MiVIA Program Lets Migrant Workers Access Electronic Health Records From Any Computer
by Candi Helseth
MiVIA users fill in health records that are transferred to an electronic resource that can be accessed by providers in various locations.A mobile medical assistance program is allowing California migrant workers and other transient populations to carry and access their personal health records no matter where they are. The MiVIA program was launched in Sonoma County, Calif., in 2003 for migrant and seasonal workers whose medical care was compromised by the fact that they spoke poor English and moved frequently. In the last two years, the MiVIA concept, and use of its software, has expanded into five more states as well as being used for homeless people in Sonoma County.
MiVIA keeps personal health records stored on remote servers that health care providers can access quickly. Unlike electronic health records, which are owned by the clinic or hospital, the individual owns MiVIA information and it’s accessible at any location with Internet access.
“Electronic health records are great for stable populations, but they don’t work well for mobile populations,” said program co-founder Heidi Stovall. “When farm workers left our community, they left their medical records behind. We built MiVIA (pronounced “mee-vee-ah,” which stands for “My Way” in Spanish) so patients could keep their information with them. They love it because it’s so simple to use. Providers embrace it because it’s such a good way for them to connect with other providers that have taken care of these individuals. It helps providers solve problems they can’t resolve with the patient because of language and cultural barriers.”
MiVIA members carry a photo identification card that lists emergency contacts, medical conditions, medications and allergies, as well as information on how to access the website for their online medical records. The card also helps identify the individual in case of emergency or communication barriers.
MiVIA, an electronic health system, was developed to meet the needs of migrant farmworkers living in California’s Sonoma Valley.Using a password and login they are given when they enroll in MiVIA, users can access their electronic health record from MiVIA’s secure server wherever Internet access is available. Although most users don’t have personal computers, Stovall said the Internet is easily accessible in public spots.
The individual gives the health care provider access to the secure online patient chart and the provider can view past medical history and then enter current medical information from that appointment. That way, Stovall explained, patients’ health records travel with them to the various locations where they may live. Cards can be updated and reprinted from any computer when changes are necessary.
In Sonoma County, which is wine country, seasonal workers move frequently, are generally uninsured, have incomes below the federal government’s poverty guidelines, and speak little or no English. They are among the more than three million migrant and seasonal farm workers estimated to be in the United States at any given time, according to the National Center for Farmworker Health.
In addition, MiVIA is being used for other populations. St. Joseph’s Health System in Sonoma and the Community Health Resource and Development Center (CHRDC) in San Joaquin are enrolling homeless clients.
MiVIA’s benefits have extended beyond its initial record-keeping benefits, according to Paul Castro, deputy program director of California Farm Worker Services. Castro’s office works with migrants to help them access appropriate care and get screenings and medications. Enrolling in MiVIA has helped workers take more personal responsibility for their health care, and Farm Worker Services has been better able to refer farm workers to proper channels for screenings and diagnoses.
“There is a lot of diabetes among farm workers,” Castro said. “One family, the woman was on three or four meds and she couldn’t keep track of what she was taking. When she got it on her card, she got better because the doctor got the right information when she brought him the card. Another family, when they enrolled, the husband wasn’t getting treated for his diabetes. We helped him get on medications and then he was able to work and even took vocational training.”
When they began developing MiVIA, Stovall said, they involved seasonal workers and family members in preliminary focus groups. Technology was the first barrier; seasonal workers had never used computers.
“The Vineyard Workers Services, our outreach partner, set up computer classes and showed them how easy it was to use,” Stovall said. “For some of these seasonal workers, this email address is their only permanent address. Families really embraced it.”
Migrant workers or family members who didn’t speak English began bringing family members and children, along with all their medications, to the outreach center to be sure their information was entered correctly. While most had never been to the library previously, the classes opened the door for them to use the library for additional resources.
The idea for “follow-me” health records originated out of discussions between Stovall and Cynthia Solomon, a longtime friend who is MiVIA’s co-founder. Solomon’s child was diagnosed 30 years ago with a disease that took the family to many different providers in different locations. Solomon carried her son’s medical records in the back seat everywhere they went.
Knowing they would need additional resources, the women turned to area providers for assistance. Vineyard, St. Joseph’s and CHRDC partnered with them to build MiVIA. The Rural Community Assistance Corporation and the California Endowment funded the program.
In addition to expanding within California, customized follow-me personal health records are being used for projects in Oregon, Minnesota, New York, Iowa and North Carolina.
For more information, contact:
Heidi Stovall
MiVIA.org
639 Third St. West
Sonoma, CA 95476
707-935-4880
Website: MiVIA
AROUND THE COUNTRY
Mobile Service in Florida Helps Homeless Veterans
Homeless veterans line up for services at the Florida Veterans Mobile Service Center's van.
In some of Florida’s most isolated areas, there are veterans living in tents, old vehicles and makeshift shelters they’ve built from scraps. Florida Veterans Mobile Service Center (MSC) is working to break their self-imposed isolation by bringing medical care and social support to the rural encampments where these homeless veterans live.
The 40-foot mobile service vehicle, owned and operated by Volunteers of America of Florida, is equipped with medical and dental exam rooms, dental X-ray equipment, medical supplies, medications, and advanced mobile technologies linked to the U.S. Department of Veterans Affairs (VA). Now in its 10th year, MSC provides homeless veterans with immediate needs such as food and clothing, as well as with physical and social support. Services include physical and dental exams, VA benefits eligibility verification, counseling, and assessments for housing, mental health, substance abuse, employment, educational and vocational needs.
“With MSC, we’re going to them and we’re able to reach out one-on-one,” said Ed Quill, chief administrative officer for Volunteers of America of Florida. “Most of these individuals are Vietnam era vets and many will tell you they were harassed and even spit on when they came back home. What happened postwar was an unfortunate comment on their military service. The reception they received when they came home has made them want nothing to do with the red tape of social services or hospitals. They’re not likely to reach out to the VA for help. They’ve felt rejected by society and they’ve withdrawn from it.”
Volunteers of America of Florida offers transitional housing to homeless veterans throughout the state, including this house in Punta Gorda, Fl.The number of homeless veterans in Florida is estimated to be 17,500. According to the National Coalition for Homeless Veterans, an estimated 131,000 veterans in the United States are homeless on any given night and approximately twice that many are homeless over the course of a year. “In addition to the complex set of factors affecting all homelessness—extreme shortage of affordable housing, livable income and access to health care—a large number of displaced and at-risk veterans live with lingering effects of Post Traumatic Stress Disorder and substance abuse, compounded by a lack of family and social support networks,” according to the Coalition’s website.
As MSC staff has built relationships with veterans, they’ve been able to reconnect them with area services in those locations.
“We maybe can’t get them to move out of the woods but we can help them access services near them and make a connection with providers that are in that area,” Quill said.
For veterans who want to change their circumstances, Volunteers of America of Florida also addresses the root causes of homelessness through its Housing, Health and Training, Education and Employment Services. Veterans can move into any of 10 transitional housing programs, located throughout the state. They are able to live there for up to two years and access assistance such as education, job training and placement. If they have problems such as substance abuse or other issues that need addressing, they also receive those services.
MSC’s services have extended beyond its original borders by reaching out to neighboring states that have experienced natural disasters. MSC has traveled to four major hurricanes in the last five years, Quill said, providing medical support and communication systems.
“After Katrina, the VA Gulf Coast Health Care System and Clinic in Mobile, Alabama, didn’t even know where their staff was and all their phones were out,” Quill said. “With our capabilities of satellite uplink, we can do just about any type of communication. We provided them with communications support and we also saw patients. MSC then moved on to Hammond, Louisiana, and performed triage and medical support there.”
As veterans return from Iraq and Afghanistan, many of them with physical disabilities, Quill said it’s important that intervention begins immediately. Quill said Volunteers of America of Florida is modifying its approach to outreach to specifically reach veterans from operations Iraqi Freedom and Enduring Freedom.
“The more acute intervention we can provide now, the less likely there will be long-term issues,” he said. “As the problems become more entrenched, they are more difficult to deal with. We’ve seen the pain, and we don’t want to see the soldiers who are coming back now go down that same path.”
Grant funding from the VA’s Homeless Providers Grant and Per Diem Program supports both the mobile veterans’ outreach and transitional housing program.
For more information contact:
Wendy Whitescarver
Volunteers of America of Florida
1205 E. 8th Avenue
Tampa, FL 33605
Tel: (813) 321-6945
Fax: (813) 287-8831
Email: wwhitescarver@voa-fla.org
