students in my HIT 101 who work in hospitals and are bringing a real richness to the discussion boards,” she says.

Share Your Experience

Educators, what “extracurricular” lessons has the working world brought to your teaching? Students, what real-world lessons have teachers shared that helped prepare you for your career? Comment below!