CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 36 0000. ref SDS 33 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 100729 0510 at 1700 Millie died with her family and friends at her
040902 - bedside. ref SDS 17 EK4I
040904 - ..
040905 - On 100731 2221 memoriam celebrating and honoring Millie's life
040906 - submitted to family, friends, co-workers. ref SDS 20 RJ5H
040908 - ..
040909 - On 100807 1300 memorial services for Millie at Ron and Kim's in
040910 - Clayton, ref SDS 23 RJ5H, extending memoriam on ending Millie's time,
040911 - reported, 100731 2221, ref SDS 20 RJ5H
040913 - ..
040914 - On 100808 1217 Millie's children packing her clothing into black bags
040915 - for donating to Hospice. ref SDS 25 WB7O Found pearl earring in back
040916 - seat of car; could be one missing for some months. ref SDS 25 LH6L
040918 - ..
040919 - On 100808 1234 letter from Karen asking about services for Millie on
040920 - 100807 at Ron and Kim's and reporting the family in Colorado also held
040921 - services for Millie. ref SDS 26 Q67M
040923 - ..
040924 - On 100808 1839 letter to Pam reporting pearl earring found this
040925 - afternoon is now missing again; did the girls take it. ref SDS 27 WB7O
040927 - ..
040928 - On 100809 0811 letter to friends and family transmitting record of
040929 - memorial services for Millie on 100807. ref SDS 28 WB7O
040931 - ..
040932 - On 100809 1218 letter from Kim notifying that the kids plan to remove
040933 - Millie's belongings on 100822. ref SDS 29 WB7O
040935 - ..
040936 - On 100809 1321 letter from Ross appreciated memorial services for
040937 - Millie. ref SDS 30 WB7O
040939 - ..
040940 - Called Ross about visiting in a week or two. ref SDS 32 WB7O
040941 - Submitted confirming letter. ref SDS 32 JV6N
040943 - ..
040944 - Letter from Ross on visiting at the end of August. ref SDS 33 WB7O
040946 - ..
040947 - On 100829 0700 arrived at JFK in New York, ref SDS 37 WB7O, Ross and
040948 - Claudia got there about 0736; drove first to New York and went to
040949 - church at St Patrick's Cathedral. ref SDS 37 PQSV
040951 - ..
040952 - On 100911 0800 leave for JFK and flight home. Getting ticketed and
040953 - through security worked better on this return flight. ref SDS 0 WB7O
040954 - Good discussion with VA doctor interested in improving case
040955 - management. ref SDS 0 OL4H
040956 -
040957 -
040958 -
040960 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Leave for JKK, and arrive about 0910.
041308 - ..
041309 - Ross explained do not need e-ticket from UAL, just use the credit
041310 - card, and the system figures out the passenger has a ticket.
041312 - ..
041313 - UAL attendant, again helped use the computer to get the system to
041314 - produce a boarding pass, and to use the Wells Fargo debit card to pay
041315 - $25.00 for checking a bag, as occurred for the flight from SFO,
041316 - reported on 100828 1830. ref SDS 36 1O7U
041318 - ..
041319 - Got seat 17E, which is a middle seat. Asked to switch to an aisle or
041320 - window, and was put on a check list. This did not work out.
041321 -
041322 -
041324 - ..
0414 -
0415 -
0416 - 0933
0417 -
041701 - Arrive Gate 7 to wait for UAL flight xx to SFO.
041702 -
041703 - Easier finding a chair next to an electrical outlet. There is
041704 - actally a kiosk with outlets for folks to charge their cell phones,
041705 - which does not work for the computer, but there was a lounge chair
041706 - next to a wall outlet that worked well.
041707 -
041709 - ..
0418 -
0419 -
0420 - 1044
0421 -
042101 - Boarded plane, and wound up in middle seat. This is really too
042102 - cramped to work efficiently. The computer has to be stored under the
042103 - seat for take-off. Getting it out from under the seat, out of the
042104 - case, and putting the case back under the seat is difficult with very
042105 - limited quarters. Configuring the computer on the seat tray is also
042106 - too cramped for using the onboard keyboard, especially when the person
042107 - in front reclines their chair back.
042109 - ..
042110 - Reset computer to Pacific time zone.
042112 - ..
042113 - Was able to start this record, per above, ref SDS 0 WB7O, and did more
042114 - editing analyzing the letter from Anita on the issue of building a
042115 - Mosque at Ground Zero, reported on 100908 1909. ref SDS 38 SC92
042117 - ..
042118 - Because of difficulty using the computer, finally stowed it back under
042119 - the seat and just rested for most of the flight.
042120 -
042121 -
042123 - ..
0422 -
0423 -
0424 - 1227
0425 -
042501 - About 2/3rds through the flight, interesting discssion with Bob, a
042502 - neurologist at the VA Medical Center in Brooklyn New York. Wikipedia
042503 - explains neurology, reported below. ref SDS 0 SO3F
042505 - ..
042506 - [On 100925 1420 letter thanks Bob for chatting and requests
042507 - feedback on tools and methods discussed today. ref SDS 39
042508 - WB7O
042510 - ..
042511 - Initially, we noted looking out the window flying from 35K feet how
042512 - sparsly populated the country seems with few signs of life, despite
042513 - worries of overpopulation.
042515 - ..
042516 - On learning Bob is a doctor at the VA in Brooklyn, commended care the
042517 - past 5 years working with VA, and most recently heart surgery on
042518 - 091022. ref SDS 8 01F9 Cited the meeting with Doctor Tseng, who
042519 - ordered discharge on 091104. ref SDS 9 PR4V
042521 - ..
042522 - Bob seemed to indicate VA qality varies for each jurisdiction.
042524 - ..
042525 - Bob advised that the VA recently improved access to patient records
042526 - between jurisdictions. This helps resolve problems reported last year
042527 - getting records at the San Francisco Medical Center from the VA server
042528 - in Sacramento for work at the Clinic in Martinez, reported on 091119
042529 - 1000, ref SDS 13 938N, and further in the same record. ref SDS 13 9S5F
042530 -
042531 - [On 110429 1230 challenges persist getting medical records
042532 - in time to be effective for health care decisions.
042533 - ref SDS 40 NM9G
042535 - ..
042536 - [On 110727 1238 Melissa had difficulty using the VA
042537 - computer in the Martinez Primary Care Department to find
042538 - Doctor Egan's work plan in the Cardiology Department on
042539 - adding mercury to the lab. ref SDS 41 A25H
042541 - ..
042542 - Later on 091208, Doctor Tabrizi in the Surgery Department explained
042543 - that even though computer access is fast and easy, finding patient
042544 - history relevant to immediate needs can be very difficult, because it
042545 - takes time to wade through VA records. ref SDS 14 QB7H Instead of
042546 - investing time to rely on patient history in the VA record, providers
042547 - ask the same questions and re-enter the same redundant information
042548 - over and over again, with inevitable variance between the patient
042549 - telling the story, and practitioners interpreting and writing things
042550 - down over and over again. Variance in the story for the same event
042551 - mutates understanding into a contagion of confusion and conflict.
042552 - Errors accelerate like cancer growing out of control, as everyone is
042553 - overwhelmed by information overload that costs lives, time, and money.
042555 - ..
042556 - Compound redundancy encourages doctors to ignore the record creates a
042557 - Knowledge Management loop that collapses productivity and vitiates
042558 - care. This is illustrated by case study reported for the meeting with
042559 - the Cardiothoracic team on 091021. It shows the same complex patient
042560 - history was requested and entered 14 times, because the VA cannot cite
042561 - the record for consistent reporting, that is fast and easy to perform
042562 - case management. ref SDS 7 FB5N
042564 - ..
042565 - Bob was familiar with these problems and others, also cited in a
042566 - recent paper delivered at the System Sciences (HICSS), held in
042567 - January, 2010 43rd Hawaii International Conference, reported in the
042568 - record on 100709 1130. ref SDS 15 W45P
042570 - ..
042571 - Challenges writing medical reports, and getting doctors to read and
042572 - incorporate, for example 2nd opinions, into treatent plans, was cited
042573 - a few weeks ago on 100827 2047. ref SDS 35 V84R This is an even
042574 - bigger problem for test reports, cited in case study on 060428.
042575 - ref SDS 2 VG5L
042577 - ..
042578 - Discussed improving care with greater reliance on doctor patient
042579 - partnership, commonly called out by health care professionals, e.g.,
042580 - Kaiser's Healthwise Handbook, reviewed on 990625 0945. ref SDS 1 4185
042582 - ..
042583 - Bob feels not all patients can write useful records to help doctors
042584 - provide effective care. He further noted that medical training does
042585 - not prepare doctors to write notes of patient care that are effective
042586 - for improving outcomes.
042588 - ..
042589 - This presents an evolving skill issue resolved by experience. More
042590 - people writing a greater share of the record on daily work increases
042591 - the quality of care. Synergy between writing the record and providing
042592 - care grows experience that improves quality of both. Limited time
042593 - makes writing cursory and erroneous, reflecting stress and gaps in
042594 - memory. SDS technology helps solve the problem.
042596 - ..
042597 - Fortunately, not all patients and doctors need to write useful records
042598 - in order for care to be improved by those who do. As Bob notes today,
042599 - quality of care varies between VA facilities. ref SDS 0 LT9M Even
042600 - with variable performance a "rising tide lifts all boats."
042602 - ..
042603 - Discussed the role of computers to increase the power of editing by
042604 - orders of magnitude. Facile editing explained in POIMS, ref OF 9
042605 - 6M5H, enables people to refine and sharpen understanding essential for
042606 - quality health care, under the rubric of "thinking through writing,"
042607 - explained in POIMS. ref OF 1 2141
042609 - ..
042610 - Bob related physician practice writing notes based on first
042611 - impressions, and not investing time for editing, common to most busy
042612 - executives and professional people.
042614 - ..
042615 - Bob noted that SDS is not designed for managing health care, per se,
042616 - but provides a general improvement for literacy to increase accuracy
042617 - of communication in all professional work. In simplest terms, SDS
042618 - leverages the power of alphabet technology, explained in POIMS,
042619 - ref OF 6 ER3G, by adding dimensions of chronology and context to
042620 - organize traditional narrtive in a well ordered record that "connects
042621 - the dots" of causation, commonly called "intelligence," also explained
042622 - in NWO. ref OF 16 CO5U
042624 - ..
042625 - Bob observed work with SDS during the flight entering notes in this
042626 - diary record, per above, ref SDS 0 RQ7M, and using SDS tools to edit
042627 - the writing, add links to verify accuracy, and "connect the dots" for
042628 - understanding cause and effect.
042630 - ..
042631 - He feels "Schedule Diary System" is not effective marketing because
042632 - "SDS" was an acronym for a student activist group in the mid-60s, and
042633 - so creates negative associations that repell mainstream customers.
042634 - Bob seems to be in his 60s, and so remembers Students for Democratic
042635 - Society - SDS.
042636 -
042637 - http://en.wikipedia.org/wiki/Students_for_a_Democratic_Society
042639 - ..
042640 - Today, we did not discuss viability of POIMS - Personal Organizational
042641 - Integrated Management and Memory, i.e., 2-"MS", ref OF 6 0001, which
042642 - drives technology design for SDS.
042644 - ..
042645 - Bob explained his practice for writing good progress notes applies
042646 - methods common to the structure of writing for legal work that frames
042647 - issues and actions. He said the health care process entails...
042648 -
042649 - diagnosis <----------------\
042650 - prescription |
042651 - treatment -------------------/
042653 - ..
042654 - SDS facilitates using good management practices routinely using a
042655 - general form based on time and context using line numbers, similar to
042656 - legal briefing, that maintain a well ordered record, explained in
042657 - POIMS. ref OF 9 6649, as....
042658 -
042659 - plan <---------------------\
042660 - perform |
042661 - report ----------------------/
042663 - ..
042664 - "Good management" requires applying technology to aid innate mental
042665 - biology, thus "augmenting intelligence", also explained in POIMS.
042666 - ref OF 6 1X6G
042668 - ..
042669 - Examples using "good management" aided by SDS tools to strengthen
042670 - health care, are seen...
042671 -
042672 - 1. Agenda submitted for meeting
042673 - doctor................................. 091112 0752, ref SDS 10 IL8L
042674 -
042675 - Above the record for the agenda
042676 - is a summary of relevant
042677 - background............................. 091112 0752, ref SDS 10 WV5I
042679 - ..
042680 - 2. Meeting with doctor at Kaiser applies
042681 - agenda to plan changing treatment
042682 - due to progression
042683 - of cancer.............................. 091112 0930, ref SDS 11 UT7M
042685 - ..
042686 - Bob plans to investigate application of SDS to health care in....
042687 -
042688 - http://www.welchco.com
042690 - ..
042691 - "Sorry, sorry..." rush, rush, hectic schedule -- everyday causes
042692 - bumbling due to failed "memory" that plagues everyone in a world of
042693 - expanding complexity illustrated by medical scenario in NWO.
042694 - ref OF 18 VP7L The only solution is technology that leverages innate
042695 - mental biology for better "command and control of the record,"
042696 - explained in POIMS. ref OF 1 1113
042698 - ..
042699 - The VA leads in performance, and has become a powerful voice for
042700 - giving decision-makers better "command and control" of "data" in
042701 - health care records, see VA publication received on 091113 1017.
042702 - ref SDS 12 PR5H Evidence-based medicine is the latest mantra for
042703 - relying on the record rather than guess and gossip, hunch and hope.
042704 - Review last year on 100725, shows authorities call for computer
042705 - technology to handle complex medical records, yet this is largely an
042706 - unmet goal. ref SDS 6 MP8O VA as well recognizes more can be done to
042707 - improve case management for better patient outcomes, noted in recent
042708 - published study, reported on 100709 1130. ref SDS 15 W45P
042710 - ..
042711 - SDS adds "command and control" of narrative that "makes sense" of data
042712 - by transforming "information" into the power of knowledge that
042713 - controls the future under the "locality principle," explained in NWO.
042714 - ref OF 15 I38N
042716 - ..
042717 - Reporting on 100709, further indicates VA is beginning to recognize
042718 - that "making sense" of narrative is the key to making case management
042719 - effective for saving lives, time, and money. ref SDS 15 XG38
042721 - ..
042722 - More simply, technology is only part of the solution.
042724 - ..
042725 - Better care requires transformation from "information" to a "culture
042726 - of knowledge" that adds a work role for "intelligence support" to
042727 - "connect the dots" so people are not overwhelmed by information
042728 - overload. Health care is moving in this direction with physician
042729 - assistants and patient assistants. Analysts writing reports on
042730 - radiology and pathology tests underscore the importance of a role to
042731 - aid the doctor in "making sense" of mere "data." Life and death that
042732 - permeate health care decisions encourage transition to work faster,
042733 - better, and cheaper.
042735 - ..
042736 - Neuroology that focuses on brain function and memory, might be a
042737 - strategic partner to aid this transformation in health care, so that
042738 - others benefit from improved outcomes reported for Millie at Kaiser on
042739 - 090325. ref SDS 5 P39M
042741 - ..
042742 - Research in Wikipedia indicates neurology treats mental function...
042743 -
042744 - http://en.wikipedia.org/wiki/Neurology
042746 - ..
042747 - Medical speciality for the nervous system.
042749 - ..
042750 - UCSF Medical Center
042751 -
042752 - http://www.ucsfhealth.org/adult/medical_services/neuro/
042754 - ..
042755 - UCSF Medical Center is one of the top hospitals in the nation
042756 - in neurology and neurosurgery... in Northern California, we
042757 - have the only comprehensive memory disorders center... Our
042758 - neurologists and neurosurgeons take a team approach...
042760 - ..
042761 - Cedars-Sinai
042763 - ..
042764 - Memory Disorders
042765 -
042766 - http://www.cedars-sinai.edu/Patients/Programs-and-Services/Neurology/Conditions/Memory-Disorders.aspx
042768 - ..
042769 - Adults of all ages occasionally forget where they put their
042770 - keys or glasses, where they parked their car or the name of an
042771 - acquaintance. Older adults may take longer to retrieve
042772 - memories. Although not universal, memory changes are a normal
042773 - part of aging and often are more annoying than serious.
042775 - ..
042776 - Memory loss that begins suddenly or that significantly
042777 - interferes with daily life is more than ordinary forgetfulness.
042778 - Examples are dementia and delirium - transient disorder of
042779 - cognition causing acute confusion.
042780 -
042781 -
042782 -
042783 -
042784 -
042785 -
042786 -
042787 -
0428 -