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SUBJECTS
Case Study Collaboration Teamwork Failure Kaiser UCSF Clinical Study

2503 -
2503 -    ..
2504 - Summary/Objective
2505 -
250501 - Follow up ref SDS 23 0000, ref SDS 3 0001
250502 -
250503 -
250504 -
250505 -
250506 -
250507 -
250508 -
250510 -  ..
2506 -
2507 -
2508 - Progress
2509 -
250901 - Case Study Level of Effort Collaborating Kaiser UCSF Drug Trial
250902 - Collaboration Primary Care at Kaiser with UCSF Standard of Care
250903 -
250904 - Follow up ref SDS 23 RM4G.
250906 -  ..
250907 - On 041013 Boeing cited Kaiser for example of advanced efforts using
250908 - Knowledge Management. ref SDS 1 W14V  On 050414 Knowledge Management
250909 - expert cited UCSF for using Knowledge Management in medical practice,
250910 - ref SDS 2 LX7F, with "earth-shattering achievements" over the past 10
250911 - years. ref SDS 2 JY5Y
250913 -  ..
250914 - Kaiser and UCSF have worked hard collaborating on referral to resume
250915 - treatment of IBC in time to be effective, carrying out care prescribed
250916 - by Kaiser on 070105, as shown in the study.  This is a project
250917 - management problem solved with proactive coordination, which reflects
250918 - goals for Knowledge Management, cited in POIMS. ref OF 4 O87L
250920 -  ..
250921 - Case studies listed on 061018 show opportunities to support medical
250922 - practice. ref SDS 3 0001
250924 -  ..
250925 - Case study of Kaiser's referral to UCSF delayed treatment 4 weeks
250926 - resolving coordination issues, illustrates health care strengthened
250927 - through planning and communication for teamwork performing divided
250928 - responsibilities...
250929 -
250930 -    1.  Millie's last treatment for IBC with
250931 -        Taxotere and capecitabine at
250932 -        Kaiser................................ 061201, ref SDS 4 407N
250934 -         ..
250935 -    2.  Kaiser reports treatment options limited
250936 -        for Millie's triple negative condition and
250937 -        advancing inflammatory breast cancer
250938 -        (IBC); presents plans for switching
250939 -        treatment to old technologies
250940 -        Gemzar or Navelbine................... 061201, ref SDS 5 ZZ9H
250942 -         ..
250943 -    3.  Kaiser decides next treatment will be
250944 -        Navelbine and begin on
250945 -        070105................................ 061208, ref SDS 6 RW5I
250947 -         ..
250948 -    4.  Patient history shows Navelbine presents
250949 -        risks of cancer and or pulmonary
250950 -        embolism quickly cascading
250951 -        out of control........................ 061208, ref SDS 6 VD5G
250953 -         ..
250954 -    5.  Drug trial due diligence Kaiser plans
250955 -        review UCSF proposals in 2nd opinion
250956 -        listing additional treatments
250957 -        for Millie............................ 061208, ref SDS 6 WI3J
250959 -         ..
250960 -    6.  Kaiser requests assistance finding drug
250961 -        trial proposals in 2nd opinion UCSF
250962 -        submitted to Kaiser on or about
250963 -        060929................................ 061208, ref SDS 6 I14L
250965 -         ..
250966 -    7.  UCSF drug trial proposal received
250967 -        from Kaiser on 060929 submitted
250968 -        to Kaiser for due diligence
250969 -        review................................ 061218, ref SDS 7 086H
250971 -         ..
250972 -    8.  Kaiser performing due diligence
250973 -        collaborating with UCSF to evaluate
250974 -        drug trials that expand treatment
250975 -        options for Millie.................... 061226, ref SDS 8 YE6N
250977 -         ..
250978 -    9.  Kaiser submits summary of patient history
250979 -        on diagnosis and treating IBC, asks
250980 -        UCSF for consideration qualifying
250981 -        Millie to get treatment on
250982 -        clinical study drug
250983 -        trial................................. 061228, ref SDS 9 OU5K
250985 -         ..
250986 -   10.  Kaiser cites cetuximab with carboplatin,
250987 -        and Abraxane with lapatinib proposed by
250988 -        UCSF to Kaiser and reviewed on 060929
250989 -        in 2nd opinion letter prepared
250990 -        by Doctor Benz........................ 061228, ref SDS 9 D76W
250992 -         ..
250993 -   11.  Kaiser and UCSF agree on terms of referral
250994 -        authorization for Kaiser to pay any costs
250995 -        not covered by the trial for UCSF to
250996 -        treat Millie with cetuximab and
250997 -        carboplatin........................... 061230, ref SDS 10 3X6K
250999 -         ..
251000 -   12.  UCSF plans to schedule meeting
251001 -        with Millie to begin
251002 -        treatment............................. 070101, ref SDS 11 E23W
251004 -         ..
251005 -   13.  Kaiser advises patient that UCSF clinical
251006 -        study is the best course of chemotherapy
251007 -        available for Millie because cetuximab
251008 -        and carboplatin drug agents attack only
251009 -        cancer cells rather than all cells
251010 -        in the body, and also fits Millie's
251011 -        triple negative status that limits
251012 -        cancer treatments..................... 070105, ref SDS 12 PK7L
251013 -
251014 -           [On 070830 case study previous Kaiser
251015 -           referrals for clinical trials routine
251016 -           part of oncology practice.
251017 -           ref SDS 34 LQ5I
251019 -         ..
251020 -   14.  Patient requests Kaiser notify UCSF
251021 -        to expedite treatment of rising
251022 -        symptoms and prevent cancer
251023 -        from cascading out of
251024 -        control............................... 070105, ref SDS 12 G44N
251026 -         ..
251027 -   15.  Kaiser focusing on referral to UCSF
251028 -        for Millie to treat cancer, not enough
251029 -        time for referral to heart specialist
251030 -        to treat heart disorder Cor Pulmonale
251031 -        diagnosed by CT test on 060930, and
251032 -        in context that heart disease may
251033 -        take years to become life
251034 -        threatening........................... 070105, ref SDS 12 MA8O
251036 -         ..
251037 -   16.  CT test on 061227 expedites starting
251038 -        new treatment at UCSF; avoids delay
251039 -        ordering a new test, scheduling
251040 -        the work, and waiting for
251041 -        Kaiser to peform the
251042 -        test.................................. 070105, ref SDS 12 DT5N
251044 -         ..
251045 -   17.  Blood work order prepared by Kaiser
251046 -        to expedite getting blood test for
251047 -        starting new clinical study at
251048 -        UCSF.................................. 070105, ref SDS 12 YW6O
251050 -         ..
251051 -   18.  Patient requests Kaiser expedite
251052 -        contacting UCSF to expedite starting
251053 -        treatment............................. 070109, ref SDS 13 WZ4L
251055 -         ..
251056 -   19.  Kaiser contacts UCSF to expedite
251057 -        treatment............................. 070110, ref SDS 14 NN6I
251059 -         ..
251060 -   20.  UCSF coordinates with Millie on
251061 -        qualifying for drug trial
251062 -        protocols............................. 070116, ref SDS 15 NK8F
251064 -         ..
251065 -   21.  Planning start treatment before 070124
251066 -        in order to use CT test on 061227 to
251067 -        evaluate progress from treatment with
251068 -        cetuximab and carboplatin
251069 -        chemotherapy drug
251070 -        agents................................ 070116, ref SDS 15 428N
251072 -         ..
251073 -   22.  Patient submits questions on UCSF
251074 -        clincial study
251075 -        consent............................... 070117, ref SDS 16 1G3K
251077 -         ..
251078 -   23.  UCSF answers patient questions on side
251079 -        effects and other issues to approve
251080 -        proposal for treatment on cetuximab
251081 -        carboplating clincial study
251082 -        drug trial............................ 070117, ref SDS 16 QM7I
251084 -         ..
251085 -   24.  UCSF coordinator, Jackie, asks about
251086 -        referral authorization of payment for
251087 -        Millie's treatment at
251088 -        UCSF.................................. 070117, ref SDS 16 LY4Y
251090 -         ..
251091 -   25.  Patient notifies UCSF coordinator that
251092 -        referral authorization was discussed
251093 -        and agreed upon through collaboration
251094 -        between principles on 061230, and
251095 -        terms of payment were documented
251096 -        at that time.......................... 070117, ref SDS 16 5F4R
251098 -         ..
251099 -   26.  UCSF expedites treatment schedules
251100 -        start on 070119....................... 070118, ref SDS 17 1G3K
251102 -         ..
251103 -   27.  Blood test requested by UCSF to start
251104 -        treatment on 070119, ordered previously
251105 -        by Kaiser on 070105 to expedite the
251106 -        schedule.............................. 070118, ref SDS 17 5S6L
251108 -         ..
251109 -   28.  UCSF reports possible delay getting
251110 -        referral authorization from Kaiser
251111 -        previously agreed on
251112 -        061230................................ 070118, ref SDS 17 YF8U
251114 -         ..
251115 -   29.  Patient notifies Kaiser treatment scheduled
251116 -        to start 070119, reports need additional
251117 -        collaboration on referral
251118 -        documentation......................... 070118, ref SDS 17 PK6M
251120 -         ..
251121 -   30.  Treatment at UCSF delayed until 070123
251122 -        because UCSF has not received referral
251123 -        authorization from Kaiser documenting
251124 -        agreement on 061230; Doctor Johnson
251125 -        at Kaiser, and Doctor Rugo at UCSF
251126 -        coordinating directly to
251127 -        expedite resolution................... 070119, ref SDS 18 AS96
251129 -         ..
251130 -   31.  Blood work report received from
251131 -        Kaiser  incomplete for starting
251132 -        treatment at UCSF..................... 070119, ref SDS 18 AS6M
251134 -         ..
251135 -   32.  Kaiser advises referral authorization
251136 -        was signed today; procedures confusing,
251137 -        Kaiser UCSF collaborating to expedite
251138 -        treatment............................. 070119, ref SDS 18 4R4M
251140 -         ..
251141 -   33.  Patient notifies Kaiser treatment
251142 -        delayed until following
251143 -        week.................................. 070119, ref SDS 18 VX64
251145 -         ..
251146 -   34.  Patient requests that Kaiser submit
251147 -        missing parts of blood work report
251148 -        to UCSF............................... 070119, ref SDS 18 TH6Q
251150 -         ..
251151 -   35.  Kaiser determines scope of blood test
251152 -        ordered on 010705 was incomplete;
251153 -        primary care physician interrupts
251154 -        vacation, comes into Kaiser's office
251155 -        to avoid delays and mistakes ordering
251156 -        another blood test for treatment
251157 -        on UCSF clinical
251158 -        study................................. 070122, ref SDS 19 AS6M
251160 -         ..
251161 -   36.  Referral authorization resolved by
251162 -        primary care physician at Kaiser
251163 -        calling Outside Referral Department
251164 -        to communicate
251165 -        with UCSF............................. 070122, ref SDS 19 LX8B
251167 -         ..
251168 -   37.  Patient thanks Kaiser for expediting
251169 -        blood work to avoid delay starting
251170 -        treatment at UCSF
251171 -        tomorrow........ ..................... 070122, ref SDS 19 PQ5U
251173 -         ..
251174 -   38.  Patient gets blood work for
251175 -        treatment later
251176 -        today................................. 070123, ref SDS 20 AS6M
251178 -         ..
251179 -   39.  UCSF notifies patient that treatment
251180 -        scheduled for today delayed again by
251181 -        failure to receive referral authorization;
251182 -        advises complex, extended efforts
251183 -        have failed, and asks for patient
251184 -        assistance............................ 070123, ref SDS 20 MW5Y
251186 -         ..
251187 -   40.  Patient notifies primary care physician
251188 -        at Kaiser that prior understandings on
251189 -        authorization referral are reported by
251190 -        UCSF to have failed; asks Kaiser to
251191 -        expedite referral so that cancer does
251192 -        not cascade out of control after
251193 -        2 months without
251194 -        treatment............................. 070123, ref SDS 20 J94L
251196 -         ..
251197 -   41.  Kaiser reported that primary care
251198 -        physician on vacation and not responding
251199 -        to requests for patient
251200 -        support............................... 070123, ref SDS 20 LP4L
251202 -         ..
251203 -   42.  UCSF notifies that no treatment is
251204 -        scheduled for Millie.................. 070123, ref SDS 20 J43I
251206 -         ..
251207 -   43.  UCSF requests further patient
251208 -        assistance to expedite referral
251209 -        by Kaiser............................. 070123, ref SDS 20 FS33
251211 -         ..
251212 -   44.  Patient submits request to Kaiser to
251213 -        expedite referral authorization based
251214 -        work history of failed
251215 -        efforts............................... 070124, ref SDS 21 YF8U
251217 -         ..
251218 -   45.  Patient leaves for vacation to allow
251219 -        Kaiser and USCF more time to solve
251220 -        referral issues....................... 070124, ref SDS 21 KX9H
251222 -         ..
251223 -   46.  Kaiser expedites distribution of
251224 -        patient's letter requesting timely
251225 -        action to avoid further treatment
251226 -        delays................................ 070124, ref SDS 21 UE4O
251228 -         ..
251229 -   47.  Kaiser Authorization Department reports
251230 -        problem solved after spending 8 hours
251231 -        in consultations with other Kaiser
251232 -        business units........................ 070124, ref SDS 21 6S6L
251234 -         ..
251235 -   48.  UCSF schedules Millie for treatment
251236 -        on 070131............................. 070125, ref SDS 22 YF8U
251238 -         ..
251239 -   49.  CT test ordered because treatment
251240 -        delayed beyond period for using prior
251241 -        test on 061227........................ 070125, ref SDS 22 Z24H
251243 -         ..
251244 -   50.  Doctor Rugo relieved to work on medical
251245 -        treatment after resolving complex
251246 -        communications coordinating referral
251247 -        from Kaiser........................... 070130, ref SDS 23 LC60
251249 -         ..
251250 -   51.  CT test performed to start treatment
251251 -        on revised schedule for
251252 -        070201................................ 070131, ref SDS 24 ZL9M
251254 -         ..
251255 -   52.  Blood test ordered again to start
251256 -        treatment on revised schedule for
251257 -        070201................................ 070131, ref SDS 24 8U4P
251259 -         ..
251260 -   53.  Coordination failed getting normal
251261 -        feedback from Kaiser Coagulation
251262 -        Control Clinic notifying that blood
251263 -        test report from UCSF adequate
251264 -        for prescribing Coumadin to treat
251265 -        pulmonary embolism.................... 070306, ref SDS 25 UI5H
251267 -         ..
251268 -   54.  Coordination using data from referral
251269 -        hospitals complex, creates a lot of hard
251270 -        work getting blood test results into
251271 -        Kaiser's computer to manage Coumadin
251272 -        treatments for pulmonary
251273 -        embolism.............................. 070307, ref SDS 26 UH4M
251275 -         ..
251276 -   55.  CA 15-3 test blood test results for
251277 -        February could not be obtained from
251278 -        Kaiser for assessment at UCSF,
251279 -        case study............................ 070307, ref SDS 26 Q65K
251281 -         ..
251282 -   56.  CT test Kaiser difficulty ordering to
251283 -        review measurable disease on clinical
251284 -        study at UCSF; and ordering spiral CT
251285 -        test for pulmonary embolism,
251286 -        case study............................ 070307, ref SDS 26 G56L
251288 -         ..
251289 -   57.  Coordination problems scheduling blood
251290 -        tests ordered by the doctor at
251291 -        UCSF.................................. 070308, ref SDS 27 1M6H
251293 -         ..
251294 -   58.  Coordination problems scheduling weekly
251295 -        treatments ordered by the doctor
251296 -        at UCSF............................... 070315, ref SDS 28 1M6H
251298 -         ..
251299 -   59.  Coordination failed to be prepared for
251300 -        productive meetings with comprehensive
251301 -        review of side effects because people
251302 -        object to electronic transmission that
251303 -        increases speed and accuracy of daily
251304 -        communication by orders of magnitude
251305 -        with links supporting precsion access
251306 -        that connect to relevant context applying
251307 -        the power of knowledge by working
251308 -        intelligently......................... 070329, ref SDS 29 945F
251310 -         ..
251311 -   60.  Coordination failed medical chart at
251312 -        Kaiser shows only "lab at UCSF," rather
251313 -        than diagnostics for blood test on
251314 -        070301 submitted to Kaiser to aid
251315 -        patient care.......................... 070330, ref SDS 30 128S
251317 -         ..
251318 -   61.  Primary care physician confirms failure
251319 -        coordination between Kaiser Oncology and
251320 -        Imaging Department fails perform doctor's
251321 -        order for thin slice spiral CT test for
251322 -        pulmonary embolism and heart
251323 -        disorder enlarged right
251324 -        ventricle............................. 070330, ref SDS 30 0136
251326 -         ..
251327 -   62.  Coordination improves using email with
251328 -        links for precision access UCSF medical
251329 -        team prepared for productive meeting;
251330 -        new way of working intelligently needs
251331 -        training orientation assistance for
251332 -        intelligence support.................. 070419, ref SDS 31 CQ6J
251334 -         ..
251335 -   63.  Coordination communications between
251336 -        Kaiser and UCSF collaboration on Millie's
251337 -        treatment for Cellulitis failed to reach
251338 -        concensus; reasons for different
251339 -        opinions prescribing treatment
251340 -        not presented......................... 070611, ref SDS 33 JQ6F
251342 -         ..
251343 -   64.  Case study Kaiser has prescribed many
251344 -        referrals in this case for clinical
251345 -        trial treatments and paid all costs not
251346 -        covered by the trial as part of Kaiser's
251347 -        obligation to provide professional
251348 -        care for Millie's patient
251349 -        profile............................... 070830, ref SDS 34 LQ5I
251351 -         ..
251352 -   65.  Schedule coordination providing meeting
251353 -        dates with medical team difficult to
251354 -        accomplish............................ 080320, ref SDS 35 2R5G
251356 -         ..
251357 -   66.  Doctor patient partnership referral
251358 -        coordination doctor requests patient
251359 -        write letter to Kaiser with SDS links
251360 -        to background with context explaining
251361 -        prescription for Neupogen saves time
251362 -        for doctor writing on hold
251363 -        calling............................... 080403, ref SDS 36 4U9O
251365 -         ..
251366 -   67.  Collaboration failure referral coordination
251367 -        blood test at UCSF on 080306 sent to Kaiser
251368 -        on 080307 was not evaluated for emergency
251369 -        care at Kaiser on 080409; Kaiser compared
251370 -        blood test on 080409 with data on 071017
251371 -        because nobody entered 6 months of test
251372 -        data in Kaiser computer; if data is
251373 -        not in the computer it does not
251374 -        exist................................. 080409, ref SDS 37 439L
251376 -         ..
251377 -   68.  Doctor patient partnership referral
251378 -        coordination nurse requests patient
251379 -        submit scope blood tests for labs with
251380 -        links to UCSF Chemotherapy Orders
251381 -        issued by doctor...................... 080423, ref SDS 38 P45J
251383 -         ..
251384 -   69.  Terrific referral coordination Kaiser
251385 -        Oncology submits explanation scope to
251386 -        surgery department from SDS record
251387 -        facilitates productive meeting
251388 -        to plan surgery applying
251389 -        new technology........................ 080605, ref SDS 39 635W
251391 -         ..
251392 -   70.  CT test report was not submitted by
251393 -        Kaiser in time for review with patient
251394 -        during examination at
251395 -        UCSF.................................. 080724, ref SDS 40 VE8O
251396 -
251397 -
251398 -
251399 -
251400 -
251401 -
251402 -
251403 -
251404 -
251405 -
2515 -