THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: February 9, 2006 08:00 AM Thursday; Rod Welch

Manometry test for achalasia at VA in Sacramento, Mather AFB. .

1...Summary/Objective
2...Test Scheduled 060209 0800 Mather AFB in Sacramento
3...Test Delayed Due to Equipment Maintenance Problems
4...Test Schedule Changed to 060223 Pending Equipment Repairs


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SUBJECTS
Manometry Test for Achalasia Treatment VA Mather AFB Delayed Due to

1603 -
1603 -    ..
1604 - Summary/Objective
1605 -
160501 - Follow up ref SDS 40 0000. ref SDS 38 0000.
160502 -
160503 - Test could not be performed due to equipment failure.  Scheduled
160504 - another try in two weeks.  Consideration can be given to skipping the
160505 - test in order to avoid further delay to remedial work on the
160506 - esophageal sphincter valve. ref SDS 0 NJ5L  Submitted letter to Jimmy
160507 - with link to this record confirming understandings. ref SDS 0 4W44
160508 -
160509 -     [On 060220 letter asks to confirm meeting on 060223, if equipment
160510 -     has been repaired, or is there another delay. ref SDS 42 GG9I
160512 -      ..
160513 -     [On 060221 Jimmy says manometry equipment still broken; has been
160514 -     sent out for repairs and there is no date at this time on when the
160515 -     equipment will be available for use at the VA. ref SDS 43 ND7M
160517 -      ..
160518 -     [On 060221 letter to Doctor asks about alternatives to manometry
160519 -     testing, and whether treatment for achalasia can proceed.
160520 -     ref SDS 43 7U8H
160521 -
160522 -
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160524 -
160526 -  ..
1606 -
1607 -
1608 - Discussion
1609 -
160901 - Test Scheduled 060209 0800 Mather AFB in Sacramento
160902 -
160903 - Follow up ref SDS 41 G49P, ref SDS 40 GG9I.
160904 -
160905 - Lead doctor on this issue at the VA GI Clinic in Martinez, plans to
160906 - attend and assist with this test, and the only day of the week he is
160907 - at Mather AFB VA hospital is on Thursdays. ref SDS 40 IR5O
160909 -  ..
160910 - Checked in at the GI Clinic.  James registered the meeting.
160911 -
160913 -  ..
1610 -
1611 -
1612 - 0815
1613 -
161301 - Test Delayed Due to Equipment Maintenance Problems
161302 -
161303 - Follow up ref SDS 40 GG9I, ref SDS 38 I96J.
161304 -
161305 - Vi came out and said the manometry testing machine is broke.  She
161306 - tried calling us this morning at 0700, but by then we had already left
161307 - from Concord at 0600 in order to arrive in time to meet in Sacramento
161308 - at 0800.
161310 -  ..
161311 - A technician is trying to fix the problem.  Doctor Lee has not yet
161312 - arrived to support the meeting, as planned in his letter received on
161313 - 060111, ref SDS 38 696L, and noted in Vi's call on 060125. ref SDS 40
161314 - IR5O
161316 -  ..
161317 - We decided to wait for a half hour or so, to see if the machine can be
161318 - fixed.
161319 -
161320 -
161321 -
161323 -  ..
1614 -
1615 -
1616 - 0840
1617 -
161701 - Vi came out and explained that the technician has to order parts.  She
161702 - decided to reschedule.  Equipment failures frustrate schedules and
161703 - people, shown by problems with the Differential Analyzer at Aberdeen
161704 - Proving Ground, reported in NWO. ref OF 14 OP5G
161706 -  ..
161707 - Doctor Lee has still not arrived.  Vi will explain what happened
161708 - today.
161709 -
161710 -
161712 -  ..
161713 - Test Schedule Changed to 060223 Pending Equipment Repairs
161714 -
161715 - Jimmy, who manages administration for the GI Clinic, was at the
161716 - counter.  He looked at the schedule on the computer and proposed
161717 - meeting on 060223 again at 0800.  This will fit with the doctor's
161718 - schedule working at Mather VA on Thursdays.
161719 -
161720 -     [On 060220 letter asks to confirm meeting on 060223, if equipment
161721 -     has been repaired, or is there another delay. ref SDS 42 GG9I
161723 -  ..
161724 - Timely re-scheduling demonstrates VA effectiveness and commitment,
161725 - that occurred previously on 051115. ref SDS 28 TP4L  This experience
161726 - indicates that Tom Munnecke's concern on 020911 that the VA was unable
161727 - to transform work practice to improve delivery of care with computers
161728 - may have been premature. ref SDS 6 PV7H
161730 -  ..
161731 - Another question is whether this manomtry test can be skipped, and
161732 - simply perform the dilation procedure to restore function to
161733 - esophageal sphincter valve, planned in the meeting on 051209.
161734 - ref SDS 32 NZ5H  At that time, on 051209, the doctor did not mention
161735 - the need for a manometry test, which suggests it may not be critical,
161736 - but rather is helpful, provided the work can be performed within a
161737 - reasonable time.
161739 -  ..
161740 - Jimmy indicated today there have been continuing problems with this
161741 - equipment.  If the problems cannot be resolved to reduce the frequency
161742 - of breakdowns, the VA may have to purchase new equipment.  In that
161743 - case, the test scheduled for 060223 would be further delayed
161744 - indefinitely.
161745 -
161746 -     [On 060220 letter asks to confirm meeting on 060223, if equipment
161747 -     has been repaired, or is there another delay. ref SDS 42 GG9I
161749 -      ..
161750 -     [On 060221 Jimmy says manometry equipment still broken; has been
161751 -     sent out for repairs and there is no date at this time on when the
161752 -     equipment will be available for use at the VA. ref SDS 43 ND7M
161754 -      ..
161755 -     [On 060221 letter to Doctor asks about alternatives to manometry
161756 -     testing, and whether treatment for achalasia can proceed.
161757 -     ref SDS 43 7U8H
161759 -  ..
161760 - Possibly there is another test that would not be as conclusive as the
161761 - manometry test, but would provide some of the additional evidence the
161762 - doctor wants.
161763 -
161764 -
161766 -  ..
1618 -
1619 -
1620 - 1312
1621 -
162101 - Submitted ref DIT 1 0001 to Jimmy, confirming these understandings...
162102 -
162103 -    1.  Thanks very much to you and Vi for rescheduling subject test
162104 -        with Doctor Lee on February 23, 2006 at 0800.  We will follow
162105 -        the procedure for preparation that Vi presented in her call on
162106 -        January 25, ref DIT 1 0001, i.e., clear liquid diet 48 hours
162107 -        prior to the test. ref SDS 40 HE53
162108 -
162109 -            [On 060221 Jimmy said he gets so many email at the VA that
162110 -            his directory is full, and he does not have time to read
162111 -            the letters nor to delete anything. ref SDS 43 NT6J
162113 -         ..
162114 -    2.  You asked about Communication Metrics using computer
162115 -        technology. ref DIT 1 JS6I  This letter linked to the record of
162116 -        our meeting today illustrates the "feedback" metric for
162117 -        accuracy. ref SDS 0 0001
162118 -        Another example is the four (4) year study on cancer
162119 -        treatment, listed on 050812. ref SDS 22 0001
162121 -         ..
162122 -        Accurate records save the doctor time by empowering "patient
162123 -        partnership" to expand span of attention (see example of agenda
162124 -        meeting with the doctor).  Accuracy obviously saves lives by
162125 -        avoiding mistakes.  The Schedule Diary System (SDS) software
162126 -        saves lives, time, and money by managing personal and
162127 -        organizational memory with chronology, context, and connection.
162128 -        While this sounds like a lot of "seminar buz words," if you
162129 -        have time to check the examples, you can see SDS capability is
162130 -        beyond reach of other technology.
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