At MEDITECH’s recent Clinical Informatics Symposium, Dr. Virna Little, PsyD, Co-Founder and Chief Operating Officer of Zero Overdose, which operates the SPiER (Suicide Prevention in Electronic Records) initiative, and MEDITECH’s own Jacqueline Rivera, RN, Analyst, Clinical Excellence, collaborated in a joint session addressing best practices for suicide prevention within EHR platforms and healthcare organizations as a whole.
Dr. Little has an extensive background as both a clinician and administrator. She has led and managed behavioral health operations within diverse environments, including integrated primary care settings, federally qualified health centers, community mental health centers, medication-assisted treatment programs, and is part of the national Zero Suicide faculty. In addition to her work at Zero Overdose, she co-founded America’s leading behavioral health medical group, which works to incorporate behavioral health into primary care settings. Zero Overdose, with support from the Four Pines Foundation, leads the SPiER initiative to support technology advancements and partnerships to prevent suicide.
Rivera has profound insight into the behavioral health sphere as well. Notably, she has worked to create two toolkits (best practices to help customers achieve measurable and improved outcomes for their patients) in her time at MEDITECH so far. One of them is the Depression Screening and Suicide Prevention Toolkit, which was a focal point in her and Dr. Little’s discussion at the symposium.
Both Dr. Little's and Rivera’s expertise in building effective behavioral health systems is particularly critical given the current public health landscape.
There’s no question that coordinated responses to suicide risk are important now more than ever; according to the CDC, the number of deaths by suicide has risen over 35% in the United States since the year 2000. When it comes to suicide risk, however, there are all kinds of elements to consider — including those beyond a diagnosis of depression.
“Many people who die by suicide don’t have a diagnosed mental illness at the time of death,” Dr. Little said. As a result, she emphasizes the importance of talking to patients about suicide directly and early on. Factors such as substance abuse, anxiety, life transitions, bullying, and alcohol abuse are just a few she cites as contributing factors to death by suicide.
The extensive number of possible contributors to suicide is what makes thorough screening for suicide risk essential in all healthcare settings. That’s why Rivera says the Depression Screening and Suicide Prevention Toolkit recommends all patients be briefly screened for suicidal ideation. This recommendation applies even if their visit is for a non-behavioral health related concern and regardless of whether they’re seen in the emergency department or ambulatory care setting.
A robust framework is critical, according to Dr. Little, given that proactive screening needs to occur across all points of care and particularly in the primary care setting. "Most people who die by suicide were seen by their Primary Care Provider, many of them in the month prior to death,” she said.
Visiting their PCP is often a patient’s first step in seeking professional help for mental health concerns. Recognizing this vital link, MEDITECH's toolkit is designed to help PCPs deliver suicide-safer care within their existing workflows. For example, nurses are prompted to administer the Columbia-Suicide Severity Rating Scale (C-SSRS) if a patient’s response to the PHQ-9 indicates a risk of self-harm in any capacity.
“The C-SSRS questionnaire helps identify if someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that that person needs,” Rivera said. Reminders to administer the C-SSRS to patients who are eligible, what their answers were to the questionnaire, and why they were prompted to take it, are all embedded within their charts, making them easily accessible for physicians.
A comprehensive utilization of the C-SSRS is part of what aligns MEDITECH’s toolkit with industry guidelines such as the Zero Suicide Toolkit, The Joint Commission, and the CMS Quality Payment Program. According to Rivera, it’s this commitment to aligning with industry best practices and embedding support directly into EHR workflows that ensures healthcare organizations can provide coordinated, evidence-based care — ultimately fostering an environment that promotes safety.
As Dr. Little profoundly stated, “There’s one thing that saves more lives than anything else, and that’s hope. Anyone, regardless of their experience, their credentials, their licensure, has the ability to give someone hope.”
Ultimately, MEDITECH’s efforts are about leveraging technology to enable every healthcare professional to instill that hope and save lives.
