Expansion of EMR program for California migrant workers

A program enabling physicians to electronically access the health records of migrant workers who stream through California's wine country every fall is expanding its geographical reach to other parts of the state.

Under the initiative called Mi Via, Spanish for "my way," migrant workers who sign up for the free service will have their medical history, including medications, allergies and x-rays, stored online.

Any doctor in the country, even those outside the West Coast region the project is concentrating on, can access that information as long as the worker gives his or her user ID and password to the physician, said Heidi Stovall, a principal at Access Strategies Inc., a Sonoma, Calif., health care technology company that helped organize the project.

Both doctors and patients can enter information into the record but cannot change each other's entries, she said. Participating migrants will receive a laminated identification card with their name, photograph, address, medical condition, emergency contact and name of their physician, if they have one. The card also includes the address of the secure Web site where their information is stored. Workers also will get an e-mail address they can use to communicate with their physician, and vice versa.

Since its inception in 2003, Mi Via has largely focused on the estimated 16,000 seasonal workers who pass through the Sonoma Valley every year. But it is expanding its geographical reach to Lake and Mendocino counties in northern California, said Cynthia Solomon, co-founder and CEO of Access Strategies. The company expects to add 1,000 migrant workers in those counties by June, she said.

Mi Via was born after Access Strategies noticed a lot of migrant workers treated at the health center it opened in 1992 didn't return, as they moved between California and Washington searching for work.

"As they moved along, their records stayed in our facilities here but didn't go with them," Stovall said. That meant when workers sought care in a new community, they and their clinicians had to start from scratch, resulting in duplication of services and a waste of health care resources.

Fed up with constantly assembling and carrying paper records when her son was under the care of several physicians, Solomon first developed a Web-based personal health record for him. That product evolved into a commercial PHR service which Access Strategies adapted for patients with chronic conditions. "It just seemed a natural for us to put it into this migrant population who, a lot of times, don't have a permanent address," Stovall said.

To offer the service, funded by grants from nonprofit organizations, Access Strategies has joined with Vineyard Workers Services, a Sonoma-based nonprofit organization that helps farm workers obtain housing and health services. As part of Mi Via, the nonprofit recruits migrants and teaches them how to use computers and where to find them for free (namely, public libraries). Another partner is Santa Rosa, Calif.-based St. Joseph's Health System. Access Strategies is in talks with other potential partners to expand the project statewide, Solomon said.

The program has helped physicians coordinate care of patients who are difficult to care for, because it provides a readily accessible record of their medical history, said Mary Maddux-Gonzalez, MD, MPH, public health officer of Sonoma County Public Health Dept.

Having seen the benefits of Mi Via up close, the department has discussed using it for tuberculosis and HIV patients who move between California and Mexico.

"It's been mainly discussed at some international meetings as a venue worth pursuing," Dr. Maddux-Gonzalez said. "I think it can be a very valuable asset in managing patients' challenging circumstances where they don't have an established medical home, are traveling among different locations, or have very complex medical conditions and are seen by a variety of physicians."