Dr. Jonathan Leviss is the first chief medical officer to serve at the Rhode Island Quality Institute. He is also continuing to practice as a primary care physician with Thundermist Health Center in West Warwick.
Providence Business News asked Leviss to talk about how he is defining his new role as both a clinical and informatics leader in promoting innovation in health care delivery in Rhode Island as well as a cheerleader for CurrentCare, the health information exchange in Rhode Island.
PBN: As Rhode Island Quality Institute’s first chief medical officer, how are you defining your role? How involved will you be in the efforts to increase patient adoption of CurrentCare?
LEVISS: As chief medical officer, I provide physician leadership across Quality Institute initiatives and serve as the physician representative of the Quality Institute for Rhode Island and nationally.
My strategy is pretty simple – I’m engaging both the team at the Quality Institute and Rhode Island’s health care community to identify where clinical and informatics leadership is needed most to support significant improvement in quality, safety and value of health care in Rhode Island.
Initially, I am focused on the federally funded Rhode Island Beacon Community Program and the Behavioral Health Integration Project.
Through these initiatives, I collaborate with teams that support key programs, including CurrentCare, Rhode Island’s health information exchange.
My day-to-day responsibilities are strategic and tactical. I participate in development of new services or new quality improvement programs with Rhode Island’s health insurers. Because of Rhode Island’s size, I can also spend time at physician practices and hospitals; I regularly meet with physicians, nurses, pharmacists, and medical office staff. I hear firsthand about the issues they struggle with while treating patients and help identify where the Quality Institute can provide innovative solutions.
Naturally, part of my role is to spread the word about CurrentCare’s benefits. As a physician, I want my patients to participate in CurrentCare just as my family and I do – so that they can receive better care.
Rhode Islanders who enroll in CurrentCare now receive direct benefits. Their primary care physician can know immediately when they are hospitalized or seen in the emergency department. Physicians can also access CurrentCare to view their health record, including lab tests and medications.
PBN: You are continuing seeing patients as a primary care physician at Thundermist Health Center in West Warwick. Why do you believe that is important?
LEVISS: It’s a privilege to care for patients, especially the underserved people I meet at Thundermist. Practicing medicine keeps me focused on the challenges patients and providers face and our need for better-connected care.
In the late 1990s, I became involved in health information technology because I wanted to make it easier to give high quality care to patients. I continue to practice medicine because it grounds me in the real goals of our field.
PBN: Partners Healthcare in Boston has decided to move to a new IT infrastructure more compatible with Big Data, in order rather than stay with its own system, to create a unified platform across all of its hospitals. Lifespan is considering a similar move. Does that mean that Rhode Island Quality Institute and its health information exchange will need to upgrade its IT infrastructure in the near future?
LEVISS: CurrentCare was designed to be capable of gathering and leveraging Big Data from the beginning. The foresight of was to develop the CurrentCare on a technology platform that incorporates data from disparate sources, across proprietary boundaries, including hospitals, physician practices, diagnostic labs, pharmacies and other places that provide health care services to Rhode Islanders who agree to participate.
Several current projects demonstrate how CurrentCare embodies Big Data – aggregating data from multiple sources to provide useful information that supports improved health care for Rhode Islanders.
Another is the CurrentCare Viewer, which provides access to review a patient’s health record, including lab results from any of the major lab systems in Rhode Island or diagnoses made by treating physicians. We’re developing analytic services that can, for example, help track population health measures and provide practices with comparative performance metrics.
PBN: In your previous work, you served as director of Clinical Solutions for Microsoft. What did you learn from that position that you will bring to Rhode Island Quality Institute?
LEVISS: At Microsoft, I consistently observed that the greatest barriers to solving problems in our health care system are people and organization-based.
When health care leaders and treating providers believe a problem needs to be addressed, and then commit energy to solve it, we can resolve most issues. Technology only helps solve problems after these two criteria are met.
Many of the problems in health care are data problems, which technology can help solve. Technologies can make the right data available to the right people at the right time, in a clear, useful way.
We can analyze populations of data to understand disease patterns, identify new health risks and evaluate new treatments. We can eliminate some of the work involved in administering health care so that providers can focus on treating patients, not generating records. We can engage consumers to more effectively manage their own health.
Our opportunity at the Quality Institute is to integrate our advanced technologies and health care transformation efforts where the motivation to change already exists. Then, we can promote new models of care across Rhode Island and stimulate further progress.
PBN: The adoption of electronic health records by small practitioners in Rhode Island has been slower than originally hoped for. Do you believe that open source software may provide a cost-effective solution for such practices?
LEVISS: Open source software has proven valuable in many industries, including health care. Some of the largest electronic health record (EHR) programs in the world are open source, such as the U.S. Veterans Health Administration system, VistA. However, open source EHRs have not yet succeeded in the small practice market.
In my opinion, the real cost of an EHR is in implementation and transformation of clinical and office processes. I believe the elimination of a software license fee does not appear to outweigh other advantages of the commercially available EHRs for most practices, including widely available implementation and support services.
Many of my medical informatics colleagues and I have been advocating for broad EHR adoption for over 15 years. By that standard, we have all hoped for faster progress across the entire nation.
Rhode Island’s EHR adoption rate in a survey by the National Center for Health Statistics increased from 21 percent to 29 percent between 2010 and 2011, a greater rate of change than the national trend in the same survey.
Our progress in Rhode Island is remarkable considering our large number of independent, small physician practices. The Quality Institute’s Regional Extension Center has successfully supported EHR adoption in physician practices across the state. We will continue to lead this effort as physicians work toward making meaningful use of EHRs.
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