CONTACTS 

SUBJECTS
Medical Practice Requires Records
Privacy, Security - Discovery
Kathy and Amy

0805 -    ..
0806 - Summary/Objective
0807 -
080701 - Follow up ref SDS 3 0000, ref SDS 2 0000.
080702 -
080703 - Kathy submits liturature today on medical records practices, and on
080704 - prostrate cancer test and treatment issues.  Articles on medical
080705 - records show the tension between maintaining adequate information for
080706 - treatment, and inappropriate disclosure and use of information outside
080707 - the doctor/patient relationship.
080708 -
080709 - There is also an advertisement for Synvisc to treat osteoarthritis by
080710 - injecting a fluid.  It seems to be mostly for people who experience
080711 - constant pain, or pain while walking, rather than to permit strenuous
080712 - activity. ref SDS 0 9894
080713 -
080714 -     [On 990728 sent response to Kathy. ref SDS 14 0001]
080715 -
080716 -     [On 990731 notified Syed at Kaiser about Synvisc. ref SDS 15 0001]
080717 -
080718 -     [On 990925 report from Doctor Boulris recommends Syvisc after
080719 -     cortisone. ref SDS 18 3955]
080720 -
080721 -     [On 990928 notified Kathy of results. ref SDS 19 0001]
080722 -
080723 -
080724 -  ..
0808 -
0809 -
0810 - Progress
0811 -
081101 -  ..
081102 - Security of Medical History
081103 -
081104 - Received letter from Kathy, ref DRT 1, transmitting an article in Good
081105 - Housekeeping on records management in the medical care profession..
081106 - ref OF 1  This follows up my letter to Morris, ref DIP 1 2989, sent on
081107 - 990628, concerning mistakes caused by information overload, where I
081108 - suggested patients have a self-interest role. ref SDS 3 0001,
081109 -
081110 - The article explains the potential for abuse of sensitive medical
081111 - history, when care is not taken to supervise access and distribution.
081112 -
081113 - A bill is being debated in Congress to strengthen safeguards against
081114 - misuse of medical information. ref OF 1 5580
081115 -
081116 - On 990718 Dan Palanza cited security of sensitive information as a
081117 - requirement for Communication Metrics. ref SDS 9 0968
081118 -
081119 -     [On 990720 cited article as example of Dan's concern in relation
081120 -     to support for NSF proposal. ref SDS 11 0001]
081121 -
081122 -     [On 990727 article on Microsoft Office 2000 reviews concerns about
081123 -     security, calls for balancing between security and productivity.
081124 -     ref SDS 13 1185]
081125 -
081126 -
081127 -  ..
081128 - Communication Requires Common Efforts for Effective Execution
081129 -
081130 - A second article, published in the Sacramento Bee, is a column by Dear
081131 - Abby on the need for joint efforts to maintain effective medical
081132 - records. ref OF 3  There are two letters.  The first letter is from a
081133 - doctor who says that doctors are responsible to notify patients of
081134 - test results. ref OF 3 8748  This doctor complains of colleagues in
081135 - the profession who require patients to contact them for test results.
081136 - The writer suggests that, if a patient does not receive a report, call
081137 - the doctor to request it. ref OF 3 9408
081138 -
081139 -     [On 990628 Doctor Syed Naqvi advised his practice is to notify
081140 -     patients of test results. ref SDS 4 7420]
081141 - ..
081142 - The second letter is from a patient who urges that everyone
081143 - maintain their own records of medical history as a check on the
081144 - doctor's records. ref OF 3 4902
081145 -
081146 - The writer reports common mistakes in medical records. ref OF 3 7980
081147 -
081148 -       [On 990910 medical records mistakes caused delay. ref SDS 16
081149 -       3038 and, ref SDS 16 6305]
081150 -
081151 -       [On 990912 article on high cost of medical mistakes. ref SDS 17
081152 -       0001]
081153 -
081154 -     These issues can be supported by professional management of
081155 -     communications where organizations are "flattened," by eliminating
081156 -     support staff under the guise that technology enables fewer people
081157 -     to do more, and that line managers, including professionals, like
081158 -     doctors, lawyers and engineers, maintain their own records.
081159 -
081160 -     The only technology that can replace humans in "remembering" how
081161 -     to find key information is SDS, and it is used by only 2 or 3
081162 -     people in the world, as noted by USACE District Counsel in a
081163 -     letter on 990303. ref SDS 1 9499  Everyone else is lost.
081164 -
081165 -     Neither article addresses the pressures that prevent performance
081166 -     of effective practices to maintain good medical "intelligence"
081167 -     reviewed on 990625. ref SDS 2 0889
081168 -
081169 - These letters support the need for care in maintaining useful medical
081170 - history, which aligns with Kaiser's partnership communication model
081171 - reported on 990625. ref SDS 2 4185
081172 -
081173 -     [On 990727 article on Microsoft Office 2000 reviews concerns about
081174 -     security, calls for balancing between security and productivity.
081175 -     ref SDS 13 1185]
081176 -
081177 - The letter to Morris is linked to Kaiser's guidelines for doctor -
081178 - patient communication, which calls for keeping notes of discussion and
081179 - getting feedback, reviewed on 990625. ref SDS 2 0806
081180 -
081181 - I later talked to Kathy about her hospital's guidelines on patient/
081182 - doctor communication and partnership.
081183 -
081184 - She was not aware of published policies on communication between
081185 - doctors and patients, but planned to investigate.
081186 - ..
081187 - Kathy liked the idea of a patient advocate set out in the record
081188 - for 990625. ref SDS 2 0899
081189 -
081190 -
081191 -
081192 -
0812 -

SUBJECTS
Prostrate Cancer Testing

0904 -
090401 -  ..
090402 - Prostate Test, PSA, Partially Reliable
090403 -
090404 - Kathy submitted another article, this one taken from Parade magzaine
090405 - section of the Sunday paper on 990530.
090406 -
090407 - The article says that PSA test results over 4 are "abnormal" and so
090408 - indicate potential for prostate cancer. ref OF 5 6237
090409 -
090410 -     This aligns with the report from Kaiser received today. ref SDS 10
090411 -     4416, also. ref DRP 1 7089.
090412 - ..
090413 - Article reports PSA test results, both positive and negative,
090414 - are false 30% of time. ref OF 5 6237
090415 -
090416 - Prostate cancer is a tumor, I would liken it to a blemish on the skin,
090417 - that can be local, the article says "innocuous";, ref OF 5 9766; or,
090418 - it can become pervasive and life threatening.  Distinguishing these
090419 - conditions at an early stage is difficult.
090420 -
090421 - A third of all men over 50 probably have some form of prostate cancer.
090422 - ref OF 5 6755
090423 -
090424 - The article cites over-emphasis on surgery which can lead to post-
090425 - operative complications that are more severe than a slow growth
090426 - prostate cancer. ref OF 5 2442
090427 -
090428 -
090429 -
090430 -
0905 -

SUBJECTS
Synvisc Injection Therapy

1004 -
100401 -  ..
100402 - Synvisc Hylan G-F 20 Knee Therapy for Osteoarthritis
100403 -
100404 - Follow up ref SDS 8 7332 ref SDS 7 0001.
100405 -
100406 - Kathy submits a page from what seems to be a magazine published by
100407 - Hearst Communications.  The name of the publication, the date and the
100408 - page number are not shown. ref OF 8
100409 -
100410 - This is an advertisement for...
100411 -
100412 -
100413 -                      Synvisc Hylan G-F 20
100414 -
100415 -
100416 - ...a fluid injected into the knee joint for treating osteoarthritis.
100417 - ref OF 8 7452 and ref OF 8 5678
100418 -
100419 - This seems to be a "hyaluronic acid" treatment cited in the article
100420 - discussed with Doctor Sylvia Connolly on 990625. ref SDS 2 8966
100421 -
100422 -     [On 990910 Doctor Craig Boulris does not recommend using Synvisc.
100423 -     ref SDS 16 7802]
100424 -
100425 -     [On 990925 report from Doctor Boulris recommends Syvisc after
100426 -     cortisone. ref SDS 18 3955]
100427 -
100428 -     [On 990928 notified Kathy of results. ref SDS 19 0001]
100429 -
100430 - The article under review by Kaiser says this treatment is for previous
100431 - injury and to repair ordinary wear and tear. ref OF 7 7921
100432 -
100433 - Biomatrix is the manufacturer. ref OF 8 4087
100434 -
100435 - Wyeth-Ayerst Pharmaceuticals is the distributor. ref OF 8 1716
100436 - ..
100437 - Injected fluid is a viscous, elastic mixture of hylan A fluid,
100438 - hylan B gel, and salt water with comparable viscous and elastic
100439 - properties to synovial fluid of 18 to 27 year old healthy human knees.
100440 - The number of injections is not specified. ref OF 8 5678
100441 -
100442 -     [On 990925 Doctor Boulris discusses a series of 3 injections.
100443 -     ref SDS 18 3955]
100444 -
100445 - The two hylans are manufactured from hyaluronan (sodium hyaluronate)
100446 - that comes from chicken combs. ref OF 8 7452
100447 -
100448 - Hyaluronan is a natural chemical found in the body and is present in a
100449 - high amount in joint tissues and in the flud that fills the joint. The
100450 - body's own hyalurronan acts like a lubricant and a shock absorber in
100451 - the joint, and is needed for the joint to operate properly.
100452 -
100453 - Treatment is designated only for osteoarthritis. ref OF 8 7568 and
100454 - under precautions. ref OF 8 6782
100455 -
100456 - The advertisement says Synvisc has comparable viscous and elastic
100457 - properties to synovial fluid of 18 to 27 year old healthy human knees.
100458 - ref OF 8 5678
100459 -
100460 -
100461 -  ..
100462 - Running and tennis should be avoided after treatment with Synvisc
100463 -
100464 -    It is not clear from the advertisement whether this is a near-term
100465 -    precaution, or whether these activities are precluded generally
100466 -    following treatment. ref OF 8 5622
100467 -
100468 -    Our objective is to get treatment to permit this activity.
100469 -
100470 -
100471 - Clinical Trials are reported, but do not indicate how long after
100472 - treatment strenuous activity can be resumed. ref OF 8 6744
100473 -
100474 -    On 990701 Doctor Sylvia Connolly indicated Kaiser relies on
100475 -    clinical studies. ref SDS 5 6555
100476 -
100477 -    [On 990925 report from Doctor Boulris recommends Syvisc after
100478 -    cortisone. ref SDS 18 3955]
100479 -
100480 - The ad says pain relief and the greatest amount of treatment success
100481 - occurred 8 to 12 weeks after synvisc treatment began. ref OF 8 7568
100482 -
100483 - Taken together, these points seem to suggest that Synvisc treatment is
100484 - for people who experience constant pain, or pain walking, rather than
100485 - pain after exercise, and the goal of treatment is relief for the
100486 - former condition, rather than to support strenuous activity, like
100487 - tennis and running to maintain conditioning, weight, and cholesterol.
100488 -
100489 -
100490 -
100491 -  ..
100492 - Kaiser Reviewing Knee Treatment Options
100493 -
100494 - On 990713 asked Doctor Syed Naqvi to assist Sylvia in providing the
100495 - article on knee therapies to the orthopedist. ref SDS 8 0001
100496 -
100497 -     [On 990722 letter to Doctor Sylvia Connolly, with copy to Doctor
100498 -     Syed Naqvi, asks about progress of the review Kaiser is making for
100499 -     treating my knees based on submission of an article that reported
100500 -     eight (8) new therapies. ref SDS 12 2646]
100501 -
100502 -     [On 990730 sent follow up to Syed. ref SDS 15 0001]
100503 -
100504 -     [On 990910 Doctor Boulris did not receive treatment options to
100505 -     review during meeting. ref SDS 16 3038]
100506 -
100507 -     [On 990925 report from Doctor Boulris did not review treatment
100508 -     options reported in the record. ref SDS 18 6734]
100509 -
100510 -
100511 -
100512 -
100513 -
100514 -
1006 -