Program Abstracts
Mi VIA: Using Technology to Improve Health for Agricultural Workers
Kathy Ficco, Executive Director
St. Joseph Community Health Center, Santa Rosa, CA
Migrant and seasonal farm workers suffer disproportionately from undiagnosed and/or unattended chronic medical conditions due to a lack of continuity of care resulting from a transient lifestyle. This fragmentation of care contributes to poor health outcomes and increased costs. Visitantes Informacion Acceso (Mi VIA) offers a solution. Mi VIA is an electronic and therefore transportable, Personal Health Record (PHR). The ability to store and download critical health information such as diagnosis, medications, allergies, chronic conditions, treatment plans and test results will enhance health outcomes and decrease duplication of services.
Program Overview
The goal of Mi VIA is to improve health outcomes of migrant and seasonal workers in California. Building on an existing pilot program, the next phase will include expanding the technical capabilities as well as planning and implementing a comprehensive multi-region and multi-state expansion of the program. Even when workers are able to access health care, that care is sporadic and fragmented as the workers move from job to job and community to community, leaving their medical records, test results and care plans behind and resulting in unnecessary duplication of services. This lack of continuity in their health care contributes to poor health outcomes and increased costs to an already burdened health care system.
Each worker's PHR is password-protected using 128 encryption and is HIPAA-compliant, provides an audit trail, secure messaging and provider entry portals. VIA allows patients, or any advocate whom they authorize, to download their information at any time or to have the information downloaded by a health care provider. The benefits of this HIPAA-compliant, web-based application include:
- The promotion of continuity of care, allowing healthcare records to travel with the worker from community to community. Once authorized by the PHR owner, this record is immediately available to the provider of care for important medical decisions.
- Improves worker access to care by providing community based information on local clinics, programs and services.
- A cost efficient, user-friendly system that accommodates the cultural and linguistic needs of clients.
- Personal worker e-mail address and a printable emergency card with a photo ID and identification of serious conditions, immunizations, allergies and emergency contact information.
- VIA is cost effective. No investment in expensive software or hardware required. Providers and VIA users only need access to the Internet.
- Empowers the VIA member to understand their health condition, promoting healthcare literacy.
Impact
- Continuity of care for patients across multi-jurisdictional and multi-provider settings
- Improved access to health care through expansion of enrollments to Mi VIA
- Adoption of health-promoting behaviors through an increase in patient understanding of their illness and treatment
- Increased utilization of health services through targeted outreach
- Improved patient satisfaction with the healthcare system
- Narrows the digital divide by enabling VIA members to learn about computers, the Internet, libraries and other educational and community-based opportunities in their community
VIA, a scalable program can be replicated on a regional, statewide and even national level contributing to the health and well being of farm workers throughout the United States. This would result in improved health outcomes while decreasing duplicative medical costs. A pilot project in California's Sonoma Valley (2002-2004) confirmed the functionality of the program and a positive response of the more than 1,400 users/members. The innovation and potential of Mi VIA is clearly recognized by such diverse groups as the e-Health Initiative (VIA- Best Practices March 2005), Markle Foundation and federal and state agencies including NHII, CDC, DHHS, etc. In the report Ending the Document Game, Mi VIA is the only PHR that was actually referenced and featured.
Sustainability
Mi VIA is in the process of developing a long-term sustainability plan that is both cost-effective and competitive. The initial development and outreach expenses are covered by grants. We anticipate low annual fees to clinics and facilities as well as corporate sponsorships of the web-based e-mail program and resource links. Because the program is web-based, there are no expensive software or maintenance costs. Once the system is deployed on a regional statewide basis, a low annual fee of $100 is charged per month per clinic or provider plus $1 per year for each enrolled VIA member.
Mobile Technology, Design and Operational Applications
George Hayes, NCPT, Program Manager
The Whittier Institute for Diabetes/Scripps Health, LaJolla, CA
In design and planning for mobile operations, making the appropriate choices can be daunting, with ever-changing devices, protocols, and technology lifespans. What is appropriate for health care? How much technology savvy does the clinical staff need in order to operate or to set up systems? Discussion will include technology ideas for the multiple tasks of medicine, disaster preparedness, and community service.
Technology choices will be addressed: what's essential, what's an option, based on the multiple tasks mandated to many mobile units. The discussion will include technology choices that have worked and those that have not in actual operations, as well as systems life-cycles, innovative and unusual methods.
George discussed technology operations in specialty care for diabetic patients, including program experiences with disaster preparedness based upon the Whittier program.
Objectives
- Understand relevance of different systems
- Understand the value and the purpose these systems
- Discuss how devices and policy have affected planning of mobile units for technology
Outline
I. Data Systems: satellite vs. wireless; radio vs. wireless, voice; landlines vs. wireless and satellite
- Cost
- Physical plant
- Medical device needs ( i.e., equipment)
- Reliability and system speed
- Technology-refresh issues
- Disaster preparedness
- Staff competencies
- Data-internet, VPN
- Medical equipment, EKG, Retinal
- Voice and facsimile
- Radio systems; private and public safety
- Qtracs
- HIPAA
- Telemedicine
- System security
Through Project Renewal's direct experience after September 11th, we have seen the critical role that mobile health clinics can play in times in disaster, and their essential role in emergency response and preparedness. In terms of response and recovery, firstly, mobile health clinics provide surge capacity, meaning extra resources, including mobile facilities, staff, and equipment/supplies. Furthermore, staff are trained in communications systems that are vital in times of emergency, systems that include the use of cell phones, telemedicine, wireless technology, and electronic medical records. Also, mobile health clinics are experienced in working with marginalized and hard-to-reach populations that are very similar to disaster victims. Indeed, many mobile health care clinic staff have already responded to disasters and have hands-on experience with “lessons learned.” In addition to response and recovery in a disaster, mobile health care clinics are able to offer emergency preparedness. They can provide surveillance and export data, being the first to identify biological disasters and send data to the appropriate health agencies for analysis. They are the first to respond to biological disasters and to communicable diseases of public health concern. With this in mind, in this forum we will discuss the next steps to ensure appropriate coordinated response by our mobile health clinics in times of disaster:
- A nationwide questionnaire to identify all of our interests and resource.
- A formal proposal to the CDC for a nationwide "on-call response registry"
Outline
I. What role do mobile health clinics play in terms of response and recovery during a disaster? a. Provide surge capacity. Extra resources include mobile facilities, staff, equipment/supplies b. Staff are trained in communications systems: cell phones, telemedicine, wireless technology,electronic medical records c. Experience working with marginalized populations that are similar to disaster victims d. Previous experience with disaster e. Point of distribution for medications and vaccinations II. What role do mobile health clinics play in terms of preparedness during a disaster? a. Surveillance b. First responder for biological disasters c. First responder for communicable diseases of public health concern d. Isolation protocols III. What are the next steps to ensure appropriate/coordinated response by mobile health clinics in times of disaster? a. Nationwide questionnaire to all mobile health clinics b. Formal CDC proposal for on-call response registry c. Training – core curriculum, personal protective equipment and decontaminations, exercises and drills
Medical & Dental Access - The Mobile Health Solution
Nancy E. Oriol, MD, Founder The Family Van, Harvard Medical School, Boston, MA
Background
The Family Van was founded in response to the poor health outcomes in Boston, a city with an abundance of health care resources, yet an alarming disparity in infant mortality rates between Blacks and Whites. A belief that infant mortality is only one symptom of an unhealthy community, and the observation that many women – indeed, families -- did not know about or feel entitled to utilize the available health and social services, led to the creation of the Family Van, a public/private collaboration that addresses the health of the individual, the family and the whole community.
Mission
We found that the issue for most of our clients was not simply insurance, or transportation; it was, broadly speaking, a sense that the institutions designed to serve them, were unwelcoming or even hostile. It was the unease of the outsider looking into a fast-paced world that could not hear their whole story or begin to address the holes that a lifetime of alienation had created in the ability to manage the business of life. It is the mission of the Family Van to welcome in our neighbors, listen to their stories, share our resources and open the doors to Boston's wealth of institutions.
Outcome
The Family Van created an amazing synergy by bringing together the knowledge and wisdom of our patrons; the social capital of our communities; seven neighborhood health centers; numerous community- based organizations; medical and allied health colleges; and the local academic medical centers. This breadth of collaboration is unique in that it crosses competing health care systems and local turf boundaries – all for the shared vision of healthier families. Now, almost 15 years later, the program is well known, well utilized, and has an ever-expanding family.
Objectives
After listening to this lecture, attendee will: 1. know that van programs share in the miracle of giving 2. know the trials, tribulations and joys of running a van program 3. be inspired to persist in working in mobile healthOutline
I. The miracle of the Family Van
Specialty Mobile Medical Services
Brain Quinn, MA, Grants & Communications Director
Friends of the Congressional Glaucoma Caucus Foundation, Lake Success, NY
The leading cause of preventable, irreversible blindness among Americans is glaucoma, a disease of the eyes that attacks without discernible symptoms until the damage to the optic nerve is extensive, by which time it is too late. The disease strikes minorities -- both African-Americans and Hispanics -- especially hard. Both groups have a four to five times higher risk of glaucoma than Caucasians, and in Blacks the disease strikes at a younger age and causes blindness more quickly. Both groups, too, are underserved and underinsured.
And yet glaucoma can be controlled fairly easily with medications or with surgery, once it is uncovered in an individual. Until about five years ago, however, glaucoma screening was done mainly in ophthalmologists' offices, seldom visited by the poor, the uninsured, and many minorities.
This lecture will describe the origin of the Congressional Glaucoma Caucus and its operational partner, the Friends of the Congressional Glaucoma Caucus Foundation. It will briefly recount the history of the organization, and how it grew from a small group of volunteers doing occasional glaucoma screenings in Washington, DC, with a budget in the low three-digit range, into a nationwide effort involving 15 mobile units and an annual budget of $4.5 million. The lecturer will discuss the obstacles the Foundation faced and how it overcame them to conduct screenings of more than 100,000 persons in 33 states, the District of Columbia, Puerto Rico and the US Virgin Islands. The Friends of the Congressional Glaucoma Caucus Foundation's public relations efforts, its alliances with medical schools, hospitals, physicians, ophthalmological associations, and vendors will be touched upon. The benefits of having a powerful partner (the U.S. Congress) will be explained, as will the drawbacks of that same relationship. How to foster such a relationship and possible steps to obtaining special support will be explained.
Objectives
After listening to this lecture, attendee will: 1. Have been introduced to a relatively young but very successful Mobile Screening Program 2. Have a better understanding of the potential Congressional support available today 3. Have a roadmap for potentially obtaining such support 4. Know of at least one more vision program offering services that may be beneficial in theattendee's own community
Outline
I. What is the Friends of the Congressional Glaucoma Caucus Foundation
a. History
b. Achievements and population served
II. How to utilize the Foundation in local communities
a. Scheduling a screening
b. PR, how to bring a crowd
c. Involving the local politicians
III. Obtaining support from Congress
a. The Foundation's experience
b. Reaching out to Members of Congress
c. Learning that “pork barrel” isn't evil
Mobile Health Services – Lessons Learned
Herrmann Spetzler, BS, MA, MIS, CEO/Executive Director
OPEN DOOR Community Health Centers, Arcata, CA
The geography of California is often misunderstood. While one out of every eight Americans lives in California, and Los Angeles, San Diego and the San Francisco Bay Area are seen as “California,” more than three-quarters of the state is defined as rural. Rural California presents special challenges. The mobile programs provided by OPEN DOOR Community Health Centers cover an area the size of Connecticut, including mountains and many frontier areas.
The first services were offered in 1977 in an old converted schoolbus, with more youthful vigor than economic reality. It soon became clear that this model was not sustainable.
After many different approaches had been tried, it became clear that a centrally organized mobile outreach program was preferable to community-based planning.
Mobile dental services began with central planning: where and when the dental van would be in a community, and for how long. After many years of moving on before the job was done, we now stay until all treatment plans are completed before moving to the next service site. The challenge of finding and retaining provider staff was successfully addressed by the implementation of a rotation model, rather than the utilization of full-time mobile providers.
Evaluation of services has shown real improvement in easily identifiable statistics, e.g., immunization rates; identification and treatment of children with dental caries; participation in diabetes collaborative, etc. Other valuable evaluation tools have addressed measures of patient satisfaction, access times, prevention focus, etc.
The big-picture evaluation of mobile services includes constant review of whether the services are sustainable in today's healthcare environment. Is grant support realistic in the long run? Can fees support a permanent model? Is delivery of a particular service based upon the participation of one or two individuals? Is the service a part of a larger system, or can it stand on its own?
Is there a role for telehealth and mobile health services? Are we a part of the disaster preparedness plan in our region? Does “mobile” mean “wheels”? Can we be a part of the solution to the problems associated with addressing surge capacity as a critical component of disaster preparedness?
The future is just around the corner. Will we follow, or will we lead the way?