S1E5: Algorithmic Suicide Prevention (ft. Sunila Levi, CommonSpirit Health)

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Sunila Levi
Move all. Thanks, John, and thanks for that question. I think that is so crucial behavioral health, mental health is so crucial at this time, especially as we come out of COVID and you hear of things that are happening with the teams specially as well as adult population. I think the impact of COVID on mental health, I think we’ll realize that even.

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Sunila Levi
Ohh yours to come. I think it will be. Ohh everybody has gone through a transformation I think and.

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Sunila Levi
Ohh, I hear of strategies that we are looking at saying hey, what can we do? Post COVID COVID has transformed us. I think we should be really thinking about it holistically and saying OK, where is the patient, what does the patient need and how do we meet the patient where they are. I think the Triad Triad goals of healthcare still applies access improving access to care still applies low cost and quality but not.

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Sunila Levi
Compromising and quality. So those triad goals still apply, but to your question about mental health and what’s and what I’ve been doing so and introducing new services. So like I mentioned the I would say I was thankful for the opportunity to modernize the health, the call center system that was supporting national suicide prevention line in Texas, so.

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Sunila Levi
Ohh thought that I brought in. We were at a old legacy system and the system would go down every. I think the last at was 17 times in the last three years or which averaged out to two per two to three per month. So modernizing system was one thing. Moving away from PRI to voice over IP. So there are technologies, call center clouds technologies out there but the value of the data that we are capturing through these call center.

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Sunila Levi
He’s the most crucial thing, I think, and that’s where I was able to.

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Sunila Levi
The but the integral care and we are business as a partner working with business as partner was it was it was able to capitalize kept was able to use see the value of the data that presents the calls that are coming into the call center and it’s not like.

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Sunila Levi
Umm, they don’t have no suicide ideation methodologies before they were all done on a paper. Colombia assessment is done on a paper. You know, when the clinician meets with the patient’s, they give a Colombia assessment on a sheet to go through questionnaire. Some 200 questions to go through to see where the mind of the patient is and is suicide ideation is, is, is happening there with the patient. So what we did with IBM was have those conversations.

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Sunila Levi
How could we?

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Sunila Levi
From the call center data, integrate that call center data with the suicide ideation data in the EHR system and then see is this patient. Ask those questions. Elevate those questions to the call center representative so the call center representative can ask them and as well as green from the data that’s captured in the call center. Using sentimental analysis using algorithms and saying is the patient at a risk for suicide ideation.

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Sunila Levi
So we use the tried and true methodologies of the assessment sheets and the questionnaires that are in the assessment sheet as well as integrate them and use the call center data with the algorithms, live algorithms and sentimental analysis to see if the suicide, if the patient is at a risk for suicide ideation that does that help.

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Jordan Cooper
It doesn’t know and I’m I’m thinking as you’re talking, is this workflow affecting the? Are there best practice advisories that are popping up for the call center representatives in real time that is guiding the care that they’re providing these patients? And is that in addition to ex post facto care, so they call in and in a provider follows up a few days later to see how they’re doing? Is it both cases?

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Sunila Levi
It is both. It is both Jordan one is that’s the intent of modernizing. I was I went to the board and modernized my call center system not just for the sake of modernizing, but also having that value add services. So when a call center, when a call comes into the call center, the call center knowing that, hey, this number is already in our system. So this is an existing patient. The patient has all these again using AI using ML.

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Sunila Levi
Using NLP and and saying this patient is already in our system. This is the name. This is the medication that the patient is on. So the workflow automation there to know your.

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Sunila Levi
Ohh look patient or consumer you know moving from patient to a consumer, not just ohh this this person is calling in but knowing that.

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Sunila Levi
Ohh, that person that he, he or she or they are a patient and a consumer and then and connecting with them saying hey, you’ve called yesterday. How are you doing and knowing them so it’s that proactive real time assessment of workflow as well as retroactively after the call or during the call real time analysis and saying hey this call is going towards is this call is critical this call in.

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Sunila Levi
He’s going towards or is showing symptoms of suicide ideation or and there is a risk there. So addressing it real time as well as after.

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Jordan Cooper
So.

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Jordan Cooper
Sunila you said that in that these call centers is a national call center, but then I also know that you’re working specifically with common spirit health and you mentioned at the call centers connected to an electronic health record at the healthcare delivery system. So is this for patients across the country with many different payers and many different provider access points or these mostly for patients just with who already have a common spirit electronic health record?

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Jordan Cooper
No.

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Sunila Levi
No, it’s two different things. National Suicide Prevention line is supported in Texas, and that’s integral care. That’s my tenure at integral Care. So national societies line ends in in Texas, is supported by integral care. And that’s what we are talking about when it comes to national suicide prevention. So any call that, that 988, so anywhere in Texas 988 is used, it ends up into my call center.

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Sunila Levi
And.

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Jordan Cooper
And so how does it? How do the different electronic health records interoperate?

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Jordan Cooper
OK.

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Sunila Levi
So integral care has ohh, so I’ll call center is integrated with the integral cares EHR system and we were also working with the HIE local HIE to get all the EHR data as well. So there are two different things the local hi the state HI and then the integral care EHR systems that would integrate with the call center data.

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Jordan Cooper
Got it. OK. Thank you for clarifying. And I guess finally, just to pull all this together, I’d like to ask if there’s any anecdote that sticks out in your mind that you could perhaps walk us through that demonstrates how the initiatives that you’ve worked on have improved, have led to positive patient outcomes. So have there been any times when one of these advisories have popped up during a call center and you kind of maybe you prevented us suicide or you had emergency outreach for a particular person in order to?

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Jordan Cooper
You know, intervene in, in, in their crisis as you do. You have an anecdote you could share.

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Sunila Levi
You you can say that for every single call Jordan just being you are just so the current, the current state when I took on the CIO, CTO role was the system was was having outages that means we were losing suicide calls. Just imagine the weight of it. You know the the suicide calls we were losing the risk of losing a patients life. So I think just so one thing I would answer is anecdote I would say is just having a system that’s stable.

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Sunila Levi
Then then it still stops to hit or anything happens in Texas. Having a stable system is in itself is a big thing, because that earns our trust right in the in the Community that we are operating. The people can call in and not have their calls lost, but above and beyond that, to answer your question, yes, we are because of the system that’s running and capturing all the data and we were able to introduce new AI algorithms and services.

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Sunila Levi
One of the things where we were able to answer our stakeholder questions saying ask our children calling in so one of the example I would say is capturing all this data and looking at this data and seeing if children are calling in with food crisis during COVID specially what are the needs around the Community and how can we meet. So that’s another one we were able to say. Yes children are under 13 so many calls are coming in into our system in a given month.

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Sunila Levi
And this is this has been the experience and this is what they’re looking for. So that’s one thing. And then other thing I would say is introducing algorithms like the suicide ideation prevention as well as kidney disease risk. Howard has a Chan School of Business that how would you university has an open source AI algorithm for kidney disease prevention and even that introducing that model and looking at four to six points from the EHR system.

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Sunila Levi
And then laying out saying if this patient stays at this level at these four points, then the this patient is a is at a high risk for kidney disease risk and then showing that back to the clinician in a on the EHR system and they’re having that conversation with the red, yellow saying, hey, this patient is at a high risk or this patient if he stays is at a risk of developing kidney disease risk. That’s a very good example that we’ve implemented and the clinician see and and have the conversation with the patient.

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Sunila Levi
Back and saying you have to improve your, you know, blood pressure level, the four to six points and say you need to improve, otherwise you’re at a risk of developing kidney disease risk. So so many examples Jordan that enable patient care and and I think there is a lot of potential for AI algorithms especially in the predictive model say and improving patient care. Does that help?

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Jordan Cooper
It does help. So on the topic of improving patient care, we’ve just spoken about mental health needs, which really exploded during COVID with high isolation at home. Another topic that relates to COVID is the increased incidence of cyber attacks on healthcare centers.

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Jordan Cooper
I you’ve spoken in the past about good cyber hygiene, could you elaborate for our audience what is good cyber hygiene and how have you been able to respond to cyber attacks to make your your your healthcare delivery systems more impregnable, impregnable, less impregnable from these attacks?

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Sunila Levi
Yes, thank you for that. Thank you for that. I’m telling you, CIO, CTO’s, as healthcare leaders, they should be on the forefront because we have the most critical data, patient health information, Phi and π. So I would encourage the leaders to keep that in mind. You have the most precious data, PHP, HI. And π and then the best hygiene. I approached it from Enterprise architecture framework business data.

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Sunila Levi
Application and technology at 4 layers. How can I put in controls to to secure my environment? But I would say very first thing. Best practice is clean out access. Who the three ace right access authentication and authorization. So who has access into your environment just won into that. Remove all excess access, go through the list, do the groundwork and remove clean up your access.

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Sunila Levi
And then other other second thing is after cleaning up access is endpoint security your access points, everything address those security controls and then I would also say is education, have the education program for your end users, for your employees. Do those phishing tests? Do the penetration tests we be up on those education and training and tests aspects?

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Sunila Levi
So I would say those three basic controls, you know access make sure the systems that you have are accessed and authorized and authenticated to the user that they need to have just clean it, clean it up, clean up the closet of your security, I would say. And then second is that education and then and then education and training and then endpoints your network access endpoints controls. So those are those basic three things at least I would say to start on.

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Jordan Cooper
Thanks anyway. So that’s a cyber access security. You gotta improve access authentication and authorization.

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Jordan Cooper
You’re involved in coordinating so many different entities at common spirit health. You’ve been driving strategy development work with eight different CIOs, Csos and other sea level stakeholders across over 1000 hospitals and clinics and 21 different states. Tell me about how you’ve been developing that strategy and what sort of factors are influencing your decisions.

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Sunila Levi
Jordan, I I don’t want to say that I have left comments, but it so that’s my last 10 years. So I’m not there. Yeah, at this time. But yes, that was one of my functions, ace to oversee, to work with the eight different CI iOS and CSOS and lay out the workshop strategy workshops to work with their CTR. So. So I would work with the CIO and CSO and set up the workshop for Strategy Planning. So really listening, I think the very first step is as VP’s.

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Sunila Levi
As leaders, healthcare leaders have to spend time with the business. So sit with the business and learn about their business, what are their strategies? One to three-year strategies? What are they business is looking for is it?

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Sunila Levi
You know, care what? What type of care do they want to aspire to? So one of the divisions wanted to be, you know, they want to reach their remote patients, remote patient care. So really listening to the business, what are their business strategies and then helping the CIO iOS saying, OK, These are our foundational strategies that can really align to the business strategy. So laying out those technology Rd maps one to three-year Rd maps but delivering on the very first year.

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Sunila Levi
Bill, bill. Bill. Build the trust. So I would say listen to the business. So that’s been my work working with the CIO, CSO, setting up those workshops to learn from the business what their strategies are and then aligning the technology foundational services.

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Sunila Levi
Love, I just next Level Services, MVP services and then one to three-year road map technology services that align to the business and help them reach their strategies. So that’s been the work that’s that’s that answer your question.

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Jordan Cooper
It does. So you’re coordinating among many different people. You’re wearing many different hats. You begin work as a Java developer. How common is it? What do you nique insights? Do you have having risen through the ranks, starting in the very front lines as writing code? What unique insights you have into digital transformation, particularly around the three levers of business transformation that you’ve previously enumerated, which are human centricity, technology and speed and continuous Business Innovation? How does your background as a developer?

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Jordan Cooper
Help inform your meeting. The business needs of the large healthcare systems.

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Sunila Levi
The the Java development experience has really helped me understand how the systems work together. You know I wrote code so I know how the systems are are developed. Digital is a new delivery model. That’s how we need to deliver first. It was the Java web full stack environment where people would come in. It’s a Web 1.0 I guess right or 2.0 where people would come and.

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Sunila Levi
And learn about the services and that’s the entry point. But now I think digital services is that digital front door and it’s not after COVID. It’s not one of it has to be it. The digital front door digital services has to be.

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Sunila Levi
Ohh, provided so you are not stuck in the old traditional way of just come coming to our front door and that’s how we provide services and not a digital front door. I think businesses it’s become imperative to the businesses to provide both open on site services as well as digital services. So learning how the systems are built and then looking at it how it how we have evolved into providing new business models.

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Sunila Levi
It really helped me saying, OK, this is where we are and this is where we need to be. What’s the new thinking? What’s the new frameworks or thinking that we need to bring in to efficiently deliver through digital? So it’s like, you know how to use the hammer and the nail and then you can put up whatever.

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Sunila Levi
Like uh, you know, you need, like, the is it an artwork or is it a mirror or anything? But since you know how to operate the tools, you can you can support any any type of model or delivery. So that’s how I see it.

0:19:14.830 –> 0:19:39.100
Jordan Cooper
Well, senior, I appreciate that insight. We are approaching the end of this podcast episode, so I’d like to ask you offer you a final opportunity to sum up a message that you’d like to convey to CIO’s across the country who are listening right now. Large healthcare delivery systems. What’s going on with virtual health digital strategy? What should CIOs be on the lookout for? What final message do you have for our audience?

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Sunila Levi
So I would say Healthcare is the best profession. Ohh so healthcare leaders, you’re in the best profession of delivering care because at the end of the day it’s towards patient care. So I think it’s the best profession to be in. It’s a it’s a profession of service. So I would say keep at it. It’s I know it’s healthcare right now is very hard and industry is very hard. But keep at it, meet the Triad goals of healthcare. That’s the first thing.

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Sunila Levi
Second thing is I think there’s a lot of opportunity. We are data rich, but information poor. So I would say there’s a lot of opportunity in healthcare, a lot of challenges, but a lot of opportunities, the challenges become opportunities. So I would say looking to clinical optimization, that’s where I think we can really provide.

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Sunila Levi
Value nurses providers are struggling. So second thing I would say is look into opportunities of clinical optimization and digital health platform. Digital health services has ease is a big player is a big player and I think healthcare, healthcare industry, healthcare leaders have to really pursue that. So open at startup with digital services, virtual care as first make your providers provide.

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Sunila Levi
What enable your providers virtual health and then move on to virtual health products have a maturity plan, have a framework start with one or two products, but then grow in that framework and maybe one day opening up as an app marketplace. Once you have all your data and then you’re able to open that data through APIs, you can now have a create a maturity road map for an app marketplace. So there is lot of maturity and growth in the digital health platform and.

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Sunila Levi
Ohh and digital services so first is ohh move towards providing the Triad goals of healthcare. Second is looking to clinical optimization through AI, ML and just unburdening the nurses and providers. And 3rd is digital. There is a lot of opportunity with digital and to grow in the digital maturity. Those would be my three points.

0:21:57.0 –> 0:22:29.70
Jordan Cooper
Well, thank you. This has been a sunila levy, the VP of Digital Healthcare platform strategy at Common Spirit Health. We’ve covered a lot of ground today from how to leverage digital data strategies and insights to address suicide ideation and to leverage digital algorithms in order to alert providers in real time of best practice advisories in order to address the behavioral health needs of their patient population. We’ve also discussed AI driven kidney disease risk models in order to.

0:22:29.210 –> 0:22:49.160
Jordan Cooper
Again, drive community engagement and health. And then we’ve spoken about high cyber hygiene, cyber hygiene, business transformation, similar time as a developer and and how to coordinate among a variety of different executive stakeholders. Sunila. I appreciate your time. Thank you for joining us today.

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Sunila Levi
Thank you, Jordan.

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