CONTACTS 
0202 - University of California San Franci                                                                                                                                O-00000835 0406
020201 - Ms. Margaret Rubino                                                                                                                                              O-00000835 0406
020202 - New Patient Coordinator
020204 - Admissions                                                                                                                                                       O-00000835 0406

SUBJECTS
Schedule Meeting UCSF Doctor Benz 060821 0930 2nd Opinion IBC Recurr

2103 -
2103 -    ..
2104 - Summary/Objective
2105 -
210501 - Follow up ref SDS 40 0000. ref SDS 37 0000.
210502 -
210503 - Scheduled meeting with Doctor Benz at UCSF on 060821.  Patient
210504 - coordinator was able to open patient history, and indicated this
210505 - method of navigating the record will be effective for the doctor to
210506 - prepare 2nd opinion.  She will work with the doctor on navigating the
210507 - record using SDS links. ref SDS 0 6U61
210508 -
210509 -
210510 -
210511 -
210512 -
210514 -  ..
2106 -
2107 -
2108 - Discussion
2109 -
210901 - Called Margaret again at UCSF, continuing efforts on 060807, which
210902 - shows background. ref SDS 40 YK6N  Follow up today recognizes Millie's
210903 - letter today, ref SDS 41 1L5P, commenting on correspondence from
210904 - Kaiser recommending 2nd opinion for treatment plan to stem worsening
210905 - IBC. ref SDS 41 3J4O
210907 -  ..
210908 - Margaret answered the phone - a miracle.
210910 -  ..
210911 - We scheduled a meeting with Doctor Benz on...
210912 -
210913 -                 060821 0930.
210914 -
210916 -  ..
210917 - Organizing Medical Records Takes Too Much Time Handling Documents
210918 - Patient Coordinator Hectic Schedule Not Enough Time to Coordinate
210919 -
210920 - Margaret said it would be helpful to get records for the doctor
210921 - already organized.  She said that more than half of her time is taken
210922 - up arranging documents in a sensible order for the doctor to review.
210923 - This is not really her job.  Helping out arranging documents reduces
210924 - time to coordinate new patients; she said that's why patients get
210925 - frustrated when she doesn't have time to call back, as occurred on
210926 - 060801, and on 060807. ref SDS 40 YK6N
210928 -  ..
210929 - On 040622 Jack Park at SRI talked about tools and practices to help
210930 - people make sense of complex information. ref SDS 3 FM5W  Earlier, on
210931 - 000221 Jack discussed the difficulty of managing complexity with the
210932 - organic structure of context. ref SDS 1 L58O
210933 -
210934 -     [On 060819 confirmed schedule for meeting, and presented new
210935 -     information and issues. ref SDS 42 IX3O
210937 -  ..
210938 - Since Millie is a stage IV cancer patient who has relapsed 3 times
210939 - over the past 5 years, her patient history is very complex, noted by
210940 - Doctor Grissom on 060802. ref SDS 38 IT8P  Today, Margaret recognized
210941 - the large number of examinations, treatments, and tests in Millie's
210942 - medical records.  She said that figuring out contextually relevant
210943 - order, verifying a complete record, avoiding duplication, and
210944 - arranging documents takes a lot of hard work to reduce mistakes by
210945 - avoiding confusion.  A lot of doctors don't like complex cases,
210946 - because understanding patient history is a big problem.
210948 -  ..
210949 - Problems arranging medical records occurred two years ago on 041014,
210950 - ref SDS 7 0001, and again last year on 050907 getting documents for
210951 - the second round of 2nd opinions. ref SDS 24 028E  These problems
210952 - affected Doctor Benz on 041018.  He had difficulty using the computer
210953 - to access patient history online, and so used Kaiser's printed
210954 - documents.  Confusion made the doctor's work difficult. ref SDS 8 EN5L
210956 -  ..
210957 - This time for the 3rd second opinion we have again assembled a simple
210958 - chronology with links into details of patient history on the computer.
210960 -  ..
210961 - Margaret appreciated that patient history is accessible online.  She
210962 - said it takes time for people to try doing things differently, but
210963 - handling documents is so difficult that folks may be more willing this
210964 - year to try new methods that save time.
210966 -  ..
210967 - Margaret asked how to access the records online?  She did not remember
210968 - seeing Millie's letter, ref DIP 2 0001, to UCSF on 060725, asking
210969 - Margaret to schedule a 2nd opinion. ref SDS 36 ST9O  Margaret said her
210970 - schedule has been very hectic; so she may have seen it, but has not
210971 - had time to respond.
210973 -  ..
210974 - While we talked, Margaret found Millie's letter in her email software
210975 - program.
210977 -  ..
210978 - Margaret was suprised that the entire patient history over four (4)
210979 - years can be opened and accessed simply by clicking links.  We opened
210980 - phase 1 from case inception until before surgery on 051021, and listed
210981 - in the record on 050812. ref SDS 21 UF4J
210983 -  ..
210984 - Margaret feels that Doctor Benz will be primarily interested in phase
210985 - II of patient history from mastectomy surgery on 051021 to the
210986 - present, listed in the record on 060722. ref SDS 35 XQ7H
210988 -  ..
210989 - Margaret found the link in Millie's letter to the history on CA 15-3
210990 - cancer marker, and, also, image test reports. ref DIP 2 3I3L  She
210991 - feels this the most important part of the record for a 2nd opinion.
210993 -  ..
210994 - We did a short orientation to understand clicking links to get more
210995 - details about events listed in patient history.  Margaret understood
210996 - the date format, of year, month, day.
210998 -  ..
210999 - Margaret asked how it's possible to create a long, complex record with
211000 - flexible organization that enables people to step precisely to
211001 - specific facts with contextual relevance over a 5 year period?  She
211002 - feels that besides saving her time, discussed above, ref SDS 0 I73H,
211003 - this will save the doctor a lot of time making sense of patient
211004 - history.  This aligns with Jack Park's call on 040622 for technology
211005 - to apply complexity theory for "sensemaking." ref SDS 3 FM5W
211007 -  ..
211008 - Margaret plans to work with Doctor Benz on precision access into the
211009 - record of patient history rather than use printed documents from
211010 - Kaiser.  She was very pleased to avoid having to organize a lot of
211011 - paper.
211012 -
211013 -        [On 060821 this effort was not successful. ref SDS 43 TQ5F
211014 -
211015 -
211016 -
211017 -
211018 -
211019 -
211020 -
211021 -
211022 -
2111 -