Imagine that you were working internationally and had a serious stomach ache and needed to see a doctor. When you went into the medical clinic, the doctor asked you what medicines you were taking and what the status of your medical conditions were. What if you didn’t know or couldn’t tell them because you were in so much pain or you had seen a doctor but they didn’t give you a copy of your medical record. What if you lived in that same community for 5 years, but weren’t sure if you needed any medicine or treatment to prevent illness, and no one was keeping track. What if it felt like you didn’t belong….
While in California, I was honored to be invited to visit with the principals of MiVia, based in Sonoma, California. Here’s a short history of the system
MiVIAâ„¢ (My Way) was designed as a collaborative effort of Vineyard Worker Services, St. Joseph Health System- Sonoma County and Community Health Resource & Development Center in 2002. Since then, these community based organizations have worked closely to help improve the quality of life and health conditions of farm workers living and working in the Sonoma Valley and beyond.
Today I will post about my experience with the health care associated with MiVia. Tomorrow, I’ll post a virtual tour of the system.
I arrived at the MiVia headquarters in Sonoma, a humbly-appointed, former OB-Gyn practice, where I was greeted by Cynthia Solomon and Heidi Stovall. Heidi offered me the choice of an overview of the work before heading over to the mobile health units. Of course I chose to go to where the work happens, and Heidi told me the story along the way. During our ride, I learned that MiVia was born out of a personal family need for members with significant health conditions to have their medical information available at all times. Then, in looking at the community, for them to have this access as well. What Cynthia and Heidi did was take their experience managing private medical practices, and apply it to community clinic settings, and ultimately in the care of this population (farm workers without ready access to care), and I am so glad I got to see it from this perspective.
We arrived at La Luz Community Center, where the St. Joseph’s Mobile Medical Clinic was parked, and I was introduced to Jessica Alcantar, one of the “Promotores de Salud,” and Jackie Williams, the Supervisor of the Clinic. Jessica showed me how she brought families into the care system by signing them up for MiVia first. The Promotores program is an innovation of this health system, and is essential to the use of the personal health record system. It allows anyone to have access to MiVia, and the team also does educational sessions about the use of the Internet for this population. Jessica told me that as an exercise, she taught the use of Google Earth to show people how they could find their nearest library. I asked about the value of the Internet in this population, and Jessica said, “They know the advantage of being able to connect with people back home.” A great demonstration of the shattering of conventional wisdom that the Internet is only useful for some and not all.
MiVia was developed in collaboration with the people it serves, and one of the unanticipated “wins” of the system was the MiVia ID card (see pictures). These can be printed on demand off of the Web, and are also issued to members as laminated card. For the people being served, this is often the only identification they have, their only tangible “belonging” to this community. The card is not just identification…more on that tomorrow.
In La Luz, a healthy cooking class was taking place as patients were being seen in the mobile clinic.
Here are my pictures from the visit, click on any to see full size, and then the “continue” link below to read on….
The mobile clinic itself is very modern, with an Internet connection via satellite, and with exam rooms and a small laboratory. The clinic is supported by the St. Joseph Health System of Sonoma County as part of their Community Benefit program. MiVia is used as the electronic health record as well as the personal health record for these patients. Providers do their documentation right into MiVia. I did not shadow a patient visit, unfortunately, due to a desire to maximize the privacy of patients in this particular environment.
Jessica next gave us a tour of the mobile dental unit, at a different location. Jose Fernandez was the Promotore supporting dental care at this facility. MiVia is a personal health record for comprehensive health – oral health included. This is the first PHR system I have seen that does this. In some ways, this system is more comprehensive than what are offered to patients in the most advanced health systems. I spoke with Chris Tomaszewski, DDS, the dentist, and Susanne Hansen about their provision of dental care. Chris said that she’s very comfortable with mobile dentistry, as she formerly practiced for the Navy, and both Chris and Susanne seemed to echo the feeling I got from all of the providers that they really enjoy what they are doing. As with the mobile medical unit, this appeared state of the art to me. Chris does the data entry into MiVia so that patients’ oral health issues are present in their record wherever they go. In addition, the comprehensiveness of the record allows the dental team access to the medical history of the patient.
Both the Promotores and the mobile health units are funded out of the Community Benefit office of St. Josephs. What impressed me about this was that the Community Benefit was applied proactively in this community to reach a group where they are, as opposed to reactively, by providing care in the emergency room / tertiary care setting.
Right now, there are about 5,000 patients’ records in the secure MiVia system. Tomorrow, I will post on the features of the system, which include patient control and access, and even temporary access on demand.
I think this work is very important in the transformation of a health system to become accountable and accessible to patients. The MiVia team are serving a group of patients that would otherwise not be served by health information technology efforts in the community, and in many ways, their service is better than their insured counterparts. Heidi and Christine estimate that there are 15,000 farm workers eligible to be a part of this system, and are working to fund the system to provide that care. If I think about the fact that every community has a population like the one that MiVia serves, and will not be served by other systems implementing HIT, this could be a key piece of ensuring that every patient in every care system has access to, and is empowered by, their own clinical information. MiVia is being designed for interoperability (more on that tomorrow, as well).
My question to the people I met was, “why did you decide to do this?” and the answers remind me why people that go into healthcare are exceptional. I think what is special about this provider group is that they get to see the impact of what they do for the community, and of the many things about this work that can be applied to all of health care, it is helping every piece of work be tied to the impact that it makes for a patient and their family.
With thanks to Heidi, Christine, Jessica, Chris, Susanne, Jackie, Jose, and the MiVia and SJHS Community Health Clinics Teams for their time and inspiration.
Tomorrow I will post a virtual tour of MiVia, including the features that make the scenario described at the top of this post not so scary for this population, because they deserve not to be scared.