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VA uses EHRs, natural language processing to spot suicide risks

By Jennifer Bresnick

- With active military and veteran suicides rising at a shocking rate, eclipsing combat deaths in Iraq and Afghanistan, the Department of Veterans Affairs is placing an increasingly heavy emphasis on its mental health programs, from remote telehealth conferencing to proactively mining EHR records for signs of PTSD, depression, and risks of self-harm.  Using natural language processing (NLP) software to comb through more than 2 billion EHR documents, the VA hopes to unlock the information in free-text physician input to better serve its most vulnerable patients.

Past attempts at suicide are the biggest predictor of future risks, the VA says, almost twice as likely as episodes of major depression to spark a subsequent effort.  Patients with a history of attempted harm are forty times more likely to complete a suicide at some point, and EHRs are crucial for identifying and flagging significant incidents in the medical history.

“The electronic medical record system stores a very large body of clinical notes,” explains Ken Hammond, MD, a retired VA psychiatrist involved in the latest research. “We’ve shown that we can use search engine technology to more easily identify those Veterans who have attempted suicide at some point in their lives. That can help us prevent future attempts.”

One of the challenges of developing accurate free-text queries was ruling out mentions of suicide that were parts of risk screenings from instances of actual harm, Hammond says, but researchers have developed algorithms based on natural language input that are 80% accurate when identifying past suicide events.  Hammond and his colleagues are also investigating using recognized risk factors such as child abuse to further refine the identification of troubled patients.

The work is part of a larger effort by the VA to take control of growing mental health problems among its target population, including soldiers and veterans who have not served overseas.  While the VA works to better integrate its records with the Department of Defense, which handles active service healthcare, the health system is pinning its hopes on telehealth as a way to deliver high quality mental and behavioral healthcare to its patients.

“This is going to be the way we do business.  This is the way medicine is going to be delivered,” said Dr. Robert Petzel, VA Undersecretary for Health at the recent Connected Health Showcase.  Petzel recounted the example of one veteran suffering from PTSD who was able to significantly reduce his stress levels just by eliminating the 45-minute drive to his therapist’s office, replacing the journey with an online session accessible from home.  Other initiatives include improved home monitoring programs involving iPads to coach patients through PTSD and chronic diseases, as well as a more integrated approach to scheduling and providing mental health appointments through an online booking feature.

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