Building Suicide Prevention Into the EHR: A Critical Tool for Zero Suicide Implementation

While suicide prevention requires sustained attention year-round, Suicide Prevention Awareness Month creates a timely opportunity to examine a part of the prevention infrastructure that often receives less attention: the electronic health record (EHR). For health care organizations implementing the Zero Suicide framework, a well-configured EHR can prompt screening, route results, surface safety plans, and flag missed follow-ups. When the system does not support those workflows, clinicians must spend more time navigating administrative barriers while trying to keep patients safe. 

For health care organizations implementing suicide prevention initiatives, EHR readiness can influence the consistency of screening, follow-up care, reporting, and continuous quality improvement. Understanding whether implementing organizations have the technical infrastructure to support suicide prevention workflows can also help inform technical assistance, implementation planning, and long-term sustainability efforts. 

Through the Indian Health Service (IHS)-funded Zero Suicide Initiative Coordinating Center (ZSICC), RTI provides training and technical assistance to Urban Indian Organizations implementing the Zero Suicide Initiative (ZSI). Across this work, one challenge is consistent: many EHR systems are not designed for behavioral health or suicide prevention. Grantees describe adapting medical-visit templates, searching across mismatched fields, and planning EHR transitions without a clear roadmap for preserving critical suicide prevention workflows. 

How can an EHR support suicide prevention? 

ZSI grantees build capacity across seven core elements: Lead, Train, Identify, Engage, Treat, Transition, and Improve. Each element depends on reliable documentation, tracking, communication, and access to information. 

In practice, suicide risk screening tools should be embedded in the patient record and prompt providers when screening is due. Safety plans should be stored in a consistent, accessible location. A positive screen should trigger a clear next step, such as an alert, task, or work queue entry. These functions require deliberate configuration, ongoing maintenance, and coordination among clinical teams, information technology staff, and EHR vendors. 

A scoping review of EHR implementation and adoption identified common barriers, including limited resources, insufficient training and support, technology skill gaps, and difficulty integrating EHR tools into clinical workflows. These findings reinforce the need for EHR systems that are practical, supported, and designed around how staff deliver care. 

Why EHR readiness matters for suicide prevention implementation 

Technical assistance is most effective when it starts with a specific, actionable need. Saying an EHR “isn’t working” gives clinic staff and a technical assistance provider little direction. Identifying the absence of an automated alert after a patient with a safety plan misses an appointment creates a concrete problem the team can address. 

The checklist also gives grantees a shared vocabulary for discussing EHR gaps with colleagues, leaders, vendors, and technical assistance providers. It can support workflow redesign, vendor conversations, training requests, and longer-term planning. Repeating the assessment over time can also help organizations document progress. 

A functioning EHR does not replace clinical judgment or a caring workforce—it reduces friction when that judgment matters most. It helps a screening result reach the right provider, keeps a safety plan accessible, and turns a missed follow-up into an action instead of a lost signal. 

How the EHR Readiness Checklist strengthens suicide prevention programs 

To help organizations move from broad concerns to specific action, RTI developed an EHR Readiness Checklist based on lessons from training and technical assistance, peer learning, and grantee experience, where discussions about common EHR challenges and solutions revealed a need for a practical readiness assessment tool. 

 The self-assessment is organized around the Zero Suicide elements: 

• Lead and Train: leadership oversight, EHR expertise, vendor communication, staff training, and data quality monitoring. 
• Identify: validated screening tools, automatic scoring, structured documentation, and clear routing of results. 
• Engage: safety plan templates, provider notifications, and alerts for missed follow-up appointments. 
• Treat: embedded treatment guidance, clinical decision support, and accessible treatment plans. 
• Transition: follow-up reminders, warm handoff protocols, and data-sharing agreements. 
• Improve: reporting, outcome tracking, and continuous quality improvement methods that turn EHR data into process change. 

Each section asks a practical question: Is this capability in place, or is it a gap that needs attention? An action-planning table then helps organizations prioritize short-term (up to 6 months), intermediate (6 to 12 months), and longer-term improvements that may require additional time and resources, while assigning responsibility for each action. 

Use the EHR Readiness Checklist to strengthen suicide prevention workflows 

The EHR Readiness Checklist is available on ZSICC.com with other tools developed through the Coordinating Center’s training and technical assistance work. Organizations implementing Zero Suicide can use it to identify EHR gaps, establish priorities, and build a shared roadmap for strengthening suicide prevention workflows. 

Learn more about the Zero Suicide Initiative Coordinating Center and RTI’s work in Suicide Prevention Research.

The authors would like to thank Michelle Dougherty, RTI senior manager and health informaticist, for her technical review of this blog post.