The Torkel Saga 2059: June 2016

20160604-SAT
Keith E Torkelson - MS

Introduces Dr. David M Dobos at Kaiser A Model Doctor On Call

1A-Need
Psychiatrists in Orange County California are sitting on a treasure trove of data. They have collected informal and formal material about the efficacies of medications in associated with client outcomes. The Health & Human Services (HHS) industry has been transitioning into the age for accountability and transparency. A need in context is that psychiatrists prove their practices using formative and summative quantitative assessment tools. I have never had a psychiatrist measure (other than a GAF) how “We” are progressing or measure the performance for their methods.

01B-Parent Post
This is the link for the parent post off of which this dovetails.

Dobos Parent Document Including Measurements

01C-20160414: Tables
As you saw in the Results Up Front (RUF) section in the parent document we provide tabular data. The data ranges from federally reported (CMS-Stars) to the Commercial-off-the-shelf (COTS) VITALs (online patient ratings) method and our own Beta Assessment Tools (MSG, 2016) for filling in gaps. This document addresses Dr. Dobos. Some of the sections may be generalized. We use Doctor BSL as our control. BSL is ciphered because we are at the present receiving services from him. We do not wish to taint our therapeutic relationship with premature disclosure at this time.

01D-20160510-TU: Results Up Front Method (RUFM)
Normally, if this were a referred or graded paper we would follow a typical format for science papers. Yet since it is designed to be shared via Blog we have decided to sustain our Results Up Front Method (RUFM). This tabular data is found in the parent post.

01E-Rating the Doctor On Call -Subjective from Lived Experience
A top administrator for the Orange County Health Care Agency (OCHCA) repeatedly indicates that Consumer Lived Experience is of value. Here we share more about a personal rather than population or professional approach. This is not science. None of the information here would be considered statistically significant. The sample sizes are too small. Yet it does have value as a launching point. We hope you find something of value on your journey to measurably (quantifiable) superior: Health, education, and welfare (HEW).

02-Statement of Intent
We are faced with shopping for a new psychiatrist (succession). The intent of this paper is through rigorous investigation we make an informed choice. We are also taking a look back at what made our good psychiatrist’s good we hope to secure a relationship with a great best yet psychiatrist. Doctor Dobos was one of our better if not he best psychiatrist we contracted with.

03-Subject - Dr. David M Dobos MD (Psychiatrist)
We will assert up front that we are slightly biased with regards to our partnership with Dr. Dobos. If someone asked prior to 2015 what we thought of Doctor Dobos: We would have relied that he is a nice guy and he helped us significantly.

04-Purpose(s)
On the population level we are hoping to pursued any psychiatrist that it is worth the extra work to start processing their data, share outcomes with the health community (accountability and transparency, and improve their digital presences PRN. Our standard for digital presence is Dr. Daniel Amen.

FYI > http://danielamenmd.com/ (Homepage)
We applied Amen’s materials for bibliotherapy with a moderate degree of success (improvement). I had three Kaiser psychiatrists serve me (1999-2005): None of them supported me with my bibliotherapy work. One weakness for the Amen approach was that he did not support the methods with psychometrics.

05A-Health Outcomes Survey (CMS-HOS)
Just as we were getting ready to post this introduction section we received our Centers for Medicare & Medicaid Services’ (CMS) Health Outcomes Survey (HOS). Being the company people we are MSG dropped everything and filled it out. The last HOS we were solicited to help with was around May of 2014. At that time as an adjunct to the form we requested our results. In just over two (2) years our results have never been returned to us. Before submitting this years (2016) survey we have asked the appropriate body, the National Committee for Quality Assurance (NCQA), for our 2014 results.

05B-National Committee for Quality Assurance (NCQA)
They indicated that our 2014 results would be emailed to us. So as not to get held up with this report we further developed (begun in 2015) our scoring algorithms for the HOS (Algorithm-HOS-2014 & Algorithm-HIS-2016). The HOS is a very difficult assessment to score. In 2015 we stopped for two (2) reasons: 1) Too complex and 2) We believed that after not being assessed in 2015 we would not be asked again. We have been asked to update and submit a HOS once more. We touched up our 2014 algorithm and arrived at a result for 2014. For the 2016 we applied a more accurate scoring algorithm (Algorithm-HOS-2016). The following are results including retroactive results for 1985 & 2012. When we do get our professionally scored 2014 HOS result, it will be nice to compare how we did.

Assess_CMS_HOS_16052501_Results


Timestamp	Assessment Scoring	Result % (Items)	Note


20160530-M	1985 Retroactive by MSG	HSV = 95.9 (60)	Alg_HOS_2016
20160530-M	2012 Retroactive by MSG	HSV = 44.5 (60)	Alg_HOS_2016

20140515	2014 by MSG	HSV = 60.2 (61)	Alg_HOS_2014
	2014 by TMG via SPH		Referred to NCQA
20160526-TH	2014 via SPH by NCQA
	2014 via TMG		Result(s) Never Came

20151111	2015 on Own by MSG	HSV = 58.5 (60)	Alg_HOS_2014
20160101	2015 Skipped by NCQA

20160531-TU	2016 by MSG	HSV = 52.8 (64)	Alg_HOS_2016
20160602-TH	2016 by SPH		Mailed
	2016 via NCQA

Table as of June 1, 2016 – Health Status Value (HSV) – For Author
Health Status Value - Table Key

20160529-SUN: More Acronyms

-
AcroCode	Description
-
HEDIS	The Healthcare Effectiveness Data and Information Set
CAHPS	Consumer Assessment of Health Plan Study
HOS	Health Outcomes Survey
HSV	Health Status Value
TMG	The Myers Group
NCQA	National Committee for Quality Assurance
CMS	Centers for Medicare & Medicaid Services
SPH	Symphony Performance Health
SPH-Analytics
TMG_HOSS	The Myers Group Health Outcomes Survey Support
SR	Star Ratings

Table of Acronyms (AcroCodes)

06-Some Redundancy
In the some odd fifty-five pages in the two posts centering on Doctor Dobos there is bound to be some redundancy.

07-Stop Here
For the most part if you are only interested in data this would be a good place to stop. What follows are discussions about elements we found of further interest and worthy of fleshing out more.

A-Z Section of 1-Z Section (There may be some slight faults with our ordering)

Accountability - Accountability & Transparency Progress Score (A&TPS)
Before 2008 we here at MSG (at the time TRC) had never heard accountability and transparency (A&T) were desirable or even possible processes about the medical specialty psychiatry. For as long as we can remember public school teachers were held accountable to deliver superior product. A psychiatrist once told us not to be personally accountable or transparent. Even though A&T processes have historical roots we did not come across them until we reviewed the promises for California’s Mental Health Services Act (MHSA). We here at MSG have drafted A&T assessment tools twice now. We found a Commercial-off-the-shelf (COTS) instrument to run tandem with our own A&T tool (MSG-Beta, 2016). Both COTS and MSG tools yield what we describe as the Accountability & Transparency Progress Score (A&TPS).

Accountability Research
MSG has been researching accountability about many Health and Human Services (HHS) specialties including psychiatry for nearly six years now. We have also been researching and in some cases filling gaps in Health & Human Services (HHS) assessments. There are COTS instruments for evaluating agencies such as non-profits yet there are few for evaluating individual providers (psychiatrists).

Agency - Kaiser & Dobos
Dr. Dobos is a Kaiser Permanente psychiatrist. For MSG in a side job we work about the Orange County Health Care Agency (OCHCA) Electronic Health Record (EHR.). In 2009 to get up to speed we evaluated the E.H.R. movement using Los Angeles County – Department of Mental Health (LAC-DMH) MHSA technology plan as our enterprise level county reference. In our out of MHSA scope we examined the Kaiser (Epic Systems) EHR. information available on the web. Last we looked a bit into the Veterans Administration (VA) EHR. Kaiser’s is often gifted with being described as a standard for excellence (S4E).

Agency - Kaiser Permanente & Strategic Partners Patient Outcomes Research To Advance Learning (PORTAL) Network – Phase I & II - PCORnet

http://www.pcornet.org/clinical-data-research-networks/cdrn5-kaiser-foundation-research-institute/
“Jul 20, 2015 - Research To ... Building on PORTAL's Virtual Data Warehouse,”

“Reference in this Web site to any specific commercial products, process, service, manufacturer, or company does not constitute its endorsement or recommendation by the Patient-Centered Outcomes Research Institute (PCORI). PCORI is not responsible for the contents of any "off-site" Web page referenced from this server.”

Agency – Examination – Measuring Psychiatry
Quick examination of the website above PCORnet and its’ association with Kaiser reminds me of how much work about physical care (including HEDIS) is in progress while very little on the expansion of HEDIS to address and better standardize measurements about psychiatry.

Anonymous Individual Identifiers (AIIs)
We use anonymous identifies (ciphers) to avoid tainting our current therapeutic relationships. For example we cipher any doctors that see or will see me in an outpatient setting. We have ciphered RPS because she might see on us on the psyche ward and RBB because he might be future psychiatrist (out-patient).

Assessments
We here at MSG were introduced to assessment in the public education environment. In 2009 were began formally studying assessment and measureable outcomes in the context of Health and Human Services (HHS). California’s Mental Health Services Act (MHSA) is built on several components: Community Services and Supports (CSS), Prevention and Early Intervention (PEI), Capital Facilities & Technological Needs (CF-TN), Workforce Education and Training (WET), General Systems Development (GSD), Innovations (INN), Etc. We here at MSG familiarized ourselves about all of them and decided to focus on cross cutting measures and what measuring outcomes improve. We always prefer a great Commercial-off-the-shelf (COTS) tool to writing our own. Measuring promises in the MHSA such as biopsychosocial Resilience it is not always immediately possible. Some variables such as Resilience do not have affordable or good fitting COTS assessment tools for meeting a specific purpose.

Assessment – Central
The three derived assessments applied for our parent post are - our:

Accountability & Transparency
Doctor On Call Assessment
Technology (Teckno) Driven Case Management Assessment

Assessment – Controls
Where possible we look for assessments to run parallel as controls for our derived assessments. We used VITALS for gathering objective doctor ratings. Incidentally in Orange County VITALs is underutilized when it comes to assessing psychiatrists. VITALS are really not going to come into their own until they gather one-hundred (100) or more comments per doctor. We use CMS Stars as a reference for the agency the doctor works or contracts for. Last we found a pretty good assessment for rating agency Accountability and Transparency (COTS-The Edmonton).

Assessment – Doctor On Call Assessment (MDOCA-Beta)
For Comparing Psychiatrists: We dedicate our Doctor On Call Assessment to June Elizabeth Stoutenburg-Torkelson (JET). JET was a small business owner serving doctors and managing their communications. We heard JET say thousands of times: Who is the Doctor On Call? An actual patient about a doctor they have seen may only apply our MDOCA. Because of this constraint the average consumer may only have a half dozen psychiatrists to test out. We have applied our MDOCA (Beta, 2016) ten (10) times to date. The more we use it the more it would appear we have a home run in development.

Asessment – Stars & Origin
[PDF] - The Medicare Advantage 5-Star Rating Program - (32 Pages)

https://www.soa.org/library/newsletters/health-watch-newsletter/2012/may/hsn-2012-iss69.pdf

Assessment – FYI – CMS Stars
Society of Actuaries - The Medicare Advantage 5-Star Rating
Program and Its Implications for Actuaries
By Gabriela Dieguez, Brad Piper, and Adrian Clark

“The introduction of a five-star quality rating system by the Affordable Care Act (ACA) will lead to important changes in the Medicare Advantage (MA) market. Starting in 2012, the Centers for Medicare and Medicaid Services (CMS) payments to MA organizations are linked to their quality ratings. The financial implications are substantial, and ignoring them is not a wise long-term strategy for any MA organization. Actuaries can help organizations understand and assess the financial implications and evaluate strategies to remain profitable.”

Assessments – Betas (MSG, 2016) - Themes
At this time we have no means to share and track the usages of our Beta Assessment Tools. We have three themes for assessment: We call our fifteen item or less “Screeners”, the intermediate (16-99 Item) “Fleshers”, and the one hundred or more item “Exhausters” instruments.

Assessments – Commercial-Of-The-Shelf (COTS)
COTS or Commercial-off-the-shelf tools range greatly in their quality. None of our control assessments should be considered as “Complete”. Complete assessments have to satisfy about twenty psychometric or sociometric requirements and specifications. We avoid trying to sell anything as complete because we would get bogged down on only five to ten assessments. There are people in the universities that have focused much if not all of their careers on completing one assessment.

Assessments – MSG
We are going to search our MSGBase for our first reference to MSG. The first file that we saved with MSG in the file name was on January 4, 2011. The major difference with our MSG approach is in orientation: Our prior methodology Tork Reconstruction Company (TRC) was Recovery based while MSG is Prevention based. MSG is our system to overwrite our prior Tork Reconstruction System (TRS). We wrote and informally tested about a dozen or so assessment tools as TRS. For the first time we share now what MSG means. MSG is the acronym for Mentalation (Mental Actions and Processes) Solutions Group (2011-2016). The principals for MSG are: LAK (The Kline Coalition-Realic), KET (Datic), and TheDAG (Lunic).

Assessments – On-line
For this paper we did not use any on-line assessments directly. We did steal the patients rating format from VITALs. For that we promote their website and service.

20160520-F: Vitals - Find a Doctor, Doctor Reviews & Ratings

http://www.vitals.com/

“Find, rate or check up on a doctor in the United States. Search by location, specialty or ailment.
‎Find Doctors by Specialty - ‎Location” Over a year ago after scoring our Dermatologist very favorably (4.5-5) we realized that we cannot score those we review because it would bias our objective standards such as VITALs.

Challenge Orientation – Model Partnership
One of the things that made Dr. Dobos special to us is: We partnered on a performance challenge. Our goal was to do “Whatever It Takes” (WIT) medication wise for me (Us) to succeed by passing the prerequisite courses and a board review that we may enter the Secondary Teaching Credential Program at California State University at Fullerton (CSUF). For Doctor Dobos and us it was possible to make weekly adjustments to our medications about dosage and type if needed. I remember while taking Botany, I came into the final as class high. On Friday before the final Doctor Dobos and I made an adjustment – it wasn’t working - I could not focus. On Saturday morning I calculated my course points and determined if I could not show I would still get and A. On Saturday night I went and purchased Melatonin. About noon on Sunday I began to study. I showed for my final and earned a higher A. I finished the course and retained my class high status (Horlings, Saddleback, Circa 2000). There were many hurdles Dr. Dobos, staff, and I met together. This was truly a model partnership.

Challenge Orientation – Results - Goal and Objectives Oriented

Doctor Dobos and Our Performance Challenge

-
Process	Outcome	Note	Campus
-
Earth Science	A	Class High	Saddleback
Botany	A	Class High	Saddleback
Physical Geology	A	Class High	Saddleback
Adolescence	A or Pass		CSUF-South
Teaching Experience	A or Pass		CSUF-South
-
Interview Teaching Program	Passed Board Screening	Accepted	CSUF-Main
-
Percentage of Goals Satisfied	100
Concurrent Small Business Owner	Sustained Income Level	Company & Personal	Home Office

20160514-SAT: The Dobos – Torkelson Partnership Circa 2000 - Results
CSUF = California State University @ Fullerton

Keith Edward Torkelson - Curriculum vitae (2013-2015)
Last Update: March 13, 2015

http://ktork46.blogspot.com/2013/01/keith-torkelson-curriculum-vitae.html

C MS – Health Outcomes Survey (HOS)
We already covered it above.

Community Partner(s)
We have included photographs (images) of MSG’s near mature list of community partners. I have also included a table describing a few of each partner’s nuances. Back in 2011 and even earlier we used to promote organizations and agencies such as the California Mental Health Services Oversight and Accountability Commission (MHSOAC) as our partners. The major change for 2016 is that we promote the people impacting our organization and lives. Peter “Brian” Gabriel began influencing us back 1975. He is for many others and “Us”: A Man Of PEACE (TGTU, 1975-Present). Inspirational message from Kate and He: “Don’t Give Up”.

Comparisons
When we started this study our model psychiatrist was Dr. Ravinder P Singh (Garden Grove, California). She probably made some of the best decisions for us ever. Yet when we applied our assessment tools she scored lower that Dr. Dobos. Once again, one of our priorities about our Doctor On Call study is to make a better decision (if we have a say in it) with regards to our next psychiatrist. We will stop comparing as soon as we are satisfied.

Concern Classification
Doctor Dobos appears to have no: Sanctions, malpractice issues, board actions against him. The is no information about his education, training or professional development.

ConMan App
MSG’s ConMan App (2015-2016) is a shortcut method for just getting our Concerns (A Con) out without much or even any data to support our lived experiences about Health & Human Services. We have two outstanding concerns one of which with Doctor Dobos never occurred – An error with medication. The basic information we collect for a “Con” is a timeline of actions and the people involved.

COTS Assessments & Values
For this study we are applying both MSG derived assessments and those that are commercially (COTS) available. The values we assign to our derived assessments are For Your Interest or FYIs.

Data - For Doctor David M Dobos
We would prefer that as we search online about Dr. Dobos we find data and evidence to support what we believe(d) is (was) a promising “Practice”. I am sure Doctor Dobos silos all kinds of information that can get around HIPPA and when shared would benefit the community at large.

Data – Define HIPPA
The Health Insurance Portability and Accountability Act of 1996 (HIPAA; Pub.L. 104–191, 110 Stat. 1936, enacted August 21, 1996) was enacted by the United States Congress and signed by President Bill Clinton in 1996.

Defense Dilemma
Unfortunately the doctors are not supposed to provide case level specific defenses at this time due to confidentiality restrictions (HIPPA). Yet, they can address aspects that they themselves can change about their practices, services, and character. Just this week (June 5, 2016) in the news they described doctors that were critiqued on Yelp. Allegedly doctors used confidential case information in their defenses. The news article also over valuated a review on Yelp saying that one bad review can hurt the doctor’s practice and therefore profit. FYI – We just searched for Doctor Dobos on Yelp. He doesn’t have any evaluations yet.

Desirable Search – String
Patient Name (In a transparent world) – Agency (Could be Doctor) – Doctor (Psychiatrist)
Possibly Date of Birth (YYYYMMDD).

Note: Transparency (new school) and Confidentiality (old school) are near polar opposites. HIPAA may be impeding progress and sustaining stigma.

TheDag GBDP BSL [Confidential Date of Birth]
Did not return anything

Digital Presence - Doctor Online
When MSG begins profiling we more often than not perform an investigation on our target’s digital presence (new school). We check for photographs,> text information (about), > text information (authored by) > sound bites, Etc. As of May 20, 2016: Doctor Dobos has a small digital presence. We are now in the age of digital preservation. Outcome from all the experimentation on consumers since deinstitutionalization needs to be preserved.

“Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability.”

Discuss Doctor On Call and Doctor Tech Assessments

Doctor On Call = Cataloging
We are working to keep track of the doctors we study by numbering them such as Dobos (DOC-02) and Singh (DOC-01). If we alphabetize them and close the project early people will wonder what happened to DOC-05 or whatever. For now we file them with their initials.

Doctor On Call Assessment (MDOCA Beta)
From 2009-2012 we had a test population of about twelve (12) consumers (Consumer Action Advisory Committee or CAAC) for testing our derived assessments. With them our Beta versions could move along in maturity (100 uses). Until we get another test population of consumers our new assessments will be stuck in a Beta Testing Phase (BTP).

Doctor On Call Assessments (MDOCA) – Old School
Our Doctor On Call Assessments: High Weight Screening and Low Weight Fleshing reflect reality well for a first run at it. Our MDOCA has few elements (Items) assessing modern technology based practices. Even though Dr. Dobos had technology to support his practice many of the features such as emails from client to doctor or tele-psychiatric appointments really were not in vogue yet.

Doctor On Call Assessment (MHOCA) - Control
Our intent here at MSG with our Doctors On Call Project (MDOC-P) is to provide a bit of transparency about the doctors whom have treated us so graciously (Lived Experience). Also, we seeking to be better prepared when selecting our next doctor. We have few options right now as compared with options we had when could afford a direct pay psychiatrist. In other words when we paid cash we could choose our doctor. We are in the process of choosing a control doctor for our Doctor On Call Assessment (MHOCA). We had hoped that our control doctor could be Dr. Singh or our current psychiatrist BSL. After round one scoring efforts we determined that Dr. Dobos is better model and control.

Doctor Tech Assessment Tools (TDCM-TecknoHealth)
I have been helping the county with its MHSA Technological Needs as a volunteer (non-monetary compensation) since 2009. In 2009 the order of success with technology driven case management was supposed to be Veterans Administration > Kaiser > Los Angeles County Department of Mental Health (LAC-DMH) > OC Health Care Agency > Smaller Operations > Tiny Operations. The technological features that are now considered promising are nothing close to universal. This holds true particularly when comparing public health with non-profit health organizations. So when applying our derive Tech (MSG-Teckno) assessments to Dr. Dobos (DMD) and our partnership I fudge a bit for him. FYI – Naturally we want agencies in Orange County to come out on top.

DMD - Stats
Dr David M Dobos, MD Kaiser Psychiatrist in Aliso Viejo, CA – Doctor On Call - Stats by The statistics in this study were collected by Keith E Torkelson, MS for MSG (MSG-Datic).

Establishing Objectivity – Subjective Evaluation
We collected what little objective information we could about Dr. Dobos, his practice, and his agency. Back around 2000 Kaiser (Aliso Viejo) hosted a weekly group. Other than discussing our lives and symptoms (lived experience) we could share medication information and changing needs with a Medication Nurse. She would collect up all our concerns and desired changes and bring them to the psychiatrist of the day (POTD). About a half hour later the “Med” Nurse would come back and update us all with individualized Doctor’s Orders. This is one of the most efficient medication management systems I have ever experienced.

Establishing Satisfaction
The shortfall when it comes to finding objective information is that: Our group at Kaiser was never offered Satisfaction Assessments and therefore Consumer Satisfaction has never been directly reported. In hindsight we would have scored the medication management processes high yet scored progress on our symptoms low. If you are satisfied with your symptoms: Why take an afternoon from one’s busy schedule to go to a group? An aside FYI: I collected evidence from more that one year of observing each about two populations. Hypothesis: Higher income people (Aliso Viejo, California) suffering the same intensity of behavioral health symptoms than low-income people (Santa Ana, California) dress better.

External Quality Review (EQR) - Prosumption
This document is an External Quality Review (Pro-bono). We author this document with our faith that there will be brighter futures for the Seriously and Persistently Mentally (Behaviorally) Ill (SPMI) We begrudgingly classify ourselves as SPMI - Prosumer and Para-Prosumer offering Prosumption. We feel that delivering Prosumption is one of the highest aspirations for a consumer including certificated consumer peer support specialists. Prosumption is graduated with support that may assist a consumer for setting themselves free from systemic and programmatic traps such as Conservatorship.

Integrated Evaluation (Objective V Subjective) – Dobos
As this time the assessments applied in this study are not really all that integrated. An integrated assessment would address all of the following elements in the same instrument: Quality of: Service, supports, intervention, prevention, health technology, facilities, practices, promising methods, etc.

Inventory
Unfortunately this study clashes with the twelve (12) step program principle of not taking another persons inventory. Actually this is one of the really weak 12-step principles in real world settings. It does matter what other people think of you. Other people of importance do take your inventory. A psychiatrist inventories you when deciding which medications for experimenting on us (trial and error). A potential boss inventories you when they wish to pay you to work for them. The disciplines of quality assurance and external quality review are founded on taking inventories.

Low Weight Assessments
Here at MSG we tend to apply our high weight assessments as screening tools. The low weigh assessments have more items and constitute our fleshing tools. Assessments with 100 items or more will be our complete assessments. We were going leave out results from our low weight tools out. Yet, since we did the work we are including them.

Maturing the Assessment
The following patterns map how assessments are matured. For us here at MSG the magic number is Items X Uses = one-thousand (1000) or more.

-
Items	Uses	Example Education	Example HHS
-
1	1000		GAF or SOFAS
10	100	Biology Quizzes	Satisfaction Survey for Job Fair
15	67	Biology Quizzes & Problem Sets
20	50	Biology Study Guides
50	20	Biology Exams
100	10	Physical Sciences Exams
-

Table – Experience Maturing Assessments – Context of Teaching

Maturing Assessments in Practice
Because we had a population of some 100 high school students to work with (Circa 2001) we matured our teaching materials (quizzes, exams, etc) all in one quarter. In the domain of health and human service (HHS) we helped deliver four (4) consumer job fairs. One of our duties was to collect participant satisfaction information. We applied the satisfaction survey results to re-sell the funding agency to fund the next job fair round. MSG’s goal was to apply our satisfaction survey one-hundred (100) or more times. In reality inclusive of four job fairs we had about eighty (80) surveys that were submitted as gradable. At this time we do not expect to mature any of the assessments we wrote for this study about Dr. Dobos. Our MDOCA will not mature in the near future because we lack the number of relationships (partnerships) to do so.

MDOCA Series
The reason we constructed assessments ourselves was we couldn’t find any Commercial-off-the-shelf assessments (COTS) that met our needs. We here at MSG are focused on service and support experiences and how technology is applied to clinical decision support. If we were to write one more assessment in the MDOCA series is would be an integrated tool(100 or more items). We just remembered we probably would write a few medical error assessments in our Legal Concerns Division (ConMan, 2016).

List of the MDOAC Series Assessment Tools (MSG-TecknoHealth)
Final Naming Elimination

-
AcroCode	Description	Note (Uses)
-

MDTAT-HWS	Doctor Tech Assessment Tool – High Weight Screener	10
MDTAT-LW	Doctor Tech Assistance Tool – Low Weight	10

TDCMA-C	Technology Driven Case Management Assessment Consumers Version	2

TDCMA-P	Technology Driven Case Management Assessment Provider Version	2
-

Table – 20160604 - Assessments – Doctor On Call (MDOC) - Technology Driven Case Management (TDCM) – Service Driven Case Management

Med Management - Dobos Model (Circa 2000)
Once again, medication management was one of Dr. Dobos’ fortes. At least once a week there was a group held at the Aliso Viejo Kaiser Facility. At or near the beginning of the meeting the “Med” Nurse would drop in and collect medication update information from the attendees. Before the end of the meeting the Med Nurse would return with individualized Doctors Orders.

Medicare Stars (See Stars Assessment(s) below)

Medication Management Networks – Individualized
At this point we will return to the purpose of this study. We are in the process of succession across our biopsychosocial domains. Our current psychiatrist is about to time our (retire). We need to secure a new psychiatrist that is a good fit. The most important feature for our new psychiatrist is their capacity to manage medications exceptionally. We determined that it might be wise to investigate what for us makes a great psychiatrist. We would like being subjected to no more pharmacologic experimentation. Our current medication is time tested as a great fit. The last experiment in 2012 with Invega contributed directly to a Crash & Burn (&B). If the prescribing psychiatrist (Daniels) had taken a thorough history they would have been able to determine that we do not respond to Risperdal [SPELLED] or anything related to it such as Invega.

Method – Stars (See Stars Assessment – below)

Method – VITALs - Utilization
VITALs dot com competes with other Rate Your Doctor websites such as HealthGrades or Yelp. Overall in Orange County these grading systems are underutilized. Most of them are based on a score range from 1-5 with five (5) being superior. All doctors in our super-study (MDOCA-P) have not been rated using VITALs. Yet the questions asked on the various sites are similar. Therefore we can fudge a bit by pirating HealthGrades outcomes as if they were VITAL’s outcomes.

MSG – ConMan (MSG-ConMan, 2016)
Yields from our ConMan application is different than how material was presented here. The material presented here centers about evaluation and measurements. ConMan is designed to manage grievances, appeals, complaints and the like. Con stands for “Concern” and Man stands for “Manager”. We pick concern over complaint because the latter sound whiny. As addressed earlier, the foundation for a concern is a timeline and persons involved. With Dr. Dobos we had few if any concerns.

MSG Assessments & AssBase
Over the past fifteen (15) or so years the language of Health & Human Services has evolved substantially. Therefore the requirements and specifications about measurement tools have changed. We participated in the OCHCA Data Outcomes Advisory Committee (2011) long enough to learn that the assessment base or (AssBase) was not keeping pace. At a technology conference about three (3) years ago a presenter out of TheFed stated that as a state (California) we needed to standardize our HHS AssBase or assessment library. He indicated that Australia had already accomplished standardized AssBasing. We wrote one of our first assessments (TRC-Mania) back around the year 2000. Previously, we have shared MSG prefers using COTS assessments. Yet as so many others have expressed we can’t always find a good fit to explain phenomena personal to us. We have a pending assignment for determining the recovery value for technology. Quick search “recovery value for technology”. All we come up with is Value Recovery. Value Recovery is out of scope. Here we get credit for doing one thing that can be applied about two of our deliverables.

PDF Format
Sample – PDF Accountability and Transparency Board Self-Assessment - Charity Central (4 pages – Tool itself “The Edmonton” & A&T-Edmonton). This just an example of why it is helpful to search for the pdf format of what you are looking for. When searching for assessment tools it is quicker to narrow your searches to the pdf format. Above we found our COTS tool for measuring Accountability and Transparency. After we calculate the COTS version we can compare the results with the version we derived.

Performance Challenge Opportunity (Unique)
We have already discussed that one of the unique features in our relationship (Adult to Adult - Thomas Anthony Harris, 1967) with Doctor Dobos. This being, we partnered on a performance challenge. The goal was to get me into the California State University @ Fullerton’s Secondary Teaching Education Program. We succeeded. Right now, due to a medication error related Crash & Burn (C&B, 2012) I have no planned grand performance challenges. If I can get on my feet enough, I would like to test into and as a Certified Project Manager. I just took my 2016 CMS Health Outcomes Survey (CMS-HOS, 2016). It looks like since 2014 I have not improved. My risk of falling to the ground is really high right now. Walking is my primary mode of transportation. My aunt (Born 1925) says that I am not any better. Maybe Doctor Dean (1989) was right and I haven’t on average gotten any better. My current psychiatrist stated about one (1) year ago “you look better”.

Prosumers - Defined
What are the definitions for: Nosumer, Consumer, and Prosumer? A Nosumer is an individual that has services available in their program or plan and barely utilizes them. A consumer is satisfied with business as usual and really does not value or contribute much. A consumer may also be a person who purchases goods and services for personal use. In HHS consumers really do not demand much including help resolving their issues. It is hard to find a good fitting service team to partner with. Many programs do not treat their consumer well. Many programs know that the consumer is trapped and therefore do not deliver substantive help. Hopefully new programs applying higher standards, more promising practices, measured outcomes, “teaching to the test”, and stellar expectations will open and compete.

Quote: "If you're a satisfied consumer, we've done our job"

Prosumer – Features
Below are just a few features for our really cool time tested term – Prosumer. A prosumer is a professional consumer of Behavioral Health Services. In 2009 we trained for 160 hours as a Consumer Trained in Paraprofessional Mental Health Work (PMW). This document is part of our ongoing paraprofessional development.

	-
Item	Requirement (Feature)	Progress
	-
01	Advocates	Very challenging
	Applies Lessons Learned	PASS
	Assesses Self	PASS
	Attends	PASS
05	Committed Life-Long-Learner	PASS

	Contributes Meaningfully	PASS
	Garners High Expectations	Very challenging
	Graduates	Very challenging
	Hopeful About Partners	Very challenging
10	Informed & Informs	PASS

	Maintains Recovery Materials – Program Binder	PASS
	Organized	PASS
	Prepares	PASS
	Refines Methods	PASS
15	Savvy Shopper	PASS
	-

20160604-SUN: Array – Features of a Prosumer (MSG)

Purpose(s) - Refined

The primary purpose for this study was to shop in advance for our next psychiatrist (succession). We wish to spread the lifetime costs of treatment around a bit. Whereas Personal Care Physicians (PCPs) have fairly exhaustive criteria to meet, such as HEDIS, psychiatrists can still remain opaque and not accountable. Our first psychiatrist (Dean @ Yolo General Hospital) stated that we would never get better (Circa 1989). We were hospitalized because our risk of accidental death was high.

Purpose of the MDOCA

Our purpose for this study is that we may used knowledge gained while shopping for a successor psychiatrist. We are taking the expense of lessons learned from prior psychiatrists and re-applying it. In addition, we hope to help any or all psychiatrists with their accountability and transparency issues.

Rates – Error - Rates Psychiatrist(s)

As we all know psychiatrists do not make mistakes. If there is an error about treatment leading to worsening symptoms it is the consumers fault. One of the most common consumer faults is not taking their medication as prescribed (compliance or adherence). As we examined the online ratings others gave our sample psychiatrists (Dobos and BSL) we saw scores like 3.5 out of 5 (with 5 being superior). With a score of 3.5 what does the 1.5 difference translate into? Of course it has to be the Error Rate. Unlike doctors and many patients MSG’s error rate is calculated from standardized testing events. For example, we can use our GPAs to determine our error rate. Our graduate school GPA is approximately 3.5/4 = 87.5%. Thus our error rate is 12.5%. Our Graduate Records Examination Math Sub score was 800/800 or the 99th Percentile of the cohort. As reported by our sample doctors they are not transparent about their errors. Oh we forgot: As we all know psychiatrists do not make mistakes.

Recouping Losses

Since falling ill fall 1988 we have been served by more that one dozen psychiatrists. Dr. Dobos and Kaiser served us about fifteen years ago. At the time I was a partner in a small business. My premium for Kaiser was around $400.00 per month. If I purchased my medications at cost the cost per month would have exceeded $400.00. Our core medication was Seroquel. The reason it was a loss is because, as time would tell Seroquel is not the best medication for me. With this study and others planned we hope to begin recouping the costs of treatment.

Real World Experiences (RWEs)

We just saw an ad on TV (May, 2016) that a private school was offering real world experience. We gather that since we are not enrolled in school right now that all we do is real world experiencing. I wish to take this opportunity to discuss PeerLoads (MSG, 2015). For us a peer is someone with a behavioral health diagnosis and that you spend significant amounts of time with. An example for a peer would be one’s roommate. I live with about ten people with diagnoses and some living out a tragedy. I am the only one using structured and hopefully promising methods with the intent for bettering myself.

Research

If this were a formal work we would have had to track the one-hundred or so references that we gleaned for content to include here.

Results Up Front Method (RUFM) – 20160510-TU
Our results are included up front in the parent document. There are some results included PRN in this Introduction.

http://the-torkel-saga-2059.blogspot.com/2016/05/dr-david-m-dobos-md-kaiser-psychiatrist.html

Usually the key results are addressed in the Abstract (Executive Summary) section. Yet, due the number of data points we only put a few in the Abstract. In a typical paper the Results would occur after the Methods section. Yet we find by reading other people posts that we just want the results up front (RUFM).

Lived Experience
How much is “lived experience” worth? How do we make a little off of our and our peers suffering and injury. The value of lived experience is very important for us as it applies to the consumer-provider movement. It is hard to take a disabled person who only has bus transportation and get them working full-time with benefits at minimum wage. There needs to be monetary compensation for lived experience. At present MSG calls this schedule an unreasonable accommodation.

Safety Net Value (SNV) – Still Pending

[PDF] - Safety Net - Stanford Center on Poverty and Inequality

http://inequality.stanford.edu/sites/default/files/Pathways-SOTU-2016-Safety-Net-3.pdf

Key words: Parameters, Indexing, Safety net dimensions, Amount of relief, Assessing, Poverty Threshold

Once again we just wished to find a COTS assessment to measure the safety net value of having superior psychiatrist on our team. There appears to be a gap here with COTS tools for psychiatrists. Doctor Dobos was pretty good helping us stay safe.

Scoring
Unless the Commercial-of-the-shelf (COTS) assessment specifically has a scoring system that meets our Easy Score Protocol we score with 1=Yes/0.5=SoSo/0=No. We use our method for scoring both our MD On Call Assessments and our Teckno Case Management Assessments. The Health Outcomes Survey (CMS-HOS, 2016) fails our Easy Score Test (EST).

Service Model
So which of my dozen or more psychiatrists have (had) the best service model? So far it would be Dr. Dobos. He was superior about medication management – the primary function of psychiatrist. He also wrote two important letters for me. In regard to how I triturated my medication to meet a need Doctor Dobos told me “sometimes the patient knows best”. One of my weekly needs was to overcome medication-induced impotence so I could have quality time with my Most Significant Other (MSO) Joan. In addition, we also addressed Over-the-counter (OTC) medications and how to use them to solve medication related problems and unwanted side effects such as impotence. I briefly tried Viagra yet the down side far exceeded the benefits.

Shopping and Small Networks
We here at MSG figure that one in ten psychiatrists will be a good fit. Currently our network has four psychiatrist and we are being (hearsay) served by the best on of them. At a given location such as Kaiser Aliso Viejo I figure we are lucky to have four to choose from. If I go Medi-Medi we have more choices yet lose our psychosocial supports. This it the catch: Even thought we do our homework we are not guaranteed a good successor psychiatrist. We sort of want Doctor Singh back yet she is a Medi-Medi psychiatrist not taking our current insurance. FYI: Medi-Medi is the brief for Medicare and Medi-Cal (Medicaid). It is also called dual eligible.

“Sometimes the patient knows best”
(Comment about Medication Management-Dobos, Circa 2000)”

Stars Assessment (Defined - Interpreted)
“The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure Medicare beneficiaries' experience with their health plans and the health care system.” Dr. Dobos works for a five star agency (Kaiser). We wondered with the number of elements that feed into a Star score, how could anyone or agency score a five (5). We found that the scores can me rounded. Yet, anyway 4.8 Stars is pretty incredible. It would mean that practice; business, service, etc across the board would average about 4.8 or 96%. What little objective data we could come across indicates that there is a disparity. Using the VITALs data we interpret that 3.5 or above is reported by a person that likes their doctor. Whereas scores below 3.5 is usually form someone that does not like their doctor. MSG (and TRC) liked Dr. Dobos and therefore he earned a good score (4.5).

Strengths V Deficits (Case Centered V Generalized)
In general we brainstorm a list (MSG-ListerLista) about a psychiatrist’s strengths of practice (SOP) first. Then we compile a ListerLista around their deficits. We choose the number or items from the shorter of the two lists as the number of items that we share from the longer list. At the last moment we just went ahead and shared all items about Doctor Dobos. Some of our relationships with psychiatrists have been injurious, costly, and associated catastrophic loss. For the most part the benefits with Dr. Dobos far outweighed the deficits.

Succession
We already addressed adequately in prior material. Good orderly succession (GOS) is one of our highest priority goals. This paper is part of our objective to satisfy our need.

Summary of Research
The research for this paper (study) was done from memories of lived experience, using Google to search for germane information, a bit of textbook information, and retrieval of documents in our paper and electronic personal health records (PHR).

Tech MD Series (TecknoHealth-MSG, 2016)
Here at MSG we believe that Technology may help deliver better outcomes. The major difference between our TecknoHealth Series and other HHS assessments is that TecknoHealth is solutions’ and perfection based. We didn’t address it this paper yet one of our best COTS assessments is from Hewlett Packard (HP) addressing customer technical support experience (MSG Standard 2012-Present). On multiple occasions HP has solved our technical issues perfectly. Since 2000 we have used their warranty periods to solve dozens of hardware and software issues. In Health & Human Services the tendency is to refer away. While with HP if the Tech on the phone cannot solve the issue at hand they escalate to a superior problem solver within the organization. This is truly the no wrong door (NWD) policy.

Techno Case Management Score (Low Weight)
At this time our TecknoCase (MSG, 2016) Management Low Weight Assessment has a total of 16 Items (>15 Items = Fleshing Tool). This makes it a fleshing tool and a candidate for extension by concatenation.

Techno Health (TecknoHealth)
Really we are beginning to prefer calling Technology In Health – TecknoHealth (MSG, 2016). For our volunteer work we partner with County Level Enterprise Health IT Solutions. In our recovery work we partner with an underperforming (3 Stars) non-profit agency. For our recovery work we have an outstanding grievance (ConMan-Medication Error, 2016). The concern is in the form Medication Errors for two out of our three medications. These errors coincide with using computers it the prescription stream. If we hadn’t gained any ground about health we would more than likely be on the Psych Ward rather than publishing this today. On the Psych ward there is a chance that the doctor in charge would treat me for not taking my medicine or that the medicine I take is not working. The other thing is that I would be injured with a share of cost that when billed would further impair my recovery. Kaiser had a different system call Maximum Out of Pocket. It was a bit better than Share of Cost yet could still leave you trapped without the funds to improve your outpatient conditions including housing.

Test Subject - Dr. David M Dobos MD (Psychiatrist)
The test subjects for this Doctor On Call (MDOC) series fit a requirement: We had-have to have lived experience with them. This opens the door to research doctors we have not partnered with yet. Again, this report is to help recoup losses we sustained from psychiatrist while they were never making mistakes. If a psychiatrist would read this and decide to fess up it would be a great reward for our efforts. Also, if we can help just one person link with the best psychiatrist of their life’s it will be worth it all the more.

The Medicare Advantage 5-Star Rating
We just (May 20, 2016) received our CMS Health Outcome Survey (HOS). Medicare Health Outcomes Survey (HOS)

http://www.hosonline.org/

“Welcome to the Medicare Health Outcomes Survey (CMS-HOS) Website. The Medicare HOS is the first patient-reported outcomes measure used in Medicare - It appears to originate around 1998. When we saw Dr. Dobos we didn’t get offered a HOS because Kaiser is not Medicare. If memory serves us right we here at MSG believe HOS results factor into the CMS Stars Score. Unanswered question for now: Kaiser has Star scores – What do they use in place of the HOS information?

The Transparency Principle (Vision)
Transparency will be slow to come from the doctors while the appropriate legal hacks are developed by information technology specialists about the realm of health and human services.

The Zager Rule Modified
Gary Zager was our Health & Human Services professor at Cypress Community College. He taught us Introduction to Health and Human Service and Crisis Intervention Management (CIM). In the CIM classed he indicated his rule for addressing dual relationships. He said to globally avoid them because you may require the partner again in a professional treatment relationship.

Title Selection
In delivering by Blog the title you pick with make or break you. We chartered this study with the intent of sharing all of it in one post. We used our gallery first method. Next we added the charter information that includes the title. Today, May 21, 2016 (SAT), we just checked our title penetration value by searching with Google. Our goal by now was to break into the first page of hits with regards to Dr. Dobos. We have failed thus far. We have a do not delete policy that included changing titles. We will remove information if it is requested by a stakeholder in the form of a comment – saying they wish to be removed. In over two (2) years only one person has asked to be unlinked. To get a second shot as title penetration we are publishing this Introduction section separate and with hopefully a more marketable title.

Tools - Naming Assessment Tools
What is the difference between: Assessment, instrument, tool, scale, examination, test, quiz, index, etc? For the most part in the Health & Human Services literature there is really no concrete distinction. So if we apply teaching again as a reference we get the following by searching: “differences assessment, instrument, tool, scale, examination, test, quiz”

-
Assessment	Specification	Ours	Example
-
Assessment	Process of administering Clash with material itself
Evaluation
Examination	51-300 questions (items)	Full	GRE Math CMS HOS
Instrument	Assessment material itself
Measure
Measurement
Practical	Laboratory exam	F2F
Pre-Test
Quiz	5-15 questions (items)	Screening	PHQ-9
Scale	Scoring system
Survey	A pre-test		Prior Knowledge Science
Test	Exams & quizzes
Tool
Exam	16-50 questions (items)	Fleshing

Table – Assessment Classification (MSG-Beta)

Transitional Assessments – Discussion
The space between COTS assessments and our Doctor-On-Call assessments is filled with transitional assessments such as our Doctor Tek Tools (DTTs-TecknoHealth).

Transparency - Addressing Transparency Tool (ATT)
We wrote our own tool to address transparency that includes accountability. On-line we found a transparency assessment (The Edmonton). The problem with The Edmonton is that it targets Non-profits. Dr. Dobos works for Kaiser a “consortium of for-profit and not-for-profit entities”. The entity that I experienced with Kaiser showed no indications that my services were provided by the not-for-profit entity. So we fudged a bit trying to apply The Edmonton to Dr. Dobos and Kaiser. Once again, confidentiality and transparency are nearly polar opposites.

Transparency Progress Score (TPS)
Transparency in Health and Human Service is a work in progress (formative). The nationally know Dr. Amen is our standard for transparency. As a minimum: He has a website, a strong digital presence, and has published at least one book. . Progress rather perfection will be our aim for quite some time.

Weighting
We first discovered weighting with essay questions and problem sets. Over ten (10) years ago we discovered weighting with regards to stress management. In short all stressors are not equal and thus carry differing weights. In our assessments rather than progressively weight different items we split them by high weight and low weight. Our high weight (items) evaluations usually consist of fifteen items or less. Again, we call tools that consist of fifteen items or less our “Screeners” or screening tools.

Why and When to Cipher - Reasons to CipherWhen practicing advocacy

If a therapeutic relationship may develop in the future
Reducing harm while addressing the truth
When spelling it out clearly could cause harm to others
If the doctors rebuttal potential propagating harm is high
Others – PRN

Why We Use the Term “Assessment”
At CSUF in the Teaching Program you are introduced to frameworks and standards. These regulations specify items to include in one’s teaching portfolio. Some of the sections are: Pedagogy, administration, and classroom management. All quizzes, surveys, tests, exams, etc fall nicely into the Assessment Section (group). Only thing for us right now that is not an assessment per se are our Indices. For MSG indices are more like report cards including results across multiple assessments.

Z-End – Summarize Product Names
At some point we are going to go through the some odd thirty-three pages of this report and extract the nomenclature for our products we support or are developing. If you made it to here: Thank you very much for your time and consideration.

#Liberty - #LifeWLiberty

The Torkel Saga 2059

Friday, June 24, 2016

Keith Torkelson Loves Joan Zhorne - Lived Experience (LiveX)

Saturday, June 4, 2016

Keith E Torkelson - MS Introduces Dr. David M Dobos at Kaiser A Model Doctor On Call