Using Technology to Improve
Migrant Health Care Delivery
Collaborative Project of St. Joseph Health System Sonoma County Community Health Resource Development Center Vineyard Worker Services
n Web-based
n Secure & HIPAA
compliant
n Designed with input
from clients
MiVIA is a patient “owned” electronic Personal Health Record (PHR) originally designed for
Migrant Agricultural Workers and expanded to include anyone with a medical condition; i.e., Homeless, Special Needs, Women, Children.
MiVIA
2003-2008
Serving Vulnerable Populations
n Started as PHR for migrant workers n Serves mobile populations
n Patients access many clinics and health
systems
n MiVIA serves as the “bridge” between
health systems
n Promotes continuity of care
n Engages and empowers the patient as
MiVIA Personal Health Record
(PHR)
n Stores medical and dental health information n Provides Photo ID and Emergency Info Card n Includes email account offering a
“permanent” address
n Provides information and resources with links
to Medline Plus and other Health Info resources
n Individual and Family memberships
n Includes clinician portal for professional entry
MiVia 4.0 Features
n Access granted to clinicians by permission of member
n On-the-fly clinician sign-up for up to 5 member
patients
n Spanish version
n Service Wheel: Identifies resources by special
population or region
n Export Continuity of Care Record
n HIPAA compliant
n Complete audit and edit trail with date and time
stamp
n Security: Managed servers at co-location facility,
Promotores de Salud
are Key to Success
n Provide enrollment and
training in use of MiVIA
n Over 5000 MiVIA Enrollees
in Sonoma County
n Provide cultural & social
support
n Check in with clients on
n Promotores start with the basics.
n What the computer is used for and how to
access different programs.
n Quick overview of the Internet and show some
sites
n MiVIA training in purpose, use, enter and access
data
n Training can be intense so we recommend they
return for a MiVIA review.
n Repetition is a learning mechanism that helps
clients gain comfort and understanding of all elements.
MiVIA Training
and Enrollment
Clinician Portal Features
n Alphabetical individual clinician or clinic /
organizational patient list
n Access patient records online, any time, any
place
n Access to patient records by permission only n Data entry protected – read only to member
patients and other clinicians
n Improved data entry fields - SOAP Format, etc. n Track preventive, emergency, or chronic care
visits
Clinician Patient Record –
Allergies & Reactions
Clinician Patient Record –
Immunizations
Clinician Patient Record –
Summary Medical Report
Client Benefits
n Reduces the digital divide.
n Access to Health and Community
Services, clinics, libraries, ESL
n Empowers consumers to be involved in
their health condition.
n Promotes healthcare literacy
n Peace of mind, knowing their info is
MiVIA for Homeless
Lessons Learned
n Clients are thrilled to have a concise
document to store health information
n HUD HIMS Photo ID and relevant data
can be copied and pasted into MiVIA
n The MiVIA Photo ID allows clients to pick
up their prescription voucher at local pharmacies.
Expansion of MiVIA to
Children with Special Needs
n Multiple conditions, medications and
doctors
n Parents are usually busy with their
medical appointments
n Easier to carry their health information
MiVIA Satisfaction
Client Follow up
n 613 clients were contacted
n 40% of people enrolled stated they use
MiVIA on a regular basis.
n 8% (50) of these clients had no prior
computer experience and received basic computer training
n 87% of clients enrolled do not have a
MiVIA Platform Evolution
n 2003
Ø Consumer Portal for information storage n 2005
Ø Clinician Portal to PHR (with client permission)
data entered is read only
n 2006
Ø Expanded to include homeless shelter n 2007
Ø Used by some as EMR “light”
PHR/EHR Solution
n Now being licensed to hospitals and
clinics for mobile populations
n Serves as an affordable EHR for small
clinics and rural providers
n Disease Management Tool n RHIO and EMR Linkages
“The elegant simplicity is the beauty of
MiVIA System Expansion
n Sonoma County
• Mobile medical and dental
clinics
• Community clinics
• Family Practice Residency
“Bridge” clinic for diabetics
• Homeless center • Resource center
n Hood River, Oregon
• Hospital
• Mobile Medical Clinic • Rural Clinic
n Central Valley
California • 2 Hospitals • 3 Rural clinics
n Humboldt County n Finger Lakes, New
York
• 5 clinics
• 3 voucher sites
• Integrated network • Telemedicine
Lessons Learned
2003-2008
n Each Community is different n Value of Photo ID
n Promotores are trusted resources n Clients gain computer skills
n Partner with Libraries and
Community-Based Organizations to provide computer and ESL classes
MiVIA Program Challenges
Serving LEP Members
n Printed and online content not easily
available
n Appropriate translation services
difficult to locate
n No mechanism to measure quality of
Recommendations:
“Patient Centered” HIT Programs
n RFPs should address efforts to serve LEP
as a prerequisite to funding
n Resources made available to assist
organizations in accessing, measuring
and deployment of health content that is relevant and respectful of cultural
differences
n Development of downloadable audio
MiVIA …
….
to the future
n The ability to have doctors send patient
information to the PHR directly from any
EHR
n Condition-specific modules for self
management
n Access to critical information 24/7 n Bridge language barriers between
www.MiVia.org
Contact Info: Kathy Ficco
St. Joseph Health System Sonoma County 707.546.5899
Cynthia Solomon
Community Health Resource and Development Center
800.300.4400
