Medical notes

Unfortunately, my wife and I have had medical issues, and no longer being 25, navigating the medical system is complex, and often exasperating.

I notice that basically, i.e. on the whole, the systems and people are wonderful, caring, and really interested in keeping you healthy.

Unfortunately the system "breaks" at the smallest issue, being an engineer, it's frustrating navigating things that are not clear, and are poorly designed systems.

I'm going to list tips in no particular order.

 

We are with UCSD medical, headquartered in La Jolla, California, so much of the information will be UCSD - specific.

Again 80% to 90% of the "experience" is GREAT, and we have a great GP and Cardiologist.

 

The EPIC system - UCSD, Scripps, etc.

This is the computerized base of operations for many medical groups. Used properly, it's pretty good. In San Diego, UCSD, Scripps, and North County Health all use it,

BUT!! There are a number of features and not all groups have all the features.

Your daily MyChart / EPIC routine:

You must realize that this is a complex system, and the information you NEED to access on a daily basis is in several places. To make things easier, you can customize your menu to put the things you use most often in your personal menu. I suggest the following order for at least the first 4.

Messages

This is where most stuff comes, and it is like text messages on your phone. When you enter, you see them sorted by date, the newest on top. Note that sometimes someone sends you something that you cannot reply to! Sometimes this is a mistake, but if you have no way to reply you need to make a phone call.

Important thing to remember with UCSD's implementation is that you cannot just send a message to anyone, they need to be on your "list", which at the minimum should be your primary doctor. You can also call someone and ask them to message you via mychart. Very frustrating some times, this underscores the need to have phone numbers for EVERY office you may have to contact.

Visits

You need to be sure to check this regularly. Often you receive no other notice, and sometimes an upcoming visit disappears. (Not all parts of the UCSD system use Epic well, and some maintain their own scheduling system and often miss updating Epic)

You can see the upcoming visits, and the past visits.

Check your upcoming visits to see their status, that you have answered all questionnaires and confirmed. You will normally get notices to do this, but DO NOT RELY on the system letting you know.

Very important: The Past Visits have the doctor's notes and the after visit summary. You need to read this stuff yourself. It's great it's there, but read it, there could be recommendations you need to follow that you missed in the visit, and also check for wrong information.

Test Results

This is another thing you need to keep up on. Your doctor may be concentrating on a particular thing and miss results pointing to something else. Once you get a test result, notice the tab "Graph of Past Results", check that and you can see trends that your doctor may have missed.

There is a tab for Past Results, but it does not show the normal and high and low limits.

Do this every time you have a blood draw.

NOT AVAILABLE ON YOUR PHONE !!! (In fact don't use your dang phone except to check appointment times and show your Covid status)

Upcoming Tests & Procedures

This category really should be combined with Visits, since it can be very similar. It only has upcoming, since the results go in Test Results or Visits.

So, you need to check this too, as it shows upcoming things to do.

It's also where "orders" for tests like blood draws, mammograms are put, so you can see that something is authorized already.

Letters

Sometimes someone will send you a letter. This is a more formal communication from the hospital/doctors. You cannot reply AND notice that the system notes the day you viewed the letter, so you should read these, and check periodically, since they have "legally" delivered the "letter" to you.

Other things to check in EPIC on a regular basis:

Medications

 Things can change by someone making a mistake. Often when you are in hospital, the team taking care of you screw around with other medications, often forgetting to give you medications for other issues they are not treating. You should be SURE to check your medication list after you discharge. Also while in the hospital, you can see you special pages for the in hospital care, and check the medications there, look for ones missing.

Account information

Check this out, both my wife and I had the issue that the contact phone number was unverified. Mine took 6 months to fix and my wife's is STILL unverified after one year! Call the website support people, get a case number and call them weekly. Really screwed up.

Messaging / contacting your doctor (also called conversations0

Another huge nightmare! The best way in my opinion is the messaging system, because someone eventually sees it. If you have a fantastic doctor as we are blessed to have, they are on it, and his staff or even he himself answers.

But often you can get a smart-alec person telling you to go somewhere. The good thing is there is a record of the bad treatment. (The bad thing is even reporting it to the UCSD "customer service" office probably does nothing). But the message/conversation is documented, and if you do get into a pissing match, someone eventually notices at the doctor level. In my case the doctor still did not get it at all.

OK, so to send a message, you need to RECEIVE a message first, AND it must be sent without REPLY BLOCKED. I still feel this is the best way since it is documented.

Next best way, and the way you need to follow if you cannot message is to call the Doctor's assistant, but you need to find this person, and it is difficult.

MAKE A LIST of all the people and their contact numbers. Be aware often they give you some general number to the hospital, which is worthless, you need to get to at least the voicemail of the specific person.

See more on Phone Numbers below.

Know your phone numbers

Get every direct phone number you can get. Hospital operators are USUALLY just trying to get you off the line and into someone's voice mail.

UCSD La Jolla numbers

all numbers start with 858-657-xxxx

Sulpizio

  • 6700 - CVC 2 ICU –  actually on 2nd floor in Thornton bldg
  • 8260 - 2nd floor PTU
  • 8330 - 3A ICU - rm 301-312 – 3rd floor
  • 8340 - 3B PCU - rm 313-327 – 3rd floor
  • 8410 - 4A PCU – rm 401-412 – 4th floor
  • 8420 - 4B PCU – rm 413-427 4th floor
  • 8246 - Heart failure pharmacist               
  • 8530 – main sulpizo – to cath lab, etc, usually worthless
  • 5050 – heart transplant unit

Visiting at UCSD La Jolla

Layout and parking

What a mess! I will speak to the main complex. There are 2 "complexes", one at 9300 .... off of genesse... follow the signs. There is a second complex just a bit further south, where you go for Urology.

The main complex has a circular loading area, where you can valet your car. The valet parking is the same cost as the parking structure, so for most people

Getting in:

This requires following the rules:

  • To get on the list:
  • Currently only one visitor per day, and ICU has a 15 minute visitor limit (which is not enforced if you are nice and don't bug the nurses.)
  • First, for at least ICU, PCU, PTU (see meanings elsewhere) you MUST be on the visitors list.
    1. you must call the ward where your patient is, see the phone numbers below.
    2. you are supposed to talk to the Charge Nurse (see definitions below), but that can be tough
    3. Whoever you wind up with, have them put the visitor's name "on the list"
  • Supposedly after about 5 to 10 minutes later, the people at the entry will see you are on the list and let you in.

BUT!!!!

This breaks down all the time.... people don't put you on the list, the people at reception are untrained (quite often) and the list is ERASED every midnight (what idiocy!!!)

Also, there are shift changes at 7 am and 7 pm, anything done within 1/2 hour of those times is often screwed up.

So, when you go to visit, if you are not the spouse, then you need the spouse or caregiver available by phone to call the ward to "put you on the list"

There is NO external way to check "the list" except calling the ward. If it is ICU. PCU, PTU, or the ER, it's hard to get anything done.

UCSD Billing issue

This has happened to me 3 times, so you have to look out! I got a copy of a statement from a visit to my GP lately. Just using rough numbers for the example, the service was billed, medicare paid part, and the part left over was $140. The ORIGINAL bill shows this detail, and shows that the $140 is being sent to my supplemental provider, who will pay the rest of what medicare does not pay.

(for those not familiar with how this works, medicare will often pay 80% for a qualified procedure. Then supplemental insurance you obtain will pay the other 20%, net zero cost to you for medicare-covered procedures. If you are on medicare, tell your providers that in no circumstances should they do anything that medicare does not cover)

So back to the issue. the first bill comes in and says the 20% that medicare did not pay (after medicare covered 80%) was being sent to my supplemental insurance.

So far, so good, BUT!! I immediately get billing notices for the $140 on the web/phone app, in fact it pops up first, interfering with me using the app. Today I got a bill for it, and here is something to remember, after the first bill with the breakdown, ALL subsequent bills have NO DETAIL, and just say you owe $140.

That is bad, and I called up because I fell for this before, and yelled at the billing people. I asked why I was getting the bill, and she came back and said that my secondary insurance was not contacted.

How the hell does this happen? Since my insurance information is on a single web page and both medicare AND my supplemental show, and this seems to often happen at the same medical location, somehow it must be human error.

So the lesson is be vigilent! Check every bill/statement that comes in. Make a note if they say they are submitting the bill to the secondary insurance, and if you get something in the mail, raise hell immediately! Last time this happened I got a call from a collection agency. Shame on you UCSD and your lousy system!

 

Scripps La Jolla (Genessee)

 

Surgery Postop / Recovery 858-626-6187

Surgery Preop 858-626-6923

 

UCSD imaging

 How to get a scan (CT, MRI, ETC) into the UCSD data system.

Call the Perlman Digital Library people, 619-543-6586, often they can get the upload to the Epic system done in a few minutes. I talked to Rosa, fantastic help!

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