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Health Care Doctor Patient Partnership Medical Practice Case Managem

2203 -
2203 -    ..
2204 - Summary/Objective
2205 -
220501 - Follow up ref SDS 14 0000, ref SDS 10 ST6F.
220502 -
220503 - After the doctor visited with the patient in the Chemo Clinic,
220504 - ref SDS 14 WR62, we met for a few minutes in a near-by office.
220506 -  ..
220507 - Discussed doing a study to evaluate using SDS for medical support,
220508 - similar to the evaluation being done at Aerospace company using SDS
220509 - for engineering management and research, illustrated by the record on
220510 - 040302 showing the person using SDS has become "famous" for adding
220511 - value to daily communications. ref SDS 11 N03C  A common way of
220512 - discussing SDS support for Communication Metrics is "knowledge
220513 - management," discussed in POIMS. ref OF 4 O87L
220514 -
220515 -     [On 040610 delayed research using SDS for intelligence to support
220516 -     medical management due to complications Millie diagnosed with IBC.
220517 -     ref SDS 16 OG5U
220519 -      ..
220520 -     [On 040807 Millie's condition improved contacted Doctor Johnson to
220521 -     review intelligence support for medical management. ref SDS 17
220522 -     Z34V
220524 -  ..
220525 - The doctor is familiar with "knowledge management," based on Kaiser's
220526 - work to apply computers in health care, which he cited during the
220527 - meeting on 020726. ref SDS 10 ST6F
220529 -  ..
220530 - We reviewed the concept that medical management and patient care are
220531 - strongly related to good communications and accurate understanding of
220532 - patient history.  These issues have become a big challenges in health
220533 - care, as in other fields, reported on 990912. ref SDS 5 0001  SDS is
220534 - being used at a major Aerospace company for a system of Communication
220535 - Metrics developed since 1985, reported on 000723. ref SDS 8 0008
220536 - Kaiser has applied some of these ideas in its technology and in work
220537 - practices for team care that fosters the doctor and patient
220538 - partnership, reviewed on 990625. ref SDS 3 4185
220539 -
220540 -     [On 050520 the doctor began capturing a legible record on Kaiser's
220541 -     computer, and disclosed Kaiser's plans to equip patient
220542 -     examination rooms with ergonomic work stations for efficiently
220543 -     investing intellectual capital. ref SDS 18 HX6J
220545 -      ..
220546 -     [On 051121 Kaiser email support for doctor/patient partnership
220547 -     communication. ref SDS 19 V25O
220549 -  ..
220550 - SDS technology supports goals for adding "intelligence" that "connects
220551 - the dots" in daily communication for turning information into
220552 - knowledge of cause and effect (see "locality principle" that drives
220553 - the "power of knowledge," reviewed recently on 040312. ref SDS 12
220554 - YH4G)  Understanding the chronoloogy of events based on context,
220555 - drives productivity that saves lives, time, and money, and so offers a
220556 - effective approach to Knowledge Management, as explained in POIMS.
220557 - ref OF 4 1850
220559 -  ..
220560 - Doctor Johnson suggested we go to another room.  We walked around the
220561 - cornor and down the hall to an examination room that had a computer.
220562 - This was the same room, or similar, to the last visit with the doctor.
220563 - It had a modern PC configured with Microsoft Windows 2000 operating
220564 - system, reported on 040416. ref SDS 13 LK5L
220566 -  ..
220567 - The doctor explained having gotten training yesterday on implementing
220568 - Kaiser's new Knowledge Management technology to support medical
220569 - practice.
220571 -  ..
220572 - We discussed Jeanne Bradley's letter from the Park Shadeland's clinic
220573 - on 000121 that reported Kaiser's plan to improve medical management by
220574 - using technology to manage a patient's medical chart, scheduled for
220575 - release in 2001. ref SDS 6 CG61
220577 -  ..
220578 - The doctor advised that Kaiser is now deploying this capability to his
220579 - Oncology department in Walnut Creek.  The doctor used the computer to
220580 - demonstrate what he learned yesterday for an all electronic, or
220581 - "paperless," medical chart.  One feature sounds like keeping a record
220582 - of communication, that is similar to how SDS is used for Communication
220583 - Metrics.
220585 -  ..
220586 - Since the system is new, there were some difficulties that prevented
220587 - use, but the enthusiasm for transformation to improve productivity and
220588 - efficiency of handling the medical chart was evident in the doctor's
220589 - discussion of the new system.
220590 -
220591 -     [On 040517 delay and difficulty finding computer file on Tumor
220592 -     Board "minutes." ref SDS 15 FM5V
220594 -  ..
220595 - The doctor indicated that Kaiser's system is "web-based," and is
220596 - expected to be fully operational next year in 2005.  He is not part of
220597 - the development team, for example as a "practitioner advisor," but may
220598 - be an early participant/user in the system, when it is rolled out next
220599 - year, shown by the training he received yesterday, and demonstration
220600 - today.  For some reason, the feature that may relate to SDS could not
220601 - be displayed today; the problem appeared to be a user id and password
220602 - issues, reflecting orientation and early roll out snafus.
220604 -  ..
220605 - Doctor Johnson described a vision to expand team care practice to
220606 - fully integrate oncology care at Kaiser.
220607 -
220608 -        [On 080118 integrated oncology was descirbed as a "Palliative
220609 -        Care Project" at Kaiser. ref SDS 20 KJ40
220611 -  ..
220612 - We reviewed the record in Millie's case beginning on 020208, when she
220613 - initially reported a lump in her breast. ref SDS 9 0001
220615 -  ..
220616 - The doctor seemed to indicate today that Millie's case demonstrates
220617 - patient assistance for timely, comprehensive communication facilitates
220618 - integrated oncology that optimizes chances of recovery and quality of
220619 - life for cancer patients.
220621 -  ..
220622 - Discussed opportunity to implement Kaiser's guidelines for
220623 - communication, reported on 990625, ref SDS 3 3190, that makes the
220624 - doctor/patient partnership effective, also, reported on 990625.
220625 - ref SDS 3 4185
220627 -  ..
220628 - Explained concept that medical care can be strengthened by better
220629 - technology, new methods and a new professional role to solve the
220630 - problem of information overload that overwhelms human span of
220631 - attention, as explained in POIMS, ref OF 3 3385, causing continual
220632 - mistakes due to meaning drift, also, explained in POIMS. ref OF 4 049O
220634 -  ..
220635 - The doctor cited advantage of continual improvement in quality, which
220636 - is a derivitive of continual learning enabled by SDS, reviewed on
220637 - 950911. ref SDS 2 2222
220639 -  ..
220640 - The doctor noted the problem of information overload will greatly
220641 - compound over the next 5 years as the Baby Boom generation begins to
220642 - incur the infirmities of age, which will accelerate demand for medical
220643 - support.  Since a large component of treatment is driven by
220644 - communication, the need for a system of "metrics" to maintain
220645 - alignment will necessarily grow.
220647 -  ..
220648 - The doctor agreed to look at the record in this case to see if SDS and
220649 - methods of Communication Metrics appear to duplicate Kaiser's plans
220650 - for applying technology to strengthen medical management and health
220651 - care.  If SDS and a new work role along the lines of the way SDS is
220652 - applied at Aerospace company appear to add value to Kaiser's systems,
220653 - then this finding could support an application for a study to evaluate
220654 - the general use of SDS and Com Metrics in health care.
220655 -
220656 -     [On 040610 delayed research using SDS for intelligence to support
220657 -     medical management due to complications diagnosed with IBC.
220658 -     ref SDS 16 OG5U
220660 -      ..
220661 -     [On 040807 patient condition improved contacted doctor to review
220662 -     intelligence support for medical management. ref SDS 17 Z34V
220664 -  ..
220665 - We walked back toward the doctor's office, and met Rosalie in the
220666 - hallway.  The doctor mentioned to Rosalie that I will send her an
220667 - email for him.  Rosalie will forward the letter to the doctor, and he
220668 - will then respond to me, which will provide his email address.  We can
220669 - then communicate directly on this matter going forward.
220670 -
220671 -
220673 -  ..
220674 - Review Plan Limited to a Few Records and Click on Only a Few Links
220675 -
220676 - Since the doctor's time is limited, will try to develop a plan for
220677 - review with a few objectives in mind.
220679 -  ..
220680 - Key objective is obtain comments from the Doctor along the line of
220681 - prior comments by other doctors at Kaiser who have interacted SDS
220682 - records...
220683 -
220684 -        Doctor Zipperstein
220685 -        was supportive..................... 940728, ref SDS 1 0001
220687 -         ..
220688 -        Doctor Naqvi
220689 -        prefers conventional methods....... 990802, ref SDS 4 9108
220691 -         ..
220692 -        Medical coordinator found
220693 -        SDS "pretty neat".................. 990802, ref SDS 4 0406
220695 -         ..
220696 -        Doctor Racah
220697 -        was supportive of SDS methodology
220698 -        and found record was accurate...... 000207, ref SDS 7 0785
220700 -  ..
220701 - In all of these cases, exposure to SDS on a particular matter was
220702 - minimal, i.e., a few visits over a few months.  In the current
220703 - situation, we have a 2.5 year history that can be examined for adding
220704 - value to medical practice.  While pracitioners have largely been
220705 - shielded from the record in order to avoid disruption of normal work
220706 - flow, now is a good time to make an interim assessment along the
220707 - following lines...
220708 -
220709 -        1.  Medical case management is a highly complex process similar
220710 -            to "project management," where there is a single patient as
220711 -            the "project."  The primary care physician is similar to
220712 -            the role of "project manager," who directs the work of
220713 -            related specialists (subcontractors) and allocates time and
220714 -            resources based on progress.
220716 -             ..
220717 -        2.  Communication is the engine that drives the system.
220719 -             ..
220720 -        3.  While Kaiser has developed important new information
220721 -            technologies to manage the medical chart, reported by
220722 -            Jeanne on 000121, ref SDS 6 CG61, this capability can be
220723 -            complemented to save time, money and lives by adding
220724 -            intelligence that converts information into knowledge of
220725 -            cause and effect.  Understanding causation by creating a
220726 -            connected record showing traceability to original sources,
220727 -            gives doctors, patients and staff command and control of
220728 -            the work for getting things done correctly, on time and
220729 -            within budget.
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