Open Source Agility - Perceptive Reach: Upstream Suicide Prevention

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About 22 Veterans take their own life every day. While studies show decreases in suicide rates for Veterans who seek care within VA’s health system, reaching at-risk Veterans and persuading these individuals to seek care remains a challenge. Less than 23% of Veterans who committed suicide are patients in the health system. Identifying individuals outside of the health system and overcoming stigma associated with mental health issues presents a major obstacle for outreach programs.

Client Challenge

Our client is seeking to develop a system that incorporates a deep and substantive understanding of the epidemiology of suicide and associated risk factors with rigorous methodologies for intervention. They would like to expand suicide prevention to include upstream approaches designed to reduce initiation or escalation of a risk factor. The client requires a solution that promotes the general health of the at-risk Veteran population and effectively intervenes in issues before they escalate in crisis.

In an effort to promote innovative thinking, minimal software licensing costs, collaboration, and rapid development the client requires the system to be developed as an open source software solution using Agile methodologies. Agile is an iterative software development approach that delivers software incrementally from the start of the project, leverages continuous client interactions, and adapts to changing requirements. Open source software is modern licensing model providing grantees the rights to study, change and distribute the software. Open source software is often developed in a public, collaborative manner.

Proposed Solution

The Perceptive Reach solution is an integrated data analytic and predictive modeling database solution that provides our client a system that utilizes predictive analysis for an early intervention and treatment solution to prevent Veteran suicide.

The system has four major components:

  • Reach Database. A SQL database used to aggregate clinical and demographics data sources.
  • Data Analytics Platform and Dashboard. An integrated collection of analytics and visualization tools, including a surveillance dashboard aimed at identifying at-risk individuals and populations.
  • Direct Messaging. A method to construct and transmit a secure message to authorized outreach and intervention service providers.
  • Outreach and Intervention. A pilot workflow that includes the process by which outreach and intervention resources are notified and act upon the data provided.

Agile and Human-Centered Design

Our design approach integrates both Agile and Human-Centered Design methodologies. Our Agile methodology provides both accountability and transparency in our efforts, while also reducing project risk, including risk introduced through unexpected challenges and changes in requirements. This methodology is comprised of iterative development cycles (Sprints) for planning, development, verification, and analysis. The Agile approach enables iterative progressions of work with the means to frequently assess and measure results, and adjust tasks to maintain alignment with client priorities. Using Human-Centered Design methods we conduct qualitative user research and synthesize findings to define the needs of the stakeholders. These interviews with product end users and subject matter experts follow a structured Human-Centered Design methodology. The sample of end users interviewed is representative of the full range of anticipated use cases.

Using Open Source and Collaborative Development Methodology

The client and the open source community provide a powerful collaborative input to this effort.

  • The client provides access to an approved public facing open source software repository.
  • Open source software used in the solution is reviewed and approved by the client.
  • At the end of each Agile sprint, the source code, test data and documentation is submitted to the open source repository.
  • The client and the open source community reviews and provides feedback on the open source software contribution and is encouraged to collaborate with the development team in subsequent design efforts.

Below are several of the open source tools that our team freely utilizes for development, testing, planning, collaboration and project tracking:

Impact to Client

The primary benefits of the Perceptive Reach innovation include:

  • The most significant benefit of the Perceptive Reach innovation is the anticipated reduction in attempted and completed suicides through early identification, effective intervention, and early treatment.
  • Due to the early identification and treatment for a broad range of clinical, socioeconomic, and environmental conditions, outreach and intervention programs leveraging Perceptive Reach will promote wellness and are therefore likely to decrease the probability of more serious health conditions in the future.
  • The organization and visualization of near real time information will simplify VA business processes, minimizing or eliminating the costs of producing static reports, and eliminating the costs of actions taken on stale data.
  • Program funding and resources can be optimized and tailored to specific regional needs, preventing waste.
  • The Perceptive Reach innovation will highlight the need for policies and governance surrounding the use of public and non-public data to manage both population and individual health outcomes.

The secondary benefits of the Perceptive Reach innovation include:

  • Perceptive Reach will provide a cost effective framework from which health data can be studied, hypotheses tested, and where proven analytic methods can be automated, including the automation of report and notification messages.
  • As risk factors change over time, and as new risk factors are identified, new analytical models and new data sources can be incorporated into Perceptive Reach and the method of identification, notification, and intervention can be re-applied.
  • Through near real time analysis, and a surveillance dashboard, Perceptive Reach will allow VA to respond to regional and temporal events and trends with more agility and precision, while also providing a means to monitor and measure the results from specific initiatives.
  • The precision provided in the system will reduce program expenditures as more focused funding can be applied, and ineffective programs can be assessed and terminated.

Contact us

Alicia Harkness
Healthcare and Education Industries Lead, PwC US

Paul Bradley
Director, PwC US
Tel: +1 (202) 730 4417

Monica Mohler
Manager, PwC US
Tel: +1 (202) 414 3712

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