Provider perspectives on care for veterans with electronic health record flags for high suicide risk: A mixed methods study.

Abstract

Electronic health record (EHR) flags alert staff within the Veteran Health Administration (VHA) to patients at high suicide risk for the purpose of enhancing their care. VHA implemented patient record flags category I-high risk for suicide (HRS-PRFs) in 2008, yet little is known about provider perceptions. In non-VHA settings, some EHR flags and alerts are perceived unfavorably by providers. This mixed methods quality improvement study examined perspectives of VHA mental health clinicians and suicide prevention coordinators (SPCs) regarding the perceived utility and drawbacks of HRS-PRFs. We conducted a national survey of SPCs (N = 286; February-March 2022) and semistructured qualitative interviews (January-July 2022) with a separate sample of SPCs (n = 5) and mental health clinicians (n = 20) with recent HRS-PRF experience. Providers reported satisfaction with HRS-PRFs and believed that they identify at-risk veterans and facilitate engagement in care. Survey and interview findings highlighted differences between SPCs and mental health clinicians regarding negative perceptions of HRS-PRFs. In the survey, one in five SPCs were dissatisfied with the administrative burden of delivering caring contacts, a required evidence-based suicide prevention intervention mailed for a year following flag inactivation. In the interview findings, some clinicians expressed concerns about unintended consequences on therapeutic rapport and stigma. Additional evaluation is warranted to assess veterans' experiences and clinical effectiveness outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).