CONTACTS 
0201 - Kaiser Permanente - Shadelands                                                                                                                                     O-00000718 0403
020101 - Walnut Creek, CA                                                                                                                                                 O-00000718 0403
020102 - Ms. Jeanne Bradley; Coordinator
020104 - Administration Department                                                                                                                                        O-00000718 0403

SUBJECTS
MRI on Knees
Knee Examination by Orthopedist on 000124
Care Handling Medical Records Emphasized to Staff
Medical Mistakes

0706 -
0706 -    ..
0707 - Summary/Objective
0708 -
070801 - Follow up ref SDS 24 0000, ref SDS 23 0000.
070802 -
070803 - Jeanne suggested I call Doctor Yamamoto about whether I need to meet
070804 - with him in order to assess the MRI issue.
070806 -  ..
070807 - Asked if I need to provide the medical history and xrays?
070809 -  ..
070810 - Jeanne said that when she spoke to the person who made the
070811 - appointment, they said it is routine for the medical chart and xrays
070812 - to be sent to the doctor for meetings with patients.
070814 -  ..
070815 - Accordingly, there is no evident procedural explanation for the
070816 - failure that occurred on 990910. ref SDS 4 3038
070817 -
070818 -     [On 000124 appears multiple medical charts used. ref SDS 26 2065]
070819 -
070820 -     [On 000124 medical chart omits patient history. ref SDS 26 3862]
070822 -  ..
070823 - Jeanne advised that Mark Mangrai has taken another position, and so
070824 - is no longer available for Patient Assistance.
070825 -
070826 -
070828 -  ..
0709 -
0710 -
0711 - 1024 called Doctor Yamomoto          925 295 4130
0712 -
071201 - Talked to Mary Ann, Advice Nurse.
071202 -
071203 - Where is the meeting:
071205 -                          ..
071206 -                         Doctor Yamamoto
071207 -                         000124 0830
071209 -                          ..
071210 -                         Orthopedics
071211 -                         1425 South Main
071212 -                         Walnut Creek
071214 -           ..
071215 -          Newall and Main.
071216 -          1st floor.
071218 -  ..
071219 - Reviewed the draft letter for Jeanne, ref DIP 10 0001 asking if I need
071220 - to meet on 000124 since there is nothing further that can be added to
071221 - the record.  If they decided to do the MRI, would it be done right
071222 - then, or scheduled for another day, in which case, I am not needed on
071223 - 000124.
071225 -  ..
071226 - Mary Ann expects Doctor Yamamoto will want to perform a range of
071227 - motion examination in connection with deciding on recommending an MRI.
071229 -  ..
071230 - She said the MRI will be done on a different date, if it is decided
071231 - to do an MRI.
071232 -
071233 -
071234 -
0713 -

SUBJECTS
Medical Mistakes Require Review

0803 -
080401 -  ..
080402 - Kaiser Reports Status Reviewing Medical Mistakes, Takes Action
080403 -
080404 - Follow up ref SDS 22 3248, ref SDS 20 0001.
080405 -
080406 - Received ref DRT 1 0001 from Jeanne pursuant to request on 000118.
080407 - ref SDS 22 4740   Jeanne addresses each of the 6 medical issues in the
080408 - record on 991008. ref SDS 10 9055
080409 -
080410 -     [On 000206 sent response. ref SDS 29 0004]
080412 -      ..
080413 -     [On 000207 met with Jeanne and reviewed progress. ref SDS 30 0004]
080414 - ..
080415 - Received ref DRT 2 0001 from Tom Connolly, MD responding to the
080416 - letter, ref DIP 2 0001, requesting support for correcting medical
080417 - mistakes submitted on 000113. ref SDS 20 0001  Tom makes two points...
080418 -
080419 -    1. Suggests contacting Doctor Naqvi for new medical issues, which
080420 -       conflicts with the record on 991008 discussing need to change
080421 -       Primary Care physician.
080423 -        ..
080424 -       This conflicts with Jeanne Bradley's letter, also, received
080425 -       today that provides procedure for changing Primary Care
080426 -       physician. ref SDS 0 0788
080427 -       ..
080428 -    2. Recommends KPOnline for using webmail to enhance patient
080429 -       communication.
080431 -        ..
080432 -       This conflicts with the record on 000113 notifying Kaiser that
080433 -       this suggestion was not responsive. ref SDS 20 0785
080435 -  ..
080436 - Jeanne's letter responds to the following requests for assistance...
080437 -
080438 -    Letter to Jeanne, ref DIP 3 0001, on 000104. ref SDS 21 0001
080439 -    Letter to Tom Connolly, ref DIP 2 0001, on 000113. ref SDS 20 0001
080440 -    Letter to Jeanne, ref DIP 1 0001, on 000104. ref SDS 19 0001
080441 -    Request on 991217 to meet per Tom Driscoll. ref SDS 18 0001
080442 -    Letter to Tom Driscoll, ref DIP 8 0001, on 991216. ref SDS 17 0001
080443 -    Letter to Tom Driscoll, ref DIP 7 7600, on 991210. ref SDS 16 3072
080444 -    Letter to Mark Mangrai, ref DIP 17 0001, on 991021. ref SDS 13 0001
080445 -    Letter to Mark Mangrai, ref DIP 16 0001, on 991016. ref SDS 11 0001
080446 -    Letter to Mark Mangrai, ref DIP 15 0001, on 991008. ref SDS 10 5727
080447 -    Letter to Mark Mangrai, ref DIP 14 0001, on 991006. ref SDS 9 0896
080448 -    Letter to Mark Mangrai, ref DIP 13 0001, on 990927. ref SDS 8 2318
080449 -    Letter to Mark Mangrai, ref DIP 12 0001, on 990921. ref SDS 6 0477
080450 -    Letter to Mark Mangrai, ref DIP 11 0001, on 990913. ref SDS 5 8058
080452 -  ..
080453 - Jeanne recommends for future medical concerns first contact primary
080454 - physician and his office staff.  Should patients be unable to obtain
080455 - satisfaction at this level, contact Member Services at 925 906 2209.
080456 - She reports her administrative duties in other areas prevent her from
080457 - coordinating future issues. ref DRT 1 3468
080458 -
080459 -    [On 000206 submitted letter explaining doctors need coordinator
080460 -    support. ref SDS 29 5568]
080462 -  ..
080463 - The record shows that Kaiser's policies were followed...
080464 -
080465 -    Primary Care Physician was contacted on 990628, and scheduled a
080466 -    colonoscopy. ref SDS 1 2099
080467 -
080468 -    Primary Care Physician was contacted on 990829 to submit medical
080469 -    history and xrays for meeting on knee exam. ref SDS 3 7387
080471 -     ..
080472 -    Primary Care Physician was contacted on 990813 to submit medical
080473 -    history and xrays for meeting on knee exam. ref SDS 2 1457
080475 -     ..
080476 -    On 991019 Patient Assistance reported doctors failed to respond to
080477 -    requests for assitance. ref SDS 12 0001
080479 -     ..
080480 -    Member Services was contacted according to Kaiser's recommended
080481 -    procedures, and reported on 991021 failure to perform. ref SDS 13
080482 -    2255
080484 -  ..
080485 - The site coordinator became involved to coordinate multi-function
080486 - response, as shown in Jeanne's letter today. ref DRT 1 0001
080488 -  ..
080489 - The missing ingredient is a coordinator to help doctors deal with a
080490 - complex array of people and processes that require proactive
080491 - management, rather than passive reaction.  This takes people willing
080492 - and able to engage the record, rather than merely field a continuous
080493 - stream of verbal communication, as reported on 991108. ref SDS 15 4505
080495 -  ..
080496 - Jeanne has done a great job, but has tired of the effort.  It is not
080497 - clear who else in Kaiser can coordinate the resources required to
080498 - respond as Jeanne has done.
080499 -
080500 -
080501 -
080502 -
080503 -
0806 -

SUBJECTS
Technology Improvements Planned to Solve Communication Problems with
Medical Mistakes, Rod Welch
Communication Problems Solution Planned Technology Improvements Plan
Medical History, Xrays Not Submitted for Meeting
Care Handling Medical Records Emphasized to Staff
Medical Chart Not Delivered for Meeting with Craig
Communication Problems Solution Planned Technology Improvements Plan
Paperless Virtual Office Webmail Anytime Anywhere Intelligence on In
Paperless Office Medical Chart Online Knowledge Management Medical M
Technology Improvements Planned to Solve Communication Problems with
Medical Practice Doomed to Fail Good Management Ineffective Slippery

3513 -
351401 -  ..
351402 - Kaiser System to Fix Communication Mistakes Scheduled for Late 2001
351403 - Ideas for Improving Team Care, Doctor/Patient Partnership Not Offered
351404 -
351405 - Follow up ref SDS 10 9055.
351406 -
351407 - Jeanne says...
351408 -
351409 -     You had complained that your records and films were not available
351410 -     when you went to see Doctor Boulris [on September 10, 1999].  We
351411 -     acknowledge how terribly frustrating it is to arrive at a
351412 -     physician's appointment without your medical records.  Please
351413 -     believe that it is equally frustrating to the physician.
351414 -     ref DRT 1 2501
351415 -
351416 -        On 990910 Doctor Craig Boulris seemed to indicate review of
351417 -        patient medical history is not necessary. ref SDS 4 9130  This
351418 -        record does not support a conclusion that physician's are
351419 -        frustrated when patient history is not provided.
351421 -  ..
351422 - Jeanne says...
351423 -
351424 -     ...you also noted that your Radiology requisition was mislabeled
351425 -     with another patient's name & medical record. ref DRT 1 1855
351427 -  ..
351428 - Problem to solve, illustrated by the record in this case, per above,
351429 - ref SDS 0 4967, is gaining command and control of the record, so that
351430 - doctors can work "intelligently," as explained in POIMS. ref OF 3 1X6G
351432 -  ..
351433 - Kaiser's solution will be implemented OA late 2001, i.e., in 2
351434 - years...
351435 -
351436 -     ...adoption of an electronic medical record. We believe that the
351437 -     implementation of this system will allow us to minimize the sorts
351438 -     of communication errors that you have mentioned.  This electronic
351439 -     medical record will be rolled out in Northern California in late
351440 -     2001.  Since this project is enormously broad in scope, it will
351441 -     require a substantial consumption of resources to roll out.  We
351442 -     will not be attempting interim solutions but will continue to
351443 -     emphasize, to all staff, the importance of care in their handling
351444 -     of all patient records. ref DRT 1 7938
351446 -  ..
351447 - This seems like a long time to wait to get the medical chart
351448 - delivered for the next meeting with the doctor.
351449 -
351450 -        [On 000124 it appears that a big problem is using multiple
351451 -        medical charts. ref SDS 26 2065]
351452 -
351453 -        [On 000127 big computer projects typically fail. ref SDS 28
351454 -        8960]
351456 -         ..
351457 -        [On 000211 Dale Ames was diagnosed incorrectly for 9 months,
351458 -        then wrong xrays were used, a comedy of errors. ref SDS 33 3600
351460 -         ..
351461 -        [On 000324 research at SRI reports all KM projects around the
351462 -        world have failed. ref SDS 34 4877
351464 -         ..
351465 -        [On 001220 research shows reliance on technology to solve
351466 -        medical management failures may not work very well. ref SDS 35
351467 -        UT4O
351469 -         ..
351470 -        [On 040416 the doctor in the Department of Oncology and
351471 -        Chemotherapy at the Kaiser Walunt Creek hospital and clinic
351472 -        used a new computer using Windows 2000 operating system.
351473 -        ref SDS 37 LK5L
351474 -
351475 -         [On 040504 the doctor demonstrated new system; initial
351476 -         difficulties related to training delayed demonstration; high
351477 -         interest in productivity gains from electronic handling of
351478 -         information, described as "Knowledge Management." ref SDS 38
351479 -         I86F
351481 -          ..
351482 -         [On 050311 doctors have difficulty with communication and
351483 -         collaboration among themselves preparing timely reports,
351484 -         distribution, review, and feedback. ref SDS 39 PB8N
351486 -      ..
351487 -     To whom, what form and frequency is importance of handling
351488 -     patient records "emphasized"?
351490 -      ..
351491 -     Is there a log procedure for signing medical records out, who
351492 -     makes the request, who picks up the records, who receives them,
351493 -     and when are they returned?
351495 -      ..
351496 -     How often is the system audited and reviewed for compliance and
351497 -     improvements?
351499 -      ..
351500 -     Can patients in the interim assist by transporting medical records
351501 -     so doctors have time to prepare for meeting with the patient?
351503 -      ..
351504 -     On 990910 Kasier was reminded on three (3) different occassions to
351505 -     provide medical history and xrays for the meeting with Craig. This
351506 -     supplemented Kaisers procedures to emphasize proper handling of
351507 -     medical records, yet failed to perform two discrete records
351508 -     delivery tasks. ref SDS 4 3038
351510 -      ..
351511 -     This indicates present practice is too tenuous to wait for a high
351512 -     tech solution in two years.
351513 -
351514 -         [On 000124 discovered multiple medical charts are used, which
351515 -         further compounds the challenge of effective review for
351516 -         patient history. ref SDS 26 2065]
351518 -          ..
351519 -         [On 000125 report in Colloquium at Stanford that most high
351520 -         tech projects fail. ref SDS 28 8960]
351521 -
351522 -
351523 -
351524 -
3516 -

SUBJECTS
Primary Care Physician
Personality Patient Impact Health
Personality Impacts Willingness Doctors to Perform

3805 -
380601 -  ..
380602 - Primary Care Physician Should Align with Patient Personality
380603 -
380604 - Follow up ref SDS 10 5728, ref SDS 9 0669.
380605 -
380606 - Tom Connolly suggests using Doctor Naqvi, and does not offer guidance
380607 - on implementing Kaiser's Healthwise Handbook procedure for changing
380608 - doctors. ref DRT 2 0001
380610 -  ..
380611 - Jeanne says in her letter...
380612 -
380613 -     You had requested a new Primary Care Physician. ref DRT 1 2408
380614 -
380615 -        On 990927 asked Patient Assistance to assist in assigning a
380616 -        different Primary Care Physician, ref DIP 13 3570, as reported
380617 -        in the record. ref SDS 8 3776
380619 -         ..
380620 -        On 991006 raised issue again. ref SDS 9 0896
380622 -      ..
380623 -     Unfortunately Doctor Connolly is no longer accepting new patients
380624 -     due to his heavy administrative load.
380625 -
380626 -        In telecon with Jeanne Bradley on 000118 suggested assigning
380627 -        Tom Connolly Primary Care Physician, since he is comfortable
380628 -        with technology. ref SDS 22 4740
380630 -      ..
380631 -     Since the choice of any primary physician is heavily dependent on
380632 -     personality factors, we encourage you to meet several of the
380633 -     physicians with open panels and determine whose personality best
380634 -     matches your own.  You may contact Michelle Kitts at 925 906 2320
380635 -     for list of physicians with open panels. ref DRT 1 2408
380636 -
380637 -       [On 000124 article reports personality can be factor in
380638 -       obtaining needed medical treatment. ref SDS 27 0001]
380640 -        ..
380641 -       [On 000207 called Michelle to follow up. ref SDS 30 0788]
380643 -        ..
380644 -       [On 000208 Doctor Racah found that SDS enables amazing records
380645 -       with accuracy comparable to tape recordings. ref SDS 32 0001
380646 -
380647 -
380648 -
380649 -
380650 -
3807 -

SUBJECTS
Glucosamine Chondroitin

3903 -
390401 -  ..
390402 - Glucosamine, Chrondroitin Treatment Follow Vendors Instructions
390403 -
390404 - Follow up ref SDS 10 3040, ref SDS 14 2596.
390405 -
390406 - Jeanne says regarding...
390407 -
390408 -     ...typical dose of glucosamine and chondrotin. Although there is
390409 -     no widespread agreement about the use of these medications in the
390410 -     treatment of degenerative joint disease, usual practice is 500
390411 -     milligrams of glucosamine three times daily with 400 milligrams
390412 -     chronroitin also three times daily.  We cannot offer you any
390413 -     assurance that these medications will be of any benefit;
390414 -     nevertheless, they appear to be relatively free from adverse side
390415 -     effects. ref DRT 1 0495
390417 -  ..
390418 - This clears the action item on 990925. ref SDS 7 P292
390419 -
390420 -        On 991008 citied this issue. ref SDS 10 3040, based on response
390421 -        from Doctor Craig Boulris on 991028. ref SDS 14 3621
390422 -
390423 -        [On 000124 Doctor Vincint Yamamoto supports Jeane's
390424 -        prescription. ref SDS 26 1680]
390425 -
390426 -
390427 -
390428 -
3905 -

SUBJECTS
Colonoscopy Test

4003 -
400401 -  ..
400402 - Sigmoidoscopy (also Conoloscopy) Scheduled for 000208
400403 -
400404 - Follow up ref SDS 10 2860
400405 -
400406 - On 991008 cited this issue, ref SDS 10 2860, based on meeting with
400407 - Doctor Syed Naqvi on 990628. ref SDS 1 2099
400409 -  ..
400410 - Jeanne says...
400411 -
400412 -     Your routine screening sigmoidoscopy recommended by Doctor Naqvi
400413 -     is scheduled for Tuesday, February 8th with Doctor Edwards at the
400414 -     Park Shadelands facility.  Please register for your appointment in
400415 -     the Allergy department.  If you have questions about this
400416 -     appointment or about prepping procedures, please call 925 295
400417 -     4080. ref DRT 1 6392
400419 -    ..
400420 -   [On 000208 this work was performed. ref SDS 31 0001]
400422 -    ..
400423 -   [On 010110 examination schedule again. ref SDS 36 0001
400424 -
400425 -
400426 -
400427 -
4005 -

SUBJECTS
MRI on Knees

4103 -
410401 -  ..
410402 - MRI Right Knee Second Opinion Schheduled for 000124
410403 -
410404 - Follow up ref SDS 10 2860
410405 -
410406 - Jeanne says...
410407 -
410408 -     You had requested a second opinion regarding the need for a MRI of
410409 -     your [right] knee.  The usual procedure for obtaining the second
410410 -     opinion is to call the orthopedics department in Walnut Creek and
410411 -     request one.  In this case we have held an appointment for you
410412 -     with Doctor Yamamoto on Monday, January 24, 2000 at 0830 am.  If
410413 -     this time and date do not work for you, please call 925 295 4130
410414 -     to cancel and reschedule. ref DRT 1 7350
410415 -
410416 -        [On 991008 citied this issue. ref SDS 10 8966, based on task
410417 -
410418 -
410419 -
410420 -
410421 -
410422 -
4105 -