Wednesday, October 25, 2017

Chester Diokno Mojica MD Performs Routine Annual Physical Examination on Insured Consumer by and for KE Torkelson, M.Sci. – Pathology (2017)


Chester Diokno Mojica MD Performs Routine Annual Physical Examination on Insured Consumer by and for KE Torkelson, M.Sci. – Pathology (2017)

Parent Agency Brand New Day
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Parent Document


11_GHlth_CCCHC_CDM_17100502_Physical_Report 3.5.4
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Stats About Literacy & Readability


Core Topic – Elimination List

-
Special Topic
Chosen
-
1-Satisfaction
In Depth
2-Lab – Blood Carbon Dioxide Levels
Honorable Mention
2-Lab – Blood Glucose Level
In Depth
2-Lab – Complete Blood Count
Brief
2-Lab - Fecal Occult Blood Test (FOBT)
Left Out
2-Lab – Lipids - Cholesterol
Brief
ADDRESSING ASSESSMENTS

Matrix of Core Topics – Last Reviewed: 20171023-M:
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Special Topic – Elimination List
For the Most Part Concentration on All Special Topics Eliminated in due Course
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Special Topic
Chosen
Christmas Report Card
Compassion Fatigue
Digital Appointment
Under Assessments
Global Health Fitness (HEDIS)
Under Assessments
Metadata & Metadata for Special Topics
Was - In Depth
MSG’s Celery Diet
Was - Brief
MSG’s Health Related Engagements (HREs)
MSG’s Structural Temporal Reconciliation (STR)
Patient Portals
Was - In Depth
Record Request
Scheduling
Link to Legacy Report
[RETAINED]
Show and Tell
Sleep Disorder
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Matrix – Special Topic Elimination List: Last Updated: 20171020-F:
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The Cut In Due Course
In order to meet our deadline we have decided to cut out our non-lab and non-assessment Special Topics.  Some Special Topic material is embedded with the lab and assessment sections.  We think the report will be a better read if it is not too long.  It should come out around thirty (30) pages. (MSG – Division 11 – Pathology, 2017)
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Abstract _ Executive Summary
On October 10, 2017 (20171010-TU @ 130) we visited our Primary Care Physician (PCP) Doctor Chester Diokno Mojica (CDM) for our annual Physical Examination.  We saw him at his offices in Garden Grove in the Central City Community Health Center Facility.  This constituted our fifth (5th) annual physical in five (5) years.  This year up to this point (20171010-TU) we counted the following as Health Related Engagements (HREs).  Total HREs = 99: In Network HREs = 36: Out of Network HREs = 59.  HREs are similar to Dosage.  We had hoped that our Dosage could have been decreased this year (2017).  The trend indicates that we still need intensive care.
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Outcomes
By the end of the physical doctor and we mutually agreed that this year’s physical is a 94.0 % success or an A.  This was our best physical in five (5) years with Doctor Mojica.  He closed the appointment indicating that we should remain Guarded and not to go “out and party”.  For our appointments we prepare in advance.  We usually have one or more items to Show and Tell.  This time we shared the results of one of our UC Davis Physics Exams.  We indicated that we were getting rid of memories.  He said “Why are you getting rid of this good memory”.  Our response is it is part of our (Torkel Saga) Digitization Project.  Doctor indicated that we hit the Blood Glucose Level (BGL) Issue out of the park!
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Our Results Up Front Method (ORUFM) - Subjective
In most of our studies we present the objective material first.  More often than not we are subjectively more critical than the objective findings.  This time we present our subjective findings first because it presents a better picture than our objective sources do :o).  Make note we are evaluating the whole team of individuals that contributed to our annual physical.  For the sake of accountability we assign our outcome measure to the principal I.e. Doctor Mojica.  For the purposes of this report Doctor Mojica may be denoted as CDM.  The consumer is Keith Edward Torkelson, M.Sci.  Around here we like to call him Buster!  MSG is his business.  Satisfaction is his passion.
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Subjective Up Front Method (SUFM)
For this report we place our subjective findings before the objective findings.  Below: A table presenting our findings about our physical with Doctor Chester D Mojica (CDM).  We used MSG’s Quick Score Method (QSM).  This would be an example of a consumer rating Services and Supports.  The insurer is Brand New Day – Universal Care.  The contractor for PCP care is Central City Community Health Center (CCCHC).  The provider is CDM and Team.

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#
Tool
Note
20171013-F
QSM
20171013-F
Letter
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1
Virtue and Value
Boy Scouts Style
2
C
2
Vitals
Online Rate Your Doctor
Mutual Agreement
3.7
A-
(94%)
3
Vitals
Derived
3
B
4
Vitals Plus (MSG)
LiveX Development (Theta)
3
B
5
Blood Glucose Levels (BGL)
Doctor Perspective
4
A
6
Blood Glucose Levels (BGL)
Consumer Perspective
4
A
7
Lab Assessment
3.7
A-
8
Clinical Assessment
3.7
A-
9
Clerical Assessment
3.7
A-
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Total/Items Scored
[Grade Point Average]
{Grade}
30.8/9
[3.4]
GPA
{A-}
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Table - Last Update: 20171013-F: Date of Key Appointment: 20171010-TU: Nature of Appointment: Yearly Routine Physical Examination By CCCHC PCP and Team.
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What’s Up With The “C”?
Just because your doctor gets to transact with you does not mean she or he is your friend.  One of MSG’s assessments to determine if an individual has the character to make a good friend is our Commercial-Off-The-Shelf (COTS) Boy Scout of America Value and Virtue (Law) Assessment (BSA).  At this point Doctor Mojica makes a better doctor than a friend.  We will share his BSA results a bit latter on.
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Objective – Satisfaction
We take the majority of our objective data from online rating sites.  The two we use most frequently are Vitals and Healthgrades.  For us the numbers are weak indicators until we can find a total number of votes at or greater than one hundred (100).  As you can see below that Doctor Mojica’s on-line ratings exceed that of the parent plan Brand New Day (BND).  This very likely translates that CDM can step it up and in the process improve the plans CMS Stars Ratings (CSR).  Brand New Day’s CSR for 2017 is reported as 3.0 Stars.


Initializing Our Objective Evaluation of Doctor Chester Diokno Mojica MD
TimeStamp
Method
# Of
Votes
Rating
5.0 is Best
Interpretation
20170319-SU
Healthgrades
9
3.2
20170521-SU
Healthgrades
9
3.2
20170319-SU
Vitals
9
3.8
20170521-SU
Vitals
10
3.9
20170324-F
POR
18
3.5
*
Above Average
Mediocre
20170521-SU
POR
19
3.6
*
Showing
Improvement
20161124-TH
BND Health Plan CMS Stars (2017)
Parent Plan
**
3.0
“Work of a satisfactory standard”
20171006-F
Healthgrades
10
3.0
20171006-F
Vitals
11
3.9


Last Reviewed: 20171023-M: Table – Stars Data for Doctor Chester Diokno Mojica MD – Objective Assessment Results – POR = Pooled Objective Results. Cleaned Up: 20171006-F:  Updated: 20171006-F:

Updating Frequency
We updated this table about four (4) times in 2017.  In the future we will probably only update twice per year.
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FYI – Query: “chester mojica vitals”

Give it a try for yourselves.  Enter “chester mojica vitals” in the search engine of your choice.

Satisfaction – Brand New Day Consumer Satisfaction

Matrix – Coding Legend – Prescribed Satisfaction Assessment
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Code
Meaning
Code
Meaning
X
Extraction
W
Whole
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Matrix – Coding Legend – BND Corporate Prescribed Satisfaction Assessment
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Acro
Instrument
Target
Offered by
KCSS-X
Kansas City Satisfaction Survey
Consumer
BND
ACSS-X
Annual Consumer Satisfaction Survey
Consumer
BND
KCSS-W
Kansas City Satisfaction Survey
Consumer
BND-2013
ACSS-W
Annual Consumer Satisfaction Survey
Consumer
BND-2015
Table – Satisfaction Assessment – Last Update: 20171020-F
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Prescribed Satisfaction Assessments
For this report we left out our findings based on Satisfaction Assessment that we prescribed by the parent organization or insurer Brand New Day (BND).  These surveys consist of some odd twenty-five (25) questions (Items).  Part of the questions deal with treatment experiences with the plan doctors.  BND changed the format and some of the content between 2013 and 2015.  The scoring algorithm we wrote for 2013 does not fit 2015 or later formats.  Because Satisfaction is an MSG Value (Passion) we will puzzle the prescribed assessment for a re-purpose.  In the past, for example 2012, Doctor Mojica’s office offered their version of a Satisfaction Survey.  They stopped offering it.  This constitutes a step back when a provider is proving that they are achieving a measureable impact.  For us this falls partially under Technological Needs fix and we will report on it separately under consumer computing needs.
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Key Dates (KD)
We here at MSG have clocked several Key Dates (KDs) for 2017.  The KD for this report is 20171010-TU.  20171010-TU also constitutes a Major Milestone.  This is the date of our most current and most successful Physical with Doctor Chester D Mojica.

Satisfaction – Brand New Day Consumer Satisfaction – Metadata


Satisfaction – Brand New Day Consumer Satisfaction – Metadata
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Metadata
“Metadata is "data [information] that provides information about other data".  Three distinct types of metadata exist: descriptive metadata, structural metadata, and administrative metadata”.  We here at MSG are really in to metadata because in Health & Human Services as compared to Computer Programming (done right) we find it lacking.  In programming the documentation (metadata) can be more voluminous that the code.  Above is just an example of one means we use to manage and share our metadata about TorkBase (2014 and Before) and AVEYBase (2015 to Present) two of our databases.
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Applied Patient Portal – My Quest – Labs
We chose to address the lab work now because it also constitutes objective data.  After the labs we move on to our Special Topics that tend towards subjectivity (cut out).  At the heart of the new improved Primary Care Physician Movement (PCPM) is the Blood Work Panel (BWP).  Quest calls theirs the Comprehensive Metabolic Panel or CMP.  Looking at the Quest Patient Portal – MyQuest it looks like the samples tested are fasting blood and urine by micturition.
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Comprehensive Metabolic Panel Result: What does it mean?
“A Comprehensive Metabolic Panel (CMP) is typically ordered as part of a routine health exam; when you are being monitored for a specific condition or are taking medications that may impact your kidney or liver.” (Quest, 2017)

Test Name: CMP: Collection Date - 09/14/2017
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Tests in a CMP
“Cholesterol, Total, HDL Cholesterol, Triglycerides, LDL-Cholesterol, Chol/HDLc Ratio, Non HDL Cholesterol, Comprehensive Metabolic Panel, Urinalysis, Complete, CBC (Includes Diff/Plt), Rpr (Monitor) W/Refl Titer, Hemoglobin A1c, Creatinine, Random Urine, Microalbumin, Random Urine (W/Creatinine), TSH, PSA, Hepatitis A IgM, Hepatitis B Core Antibody (IgM), Hepatitis C Ab W/Refl To Hcv RNA, Qn, PCR, Hepatitis B Surface Ag W/Refl Confirm (Refl), HIV 1/2 Antigen/Antibody, Fourth Generation W/Rfl”
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Comprehensive Metabolic Panel (CMP) - Current: Annual for 2017
In the list of lab tests above there are some case errors.  When Quest reports the test in a codified form they YELL or use all uppercase.  In converting to mixed cases in order to make the codes realistic we may have missed a few.  Example: W/Rfl just doesn’t look quite right.
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MyQuest Notation
“Note: Data displayed only for results that meet strict identification matching. Historical result view may vary based on corrected or updated patient demographics. The reference range displayed may vary due to potential changes in laboratory testing methods. Please refer to the published reference range on each lab report.” (MyQuest, 2017)
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Aside - Hospital Pathologist Central Laboratory (HPCL)
One day we may write about our really hey it is cool happening job as a Clinical Laboratory Associate/Specialist back about 1990 working with Doctor Harry Inami and Team.
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Patient Portal LiveX
MSG obtained our lab information and data using Quest Diagnostics’ Patient Portal called MyQuest.  My Quest is available to any consumer using Quest Labs as their lab.  As one of our side endeavors we sell the Patient Portal concept.  For example we presented earlier this year to the Orange County Health Care Agency (OCHCA) Mental Health Services Act (MHSA) Consumer Action Advisory Committee (CAAC).  CAAC has the role of advising to and for the OCHCA Mental Health Services Act (MHSA) interest.  We assessed as to whether the CAAC members were satisfied with our presentation.  On average they gave us a B-.  We asked our supervisor who was in attendance and in support this day: What grade do you give us?  She said an A+.  She said the CAAC members went from knowing little or nothing to improving their Patient Portal situational awareness.
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Linkage by Referral
More often than not consumers discover their patient portal resources by referral.  No one in our BND and CCCHC support teams referred us to MyQuest.  We discovered MyQuest by ferreting about.  Of course we all will eventually have Patient Portals about our Primary Care provider.  CCCHC is behind the curve for implementing a Patient Portal.  There is a chance they are piggy backing their Meaningful Use requirement on BND’s Cerecons.  If you are lucky enough to be served by Quest Diagnostics give MyQuest a try because it is the highest quality patient portal we have tested to date.  Now let us get to the lab work! :0)
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FYI - Quest Diagnostics Patient Login
https://myquest.questdiagnostics.com/web/home

FYI - Tiny Detail - CARBON DIOXIDE [Example of MyQuest YELLING]
Collection Date - 09/14/2017
Result = 19 mmol/L
Reference = 20-31 (mmol/L)

Addressing Lab Findings - Slightly Low CO^2
Our latest lab results indicate that we have slightly low carbon dioxide levels.
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Interpretation
“Low values. Low carbon dioxide (bicarbonate) levels may be caused by: Hyperventilation, aspirin or alcohol overdose, diarrhea, dehydration, or severe malnutrition.” In addition low carbon dioxide may indicate: “Liver or kidney disease, a massive heart attack, hyperthyroidism, or uncontrolled diabetes.” (Quest, 2017)
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Indicators for Us > Eating Less Calories > Diarrhea > Dehydration

No Comment Necessary
This is an example of data presented in text form only.  Next we will present data as graphics for tables, figures and time series graphs.

Lab – Blood Glucose Level
Our Blood Glucose Level (BGL) results we present in the most detail.

Blood Glucose Level
Collection Date - 09/14/2017
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What we deserve at the Physical
Before looking at the data know that we were facing Doctor Mojica pointing out a defect that may have led to a medical intervention rather that a behavioral one.  We obtained our results before the exam and saw that he had ordered a diabetes confirmatory test A1c.  This led us to believe he was readying to make an issue of it.  The results below show that our behavioral fixes including our new and improved Celery Diet worked.  For the appointment we thought it appropriate for CDM to state something like: Wow! I see that!  How did you do it?  MSG prepared and had on hand our 1-page summary for behavioral and nutritional changes we made.  We will share it in a Special Report as MSG’s new and improved Celery Diet.  Surprisingly Doctor did make a good deal about the changes we instrumented.  Doctor CDM is moving into pacific waters of Strengths Based Service.
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Avoid the Tiny Details Approach (ATDA)
Temporarily we are avoiding tiny details to get into the big picture and finish this report.  We did notice that there was a glitch in our appointment card.  They scheduled us for two pre-physicals and no physical.  It didn’t matter because it was easily corrected.  We were looking forward to a Strengths Based appointment because we deserved it.  Again, some of the monologue that we wished to hear was: Wow! I see that…How did you do it?  We were prepared to give Doctor Mojica as one (1) page how we did it document.  What we expected was business as usual.  In our past CDM has preferred the choppy seas of a Deficits Based Approach (DBA).  Now let’s address the blood glucose related lab results: Blood Glucose and A1c.
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Blood Glucose Level (BGL) Results – Graphic - Time Series or Longitudinal
Collection Date - 09/14/2017
Results 88 mg/dL
65-99 (mg/dL) - Fasting reference interval

Figure - Blood Glucose Level (BGL) Results – Graphic - Time Series or Longitudinal
Collection Date - 09/14/2017

Getting It Right
For this year’s Physical what was it that we got right?  One: We saw our results in advance, which gave us enough time to intervene where necessary.  Two: As usual we fasted.  Three: For the first time we drank absolutely no coffee.  The collection date was at our Pre-physical on 20170914-TU @ 1030am.  The actual scheduled Physical Exam was 20171010-TU @130pm.  Four: Most importantly we showed up per schedule.  Doctor Mojica (CDM) serves a population that is hard to get into the office.  Some of his cases have trouble waiting for more than ten (10) minutes before they walk away.

Hemoglobin A1c

Collection Date - 09/14/2017
Results 5.3 (% of total Hgb)
Reference <5.7 (% of total Hgb)
Purpose - For screening for the presence of diabetes: 

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% Of Total Hgb
Indicates
Note





<5.7%
Consistent with the absence of Diabetes
We are here now

5.7-6.4%
Consistent with increased risk for diabetes (Pre-diabetes) 
Four months ago we were here

> Or = 6.5%
Consistent with diabetes


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Table Created: 20171019-TH: Hemoglobin A1c Reference Ranges Per MyQuest 2017
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Interpretation - Hemoglobin A1c (MyQuest, 2017)
“This assay result is consistent with a decreased risk of diabetes.  According to American Diabetes Association (ADA) guidelines, hemoglobin A1c <7.0% represents optimal control in non-pregnant diabetic patients. Different metrics may apply to specific patient populations.  Standards of Medical Care in Diabetes (ADA).

Doctor’s Prescription – “Keep up the good work (CDM, 2017)”.
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What we got and paid for?
The appointment of interest is: 20171010-TU @130pm – Physical with Doctor Mojica (CDM).  As we mentioned earlier, this is our fifth (5th) and best physical yet with CDM.  He did mention our Wow! I see that …you tackled the Blood Glucose Level issue.  He pointed our far more strengths that deficits.  Hats off to Doctor Mojica he’s navigated through the Panama Canal :o)
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Lab – White Blood Cells (CBC and WBC)
Now we move ahead to examine our Complete Blood Count (CBC).  We first regularly (1 per month or even more frequent) had a Complete Blood Count (CBC) back in 2006.  This lab test is a big time topic in a context other that our Physical.  CBCs and how they are important for us have been and will be addressed in other MSG papers.  For now, over time our White Blood Cell (WBC) Count (WBCC) has fluctuated up and down.  Most of the time we face results measuring that our WBC Count is elevated.  Since 2007 no doctor has ever been able to satisfactorily explain what is going on.  For us an elevated WBCC is protective.  That aside we feel the highest correlation is between our dental health and lab fluctuation.  Doctor Mojica recently associated our elevated WBC’s with a toe injury.
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[INSERT TOE INJURY]

Image - Toe Injury That Doctor Associated with Elevated White Blood Cell Count

20171019-TH: My Quest Update


Figure - Lab – White Blood Cells (CBC and WBC) – Period: 20170123-20171004

No Comment Necessary
This is an example of data presented in time series graph form (Line Graph) or longitudinally.  We address this data in separate reports under CBCs and the CBC Registry (For Clozapine).  See the area below 6.0 now that would be a serious problem for us.
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Lab – Lipid Panel
Here we will give you the Full Monty of data presentations: Text, lab report, level one and drill down to longitudinal results.  They each have some value.

20171021-SAT: Applied: Date of Service: 20170307
For Date of Service 03/07/2017 we had our Lipid Panel run.  We are high (H) on Cholesterol, Total and LDL-Cholesterol.  For managing our elevated Cholesterol Doctor had put us on Med-A.  There was a gap in getting Med-A refilled.  Without it our Cholesterol went back up to were the report below shows.  To get a look at these results we discovered and signed in with MyQuest.  We were looking for a report that indicated we actually had been controlled using Med-A.  Thus we were looking for a 2015 report.  This is how we found out the MyQuest only supports 2017 results and onwards.  For the 2015 report we got to use Quest’s manual method.  They provided us with what we were looking for Free-Of-Fee (FOF).  We here at MSG like FOF or pro bono.  Pro bono might be described as denoting work undertaken without charge, especially legal work for a client with a low income.

Three Different Formats - Name the Formats

Lab Report
Graphic Organizer
Time Series (Longitudinal) – Line Graph

Figure – Lab Report Format

We just checked and this format is not available online using MyQuest.  It would be the format if Quest were to send a paper report to the doctor or you as consumer (client).  For long reports this is the best format.  This format has been in use at least since the 1980s.


20170914 – Lipid Panel Update
Collection Date - 09/14/2017


Aside: ASK-Ahnika
Brief promotion for our ASK Ahnika Idea.  We have a niece Ahnika that is a PhD and MD.  We think that one day she may start an ASK Ahnika Service.  When we ask her Health & Human Services (HHS) questions she boggles us.  By increasing her encounter rate through her ASK Ahnika Services she might begin to better serve us her at MSG.  We tried to associate us as her paraprofessional yet to no avail.  That means we have still failed to sell our service.
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Lab - Last format: Time Series or Longitudinal
Nate: Actually Time Series is a better name for what many are calling Longitudinal.

Lipid Panel Update
Collection Date - 09/14/2017
Result – 148mg/dL
Reference - <200mg/dL


Figure - Time Series Line Graph – Longitudinal Format – Cholesterol Update


Lab Topic - PSA, TOTAL – Is It Sexist?
There are far more results to Metabolic and Urine Panels.  Yet considering that most are unremarkable we will close with our Prostate-Specific Antigen or PSA results.  PSA is a test for Prostate-Specific Antigen.  As you can see below our results are favorable.  We work hard on our Prostate health.  It is good to see it is paying off.  We are rather amazed the CDM selected the PSA method to track the health of our prostate.



Collection Date - 09/14/2017
Result = 0.9
Reference = < OR = 4.0 (ng/mL)  

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FYI - Prostate-Specific Antigen
“The total PSA value from this assay system is standardized against the WHO standard. The test result will be approximately 20% lower when compared to the equimolar-standardized total PSA (Beckman Coulter). Comparison of serial PSA results should be interpreted with this fact in mind.  This test was performed using the Siemens chemiluminescent method. Values obtained from different assay methods cannot be used interchangeably. PSA levels, regardless of value, should not be interpreted as absolute evidence of the presence or absence of disease.” (MyQuest, 2017)

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FYI - PSA Measures and Protection

“Prostate-specific antigen, or PSA, is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in a man's blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood.” (MyQuest, 2017)

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Leveraging Lab Results
The three providers that may help us collect the record(s) we need are: Brand New Day (BND), Quest Diagnostics and Central City Community Health Center (CCCHC).  Respectively the consumer portals for these are named: (BND) Cerecons, (Quest Diagnostics) MyQuest, and CCCHC don’t have a portal at this time.  The next results from our physical we need are not available on Cerecons and our not warehoused by MyQuest.  We need to get them from CCCHC.

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Query “central city community health center records request form”

20171019-TH: We searched online for a Records Request Form (RRF) on the CCCHC site.  We could not find one so we called CCCHC the clinic.  They asked us to come in person to fill one out.  CCCHC is sort of behind the curve as far as what they offer online.  Next we want to know our Spirometry and Hearing Test results.  We also accessed the parent agency Brand New Day’s (BND’s) Patient Portal.  Neither our Spirometry nor our Hearing Test results were reported on the BND Patient Portal.
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Action Item - New and Improved – Informed Decision Making (AI-01)
In order to make promising and better-informed decisions we are going to request records from Central City Community Health Center (CCCHC).  We want records from two recent visits: 20170914-TH & 20171010-TU.
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Formal Paper Record Request Process (FPRRP)
Just above we addressed the Record Request Process (RRP) as an Action Item.  In our legacy reports we used to commit to many Action Items.  In this report we will keep our Action Item (AI) commitments to less than five (5).

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Assessment Segue
Now, let us dispose of the remaining Assessments.
Assessments (MSG, 2017) – MSG Assessment Elimination List


-



Acro
Instrument
Target
Offered by


-



BSA
Boy Scouts of America
Consumer & Provider
Consumer

HFA
HEDIS Fitness Assessment
Consumer
Consumer

ProQOL
Professional Quality Of Life
(Burnout & Compassion Fatigue)
Consumer & Provider
Consumer

RYD
Rate Your Doctor (Online)
Series
Provider - Objective
Consumer

SAT
Satisfaction & Satisfaction Suggestion
Provider


VOA
Vitals Online Assessment – KD
Provider
Vitals

VAP
Vitals Assessment Plus – KD
Provider
Consumer







Table – MSG Assessment Elimination List – Last Update: 20171020-F

MSG Assessments - Separatism As Measured By (AMB) - ProQOL
We addressed the Rate Your Doctors assessments such as Vitals earlier on.  We decided to leave out the Pro-QOL with one note.  The ProQOL assessment reflects some provider consumer separatism.  In general consumers are offered Quality Of Life (QOL) assessments much different from the ProQOL.  The ProQOL is designed to measure the Quality Of Life for a Professional.  This implies that consumers aren’t not worthy to share the qualities that make life rewarding as a Professional would be gifted.  As we stated earlier CCCHC (CMD) discontinued the Satisfaction Survey that they offered at Physical time.  That leaves for discussion our BSA and HFA evaluation tools.  First let us look at the BSA findings.
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Quality Of Life (QOL)





Acro
Instrument
Target
Offered by






ProQOL
Professional Quality Of Life
(Burnout & Compassion Fatigue)
Consumer & Provider
Consumer







Table – Quality Of Life (QOL) Assessment – Last Update: 20171020-F – Results Fractionated Out.

Assessment – Boy Scout Model – Virtues and Values

Metadata > Assess_Virtues_BSA_14112901_Register V2017
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Boy Scouts of America (BSA) Results Here (Lived Experience)
We guess at age eleven (11) or in 1970 our principal Mr. Torkelson began indoctrination into the Boy Scouts of America.  Because his role models were either Eagle bound or had achieved the rand of Eagle Mr. Torkelson set his sights on achieving the rank Eagle.  Our records show he was awarded the Rank of Eagle Scout in 1974.  Part of the Eagle process is one demonstrates knowledge in depth about the BSA Law.  You also commit to practice the BSA Scout Law to the best of your ability in all affairs.  MSG’s BSA instrument is derived from the Standardized Scout Law.

FYI - Scout Law (BSA Assessment – Brief Version)
-
“A Scout is trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent. The Scout Law has 12 points. Each is a goal for every Scout.”

Mutable (Adjective)
Mutable might be defined as liable to change.  If you are mindful of the Laws in all your activities you can sustain or improve your performance about the Law.

Metadata – Sampling - Boy Scouts Assessment (BSA)

Figure – A Sample of BSA Related Metadata: Last Reviewed: 20171022-SUN
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Addressing Friend or Fantasy
One of the assessments for Character and Personality that we here at MSG are familiar with is the basic version of the Boy Scout Law (BSA).  We often apply it to see if we have a good friend or a good friend in the making.  Basically most if not all of our contacts within “Central City” (CCCHC) do not qualify as Good Friends.  Next we have some BSA related data points.
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Assessment – Standard Boy Scouts’ of America (BSA) – Scout Law
Metadata > Assess_Virtues_BSA_14112901_Register V2017

MSG and Buster Rates Others (Proofed By AVEY)





TimeStamp
Role
Result (%)
MSG on…






20170916-SAT
PCP
57.5
CDM

20171010-TU
PCP
70.0
CDM






20150321-SAT
Family Therapist
70.8
JMB

20161001-SAT
Family Therapist
80.0
JMB






2013-Retro
General Control
85.0
KM

20170916-SAT
Supervisor
85.8
KM

20161001-SAT
Supervisor
90.0
KM







Last Updated: 20171018-W: Applying the Boy Scout Law (BSA) Assessment: Brief Version.

FAQ – Is it helpful for your doctor(s) have the qualities of a good friend?

FAQ – What is up with the Metadata?

Assessment – HEDIS
The Healthcare Effectiveness Data and Information Set = HEDIS
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Checklist
In the Physical process the fewer surprises the better.  Back 2012 we found in order to cope with the drama associated with a CDM Deficits Based Physical we created a checklist.  Eventually we backed our checklist with a HEDIS Criterion.  The HEDIS Criterion is not numerical in nature.  We began developing a scored reflection of HEDIS.  HEDIS is complex in given year.  HEDIS may be revised from year-to-year.  For the time being we stick with 2010 HEDIS the one we discovered first.
-

HEDIS & HEDIS Extended - Assessment Development
Again, we here at MSG developed our HEDIS tool in order to cope with Doctor Mojica concentrating on our deficits.  Even when we request our records from our Physical we expect that as usual the labs and other findings will not be quantified for application as outcome measures for us.  This year our HEDIS Fitness Assessment Score is 100%.  We still have one serious physical health risk factor.  We smoke cigarettes.  The reason our smoking does not drive our fitness score down this year is because our COPD status is Stage Two (2) of Four (4).
-

[INSERT COPD IMAGES X 2] - FYI





Metadata - HEDIS

Figure – HEDIS Findings In Our (TorkBase) Database (Metadata)
-

Assessment – HEDIS
Metadata > Assess_HEDIS_Base_17082901_Re-Develop

HEDIS 2010 Measures – 21-Item
Using the HEDIS 2010 as a template we created our HEDIS Driven Fitness Assessment (HDFA).  It is a twenty-one-item tool.  It is nowhere as refined as it could be yet it does suffice to offer a ballpark figure.  Presented in the table below are our HDFA results for three (3) TimeStamps.
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HEDIS - HDFA
Date Score
Day of Week
20161208
TH
20170902
SA
20171006
F







Section A
7 Items MAX
Score (Items Scored)
6.0 (7)
7.0 (7)
7.0 (7)

Section B
14 Items MAX
Score (Items Scored)

10.0 (10)
11.0 (11)
12.0 (12)








Fraction
Total Score/Items Scored
16.0/17
18.0/18
19.0/19


HEDIS Fitness Score (HFS) =
71.4%???
Correction
94.1%
100%
100%














Results for HDFA = HEDIS Driven Fitness Assessment – Last Reviewed: 20171020-F:
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Error Checking
On 20171006-F all scores were recalculated – Errors detected were found in our favor.  20161208-TH was 71.4%: Is 94.1% on 20171020-F:  We here at MSG have small 3% error rates in calculating.  At some point we are going to dig up all of our HDFA calculations and proof them again.
-

100% Justification
Once again, a reason we scored one-hundred (100) percent is that for the HEDIS items that apply to us the one that held us back in 2016 (Cholesterol) is under control.  In addition our Risk Factors for COPD are not impinging to full detriment (yet).
-

FYI - 20171022-SUN: HEDIS
“The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 81 measures across 5 domains of care.”
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Evaluation - Primary Care Physician (PCP) Comparative History and Quality

-




PCP (Doctor)
Friend or Foe
Association
Sample or Solution

-




Gee
Friend
Kaiser
Urinary Track Infection UTI

Hanley
Friend and Mentor
Independent
Repaired avulsed left thumb

Biorkman
Friend
Bristol Park
Jungle Rot on both feet

Mojica
Antagonist
CCCHC
Cholesterol Drama

Clark – UCD
Foe
UC Regents
FAILURE to Help

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Last Reviewed: 20171019-TH:  Comparing PCP’s and doctors that practice or have practices family medicine.
-

Nature of Our Effort(s)
Why spend so much time reporting about this year’s physical?  For one to get our numbers normalized was a huge achievement.  And two we have been generating and silo-ing a good deal of data that may help others get the most out of their physicals.  Last we are proud with put our Blood Glucose Levels we put in order and under control by behavioral rather than pharmacologic means.
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Selling Satisfaction (A Passion)
After vetting hundreds of assessments we have decided to specialize in Satisfaction Assessment half time (0.5 FTE).  We just created our new hey it is really cool and happening Resume.  We may get to graduate in the OCHCA across to a different ladder.
-

Physical – CDM (Process over Patient)
When we began seeing Doctor Mojica back in 2012 he tended to practice process over patient.  He told this on a couple of occasions: “This is how we do it around here”.  This fifth physical (2017) is the first time that we felt he was beginning to practice patient over practice.  Indeed Doctor Mojica is evolving in real time.
-
Assessments - Omitted






AcroCode
Instrument
Target
Offered by






HRA
Health Risk Assessment
Consumer
CCCHC

PHQ-9
Personal Health Questionnaire (9-Item)
Consumer
CCCHC

QOL
Quality Of Life
Consumer
BND

SHA
Staying Health Assessment
Consumer
CCCHC

SFXN
Satisfaction
Consumer
CCCHC-V


-




Last Reviewed: 20171019-TH: Prescribed Assessment Pod for Report for a Physical.
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Prescribed Assessments
Beginning in the summer of 2012 and yearly until the present a CCCHC Physical included written Assessments.   We call these Prescribed Assessments because the BND/CCCHC Axis asks you to complete them.  For 2017 The Axis dropped all of them.  Therefore we will withhold our findings and discussion associated with said omitted Assessments.  One note about Prescribed Assessments and Solicitation: If BND or CCCHC does not solicit for a particular Assessment they are very likely not to take into consideration the results.  Actually this applies across a broad range of Health and Human Services Agencies.
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Brand New Day Extracted – Satisfaction
We discussed BND Satisfaction Assessments such as the KCSS and ACSS on the corporate level earlier.  We decided to leave our findings and discussion about those as well.
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Summary and Takeaways – Loose Ends

Doctor Chester D Mojica (CDM) and Team
Even though this report has been focused on Doctor Mojica’s part in delivering a Pre-physical and Physical we also compliment his team as well at their efforts.  We would like to thank our Pre-physical nurse for her excellent bedside manner.  Using our Quick Score Method (QSM) we give her 5.0 Stars with 5.0 Stars being best.  We still don’t know her name because she does not brandish a visible Identification.
-

Presenting Problem(s) – Progress Note
We have fewer problems this year (2017) as compared we 2013-2016.  What follows are our problems that linger: Sleep Disorder, Attention Deficit Disorder, Cigarette Smoking, trying to link with a new Behavioral Health doctor of our choosing, and we are always at risk of homelessness.

Promotion – MyQuest - Manual Request Form

Secured by Quest Diagnostics © 2000-2017 Quest Diagnostics Incorporated. All rights reserved.

https://myquest.questdiagnostics.com/web/home. If the records you need from Quest are prior to 2017 you will need to do it manually using their form.
-

Satisfaction Inventory – A Legacy in and Passion about Satisfaction
It was in 2007 that we came across our first satisfaction survey in the context of Health and Human Services (HHS).  It was offered in the waiting room of the Orange County Health Care Agency’s (OCHCA) Costa Mesa Clinic.  Although the format was not ideal it introduced us to the concept of mutable Satisfaction.  In addition, the OCHCA Assessment addresses domains of living and Satisfaction such as Legal Status and Housing.

FYI - Mutable
Mutable might be defined as liable to change.

Close
Last in this report (study) we share some links to our in scope legacy publications and an image gallery to deal with lose ends and miscellaneous discoveries.


20171022-SUN: MSG and Associates
Legacy Links Associated with BND & CDM & CCCHC

Developing Objectivity – Strengths Legacy

Triple xxx TheDAG - Digital Appointment - Development | AnimaCules
http://ktork46.blogspot.com/2015/02/triple-xxx-dag-digital-appointment.html
Triple xxx TheDAG - Digital Appointment - Development. Technological Needs in Human Services. #IridiumRecords. Posted 9th February 2015 by Keith Torkelson.

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Nov 5, 2016 - Keith E Torkelson (MS) External Review Officer Findings About Central City Community Health Center Garden Grove Staff and Scheduling Central City Community

Saturday, November 5, 2016

#Central City Community Health Center #Counter Staff #Scheduling
Co-authored By Buster D Right 4 Complaint Management
http://the-torkel-saga-2059.blogspot.com/2016/11/central-city-community-health-center.html
Deadline – November 6, 2016 (SUN): Met by 1630 PST

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Brand New Day HMO - Blog Charter by Keith Torkelson & Team AVEY
20171019-TH: Keith Torkelson – 17 Views – Chartered - 5/27/17
http://brandnewdayhmo.blogspot.com/2017/05/brand-new-day-hmo-blog-charter-by-keith.html

Chester Diokno Mojica MD – Strengths By Keith Edward Torkelson, M.Sci. With MSG for 2-20171019-TH: BND_HMO - Keith Torkelson – 28 Views – Chartered - 5/29/17
http://brandnewdayhmo.blogspot.com/2017/05/chester-diokno-mojica-md-strengths-by.html
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Slide Show - Image Gallery for Annual Physical Exam - CCCHC


COPD - What Can We Say - We are at Risk
[INSERT LINK TO COPD UPDATE]




We Here @ MSG Like Cows
We think this is the Up Dog Position (UDP)
Milk is part of our Celery Diet
Cholesterol Results - Obtained by Consumer Using Patient Portal MyQuest
White Blood Cell Count Results - Obtained by Consumer Using Patient Portal MyQuest
Satisfaction and More Satisfaction
This is an example from the Health and Human Services Agency powerhouse NCQA

Show and Tell Feature of Our Appointments
For Our Physical Doctor Reviewed this Physics Exam Page in Hard Copy Form
-


MS Word 2000 Pro - Readability Stats for This Paper (Publication)

2017 Key Event - Retina Detachment Reversal Surgery
Ready as Part of Our Digital Appointment APP (Beta)
White Blood Cell Count Results - Obtained by Consumer Using Patient Portal MyQuest
Glucose Results - Obtained by Consumer Using Patient Portal MyQuest



Lipid Panel Results - Obtained by Consumer Using Patient Portal MyQuest



Waiting for Yoga to Start
24 Hour Fitness


Monitor Facing and Easy to Read by Consumer
In Network Ophthalmologist Exam Room

Celery Diet
Ratio Carbohydrate - Lipid - Protein (CLP) Favorable

Reduce All Sodas - With or Without Sugar
Celery Central
Monitor Facing Consumer and Easy to Read by Consumer
Example Kelly Paper 
Celery Diet Indicator - Weight Improvement
Health Risk Assessment (Annual)
HRA Skipped this Year (HRA)

Celery Diet - Reward - BLT w Mayo

Brand New Day Provides for Free 24 Fitness Membership
This is our yoga room just before class
Example of Technology Used for Recovery
In Network Dermatologist Exam Room
We left out details about our Celery Diet
Here is an indicator about our results
We finally get to get rid of our big person pants

Example of Technology Used for Recovery
24 Hour Fitness - Fountain Valley - California - USA


That is our principle there at yoga (AVEY)

Brand New Provides for Free 24 Hour Fitness Membership
This was our card to our yoga teacher setting boundaries for ourselves because we do not wish to mess up the therapeutic value of our relationship
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Brand New Day Provides for Free 24 Fitness Membership
This is our yoga teacher Kamara


We would like to see Central City Community Health Center (CCCHC) invest in Free Wifi for Their Consumers (Patients)
Example here free Wifi at Fountain Bowl
Right now we are publishing this at Starbuck's
They have Wifi for a cup of coffee ($1.95)

Arterial Oxygen Saturation Measurement Taken By Consumer

Doctor did Update our File that We Were Still Walking
Subject - Technology for Recover
SmartPhone - Actual Data for Keith (Buster)


Free Wifi @ Del Taco for Consumers - CCCHC Lacks Free Wifi


Image - Consumer (Patient) Computing Resources
CCCHC Lacks (Free) Wifi - Example Here Free Wifi at Walmart




Image - We Skipped Over Recent Retinal Detachment Event a Key Event for 2017
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Appendix - Metadata for Special Topics

-




Special Topic

Special Topic Metadata


-




1-Satisfaction

[PARTIAL]


2-Blood Carbon Dioxide Levels




2-Blood Glucose Level (BGL)

SCR_Lister_17092201_Energy Study
TTS_Digital_Appointment_17072006_F2F 4 Energy


2-Complete Blood Count (CBC)




2-Fecal Occult Blood Test (FOBT)




2-Lipids

Assess_ConMan_Lipids_17030501_Develop
Records_Portal_MyQuest_Lipids_17040403_Round-02







Christmas Report Card (CRC)




Compassion Fatigue

Assess_ProQOL_16031203_Results V2017


Digital Appointment

TTS_Digital_Appointment_17093003_F2F 4 Physical


Global Health Fitness

11_RENHEW_Exercise_16031204_Counts V2017
Assess_HEDIS_HDFA_16120801_Results V2017


MSG’s Celery Diet




MSG’s Health Related Engagements (HREs)

2016022801 HREs Step-03 V2017



MSG’s Structural Temporal Reconciliation (STR)

[SEE BELOW]


Patient Portals

08_Records_Portal_MyQuest_17030802_Account
Records_Portal_MyQuest_Lipids_17040403_Round-02


Record Request

Provider_CCCHC_Records_Request_17091403_Process


Scheduling

[SEE BELOW]


Show and Tell

Prosumer Prosuming with Prosumption


Sleep Disorder








Matrix - Special Topic – Metadata for Special Topics: Last Updated: 20171020-F:
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Appendix – Legacy Links

Assess_VITALS_17031902_CDM_Strengths
Below are links to two legacy reports that we have published for Doctor Mojica.  As you could see in the second one we made an effort to focus on his strengths (Strengths Based Principle).

Legacy Publications
-
Brand New Day HMO - Blog Charter by Keith Torkelson & Team AVEY
20171019-TH: Keith Torkelson – 17 Views – Chartered - 5/27/17

Chester Diokno Mojica MD – Strengths By Keith Edward Torkelson, M.Sci. With MSG for 2-20171019-TH: BND_HMO - Keith Torkelson – 28 Views – Chartered - 5/29/17
 

And…That is All She meaning me AVEY…Wrote…
#30 > #IridiumRecords > #AVEY > #Buster









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