Over the past 20 years, the United States has seen an unfortunate coincidence of increased rates of mental illness coupled with decreased funding and resources for the treatment and support for those populations in need of care. This situation has led to dramatic increases in death by suicide, homelessness, and the warehousing of US citizens in emergency departments and county jails because the appropriate care settings are not accessible. One company that recognizes the gravity of this problem is HarrisLogic, LLC, which is working to build solutions to improve mental health care.
As of 2017, one in five adults in the US — that’s roughly 45 million Americans — are currently living with a diagnosable mental disorder, according to the National Institute of Mental Health. More than 10 million of these individuals suffer from serious functionally impairing mental illnesses, such as psychotic, mood, or anxiety disorders. Despite these pervasive and growing mental and behavioral health issues across the country, mental health has largely been left out of incentive-based programs, such as US government meaningful use standards, which has provided payments to medical providers using electronic health records since 2009. These incentive payments have driven huge investments into health care technology, specifically driving the adoption of electronic health records. Contrary to this lack of national investment into mental health care, the founders and partners of HarrisLogic recognize the highly negative outcomes that emanate from inappropriate treatment of the mentally ill.
With more than 30 years of clinical experience, HarrisLogic has been building technology for the mental health care industry for over two decades. In coordination with its affiliates and subsidiaries, the company develops technology-enabled solutions and clinical platforms — such as StellaCrisis — to improve behavioral health services in a variety of settings and environments. HarrisLogic’s engineers and subject matter experts collaborate with clinical, operational, and civil liberties experts — as well as software providers such as SAP — to build solutions intended to help save lives and optimize the use of critical resources.
The Technology Designed to Combat the Problems
Currently, HarrisLogic has successfully deployed solutions for tele-mental health, suicide prevention, crisis response, and jail diversion. “At the root of every HarrisLogic solution is the belief that understanding health care by mapping out services and workflows will both expose the greatest hurdles to health care delivery and identify the biggest opportunities to improve lives,” says Hudson Harris, Chief Engagement Officer at HarrisLogic.
Detection, provision of evidenced-based practices, and connection to community-based services are among the biggest challenges in the delivery of mental health care, according to Harris. “In the criminal justice system, for instance, failure to rapidly identify and connect individuals to appropriate community-based services leads to recidivism and unnecessary utilization of higher levels of care, and emergency departments also struggle with providing evidenced-based assessment, level of care determinations, and getting persons connected to appropriate community-based services,” he says. “Failure to provide these types of services leads to recidivism and unnecessary utilization of 911, police, jail, emergency department, and inpatient services. Assuming someone is identified and evaluated, the almost universal challenge then becomes how to connect that person to the appropriate care.”
In 2006, HarrisLogic launched a clinical services company, Adapt Community Solutions, to provide suicide hotline and integrated mobile crisis services. That launch drove the business to build its own purpose-built clinical platform, today known as StellaCrisis. In 2008, HarrisLogic’s clinical operations became an American Association of Suicidology accredited crisis center, and within 12 years, the platform has been used to document more than two million crisis encounters.
The HarrisLogic technology suite, which today is named StellaLogic, is powered by five core engines (see the sidebar immediately below). These engines are combined to create solutions for mental health issues in a wide array of settings including StellaCrisis for crisis hotlines and mobile crisis outreach teams, StellaCare for emergency departments, StellaAcademic for universities, StellaWellness for mental health employee assistance programs, and StellaJustice for mental health jail diversion efforts. In addition to its technology and clinical services, HarrisLogic also provides training and consulting services to its clients. (See the sidebar at the end of the article for more information on the HarrisLogic technology platforms).
“We help communities map the available services, workflows, and stakeholders; identify how to improve the system; and then provide the technology and services to support them,” says Harris. “We also provide privacy and data governance education to help our customers understand their obligations to their clients, and we provide on-site trainings for the clinicians and their trainers on how to use the software most effectively, when to use it, and how to track it.”
Combining the Intuitive Platform with SAP HANA
In 2013, as part of a digital transformation effort, HarrisLogic began moving to the cloud. As part of this transformation, the company re-engineered its mental health jail diversion platform to run on SAP HANA to improve its speed, flexibility, and uptime. No stranger to SAP technology, HarrisLogic had been using SAP BusinessObjects solutions for several years. “One of the biggest factors that made us want to go with SAP HANA was its speed, ease of use, and native analytics engine,” says Harris. “Simply put, we needed something that was reliable, fast, and very easy to use.”
SAP HANA provides an operating environment for HarrisLogic’s solutions to operate in the cloud. In tandem, SAP BusinessObjects solutions are used to create robust reports to demonstrate key performance indicators and measures for its clients and itself. “Between 2013 and 2017, we were one of a small number of programs in Texas to hit 100% of our outcome metrics for the mental health jail diversion program we support,” says Harris. “Our ability to report through SAP BusinessObjects solutions has significantly improved our ability to demonstrate our effectiveness.”
The program mentioned above refers to an implementation of StellaJustice, which, in its current version, has been running in Dallas, Texas, for the past four years. A core component of StellaJustice is HarrisLogic’s population health engine that enables data aggregation and integration. This engine allows the jail diversion program to merge multiple data streams of criminal justice and clinical services information — such as court and jail feeds for judge and location data, Medicaid eligibility feeds, pharmacy, encounters, and historical behavioral health or crisis data.
“We create integrated, privacy-respectful client profiles that let multiple agencies operate together — and see only the data they are permitted to see,” says Harris. “We can identify people in the criminal justice system within 15 minutes instead of weeks,” he says. “Then we can get them assessed and placed into a diversion program, sometimes the same day that they come in.”
With this information readily available, when an individual is booked into jail, he or she is quickly identified, proper consents are obtained, and then clinicians perform an assessment. “We do a lot of coordination and continuity of care work where we monitor individuals to ensure they receive the services they need,” says Harris. “We connect with the providers. We follow up with the individuals and find out what they are doing and how they are doing. And then we connect them with community behavioral health providers because that is where the rubber meets the road and change begins. For our future clients, all this work will be done on SAP HANA, providing state of the art technology for support of mental health jail diversion.”
Over the course of five years, StellaJustice supported a large-scale effort involving multiple providers that brought down recidivism 5.5% over four years, which is a mountain of movement. Additionally, the program netted $30 million between cost avoidance and federal match funding.
— Hudson Harris, Chief Engagement Officer, HarrisLogic
HarrisLogic supports emergency departments in northern Texas with its StellaCare solution. This solution assists in assessments and level of care determinations for behavioral health patients. “In the span of six months, we achieved an 80% diversion rate for psychiatric patients coming to the emergency department,” says Harris. “We are proud to say that wait time went down in the emergency department, and in-patient bed days were substantially reduced.”
The aim of the jail diversion project in Dallas was to bring down the likelihood of individuals returning to jail, as well as the program being cost neutral, according to Harris. “Over the course of five years, StellaJustice supported a large-scale effort involving multiple providers that brought down recidivism 5.5% over four years, which is a mountain of movement,” he says. “Additionally, the program netted $30 million between cost avoidance and federal match funding.”
Introducing Predictive Analytics
HarrisLogic was invited to be part of an SAP innovation pilot project using SAP Predictive Analytics with SAP HANA, introducing predictive analytics in behavioral health. This project was built upon StellaJustice, with the goal of better identifying individuals who need more attention or alternative services. “The goal of that predictive pilot was to give clinicians the ability to see who is most at risk, who needs the most services, and who is not at risk and does not need as many services,” says Harris. “This allows agencies in resource-scarce environments to more specifically target what they are doing.”
The predictive pilot took three years of clinical and crisis data (such as mental health and pharmacy encounters) along with criminal justice data (such as prior charges, number of times incarcerated, and sentence lengths). Then using the native analytics of SAP HANA, the predictive model also took in contextual analytics — looking at everything from climate to unemployment to the stock market — and pulled that information into one dataset. “We created the predictive models on 30 months of data and then tested it on the next six months of data,” says Harris. “During this test, we could identify who would return within six months with a 72% degree of accuracy and who would not return with a 99% degree of accuracy.”
The ultimate goal for HarrisLogic, according to Harris, is to get people the care they need as quickly as possible so that they don’t have to wait while their condition worsens.
Creating a technological platform and collaboration space for multiple entities to improve mental health issues in the criminal justice system is not the end for HarrisLogic. For example, the company recently partnered with the Zero Suicide Institute to embed its framework into StellaCrisis. The first phase of the program will involve standardized universal screening, development of evidence-based risk scores, and identification of at-risk individuals. “It’s similar to what we did in criminal justice — the goal is to rapidly identify high risk individuals, screen them, and then connect them to the care they need,” Harris says. “Merging technology and clinical best practices are the keys to preventing suicides and fixing our national mental health problems. We can impact lives and help the people who are the most in need of it. That is what we’re here to do.”