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: October 17, 2008 00:21 AM Friday; Rod Welch

Letter from Doctor Rugo coordinates Millie starting new treatment.

1...Summary/Objective
2...Treo Poor Technology Comprehensive Management Impossible
3...Information Denisty Overwhelms Medical Professionals Using Poor Technology
4...Coordination Enables Comprehensive Care Doctor Patient Partnership
5...Comprehensive Care Enabled Doctor Patient Partnership Coordination
6...Partnership Coordination Communication Enables Comprehensive Care
7...Doctor Commends Patient Coordination Kaiser Comprehensive Care


..............
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CONTACTS 

SUBJECTS
Treo Handheld PDA Computer Technology Email High Mobility Small Scre
05 00805 CF 00022 BC 080403cc 081017cc       **Not Found**

2604 -
2604 -    ..
2605 - Summary/Objective
2606 -
260601 - Follow up ref SDS 20 0000, ref SDS 18 0000.
260602 -
260603 -
260604 -
260605 -
260607 -  ..
2607 -
2608 -
2609 - Progress
2610 -
261001 - Treo Poor Technology Comprehensive Management Impossible
261002 - Information Denisty Overwhelms Medical Professionals Using Poor Technology
261003 -
261004 - Follow up ref SDS 20 215I.
261005 -
261006 - Millie received a letter from Doctor Rugo with copies to the medical
261007 - team, and responding to Millie's letter yesterday (10 minutes ago)
261008 - asking for confirmation of work plan, ref SDS 20 J36R, to change
261009 - treatments. ref SDS 20 J38U
261010 -
261011 -    1.  Subject:  Work Plan Consider Change Treatment Sunitinib Clinical Study
261012 -        Date: Fri, 17 Oct 2008 00:09:38 -0700
261017 -         ..
261018 -    2.  Hi, I need a few short questions by email, as I just cannot
261019 -        read the really long emails and figure out what you need.  I
261020 -        receive over 500 a day, and this message cannot be easily read
261021 -        on a treo.
261022 -
261023 -            [On 081202 removed the doctor from distribution of letter
261024 -            to medical team for comprehensive case management; staff
261025 -            can brief the doctor in a manner that fits work practice
261026 -            that relies on limitations of Treo technology. ref SDS 29
261027 -            4P51
261029 -             ..
261030 -            [On 090514 0830 doctor cites hectic schedule with many
261031 -            patients who need emergency care; so, there is not enough
261032 -            time for comprehensive communication to avoid mistakes.
261033 -            ref SDS 32 LS6I
261035 -             ..
261036 -            [On 090529 1109 tried summarizing complexity of relevant
261037 -            patient history for Doctor Rugo, and submitting analysis
261038 -            for comprehensive care to the medical team. ref SDS 33 448K
261040 -  ..
261041 - Research shows "treo" is a small handheld computer for making
261042 - mistakes fast and easy...
261044 -         ..
261045 -        Palm computer products.
261047 -         ..
261048 -        Treo
261049 -
261050 -              http://www.palm.com/us/
261052 -         ..
261053 -        Phone, email, messaging, web, organizer, and digital camera --
261054 -        all in one.
261056 -         ..
261057 -        The Palm Treo combines a compact, full-featured mobile phone
261058 -        with email, including AOL, Gmail and Yahoo!, an organizer,
261059 -        messaging, and web access.  All within easy reach using the
261060 -        Treo finger-friendly QWERTY keyboard.
261062 -         ..
261063 -        Features include Bluetooth wireless technology for connecting
261064 -        wirelessly to other Bluetooth devices such as headsets and car
261065 -        kits, an MP3 player, a digital camera that captures video, and
261066 -        a vibrant color screen.
261068 -         ..
261069 -        Palm is among the trademarks or registered trademarks owned or
261070 -        licensed to Palm, Inc.
261072 -  ..
261073 - Knowledge Management dilemma using tools that seem fast and easy
261074 - compounds problems that don't fit ergonomics of 2" x 2.5" screen, and
261075 - a 2" x 1.5". keyboard  Work increases fixing mistakes from cursory
261076 - understanding that conflicts with requirements for investing time on
261077 - deliberation to meet objectives providing comprehensive service.
261078 - Comprehensive care requires understanding correlations, implications,
261079 - and nuance looking deeply into complex issues.
261080 -
261081 -            [On 081202 removed the doctor from distribution of letter
261082 -            to medical team for comprehensive case management; staff
261083 -            can brief the doctor in a manner that fits work practice
261084 -            that relies on limitations of Treo technology. ref SDS 29
261085 -            4P51
261087 -  ..
261088 - On 001207 Reuters reported earnings, stock prices, and the entire
261089 - economy fell into recession, because of declining productivity,
261090 - explained at that time by Reuters...
261091 -
261092 -            "There is a ripple effect, said one analyst.  Just too many
261093 -            people having too many problems." ref SDS 1 V54M
261095 -  ..
261096 - Two days ago, the stock market declined nearly 1,000 points, the
261097 - biggest drop in history.  Yesterday, the market increased nearly
261098 - 1,000, the biggest rise in history.  Today, the market has dropped
261099 - again.
261101 -  ..
261102 - If problems are too big for a small screen, then people should use
261103 - tools that support comprehensive treatment.
261104 -
261105 -            [On 081202 removed the doctor from distribution of letter
261106 -            to medical team for comprehensive case management; staff
261107 -            can brief the doctor in a manner that fits work practice
261108 -            that relies on limitations of Treo technology. ref SDS 29
261109 -            4P51
261110 -
261111 -
261112 -
2612 -

SUBJECTS
Meetings Results 081016 Examination UCSF Doctor Review Response Trea

5303 -
530401 -  ..
530402 - Coordination Enables Comprehensive Care Doctor Patient Partnership
530403 - Comprehensive Care Enabled Doctor Patient Partnership Coordination
530404 - Partnership Coordination Communication Enables Comprehensive Care
530405 - Doctor Commends Patient Coordination Kaiser Comprehensive Care
530406 -
530407 -
530408 - Doctor Rugo's letter continues...
530409 -
530410 -    3.  Thanks for your help with this.
530412 -  ..
530413 - The doctor responds to Millie's letter yesterday to the medical team
530414 - coordinating UCSF work plan on 081016, that requires implementation at
530415 - Kaiser in order for Millie to start treatment with the sunitinib
530416 - clinical study. ref SDS 20 J36R
530418 -  ..
530419 - The doctor previously requested assistance on 080403 coordinating case
530420 - management with Kaiser. ref SDS 14 4U9O
530421 -
530422 -            [On 090206 0747 Doctor Stritter credits Millie's medical
530423 -            team for controlling clinical, logistical and financial
530424 -            complexities caring for very aggressive cancer much longer
530425 -            than normally expected. ref SDS 30 7Q7J
530427 -             ..
530428 -            [On 090213 1140 primary care physician at Kaiser credits
530429 -            command and control of the record enables case management
530430 -            to extend Millie's longevity surviving cancer much longer
530431 -            than expected for disease trajectory. ref SDS 31 NY7L
530433 -  ..
530434 - Doctor Rugo's letter continues...
530435 -
530436 -    4.  The protocol cannot be sent out, will discuss with Pfizer, who
530437 -        help with funding and the cancer center.
530439 -  ..
530440 - Millie asked for the computer file on the study consent document, so
530441 - that this does not have to be typed up by hand in order to manage the
530442 - work. ref SDS 20 J39T
530443 -
530444 -            [On 081017 Millie invested 4 hours time for hiking to
530445 -            increase fitness and health to type of the sunitinib
530446 -            clinical study consent documents. ref SDS 21 4E8K
530448 -             ..
530449 -            [On 081031 Glenna proposed sending via email the signature
530450 -            page of the Consent document in a computer file.
530451 -            ref SDS 28 CC3O
530453 -  ..
530454 - Doctor Rugo's letter continues...
530455 -
530456 -    5.  It is not a study for triple negative alone.
530458 -  ..
530459 - The doctor does not say where in the study documents requirements for
530460 - triple negative status is specified, which was requested in the letter
530461 - yesterday on 081016. ref SDS 20 J44R
530462 -
530463 -            [On 081019 Millie sent a letter to Kaiser confirming
530464 -            understandings that the primary care physician is
530465 -            ordering the biopsy to test for cancer and status
530466 -            change requested by UCSF; hoping to get biopsy done OB
530467 -            081024. ref SDS 22 DZ5T
530469 -             ..
530470 -            [On 081022 Millie visits Kaiser Head and Neck
530471 -            Department; Kaiser expedites work schedules FNA biopsy
530472 -            on the neck in the afternoon at 1400; Millie submitted
530473 -            UCSF order for the FNA biopsy and request to check for
530474 -            status change. ref SDS 23 HD85
530476 -             ..
530477 -            [On 081023 FNA biopsy positive for breast cancer; need
530478 -            to do core biopsy because lab says FNA biopsy does not
530479 -            produce enough material to check for status change.
530480 -            ref SDS 24 W15N
530482 -             ..
530483 -            [On 081027 Kaiser delays core bipsy 3 times to 081117,
530484 -            providing more time to evaluate benefits justify risks to
530485 -            make core biopsy necessary. ref SDS 25 G15K
530487 -             ..
530488 -            [On 081029 letter to UCSF discusses doing FNA biopsy
530489 -            for status check at UCSF instead of core biopsy at
530490 -            Kaiser. ref SDS 26 C49U
530492 -             ..
530493 -            [On 081031 letter to UCSF with copy to Kaiser asks
530494 -            about doing FNA biopsy at UCSF. ref SDS 27 NN5S
530496 -             ..
530497 -            [On 081031 Glenna advised in a call that the sunitinib
530498 -            study does not require biopsy for status change.
530499 -            ref SDS 28 T27H
530501 -  ..
530502 - This suggests there may be consideration for evaluating status change
530503 - to expand treatment options, based on results of biopsy on the left
530504 - supraclavicular, considered in the record yeserday, 081016.
530505 - ref SDS 20 G88L
530506 -
530515 -
530516 -
530517 -
530518 -
530520 -  ..
5306 -
5307 -
5308 - 0033
5309 -
530901 - Millie submitted a response only to Doctor Rugo saying...
530902 -
530903 -    1.  Subject:  Work Plan Consider Change Treatment Sunitinib Clinical Study
530904 -        Date: Fri, 17 Oct 2008 00:36:14 -0700
530911 -         ..
530912 -    3.  I know that information density is a big problem.  I'm glad you
530913 -        have help.  Typically, the team takes care of most
530914 -        communication.
530916 -         ..
530917 -        Changing treatment is a major deal.  I wanted you to be aware
530918 -        of what was drawn from the meeting today, specifically the work
530919 -        plan, and to correct any misunderstandings in the beginning so
530920 -        that everyone is on the same page.  Starting out in January
530921 -        last year there were problems that eventually got worked out
530922 -        but over many months and at great expense in time and emotion
530923 -        for everyone.
530925 -         ..
530926 -    4.  I didn't mention in the initial letter, but I'm worried about
530927 -        how the payment thing will sort out.  Hoping it will just go
530928 -        through, without raising the question of this being a new deal.
530930 -         ..
530931 -    5.  Sorry for adding to your burdens.  Most of the stuff in the
530932 -        work plan is for Doctor Johnson at Kaiser.  Of course, he is
530933 -        busy too.  If we are in agreement on the work plan, then staff
530934 -        can work the details.
530939 -         ..
530940 -    7.  PS... I'm feeling better now; thanks again for kind assistance
530941 -        today.
530943 -  ..
530944 - Millie noted in the letter to the medical team late yesterday that
530945 - Doctor Rugo was effective coping with trauma of transition to the new
530946 - treatment. ref SDS 20 J35X
530947 -
530948 -
530949 -
530950 -
530951 -
530952 -
530953 -
530954 -
530955 -
530956 -
5310 -