Brand New Day HMO: June 2020

Feature Photo

Doctor Boyce and Team

Doctor Boyce Retires this Year 2020 as a Model Doctor

Specialty - Ophthalmology

Title

Tele-psychiatry I by Keith E Torkelson, MS Experimenting with Rimal B Bera MD for Brand New Day HMO

Dedicated to:

Andrew Inglis, Annie Nguyen, Bum Soo Lee, Clayton Chau, George G Torkelson, Gloria Shanks, Hans P Riemann, Joyce Maxine Brown, Kevin Weiss, Mark Refowitz, Ravinder P Singh, Rimal B Bera & the rest here at the Plum Island Annex Facility

In Memory of:

Bera Patient – Road Kill Mark

Wally “Wallace” Gator

New Old Man John

Blogs

AnimaCules

Brand New Day HMO

+/- Other

+/- Twitter Promotion

Abstract – Executive Summary

During the period 2012-2014 we here at Mentalation Solutions Group (MSG) enjoyed a better readership. The page views for our publications were typically in the hundreds with few instances in the thousands. One reason early on for our superior readership is that Buster wrote about his interests rather than his problems. At the end of this report your will see a few of our reports that have delivered a degree of readership that inspires us to keep up the pace. MSG also includes some of Keith “Buster” Torkelson’s performance scores. Overall Buster has a Science Grade Point Average (GPA) around 3.5. His Social Science GPA is 4.0. The principal targets for this report are Buster the consumer of Behavioral Health Services (BHSs) and Rimal B Bera a provider of BHSs. On and off we use doctor Andrew Inglis MD as our “Control” doctor. For most of our assessment scores shared here: High scores are favorable.

Assessment Results

For both doctors Inglis and Bera we applied one of Mentalation Solutions Group (MSG) assessment tools that yields a Practice Module Score or PMS. For his services with Buster back in 2007 Dr. Inglis earned himself a Quick Grade Score (QGS) 23.3 over 24 Items. This score equates to an “A” or 3.9 Grade Point Average (GPA). For doctor Bera’s services thus far this year (2020) Dr. Bera earned himself a QGS of 20.7 over 24 items. This score equates to an “A-“ or 3.5 GPA. Next we calculated a Prowess at Professional Tasks Grade (PPTG) for Dr. Bera. We tracked him over 11 Items. For his PPTG Dr. Bera earned himself a 22.7%. The time stamp for the PPTG was May 23, 2020.

Assessment Results – Technology

This assessment results section deals with professional services from a technological needs perspective. We applied one of Mentalation Solutions Group (MSG) technology screener tools on Dr. Rimal B Bera MD. For a Behavioral Health Doctor TechnoHealth Mastery Score (BHD-TMS) we assessed him twice. First we scored him a BHD-TMS for the whole of service year 2019. For this he earned a 40.9%. Second we scored Dr. Bera as if Buster and he both were using Video Conferencing. MSG offer up a future score of 40.9%. Next we addressed Dr. Bera’s prowess with his Electronic Health Record or EHR. Our assessment yields what we call an Electronic Health Record Utilization Score or EHR-US. We scored Dr. Bera about two time frames: The whole of service year 2019 and 2020 for what we expect. For Dr. Bera’s EHR-US during service year 2019: Dr. Bera earned himself a 27.1%. When he converts Buster to Tele-health we here at Mentalation Solutions Group (MSG) do not expect much better unless Dr. Bera authors and gives to his clients an appointment, RIGHTing, and recovery workbook.

American Psychiatric Association (APA)

The American Psychiatric Association (APA) is fully engaged with Tele-health, Telepsychiatry, and Distance Medicine. The APA enumerates several benefits with distance psychiatry. Here Mentalation Solutions Group (MSG) calculates and shares an expected TecknoHealth score for doctor Bera. For his Benefit of Telepsychiatry Score or BTS he earned himself a 33.3%. Teladoc a seasoned tele-health provider is one of our standards for evaluating tele-health. Following a service call from Teladoc they request a consumer-driven quality of encounter assessment. We are sure Dr. Bera if he applies similar Quality Control as does Teladoc his BTS may improve immensely.

Comparisons

What follows are the results of three assessments that compare. We compare Teladoc, Bera, Chester D Mojica, and Inglis. Our first instrument yields a Telehealth Comparative Benefit Score or TCBS. For Teladoc we snap a shot of Buster’s telephone encounter on March 21, 2019. Our Teladoc that day was Annie Nguyen. Overall we compare Annie, Rimal, and Chester. Respectively doctors earned themselves a 100% (Annie), 27.8% (Rimal), and 44.4% (Chester). Bera’s score is for the 2018-2019 interval. Mojica’s score was captured in real time (RT) near the close of 2019. Our second instrument yields a Psychiatric Service Score or PSS. We apply this test to Bera and Inglis. Remember Dr. Inglis is our high performing control doctor. For his PSS for the service year 2019 Dr. Bera earned himself a 50.0%. For his PSS for service year 2007 (Scored retroactively) Dr. Inglis earned himself an 85.0%. Again we compare doctors Inglis and Bera. Using a another screener we calculated their TechnoPsychiatry Performance Earned Value Score or TP-PEV. Respectively they earned an 80.0% and a 35.0%.

Tele-health

As one can and will vision we here at Mentalation Solutions Group (MSG) have developed quite a few assessments that we call the Tele-health Cluster (THC). We authored another screening tool that yields a Practitioner Specific Tele-health Value Score (PSTVS). On May 23, 2020 we scored what Buster might expect on his first tele-video appointment. Tele-video (telephone) differs a bit from Personal Computer Video. For his PSTVS we expect Dr. Bera to deliver in the 20.8% range. Dr. Bera has a hard time with Bedside Manner. So what are the benefits of Tele-health? So far this year 2020 we attended two Tele-health encounters. On March 26, 2020 we met with Teladoc’s “Doc” Kevin Weiss over the phone. We calculated Kevin’s Tele-health Benefit Score or THBS. For this service window doctor Weiss earned himself an 87.5%. We also evaluated him using Teladoc’s online service quality evaluation tool. Using Teladoc’s evaluation tool we scored him on par with 87.5%. For doctor Bera’s THBS we expect an improvement after he cuts Buster and Buster’s peers over to tele-health. Last for this Tele-health section we derived a Tele-health Outcomes Score or THOS. For doctors Mojica, Weiss (Teladoc), Bera, and Bera expected each earned the following scores respectively: 25% (Mojica), 81.2% (Weiss), 12.5% (Bera), 12.5% (Bera Expected). Unless doctor Bera gets on the ball with Quality Assurance (QA) including authoring a roadmap to recovery and RIGHT we do not expect much improvement.

Balance Scorecard

Behavioral Health Doctors (BHDs)

Buster enjoys giving grades. As a student teacher with high school science students circa 2000 he gave about ninety (90) summative grades each quarter. In addition, Buster gave far more formative grades. Grades are nice because as a (student) teacher you routinely discover how you are doing with your pedagogy. Overall Buster and Buster’s support system(s) have paid more than ten (10) Behavioral Health Doctors for services rendered. In keeping with Mentalation Solutions Group (MSG) External Quality Review (EQR) efforts we offer up some “Balanced Scorecards”. Buster saw Dr. Andrew Inglis MD over most of 2007. The stakes were high and doctor Inglis pulled through. We award doctor Inglis a Quick Grade Method (QGM) Grade “A”. There is a complication. When we saw doctor Inglis Buster’s demands were less of him than they are with doctor Bera.

Potential

For service year 2018 we here at Mentalation Solutions Group (MSG) award doctor Bera a QGM Grade “B-“. Two of Bera’s strengths are that he speaks in public and he dresses appropriately. Last let us address MD-Quality Assurance (MD-QA). For our QA sub-study we include doctor David Dobos (Kaiser Permanente). With our MD Quality Assurance Screener (MD-QAS) we tested Doctors: Dobos, Inglis, Lee, and Bera. Dr. Lee was Buster Behavioral Health Doctor (BHD) until he retired. Dr. Lee watched Buster’s back from 2012-2017. Doctor David Dobos is our BHD high scoring control. For their MD-QAS each doctor earned 85.0% (Dobos), 75.0% (Inglis), 80.0% (Lee) and 45.0% (Bera) respectively. Doctor Bera has much of Doctor Alan Vu MD phrases: Potential!

Outline

Dedicated to:

In Memory of:

Abstract – Executive Summary

Target Audience

In Scope Professional Network

User Friendliness & Pro-activity of Medical Help

TecknoHealth Defined

Mental Health Services Act (MHSA) Paradox

Let see what others say about you - Bera and Inglis - Inglis First

Command Level

Dr. Bera's Performance – “And Through The Wire”

Subjective Quality Assurance Bera and Inglis

Lived Experience (LxE)

“Top Doc”

2009 – Consumer Training Program

Quick Teladoc Comparison

Insert some Bera Blog Post Stats

Balance Scorecard Behavioral Health Doctors (BHDs)

Haggard - Not

Pagers in Progress - Integrating About Technology

Health Related Engagement (HRE)

Experimentation Using Human Subjects

TecknoHealth – Tele-health & Video-health – Medical Doctors (MDs)

Cutover – Preparing in Advance

Telepsychiatry Value Study – Benefits and Promises

On Operations Manuals

Telepsychiatry Value Study – Applied InSight Benefits Model

ProSumer – Integrated Meaningful Engagements

How Is Telepsychiatry Used? – TecknoHealth Comparative Score Card

Lived Experience (LxE) – Comparative Models of Professional Practice

Sample Encounter - Request for Medication Trial Experiment

Teladoc Benefit Practical - Brand New Day HMO

Special Topic – Teladoc Telemedicine Model

Psychiatry and Telepsychiatry Service Elements (Comparative Screener)

Table – Telehealth Comparative Benefits per American Psychiatric Association (APA)

Benefits of Video-based Telespychiatry

What is Telepsychiatry? - American Psychiatric Association – Electronic Health Records

What is Telepsychiatry? American Psychiatric Association – Applied Definition

Aspects Regarding Telehealth

Psychiatrist Middle Man

Applied Job Duties and Tasks for: "Psychiatrist"

Summary – Choosing Psychiatry as a Profession

Implications of Malpractice – Errors - Psychiatric Malpractice

Improvement – Accountability & Transparency

Partners

Reference & Standards

Google for Free Blog

Target Audience

We here at Mentalation Solutions Group are writing the paper as if we were going to share parts of it with doctors: Bera MD, Chau MD, Nagel PhD and Inglis MD. In addition, we here at Mentalation Solutions Group (MSG) may share parts of this report with the Orange County Health Care Agencies (OCHCA) Kathleen Murray Buster’s former supervisor in Technological Needs. Next, MSG may share extracts of this study with Brand New Day (BND) Corporate. BND is Buster’s health insurer. BND contracts and oversees doctor Bera Buster’s Behavioral Health Doctor (BHD). Finally, of course we will share this paper in its’ entirety with our loyal yet small Blogger audience that has an international flavor.

[INSERT SAMPLE OF STATS & INTERNATIONAL AUDIENCE]

Cycle

In Scope Professional Network

Orange County Health Care Agency (OCHCA) Behavioral Health Services (BHS)

Including Mental Health Services Act (MHSA) Mentors

-
Professional	Association	Now	Project
-
Rimal B Bera	Current BHD	BHD wanting Telepsychiatry	Telepsychiatry
Andrew Inglis	Legacy BHD A Control for Bera	OCHCA Top BHD	Assignment of Title & Role
Jeffery A Nagel	MHSA Friend	OCHCA Deputy Director	Housing Help Line R&B Coalition
Clayton Chau	CTP Instructor Volunteer Work	OCHCA Director	Corona Eradication
-

Last Reviewed: 20200523-SAT: BHD = Behavioral Health Doctor: R&B = Room & Board

Targets for Sharing - Friends

In general whether it is text or a PowerPoint when Buster picks people with whom to share our work he follows through. The table above includes Buster’s targets for sharing this work in part or as a whole. 20190403-W: At Buster's usual Medication Management appointment Dr. Bera says,” No talking”. “Talk to your friends.” We believe he was referring to our associates such as doctors Chau and Nagel. Since our first appointment with Dr. Bera back in 2018 we have spent a good deal of time identifying our support networking. We include Clayton Chau MD and Jeff Nagel PhD in our network of associates. If Buster were still formally working with the Orange County Health Care Agency (OCHCA) both doctors Chau and Nagel would be his bosses. This was the case with the OCHCA’s Mark Refowitz and Kathleen Murray. Buster ended his formal association with the OCHCA during his 2012 episode of Catastrophic Losses.

A Word on Organization

When Buster grew up his father George Gerald gave him many assignments. One was to investigate American Authors. George seemed particularly interested in Thoreau, Steinbeck, and Hemmingway. Last night, May 29, 2020 (F) Buster was triggered to look into Hemmingway. We here at Mentalation Solutions Group (MSG) found one part of Hemmingway’s Wiki important to us. Like Hemmingway, Buster’s manuscripts are growing “out of control”. We here at MSG have to keep trimming by pushing large chucks into our now questionable publication future.

ADD and Inspiration

“In mid-1959, he visited Spain to research a series of bullfighting articles commissioned by Life magazine. Life wanted only 10,000 words, but the manuscript grew out of control. He was unable to organize his writing for the first time in his life, so he asked A. E. Hotchner to travel to Cuba to help him. Hotchner helped him trim the Life piece down to 40,000 words, and Scribner's agreed to a full-length book version (The Dangerous Summer) of almost 130,000 words. Hotchner found Hemingway to be "unusually hesitant, disorganized, and confused", and suffering badly from failing eyesight.”

User Friendliness & Proactivity of Medical Help

Context Corona Related Contacts

Contacts – The Corona Test – Centered About Brand New Day (BND)

-
Method	As of 2020 0525-M Core Contact Examples	Ancillary Examples
-
Phone	Teladoc BND Customer Service	BND - Contractors Dermatology Optometry
Email	BND Corporate
Mail	BND Corporate	Orange County Health Care Agency
In person	BND – Rick Marks (Broker)
No contact	Central Community Health Center (CCCHC) Contractor BHD Bera Contractor PCP Mojica	BND Contractors Hoped for email updates from Bera and Mojica
-

Last Reviewed: 20200525-M: BHD = Behavioral Health Doctor: PCP = Primary Care Physician

Sample Context - Advice and Testing Updates

Ever since Corona broke out earlier this year (2020) we here at Mentalation Solutions Group (MSG) have been collecting Intel about how to go about our daily business. In 2020 yet before the Corona crisis Dr. Bera indicated that he would prefer Video Conferences rather than Face-to-Face (F2F) appointments. A Video Appointment is a branch of health technology. In addition, so are health related e-mails a part of health technology. Both Mojica and Bera appear to not understand that their clients need their input during these hard times. In particular Buster is trying to get input about Corona Testing. Brand New Day (BND) customer service says they cannot help. Buster will have to see doctors Mojica and or Bera for assistance with managing Corona concerns. Maybe Buster does not need to be tested. Why? We do not know. Using the Teladoc Model Criteria (TMC) both Mojica or Bera do not seem like a strong candidates for telehealth and TecknoHealth (MSG, 2020)

Parallel Work Metadata >

Digital_Appointment_CDM_RBB_Annual_20031101_Integrated

TecknoHealth Defined

Metadata >

13_Product_Foundation_MSG_TecknoHealth_I_20040901_Notes

20200409-TH: MSG TecknoHealth

Basically Health Technology (HT) is the strategic use of technology from the provider angle. We here a Mentalation Solutions Group (MSG) put forth a beta definition for TecknoHealth. At this time for us here at Mentalation Solutions Group (MSG) TecknoHealth is the practical use of Health Technology from the user (consumer) aspect. TecknoHealth includes yet is not limited to the following: Access to the target Electronic Health Record(s) (EHR(s)), maintenance and leveraging Personal Health Records (PHRs), Blogging, ownership of a personal computer, access to the world wide web (Internet), online assessment access and application, ownership of a SmartPhone, printing facilities, a technical support budget, telehealth benefits, submitting quality assurance solicitations, etc. TecknoHealth is best actualized when its’ products are taken into consideration at Health Related Engagements (HREs) including health related appointments.

Mental Health Services Act (MHSA) Paradox

A paradox might be defined as: “A seemingly absurd or self-contradictory statement or proposition that when investigated or explained may prove to be well founded or true”. Back Circa 2003 various professionals and non-professionals began defining shortfalls in mental health care delivery system about the state of California. About the same time Darrell Steinberg (2020 Now Mayor of Sacramento) and associates begin documenting the solution in what we here at Mentalation Solutions Group (MSG) fondly call Steinberg Programming Language (SPL). Terms like inappropriate service, underservice and unmet needs were included in a body of legislation in California put to the vote sometime around 2003-2004. It narrowly passed! And so California’s MHSA (“The Act”) was born. Paradox: The code does not blame people and professionals yet it implies fault. If the issues brought forth were solved then there would be no expansion needed rather than maintenance spending. A point is: There are defects across the full spectrum of behavioral health services including services delivered by the Behavioral Health Doctor (BHD). “The Act” puts forth the promise of improved Accountability and Transparency. This paper is part of delivering about “The Act”. Side note: One of the institutions we use to gage MHSA revenue futures is the behavior of The Irvine Company (TIC). Due to Corona TIC is cutting. These cuts may be reflected by a reduction with upcoming MHSA revenue. Orange County has a good MHSA Prudent Reserve yet: We advise weathering the lost revenue rather that start augmentation using MHSA Prudent Reserve monies.

Let see what others say about you - Bera and Inglis - Inglis First

Metadata >

15_MDOC_Profile_16041002_Inglis V2020

Figure – Updated Objective Findings

MSG Stars – Andrew Inglis MD

When we found these objective numbers about Dr. Inglis we were surprised. Buster’s experience with him over the course of about one (1) year was far better than 2.6 MSG Stars. The average length of an appointment with Dr. Inglis was fifteen (15) minutes. In that time he took the opportunity to generate a new, as compared to cut and paste, Mental Status Examination (MSE). Doctor Inglis’ reports about Buster’s were in his Health Care Agency (HCA) health records if ever he or anyone else ever needed it. Buster used Dr. Inglis’ records back in 2009 on an assignment for his Consumer Training Program (CTP) class. During the last five (5) minutes of each appointment Dr. Inglis partner in crime Heather Rink would step in to collect whatever information she needed so she could bill for her share of the time. The Buster, Inglis, Rink collaborative was rather productive. Buster was successfully graduated out of Inglis/Rink care :0)

[INSERT INGLIS PHOTO]

HCA What's Up Newsletter - March 2018 - Health Care Agency

https://www1.ochca.com//ochealthinfo.com/docs/newsletters/whatsup/2018/18-03.pdf

PDF - Collaborative Court Programs Help…Heather Rink-Rosas

[INSERT HEATHER RINK WORKING]

What’s Up Consumer Rep Technology Advisory Committee (TAC)

A word about What’s Up. Buster began tracking the OCHCA MHSA Newsletter call Recovery Connections back November of 2008. His intention was to position himself to perform well if he were accepted into the MHSA funded Consumer Training Program for Paraprofessionals. He was accepted for the class of Spring 2009. In the end he came in second in his class. Even before graduation he was interviewed by the OCHCA Center of Excellence for a future committee called Innovations Advisory. His ultimate superviser Kate Pavich said while you wait we offer you a seat on the Technology Advisory Committee or TAC. Particpating on the TAC as as consumer representative was nearly ten (10) years of great adventure and experience.

BHS EHR Project Enhancement is underway

“What is the Behavioral Health Services Electronic Health Record? An EHR is a computerized system where consumer health-related records are created, stored, used, exchanged and retrieved. The Integrated Records Information System (IRIS) is the electronic health record for BHS. In its entirety, the BHS EHR will include a longitudinal electronic record of all relevant consumer health information such as demographics, financial/insurance information, assessments, progress notes, treatment plans, e-prescriptions, medications, past history and appointment schedules. Some of this functionality is present in IRIS today and has been used successfully for several years, such as registration, scheduling, reporting and billing. The current goal is to expand upon this functionality using a three-phased approach. The first phase includes…”

Recovery Connections

Command Level

You know the saying that when you have sex you are sleeping with every partner the other slept with. The same goes for Behavioral Health! When you meet or share a room with a behaviorally disabled person whom you try to orient and correct you are sharing a sum product of all the Psychiatrists that the person has engaged with. At any given time the most accountable person is the Behavioral Health Doctor (BHD). What ticks us here at MSG very much is when a consumer dies too young and no one steps up and takes some responsibility. Much of what the 1960s protest music addressed were commanders and there indifference. In war this has to be. In behavioral health it is a crime. Maybe psychiatrists are what Supertramp wrote is the Crime of the Century. In this 21^st Century there is time to get it right as Mark Refowitz was fond of saying.

[INSERT IMAGE OF MARK REFOWITZ]

Let see what others say about you - Bera and Inglis - Bera Next

Metadata >

Assess_Vitals_Plus_Bera_RBB_19120501_Appt-2019-05 V2020

Figure – Updated Objective Findings

MSG Stars – Rimal B Bera MD

For the most part 3.1 MSG Stars is about right for doctor Bera. He has proctored some good appointments with Buster and a couple of really back appointments with Buster. As doctor Bera continually tried to cut the time spent down to less than nine (9) minutes Buster commented to Doctor Bera’s that his due diligence was “Sad”. Back in 2017 Buster’s Behavioral Health Doctor (BHD) at the time indicated that he would be retiring soon. As far back as 2013 Buster had been shopping for a replacement. He could stay in network with Bera or Waknine or go out of network with Ravinder Singh. People around town were not saying very good things about Dr. Bera. Yet Waknine was receiving reviews that were on average less favorable. Here is what another said about Dr. Bera.

[INSERT PHOTO OF DOCTOR BERA]

Dr. Bera's Performance – “And Through The Wire”

https://www.healthgrades.com/physician/dr-rimal-bera-2xn5c

Objective Narrative - 20200523-SAT: What People Say About Dr. Rimal Bera, MD

“This man is completely indifferent, could care less about your well-being, barely makes eye contact or asks questions about how you’re feeling. You’ll get 15 minutes MAX to watch him type - I’m assuming to send refills to the pharmacy. One appointment he argued with me - told me there weren’t any refills on a med when in fact there WAS and on another visit he DOUBLED the dose of another! I do NOT recommend this man. How do you trust a doctor who can’t even get your meds correct?!?!. Go elsewhere?”

And Through The Wire

Peter Gabriel (1980) On Telephony

And through the wire

I hear your voice

And through the wire

I touch the power

And through the wire

I see your face

Friday night, you're staying at home

I'm tickling and clicking a metronome

Pressure's building-overspill

I want you

And through the wire You are secure

And through the wire We can talk

And through the wire We can walk

It's through the wire

Medication Management – Weak Memory

We here at Mentalation Solutions Group (MSG) feel like doctor Bera has 1000 patients. Bear can rarely remember much of anything. We know because Buster takes notes at an appointment. When it comes to medication management Buster finds himself repeating the same old spiel over and over again. This used to annoy and disappoint Buster yet now Buster has lower expectations for his Central City Community Health Center (CCCHC) doctors such as Dr. Bera. Buster checks doctor Bera’s work with the Psych Nurse. In the past with Doctor Lee if we found an error we wrote the doctor up. Now rather than report Bera to corporate we take the time to process and publish. In addition, doctor Bera’s Psych Nurse and Buster have a seasoned system that works as measured by (AMB) curtailing Buster’s appointment driven Anxiety.

Subjective Quality Assurance Bera and Inglis

Assessment Elimination

Table - Quality Assurance & Treatment – Psychiatry Lived Experience

-
##	Assessment	Dobos Circa 2000	Inglis 2007	Lee 2012-2017	Bera 2019
-
01	1-Vitals Online	Pass	Low	No Record	Pass
02	2-Mental Status Examination (MSE)	Yes	Yes	Yes	SoSo
03	3- Vital Plus (MSG)			Pass
04	Adequate Pay	Yes	Yes	Yes	Assume No
05	Burnout	Mild	Unlikely	Mild	Moderate
06	Consumer Satisfaction	Yes	SoSo	SoSo	SoSo
07	CV	No	No	No	No
08	Doctor On Call Assessment (MDOCA)	OK	OK	OK	Marginal
09	MDOAC Series
10	Performance Earned Value	Pass	Pass	Pass	Poor
11	ProQOL	Pass	Pass	Pass	AVG
12	Vitals Plus
13	Wrong Specialty Evaluation	Pass	Pass	Pass	Likely
-
	CALC	8.5/10	7.5//10	8.0/10	4.5/10
	MD-Quality Assurance Score (MD-QAS) =	85.0%	75.0%	80.0%	45.0%
-

Date Scored: 20200529-F: BSL = Bum Soo Lee MD

Quick Score Method

In prior reports we have been more granular with our scoring. For example both Vitals Plus and ProQOL have many items. Here we use our Quick Score Method (QSM). With the QSM it is easier for us to be generous.

Lived Experience (LxE)

In congruence with the Mental Health Services Act (MHSA) came the principle of leveraging the consumers Lived Experience (LxE). Most of Buster’s MHSA peers take this to mean you use your LxE to directly help others in need. Though we admit Buster helps people directly as needed (PRN) Buster spends more time helping those in need indirectly via our publications. We here at Mentalation Solutions Group (MSG) are doing our best to recoup the costs of care for Buster. Buster’s treatment has been very expensive.

Meeting Of the Minds Snow Job

Buster has attended several of his doctor’s public lectures. Most notably DeSilva, Bera and Chau. It makes a difference to us the level of parity or how public lectures reflect practice. A few years back Dr. Bera discussed Neurocognitive Testing so Buster thought Bera would apply or at least discuss Neurocognitive Testing during an appointment. Wrong! As evidenced by Buster’s Medical Records Dr. Bera has stopped updating Mental Status as reflected in the Mental Status Exams (MSEs).

Figure > Metadata > Cognition > Preparing for our First Encounter

Cognitive Assessment Promises

Buster’s first appointmenr with Dr. Bera was early in 2018. In May of 2017 he saw doctor speak at the annual Meeting Of the Minds (MOMs) Conference. Doctor indicated an interest in “Neuro-cognitive Testing”. So Buster puzzled things out a bit during December 2017. At the charter appointment, doctor was not interested in what Buster had learned about Cognition and Neuro-cognitive assessment. This last episodic go around which began in 2012 was hard on Buster’s cognition. We here at Mentalation Solutions Group classify 2012 as a year of catastrophic loss for Buster. Buster did not notice how much his faculties had deteriorated until in the summer of 2016 he had to take the Department of Motor Vehicles California Driver’s License written exam. His confidence was at first very low. Eventually Buster felt he was up to it. On exam day he earned a 100%. Buster now drives a car again.

MD On Call (MDOC) Concept

Try as we may we could not find much information online or in other documentation were the doctor report about themselves. Buster finds that few doctors report honestly on themselves: Knowledge, skills, demands, income, etc. After working for more than two (2) years (Interval of Service) with Dr. Bera, Buster should be able to promote Bera’s full spectrum of talents and successes. Naturally we here at Mentalation Solutions Group would balance things out periodically with some of Bera’ failures. An example of a failure is “Road Kill Mark”.

[INSERT RK MARK]

“Top Doc”

When for Buster we here at Mentalation Solutions Group hire a new doctor we more often than not have high hopes. Our high hopes are that the new doctor will be the best doctor ever. Even if others say the doctor has problems we still hope for the best. Prior to our granular studies and profiling of doctors we thought that Ravinder P Singh MD was the best. After applying our Doctor On Call (DOC) methodologies we discovered that David Dobos of Kaiser Permanente was our “Top Doc”. With his help Buster climbed up quite far. The nature of the relationship was performance driven. With Dr. Dobos’ help Buster earned 4.0 Grade Point Averages at both Saddleback College and California State University at Fullerton (CSUF). With Dr. Dobos help Buster followed through being accepted into CSUF Secondary Teaching Credential program. Doctor Dobos’ supervisor David Chandler MD said of Dr. Dobos: “He is a very good doctor”. It is easier to impress positively Buster than it is to not. We here at Mentalation Solutions Group (MSG) have published more favorable reports than negative reports. We have an informal policy for every two positive reports we get license to “muckrake”. We liken our reporting to the Dante Distribution. Each a third: Paradise, Purgatory, and Inferno.

2009 – Consumer Training Program

Back in 2009 Buster did a gig with the Orange County Health Care Agency managed Mental Health Services Act (MHSA). They sent him into a college environment to learn Paraprofessional Health Work. During the 160 hours of classroom training he met Dr. Clayton Chau MD. He also was introduced to behavioral health treatment planning. When Buster saw doctor Bum Soo Lee MD (BSL) from 2012-2017, BSL in most cases took the time to hear Buster’s plans including treatment plans as well as Buster's triumphs. Dr. Bera gets very frustrated if Buster wants to spend even a minute on plans or Show and Tell.

Quick Teladoc Comparison

Now Dr. Bera is indicating that he will substitute in person appointments for Video appointments as soon as possible. We have been fortunate to use the Brand New Day benefit called Teladoc twice once in 2019 and again in 2020. We have only favorable impressions about the Teladoc system. What it offers and how it offers it could benefit Dr. Bera with setting up his Video service. Teladoc has a strong consumer driven quality assurance system. Dr. Bera has no consumer driven quality assurance system. God help us if Dr. Bera delivers even worse service by Video than some of his patients (accounts) feel he does in person. Based upon Buster’s participating with MHSA Technological Needs doctor has some substantial gaps in both his non-technological and technological packages. He has a terrible time listening to new or emerging complaints. When Teladoc indicates they have “experienced doctors” they are referring to their stable of doctors’ telephony skills not how they would be in person. A nice feature of Teladoc is if and when the need arises a Brand New Day client can get an independent second opinion. We here at Mentalation Solutions Group have given Dr. Bera substantial press and print. In other words we have increased his digital presence and penetration. People in other countries such as Ukraine now know Dr. Bera exists.

Publications

We here at Mentalation Solutions Group (MSG) do not go back and review our publications very often. If we did we would get tied up correcting our errors. We went through our various Blogs to see how our readership is coming along. What follows is the Metadata for some of our reports (posts) in which we directly and indirectly address doctor Bera. Let’s say with ten reports at an average of thirty pages each we have dedicated more than three-hundred (300) pages of print towards optimizing the Buster-Bera partnership.

Insert some Bera Blog Post Stats

[FIGURES BERA RELATED PUBLICATIONS]

Balance Scorecard Behavioral Health Doctors (BHDs)

Table - Summative Data Worksheet – Models Of Practice

Lived Experience with Behavioral Health

-
MD#	MD	Favorite Skill	AII Codex	2020 0523 QGM
-
1988	Graham	NONE – Causes do not matter		C
1989A	De Silva, Himasiri K.	Stigma - Looks like he never sleeps	HKD or HKDS	C
1989B	Deutsch, Arnold P	Titrations – Banter - Education Telepsychiatry (1989)	APD	A-
2000 Circa	Dobos, David M	Common Sense Performance-driven Partner Approach	DMD	A-
2005 Circa	Chandler, David Royce	Can Take a Punch - Avoid confessing - Cold turkey off Ambien	DRC	B
2006	Singh, Ravinder P	Energy Clozapine Experimentation	RPS	B+
2007	Inglis, Andrew	Nice Guy - Graduated us better off Our demands we less		A
2008	Vu, Alan	Newport doctor		B
2009	Chau, Clayton	Depression Consumer-survivor		A-
2012A	Daniels	NONE – Invega Experimentation		F
2012B	Waknine, Raphael	On the Prowl for office gals		D
2012C	Lee, Bum Soo	Compliments “You would make a good doctor”	BSL	A-
2018	Bera, Rimal B	Shares in Public - Dresses appropriately	RBB	B-
-

Last Reviewed: 20200529-F:

Metadata >

11_Assess_MDs_MDOCA_16040503_Development V2019

Birth of Formal MD On-Call

Back in 1989 Buster linked up with doctor AP Deutsch MD after seeing Himasiri DeSilva for a short term. During Buster’s first appointment with doctor Deutsch, doctor stated: “So you fired DeSilva?”. And so began Buster’s interest in the comparative quality dimension of Behavioral Health Doctors (BHDs). Our records show we here at Mentalation Solutions Group formally chartered our MD On Call Project on April 10, 2016. Since then we have profiled approximately ten (10) Behavioral Health Doctors (BHDs) at least one time each. As you can see we began with doctors (Alan) Vu and (Andrew) Inglis.

[INSERT PHOTO OF DESILVA]

Haggard - Not

When Buster AKA Keith E Torkelson, MS met doctor DeSilva back in early 1989 Buster thought that DeSilva was old - probably in his sixties. DeSilva just looked so tired and haggard all the time. The treatment plan Dr. DeSilva pressured Buster in adopting was not in line with Buster’s goals so once again Buster “Fired” DeSilva. Just think of it if in 1989 DeSilva was sixty now in 2020 he would be ninety. His look finally caught up with time. We just looked at the banner below and we were wrong Dr. DeSilva looks not so much as old and frail yet highly concerned.

[INSERT BANNER LINEUP]

Line Up Impressions (Draw conclusions for yourself)

[Left to Right: Bera, Chau, Singh, Refowitz, Torkelson, DeSilva]

Pagers in Progress - Integrating About Technology

Table - Associated Papers

-
Theme	Target	Development
-
Corona - User	Chester D Mojica (CDM) MD-On Call	Report(s)
Corona - Control	Clayton Chau MD	Orange County Eradication Process
Digital Via Smartphone	Mentalation Solutions Group (MSG)	Graduate to TecknoHealth
GRAVITY	Avey CE Asus (ACEA)	Fun Paper
Health and Housing	Jeffery A Nagel (JAN)	Housing Help Line
Sleep	MSG Audience	SleepAbility
TecknoHealth	MSG Audience	Integration
Teladoc	MD-On Call	Report
Telepsychiatry	Rimal B Bera (RBB)	P4D Report
-

Last Reviewed: 20200529-F:

Health Related Engagement (HRE)

Over time we here a Mentalation Solutions Group (MSG) have developed two products for Buster. One we call Health Related Engagement (HRE) and the other we call ProSumers ProSuming with ProSumption. The primary difference about the two is that an HRE required an out of house Face-To-Face (F2F) element. A doctor’s appointment and a community meeting qualify as HREs. Now with this Corona Fiasco we find it fitting to modify our definition a bit. We first ran into the conflict with regards to a Teladoc conference call. There was no F2F yet the transaction was health related and important. In fact our Teladoc calls had more of a positive impact for Buster than did some of his F2Fs. Now with Dr. Bera indicating he may go Tele-psychiatry we are going routinely consider Tele-health as a Health Related Engagement. We still are not going to consider calls as with the pharmacy as an HRE.

Behavioral Health Doctor and Housing for Keith “Buster ...

http://brandnewdayhmo.blogspot.com/2019/05/behavioral-health-doctor-and-housing.html

May 7, 2019 - Behavioral Health Doctor and Housing for Keith “Buster” Torkelson Via Rimal B Bera MD (201905). Health Related Engagement…Emerging Concerns

You've visited this page 3 times. Last visit: 8/21/19

Preparing for an Appointment (Visit)

For the most part when Buster saw Bum Soo Lee MD (BSL, 2012-2017) he prepared over an hour. Buster would track down standardized assessments, take them, and briefly share the findings in a typical BSL appointment. A typical BSL appointment lasted for fifteen (15) minutes unless doctor Lee was behind by fifteen minutes or more. Buster could tell how BSL’s appointments were coming by talking with other patients in the waiting area. Buster’s preparing is a component of Mentalation Solutions Group (MSG) ProSumption Product. ProSumption was borne out of a combination of author Stephen Covey’s pro-active and Buster’s Lived Experience (LxE). Planning ahead for appointments, high expectations with doctor, and using checklists in appointments are a few features that make Buster a bit different than those sharing his cohorts. One other element is important: In events were a particular doctor is not game to listen well we here at MSG along with Buster publish our findings. It is just safer to migrate things to the public record then getting to eat the frustration and disappointment.

[INSERT SAMPLE PHOTOS OF THE HOME COHORT]

Metadata >

HHS_ProSumer_WRAPAbout_10012002 V2020

Experimentation Using Human Subjects

Back in late 2009 Buster was invited to attend what was called at the time the Orange County Health Care Agency (OCHCA) Data Outcomes Advisory Committee (DOAC). The first challenge presented was coming up with a tool to assess Resilience. That was when he first heard doctor Janel Alberts (PhD) speak. She reminded Buster of a pathologist in training at UC Davis. In 1988 or 1989 Buster was accepted as a Master’s Degree Candidate in the UC Davis Department of Pathology. At the time there were only five (5) graduate students in the department. The other four (4) were post-docs. Buster was the chairs experiment. Buster made two (2) promises to the department chair: One he would work on methodologies to better detect anaplastic cells and two he imagine three-dimensional "hologramic" microscopy. Dr. Alberts reminds Buster of one of the brainy post-doc pathology PhD candidates. So Buster arrives at a DOAC meeting early as is more often the case just to find that Dr. Alberts had presented in a prior meeting. Buster discovered that some person had left their handout behind. This is often the case with presentations in Health & Human Services. The title on one of the handouts (forms) said “Experimentation Using Human Subjects”. Dr. Alberts was listed as the principal. And so begin our new paradigm here at Mentalation Solutions Group (MSG). Much of our work with Behavioral Health Doctors (BHDs) is merely experimental.

Metadata > Data Outcomes Advisory

[NO GOOD PHOTO of Janel AVAILABLE]

Metadata – Figure – “Teleps”…

TecknoHealth – Tele-health & Video-health – Medical Doctors (MDs)

Table – Comparative Evaluation of Select Medical Doctors

-
Focus about doctors:	Routine	In Crisis	Specialty
-
Rimal B Bera	Below AVG	Predicted Weak	BHD
Chester D Mojica	AVG	Predicted Weak	PCP
Annie Nguyen	Above AVG	Proven Strong	TeleMedicine
Kevin Weiss	Above AVG	Proven Strong	TeleMedicine
Andrew Inglis - Retro	Above AVG	Proven Strong	BHD
-

Last Reviewed: 20200326-TH:

A Tele-health Scorecard

One might wonder how Corona and Telepsychiatry are related. Dr. Bera on March 18, 2020 indicated at Buster’s routine Medication Management that he was interested in Video Tele-psychiatry. Buster’s most recent and fitting tele-health appointment was with Teladoc. Over the course of two (2) years Buster’s confidence with Teladoc has grown. Teladoc is a good model for Dr. Bera to follow particularly the quality assurance component of their product. In addition, setting up membership and an account with Teladoc is user friendly. On February 26, 2020 Buster got a head start combating this years cold symptoms. Midstream in the Corona Crisis Buster called Teladoc. The Teladoc phone triage group indicated that if his symptoms were not grave wait. So Buster fell back using a course of Over-The-Counter (OTC) preparations and a good deal of rest. Teladoc gave Buster the confidence to weather his symptoms. If Buster finds the need for antibiotics as indicated by green mucous and sputum his first line of help is Teladoc. With regards to prescribing antibiotics, Teladoc “Docs” have been more helpful than his Primary Care Physician. Due to Corona we here at Mentalation Solutions Group now better understand those entities and individuals in the health field who are helpful, who are questionable, and the entities that really make a difference for Buster.

Cutover – Preparing in Advance

Table - TecknoHealth Evaluation Tool (THET)

Review Of Key Telepsychiatry Outcomes - NCBI

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919267/

2020 – Theme Preparing in Advance

	-
##	Category	2020 0317 (TU) In Person PCP (CDM)	Teladoc General Medicine	2020 0318 (W) In Person BHD (RBB)	Expected BHD (RBB)
	-
01	Accountability (Invoicing)	Poor	Poor	Poor	Poor
02	Cost Effectiveness	Poor	Good	Poor	Better
03	Implementation Outcomes	Teck SoSo	Good	Teck to Date SoSo	Poor
04	Legal Issues	Stayed	Good	Stayed	Stayed
05	Reliability	Low	High	Low	Low
06	Satisfaction	Moderate	High	Low	Low
07	Transparency (Capture encounter and share)	SoSo	SoSo	Poor	Poor
08	Treatment Outcomes	Below AVG	Excellent	AVG	Below AVG
-
	CALC	2.0/8	6.5/8	1.0/8	1.0/8
	Tele-health Outcomes Score (THOS) =	25.0%	81.2%	12.5%	12.5%
-	-

Last Reviewed: 20200529-F:

Telepsychiatry Value Study – Benefits and Promises

Transformation In Progress

[PDF] - Telepsychiatry 101 - InSight Telepsychiatry (30 Pages)

Table - What Organizations Implementing Telebehavioral Health Need to Know

http://insighttelepsychiatry.com/wp-content/uploads/2015/05/Telepsychiatry-101-White-Paper.pdf

-
##	Benefit	2020 0326 (W) Kevin Weiss	2020 0422 (W) Rimal Bera	2020 (W) Rimal Bera Expected
-
01	Increased Access To Specialists	SoSo	No	SoSo
02	Reduced Hospital Admissions	Yes	SoSo	SoSo
03	Reduced Transport Costs	Yes	SoSo	Yes
04	Reduced Emergency Department (ED) Boarding	NA	NA	NA
05	Improved Safety	Yes	No	Yes
06	Decreased Liability	NA	SoSo	NA
07	Reduced Readmissions	NA	No	SoSo
-
	CALC	3.5/4	1.5/6	3.5/5
	Tele-health Benefit Score (THBS) =	87.5%	25.0%	70.0%
-

Last Addressed: 20200529-F:

FYI - Emergency Department (ED) Boarding

“Boarding is the practice of keeping admitted patients on stretchers in hospital ED hallways for hours or days, according to the report. Boarding causes ED crowding and can hamper quality patient care.” Aug 7, 2012

Aside - ACEP // Definition of Boarded Patient

https://www.acep.org/patient-care/policy-statements/definition-of-boarded-patient/

What is a boarded patient?

“In order for emergency departments to continue to provide quality patient care and access to that care, ACEP believes a “boarded patient” is defined as a patient who remains in the emergency department after the patient has been admitted or placed into observation status at the facility, but has not been transferred to an inpatient or observation unit.”

Endo-toxicology - Teamwork

If Buster had selected to apply to the UC Davis School of Medicine he would have concentrated on a combination of Endocrinology, Neurotoxicology, and Toxicology. Rather he selected to attend UC Davis School of Veterinary Medicine with a concentration on One Health and the World Food Problem. He put in many hours with food animals such as commercial turkeys, chickens, and hogs. For the United States Department of Agriculture (USDA) Buster was on an inspector on a hog line processing an average of 6,000 hogs each work day. Every hog was individually examined for pathologies across three stations. Buster knows how to detect and properly dispose of disease incidents. How the USDA gets inspectors up to speed are a series of tests. Each inspector’s test results are shared about an assignment location with one or more senior site veterinarians and a high-ranking inspector. If everyone on a particular inspection team does not agree a novice inspector shows promise the going can get pretty rough. Inspection also called slaughter inspection is a demanding profession. The desired outcome is a high level of global harmony, efficiency, stamina, and productivity. With regard to Behavioral Health Doctors (BHDs) such as Dr. Bera when we check-in with people on his team and find discord it alarm us here at Mentalation Solutions Group.

Med School Analogy

In Med School the schools promote purchasing literature and documentation to augment lecture materials. At UC Davis School of Vet Med more often that not lecture notes were provided for a small fee. More often than not the professor and/or persons on their team authored the lecture notes. Dr. Ralph L Kitchell’s [SPELLED] neurology notes are the product of his own research. The point is: That if a doctor uses notes to master a subject than why do so few doctors supply documentation so that the consumer can master their own cases, the doctors practice then engage meaningfully as a proactive consumer (MSG ProSumer). A few competencies would help the consumer make the most with their five (5) minute appointments. We suggest the doctor tutor and guide their clients about: Telehealth, assessment, medication management, experimentation, performance earned value (PEV), failure rate, housing, etc.

On Operations Manuals

Doctors just don’t lead themselves into practice. Securing a practice requires achievement, attending lectures, taking good notes, performing well on examinations, etc. In addition they may be asked to reference textbooks and lab practical instructions. Our point is, if a doctor does not have a proclivity with growing documentation for helping their client then the clients are aimless or blind. Every month practitioners might best write up the consumer of the month and all consumers that die under their watch. Rather than let others passively report about a doctors service the doctor might best derive and apply a: Practice Performance Earned Value Scheme.

[INSERT RIEMANN’S BOOK – Sample Content & Operations Manual]

Confidentiality and the Dead - Does HIPAA protect deceased?

“The HIPAA Privacy Rule protects the individually identifiable health information about a decedent for 50 years following the date of death of the individual. Sep 19, 2013”

Telepsychiatry Value Study – Applied InSight Benefits Model

[PDF] - Telepsychiatry 101 - InSight Telepsychiatry (30 Pages)

What Organizations Implementing Telebehavioral Health Need to Know

http://insighttelepsychiatry.com/wp-content/uploads/2015/05/Telepsychiatry-101-White-Paper.pdf

Table - Benefits Of Telepsychiatry - Qualitative

-
##	Benefit	Context RBB 2020 Expected	2020 0523 (SAT) RBB Share
-
01	Decreased Liability	We do not know what liabilities he faces other than staff or himself contracting Corona	0.25
02	Improved Safety	Count help him out – we feel relatively safe from conversion during an appointment	0.00
03	Increased Access To Specialists	Specialists that we would like to see: Radiology & Imaging, Acupuncture, Physical Therapy	0.00
04	Reduced ED Boarding	NA
05	Reduced Hospital Admissions	Coming up on seven (7) years 84 months without a hospitalization	0.50
06	Reduced Readmissions	He has never had to admit us yet with other patient we talk with this may be a concern	0.25
07	Reduced Transport Costs	No ambulance since 2012	0.25
-
		CALC	1.25/6
		Practitioner Specific Telehealth Value Score =	20.8%
-

Last Reviewed: 20200529-F:

ProSumer – Integrated Meaningful Engagements

Activity – Transitional - TecknoHealth

-
Activity		Note
-
Accountability & Transparency		About self and helpers
Family Involvement AGK’s Book #3		Complete
Blogger		New problems new solutions
BND Rewards		Pending
Charter Telepsychiatry		Hope by end of May 2020
Corona Report for Dr. Chau
Daily Activity sleep and sleep related as priority #1
Drive to Fallbrook		Planned
Fraud
Instagram		Held back
Intimacy		Sustain
Introduce Dr. Chau to corona notions		Planned
Land stellar RASR Roommate
New Car Tires		Resolved
New ID/CDL		DMV initiated tele-support and set date for June 3^rd
Pinterest		Effort crashed
Rewards - Other
Share Telepsychiatry & Social Pathologist Resume with Dr. Inglis		Planned
SOC-PATH		Meet with Dr. Inglis
Submit Housing Innovation Idea formally		Planned
Trends		Lost social options
Weekly Publications		Stayed across 3 reports
-

Last Reviewed: 20200529-F: Brief definition for ProSumer is a Proactive Consumer.

How Is Telepsychiatry Used? – TecknoHealth Comparative Score Card

What Organizations Implementing Telebehavioral Health Need to Know

http://insighttelepsychiatry.com/wp-content/uploads/2015/05/Telepsychiatry-101-White-Paper.pdf

Table – TecknoHealth Grade Card

-
##	Usage / Utilization Address…	2007 Retro Andrew Inglis	2018-2019 Prediction Rimal B Bera
	-
01	Major psychiatric disorder treatment (Success AMB)	Anxiety Sleep	Bi-polar Sleep
02	Loss and grief treatment	Weak about reunification of Family	Weak about JMB & JNZ
03	Substance use treatment	Not well	Incidental Success
04	Evaluation of change of mental status or delirium	Improvement	Weak
05	Medical decision capacity evaluations	Good	SoSo
06	Behavioral management of difficult behaviors (Success AMB)	Panic	Frustration & Disappointment
07	Family therapy or intervention	Not done	Not Done
08	Treatment team meetings	Yes Team of 3 Graduated	None
09	Medication management	Success With Clozapine	Below AVG Failed situational awareness test
10	Due diligence and rigor about assessment and records	Very good	Weak
-
	CALC	8.00/10	3.50/10
	TechnoPsychiatry Performance Earned Value Score (TP-PEV) =	80.0%	35.0%
-

Last Reviewed: 20200529-F:

Lived Experience (LxE) – Comparative Models of Professional Practice

Table - Summative Data Worksheet – Models Of Practice

Experience with Telehealth – Physical Health

-
Doctor	Association	Note	Impression
-
Andrew Inglis	OCHCA Legacy BHD	As If (*)	Favorable
Annie Nguyen	Teladoc #1		Favorable
Bum Soo Lee	BND Legacy BHD	Said Buster was a nice guy and that he would make a good doctor	Favorable
Chester D Mojica	PCP		SoSo
David Dobos	Kaiser Permanente	Performance driven therapy Great with documentation	Excellent
John Hanley	Childhood Family Doctor and Surgeon	Surgically saved Buster’s left thumb and pinky finger	SoSo
Kevin Weiss	Teladoc #2		Favorable
Ravinder P Singh	WMA Legacy BHD	Clozapine Experiment Trial	SoSo
Rimal B Bera	BHD		SoSo
-

Last Reviewed: 20200529-F:

(*)As If…

We are editing this report in concordance with probable review in part or whole by Buster’s legacy doctor Andrew Inglis MD.

Record of Current Medications

20200422-W: Matrix - Current Medication List

-
Pharmaceutical	Prescribing Doctor	Dose per unit	Total Dose per Day	Note
-
Aspirin EC	CDM	81mg	81mg
Atorvastatin	CDM	40mg	40mg	Actually works!
Clozapine	RBB	100mg	200mg	Divided Dose May be causing muscular weakness
Lithium	RBB	300mg	600mg	Adherence checking
Lorazepam	RBB	1mg	1/2mg	As Needed - PRN
-

Last Reviewed: 20200529-F:

Sample Encounter - Request for Medication Trial Experiment

Table – Record - Lived Experience – Behavioral Health Doctor – Medication Change Request

08_LS_Medication_Change_Restoril_Working_19052202_Bera

-
Specification	Note	Detail
-
Next Appointment	September 25 (W) 2019
Doctor In Charge	Rimal B Bera (RBB)
Type of Appointment	Medication Management	Clozapine Contingency
Facility	Central City Community Health Center	Garden Grove
Appointment Billing	Medication Management
Copay	None
Amount Billed	Unknown	Accountability Issues
Average Time Spent	7 minutes	Due Diligence Issues
Operations Manual Provided	No	*Compare with Schwabe
Satisfaction Survey Provided	No
Telephone Option	No	Never talked on phone
Conference Call Option	No	No conference calls
Video Appointment Option	No	Indicates he wishes to set this up
E-Data Transfer Option	No	No data transferred to us
Duration of Partnership	2018-2020 (Present)	How time flies
Outcome	Negative	We still have no tangible alternatives to Clozapine
-

Last Reviewed: 20200526-TU:

Referral and Linkage Part-II – Keith Torkelson Partners with ...

http://clozapinerx4ecstasy.blogspot.com/2018/04/referral-and-linkage-part-ii-keith.html

Apr 2, 2018

Rimal B. Bera, MD Evaluated by Keith E Torkelson MS as a Doctor On-Call (2016).

Abstract – Executive Summary (Reprint)

As you can see previously Rimal B Bera (RBB) has been rated on three Online Rate Your Doctor sites. A total of twenty (20) people as of March 20, 2018 rated Dr. Bera. From these people Dr. Bera earned an average of 2.8 Stars (5.0 is the best possible) from these objective raters. Since we first began tracking Dr. Bera Online his raters have been offering harsher ratings. We here at Mentalation Solutions Group assessed Dr. Bera across multiple latitudes. Out of our derived assessments we hope to select about three to use routinely. The most important thing with our initial Linkage Appointment was to get our Clozapine medication right. Doctor Bera did indeed get Buster’s Clozapine right. Nice start.

Special Topic – Teladoc Telemedicine Model

Teladoc Benefit Practical - Brand New Day HMO (Revisited)

http://brandnewdayhmo.blogspot.com/2019/04/brand-new-day-teladoc-benefit-practical.html

Apr 4, 2019 - Brand New Day – Teladoc Benefit Practical

This report addresses the client Keith “Buster” Torkelson. He is a patient of Chester D Mojica MD (CDM). CDM either is employed by or contracts for Central City Community Health Center (CCCHC) in Garden Grove California. This paper addresses the topic applied Telehealth. Keith’s insurer is Universal Care Brand New Day (BND). BND provides free of charge a service called Teladoc. Teladoc provides Telehealth services. On March 21, 2019 Keith initialized his Teladoc account using both telephone and the Internet. In the mid-afternoon Keith received a phone call from his assigned Teladoc doctor, Annie Nguyen. Keith was very satisfied with Dr. Nguyen because she immediately provided for his unmet need. Annie prescribed the antibiotic Doxycycline hyclate. For this she provided a solution. Applying our Vital Plus (25 Item) Assessment about Satisfaction we score Teladoc Clerical 4.4 Star Equivalents (SEs) with 5.0 SEs being Superior. Applying the same assessment we offer up 4.8 SEs to Doctor Annie Nguyen.

Phone Health Service Benefit Teladoc

Metadata >

http://brandnewdayhmo.blogspot.com/ (Apr 4, 2019)

With this report we here at Mentalation Solutions Group (MSG) address the Teladoc Phone Health Service (PHS). The Teladoc PHS is provided FREE of charge by Brand New Day (BND). BND is Keith “Buster” Torkelson’s insurer. “Buster” is our principal around here at MSG. We here at MSG agree that Healthcare is a team effort involving many partnerships. With this study we evaluate a few of “Buster’s” service and support teams including: A Primary Care Physician (PCP) and a Behavioral Health Doctor (BHD). As for Teladoc we evaluate “Buster’s” first (2019) Tela-doctor Annie Nguyen. For her services for Buster’s 2019 transaction we give doctor Nguyen a MSG Star Equivalent Score of 5.0 with higher scores being superior. We also award Dr. Annie Nguyen 5.0 about our Star Screener Tool (SST). At this point Teladoc is largely limited to treating physical conditions. In this and other reports MSG relies much on “Buster’s” Lived Experience (LxE). We do not have a service to compare with Teladoc. After an eligible consumer sets up a basic Teladoc account they are ready to make the call. In conjunction with a Teladoc telephone consult the consumer may submit three documents including images. For “Buster’s” 2019 call (“visit”) we felt that his Complete Blood Count (CBC) labs over time might be helpful. Buster on and off runs a bit high on his CBC Neutrophil Count. For Buster this is protective.

Special Topic – Teladoc Telemedicine Model

Comparing Teladoc with CDM and RBB

Telepsychiatry – Telepathology – Telehealth (Teladoc)

Figure – Teladoc Metadata – Studies some open some closed

How is it Teladoc?

Having set up a Teladoc account as well as having two (2019 & 2020) Teladoc phone visits, Teladoc is our best model for phone-based care.

What is Telepsychiatry? - American Psychiatric Association

https://www.psychiatry.org/patients-families/what-is-telepsychiatry

“Telemedicine is the process of providing health care from a distance through technology, often using videoconferencing. Telepsychiatry, a subset of telemedicine, can involve providing a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management.”

What is Telepsychiatry? - American Psychiatric Association

https://www.psychiatry.org/patients-families/what-is-telepsychiatry

Nature of Telepsychiatry

“Telepsychiatry can involve direct interaction between a psychiatrist and the patient. It also encompasses psychiatrists supporting primary care providers with mental health care consultation and expertise. Mental health care can be delivered in a live, interactive communication. It can also involve recording medical information (images, videos, etc.) and sending this to a distant site for later review.”

Telemedicine in Psychiatry

“Telemedicine in psychiatry, using video conferencing, is a validated and effective practice of medicine that increases access to care. The American Psychiatric Association supports the use of telemedicine as a legitimate component of a mental health delivery system to the extent that its use is in the best interest of the patient and is in compliance with the APA policies on medical ethics and confidentiality.” 2015

Psychiatry and Telepsychiatry Service Elements (Comparative Screener)

Table – Samples of Services - Framework Source:

https://www.psychiatry.org/patients-families/what-is-telepsychiatry

“Telepsychiatry, a subset of telemedicine, can involve providing a range of services including…”

-	-
#	Service	2019 RBB In Person QUAL	2019 RBB QUANT	(2007) Inglis Retro QUANT
-	-
01	Psychiatric evaluations	Poor	0.25	1.00
02	Individual therapy	Poor	0.25	0.75
03	Group therapy	Poor	0.25	NA
04	Family therapy	Poor	0.25	0.75
05	Patient education	SoSo	0.50	0.75
06	Medication management	SoSo	0.50	1.00
-
	CALC		3.00/6	4.25/5
	Psychiatric Service Score (PSS) =		50%	85.0%
-

Date Scored: 20200524-SUN: Last Reviewed: 20200529-F:

Table – Telehealth Comparative Benefits per American Psychiatric Association (APA)

What is Telepsychiatry? - American Psychiatric Association

https://www.psychiatry.org/patients-families/what-is-telepsychiatry

“Video-based telepsychiatry helps meet patients’ needs for convenient, affordable and readily-accessible mental health services. It can benefit patients in a number of ways, such as:”

-
##	Benefit	Teladoc Experiment 20190321 (TH)	Bera Fit 2018-2019	CDM 2019-RT
-
01	Bring care to the patient’s location	Yes	Yes	Yes
02	Help integrate behavioral health care and primary care, leading to better outcomes	NIS	SoSo	SoSo
03	Improve access to mental health specialty care that might not otherwise be available (e.g., in rural areas)	NIS	EP	EP
04	Improve continuity of care and follow-up	Yes	EP	SoSo
05	Reduce delays in care	Yes	EP	EP
06	Reduce potential transportation barriers, such as lack of transportation or the need for long drives	Yes	Yes	Yes
07	Reduce the barrier of stigma	Yes	Poor	Yes
08	Reduce the need for time off work, childcare services, etc. to access appointments far away	Yes	No	No
09	Reduce the need for trips to the emergency room	Yes	Poor	Poor
-
	CALC	7.00/7	2.50/9	4.00/9
	Telehealth Comparative Benefit Score (TSBS) =	100%	27.8%	44.4%
-

Last Updated: 20191002-W: NIS = Not In Scope: EP = Expected Poor

Benefits of Video-based Telespychiatry

https://www.psychiatry.org/patients-families/what-is-telepsychiatry

“Video-based telepsychiatry helps meet patients’ needs for convenient, affordable and readily-accessible mental health services. It can benefit patients in a number of ways, such as:”

Table – Benefits of Telepsychiatry – Video-based Telepsychiatry

-
##	Benefit	Note QUAL	RBB EXP	Note
-
01	Bring care to the patient’s location	SoSo	0.50	He really doesn’t care much
02	Help integrate behavioral health care and primary care, leading to better outcomes	Poor	0.00	Heather Rink principle
03	Improve access to mental health specialty care that might not otherwise be available (e.g., in rural areas)	SoSo	0.50	We have yet to get a referral to another specialist
04	Improve continuity of care and follow-up	Poor	0.00	In over 2 year he has never followed up
05	Reduce delays in care	Poor	0.00	Does not promote calling between appointments
06	Reduce potential transportation barriers, such as lack of transportation or the need for long drives	SoSo	0.50
07	Reduce the barrier of stigma	Poor	0.00	He actually promotes stigma
08	Reduce the need for time off work, childcare services, etc. to access appointments far away	Good	1.00
09	Reduce the need for trips to the emergency room	SoSo	0.50	He has very little part in this
-
	CALC		3.00/9
	Benefit of Telepsychiatry Score (BTS) =		33.3%
-

Date Scored: 20200524-SUN:

What is Telepsychiatry? - American Psychiatric Association – Electronic Health Records

https://www.psychiatry.org/patients-families/what-is-telepsychiatry

Electronic Health Record (EHR)

“A systematic collection of electronic health information about individual patients or populations that is recorded in digital format and capable of being shared across health care settings via information networks or exchanges. EHRs generally include [More or less 12 Items]…

Table – Electronic Health Record Aspects – 12 Item Prowess Assessment

	-
##	E.H.R. Aspect	2019 RBB Retro	2020 RBB EXP	Note
	-
01	1-Patient Demographics	0.25	0.25
02	Allergies	0.50	0.50
03	Billing Information	0.00	0.00	Bera not accountable We were invoiced both by the OCHCA and Kaiser
04	Characteristics Such As Age And Weight	0.25	0.25	With doctor Inglis we used to talk about weight
05	Immunization Status	0.50	0.50
06	Laboratory Test Results	0.00	0.25	Fails to discuss
07	Medical History	0.25	0.25	Doctor Dobos did the best at this
08	Medication	0.50	0.50	Pretty much only activity
09	Other Medical Images	0.25	0.25	We would like cranial imaging
10	Radiology	0.50	0.50
11	Vital Signs	0.25	0.25
12	-Other	0.50	0.50	MSE as substitution

		3.25/12	3.50/12
	Electronic Health Record Utilization Score (EHRUS) =	27.1%	26.9%
	-

Date Scored: 20200524-SUN: EXP = Expected

What is Telepsychiatry? American Psychiatric Association – Applied Definition

Table – Specifications About Telehealth (TechnoHealth)

https://www.psychiatry.org/patients-families/what-is-telepsychiatry

	-
##	Specification	Note	2019 RBB In Person	2020 RBB Digital EXP
	-
01	Increase Access to Services	For “Buster” this would mean monthly consults with his BHD	0.25	0.25
02	Originating Site	Medicare Beneficiary Location	0.75	0.75
03	Effectiveness	the degree to which something is successful in producing a desired result; success.	0.25	0.25
04	Distant Site	Location of Eligible Provider	0.75	0.75
05	Synchronous	Live Discussion	0.25	0.25
06	Teleconferencing	The use of telecommunication devices to hold discussions between participants in different locations.	0.25	0.25
07	Teleconsultation	A general term for any consultation between doctors or between doctors and patients on a network or video link (e.g., Internet, Skype, etc.).	0.25	0.25
08	Telehealth	The provision of healthcare remotely by means of telecommunications technology.	0.25	0.25
09	Telemedicine	The remote diagnosis and treatment of patients by means of telecommunications technology	0.25	0.25
10	Videoconferencing	A conference in which participants in different locations are able to communicate with each other in sound and vision.	0.25	0.25
11	HIPAA	Health Information Portability and Accountability Act	1.00	1.00
-
		CALC	4.50/11	4.50/11
		BHD TechnoHealth Mastery Score =	40.9%	40.9%
-

Last Reviewed: May 29, 2020: EXP = Expected: BHD = Behavioral Health Doctor

Aspects Regarding Telehealth

Table - FAQs - Telehealth

-
Aspect	Note	Detail
-
Telehealth Background	2 Teladoc Consults
Cost Effectiveness	The best place to save is by cutting unnecessary costs	When BHD is taken out of the loop
Medi-Cal Coverage	Covered by Brand New Day
Psychiatric Diagnostic Interview Examination	2018 Inadequate
Communication	Existing poor doctor communication skills may get amplified with Tele-service
Integration	PCP to BHD BHD to PCP	Weak so far
Potential Issues	[HELD OVER]
Benefit Expansion	Currently Teladoc is covered	Due to COVID-19 encouragement we expect our PCP & BHD will be covered
Information for Providers
E-Consult	PCP finds this challenge we have a backlog
-

Last Reviewed: 20200529-F:

Psychiatrist A Middle Man

From the consumer angle it is hard to see where or how doctor Bera is making substantial money off Buster’s account. Dr. Deutsch (APD) usually made one to two dollars per minute. A typical appointment with APD was fifty minutes. It is possible if we find an invoice from APD he made more. Dr. Bera has met in person with Buster over the past two years (2018-present). The highest frequency was once every three months. During the course of 2018-2019 Buster has never had an emergency appointment with Dr. Bera. Each appointment with doctor Bera was scheduled as Medication Management. These appointments average five (5) minutes in duration. To the best of Buster’s knowledge Dr. Bera has the choice to bill medication management office calls as: Limited, Brief, Extended or Comprehensive. For the actual five minutes, if Bera were on the up and up he might best bill no higher than a Brief or Limited. If the industry had a five-minute Hi and Bye fixed window at ten dollars ($10) lid we here at Mentalation Solutions Group (MSG) posit that would be most fitting.

Profession Turnover

We do know that at times Bera spends time after the appointment to catch up with records and pharmacy orders. Previously some of Buster’s Behavioral Health Doctors (BHDs) let Buster stay in the exam room while the doctor caught up and for small talk. On the supply line from consumer to delivery of the correct medication(s) there are just a few person involved: The consumer, clerical staff, clinical staff, and pharmacy. As we move ahead into the age of Digital Medicine (Tele-health & TecknoHealth) we feel in Buster’s case the weakest person in the chain is the psychiatrist. We call this the Arnold P Deutsch MD Principle (APD-Pri). Removing the MD will help the Pharmacist actualize their skills about Medication Management. Also the psychiatrist may better be replaced with some innovative technology we here at MSG call MedMngr. In MedMngr the consumer submits the request and the pharmacist makes the final decision. Some of the Physician Assistants and Physician Assistant trainees that Buster has met about Dr. Bera’s office indicated that they can or will replace the psychiatrist.
-

Applied Job Duties and Tasks for: "Psychiatrist"

https://job-descriptions.careerplanner.com/Psychiatrists.cfm

Table - Pertains about Rimal B Bera MD and Keith Torkelson MS Partnership

-
##	Term	Task	2020 0523 (SA) RBB	2020 0523 RBB QUANT
-
01	Analyze & Evaluate	…patient data and test or examination findings to diagnose nature and extent of mental disorder.	SoSo	0.50
02	Prescribe	…direct, and administer psychotherapeutic treatments or medications to treat mental, emotional, or behavioral disorders.	SoSo	0.50
03	Collaborate	…with physicians, psychologists, social workers, psychiatric nurses, or other professionals to discuss treatment plans and progress.	Poor	0.00
04	Gather & maintain	…patient information and records, including social and medical history obtained from patients, relatives, and other professionals.	Poor	0.00
05	Counsel	…outpatients and other patients during office visits.	SoSo	0.50
06	Design	…individualized care plans, using a variety of treatments.	Poor	0.00
07	Examine or conduct	…laboratory or diagnostic tests on patient to provide information on general physical condition and mental disorder.	SoSo	0.50
08	Advise & inform	…inform guardians, relatives, and significant others of patients' conditions and treatment.	Poor	0.00
09	Review & evaluate	…treatment procedures and outcomes of other psychiatrists and medical professionals.	Poor	0.00
10	Teach & conduct research	…and publish findings to increase understanding of mental, emotional, and behavioral states and disorders.	SoSo	0.50
11	Prepare & submit	…case reports and summaries to government and mental health agencies.	Poor	0.00
-
		CALC		2.50/11
		Prowess at Professional Tasks Grade (PPTG)	=	22.7%
-

Last Reviewed: 20200523-SAT:

20200601 (TU) Summary – Choosing Psychiatry as a Profession

https://job-descriptions.careerplanner.com/Psychiatrists.cfm

The behaviors of a psychiatrist are numerous. They include duties & tasks, activities in scope, skills or practices, innate abilities, and expertly applying knowledge. We here at Mentalation Solutions Group (MSG) often ask ourselves: Has Rimal B Bera MD made the right career choice? Was this his very best career choice? Is he really pursuing is interests? Does Dr. Bera have a higher calling? Dr. Bera’s personality does not seem in alignment with a helping profession such as doctoring. Has he been proactive about quality assurance and accountability to his profession? Is her really setting a great example for those that follow? We here at MSG have read several reports that the Health & Human Services industry is having difficultly selling the young to go into Psychiatry. The assembly line approach for Medication Management does not look glamorous. How do doctor Bera’s clients really feel about him? How is doctor Bera’s Professional Quality of Life (ProQOL)? How much is he making and is he making enough per year? We will address these questions as well as more with our next paper on Telepsychiatry.

FYI - Our Free Personality Test

Personality is more a social thing than a medical thing. Because doctors’ have so much potential to do good as well as avoid their character they can let their Personality and Bedside Manner slip. To the best of our knowledge basic doctors are not required to take a course or courses in perfecting their Emotional Intelligence Quotients (EIQs) including personality. We will check to see if in the psychiatry tract what type of courses might offer personality and character building. After one pass through online Psychiatry Tract learnings we could not find anything like Personal Character Building (PCB). We here at Mentalation Solutions Group find Dr. Inglis more virtuous than Dr. Bera. We will save our Boy Scouts of America (BSA) virtue assessment results for our next Telepsychiatry report. Yet, we find Dr. Inglis’ personality more amenable than doctor Bera’s. Think of things as if Trump qualified to serve as US President yet over and over people are attacking character. We think that Bera’s virtuosity may be superior than is president Trump’s. Lesson Learned: People including doctors do not have maintain virtuosity in order to get paid for services rendered. They don’t even have to be good at rendering services in order to bill for near nothing. Our opinion is garnered from only the few think of all the many writing favorable reviews of Dr. Rimal B Bera MD.

[INSERT DOES QUALITY MATTER BANNER]

Personality Metadata FYI >

https://www.careerplanner.com/AdvancedPersonalityTypeCareerReport.cfm?AdvertID=AreYouSure

Implications of Malpractice – Errors Psychiatric Malpractice

“Psychiatrists are still relatively low on the list of medical specialists being sued. Slawson (1979), in a poll of California psychiatrists, noted a claims rate of 3 per 100 psychiatrists per year. This contrasts to 1 in 7 physicians being sued in Cook County, Illinois, per year (Slawson, 1970).” This Sue Rate might be manipulated to mean: Out of every 100 decisions a psychiatrist makes in a year 3 of them are substantial errors. Actually when we discuss complaints with Dr. Bera’s clients Dr. Bera’s error rate comes out at around ten (10) percent.

Appendix – Matrix - Roles of a Psychiatrist Basic Job Description (Comparative)

https://job-descriptions.careerplanner.com/Psychiatrists.cfm

Diagnose, treat, and help prevent disorders of the mind

Detailed version Held Back for Telepsychiatry II

-
Part	Jobs	Defined	QGM Inglis 2007 Retro	QGM Bera 2020 RT
-
1	Duties / Tasks	A moral or legal obligation; a responsibility; a task or action that someone is required to perform.	A (4)	B (3)
2	Activities	A thing that a person or group does or has done.	A (4)	A- (3.7)
3	Skills	The ability to do something well; expertise	A (4)	B+ (3.3)
4	Abilities	Talent, skill, or proficiency in a particular area.	B+ (3.3)	A- (3.7)
5A	Knowledge Theoretical	Facts, information, and skills acquired by a person through experience or education; the theoretical understanding of a subject.	A (4)	A (4)
5B (6)	Knowledge Practical	Facts, information, and skills acquired by a person through experience or education; the practical understanding of a subject.	A (4)	B (3)
-
		CALC	23.3/24	20.7/24
		Practice Module Score (PMS) =	A (3.9)	A- (3.5)
-

Date Scored: 20200522-F: Last Reviewed: 20200524-SUN: QGM = Quick Grade Method

Inglis V Lee V Bera – Medical Record Transparency – Chronological

20070328 - Inglis Sample

20170214 - Lee Sample

20200318 - Bera Sample

[INSERT BUSTERS GRADES Sample]

Improvement – Accountability & Transparency

As you can see in the report card (transcript) Keith “Buster” Torkelson had a term (Winter Quarter 1986) GPA of 3.950 and a UC Cumulative (CUM) GPA of 3.531. Overall while progressing through his Undergraduate work Buster demonstrated an Improving Performance Trend (IPT). Buster knows what it means to improve both academically and practically. We here at Mentalation Solutions Group (MSG) External Quality Review Division (EQRD) one day hope to see both doctors Bera’s and Inglis’ medical school transcripts on-line. They or their supporters invested a good deal of money about medical school. It only makes sense to share performance figures. This would demonstrate both the Accountability & Transparency (A&T) principles as founded with Steinberg Programming Language (SPL).

-
-

Assessment

Include in Appendix

[INSERT FIGURE]

Locked Information – Tables as Figures

We here at Mentalation Solutions Group (MSG) perform a good deal of research online. Buster learned advanced database management on a Telescan Service System called Data Manager. The productivity data extracted using Data Manager was easy to transfer into both Word and Excel files. Data Manager used two options to delimit data fields: Comma Seperated Values (CSV) and Tab Seperated Value (TSV). We make us of CSV more often than TSV. An user friendly example is: Find a table, highlight and copy the table then paste it into Word yielding a perfectly formatted table in Word. Tables as figures may look nice in a report yet for all practical purposes the data is locked. Locked data has to be manually transformed if the data is to be worked with and manipulated in any manner.

Appendix - Insert some high yield Blog Post Stats

[FIGURES Our higher yield publications]