CONTACTS 

SUBJECTS
CA 15-3 36 Test 070301 Dramatic Decline Lowest Level in Over Year Me

1103 -
1103 -    ..
1104 - Summary/Objective
1105 -
110501 - Follow up ref SDS 14 2N5J.
110502 -
110503 -
110504 -
110505 -
110507 -  ..
1106 -
1107 -
1108 - Progress
1109 -
110901 - CA 15-3 36 Best Report of Millie's Condition in Over a Year
110902 -
110903 - Catherine called this morning.  She advised that CA 15-3 for the blood
110904 - test at UCSF on 070301 was 36. ref SDS 14 2N5J
110906 -  ..
110907 - This is great news, almost too good to be true, like the record on
110908 - 050520 reporting IBC rash subsiding after going up for so long.
110909 - ref SDS 3 087J
110911 -  ..
110912 - CA 13-5 36 is the best diagnostic for Millie's cancer marker for over
110913 - a year, shown by patient history in the record on 070301. ref SDS 13
110914 - 087J
110915 -
110916 -     [...below Millie notifies Kaiser of good news. ref SDS 0 045V
110917 -
110918 -     [...below latest CA 15-3 36 test results align with 2 prior tests
110919 -     during February. ref SDS 0 IE5O
110921 -      ..
110922 -     [On 070315 progress report submitted to primary care physician at
110923 -     Kaiser on recovering from IBC 3rd relapse with treatment that
110924 -     started 070201 under a clinical study for cetuximab at UCSF.
110925 -     ref SDS 22 VP5N
110927 -      ..
110928 -     [On 070511 Millie ordered CA 15-3 at Kaiser to prepare for meeting
110929 -     with primary care physician scheduled on 070525, and to
110930 -     cross-check remarkable results reported by the UCSF Lab.
110931 -     ref SDS 30 B64J
110933 -      ..
110934 -     [On 070514 Millie asks Kaiser for results of CA 15-3 test on
110935 -     070511. ref SDS 31 IN5P
110937 -      ..
110938 -     [On 070516 Kaiser reports CA 15-3 56 and describes this result as
110939 -     "stable," ref SDS 32 QN6M, which significantly conflicts with
110940 -     testing at UCSF. ref SDS 32 WV6L
110942 -      ..
110943 -     [On 070516 Millie asks Kaiser to verify accuracy of CA 15-3 test
110944 -     on 070511, and to notify UCSF to be prepared for meeting with the
110945 -     patient on 070524. ref SDS 32 ZJ9N
110947 -      ..
110948 -     [On 070517 Kaiser advised that UCSF uses a different calibration
110949 -     method for CA 15-3 that cannot be compared to the Kaiser test
110950 -     results, like comparing apples and oranges. ref SDS 34 NT3O
110952 -      ..
110953 -     [On 070517 Nurse's Notes show nurse practitioner ordered another
110954 -     blood test to verify elevated CA 15-3 56 reported in Kaiser's test
110955 -     on 070511; but did not perform the test, and decided to wait
110956 -     another week to address the issue. ref SDS 33 FG6H
110958 -      ..
110959 -     [On 070517 Brigid discloses that coordinating divided
110960 -     responsibilities on referral projects is difficult; and that UCSF
110961 -     recommends limiting laboratory work rather than empowering labs to
110962 -     cross-check tests for accuracy. ref SDS 34 466H
110963 -
110964 -
110965 -
1110 -

SUBJECTS
CA 15-3 Request Reports 2 Blood Tests 070208 070215 Kaiser Order CT

2403 -
240401 -  ..
240402 - Kaiser Authenticate CA 15-3 Trend Submit Reports on 2 Blood Tests
240403 -
240404 - Follow up ref SDS 18 PY6N.
240405 -
240406 - The prior CA 15-3 tests at Kaiser on 070208 and 070215 are needed for
240407 - treand analysis to verify accuracy of the test at UCSF on 070301.  Is
240408 - the newest test annomolus, misleading, or erroneous, or does it
240409 - continue a trend during treatment with cetuximab? ref SDS 0 U85L
240411 -  ..
240412 - Since Arlette has not had time to respond to previous letters
240413 - submitted on...
240414 -
240415 -        1.  070228  CA 15-3 CT request from Kaiser.... ref SDS 12 ED5H
240416 -        2.  070302  Results meeting Doctor Rugo....... ref SDS 15 EY5W
240417 -        3.  070302  INR blood test results............ ref SDS 15 K14H
240418 -        4.  070305  INR clarify standard.............. ref SDS 16 XG5H
240419 -        5.  070305  INR standard clarified............ ref SDS 16 B18H
240420 -        6.  070306  CA 15-3 CT request from Kaiser.... ref SDS 18 MI7J
240421 -        7.  070307  CA 15-3 CT request from Kaiser.... ref SDS 0 3X4J
240423 -  ..
240424 - ...Millie submitted ref DIT 1 0001, a follow up letter to Michelle at
240425 - Kaiser to get CA 15-3 results for blood tests on 070208 and 070215 to
240426 - cross-check and develop trends on results Catherine reports, per
240427 - above. ref SDS 0 U85L
240428 -
240429 -    1.  I sent a letter to Arlette yesterday to help coordinate pending
240430 -        issues with Kaiser and UCSF, where I am now getting treatment
240431 -        on referral.  Since I have not heard from Arlette, she may be
240432 -        on vacation, out sick, or just really busy. ref DIT 1 0001
240434 -  ..
240435 - Michelle never responded, but she works closely with Arlette, and may
240436 - have forwarded the letter to her for response.  Below, Arlette sends a
240437 - letter that does not address either issue presented in the letter to
240438 - Michelle. ref SDS 0 HS8G
240439 -
240441 -  ..
240442 - CT Scan Order to Test Pulmonary Embolism and Clinical Study Progress
240443 -
240444 -
240445 -    2.  If you have time, can you please glance through, and follow up
240446 -        on getting us CA 15-3 blood test results, and let me know if
240447 -        [the doctor] has ordered the CT test requested by UCSF.  We may
240448 -        not have a date yet for the image test, but I just want to be
240449 -        able to tell Doctor Rugo at UCSF that the test has been
240450 -        ordered, and will  evaluate for PE. ref DIT 1 MT6F
240452 -  ..
240453 - Michelle never responded, but she works closely with Arlette, and may
240454 - have forwarded the letter to her for response.  Below, Arlette sends a
240455 - letter that does not address either issue presented in the letter to
240456 - Michelle. ref SDS 0 HS8G
240457 -
240458 -            [...below, Millie asks again for results on CA 15-3 cancer
240459 -            marker tests in February. ref SDS 0 CN4R
240460 -
240461 -
240462 -
2405 -

SUBJECTS
Fax Info ?? Coordination Collaboration Communication Complex Context

3003 -
3004 - 1058
300501 -  ..
300502 - Coordination Collaboration Communication Complex Context Uncertain
300503 -
300504 -
300505 - Millie received ref DRT 1 0001 from Arlette saying in total...
300506 -
300507 -        You can just have her fax the info. 925-295-4608. ref DRT 1
300508 -        0001
300510 -  ..
300511 - The context of this letter is not clear, since Millie has been asking
300512 - for Kaiser to submit information to UCSF, per above. ref SDS 0 3X4J
300513 -
300514 -                   [...below another letter from Arlette cites actions
300515 -                   discussed last week on 070302, and which has since
300516 -                   been resolved, but without an explanation of
300517 -                   referant there is uncertainty about the actual
300518 -                   source of comments; the matter is unrelated to
300519 -                   anything presented the past two days. ref SDS 0 YI7O
300521 -  ..
300522 - There are several problems figuring out the intent of Kaiser's
300523 - letter...
300524 -
300525 -            1.  The method/format of email does not present the letter
300526 -                being answered, which supresses context.
300527 -
300528 -                   [...same problem with another letter from Kaiser.
300529 -                   ref SDS 0 W66O
300531 -                 ..
300532 -            2.  There is no explanation of context citing which of many
300533 -                letters Kaiser answers. ref SDS 0 U868  Is Arlette
300534 -                following up the letter to Kaiser this morning, per
300535 -                above? ref SDS 0 3X4J  None of these
300537 -                 ..
300538 -            3.  Research expending 10 - 20 minutes can determine
300539 -                Arlette may be responding to Millie's 2nd letter on
300540 -                070302, since it has the same subject as Kaiser's
300541 -                letter today. ref SDS 15 K14H  There are two other
300542 -                letters that went to Arlette that had the same subject,
300543 -                so without clarification, the referent in Kaiser's
300544 -                letter is unclear.
300546 -                 ..
300547 -                The letter on 070302 asks about faxing a blood test
300548 -                report to Kaiser on INR results.  This issue, however,
300549 -                was resolved in subsequent correspondence on 070305.
300550 -                ref SDS 16 XG5H
300551 -
300552 -
300553 -
300554 -
300555 -
3006 -

SUBJECTS
CA 15-3 Request Reports 2 Blood Tests 070208 070215 Kaiser Order CT

5003 -
5004 - 1056
500501 -  ..
500502 - CT Scan Order to Test Pulmonary Embolism and Clinical Study Progress
500503 -
500504 - Millie submitted ref DIT 2 0001 answering Arlette's letter, per above.
500505 - ref SDS 0 HS8G
500506 -
500507 -    1.  Thanks for responding.  I'm not sure of the context in your
500508 -        letter today saying to "fax the info." ref SDS 0 HS8G  You can
500509 -        see that the form of your reply, for some reason does not
500510 -        attach the letter that you answered, so I'm not sure what you
500511 -        want me to fax. ref SDS 0 HS8G, ref DIT 2 0001
500512 -
500513 -             [...below Millie apologizes for being confused about the
500514 -             context of Kaiser's correspondence.  SDS 0 CN6Y
500516 -         ..
500517 -    2.  My earlier letters asked if [the doctor] ordered the CT test
500518 -        that evaluates PE, ref SDS 0 K69R, and that UCSF needs the
500519 -        report in time for the meeting on 070329 to start the next
500520 -        treatment cycle.  If not, please let him know. ref DIT 2 OI5O
500522 -  ..
500523 - Patient history asking Kaiser to order the CT test...
500524 -
500525 -                070302.............................. ref SDS 15 EZ6T
500526 -                070306.............................. ref SDS 18 HS3X
500527 -                070307.............................. ref SDS 0 K69R
500528 -
500530 -  ..
500531 - CA 15-3 Trend Kaiser Submit Reports on 2 Blood Tests 070208 070215
500532 -
500533 -
500534 -    3.  I also asked if it is possible to get the report showing CA
500535 -        15-3 for blood tests on 070208 and a week later on 070215.
500536 -        Jackie did not have time last week to get this from Kaiser for
500537 -        the meeting on 070301. ref SDS 13 MP58, ref DIT 2 OI6K
500538 -
500539 -            [...below, Millie asks again for results on CA 15-3 cancer
500540 -            marker tests in February. ref SDS 0 CN4R
500542 -         ..
500543 -        CA 15-3 36 Best Kaiser Notified UCSF Findings
500544 -
500545 -    4.  But.... goooood news!! I hope! ref DIT 2 TL6O
500547 -         ..
500548 -    5.  This morning, Catherine at the UCSF Infusion Clinic called and
500549 -        said CA 15-3 for the test last week on 070301 has dropped to
500550 -        36. ref SDS 0 U85L, ref DIT 2 OI7I
500551 -
500553 -         ..
500554 -        Emotional Roller Coaster Diagnostics IBC Treatment Results
500555 -
500556 -        Follow up ref SDS 13 Y642, ref SDS 8 Y642.
500557 -
500558 -    6.  I don't know until I get your letter what the previous tests at
500559 -        Kaiser were, but this is 20 - 30 points less than before.  I'm
500560 -        still a little confused, because Catherine said they evaluate
500561 -        31 as the target, and Kaiser uses 39.  In either case 36
500562 -        suggests I'm getting better.  There was a similar mixup with my
500563 -        INR.  When they told me in the meeting last week that INR was
500564 -        2.5, I was in heaven, until I learned later that UCSF uses a
500565 -        normal range of .9 - 1.2, so 2.5 was more than double the
500566 -        target.  Later, Brigid said that INR for my Coumadin treatments
500567 -        should be between 2 - 3, so I felt better again.  Talk about a
500568 -        roller coaster. ref DIT 2 OI7N
500569 -
500570 -            [On 070309 Arlette advised that email for coordination of
500571 -            work on Kaiser's referral to UCSF should go to the primary
500572 -            care physician, which does not support efficient common
500573 -            distribution, rather than through Arlette, ref SDS 20 VP73,
500574 -            which provides both efficient distribution, and a backup
500575 -            for reminding the doctor of critical action items,
500576 -            illustrated on 070307. ref SDS 19 9Z9N
500578 -             ..
500579 -            [On 070315 UCSF asks how Millie is coping emotionally with
500580 -            major changes in assessment of treatment on the cetuximab
500581 -            clinical study. ref SDS 23 6A7J
500582 -
500583 -
500585 -  ..
5006 -
5007 -
5008 - 1232
5009 -
500901 - Kaiser Membership Number Requested for Communications Transactions
500902 -
500903 - Millie received ref DRT 2 0001 from Arlette saying...
500904 -
500905 -        It would be most helpful if you would include your medical
500906 -        record# and the fax # of Dr.  Rugo when you want me to fax
500907 -        things. ref DRT 2 0001
500909 -  ..
500910 - Actually, there is nothing Kaiser should fax to UCSF.  Kaiser should
500911 - schedule a CT test, and submit CA 15-3 test results via email, which
500912 - Millie can capture for the record, and then make distribution to the
500913 - team at UCSF.
500914 -
500916 -  ..
500917 - Kaiser Submitted Summary CA 15-3 Test Results to UCSF
500918 -
500919 - Millie received ref DRT 3 0001 another letter from Arlette saying...
500921 -  ..
500922 - This and Arlette's earlier letters, ref SDS 0 SM4H, impart anger and
500923 - aversion to patient coordination of communications with UCSF...
500924 -
500925 -        I don't need you to send me anything.  You said Jackie wanted
500926 -        to send me reports, info from Dr.  Rugo, whatever.  You said
500927 -        they could fax it to us or you could bring it by and I said
500928 -        it's fine to just fax any thing you want us to have.  Glad to
500929 -        hear about the plummeting CA15-3.  I sent a summary of your CA
500930 -        15-3's from 1-1-06 till now to Dr. Rugo this am.
500931 -
500932 -            [...below Millie requests CA 15-3 results for tests on
500933 -            070208 and 070215. ref SDS 0 CN4R
500935 -  ..
500936 - Seems to be more confusion on the direction of submissions, similar to
500937 - Kaiser's initial letter today, per above. ref SDS 0 HS8G  A letter to
500938 - Kaiser on 070302 described a radiology request form, which UCSF
500939 - declined to fax to Kaiser, and instead asked Millie to transmit.
500940 - ref SDS 15 EZ6T  There was also a blood test with INR results that was
500941 - also considered for sending with fax last week. ref SDS 15 K14H  Since
500942 - that time these matters were resolved.
500943 -
500945 -  ..
500946 - Communication Collaboration Productivity Email Practices
500947 -
500948 - Additional issues from Kaiser's first letter, per above. ref SDS 0
500949 - D84H
500950 -
500951 -            1.  Arlette comments on favorable CA 15-3 reported in
500952 -                Millie's letter this morning, ref SDS 0 045V; so this
500953 -                paragraph commingles references to different documents
500954 -                a week apart, and provides no identification for
500955 -                timely, accurate orientation of context. ref SDS 0 W66O
500957 -                 ..
500958 -            2.  Kaiser sends CA 15-3 diagnostics to UCSF, and fails to
500959 -                copy the customer (patient), to close the loop on the
500960 -                action item, and provide command and control of the
500961 -                record for effective organizational memory. ref SDS 0
500962 -                W66O
500964 -                 ..
500965 -            3.  Kaiser performs only half of pending action items;
500966 -                there is no follow up on ordering the CT test, also
500967 -                requested in several letters today, per above.
500968 -                ref SDS 0 044V
500969 -
500970 -
500971 -
500973 -  ..
5010 -
5011 -
5012 - 1257
5013 -
501301 - Millie submitted ref DIT 3 0001 responding to Arlette's letter, per
501302 - above. ref SDS 0 SM4H
501303 -
501304 -    1.  Thanks very much for coordinating with Doctor Rugo on patient
501305 -        history for CA 15-3. [cited in Arlette's 2nd letter this
501306 -        afternoon, per above. ref SDS 0 W66O, ref DIT 3 0001
501308 -         ..
501309 -    2.  My Kaiser ********* [requested in Arlette's 1st letter this
501310 -        afternoon, per above. ref SDS 0 SM4H, ref DIT 3 DL5J
501312 -         ..
501313 -    3.  I don't have a fax number for Doctor Rugo, but will ask for one
501314 -        tomorrow. [also requested in Arlette's 1st letter this
501315 -        afternoon, per above, ref SDS 0 SM4H].  Her email address is:
501316 -        ***********************, ref DIT 3 EI5L
501318 -         ..
501319 -    4.  What were results on CA 15-3 for tests on 070208 and the
501320 -        following week on 070215 [which Arlette submitted to UCSF
501321 -        today, per above, ref SDS 0 W66O]  Just wondering about the
501322 -        rate of change compared with the recent UCSF report of 36.
501323 -        ref DIT 3 EI6G
501325 -         ..
501326 -    5.  Can you check to see if [the doctor] ordered the CT test needed
501327 -        by the end of the month?  He asked on 070202, ref SDS 8 T85K,
501328 -        for early notice so he can specify including follow up on my PE
501329 -        status.  Would like to report tomorrow that the test is
501330 -        ordered, and the date, if one has been set.  Please let me
501331 -        know. ref DIT 3 EI6M
501333 -  ..
501334 - Millie requests status again on ordering a spiral CT test needed for
501335 - end of month meeting at UCSF, per prior requests. ref SDS 0 044V
501337 -  ..
501338 - Millie's letter to Kaiser concludes...
501339 -
501340 -    6.  I'm sorry about being confused earlier. ref SDS 0 4W4I  The
501341 -        only thing I can think of about sending stuff to Kaiser is a
501342 -        form Brigid filled out last week to request the CT test before
501343 -        070328.  Apparently, for some reason they didn't want to fax
501344 -        it, and gave it to me for delivery.  I can stop it by Kaiser
501345 -        tomorrow on the way home from treatment.  If you're there I'll
501346 -        say hi. ref DIT 3 00W2
501348 -  ..
501349 - Millie makes amends for evident anger at Kaiser about perceived
501350 - improper handling of coordination transactions today, and the past
501351 - week. ref SDS 0 W66O
501352 -
501353 -
501355 -  ..
5014 -
5015 -
5016 - 1632
5017 -
501701 - CT Test Not Ordered Doctor Reminded CA 15-3 Tests for Feb Received
501702 - Kaiser Submits CA 15-3 Tests for February CT Test Not Yet Ordered
501703 -
501704 - Millie received ref DRT 4 0001 from Arlette saying...
501705 -
501706 -    1.  Your CA 15-3 was 55 on 2/8/07 and 52 on 2/15/07. ref DRT 4 0001
501708 -         ..
501709 -    2.  He had not ordered the CT, so I reminded him! ref DRT 4 WD5M
501711 -  ..
501712 - Arlette refers to performing plans for ordering a thin slice spiral CT
501713 - scan to test for pulmonary embolism and enlarged right ventricle, per
501714 - Millie's letter earlier today. ref SDS 0 CN4W
501715 -
501716 -            [On 070309 Kaiser scheduled test for 070328 0845.
501717 -            ref SDS 20 VP5N
501719 -             ..
501720 -            [On 070314 Kaiser changed the schedule for the test to
501721 -            070326 at 2000, providing time for preparing analyst's
501722 -            report, and distribution in time to prepare for meeting at
501723 -            UCSF on 070329. ref SDS 21 VP5N
501725 -             ..
501726 -            [On 070329 CT test report did not include comparisons with
501727 -            prior findings of pulmonary embolism and enlarged right
501728 -            ventricle, ref SDS 25 0136, and reported no findings to
501729 -            update the prior test report. ref SDS 25 B74K
501731 -             ..
501732 -            [On 070330 primary care physician notes that Kaiser did not
501733 -            perform spiral CT test to compare progression of disease
501734 -            for pulmonary embolims and enlarged right ventricle (Cor
501735 -            Pulmonale heart disorder). ref SDS 27 0136
501736 -
501737 -
501739 -  ..
501740 - Case Study Obtaining CA 15-3 Cancer Marker Test Diagnostics
501741 -
501742 - Kaiser submits patient status data on CA 15-3 test results requested
501743 - continuously beginning on 070228,...
501744 -
501745 -        1.  070228  CA 15-3 needed by UCSF............ ref SDS 12 ED5H
501746 -        2.  070302  CA 15-3 needed by UCSF............ ref SDS 15 EY5W
501747 -        3.  070306  CA 15-3 needed by UCSF............ ref SDS 18 MI7J
501748 -        4.  070307  CA 15-3 needed by UCSF............ ref SDS 0 3X4J
501749 -        5.  070307  CA 15-3 needed by UCSF............ ref SDS 0 045Q
501750 -        6.  070307  CA 15-3 needed by UCSF............ ref SDS 0 CN4R
501752 -  ..
501753 - This study and the next one on ordering a CT test, ref SDS 0 G56L,
501754 - align with frustrations reported by UCSF staff on 070123 coordinating
501755 - referral authorization. ref SDS 6 MW4H  Complex communications listed
501756 - here reflect the larger study presented in the record on 070130 for
501757 - meeting with Doctor Rugo. ref SDS 7 4T5N  The doctor alluded to stress
501758 - and emotional tensions from coordination issued at that time.
501759 - ref SDS 7 LC60
501760 -
501761 -            [On 070309 Arlette advised that email for coordination of
501762 -            work on Kaiser's referral to UCSF should go to the primary
501763 -            care physician, which does not support efficient common
501764 -            distribution, rather than through Arlette, ref SDS 20 VP73,
501765 -            which provides both efficient distribution, and a backup
501766 -            for reminding the doctor of critical action items,
501767 -            illustrated on 070307. ref SDS 19 9Z9N
501769 -             ..
501770 -            [On 070315 UCSF asks how Millie is coping emotionally with
501771 -            major changes in assessment of treatment on the cetuximab
501772 -            clinical study. ref SDS 23 6A7J
501774 -             ..
501775 -            [On 070329 coordination failed, side effects were not
501776 -            reviewed to prepare for discussion with the patient during
501777 -            a meeting at UCSF. ref SDS 25 945F
501779 -             ..
501780 -            [On 070329 UCSF objects to timely distribution of patient
501781 -            history for being prepared to make meetings productive with
501782 -            comprehensive review of side effects on cetuximab clinical
501783 -            study. ref SDS 25 W25L
501784 -
501785 -
501787 -  ..
501788 - Case Study Ordering CT Test for Clinical Study and Evaluate PE
501789 -
501790 - Notice from Arlette today that a CT test was not ordered, and that the
501791 - doctor was reminded, ref SDS 0 X54Q, provides feedback that a critical
501792 - diagnostic for managing patient care has been expedited.  This
501793 - empowers stakeholders (customer and UCSF consultant) to follow up with
501794 - knowledge of critical connections, and has been requested
501795 - continuously since 070202....
501796 -
501797 -        1.  070202 CT order doctor req notice......... ref SDS 8 T85K
501798 -        2.  070204 CT order coordinate UCSF........... ref SDS 9 4L5Q
501799 -        3.  070208 CT order UCSF plans to notify...... ref SDS 10 PR5L
501800 -        4.  070301 CT order UCSF rqsts OB 070328...... ref SDS 13 UR9J
501801 -        5.  070302 CT order coordinate Kaiser......... ref SDS 15 EZ6T
501802 -        6.  070306 CT order coordinate Kaiser......... ref SDS 18 HS3X
501803 -        7.  070307 CT order coordinate Kaiser......... ref SDS 0 K69R
501804 -        8.  070307 CT order coordinate Kaiser......... ref SDS 0 044V
501805 -        9.  070307 CT order coordinate Kaiser......... ref SDS 0 CN4W
501806 -       10.  070309 CT test ordered wrong date......... ref SDS 20 VP5N
501807 -       11.  070314 CT test schedule corrected......... ref SDS 21 VP5N
501808 -       12.  070314 CT test schedule UCSF notify....... ref SDS 21 DT4I
501809 -       13.  070314 CT coordination stressful.......... ref SDS 23 OR5K
501810 -       14.  070326 CT test failed to perform scope.... ref SDS 24 SK8L
501811 -       15.  070329 CT fails to report on PE ERV....... ref SDS 25 0136
501812 -       16.  070329 CT coordination complex hard work.. ref SDS 25 S63K
501813 -       17.  070329 CT coordination stressful.......... ref SDS 25 II7H
501814 -       18.  070330 CT comparison failure to perform... ref SDS 27 0136
501815 -       19.  070330 CT doctor's order ignored.......... ref SDS 27 B74K
501816 -       20.  070510 CT UCSF coordinated to schedule.... ref SDS 29 519N
501817 -       21.  070510 CT schedule incorrect.............. ref SDS 29 V36R
501818 -       22.  070510 CT correcting mistakes stressful... ref SDS 29 V36O
501819 -       23.  070510 CT scope incorrect................. ref SDS 29 VP4H
501820 -       24.  070510 CT correcting mistakes stressful... ref SDS 29 TK8H
501821 -
501822 -               [On 070610 primary care physician advises channels of
501823 -               communication now established with UCSF for referral
501824 -               case management. ref SDS 35 GV9G
501825 -
501826 -
501828 -  ..
5019 -
5020 -
5021 - 1635
5022 -
502201 - Millie submitted ref DIT 1 0001 thanking Arlette for following up and
502202 - coordinating the work.  Sent a copy to Jackie at UCSF so she gets
502203 - notified about status on CA 15-3 data, and ordering the CT test.
502204 -
502205 -    1.  Thanks for data on CA 15-3 in your letter today. ref SDS 0 9Z9N
502206 -        These numbers make the report today of 36 present a consistent
502207 -        trend under the new treatment, ref SDS 0 U85L, and so will
502208 -        assist Doctor Rugo and her team in the meeting tomorrow.  I
502209 -        feel more comfortable that the numbers line up with visual
502210 -        evidence of IBC subsiding, and I am not just telling myself a
502211 -        "big story." [discussed on 070301. ref SDS 13 M68J, ref DIT 4
502212 -        0001
502214 -         ..
502215 -    2.  Thanks too for reminding the doctor to order the CT test.
502216 -        ref DIT 4 YL5N
502217 -
502218 -            [On 070309 Kaiser scheduled test for 070328 0845.
502219 -            ref SDS 20 VP5N
502220 -
502221 -            [On 070314 Kaiser changed the schedule for the test to
502222 -            070326 at 2000, providing time for preparing analyst's
502223 -            report, and distribution in time to prepare for meeting at
502224 -            UCSF on 070329. ref SDS 21 VP5N
502225 -
502226 -
502227 -
502228 -
502229 -
502230 -
5023 -

SUBJECTS
INR 2.5 UCSF Blood Test Patient Stable Middle Target Range No Change

6203 -
6204 - 1011
620501 -  ..
620502 - Conversation Expedites Email Not Enough Time Authenticate Accuracy
620503 - Email Not Enough Time Authenticate Accuracy Conversation Expedites
620504 - Feedback Critical Verify Accuracy Understanding Treatment Data
620505 - INR 2.5 Coagulation Control Clinic Familiar with UCSF Test Range
620506 -
620507 - Gloria called Millie to follow up the letter yesterday on 070306,
620508 - ref SDS 17 FJ9K, asking if Kaiser is satisfied with UCSF explanation
620509 - on 070305 of blood tests that show INR results are twice as high as
620510 - the normal range listed in the report. ref SDS 16 SN5O
620512 -  ..
620513 - Gloria apologized for not responding to Millie's letter on 070302,
620514 - ref SDS 15 K14H, and to the several letters on 070305, ref SDS 16 2C6L
620515 - Her schedule has been hectic with constant calls and work managing
620516 - coagulation issues for other patients.
620518 -  ..
620519 - Gloria explained there is only enough time to look through email once
620520 - a day, and sometimes not even that.  She sometimes reads email for
620521 - work at home, if she has time from family matters.  She feels that
620522 - when there is a lot going on, calling is more efficient for managing
620523 - complex details accurately rather than submit written instructions
620524 - through email.  There wasn't enough time today for reviewing patient
620525 - history showing Kaiser often submits written instructions to confirm
620526 - telephone calls on changing Coumadin treatment protocol and on
620527 - ordering blood tests to verify results, illustrated by Gloria's letter
620528 - on 070208. ref SDS 11 E99J
620530 -         ..
620531 -        [On 070309 Arlette advised that coordination of the work with
620532 -        email should go to the doctor, which does not support efficient
620533 -        common distribution, rather than through Arlette, ref SDS 20
620534 -        VP73, which provides both efficient distribution, and a backup
620535 -        for reminding the doctor of critical action items, illustrated
620536 -        on 070307. ref SDS 0 9Z9N
620538 -  ..
620539 - Gloria advised that she is familiar with blood test reports at the
620540 - UCSF laboratory, and so was comfortable last week with Millie's report
620541 - on 070302 that the test the day before on 070301 was INR 2.5.
620542 - ref SDS 15 K14H
620544 -  ..
620545 - Gloria explained that feedback is critical at Kaiser to reduce the
620546 - high cost of medical mistakes, reported on 990912. ref SDS 2 0960
620547 - Feedback verifies accurate communications; mere silence may mean
620548 - information was lost, forgotten, or applied incorrectly.  This aligns
620549 - with Kaiser's policy in the Healthwise Handbook calling for "ping
620550 - pong" communication practices, reviewed on 990625. ref SDS 1 3960
620551 - Kaiser routinely requests feedback from patients, cited in research
620552 - yesterday on 070306, ref SDS 17 JW4M  Reciprocity providing feedback
620553 - to the patient builds strong doctor/patient partnership, also,
620554 - presented by Kaiser procedures. ref SDS 1 4185
620555 -
620556 -        [On 070315 the next blood test on the clinical study will occur
620557 -        for starting the next cycle on 070329. ref SDS 23 159O
620559 -  ..
620560 - Gloria apologized again for not having enough time to provide feedback
620561 - responding to Millie's call and follow up letter last week on 070302,
620562 - ref SDS 15 K14H, and additional letter a few days ago on 070305 to
620563 - clarify interpretation of UCSF INR blood test criteria, ref SDS 16
620564 - 2C6L, and again yesterday, per above. ref SDS 0 UH4M  Gloria intended
620565 - to confirm that Millie should continue the same Coumadin treatment,
620566 - and that Kaiser's earlier request on 070302 for another blood test was
620567 - no longer necessary.  She feels patients and health care staff should
620568 - not incur extra time and expense for repetitive medical tests, but
620569 - there wasn't enough time until today, per above. ref SDS 0 UH5N
620571 -  ..
620572 - Limited time due to a hectic schedule prevents performing requirements
620573 - for good management was previously noted by at Kaiser on 990625.
620574 - ref SDS 1 1978
620576 -  ..
620577 - Gloria indicated today that since INR 2.5 has stabalized in blood
620578 - tests over the past month, and since this is in the middle of the
620579 - target range of 2.0 - 3.0, future testing and notice to Kaiser of
620580 - results for managing Coumadin treatment can be performed with the
620581 - blood tests on the 4-week cycle for the clinical study at UCSF to
620582 - treat Millie's breast cancer, and as planned in Millie's letter to
620583 - Kaiser on 070302. ref SDS 15 X84G
620584 -
620585 -        [On 070330 Millie notified Kaiser blood test results INR 2.4
620586 -        are stable for Coumadin to treat pulmonary embolism.
620587 -        ref SDS 26 5G9L
620588 -
620590 -  ..
620591 - Hard Work Coordination Referrals Data Entry Other Hospitals
620592 - Coordination Referrals Hard Work Data Entry Other Hospitals
620593 - Data Entry Other Hospitals Coordination Referrals Hard Work
620594 -
620595 - Gloria feels that working with blood tests from other hospitals makes
620596 - her work complex and difficult, because normally finding data in
620597 - Kaiser's computer is fast and easy for case management of Coumadin to
620598 - treat pulmonary embolism.  If she does not see a blood test report in
620599 - the computer, then she tells the patient to get a blood test.  Getting
620600 - a report from email does not fit well with these procedures, because
620601 - the data is not in the computer to backup up her work, and she only
620602 - checks email once a day or less.  This presents a coordination problem
620603 - to get the data and get it in the computer so everyone is "working on
620604 - the same page."  Gloria indicated again that conversation through
620605 - telephone calls is fast and easy.  She can type data accurately in
620606 - Kaiser's computer on blood tests rather, than get written reports with
620607 - email and use cut and paste to replicate data in Kaiser's computer,
620608 - per above. ref SDS 0 UH6L
620609 -
620610 -     [On 070426 Gloria submitted written notice that Kaiser received
620611 -     results of blood tests at UCSF and provided new instructions for
620612 -     Coumadin to treat pulmonary embolism. ref SDS 28 TL6L
620614 -  ..
620615 - Gloria explained that, if Millie calls and waits for Gloria to be
620616 - available for conversation about blood test results at UCSF this saves
620617 - Gloria a lot of time.  If Millie has to call back or if Gloria calls
620618 - back and Millie is not available, the patient still has responsibility
620619 - to convey the data to Kaiser.  If the patient forgets or doesn't have
620620 - time to call back, Kaiser can say they didn't get the data from the
620621 - patient.  That's fast and easy.  However, if Gloria gets an email, she
620622 - has responsibility to remember to allocate time for transferring data
620623 - to the Kaiser computer program.  Carrying out this responsibility to
620624 - remember to take action using Kaiser's computer system is not fast and
620625 - easy.  Worrying about forgetting to enter blood test results causes
620626 - stress and worry.  This makes working by conversation fast and easy,
620627 - because if there is a mistake it is easy to say the patient gave
620628 - Kaiser the wrong information, since there is no record of what was
620629 - submitted.
620631 -  ..
620632 - Millie thanked Gloria for taking time to call this morning.
620633 -
620634 -
620635 -
620636 -
620637 -
620638 -
620639 -
6207 -