CONTACTS 
0201 - Kaiser Permanente - Shadelands       925 906 2200
020101 - Walnut Creek, CA
020102 - Ms. Jeanne Bradley; Coordinator =925 906 2204
020103 - Jeanne.Bradley@ncal.kaiperm.org
020104 - Administration Department
0202 - Kaiser Foundation Health Plan, Inc.  510 ... ....
020201 - Mr. Tom Driscoll; Director of Operations =510 987 3584
020202 - tom.driscoll@kp.org
020203 - Call Center

SUBJECTS
Medical Practice Requires Records
Risk Communication Main Factor of Management Success
Risk Management Communication Main Task of Managers, Largest Risk
Telephone Game Shows Meaning Drift, Need to Maintain Shared
Common Administration
Team Care in Medical Practice
Kaiser Medical Group
Team Care No Process Address Medical Mistakes

1410 -    ..
1411 - Summary/Objective
1412 -
141201 - Follow up ref SDS 19 0000, ref SDS 18 0000.
141202 -
141203 - Jeanne indicated the agenda proposed for meeting with Tom Driscoll
141204 - appears constructive.  She facilitated contact through Tom's
141205 - assistant.  Discussion with Tom in the afternoon indicates there is
141206 - already testing being done on expanding application of the Internet.
141207 - Communication Metrics would meld in some respects of Tom's Call Center
141208 - scope into an integrated Enterprise Management environment using HTML.
141209 -
141210 - Tom will discuss with Jeanne, and advise OA 991210 about meeting to
141211 - explore this opportunity.
141212 -
141213 - Submitted ref DIT 1 0001 to Tom, linked to the explanation of
141214 - intelligence in POIMS. ref OF 6 0582  Sent copies to Jeanne and to
141215 - Mark.
141216 -
141217 -    [On 991207 national initiative announced to reduce high cost of
141218 -    medical mistakes. ref SDS 20 0001]
141219 -
141220 -    [On 991210 called Tom to follow up. ref SDS 21 6230]
141221 -
141222 -
141223 -
141224 -
141225 -
141226 -
1413 -
1414 -
1415 - Progress
1416 -
141601 -  ..
141602 - Tom Driscoll Can Address System Wide Cost Saving from Com Metrics
141603 -
141604 - Jeanne did not recall reading my letter, ref DIP 10 0001, submitted on
141605 - 991130, ref SDS 18 0001, suggesting an agenda for meeting with Tom.
141606 -
141607 - While we talked she reviewed the letter online, and feels it sets a
141608 - good agenda for meeting with Tom.
141609 -
141610 - Jeanne recalled seeing recent broadcasts about the high cost of
141611 - medical mistakes, cited in the record of our discussion on 991130.
141612 - ref SDS 18 1260  She advised that the cost of mistakes has greater
141613 - visibility at hospitals, than at satellite clinics, because of the
141614 - greater concentration of care that occurs in a hospital.
141615 -
141616 - She continues to feel Tom is a good person to begin discussing a
141617 - system wide improvement in management, contemplated by Communication
141618 - Metrics.
141619 -
141620 - Jeanne asked me to hold while she calls Tom's office.
141621 -
141622 - She came back online and said she just talked to Tom's assistant...
141623 -
141624 -
141625 -                     Darlene Merschat
141626 -                     510 987 3584
141627 -
141628 -
141629 - Tom is in the Kaiser...
141630 -
141631 -
141632 -                     Leadership Office
141633 -
141634 -
141635 - ...his official title is...
141636 -
141637 -                     Tom Driscoll
141638 -                     Director of Operations
141639 -                     Call Center
141640 -
141641 -
141642 - Jeanne asked about forwarding all of the Welch communication on this
141643 - to Tom?
141644 - ..
141645 - We considered holding off until we get a sense about Tom's level
141646 - of interest.  Need to focus his attention initially on a few issues.
141647 -
141648 -     1.  There are several specific patient treatment matters that
141649 -         relate to Team Care and medical management processes, from the
141650 -         record on 991008. ref SDS 5 9055
141651 -
141652 -     2.  Communication Metrics to reduce mistakes and cost, based on
141653 -         Robert Pearl's letter on 991015, reviewed on 991025.
141654 -         ref SDS 6 0800
141655 -
141656 - The overall goal is to reduce the high cost of medical mistakes
141657 - reviewed in the letter on 990924. ref DIP 2 0001
141658 -
141659 -
141660 -
1417 -
1418 -
1419 - 1312 called Darlene Merschat          510 987 3584
1420 -
142001 - Left message for Darlene to call back.
142002 -
142003 -
1421 -
1422 -
1423 - 1416 received call from Tom
1424 -
142401 - He is returning my call.  Left his number...
142402 -
142403 -
142404 -                        510 987 4921
142405 -
142406 -
1425 -
1426 -
1427 - 1509 called Tom back     510 987 4921
1428 -
142801 - Left message I returned his call.
142802 -
142803 -
142804 -  ..
142805 - Kaiser Working on Initiatives to Use Internet, Improve Communication
142806 -
142807 -
1429 -
1430 -
1431 - 1603 called Tom back     510 987 4921
1432 -
143201 - Tom advised he has looked at the Welch home page...
143202 -
143203 -
143204 -                      http://www.welchco.com
143205 -
143206 -
143207 - ...and indicated initial favorable consideration of Communication
143208 - Metrics.
143209 - ..
143210 - Tom asked about pending issues; we reviewed briefly the record
143211 - for 991008 identifying medical mistakes that have not been addressed
143212 - by Kaiser. ref SDS 5 9055
143213 -
143214 - The big issue is to improve delivery of care at less cost by improving
143215 - communication with a system of business metrics that catches and fixes
143216 - mistakes before they cause extra cost and delay, per the letter on
143217 - 990924. ref DIP 2 0001
143218 -
143219 -    [On 991207 national initiative announced to reduce high cost of
143220 -    medical mistakes. ref SDS 20 0001]
143221 -
143222 -    [On 991210 Tom responds to medical mistakes with discussion about
143223 -    email. ref SDS 21 6230]
143224 -
143225 -    [On 991216 Tom suggests contacting local Kaiser clinic for review
143226 -    of medical mistakes, despite refusal of clinic to perform review.
143227 -    ref SDS 22 4914]
143228 -
143229 -    [On 000118 Jeanne reviewed medical mistakes. ref SDS 23 3248]
143230 -
143231 -    [On 000121 Jeanne submits response to medical mistakes. ref SDS 24
143232 -    0863]
143233 -
143234 -
143235 - The strategy is to implement Kaiser's policy on doctor patient
143236 - communication, discussed with Doctor Connolly on 990625, ref SDS 1
143237 - 1978, and reviewed on 991028 in connection with the letter from Robert
143238 - Pearl. ref SDS 6 0800
143239 - ..
143240 - Tom advised that the Call Center system results in creating
143241 - Lotus Notes messages that are printed and submitted to the doctor for
143242 - action.  A copy of the message may be placed in the patient Medical
143243 - Chart.  This seems to align with understandings from the discussion on
143244 - 990802 with Jeanne Bradley, ref SDS 2 9360, corrected by Jeanne's
143245 - letter on 993001. ref SDS 18 1806
143246 -
143247 - The patient Medical Chart has not yet been automated, as reported in
143248 - the meeting on 990625. ref SDS 1 2144
143249 -
143250 - We reviewed Kaiser's current efforts to use the Internet for Patient
143251 - support, e.g., Advice Nurse, Forum.
143252 -
143253 - I explained having logged on and obtained a pin number; on 991109
143254 - received information from a Kaiser staff psychologist, and submitted
143255 - idea for using Com Metrics for narrative therapy. ref SDS 12 4088
143256 - ..
143257 - Tom related a study underway, or recently completed, at a Santa
143258 - Clara Kaiser facility, to evaluate effectiveness of an Internet
143259 - application.
143260 -
143261 - This record shows work at Kaiser on ideas and methods that meld with
143262 - Communication Metrics goals and methods.  On 991028 research from Bob
143263 - Pearl's letter on 991015 raised inquiry about developing a study.
143264 - ref SDS 6 0832
143265 -
143266 - <05966 Tom noted the high cost of infrastructure to give every doctor
143267 - a PC with access to the Internet for managing doctor/patient
143268 - communiation more effectively.
143269 -
143270 - First, the cost of PCs is coming down.  In some cases ISPs are giving
143271 - away the PCs to sell server space and access time.
143272 -
143273 - One idea to reduce the cost of infrastructure, and possibly make the
143274 - repository of medical history a profit center, is to sell advertising
143275 - space on the web pages.  Pages that doctors are likely to access a lot
143276 - could have a small unobtrusive ad from "Stethoscopes R Us," or for
143277 - patients "Plentiful Pills," etc.  A large customer and employee base,
143278 - like Kaiser, could command a revenue stream from advertising.
143279 -
143280 - Further pilot testing can demonstrate cost effectiveness.
143281 - ..
143282 - Training and leadership are also needed.  Explained briefly
143283 - ideas from the discussion with Jeanne Bradley on 991101, ref SDS 8
143284 - 1718, citing letter on reducing medical mistakes. ref DIP 2 2601
143285 -
143286 - Set following action items...
143287 -
143288 -     Rod will submit notes of this discussion (see ref DIT 1 0001)
143289 -
143290 -     Tom will review the record and talk to Jeanne Bradley about her
143291 -     experience with Com Metrics.
143292 -
143293 -     Tom will advise OA Friday, 991210 about planning scenario.
143294 -
143295 -   [On 991210 Tom left voice mail message indicating his group is not
143296 -   involved with these issues. ref SDS 21 6230]
143297 -
143298 -
143299 -
143300 -
1434 -
1435 -
1436 - 1626 called Jeanne
1437 -
143701 - Left message advising of having heard from Tom, and that he will be
143702 - contacting her to follow up.
143703 -
143704 -
143705 -
143706 -
143707 -
143708 -