1. RPMS Suicide Reporting Form in the Electronic Health Record V1.1 Patch 6 Indian Health Service Office of Information Technology

2. Objectives SRF Background and Purpose GPRA Performance Measure Access and Functionality Exporting and Reports

3. RPMS SRF Background Supports Public Health Initiatives –DHHS National Strategy for Suicide Prevention –IHS Division of Behavioral Health Suicide Prevention Initiative –Director’s Health Initiatives: Behavioral Health –Clinical Quality Performance (GPRA measure) Developed by –Office of Information Technology –I/T/U BH providers and subject matter experts Business Owners –Division of Behavioral Health (DBH) –Suicide Prevention Committee (SPC)

4. GPRA Measure The focus of the measure is the use of the form not the number of suicide events. Performance is measured by the number of forms in the aggregate national RPMS database. RPMS Suicide Reporting Forms Submitted by Year Year20062007200820092010 TargetBaseline1603175816781700 Result16031674 1598 (not met) 1687 On target

5. Scope of the Problem 8 th leading cause of death for AI/AN of all ages 2nd leading cause of death for AI/AN ages 10 – 34 Rates for AI/AN ages 10 - 34 are almost twice as high as the national average Source: CDC

6. Purpose of the SRF Improve data collection Inform suicide prevention activities –Standardized and systematic method for documenting incidents of suicide –Accurate suicide data at the point of care –Timely data –Capture specificity of location and associated risk factors

7. What data does the SRF capture? Provider who completed the SRF Patient demographics Type of suicide incident –Ideation with intent and plan –Attempt –Completion –Combination Suicide/Homicide Standard suicide epidemiological data –Method –Substances involved –Contributing factors

8. Paper-based Form Data can be captured on paper form for entry into RPMS later by Data Entry staff.

9. Dependencies for Use and Exporting RPMS Prerequisite –BHS v4.0 (namespace AMH) must be loaded in order to utilize the Suicide Reporting Form in any of the RPMS applications (EHR, PCC, BHS v4.0) Database –SRF data resides in the AMH database not the PCC database –SRF data is exported to IHS Headquarters via the monthly BHS export This is a separate export from the NDW (PCC) export

10. SRF Exports and Data Export process –Exploring options to consolidate the AMH SRF export with the NDW export Local SRF reports –Immediate access to SRF data Inform prevention and intervention efforts Data available for funding opportunities (MSPI) Aggregate national data –GPRA measure –Web-based BH data mart Provides access to aggregate data to DBH leadership and Area BH Consultants

11. Access Access to SRF data entry and reports is restricted to providers (BH, Medical and Nursing) and data entry staff EHR Suicide Form component must be installed by EHR CAC Location in EHR user interface will vary with different EHR user templates

12. Security Keys PCC (for the Electronic Health Record & PCC ) –APCDZ SUICIDE FORMS –APCDZ SUICIDE FORM DELETE Delete key should only be given to HIM Chief and BH Director –APCLZ SUICIDE REPORTS

13. SRF and the Medical Record The form is often completed in the context of a visit but SRF data is not visit-related (i.e. does not populate the RPMS Visit file) Data collection tool – not a clinical intervention tool –Services provided in response to a suicide event must be appropriately documented in the patient’s medical record

14. Standards for Entering SRF Policies and procedures for completing a SRF are determined at the local level –For example, providers may be instructed to document historical events or only those that occurred within the past 72 hours –Consistency is essential to data integrity –National guidelines from SPC are pending

15. Other EHR Tools to Trigger SRF Documentation –Crisis note TIU note title created by the provider with a CWADF icon visible when patient is in focus Note templates can be tied to the title to remind providers to complete SRF documentation once progress note documentation has been completed –Scheduled notifications EHR notification tab –Manual process to remind provider to complete a form

16. Local SRF Reports Access –Controlled by security keys Not all providers have access to RPMS Reports –SRF reports available in both PCC and BHS PCC Reports Not as robust as AMH SRF reports Can run aggregate SRF data

17. Web-based BH Data Mart Secure Web-based BH Data Mart (IHPES) Data Source: AMH Export Database –Aggregate data only (no patient identifiers) –Not AI/AN prevalence data Not all AI/ANs receive care at RPMS facilities Not all sites export RPMS data regularly SRF is underutilized Access: Restricted –Division of Behavioral Health Senior Management –Area BH Directors/Consultants –Password protection, audit log, Terms of Use Future enhancements – –More robust reports, ability to enter forms

18. EHRv1.1 Patch 6 Fixes Performance issues addressed –EHR templates that include the Suicide Form now load as quickly as other EHR templates SSN removed from form Patient demographics moved to bottom of form Type of Self-Destructive Act Field –Can now document all combinations of suicide with homicide (attempted and completed) –NOTE: Patch 6 includes two inactive codes DO NOT select ASH or CSH

19. EHR v1.1 Patch 7 Planned Changes All fields except Local Case Number and Narrative will be mandatory but not forced Lethality field will be inactivated Some field lengths will be updated to be consistent Two inactive entries from the type of Self Destructive field will be removed from the drop down list –Attempted Suicide with Homicide (ASH) –Completed Suicide with Homicide (CSH)

20. Suicide Reporting Form Location Options Suicide Reporting Form on a tab

21. Suicide Reporting Form Location Options ( continued) Suicide Reporting Form on a tree structured menu

22. Adding SRF to EHR Template Right click where you want to add the Suicide Reporting form. This is usually on a tab in the Patient Chart. Click ADD OBJECT

23. Adding SRF to EHR Template Open NAME folder Select Suicide Form and click ADD

24. Adding SRF to EHR Template Double click to maximize the form to the tab

25. Adding SRF to EHR Template Save template Exit design mode

26. Contingency Plan for SRF Patches are designed to improve package functionality however in rare occasions errors can occur and a site must plan for these instances Each site should have a contingency plan in place to capture all patient encounters in case EHR or other application is not accessible –i.e. Outpatient departments will return to a PCC form or PCC+ form until system returns –Plan for the secure storage and disposition of paper forms once the information is entered into RPMS

27. Contingency Plan for SRF SRF paper forms can be used as an alternative to direct-computer provider entry –These forms should be stored and readily accessible during down times –Download forms at: www.ihs.gov/cio/bhwww.ihs.gov/cio/bh If EHR is down consider provider documentation on paper form with Data Entry into PCC via PCC SF mnemonic If RPMS is down consider provider documentation on paper forms for later entry into RPMS by Data Entry

28. EHR SRF Data Entry Demonstration