THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com
S U M M A R Y
DIARY: February 5, 2009 01:18 PM Thursday;
Rod Welch
Doctor Johnson responds to Millie's rising pain from delay treating IBC.
requests using Kaiser Health Connect for email that slows productivity.
1...Summary/Objective
2...Kaiser Health Connect Email Degrades Productivity Case Management
3...Health Connect Email Proposed to Prevent Falling Through the Cracks
4...Falling Through the Cracks Solved by Timely Accurate Communication
5...Email Uniform Distribution Flexible Support Essential Effective Care
..............
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CONTACTS
020204 -
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS A0 0000. ref SDS 99 0000.
040502 -
040503 -
040505 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - 1. Case study dilemma balancing sunitinib treatments to optimize
040902 - recovery from 5th relapse IBC, and without increasing
040903 - debilitating side effects that prevent exercise required to
040904 - benefit from recovery. ref SDS 34 I87N
040906 - ..
040907 - 2. On 090108 examination at UCSF showed possible progression of
040908 - IBC in breastbone area, as set out in Millie's letter to the
040909 - medical team on 090109. ref SDS 36 UC4H Millie reported severe
040910 - side effects shown by wide range of blood counts falling.
040911 - ref SDS 36 UF3Q Medical team prescribed another cycle
040912 - sunitinib treatment, with cyclophosphamide paused until blood
040913 - counts increase to a safe level. ref SDS 36 UF3T
040915 - ..
040916 - 3. On 090109 Millie's letter reports rise of IBC with sunitinib
040917 - seen at UCSF on 090108 occurred previously, cited in Millie's
040918 - letter on 081125, ref SDS 28 XX4P; there was rise of IBC and
040919 - then substantial recovery reported again on 081217, ref SDS 29
040920 - YJ4V; on 081230 Millie's letter reported on 081224 and 081225
040921 - rise of IBC, and then improvement on 081226, ref SDS 34 JV5M;
040922 - most recently on 090106 Millie cited again advance of IBC on
040923 - 081224 and 081225, and now disease seems to be subsiding again.
040924 - ref SDS 35 YO4V]
040926 - ..
040927 - 4. On 090115 Millie letter to Catherine and Diane in the Infusion
040928 - Clinic at UCSF reported rising side effects of sunitinib
040929 - protocol, ref SDS 39 5J9Y; she tried hiking a few times, but
040930 - this hurts her feet (peripheral neuropathy) and legs are very
040931 - weak, shown in patient history on daily treatments. ref SDS 38
040932 - KL4J Have been spending more time in the gym doing aerobics,
040933 - which is a little more tolerable. ref SDS 38 3E4K
040935 - ..
040936 - 5. On 090116 Glenna called to ask about response to treatment and
040937 - side effects, ref SDS 40 JY6L, and was advised that IBC in the
040938 - breastbone area was stable to worse, and other sites are stable
040939 - to improved with sunitinib protocol, citing the record of
040940 - patient history the day before on 090115. ref SDS 38 124N
040942 - ..
040943 - 6. On 090116 during call from Glenna advised that Millie wants to
040944 - reduce the dose of sunitinib in order to reduce debilitating
040945 - side effects, and requested remedy to reduce side effects with
040946 - full dose of sunitinib in order to optimize recovery.
040947 - ref SDS 40 JY7J
040949 - ..
040950 - 7. On 090116 Millie received a letter from Glenna transmitting a
040951 - copy of a letter Glenna wrote to the doctor reporting
040952 - understandings from telecon in the morning on 090116,
040953 - ref SDS 42 YN9H; Glenna's letter to the doctor described
040954 - difficulty tolerating side effects of sunitinib, and IBC on
040955 - breastbone area looks worse, ref SDS 42 4P5M, that Millie wants
040956 - to reduce the dose to reduce side effects, but is afraid about
040957 - losing benefits of recovering from IBC. ref SDS 42 HV3M
040959 - ..
040960 - 8. On 090116 Glenna's letter to the doctor asked about changing to
040961 - another treatment. ref SDS 42 HV3O
040963 - ..
040964 - 9. On 090116 Glenna planned to meet with the doctor later in the
040965 - day on 090116 to discuss changing Millie's treatment.
040966 - ref SDS 42 HP4J
040968 - ..
040969 - 10. On 090116 Millie's letter to the medical team clarifies telecon
040970 - on condition following examination at UCSF on 090108, reporting
040971 - IBC in breastbone area looks stable to worse, and everywhere
040972 - else looks improved to stable, indicating recovery has slowed
040973 - ref SDS 43 IS6G, relative to findings on 081218, ref SDS 30
040974 - VD4F, confirmed in Millie's letter later that day reporting
040975 - significant recovery. ref SDS 31 GF8V
040977 - ..
040978 - 11. On 090118 Millie talks about wanting to end treatment with
040979 - sunitinib that seems now less effective and has severe side
040980 - effects after adding cycloposphamide. ref SDS 44 UC41
040982 - ..
040983 - 12. On 090121 Millie letter to primary care physician says very
040984 - pleased to take this occasion on my birthday to say thanks for
040985 - such great care the past 7 years. You noted in our first
040986 - meeting on 020321 that Oncology presents unique challenges.
040987 - ref SDS 2 R94H My case has been complicated by other maladies
040988 - that strain resources of time, money, and emotion. Having you
040989 - at the helm with Arlette's assistance has been a blessing.
040990 - ref SDS 47 F23Y
040992 - ..
040993 - 13. On 090121 Glenna calls and asks again about Millie's response
040994 - to treatment, ref SDS 48 AJ3J, following up her call on 090116,
040995 - ref SDS 40 JY6L, and per background above. ref SDS 48 JY5I
040997 - ..
040998 - 14. On 090121 during call from Glenna reported patient history,
040999 - ref SDS 48 ZO4F, on 090120 shows IBC rash looks improved to
041000 - stable, and nodules in the breastbone area seem worse,
041001 - ref SDS 46 124N, relative to detailed review on 090110,
041002 - ref SDS 37 124N, and after 11 days of treatment with only
041003 - sunitinib, and 25 total treatments with sunitinib, since the
041004 - pause on 081218 and resuming on 081226. ref SDS 45 6C4J
041006 - ..
041007 - 15. On 090121 during call from Glenna reported patient history
041008 - reported IBC worsening in breastbone area has progressed onto
041009 - the right breast and spread toward the left chest reflects
041010 - rising cancer marker, ref SDS 48 N95K, Labs at Kaiser on 090116
041011 - report CA 15-3 303. ref SDS 41 PQTQ This record indicates
041012 - Millie has suffered 6th relapse of IBC.
041014 - ..
041015 - 16. On 090121 Glenna asked for most severe side effects from
041016 - continuing with sunitinib treatment. ref SDS 48 TW53
041018 - ..
041019 - 17. On 090121 Glenna asked for Millie's records on Doctor Rugo's
041020 - plans for follow on treatments? During the call developed
041021 - background on UCSF planning for Millie's future treatment after
041022 - sunitinib. ref SDS 48 Y67L
041024 - ..
041025 - 18. On 090121 Glenna reported during the call that she would send
041026 - another letter to Doctor Rugo explaining Millie's slow response
041027 - to treatment with sunitinib, and supplementing Glenna's letter
041028 - to the doctor on 090116, ref SDS 59 SY5J; Glenna further advised
041029 - during the call on 090121 that she would meet again with Doctor
041030 - Rugo to discuss plans for changing Millie's treatment to
041031 - recover from Millie's 6th IBC relapse. ref SDS 48 N976
041033 - ..
041034 - 19. On 090121 patient history summarized to faciliate Glenna's
041035 - meeting with Doctor to figure out Millie's next treatment.
041036 - ref SDS 48 NU5H
041038 - ..
041039 - a. Laboratory blood tests listed for Millie to facilitate UCSF
041040 - considering Millie's next treatment. ref SDS 48 6Y9K
041042 - ..
041043 - b. Image test history of PET, CT, Xray, MRI listed for Glenna
041044 - to discuss with Doctor Rugo discussing Millie's next
041045 - treatment. ref SDS 48 216F
041047 - ..
041048 - c. Treatment history listed for Glenna to discuss with Doctor
041049 - Rugo discussing Millie's next treatment. ref SDS 48 H16M
041051 - ..
041052 - d. Strategy considerations for selecting Millie's next
041053 - treatment. ref SDS 48 558O
041055 - ..
041056 - 20. On 090122 telephone message from Glenna reported that the
041057 - doctor ended treament with sunitinib protocol; Glenna met with
041058 - Doctor Rugo to develop treatment plan for Millie, and UCSF
041059 - scheduled Millie to start new treatment on 090129. ref SDS 52
041060 - K96F
041062 - ..
041063 - 21. On 090123 primary care physician at Kaiser cited sudden relapse
041064 - of IBC with nodules spreading in the breastbone area, and
041065 - cancer marker elevated to CA 15-3 303 in the labs at Kaiser on
041066 - 090116, ref SDS 41 PQTQ, shows Millie needs immediate change of
041067 - treatment to prevent cancer from cascading out of control, and
041068 - that UCSF should prescribe treatment, ref SDS 57 RK6O, because
041069 - Millie's 6th relapse of IBC shows cancer has mutated to cells
041070 - that are now very resistant to treatments available at Kaiser,
041071 - as discussed previously during the meeting at Kaiser on 080829,
041072 - and cited in Millie's letter to the medical team. ref SDS 25
041073 - RP9R
041075 - ..
041076 - 22. On 090123 Millie's letter to medical team reports progress at
041077 - UCSF scheduling Millie to start on a new treatment. ref SDS 53
041078 - KR4P
041080 - ..
041081 - 23. On 090123 Glenna called and thanked her for expediting Millie's
041082 - new treatment to start on 090129 so that cancer does not
041083 - cascade out of control, ref SDS 54 TR80; request documentation
041084 - on new treatment in order to be prepared starting on 090129
041085 - 0830, as presented in Glenna's telephone message on 090122,
041086 - ref SDS 52 AT6N
041088 - ..
041089 - 24. On 090123 Glenna advised during her call that there was not
041090 - enough time to meet with Doctor Rugo on 090121; she received a
041091 - letter from the doctor to coordinate with Kaiser on getting
041092 - timely referral to start Millie's next treatment at UCSF on
041093 - 090129. ref SDS 54 118M
041095 - ..
041096 - 25. On 090123 Doctor Johnson, Millie's primary care physician at
041097 - Kaiser, called and confirmed prior advice that Doctor Rugo can
041098 - prescribe follow on treatment for Millie because her cancer has
041099 - become resistant to drugs available at Kaiser. ref SDS 57 8K6K
041101 - ..
041102 - 26. On 090127 Millie letter to medical team reporting Doctor
041103 - Johnson called on 090123 to advise of approval for Doctor Rugo
041104 - to prescribe Millie's follow on treatment at UCSF to start
041105 - immediately on 090129. ref SDS 59 TY5W
041107 - ..
041108 - 27. On 090127 Millie's letter to the medical team submitted patient
041109 - history to facilitate prescribing new treatment for Millie's
041110 - 6th relapse of IBC. ref SDS 59 TY6S
041112 - ..
041113 - 28. On 090127 Millie's letter reported side effects of sunitinib
041114 - have begun to subside after stopping treatment on 090122 in
041115 - order to prepare to start new treatment on 090129. ref SDS 59
041116 - TY8T
041118 - ..
041119 - 29. On 090128 Millie letter to primary care physician and the
041120 - medical team reported IBC worsening, and taking Vicodin for
041121 - pain. ref SDS 61 2S8X
041123 - ..
041124 - 30. On 090129 Doctor Rugo sent a letter to primary care physician
041125 - at Kaiser reporting rising pain from worsening IBC, ref SDS 68
041126 - TZ6H; and, requesting referral to UCSF for treatment with
041127 - hyperthermia and Doxil, reported in Millie's letter to medical
041128 - team on 090130. ref SDS 68 AY9Q
041130 - ..
041131 - 31. On 090130 Millie letter to primary care physician, ref SDS 68
041132 - GV4M, reports examination at UCSF on 090129 found rising vitals
041133 - signal Millie suffering rising pain, ref SDS 68 AY7T, because
041134 - IBC progressing rapidly, ref SDS 68 4S8O, as Doctor Johnson
041135 - noted earlier on 090123, ref SDS 57 8K6K;
041137 - ..
041138 - 32. On 090130 Millie letter to primary care physician advises UCSF
041139 - reported communication delay prevented getting referral from
041140 - Kaiser, which then delayed starting hyperthermia treatment on
041141 - 090129 in time to be effective. ref SDS 68 AY8Q
041143 - ..
041144 - 33. On 090130 Millie letter to medical team reports that on 090129
041145 - coordinating timely referral from Kaiser was delayed because
041146 - primary care physician was not in the office. ref SDS 68 AY9T
041148 - ..
041149 - 34. On 090130 Krshna called Millie to schedule hyperthermia
041150 - treatment in the Radiation Oncology Department, and said that
041151 - UCSF has not received referral authorization from Kaiser.
041152 - ref SDS 66 NM5H
041154 - ..
041155 - 35. On 090130 called Arlette, ref SDS 67 RY4G, and she contacted
041156 - Doctor Johnson off-site in a meeting, and he advised that the
041157 - doctor would file authorization in the evening on 090130.
041158 - ref SDS 67 PPYY
041160 - ..
041161 - 36. On 090131 2318 Millie received letter from Doctor Johnson,
041162 - primary care physician, that Kaiser authorization was issued on
041163 - 090130, ref SDS 69 GV4M, for Millie to get treatment for 6th
041164 - relapse of IBC with hyperthermia and Doxil, prescribed by
041165 - Doctor Rugo on 090129 (reported in Millie's letter on 090130.
041166 - ref SDS 68 AY9Q
041168 - ..
041169 - 37. On 090201 Millie letter reports to medical team 6th relapse IBC
041170 - getting worse by the hour requires immediate treatment to
041171 - prevent cancer from getting out of control. Rising pain from
041172 - IBC makes sleeping difficult. ref SDS 70 KN9T
041174 - ..
041175 - 38. On 090201 Millie plans to go to UCSF for treatment tomorrow on
041176 - 090202 when convenient for Doctor Hsu to provide hypethermia
041177 - treatment. ref SDS 70 KN9W
041179 - ..
041180 - 39. On 090201 Millie reports lymphedema recurrence caused by
041181 - sling-immobilizer to treat dislocated shoulder on 090122;
041182 - advises Cellulitis did not recur, as previously. ref SDS 70
041183 - KN4S
041185 - ..
041186 - 40. On 090201 Millie reports good news energy recovering after side
041187 - effects from stopping treatment on sunitinib clinical study
041188 - ordered by Doctor Rugo on 090122. ref SDS 70 KN4Y
041190 - ..
041191 - 41. On 090201 UCSF letter notifies Millie that Doctor Rugo is
041192 - communicating with Doctor Hsu using email to expedite Millie's
041193 - treatment; recommends that Millie not come to UCSF on Monday
041194 - 090202 in order to assist the medical team start hyperthermia
041195 - treatment in time to be effective. ref SDS 71 GV4M
041197 - ..
041198 - 42. On 090201 Millie letter assures medical team that the patient
041199 - would not "camp out" in Doctor Hsu's office, but would stand-by
041200 - in the cafeteria so that treatment can begin when convenient
041201 - for UCSF, and without waiting for patient to travel through
041202 - mid-day traffic, so that urgent treatment is not delayed beyond
041203 - a point when treatment can no longer be effective. ref SDS 72
041204 - GV4M
041206 - ..
041207 - 43. On 090201 Millie asks Doctor Rugo about coordinating to provide
041208 - medical records on file in the doctor's office the past 2 years
041209 - treating Millie at UCSF, ref SDS 72 5R4S, to use by Doctor Hsu,
041210 - requested by Krshna in a call the day before on 090130.
041211 - ref SDS 66 DL4J
041213 - ..
041214 - 44. On 090201 emotional trauma esclates from delays getting
041215 - treatment for aggressive cancer that seems to be cascading out
041216 - of control because of communication delays. ref SDS 72 5R4V
041218 - ..
041219 - 45. On 090202 Michelle at UCSF called in the morning, and said
041220 - Kaiser has not submitted authorization for Millie's treatment
041221 - by Doctor Hsu. ref SDS 74 9Y5I Michelle asked the patient to
041222 - coordinate with the primary care physician at Kaiser to file
041223 - Authorization, ref SDS 74 9Y6Y, reported in Millie's letter to
041224 - the medical team. ref SDS 76 GV4M
041226 - ..
041227 - 46. On 090202 Michelle was advised that Doctor Johnson reported in
041228 - a letter on 090131 that Doctor Rugo at UCSF was notified on
041229 - 090130 that Kaiser issued authorization for Millie's treatment,
041230 - ref SDS 69 GV4M, and further that Doctor Johnson would be out
041231 - of town for several days, so he is not available on 090202 for
041232 - coordinating requested by UCSF on 090202, ref SDS 73 Y35M, to
041233 - file duplicate authorization, reported in Millie's letter to
041234 - the medical team on 090202 1028. ref SDS 76 FR6P
041236 - ..
041237 - 47. On 090202 0940 numerous calls were made to coordinate.
041238 - ref SDS 75 9Y5I Florida in Kaiser Oncology Department, Walnut
041239 - Creek CA advised that Pam in Kaiser Outside Referrals
041240 - Department said the doctor did not enter a "code" in the
041241 - Authorization form for hyperthermia treatment, so Pam is
041242 - waiting to get the code when the doctor returns from traveling
041243 - sometime in the next few days, ref SDS 75 1A5J, reported in
041244 - Millie's letter to the medical team. ref SDS 76 FR7R
041246 - ..
041247 - 48. On 090202 1012 called Kaiser Outside Referrals and left a
041248 - message that we need submission of authorization, so that
041249 - Millie can get treatment in time to be effective. ref SDS 75
041250 - W17K Suggested Outside Referrals send written notice to
041251 - Michelle Williams Jones at UCSF that authorization is on file
041252 - at Kaiser, and will be submitted to UCSF, so that my treatment
041253 - can be initiated concurrently. ref SDS 75 254F, reported in
041254 - Millie's letter to the medical team. ref SDS 76 FR7U
041256 - ..
041257 - 49. On 090202 1047 Pam in Outside Referrals at Kaiser called and
041258 - disclosed that the department needed to know the type of
041259 - treatment Millie would get on referral to UCSF? Advised
041260 - treatment is "hyperthermia," in the Radiation Oncology
041261 - department at UCSF. Pam reported that Kaiser does not have a
041262 - code for "hypethermia" nor for "Radiation Oncology." Pam used
041263 - a code for "Radiology." Problem solved. ref SDS 77 QQ7N, and
041264 - reported in Millie's letter to the medical team on 090202 1139.
041265 - ref SDS 79 M88H
041267 - ..
041268 - 50. On 090202 1117 Pam called back and wanted to know if referral
041269 - to UCSF is for in-patient or out-patient treatment? Since
041270 - radiation is often out-patient care, and initial discussions
041271 - did not indicate Millie would require staying in the hospital,
041272 - Pam coded the form for out-patient care, reported in the record
041273 - on 090202 1047]. ref SDS 77 0256, and reported in Millie's
041274 - letter to the medical team on 090202 1139. ref SDS 79 C94Y
041276 - ..
041277 - 51. On 090202 1118 Doctor Rugo notified the medical team that
041278 - Doctor Hsu cannot see Millie on 090202; advises that Doctor Hsu
041279 - is aware of Millie's situation. ref SDS 78 V47L
041281 - ..
041282 - 52. On 090202 1353 Doctor Hsu's assistant, Krshna reported that the
041283 - doctor was not aware of urgency to treat Millie, cited in
041284 - Doctor Rugo's letter on 090202 1118. ref SDS 78 V47L Krshna
041285 - proposes scheduling the work on 090219, ref SDS 80 XO7G, and
041286 - does not feel comfortable asking Doctor Hsu to advance the date
041287 - for treatment, because his schedule is already booked.
041288 - ref SDS 80 SP8I, reported in Millie's letter to the medical
041289 - team on 090202 1437. ref SDS 81 R23P
041291 - ..
041292 - 53. On 090202 1353 Krshna offers UCSF Radiation Oncology schedule
041293 - hyperthermia treatment 3 weeks delay to 090219. ref SDS 80 XO7G
041295 - ..
041296 - 54. On 090202 1437 Millie notifies medical team that UCSF received
041297 - Kaiser authorizations for treating the 6th relapse of IBC,
041298 - ref SDS 81 JR4J, reported on 090202 1353. ref SDS 80 SP6H
041299 - Millie thanks Doctor Rugo for expediting authorization with
041300 - Doctor Johnson at Kaiser, citing Doctor Rugo's letter to Doctor
041301 - Johnson on 090129, reported on 090130, ref SDS 68 TZ6H, Doctor
041302 - Rugo's letter to medical team on 090202 1118, indicating Doctor
041303 - Hsu is aware of Millie's situation. ref SDS 78 V47L
041305 - ..
041306 - 55. On 090202 1437 IBC disease has advanced significantly since
041307 - examination at UCSF on 090129, and pain on chest is rising.
041308 - Since Doctor Rugo has much more experience with IBC, if this
041309 - just "looks bad," but delaying treatment to 090219 presents no
041310 - risk of losing control, then I am fine with waiting until the
041311 - 19th. ref SDS 81 R23S
041313 - ..
041314 - 56. On 090202 1437 Millie notifies UCSF that Krshna indicated if
041315 - Doctor Rugo feels earlier treatment is needed, she can notify
041316 - Doctor Hsu directly. ref SDS 80 F65G, cited in Millie's letter
041317 - to medical team on 090202 1437, ref SDS 81 R23V
041319 - ..
041320 - 57. On 090202 1437 Millie apologizes for adding to Doctor Rugo's
041321 - work load. Waiting to the 19th is a shock compared to what
041322 - Millie sees on her chest. Results for CA 15-3 from the lab
041323 - last week on 090129 have not been published, but expect it will
041324 - be 200+, since it was 303 at Kaiser on 090116. ref SDS 41 PQTQ
041325 - Those are scary numbers in Millie's patient history. Millie
041326 - avers being a "sissy." Doctor Rugo and others at UCSF and
041327 - Kaiser are working hard to help Millie and many other patients,
041328 - cited in Millie's letter to medical team on 090202 1437.
041329 - ref SDS 81 R23Y
041331 - ..
041332 - 58. On 090202 1550 called VCI and asked about Millie getting
041333 - hyperthermia treatment immediately, rather than wait to 090219
041334 - offered by UCSF. ref SDS 82 YU8H
041336 - ..
041337 - 59. On 090202 1732 Doctor Rugo letter notifies medical team that
041338 - Millie needs urgent treatment quickly to be effective.
041339 - ref SDS 83 Y15J
041341 - ..
041342 - 60. On 090203 0939 call VCI and schedule call to discuss alternate
041343 - source for Millie to get hyperthermia treatment in time to be
041344 - effective recovering from 6th relapse of IBC. ref SDS 84 9Y5I
041346 - ..
041347 - 61. On 090203 1009 letter to VCI submits patient history for review
041348 - to support telephone conference, ref SDS 84 IN94, on arranging
041349 - for VCI to provide hyperthermia treatment in time for Millie to
041350 - recover from 6th relapse of IBC. ref SDS 84 EP3S
041352 - ..
041353 - 62. On 090203 1024 called UCSF talked to Jennette in Radiation
041354 - Oncology; she will discuss with Doctor Hsu advancing Millie
041355 - getting hyperthermia treatment from 090219 to this week.
041356 - ref SDS 85 XX5I
041358 - ..
041359 - 63. On 090203 1206 Doctor Al-Bussam called and reported well
041360 - ordered record for Millie's patient history enabled expedited
041361 - review of complex medical problems. ref SDS 86 8488 VCI
041362 - offered to start work the next day on 090204 giving Millie
041363 - hyperthermia treatment in time to be effective recoverying from
041364 - 6th relapse IBC. ref SDS 86 OE4F
041366 - ..
041367 - 64. On 090203 1417 Millie's letter to medical team reports VCI
041368 - proposal to provide hyperthermia treatment in time to be
041369 - effective starting tomorrow on 090204. ref SDS 87 IS3P
041371 - ..
041372 - 65. On 090203 1417 Millie advises medical team that if UCSF can
041373 - juggle the schedule to start treatment in the next few days,
041374 - Millie prefers working with Doctor Hsu locally, based on
041375 - excellent results working with Doctor Rugo. There is a lot of
041376 - benefit to close practice collaboration at UCSF. ref SDS 87
041377 - IS3Y
041379 - ..
041380 - 66. On 090203 1417 alternatively, Millie requests a medical opinion
041381 - on risks of waiting to Feb 19th against advantages of doing the
041382 - work tomorrow at VCI. ref SDS 87 IS4R
041384 - ..
041385 - 67. On 090203 1417 Millie ask whether treatment at UCSF can be
041386 - advanced from 090219. If not, is the medical condition urgent
041387 - enough to require another provider, and, if so, is VCI a good
041388 - choice under the circumstances? Is there another way to get
041389 - this work done in time to be effective? ref SDS 87 IS5V
041391 - ..
041392 - 68. On 090203 1438 Jennette with UCSF Radiation Oncology Department
041393 - called back and advised that Doctor Hsu advanced Millie's
041394 - hypertermia treatment to begin on 090205 in time to be
041395 - effective recovering from 6th relapse of IBC, ref SDS 88 XX5I,
041396 - rather than risk waiting until 090219, as proposed yesterday on
041397 - 090202 1357. ref SDS 80 XO7G
041399 - ..
041400 - 69. On 090203 1444 Millie's letter notified medical team,
041401 - ref SDS 89 6Q3J, that Jennette in Doctor Hsu's office at UCSF
041402 - called on 090203 1438, ref SDS 88 XX5I, following Millie's
041403 - letter on 090203 1417 notifying medical team that VCI offered
041404 - to perform hypethermia treatment tomorrow on 090204 in time to
041405 - be effective for Millie to recover from 6th relapse IBC,
041406 - ref SDS 87 IS3P, and Jennette said UCSF changed their proposal
041407 - for Millie to start treatment on 090219, and instead Millie is
041408 - scheduled to meet Doctor Hsu in Radiation Oncology at UCSF to
041409 - start hyperthermia treatment on 090205, ref SDS 88 XX5I, shown
041410 - in Millie's letter. ref SDS 89 YQ5W
041412 - ..
041413 - 70. On 090203 1444 Millie sent copy of letter for the medical team
041414 - to VCI, ref SDS 89 YQ6P, thanking Nash and Doctor Al-Bussam for
041415 - timely, professional support investigating my case, ref SDS 86
041416 - JZ4F, and offering a backup solution [reported in record on
041417 - 090203 1206. ref SDS 86 OE4F
041419 - ..
041420 - 71. On 090203 1444 Millie's letter notifies the medical team that
041421 - communication with Doctor Hsu's office at UCSF in Radiation
041422 - Oncology has not been established, ref SDS 89 YQ6S, previously
041423 - noted in Millie's letter to the medical team on 090202,
041424 - ref SDS 79 C95U]. Millie routinely gets blood draws on
041425 - Thursdays at 0800, and so asks if this is needed to support the
041426 - meeting with Doctor Hsu on Thursday 090205, and if not need to
041427 - cancel the meeting with the Infusion Clinic on Thursday. By
041428 - copy alerted Catherine and Diane in Infusion that blood draw
041429 - may not be needed on 090205. ref SDS 89 YQ6S
041431 - ..
041432 - 72. On 090203 1444 Millie commended Doctor Johnson, the primary
041433 - care physician at Kaiser Oncology, and Doctor Rugo, Millie's
041434 - oncologist on referral to UCSF, for support moving forward with
041435 - hyperthermia treatment to recover from 6th relapse of IBC.
041436 - ref SDS 89 YQ6V Noting this might not work; citing research
041437 - [on 090129] indicates there is a good chance. ref SDS 65 OI6N
041438 - and ref SDS 65 SQ6L
041440 - ..
041441 - 73. On 090203 1632 Doctor Johnson, Millie's primary care physician
041442 - at Kaiser advised that Millie does not need blood draw at UCSF
041443 - on Thursday 090205 to support starting hyperthermia treatment
041444 - meeting Doctor Hsu in the UCSF Radiation Oncology Department,
041445 - ref SDS 90 3X6H, responding to Millie's letter to the medical
041446 - team on 090203 1444 asking about labs. ref SDS 89 YQ6S
041448 - ..
041449 - 74. On 090203 2257 Doctor Rugo letter to medical team commends Dr
041450 - Hsu on advancing the schedule by 2 weeks of Millie to getting
041451 - hyperthermia treatment, ref SDS 92 WX8M, responding to Millie's
041452 - letter earlier today on 090203 1444 notifying that Radiation
041453 - Oncology changed the schedule from 090219 to 090205 in order to
041454 - provide urgent treatment quickly enough to be effective, which
041455 - was requested in Doctor Rugo's letter to the medical team on
041456 - 090202 1732. ref SDS 83 Y15J]
041458 - ..
041459 - 75. On 090203 2257 Doctor Rugo notifies medical team that Millie
041460 - cannot get treatment at UCSF without authorization. Millie
041461 - does not have any regular blood draws, and the doctor
041462 - recommends checking for authorization before Millie does
041463 - anything at UCSF. This includes clinic visits. Infusion
041464 - Clinic was notified Millie's meetings should be cancelled.
041465 - ref SDS 92 L35Q This responds to Millie's letter on 090203
041466 - 1444 asking about getting a blood draw before visiting Doctor
041467 - Hsu in Radiation Oncology on 090205. ref SDS 89 YQ6S
041469 - ..
041470 - 76. On 090203 2257 Doctor Rugo is hopeful Millie can move on to
041471 - another trial after the hyperthermia, that will continue a high
041472 - quality of life experienced the past 2 years at UCSF.
041473 - ref SDS 92 L36S
041475 - ..
041476 - 77. On 090203 2247 Doctor Rugo letter to Millie advises against
041477 - getting hyperthermia treatment at VCI, ref SDS 93 DY4K,
041478 - responding to Millie's letter earlier on 090203 1417 asking for
041479 - medical opinion about getting hyperthermia treatment at VCI
041480 - today on 090204, compared to waiting 3 weeks until 090219
041481 - proposed for treatment by UCSF. ref SDS 87 IS4R
041483 - ..
041484 - 78. On 090204 0117 Millie's letter thanks Doctor Rugo for help
041485 - advancing the schedule in Radiation Oncology for hyperthermia
041486 - treatment 3 weeks, ref SDS 94 DY4K, with a letter to the
041487 - medical team on 090202 1932 advising that Millie needs urgent
041488 - treatment quickly enough to be effective. ref SDS 83 Y15J, and
041489 - the doctor's letter on 090129 expedited referral from Kaiser
041490 - authorizing hyperthermia treatment, reported in Millie's letter
041491 - to the medical team on 090130. ref SDS 68 TZ6H
041493 - ..
041494 - 79. On 090204 0117 Millie notes in a letter to UCSF that VCI said
041495 - they had treated patients on referral from UCSF, reported on
041496 - 090202. ref SDS 82 P67F Did UCSF have a bad experience sending
041497 - a patient to VCI? Patients can make mistakes when rushed to
041498 - find a solution, a la "clutching at straws," ref SDS 94 EL4U,
041499 - which seemed to occur on 090202 when UCSF had earlier advised
041500 - on 090122 that Millie should stop treatment to be prepared for
041501 - starting new treatment on 090129, ref SDS 52 J47F, and on
041502 - 090129 UCSF advised there was a communication mixup that
041503 - prevented getting treatment, reported on 090130, ref SDS 68
041504 - AY8Q, and then writes a letter on 090202 saying Millie needs
041505 - urgent treatment quickly in time to be effective, ref SDS 83
041506 - Y15J, and UCSF schedules the work 3 weeks later on 090219.
041507 - ref SDS 80 XO7G
041509 - ..
041510 - 80. On 090204 0219 Millie thanks Doctor Rugo for guidance on case
041511 - management, ref SDS 95 135F, and notes innovation will be
041512 - needed for continuing care after hyperthermia treatment at
041513 - UCSF. ref SDS 95 277X Millie requests Doctor Rugo at UCSF
041514 - continue teamwork from past 2 years with Doctor Johnson at
041515 - Kaiser, and maintain internal practice synergy with Doctor Hsu
041516 - at UCSF to collaborate on designing effective treatment.
041517 - ref SDS 95 278Q
041519 - ..
041520 - 81. On 090204 0219 Millie asks Doctor Rugo to submit an opinion on
041521 - likely scenarios and possible treatment options so that
041522 - proactive management will avoid scrambling at the last minute
041523 - to get things done for the next treatment, ref SDS 95 278T,
041524 - that were required for the current hyperthermia treatment
041525 - scheduled to begin tomorrow on 090205, and shown by case study
041526 - in this record listing chronology of delays, per above.
041527 - ref SDS 99 MN5I
041529 - ..
041530 - 82. On 090204 1528 Millie letter to medical team reports calling
041531 - Arlette returning her message on Millie's cell phone yesterday
041532 - on 090203 with instructions on pain medication, ref SDS 97
041533 - 135F, and responding to Millie's letter reporting rising pain
041534 - on 090203 1417, ref SDS 87 IS6U; following up request the
041535 - before for pain relief, on 090202 1437. ref SDS 81 R23S, and
041536 - further cited 2 days ago on 090201 1852, ref SDS 70 KN9T.
041537 - Millie reported a bad flare up of pain the previous night on
041538 - 090203 2217, and got through it by taking more Vicodin.
041539 - ref SDS 91 KE5I
041541 - ..
041542 - 83. On 090204 1528 Millie cited the record on 090203 2217 showing
041543 - only 30% of prescribed pain medicine was being taken in order
041544 - to avoid over-medicating, ref SDS 91 L74H, ignoring
041545 - instructions during examination at UCSF a week earlier on
041546 - 090129 to take more medication reported to medical team on
041547 - 090130 1722, ref SDS 68 AY7T], but with everything going on
041548 - lately, 53 case management tasks since 090129, per above,
041549 - ref SDS A0 LQ3O, the patient got mixed up and forgot.
041550 - ref SDS 97 D64P
041552 - ..
041553 - 84. On 090204 1528 following Arlette's instructions pain relieved
041554 - Millie taking a double dose of Vicodin, and if that doesn't
041555 - work then low-dose morphine will be prescribed. ref SDS 97 D64T
041557 - ..
041558 - 85. On 090204 1914 Doctor Rugo advised that UCSF has to wait for
041559 - results of hyperthermia to arrange for comprehensive cancer
041560 - care from teamwork practice synergy collaborating with Doctor
041561 - Hsu applying Doctor Rugo's experience treating Millie weekly
041562 - for 2 years, as requested in Millie's letter to UCSF on 090204
041563 - 0219, ref SDS 95 278Q, and further Millie's request for Doctor
041564 - Rugo to plan strategy for treatment after hyperthermia, also in
041565 - Millie's letter to UCSF on 090204 0217, ref SDS 95 278Q. Since
041566 - Millie's case is very complex, proactive planning to be
041567 - prepared for alternate scenarios, which was successful applying
041568 - 2nd opinions from Doctor Benz in 2005 and 2007, won't work in
041569 - 2009, because UCSF proposes scheduling is not a simple
041570 - prescription like when you first saw Doctor a consultation
041571 - after hyperthermia to talk about the options. ref SDS 99 278T
041573 - ..
041574 - 86. On 090204 1914 the cost to collaborate with Doctor Hsu for
041575 - practice synergy and proactive planning for treating cancer as
041576 - a chronic disease requires talking with the clinic manager or
041577 - patient services to determine the scope of services covered by
041578 - the Kaiser referral for hyperthermia treatment. ref SDS 99 T43Y
041580 - ..
041581 - 87. On 090204 1930 Millie thanks the medical team for explaining
041582 - strategy to defer planning treatment of cancer as a chronic
041583 - disease for Millie's 7th relapse in 8 years, until after
041584 - results of hyperthermia, because Millie's case is too complex
041585 - for proactive management to plan for alternate scenarios.
041586 - ref SDS A0 278T
041588 - ..
041589 - 88. On 090204 1930 Millie notifies medical team of risks failing to
041590 - apply collaboration synergy of a winning team demonstrated over
041591 - the past 26 months. ref SDS A0 W84Q Continuity of care from
041592 - doctors experienced with the case provides the best security
041593 - for effectiveness, as requested in Millie's letter to UCSF and
041594 - Kaiser on 090204 0219 for Doctor Rugo to collaborate on
041595 - continuing care based on 2 years of weekly treatments.
041596 - ref SDS 95 278Q
041598 - ..
041599 - 89. On 090204 1930 Millie's letter to medical team asks if Doxil
041600 - will be given in the Infusion Clinic, since this is a
041601 - chemotherapy drip treatment, ref SDS A0 W84T, which Doctor Rugo
041602 - prescribed in the recommendation for Millie's treatment
041603 - submitted to Kaiser on 090129, reported on 090130, ref SDS 68
041604 - HK3V, and UCSF stated in a letter on 090203 2257 that Millie
041605 - would no longer be treated in the Infusion Clinic. ref SDS 92
041606 - L35Q and ref SDS 92 L35Y
041608 - ..
041609 - 90. On 090204 1930 Millie reports side effects of sunitinib and
041610 - cyclophosphamide seem mostly gone. Still have pain from IBC
041611 - and mostly my shoulder (actually the arm). ref SDS A0 W84W
041612 - Doctor Johnson has prescribed treatment that is working tody,
041613 - reported in the record earlier on 090204 1528. ref SDS 97 D64T
041614 -
041615 -
041616 -
041617 -
0417 -
SUBJECTS
Kaiser Health Connect Email 1-Stop Management Optimizes Doctor's Tim
5303 -
530401 - ..
530402 - Kaiser Health Connect Email Degrades Productivity Case Management
530403 - Health Connect Email Proposed to Prevent Falling Through the Cracks
530404 - Falling Through the Cracks Solved by Timely Accurate Communication
530405 - Email Uniform Distribution Flexible Support Essential Effective Care
530406 -
530407 - Follow up ref SDS A0 278T, ref SDS 99 278T.
530408 -
530409 - Doctor Johnson, primary care physician at Kaiser responds to Millie's
530410 - letter on 090204 1833, reporting to the medical team that Arlette
530411 - submitted Doctor Johnson's revised treatment plan for pain and this
530412 - has been effective. ref SDS 97 135F
530413 -
530414 - 1. Subject: Pain Control Guidance Effective
530415 - Date: Thu, 5 Feb 2009 09:11:21 -0800
530423 - ..
530424 - 2. Is the any way that you can start using Health Connect to
530425 - communicate with us. I don't always check this email, I always
530426 - check HealthConnect. It made for enhanced patient care. I don't
530427 - want you to fall through the cracks particularly if you are
530428 - having symptoms now!
530430 - ..
530431 - Previously, on 030606, when Millie requested an emergency meeting at
530432 - Kaiser to evaluate rising symptoms of IBC, ref SDS 3 7C6W, which at
530433 - that time had not been diagnosed, ref SDS 3 P97J, the doctor was
530434 - worried about case management for Millie's care "falling through the
530435 - cracks." ref SDS 3 OJ8M
530436 -
530437 - [On 090406 1237 Doctor Johnson requests again using
530438 - Kaiser's internal email system for communication
530439 - efficiency, and responds to only 1 of 2 letters sent 20
530440 - minutes apart, and was 2 days late taking action on request
530441 - by UCSF for Millie to get examination to assess new
530442 - symptoms of pneumonia, shortness of breath, and high
530443 - temperature in connection with side effects from radiation
530444 - and hyperthermia treatments to recover from 6th relapse of
530445 - IBC. ref SDS A5 M19I
530447 - ..
530448 - [On 100601 0830 Doctor Johnson reported he could order
530449 - treatment prescribed by UCSF for Millie to recover from
530450 - UCSF medical mistakes because he could not communicate with
530451 - UCSF by telephone nor by email, so ordering her treatment
530452 - "fell through the cracks" in the health care system.
530453 - ref SDS B4 WB6J
530455 - ..
530456 - Emphasis on effective communication today aligns with the doctor's
530457 - request during the meeting at Kaiser on 081219. At that time, Doctor
530458 - Johnson asked Millie to notify Doctor Rugo to start planning treatment
530459 - at UCSF for Millie's next relapse, becasue after 5 relapses her cancer
530460 - mutated into a more aggressive disease, and so requires urgent
530461 - treatment to start quickly in time to be effective preventing cancer
530462 - from cascading out of control. ref SDS 32 V93O
530464 - ..
530465 - An example of details "falling through the cracks" occurred on 081219
530466 - when someone changed the doctor's referral order to the CT Department.
530467 - Patient history shows persistent problems ordering CT tests.
530468 - ref SDS 32 V76L
530470 - ..
530471 - On 080304 UCSF requested changing from public domain email to the UCSF
530472 - proprietary system. ref SDS 18 0T8F This was ineffective performing
530473 - case management for Millie's health care, per below. ref SDS 0 O94L
530474 -
530475 - [On 090213 1140 during meeting at Kaiser the doctor
530476 - commended Millie's support for doctor patient partnership
530477 - providing communication and coordination to prevent
530478 - critical details from slipping through the cracks.
530479 - ref SDS A3 FZ4H
530481 - ..
530482 - [On 090213 1140 doctor again asks Millie to notify UCSF
530483 - about early planning for 7th relapse on treating Millie's
530484 - cancer as a chronic disease. ref SDS A3 WZ6K
530486 - ..
530487 - [On 090213 1140 Doctor Johnson explained importance for
530488 - doctors to use consistent data standards, because
530489 - translating standards for tests performed at other
530490 - hospitals causes mistakes from hurrying to handle a lot of
530491 - data caring for many patients. ref SDS A3 4Y8F
530493 - ..
530494 - [On 090325 0830 Doctor Johnson explains that failure to
530495 - report test for CA 15-3 for the lab at Kaiser on 090309,
530496 - which was ordered on 090213, ref SDS A4 FU7H, occurs
530497 - because test tubes get misplaced in the clinic or at the
530498 - laboratory. ref SDS A4 EI8J
530500 - ..
530501 - [On 090521 0902 Pamela advised that Millie's health care
530502 - "falls through the cracks" in the Expedited Claims
530503 - Department assisting the primary care physician prescribe
530504 - treatment in time to be effective for Millie to recover
530505 - from 8th relapse of cancer. ref SDS A6 5Y8G
530507 - ..
530508 - [On 100607 1243 Judy planning to investigate Kaiser's
530509 - records to verify that Millie's Advance Directive has not
530510 - fallen through cracks, since several Hospice providers have
530511 - reported not finding documentation onf file. ref SDS B5
530512 - DN6F
530513 -
530515 - ..
530516 - Health Connect proposed in Doctor Johnson's letter today, per above,
530517 - ref SDS 0 278T, is Kaiser's proprietary Knowledge Managmeent system
530518 - that has email support, first discussed by the doctor during a meeting
530519 - on 051121. ref SDS 9 FE4I Months later on 060106 Kaiser's system was
530520 - reviewed, ref SDS 10 FE4I, and found to be headed in the right
530521 - direction for integrated knowledge management. ref SDS 10 M58N Email
530522 - support in Kaiser's closed system, however, paralyzes productivity by
530523 - degrading communication, also explained on 060106. ref SDS 10 MT9I
530524 -
530525 - [On 090406 1237 Doctor Johnson requests again using
530526 - Kaiser's internal email system for communication
530527 - efficiency, and responds to only 1 of 2 letters sent 20
530528 - minutes apart, and was 2 days late taking action on request
530529 - by UCSF for Millie to get examination to assess new
530530 - symptoms of pneumonia, shortness of breath, and high
530531 - temperature in connection with side effects from radiation
530532 - and hyperthermia treatments to recover from 6th relapse of
530533 - IBC. ref SDS A5 M19I
530535 - ..
530536 - [On 100301 0005 Millie notified medical team that regular
530537 - email using public domain addresses for doctors at Kaiser
530538 - enables efficiently directing the work providing health
530539 - care in time to be effective extending quality of life, and
530540 - that Kaiser's confidential "secure" system is a patient
530541 - benefit, which risks survival due to inefficient
530542 - communication, as presented in the record on 090205,
530543 - ref SDS 0 3Z4O, and which the patient therefore waives in
530544 - order to get the larger benefit of extended survival and
530545 - quality of life. ref SDS B0 OP4V
530547 - ..
530548 - [On 100309 1238 Millie notifies medical team that public
530549 - domain email addresses for doctors at Kaiser are required
530550 - to efficiently direct the work performing Millie's health
530551 - care, and Millie asks if Kaiser needs a signed document
530552 - authorizing public domain email for confidential "secure"
530553 - communications. ref SDS B1 HL6R
530555 - ..
530556 - [On 100310 0730 Doctor Johnson met with Millie in the
530557 - Oncology Chemotherapy Infusion Clinic and explained that he
530558 - checks Kaiser's internal proprietary email system more
530559 - often than he sees mail in his public domain address at
530560 - Kaiser; he recommends sending emergency communications to
530561 - the Kaiser internal proprietary email address. ref SDS B2
530562 - OR71
530564 - ..
530565 - [On 100310 1350 Millie explains again that public domain
530566 - email addresses for doctors at Kaiser are secure enough for
530567 - confidentiality in Millie's case; regular email also
530568 - leverages the power of knowledge through collaboration
530569 - among the medical team by keeping "everybody on the same
530570 - page," which enables Millie to survive 3 - 4 times longer
530571 - than patients using Kaiser's internal KM email system,
530572 - which does not support collaboraton. ref SDS B3 GY6P
530574 - ..
530575 - [On 100607 1243 Judy planning to investigate Kaiser's
530576 - records to verify that Millie's Advance Directive has not
530577 - fallen through cracks, since several Hospice providers have
530578 - reported not finding documentation onf file. ref SDS B5
530579 - DN6F
530581 - ..
530582 - Today, Kaiser proposes switching from public domain email that enables
530583 - comprhensive reporting with connections to relevant context, fast,
530584 - efficient, and uniform distribution for effective communication among
530585 - the medical team, illustrated by the case study in this record listed
530586 - above. ref SDS 0 X15M Since Kaiser's proprietary, closed email system
530587 - prevents comprehensive reporting, prevents linking to relevant
530588 - context, and prevents uniform distribution of communication in time to
530589 - be effective, shown by review on 060106, ref SDS 10 MT9I, making the
530590 - change proposed today would reduce productivity treating Millie's
530591 - expanding health care requirements. by causing urgently needed
530592 - treatment to routinely "fall through the cracks," precisely the
530593 - opposite of the doctor's objective. ref SDS 0 9S4T
530595 - ..
530596 - The doctor is correct today that Millie has rising symptoms of pain
530597 - from progression of IBC, cited in Doctor Rugo's letter to the medical
530598 - team on 090129, reported on 090130, ref SDS 68 TZ6H, and for which
530599 - Doctor Rugo has prescribed urgent treatment on 090202. ref SDS 83 Y15J
530601 - ..
530602 - Public domain email has been used for referral coordination between
530603 - Kaiser and UCSF the past 2 years. If Kaiser's Health Connect email
530604 - system can be used instead, it makes a lot of sense, because, as the
530605 - doctor notes extra time and effort checking multiple systems,
530606 - complicates communication, and degrades collaboration. Eric Armstrong
530607 - worked on Engelbart's OHS/DKR project at SRI in 2000. Erick described
530608 - email as "one stop" organizing technology for efficient collaboration
530609 - performing daily work, reported on 000505. ref SDS 1 4392
530611 - ..
530612 - One-stop email optimizes the doctor's time integrating communication
530613 - technology with Kaiser's medical practice, including related
530614 - departments and test data, as reviewed on 060106. ref SDS 10 M58N
530615 - Kaiser deserves support, along with the Veteran's Administration (VA),
530616 - for significant progress applying computers to enable Knowledge
530617 - Management that can potentially make health care cost efficient.
530619 - ..
530620 - Millie's health care requirements exceed capacity of Kaiser's
530621 - Knowledge Management technology at this stage of development, shown by
530622 - review above. ref SDS 0 3Z4O Therefore, preventing Millie's care from
530623 - "falling through the cracks, requires robust support using reliable
530624 - public domain email.
530626 - ..
530627 - Using the Kaiser proprietary email system has limitations like the
530628 - UCSF closed email Knowledge Management system, which UCSF asked
530629 - Millie's medical team to use on 080304. ref SDS 18 0T8F The next day
530630 - on 080305, Doctor Johnson, Millie's primary care physician at Kaiser,
530631 - could not open the letter from UCSF. ref SDS 19 US6I
530633 - ..
530634 - Proprietary, internal, closed email systems are unreliable. Scope and
530635 - features can be changed for convenience and political winds of the
530636 - propritor, with system failures that cause unnanounced denial of
530637 - access for variable durations. Documents under sole control of
530638 - interested parties can be altered and deleted to suit interests of
530639 - Kaiser.
530641 - ..
530642 - [On 100108 0852 Millie notifies medical team that a letter
530643 - dated 100108 resubmitting Kaiser's letter to Doctor Rugo at
530644 - UCSR, and submitted to Millie through Kaiser's proprietary,
530645 - closed "Securemail" system cannot be accessed. ref SDS A8
530646 - MW3U
530648 - ..
530649 - [On 100108 1616 drove to Kaiser and received a printed copy
530650 - of Doctor Johnson's letter dated 100108, and which
530651 - resubmitted Doctor Johnson's earlier letter to Doctor Rugo
530652 - dated 091211, ref SDS A9 HT7L, and which is entered in the
530653 - record on 091211, ref SDS A7 M33K; and Tara advises medical
530654 - team that Doctor Rugo prescribes PART treatment at UC
530655 - Davis, rather than at UCSF. ref SDS A9 FM5I
530657 - ..
530658 - [On 100309 1238 Millie notifies medical team that Kaiser's
530659 - Knowledge Management system has been off-line for a week
530660 - preventing access to patient medical records on lab work.
530661 - ref SDS B1 HL4V
530663 - ..
530664 - [On 100310 0730 Doctor Johnson met with Millie in the
530665 - Oncology Chemotherapy Infusion Clinic and explained that he
530666 - checks Kaiser's internal proprietary email system more
530667 - often than he sees mail in his public domain address at
530668 - Kaiser; he recommends sending emergency communications to
530669 - the Kaiser internal proprietary email address. ref SDS B2
530670 - OR71
530672 - ..
530673 - [On 100310 1350 Millie denied access to Kaiser's Knowledge
530674 - Management proprietary, internal email system still
530675 - off-line after primary care physician recommends using the
530676 - Kaiser email system for emergency communications,
530677 - ref SDS B3 GY4U
530679 - ..
530680 - [On 100310 1350 Millie explains again to the medical team
530681 - that public domain email addresses for doctors at Kaiser
530682 - are secure enough for confidentiality in Millie's case;
530683 - regular email also leverages the power of knowledge through
530684 - collaboration among the medical team by keeping "everybody
530685 - on the same page," which enables Millie to survive 3 - 4
530686 - times longer than patients using Kaiser's internal KM email
530687 - system, which does not support collaboraton. ref SDS B3
530688 - GY6P
530690 - ..
530691 - [On 100607 1243 Judy planning to investigate Kaiser's
530692 - records to verify that Millie's Advance Directive has not
530693 - fallen through cracks, since several Hospice providers have
530694 - reported not finding documentation onf file. ref SDS B5
530695 - DN6F
530697 - ..
530698 - The solution is to use an open, public domain system with proven scope
530699 - and reliability that supports everyone. For the past 9 years, email
530700 - communication with Kaiser has never been interrupted.
530702 - ..
530703 - Kaiser's email system is "closed," preventing uniform distribution,
530704 - preventing links to relevant context, and limits patients to 1000
530705 - characters, which prevents comprehensive patient history, as explained
530706 - on 060106. ref SDS 10 1O8F Limitiations of Kaiser's current system
530707 - prevent clear, concise, complete communication, essential for getting
530708 - things done correctly in time to be effective, shown by patient
530709 - history in this case...
530710 -
530711 - 1. Discovering IBC took 34 tasks
530712 - over 3 years..................... 040517. ref SDS 4 MD5W
530714 - ..
530715 - 2. Discovering pulmonary embolism and
530716 - starting treatment took 20 tasks
530717 - over 8 months.................... 060722. ref SDS 11 SV3K
530719 - ..
530720 - 3. Communication problems between Kaiser
530721 - and UCSF delayed treatment 4 weeks
530722 - starting recivery from Millie's
530723 - 4th IBC relapse, resolved by patient
530724 - coordinating 52 tasks to implement
530725 - Kaiser referral for care at
530726 - UCSF.............................. 070130, ref SDS 16 2X6L
530728 - ..
530729 - 4. Power Port for CT tests took 62
530730 - tasks over 6 months for successful
530731 - application at CT Department
530732 - in Walnut
530733 - Creek............................ 080502, ref SDS 23 VG5J
530735 - ..
530736 - 5. Work plan transition from cetuximab
530737 - Carboplating study to sunitinib with
530738 - cyclophosphamide and Methotrexate
530739 - study............................. 081016, ref SDS 26 J36R
530741 - ..
530742 - 6. Biopsy at Kaiser ordered by Doctor
530743 - Rugo to test for status change took
530744 - 50 tasks over 2 months and was
530745 - negative......................... 081016, ref SDS 26 W26G
530747 - ..
530748 - 7. Kaiser referral and scheduling urgent
530749 - treatment at UCSF in time to be effective
530750 - for Millie to recover from 6th
530751 - relapse of IBC took 86
530752 - tasks over 3
530753 - weeks............................. 090204, ref SDS A0 MN5I
530755 - ..
530756 - This record presents a knowledge management dilemma: optimizing the
530757 - doctor's time at Kaiser reduces care for Millie, because most care
530758 - occurs on referral at UCSF, and management is performed by the patient
530759 - coordinating work at Kaiser and UCSF, shown by patient history...
530760 -
530761 - 1. Doctor reports telephone practices
530762 - have degraded communication
530763 - to prevent effective case
530764 - management for patient
530765 - care.............................. 080403, ref SDS 21 J67H
530767 - ..
530768 - 2. Doctor asked Millie to use email for
530769 - coordinating treatment at Kaiser
530770 - ordered by UCSF................... 080403, ref SDS 21 4U9O
530772 - ..
530773 - 3. Coordination is very difficult to make
530774 - collaboration effective for comprehensive
530775 - medical care, and becomes much harder
530776 - coordinating complex case management
530777 - between hospitals for referral
530778 - patients.......................... 080404, ref SDS 22 SE5L
530780 - ..
530781 - 4. Doctor thanks Millie for coordinating
530782 - work plan with Kaiser changing treatment
530783 - to Sunitinib clinical study
530784 - treating 5th relapse
530785 - of IBC............................ 081017, ref SDS 27 RI6I
530787 - ..
530788 - Thus, optimizing patient care requires balancing support for the
530789 - doctor at Kaiser within a closed Knowledge Management system with
530790 - limited effectiveness and where the doctor has limited responsibility
530791 - for treatment, against rising demand for coordination between Kaiser
530792 - and UCSF, who has primary responsibility for treatment, and which
530793 - requires accomplishing a great many tasks in time to be effective,
530794 - shown by case study above. ref SDS 0 GM4H This context requires
530795 - continuing use of methods and procedures using technology that
530796 - optimize communication between the patient, Kaiser and UCSF, rather
530797 - than optimize the doctor at Kaiser to perform minimal tasks.
530798 -
530811 -
530812 -
530813 -
530814 -
530815 -
530816 -
530817 -
530818 -
530819 -
530820 -
530821 -
530822 -
530823 -
530824 -
5309 -