Suicide has risen to the status of a critical public health issue in the United States and rates are continuing to grow across the country. According to data from the CDC, the age-adjusted suicide rate jumped up by 30 percent between 2000 and 2016, when nearly 45,000 people committed suicide.
With these sobering figures, clinicians and crisis services providers have been looking at new ways to prevent suicides by using technology to identify at-risk patients and intervene before a life-threatening event.
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St. Louis, Missouri-based HarrisLogic develops clinical services and population health management software for providers, schools and law enforcement intended to help users identify potential behavioral health issues within a population and divert them appropriate resources or sites of care.
The company’s StellaCrisis platform was borne out of the company’s experience as a provider of suicide hotline and mobile crisis services to the Dallas Area.
That situation led to the development of a guided documentation software that walks hotline workers through the type of information to gather from callers and helps them perform screening and triage to help ensure patients get care in the least restrictive care setting possible.
“That puts us in a different situation to most vendors, we don’t build the technology we just use it every day,” said Hudson Harris, Chief Engagement Officer at HarrisLogic.
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Using the platform, providers receive live risk scores which can be used to determine the best care pathway for the patient. The company’s software is also in use by other suicide hotline and mobile crisis service providers in Oregon and Texas.
Harris said in the larger digital transition of healthcare, mental and behavioral health issues have been largely glossed over, as evidenced by the lack of incentive payments for mental health providers to use an electronic health record included in 2009’s HITECH Act.
What HarrisLogic is trying to create, according to Harris, is more standardization in how behavioral health issues are assessed and treated to ultimately improve outcomes for patients.
“If you have a broken ankle, then everyone in the hospital knows what to do, they know what to ask and there’s a protocol that exists,” Harris said. “The research is out there to support something similar for behavioral health, but unfortunately nobody really does that.”
StellaCare, another of the company’s products, provides on-demand telemedicine behavioral health consultations to hospital emergency departments which can allow for more effective triage inside the clinical care setting.
“In the ED there’s a strong over reliance of inpatient psychiatric care, if an individual goes into the hospital with a behavioral health issue, it’s a pretty good bet they’re going to end up in an inpatient care setting,” Harris said.
“Our platform helps clinicians understand the risk factors in a standardized way that to create a consistent approach. If we’re not talking the same language, then we’re not going to be able to move the needle healthwise.”
This in turn helps HarrisLogic to understand what a mental health crisis looks like as a distinct episode of care, as well as who’s receiving the service and who’s most likely to engage with resources to better tailor engagement and outreach to patients that need it most.
Both StellaCare and StellaCrisis are also able to be used in conjunction with existing EHR records to help better inform risk factors and inform care.
The company’s technology has also been used within the incarcerated population as a way to address recidivism and identify and treat individuals with mental health issues by combining jail book-ins with data from the local mental health authority.
The Dallas County Criminal Justice Department has used HarrisLogic’s platform for its Crisis Services Project, a 1115 Medicaid Waiver project that that works to ensure all Dallas County jail inmates with a suspected or confirmed mental health diagnosis are identified, assessed and have coordinated care to community-based services when released.
Through the use of the platform, the Dallas County Criminal Justice Department said it was able to meet the metrics laid out in the 1115 Waiver and received $20 million in matched funds to invest in additional services like linkage to housing, reconnection to community care and coordination between courts and behavioral health services.
Harris said the company is trying to moving behavioral health resources from a “fire hose” one-size fits all approach to more precision-based decision making informed by a patient’s individual context.
Ultimately, Harris said the hope combine mental and behavioral health information as part of the standard clinical documentation and workflow of providers.
Evidence has been building about the effectiveness of using combined mental health and physical records to combat mental health issues.
A study from the Mental Health Research Network and Kaiser Permanente found that EHR data, alongside a depression survey could build better predictive models than questionnaires or clinical interviews by taking into account risk factors such as prior suicide attempts, mental health and substance use diagnoses, medical diagnoses, psychiatric medications prescribed and inpatient or emergency room care.
Still, there are cultural barriers standing in the way of that larger vision.
“Everything needs to be interoperable and that’s what we want, but the desire for interoperability runs against the desire to maintain that information as distinct and separate due to the perception it’s more toxic data they don’t want in the general record,” Harris said.
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