Collaborative Project of St. Joseph Health System Sonoma County Community Health Resource Development Center Vineyard Worker Services

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Walter Parsons
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1 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 Courtesy of Sebastiani Vineyards

2 MiVIA What Is It? 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. Web-based Secure & HIPAA compliant Designed with input from clients

designed for Migrant Agricultural Workers and expanded to include anyone

3 MiVIA Serving Vulnerable Populations Started as PHR for migrant workers Serves mobile populations Patients access many clinics and health systems MiVIA serves as the bridge between health systems Promotes continuity of care Engages and empowers the patient as an active partner in their healthcare

systems MiVIA serves as the bridge between health systems Promotes

4 MiVIA Personal Health Record (PHR) Stores medical and dental health information Provides Photo ID and Emergency Info Card Includes account offering a permanent address Provides information and resources with links to Medline Plus and other Health Info resources Individual and Family memberships Includes clinician portal for professional entry and verification

Provides information and resources with links to Medline Plus and other Health Info

5 Log-In

6 Patient Dashboard

7 Photo ID Emergency Card

8 MiVia 4.0 Features Access granted to clinicians by permission of member On-the-fly clinician sign-up for up to 5 member patients Spanish version Service Wheel: Identifies resources by special population or region Export Continuity of Care Record HIPAA compliant Complete audit and edit trail with date and time stamp Security: Managed servers at co-location facility, encryption, SSL, secure login and password

5 member patients Spanish version Service Wheel: Identifies resources by special population or region

9 Promotores de Salud are Key to Success Provide enrollment and training in use of MiVIA Over 5000 MiVIA Enrollees in Sonoma County Provide cultural & social support Check in with clients on their use of MiVIA

MiVIA Enrollees in Sonoma County Provide cultural &

10 MiVIA Training and Enrollment Promotores start with the basics. What the computer is used for and how to access different programs. Quick overview of the Internet and show some sites MiVIA training in purpose, use, enter and access data Training can be intense so we recommend they return for a MiVIA review. Repetition is a learning mechanism that helps clients gain comfort and understanding of all elements.

Quick overview of the Internet and show some sites MiVIA training in purpose, use, enter and access

11 Clinician Dashboard

12 Clinician Portal Features Alphabetical individual clinician or clinic / organizational patient list Access patient records online, any time, any place Access to patient records by permission only Data entry protected read only to member patients and other clinicians Improved data entry fields - SOAP Format, etc. Track preventive, emergency, or chronic care visits Telemedicine identify visits and store files

entry protected read only to member patients and other clinicians Improved data entry fields - SOAP

13 Clinician Patient List

14 Clinician Patient Info

15 Clinician Patient Record Allergies & Reactions

16 Clinician Patient Record Immunizations

17 Clinician Patient Record Summary Medical Report

18 MiVIA Information Flow Chart

19 Farm Worker Service Wheel

20 Client Benefits Reduces the digital divide. Access to Health and Community Services, clinics, libraries, ESL Empowers consumers to be involved in their health condition. Promotes healthcare literacy Peace of mind, knowing their info is safely stored and can follow them.

Empowers consumers to be involved in their health condition.

21 MiVIA for Homeless Lessons Learned Clients are thrilled to have a concise document to store health information HUD HIMS Photo ID and relevant data can be copied and pasted into MiVIA The MiVIA Photo ID allows clients to pick up their prescription voucher at local pharmacies.

22 Expansion of MiVIA to Children with Special Needs Multiple conditions, medications and doctors Parents are usually busy with their medical appointments Easier to carry their health information at all times no matter where they are

23 MiVIA Satisfaction Client Follow up 613 clients were contacted 40% of people enrolled stated they use MiVIA on a regular basis. 8% (50) of these clients had no prior computer experience and received basic computer training 87% of clients enrolled do not have a computer in their home.

24 MiVIA Platform Evolution 2003 Consumer Portal for information storage 2005 Clinician Portal to PHR (with client permission) data entered is read only 2006 Expanded to include homeless shelter 2007 Used by some as EMR light Expanded to Special Needs clients

25 PHR/EHR Solution Now being licensed to hospitals and clinics for mobile populations Serves as an affordable EHR for small clinics and rural providers Disease Management Tool RHIO and EMR Linkages The elegant simplicity is the beauty of MiVIA David Gorchoff, MD, MPH (3/2/2007)

26 MiVIA System Expansion Sonoma County Mobile medical and dental clinics Community clinics Family Practice Residency Bridge clinic for diabetics Homeless center Resource center Hood River, Oregon Hospital Mobile Medical Clinic Rural Clinic Central Valley California 2 Hospitals 3 Rural clinics Humboldt County Finger Lakes, New York 5 clinics 3 voucher sites Integrated network Telemedicine

27 Lessons Learned Each Community is different Value of Photo ID Promotores are trusted resources Clients gain computer skills Partner with Libraries and Community- Based Organizations to provide computer and ESL classes

28 MiVIA Program Challenges Serving LEP Members Printed and online content not easily available Appropriate translation services difficult to locate No mechanism to measure quality of content/translation

29 Recommendations: Patient Centered HIT Programs RFPs should address efforts to serve LEP as a prerequisite to funding Resources made available to assist organizations in accessing, measuring and deployment of health content that is relevant and respectful of cultural differences Development of downloadable audio content as additional tools

30 MiVIA.to the future The ability to have doctors send patient information to the PHR directly from any EHR Condition-specific modules for self management Access to critical information 24/7 Bridge language barriers between patients and providers

31 Contact Info: Kathy Ficco St. Joseph Health System Sonoma County Cynthia Solomon Community Health Resource and Development Center

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