Farm Worker Health Record Effort Grows in San Joaquin Valley

“This is one of those situations where technology helps you feel more confident, more comfortable with what’s going on,” said Maria Ochoa, new owner of an online personal health record.

“These records don’t necessarily give you any control, but the fact that you can keep track of things yourself is important,” Ochoa said.

Ochoa, who lives in Lodi with her husband and four kids, is among the first wave of California farm workers to get Web-based personal health records in a project funded by the state government.

Four months ago, the Department of Managed Health Care awarded a $444,470 grant to La Cooperativa Campesina de California and its partners for a pilot project to enroll San Joaquin Valley farm workers and their family members in the MiVIA Health Advocacy and Personal Health Record Project. Billed as the first of its kind in the country, the project is part of $6 million in new state grants this year to clinics and community groups for projects aimed at improving health care delivery systems for underserved populations. 

Ochoa’s PHR is in Spanish and is more accurately an EMP — “expediente medico personal.” Most of the 5,000 Web records the pilot project hopes to create over the next seven months will be in Spanish.

Computer/Internet Access Not a Big Hurdle

Although the program is aimed at a largely migrant population, access to computers and the Internet is not as big a hurdle as one might think, according to Raul Meyreles, executive director of La Cooperativa Campesina de California.

“Getting online access is no problem. We tested it in Sonoma County and Napa County and we found that even if the family didn’t have a computer of their own with access to the Internet, they knew somebody who did, or they could go to the library or one of the clinics connected to the program,” Meyreles said.

“We’re pretty confident this kind of program can work, and there’s a good possibility it may expand to other parts of California and maybe other parts of the country,” Meyreles said. “But we have to wait and see how this pilot turns out. We don’t want to duplicate something that doesn’t work.”

“Right now, we’re encouraged by the progress but we’re not in the thick of it,” Meyreles said. “We are the sponsoring agency. Our job is to get something going and then get the hell out of the way.”

Much of the day-to-day management of the program has been turned over to the California Human Development Corporation, one of several partners in the MiVIA pilot.

Juan Prieto, California Human Development manager overseeing the project in San Joaquin County, is encouraged by the progress.

“We’ve been involved mostly with outreach and enrollment for the past several weeks, going to migrant camps, job fairs, school meetings and some church events,” Prieto said. “We’re also riding along with some mobile clinics.”

“We’re getting a positive response from the community. Some of these people have never used a computer or the Internet before so there is sometimes a learning curve but that hasn’t been much of a problem.”

“People are pretty eager to take advantage of what this program offers,” Prieto said.

ID Card as Well as Medical Record

The MiVIA program offers three features important to a migrant population: a portable electronic account of medical history, a photo ID and no charge for using it.

“When you explain to people and show them what’s possible with this system, how they can create their own electronic file that can go with them wherever they go — to Mexico or Central America or Arizona or Los Angeles or wherever — they start to see the value right away,” Prieto said.

“And they are also issued a medical card with photo, phone numbers and relevant medical information that can be a valid form of identification,” Prieto added. “That’s an attractive feature for many people.”

MiVIA, “my way” in Spanish, is a comprehensive health record with details of the patient’s medical conditions, medications, procedures, lab results, demographic data and allergies. Providers can scan documents and images, such as lab results and X-rays, and import them into the PHR.

Farm workers, according to several studies, have a higher incidence of undiagnosed and/or untreated chronic medical conditions because of fragmented care, a byproduct of a transient lifestyle. Untreated or under-treated chronic problems contribute to poor health outcomes and increased costs, state officials said.

“This grant will help to improve health care for local farm workers, using advanced technology that will allow them to bring their personal health histories with them as they travel throughout the state to harvest crops,” said DMHC Director Cindy Ehnes.  “It sets the example for other health care providers to invest in health information technology by showing how portable, electronic health records can benefit all Californians.”

Funding for the grant comes from a $50 million charitable investment required by DMHC and the California Department of Insurance from PacifiCare Health Systems when it merged with UnitedHealth Group in 2005.    

Other partners in the San Joaquin County project are:

  • Access Strategies, developer of the software used in the MiVIA system;
  • Community Health Resource and Development Center;
  • Community Medical Centers;
  • Kaiser Permanente; and
  • St. Joseph’s Medical Center.

Privacy Not a Major Issue

Privacy and security are not big issues for the people getting these PHRs, said Prieto, “but we do hear some concerns from the medical side — from doctors and hospitals and clinics.”

“These files comply with all HIPAA regulations, and we explain that to people, show them how they have their own login and password and how nobody can have access unless you give them permission.”

“Of course there’s always the threat online that somebody can hack in, but mostly people aren’t worried. They’re happy to have the advantages these records offer,” Prieto said.

“So far we have somewhere between 120 and 170 families enrolled,” Prieto said. “Considering we’ve only been actively enrolling for a few weeks, that’s not bad. We’re pretty sure we’ll hit the target 5,000 and maybe go over.”

“People seem very satisfied with how the system works once they’re signed up and get involved. Word of mouth will be the best kind of promotion,” Prieto said.

Families Are Prime Targets

Families are prime targets in the project and “getting the mother signed up first is a common practice,” said Maricela Juarez, a California Human Development health access specialist working on the MiVIA project in San Joaquin County.

Maria Ochoa is sold on the idea and plans to work on the rest of her family to set up their own “expedientes.”

“This record takes away a little of the fear that some people feel when they go into a medical situation where they don’t speak the language and they don’t know the people taking care of them,” Ochoa said.

“I think it’s a good use of technology to improve people’s lives and within the next two or three weeks, I’m going to get each of my kids and my husband to set up their own records.”

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