STFM 41st Annual Spring Conference April 30 – May 4, 2008 Baltimore, MD

Electronic Medical Records How to include the Patients with a PHR Colin Kopes-Kerr, M.D. Cynthia Solomon

Electronic what??? Electronic Medical Records (EMR) Electronic Health Records (EHR) Personal Health Records (PHRs) Personal Health Information Systems (PHIS) RHIO HIE

Patient at the Center of Care Hospital X Hospital Y Pharmacy Q Pharmacy R Pharmacy Data Hub School Nurse Payer Data Center – Health care, Medicare Home Monitoring Device Hospital System Data Hub Laboratory Primary Doctor Specialist Doctor Personal Health Record

What is a PHR… and Why Should You Care A computer-accessible, (interoperable) resource of pertinent health information on an individual. PHR is managed by the patient, and the patient determines who has the right to access and use it. The information originates from multiple sources and is used by individuals and their authorized clinical and wellness professionals to help guide and make health decisions.

What is a PHR… and Why Should You Care Patients access care from multiple sites and providers Lost or incomplete information contributes to medical errors Consumers want demand more information from their physicians

Using Technology to Improve Migrant Health Care Delivery Collaborative Project of St. Joseph Health System Sonoma County Community Health Resource Development Center Vineyard Worker Services Courtesy of Sebastiani Vineyards

Web-based Secure & HIPAA compliant Designed with input from clients MiVIA is a patient “owned” electronic Personal Health Record (PHR) originally designed for Migrant Agricultural Workers and expanded to include anyone with a medical condition; i.e., Homeless, Special Needs, Women, Children. MiVIA – What Is It?

MiVIA Serving Vulnerable Populations Started as PHR for migrant workers Serves mobile populations Patients access many clinics and health systems MiVIA serves as the “bridge” between health systems Promotes continuity of care Engages and empowers the patient as an active partner in their healthcare

MiVIA Personal Health Record (PHR) Stores medical and dental health information Provides Photo ID and Emergency Info Card Includes account offering a “permanent” address Provides information and resources with links to Medline Plus and other Health Info resources Individual and Family memberships Includes clinician portal for professional entry and verification

Log-In

Patient Dashboard

Photo ID Emergency Card

MiVia 4.0 Features Access granted to clinicians by permission of member On-the-fly clinician sign-up for up to 5 member patients Service Wheel: Identifies resources by special population or region Export Continuity of Care Record HIPAA compliant Complete audit and edit trail with date and time stamp Security: Managed servers at co-location facility, encryption, SSL, secure login and password

Promotores de Salud are Key to Success Provide enrollment and training in use of MiVIA Over 5000 MiVIA Enrollees in Sonoma County Provide cultural & social support Check in with clients on their use of MiVIA

Promotores start with the basics. What the computer is used for and how to access different programs. Quick overview of the Internet and show some sites MiVIA training in purpose, use, enter and access data MiVIA Training and Enrollment

Clinician Dashboard

Clinician Portal Features Alphabetical individual clinician or clinic / organizational patient list Access patient records online, any time, any place Access to patient records by permission only Data entry protected – read only to member patients and other clinicians Improved data entry fields - SOAP Format, etc. Track preventive, emergency, or chronic care visits Telemedicine – identify visits and store files

Clinician Patient List

Clinician Patient Info

Clinician Patient Record – Allergies & Reactions

Clinician Patient Record – Immunizations

Clinician Patient Record – Summary Medical Report

MiVIA Information Flow Chart

Farm Worker Service Wheel

Client Benefits Reduces the digital divide. Access to Health and Community Services, clinics, libraries, ESL Empowers consumers to be involved in their health condition. Promotes healthcare literacy Peace of mind, knowing their info is safely stored and can follow them.

MiVIA for Homeless Lessons Learned Clients are thrilled to have a concise document to store health information HUD HIMS Photo ID and relevant data can be copied and pasted into MiVIA The MiVIA Photo ID allows clients to pick up their prescription voucher at local pharmacies.

MiVIA Satisfaction Client Follow up 613 clients were contacted 40% of people enrolled stated they use MiVIA on a regular basis. 8% (50) of these clients had no prior computer experience and received basic computer training 87% of clients enrolled do not have a computer in their home.

PHR/EHR Solution Now being licensed to hospitals and clinics for mobile populations Serves as an affordable EHR for small clinics and rural providers

MiVIA System Expansion Sonoma County Mobile medical and dental clinics Community clinics Family Practice Residency “Bridge” clinic for diabetics Homeless center Resource center Hood River, Oregon Hospital Mobile Medical Clinic Rural Clinic Central Valley California 2 Hospitals 3 Rural clinics Humboldt County Finger Lakes, New York 5 clinics 3 voucher sites Integrated network Telemedicine

Lessons Learned Each Community is different Value of Photo ID Promotores are trusted resources Clients gain computer skills Partner with Libraries and Community- Based Organizations to provide computer and ESL classes

PHRs… ….to the future The ability to have doctors send patient information to the PHR directly from any EHR Condition-specific modules for self management Access to critical information 24/7 Bridge language barriers between patients and providers

Improving Community Health w/ PHRs Building Bridges Between Systems Santa Rosa Family Practice Pilot Community Health Outreach Workers Engaging Residents and Medical Students

Engaging patients through Personal Health Records

Challenges & Opportunities Interoperability with EMRs “Electronic” Exhaustion Workflow /Staff Buy-in Better Patient communication Builds loyalty Affordable solution for small practices

Contact Info: Colin Kopes-Kerr, M.D. Residency Program Director Santa Rosa Family Medicine Residency Program Cynthia Solomon, CEO FollowMe, Inc