Guest Blogger: Heidi Stovall, from – A PHR for migrant and seasonal workers

Josh learned about the MiVIA personal health record, and then I did. We’re both very interested in it. From the MiVIA Web site:

MiVIA™ was launched in 2003 as a personal health record for migrant and seasonal workers in Sonoma Valley, California. Today MiVIA™ provides an electronic record for several thousand people and their families across the country. The program has expanded opening the door for other populations with special or unique needs. It is especially useful for people who have no insurance, who have chronic medical conditions and/or who access care from many different providers or locations.

MiVIA™ is increasingly being adopted by clinics, mobile medical units, rural hospitals and practices as a simple easy-to-use and cost effective electronic medical record (EMR) connecting providers serving MiVIA™ members and each other.

I was interested by the idea that this project involves a population that has not previously been considered for PHR use, and interacts with health systems that may not have fully deployed health information technology.

We had the pleasure of talking with one of MiVIA’s principles, Heidi Stovall, and asked her to appear here as guest blogger, and she agreed. Here’s what she wanted people to know:

My name is Heidi Stovall. In 2002 my colleague, Cynthia Solomon and I developed MiVIA as a pilot project offering a personal health record to the migrant and seasonal farm workers that came through our town, Sonoma California, for the wine grape harvest. In 1999 we had developed our first PHR called as a result of her need to manage her son’s chronic illness (hydrocephalus) as a child by literally carrying a box of papers and scans in her car so that she would have it at all times. The customization of followme into MiVIA was funded through grants from The California Endowment to our non-profit organization.

My role with MiVIA as president of our non profit organization, is to promote, demonstrate, and sell MiVIA contracts as well as to work with our existing clients to get input and help with implementation planning. The attention we have been getting has been amazing. Many of our outcomes have been unintentional but very interesting. By demonstrating the use of the PHR in a particularly vulnerable population, we have shown that if “they” can use it and benefit from it, anyone can. And more and more people are thinking about PHRs and vulnerable populations differently now.

What I love about what I do is hearing the “ah ha!” in peoples voices when they see the demonstration. What a concept, information management with the patient at the center!

Heidi will be monitoring this thread, so feel free to post a comment about your thoughts and questions about this program.


The thing that I find most intriguing about the MiVIA experience is the following data that came out of user satisfaction survey (N=613) from the project:
– 40% of people enrolled stated that they use MiVIA on a regular basis; despite the fact that
– 87% of people enrolled do not have a computer in their home.

That suggests that many people without home computer access would regularly use a PHR if given the opportunity.

The other issue that I want to explore more in advancing PCHIT applications is how promotoras or other community health workers can be used to help engage consumers in their own care management. I know that MiVIA has made use of this strategy and would like to hear more about how they were deployed.

Promotoras (lay health outreach workers) were used from the beginning of our pilot project and is a critical piece of our implementation strategy. We trained outreach workers at our outreach partner site (Vineyard Workers Services) on the use of the MiVIA program health advocacy. Their outreach workers go out into the fields, to the employers, to places where the workers gather (churches, socials). The peer to peer interaction builds trust between the workers and the outreach center and that is what brings them to the center. Once there they are given access to computer training and taught about other community resources (libraries, health centers, etc.) and they then talk about their experiences with their friends and families. This is what builds the program.

Privacy is key to the value of any PHR. MiVIA was designed with input from our member users and with the strictest security. Any identifying data is strictly voluntary on the part of the member. In fact, members can elect to use any name they choose. As an example, I could call myself Mickey Mouse if I wanted. It is refreshing, though, to know that consumer protection is gaining attention and consideration in the PHR market.

Ted Eytan, MD