CONTACTS 
0201 - Kaiser Permanente - Shadelands       925 906 2200
020101 - Walnut Creek, CA
020102 - Dr. Syed E. Naqvi, M.D.; Physician
020103 - Primary Care =925 206 2040

SUBJECTS
Medical, Kaiser
Exam 990625 Knee, Physical, Prostrate Cancer
Exam 990628 Physical, Prostrate Cancer
Policy Procedures on Communication
Sel -evident Benefits iser Com Metrics Pretty Neat
Sel -evident Cost Savings ick Links Objectionable, Takes Time
Leadership Overcomes Resistance to Comm Metrics
Leadership Overcomes Resistance to New Methods to Avoid Future Danger
Bumbling Sunhine Profits Buy-off ice Mail
Message Centers Error Pronem, Awkward

2113 -
2113 -    ..
2114 - Summary/Objective
2115 -
211501 - Follow up ref SDS 54 0000, ref SDS 52 0000.
211502 -
211503 - Syed advised he wants patients to use the Message Center so the chart
211504 - can be updated.  Jeanne Bradley noticed that Syed has not addressed
211505 - pending issues.  She feels the Welch communication method works well
211506 - and that Kaiser's patient medical chart can be posted with notice of a
211507 - letter, as well as for a phone call.  Sylvia seems to be still
211508 - following up on my knee situation.  Jeanne will call Syed to ask him
211509 - about following up, as well.
211510 -
211511 -     [On 990808 Syed followed up. ref SDS 56 6781]
211512 -
211513 -     [On 991130 Jeanne submitted corrections. ref SDS 68 0899]
211514 -
211515 -
211516 -  ..
2116 -
2117 -
2118 - Progress
2119 -
211901 -  ..
211902 - Doctor Objects to Clicking on Links for Web Mail
211903 - Patient "Charts" Need to Manage Information from Patient
211904 -
211905 - Received ref DRT 1 from Doctor Syed Naqvi responding to my letter at
211906 - ref DIP 6 sent on 990731, ref SDS 54 0001, asking about progress on
211907 - Kaiser's review of knee treatments based on the letter, ref DIP 5, to
211908 - Sylvia on 990722. ref SDS 52 0001
211909 -
211910 - This letter is about communication processes, rather than patient
211911 - care, here knee treatment review.
211912 -
211913 - Syed wants email sent to him directly. ref DRT 1 4550
211914 -
211915 -     This may mean he cannot access links, the problem Sylvia had that
211916 -     we were trying to resolve with Erick on 990706. ref SDS 45 3135
211917 -     ..
211918 -     Or, it may mean he objects to clicking on links, as Morris
211919 -     expressed on 990712. ref SDS 47 5837
211920 -
211921 -     Below medical administration cites advantages of Welch Methods.
211922 -     using web mail. ref SDS 0 0406
211923 -
211924 -     [On 990813 Syed prefers conventional email and printed mail,
211925 -     rather than receive medical intelligence delivered via Internet.
211926 -     ref SDS 57 1254]
211927 -
211928 -     [On 990910 Doctor Craig Boulris objects to web mail without ever
211929 -     having seen it. ref SDS 61 9130]
211930 -
211931 - ..
211932 - Syed prefers to get information through Kaiser's message center
211933 - so communications become part of chart entries.   He says that Kaiser
211934 - is NOT set up to include electronic mesagges in patient charts and
211935 - that can create alot of problems. ref DRT 1 2058
211936 -
211937 - This reflects Doctor Sylvia Connolly's preference on 990625.
211938 - ref SDS 41 1846
211939 -
211940 -     [Below, correspondence from patient can be posted to patient
211941 -     charts. ref SDS 0 4620]
211942 -
211943 -     [On 991021 Doctor Ross Armstrong, Kaiser's Chief of Internal
211944 -     Medicine, reported that it is unusual for doctors to use email.
211945 -     ref SDS 67 6808]
211946 - ..
211947 - Our objective is to implement Kaiser's Healthwise Handbook
211948 - guidelines for doctor/patient care, reviewed on 990625. ref SDS 41
211949 - 0806
211950 -
211951 -     [On 990808 Syed had reviewed medical history. ref SDS 56 6781]
211952 -
211953 - Communication needs to be clear, concise and complete.
211954 -
211955 -     [On 990813 Syed prefers conventional mail. ref SDS 57 1254]
211956 -
211957 -     [On 990829 no record communication on transmitting medical history
211958 -     to Doctor Craig Boulris. ref SDS 58 7387
211959 -
211960 -     [On 990907 no record communication on transmitting medical history
211961 -     to Doctor Craig Boulris. ref SDS 59 1080]
211962 -
211963 -     [On 990910 communication failed on meeting with Doctor Craig
211964 -     Boulris. ref SDS 61 3038]
211965 -
211966 -
211967 -
211968 -  ..
211969 - Message Center is Voice Mail with Record of Call Posted to Chart
211970 -
2120 -
2121 -
2122 - 1436 called Jeanne
2123 -
212301 - Asked about what Syed might mean by "...getting information through
212302 - the message center," per above. ref SDS 0 4293
212303 -
212304 - Jeanne said the Message Center is also called the "Call Center."
212305 -
212306 - It works as follows...
212307 -
212308 -     People call a Kaiser Clinic, like Park Shadelands, and are
212309 -     connected to the Call Center.
212310 -     ..
212311 -     They talk to a representative, who jots down what seems to
212312 -     be important, and a record of the call is entered in the patient
212313 -     medical chart.
212314 -
212315 - Jeanne said these messages typically comprise a note to the doctor to
212316 - call the patient, and can include details on particular symptoms
212317 - which can be entered in Kaiser's computer data base system.
212318 - ..
212319 - Transcribing verbal expressions accurately is very difficult and
212320 - time consuming for everyone, the doctor, the voice mail clerk, and the
212321 - customer, the patient.  This presents liability issues which restrain
212322 - transcription, and invite duplication that wastes time.
212323 -
212324 - Even if voice mail could be accurately transcribed, there is no
212325 - alignment, nor links to relevant medical history.
212326 -
212327 -     [On 990924 Mark Mangrai advised that Patient Assistance suggests
212328 -     greater reliance on phone messages. ref SDS 65 2479]
212329 -
212330 -
212331 -  ..
212332 - Welch Method Improves Communications, Pretty Neat
212333 - Leadership Push, Pull, Prod, Wait, Try Again, Avoid Alienation
212334 -
212335 - While we talked, Jeanne said she opened the letter on the Internet
212336 - that I sent to Doctor Syed Naqvi. ref DIP 6 5841
212337 -
212338 - She read through and clicked on the link to Synvisc treatment for
212339 - knee arthritis.
212340 -
212341 - Jeanne said this information should be reviewed by Doctor Naqvi, as
212342 - the primary care physician.
212343 - ..
212344 - She said the letters I am sending are pretty neat, because
212345 - backup information is readily available by clicking on links.  Jeanne
212346 - said this saves a lot of time, storage space, and frustration dealing
212347 - with documents that get mixed up and misplaced, which is a big problem
212348 - in the business community due to information overload.
212349 -
212350 - Jeanne's appreciation of Com Metrics reflects comments on 981104,
212351 - ref SDS 32 4320, and supports idea on 990726 to use experience for
212352 - explaining Communication Metrics. ref SDS 53 7120
212353 -
212354 -     [On 990910 mistakes during medical exam. ref SDS 61 3038]
212355 -
212356 -     [On 990912 article published on High Cost of Medical Mistakes.
212357 -     ref SDS 62 0001]
212358 -
212359 -     [On 991130 received correction from Jeanne. ref SDS 68 5112]
212360 -
212361 -     [On 000116 Jeanne clarified that links are overwhelming.
212362 -     ref SDS 69 3128]
212363 - ..
212364 - On 940728 Doctor Kory Zipperstein in Kaiser's San Francisco
212365 - Dermatology Department commented on the benefit of Com Metrics for
212366 - improving medical practice. ref SDS 13 0001
212367 -
212368 -     [On 990907 Dave Vannier at Intel says web mail supports claims for
212369 -     Com Metrics of improved productivity. ref SDS 60 0149]
212370 -
212371 -     [On 990928 Mark Mangrai, Kaiser Patient Assistant, discovered that
212372 -     Com Metrics on the Internet is pretty neat. ref SDS 66 2501]
212373 - ..
212374 - Today, we considered a process for entering in the patient chart
212375 - a record of receiving information via email, that would be comparable
212376 - to the Call Center record Kaiser is now capturing.
212377 -
212378 - Jeanne feels this should work and it would improve the process.
212379 - ..
212380 - She said the Welch method is a very different from what they are
212381 - doing, but it is obviously helpful.  She was a bit frustrated by
212382 - resistance and the idea of reverting to the Call Center, proposed by
212383 - Syed, per above. ref SDS 0 4293
212384 -
212385 - I explained that we cannot push people too hard, too fast, without
212386 - risking alienation, reported on 920128. ref SDS 3 1199
212387 -
212388 - Critical ingredient is leadership, per 970703. ref SDS 24 9603
212389 -
212390 - Leadership gives people faith to experience new methods without fully
212391 - understanding how they work, as explained by Dr. Landauer on 960624.
212392 - ref SDS 20 1037
212393 -
212394 - We have to push, pull, prod, wait..., and try again to get people to
212395 - experience a better method, cited in POIMS, ref OF 3 8556, reviewed on
212396 - 990726. ref SDS 53 7120  Only experience working with a better method,
212397 - can overcome the desire to work in familiar ways on familar things, as
212398 - Andy Grove notes in his book "Only the Paranoid Survive," writing
212399 - about managing Intel, the giant computer company, reviewed on 980307.
212400 - ref SDS 29 2680
212401 -
212402 -  ..
212403 -     [On 990803 Palanza reviewed accountability. ref SDS 55 0306]
212404 -
212405 - Jeanne said I am a very smart man.... similar to USACE counsel saying
212406 - on 990303 that my memory is better than most. ref SDS 33 9499
212407 -
212408 - I demurred, noting I am not really very smart but, I have a lot of
212409 - "intelligence" backing me up. ref OF 3 0582  We are trying to help
212410 - other people use "intelligence," which at first seems funny and alien
212411 - to most people, as reported on 990713. ref SDS 49 1767
212412 -
212413 -     [On 990915 Jeanne supports Com Metrics. ref SDS 63 4988]
212414 -
212415 -     [On 990924 sent letter to reporter explaining cause and solution
212416 -     to avoid high cost of medical mistakes. ref SDS 64 0001]
212417 -
212418 -
212419 -
212420 -
2125 -

SUBJECTS
Examination Shows Problem on 990625
Exam 990625 Knee, Physical, Prostrate Cancer

2405 -
240501 -  ..
240502 - Knee Treatment Review Still Pending, Sylvia, Jeanne Following Up
240503 -
240504 - Jeanne noticed from Syed's letter that he does not report progress on
240505 - knee treatment review, ref DRT 1 4550, and does not indicate having
240506 - submitted information about Synvisc, which is one of the new knee
240507 - treatments to be considered by Kaiser's orthopedic review team, as set
240508 - out in my letter. ref DIP 6 5841
240509 -
240510 - She said she saw Doctor Connolly this morning.  Sylvia was upset
240511 - because the ortho people have not responded to her request for an
240512 - opinion on my situation.
240513 -
240514 -     [On 990808 Syed followed up. ref SDS 56 6781]
240515 -
240516 -     [On 990910 met with Craig Boulris in ortho dep. ref SDS 61 7388]
240517 -
240518 -     [On 990915 notified Sylvia that meeting with ortho occurred.
240519 -     ref SDS 63 0001]
240520 - ..
240521 - This sort of indicates that our communication efforts are
240522 - getting through in some manner, for a doctor to make this kind of
240523 - comment out of the blue to an admin manager.
240524 -
240525 - I explained my understanding that Syed is handling this now, per the
240526 - letter to Sylvia on 990722, ref DIP 5 0451, and to Syed on 990731...
240527 - ref DIP 6 5841
240528 -
240529 - Jeanne said that is right, but evidently Sylvia is also following up.
240530 -
240531 - Jeanne will call Syed and say that she noticed his letter does not
240532 - address the questions in my letter, and ask if he saw any of the
240533 - linked material?
240534 -
240535 - She will let me know the results.
240536 -
240537 -     [On 990808 Syed followed up. ref SDS 56 6781]
240538 -
240539 -
240540 -
240541 -
240542 -
2406 -
2407 -