Leveraging Technology to Support Mental Health Care and Suicide Prevention for Veterans

CliniComp's distinctive electronic health record system to support the mental health of veterans is discussed with Mary Russell, senior director of Clinical Implementation at CliniComp.   

Transcript: 

Please introduce yourself by sharing your name, title, organization, and experience. 

My name is Mary Russell. I am a registered nurse and I currently serve as the senior director for clinical implementation at CliniComp. I've been with CliniComp for about 13 years, and I've been a registered nurse for over 35 years. I am also a retired Navy nurse Corps officer as of 2019, so I've had a nice long career, with a great depth and breadth of experience in a variety of inpatient, outpatient military war zone environments of care.  

Please share a brief overview of the most pressing mental health care concerns for veterans.  

As a military nurse, I am acutely aware of these issues. I've seen the ravages of war, and I've seen the impact that it has on active-duty personnel and military veterans. It's certainly a topic that I'm quite passionate about. 

Last month the National Veteran Suicide Prevention Annual Report was released. It's a great retrospective review of about 20 years of data. They looked at death certificates to determine the causes of death among veterans and the sad news is that even as of 2021, veterans are still basically at a 7% greater risk of committing suicide than the general population. 

Even as late as 2021, suicide was the 13th leading cause of death for veterans overall, which is extremely high compared to the general population. But more importantly, suicide is the second leading cause of death for veterans under 45 and the second leading cause of death for people from the age of 18 to 44. That is just an astounding statistic and much needs to be done. The report is not all bad news but certainly is reflective of the stresses and stressors that our military is under daily. When personnel transition to the veteran community, those stressors continue for them. We need to find innovative ways to use modern technology and advances in AI to help our researchers, our providers, our bedside caretakers, and multidisciplinary teams find ways to mitigate these astounding statistics in young veterans. It's certainly something I'm passionate about, and I've seen it firsthand and want to see improve very shortly. 

What is CliniComp and how is it being utilized to support veterans’ mental health?  

CliniComp is a company and a product. We’ve been in business for 40 years and have had a very special and deep commitment to the military and veteran health. We provide a comprehensive electronic health record. We've been deployed around the world in the Department of Defense to provide that documentation system across all environments of care for inpatients and patient settings like the ER and preoperative areas. We've been a partner with the VA since 1992 so our comprehensive electronic health record is configurable to meet the needs of any environment of care. We have no planned downtime as a company, which is so important when you are monitoring at-risk patients like those who are inpatient mental health patients or outpatient visits. You must have a system like ours that has zero downtime and reliable data. Our company prides itself on seamlessly taking disparate data, normalizing it for documentation, moving it seamlessly through the veteran’s chart, and then outputting data for research projects.  

Chris Haudenschild, our founder and CEO, has a deep commitment to the continued optimization of our system at the highest level possible. We are expanding our business every day and we are expanding now into behavioral health at Rocky Mountain Regional VA Medical Center. 

How can care teams use this technology to create and improve patient treatment plans? 

That is a great question because these treatment plans need to be living, breathing documents. They must set goals, analyze the progress of those goals, and then move on and reevaluate. We're a very clinician-driven company. We have a team of clinicians who are customer-facing, so we deal directly with all the clinicians who use our products. We also have a team of clinicians who build products and continue to enhance our system. CliniComp is always looking at ways to take our technology to the next level to improve the treatment of our veterans.  

For us, the therapeutic relationship between the veteran and the care team is the top priority. What we don't want to happen is for our system to be burdensome in the way that users need to engage it to accurately document. We can enable multidisciplinary care teams to set a plan to document those treatment plans and goals and then track veterans' participation in all the treatment modalities that have been ordered. As a result of that, we can trend the data to include things like vital signs and labs which are very important in a behavioral health setting so that you look at the totality of the patient. And again, that data is just charted once, and it's seamless for us to be able to track improvement through the system. The goal of a mental health encounter in the inpatient setting is recovery and stability. Everything in our system is designed to lend itself to that. Because our system is so configurable it can be loaded everywhere in the hospital, including the providers and offices, so everybody doesn't have to be together physically to effectively communicate about the patient. They can each look in real-time and support whatever those veterans need.  

If, for example, a veteran goes into crisis, anybody and everybody on that team such as social workers, art therapists, recreational therapists, nursing staff, medical staff, and pharmacy staff. They can all look at the same patient's record from disparate places in the building and then make sure they come up with a therapeutic plan to mitigate this veteran’s crisis and promote their general recovery in a safe environment.  

How can this technology aid in reducing the chances of medication interactions and better managing co-occurring conditions among patients? 

Behavioral or mental health issues are not a standalone diagnosis that should be put in place. You must look at the patient holistically and recognize they have multiple providers. Perhaps they have chronic pain and they're being treated by a pain specialist as well as depression. Then you need to figure out how to medicate their pain, manage their depression, and mitigate suicide risk. Our system supports this in wonderful ways. One of the things that we allow for is oftentimes pharmacists are an embedded part of the rounding team or the multidisciplinary team and serve in a consultant capacity. When they work in that role, we allow for a dual persona for pharmacists. If today I am the pharmacist who is physically dispensing meds and verifying orders, then that's how I'm going to log into the system. But if I'm the embedded pharmacist who's working on this multi-disciplinary team, I want to make sure that my orders are going to be verified by a second set of eyes. It's so important for us to not remove that tier of double-checking that already exists in our system. 

We also send alerts to providers if they're going to be ordering a medication that has some contraindication with another medication that will pop up on the screen to warn them so that they can select another therapeutic drug for this patient, perhaps in a different class of medications. Also, we are going to put forward for them at the time of order, entry, lab results, vital signs, and other information that may help them with that clinical decision support at the time of ordering those drugs to ensure that they are compatible and restorative for the veteran. 

Then, at the point of medication administration, our system displays the veterans’ allergies for the nurses who are administering the drugs. We support barcode medication administration to help reduce medication errors from the point of consideration of what drugs we're going to order for this veteran through verification. That is how we support the co-management of the patient and ensure that we reduce errors. Having that longitudinal patient record is key to being able to see what's been happening with a patient throughout their health care experiences. 

Can you share any specific examples of how this technology has been used to enhance veteran mental health care?  

As a retired Navy nurse, I spent a little over 10 years caring for the wounded from the wars at Bethesda and worked with the veterans for 13 years. A key factor is preventing self-harm that could later lead to suicide. And I know that we have worked carefully and closely with our customers to bring the screenings down through other environments of care other than behavioral health. What we've done is take the screenings for risks of suicide, and there are several standard tools in use out there, and they are now available in every environment of care.  

If a patient presents to the emergency department, even if it's just for a minor cut or bump unrelated to a mental health issue, they still will get screened because we need to take every advantage to screen these veterans, even though they're not specifically seeking care for mental health. I think the configurability of our system and our allowing and implementing the same screening tool that will follow a veteran through their care will help to mitigate the number of suicides overall because they're going to catch them earlier. That project was wonderful to implement, and I believe that it has done a lot of good. 

The other thing is that we've had longstanding support from the military and the veteran patient population. The report that I referenced at the beginning is a retrospective view of statistics and data but where does that data come from? It comes from the documentation in systems like CliniComp. We've had providers and nurses, hundreds and thousands of them, documenting over several years. From that, the researchers can glean data that will help create new screening tools, interventions, or categories of drugs to help with this mental health crisis that is going on in our veteran community. 

By assessing the effectiveness of the current, existing treatments and then taking them and disseminating new evidence-based psychological treatments and interventions across all of the VA, you can help in real-time to drive down those numbers and provide the best practice support in the field and because our system is so configurable. It is a true commitment to support intervention in all areas of care, but certainly in the behavioral health and mental health space. 

Is there anything else you’d like to share? 

We're excited to expand again with our VA partnership in Denver to help support them with their documentation for our veterans in their behavioral health setting. I think it's an interesting time, too. The statistics I mentioned at the beginning shared that suicide is the second leading cause of death for veterans 18 to 44. This tells us that our veteran population is shifting, they're a lot younger. They have new mental stressors such as gender identity in their lives that weren't as present for our World War II veterans. So, I think that statistic illustrates most clearly that we must be adaptive and understand what drives these veterans and what is taking them to that final act of suicide. 

The world is an unstable place. Ukraine, Israel- it never stops. Unfortunately, we'll continue to build this population of traumatized veterans down the road, and we must be on the cutting edge of supporting whatever therapeutic modalities are deemed to be the best practices at the time. Given the opportunities to use things like AI and use these standardized documented tools across a broader environment of care. Certainly, as a veteran myself, and as a female veteran, doing anything and everything that we can do to drive those numbers down is certainly a priority for me and for our company as a whole.