CONTACTS 
0201 - Kaiser Permanente
020101 - Mr. Robert Johnson; Surgeon
020102 - Department of Oncology

SUBJECTS
Cat Scan CT Abdomen for Distant Metastasis Spread of Cancer
Time Not Enough for Documentation Paperwork Expedite Conversation Fas
Be Prepared Com Metrics Organizational Memory Intelligence SDS KM Avo
Meeting Unproductive
70% Day Wasted Unproductive Meetings Not Enough Time to Be Prepared f
Desk Piled High with Paper, Put in Computer
Be Prepared Squirrel Cricket Sunshine Profits Pay Experiment Innovati
Primary Care Physician Doctor Robert Johnson Oncologist
Communication Review Record of Meeting on 020321 Michelle Says Doctor

2111 -
2111 -    ..
2112 - Summary/Objective
2113 -
211301 - Follow up ref SDS 7 0000, ref SDS 6 0000.
211302 -
211303 - Left message asking to meet with Arlette for a few minutes later
211304 - today between 1300 and 1700.
211305 -
211306 -
211308 -  ..
2114 -
2115 -
2116 - 1131
2117 -
211701 - Michelle called back.
211702 -
211703 - She said Arlette is off work today, and that she and Arlette both
211704 - work with Doctor Johnson.
211706 -  ..
211707 - The objective today is to visit for about 5 minutes going over the
211708 - diary that Arlette said Doctor Johnson wants patient's to prepare for
211709 - helping everybody communicate based on the diary for the meeting on
211710 - 020321. ref SDS 5 0001
211712 -  ..
211713 - We can go over things a bit with Michelle to get some pointers on how
211714 - the Doctor likes to work.
211716 -  ..
211717 - Michelle said she can do this.   She goes to lunch between 1330 and
211718 - 1430.  So before 1300 and after 1500 is okay.
211719 -
211720 -
211722 -  ..
2118 -
2119 -
2120 - 1502
2121 -
212101 - While at Kaiser today for the bone scan test, we had some time after
212102 - lunch and before the test.
212109 -  ..
212110 - Visited the doctor's nurse, Michelle, at Walnut Creek Oncology clinic,
212111 - and reviwed the record of meeting with the doctor on 020321.
212112 - ref SDS 5 0001
212114 -  ..
212115 - Michelle commented faborably on the binder with a cover page that
212116 - says...
212117 -
212118 -                  Millie's Treatment and Recovery Plan
212119 -  ..
212120 - She feels a positive mind set is important for cancer patients.
212122 -  ..
212123 - We looked through the record showing questions highlighted for easy
212124 - review in the context of related details from the meeting on 020321.
212125 - ref SDS 5 0001  Michelle commented on some issues, then noted that the
212126 - record is more extensive than most patients prepare.  She said the
212127 - purpose of meeting on 020405 is for the Doctor to address patient
212128 - questions, so she feels the doctor can comment at that time.
212130 -  ..
212131 - We discussed leaving the record with Michelle for the doctor to review
212132 - when he has time in order to prepare for meeting on 020405, and
212133 - further explained that the record can be submitted via email to avoid
212134 - the clutter of another large document piling up and getting lost on
212135 - the desk, since an electronic version provides precision access to
212136 - relevant context that saves time, allowing the doctor to pick and
212137 - choose when he wants more details about a particular matter.
212139 -  ..
212140 - Michelle explained that the doctor has patients to treat, and has
212141 - management responsibilities as chief of Hermatology and Oncology for
212142 - the Diablo Service Area, reported in the Member News reviewed on
212143 - 020321. ref SDS 5 MK4J
212144 -
212145 -
212147 -  ..
212148 - Desk Piled High Important Papers Not Enough Time for Good Management
212149 -
212150 - Michelle said the amount of work to carry out responsibilities for
212151 - managing the oncology department and caring for patients is enormous,
212152 - shown by the doctor's desk piled high with important papers.  This
212153 - aligns with common practice, shown in the record on 000725.  The
212154 - manager of the computer department at SRI working to discover and
212155 - develop computer applications that improve communication was swampped
212156 - by papers piles high the desk. ref SDS 4 I3R5
212158 -  ..
212159 - Michelle feels the doctor's backlog of many documents shows there is
212160 - not enough time for the doctor to review communication with the
212161 - patient in the record on 020321. ref SDS 5 0000  As a result, Michelle
212162 - feels there will be no time for the doctor to prepare for meeting with
212163 - the patient on 020405 by reviewing the record of prior work, even at
212164 - the doctor's convenience, and especially by getting an email from the
212165 - patient.  Michelle explained that the doctor uses email to collaborate
212166 - with the professional staff, but not with patients.
212167 -
212168 -         [On 020708 the radiologist at Mt Diablo explained similar
212169 -         practice using email to communicate with professional staff,
212170 -         but using conversation for communication with patients.
212171 -         ref SDS 11 EY9N
212173 -          ..
212174 -         [On 020726 the doctor cited Kaiser's efforts to implement
212175 -         requirements for communications in the Healthwise Handbook,
212176 -         during a meeting on 020726. ref SDS 12 ST6F
212178 -          ..
212179 -         [On 040614 the doctor confirmed practice to avoid written
212180 -         communications to confirm understandings in meetings and
212181 -         calls, and advised patients to call the advise nurse on
212182 -         treatment matters and work with Kaiser with conversation.
212183 -         ref SDS 15 O53O
212185 -          ..
212186 -         [On 041130 the doctor objected to request for a written plan
212187 -         to analyse complex treatment scenarios and confirm discussion
212188 -         in a meeting on changing the course of treatment to address
212189 -         major change in the patient profile, ref SDS 17 YR8F, and
212190 -         commented that a written plan is unnecessary overkill because
212191 -         the case is too simple. ref SDS 17 763L
212193 -          ..
212194 -         [On 041202 Doctor Parsley used email for timely, accurate
212195 -         coordination between patient, primary care physician and
212196 -         surgeon on follow up for emergency treatment that found biopsy
212197 -         wound that failed to heal over 8 months. ref SDS 18 426W
212199 -          ..
212200 -         [On 050520 the doctor began capturing a legible record on
212201 -         Kaiser's computer, and disclosed Kaiser's plans to equip
212202 -         patient examination rooms with ergonomic work stations for
212203 -         efficiently investing intellectual capital. ref SDS 19 HX6J
212205 -          ..
212206 -         [On 051121 Kaiser email support for doctor/patient partnership
212207 -         communication. ref SDS 20 V25O
212209 -  ..
212210 - Information overload is common for busy executives who do not have
212211 - enough time to think, reported on 960418. ref SDS 1 8840
212213 -  ..
212214 - This aligns with the report on 970910 that executives do not have
212215 - enough time to think. ref SDS 2 3479
212217 -  ..
212218 - Michelle recalled Kaiser's Healthwise Handbook recommends the doctor
212219 - review communication that fosters effective partnership as an
212220 - important factor of patient care, treatment and recovery, shown on
212221 - 990625. ref SDS 3 YS49 and ref SDS 3 0806
212223 -  ..
212224 - Michelle suggested that rather than leave the record for the doctor to
212225 - review at a convenient time and develop comments on patient questions
212226 - to prepare for the meeting on 020405, it would work better to bring
212227 - the record and discuss it during the meeting, without prior review to
212228 - be prepared.
212230 -  ..
212231 - We considered using the record to aid the doctor in organizing
212232 - information that makes time effective by empowering the patient to be
212233 - an effective partner.
212235 -  ..
212236 - Michelle indicated the record for the meeting on 020321 is well
212237 - organized and provides deeper understanding of issues. ref SDS 5 0001
212238 - She indicated that good partnership between the doctor and patient
212239 - strengthens care and recovery through better understanding and follow
212240 - up on important details.  She feels, however, that at this time the
212241 - doctor does not have enough time for reviewing patient history in
212242 - order to be prepared for working productively.
212243 -
212244 -       [On 020403 called the doctor to follow up. ref SDS 9 BO6O
212246 -        ..
212247 -       [On 020405 Millie reviewed some of the record with the doctor;
212248 -       did not show the record to the doctor. ref SDS 10 MA3F
212250 -        ..
212251 -       [On 040504 met with the doctor and discussed clinical trial to
212252 -       evaluate SDS for case management. ref SDS 13 0001
212254 -        ..
212255 -       [On 040610 delayed research using SDS for intelligence to
212256 -       support medical management due to complications Millie diagnosed
212257 -       with IBC. ref SDS 14 OG5U
212259 -        ..
212260 -       [On 040807 patient condition improved contacted doctor to review
212261 -       intelligence support for medical management. ref SDS 16 Z34V
212263 -        ..
212264 -       [On 060106 Kaiser began using computer systems for team care
212265 -       collaboration on diagnosis, treatment prescriptions, capturing a
212266 -       legible record in the medical chart, referrals, and
212267 -       doctor/patient communications, which together implement
212268 -       Knowledge Management for efficient, comprehensive health care,
212269 -       ref SDS 21 FE4I; however, initial system limitations paralyze
212270 -       productivity due to inaccurate, cursory, and incomplete
212271 -       communication that increases mistakes with the illusion of
212272 -       efficiency. ref SDS 21 1O8F
212274 -        ..
212275 -       [On 061024 case study Knowledge Management goals for paperless
212276 -       office, e.g., shove all that paper into the computer, shows
212277 -       progress beginning in 1988.
212278 -
212279 -
212280 -
212281 -
212282 -
212283 -
212284 -
212285 -
212286 -
2123 -