1. The Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES)
Molly Finnerty, MD
Director, OMH Bureau of Evidence Based Services and Implementation Sciences
Fall 2011

2. Overview Introduction to PSYCKES Using PSYCKES
QI Reports
Clinical Summary
Data access & the Consent Module
Next Steps
PSYCKES Access
Technical Assistance

3. What is PSYCKES? Secure, HIPAA-compliant portfolio of Web tools
PSYCKES – State hospitals (2003)
PSYCKES – Medicaid (2008)
MyPSYCKES for consumers (2010)
Developed by OMH to support quality improvement and clinical decision-making
Calculates performance on quality indicators at state/regional/agency/site levels
Provides treatment history across settings over time
MyPSYCKES allows consumers to enter data on treatment process, outcomes and goals

4. Client Records Accessible in PSYCKES-Medicaid
NYS Medicaid enrollees
Fee-for-service claims
Managed care encounter data
Dual-eligible (Medicare/Medicaid): includes Medicaid data only
Behavioral health population, i.e., at least one of the following:
Mental health or SUD service
Mental health or SUD diagnosis
Psychotropic medication
Currently over 2.5 million individuals

5. Data Available in PSYCKES
All Medicaid-reimbursable services for which a claim was submitted, across treatment settings
Behavioral health (outpatient and inpatient)
Pharmacy (psychotropic and medical)
Medical (services, lab tests, and procedures)
Living supports (if Medicaid-billable)
Up to 5 years of data
Currently does not include data from Medicare or private insurance
For dual-eligible clients (Medicare and Medicaid), includes services but not pharmacy

6. PSYCKES Implementation
State hospitals (2003): 27 hospitals
Mental health clinics (2008): 340 clinics
NYC Hospital affiliated clinics (2010): 25 clinics/ CDTs
LGU pilot (2010): NYC, Erie
ACT Transitions Project (2010): 27 teams
MyPSYCKES pilot (2010): 2 clinics
ER pilot (2011): 4 ERs
Access for OMH and OASAS licensed hospitals and detox programs (2011)
Support goals of Phase I – Learning to use data

7. USING PSYCKES

8. PSYCKES Homepage (www.psyckes.org)

9. Logging in to PSYCKES From PSYCKES Homepage, click “Log into PSYCKES
At Login Page, enter:
User ID (first box)
Password + token code (2nd box)

10. Your PSYCKES Homepage: QI Overview Screen
Hospital/ ER related measures
High utilization (4+/yr): BH, Medical, any cause
Readmission: 7 days, 30 days
Preventable admissions: Diabetes, Dehydration, Asthma
High need ineffectively engaged
Medication related indicator sets
Psychotropic polypharmacy (by class and over all)
Dose (by class of psychotropic)
Cardiometabolic (high/moderate risk AP + cardiometabolic condition)
Youth (“too many, too much, too young”)

11. QI Overview Screen: Performance on measures with regional & state comparators

12. Drill Down on Indicator Set (e. g
Drill Down on Indicator Set (e.g. 4+ Inpt/ER) to Individual Measures (e.g. BH, Medical, All)

13. Quality Indicators Link to List of Flagged Clients

14. Recipient Search: Find an individual (search by name, ID) Find a cohort (search by demographics, diagnoses, physician, medication or services received, MCO, or QI flag)

15. Search Results Click on Recipient Name >> Clinical Summary

16. Mapping

17. Clinical Summary Header
Integrated view of all services (graph and table)
Service Summary Tables by category
Medications: BH, medical
Outpatient services: BH, medical
Inpatient/ER services
Dental and Vision
Living Support
Lab/ Xray
Transportation
Summary Table links to individual claims/encounters (“See All Data”)
Can print or save as PDF or excel

18. Clinical Summary Header: Report date, level of access, select time frame, Name, DOB, Age, MCO, Quality Flags, Diagnoses

19. Clinical Summary: Integrated View of All Services
Graph allows for rapid identification of utilization patterns, including medication adherence, outpatient and inpatient services.

20. Zoom on Period of Interest
Hovering the cursor over an individual record will show date and place of service.

21. Integrated View as Table

22. Medications: Psychotropics Drug, dose, duration, start date, last pick up, prescriber

23. Pharmacy Data: Medical Drug, dose, duration, start date, last pick up, prescriber

24. Drill Down from Medication Trials to Individual Prescriptions: Dose, Quantity, Tabs/day, Days supply, Route, Prescriber, Pharmacy

25. Outpatient BH Services Summary: Type of service, Provider, Date of First and Last, # of visits, Diagnosis, Procedures, Practitioner, “See all Data” > Links to each invoice/claim

26. Outpatient Medical Services Type of service, Provider, Date of First and Last, # of visits, Diagnosis, Procedures, Practitioner, “See all Data” > Links to each invoice/claim

27. Inpatient and ER Services Service Type (ER or Inpt, BH or Medical), Hospital Name, Date of First and Last ER/Inpatient Admission, # of Admits, Last Diagnosis, Procedures, “See all Data” > Links to each invoice/claim

28. Labs, Dental & Vision, Living Support

29. Export Data to PDF or Excel All reports, all screens can be exported to PDF or excel

30. Benefits & Uses of PSYCKES Data: Clinical
Evaluation and treatment planning
Medication reconciliation
Coordination of care across clinical settings
Assess medication compliance
Identify utilization patterns (high use, readmission)
Discharge planning
Timely – weekly updates

31. Benefits & Uses of PSYCKES Data: Quality Improvement
Performance on measures – can select comparators
Transparency – all stakeholders see the same information
Meaningful and Actionable Data - link to individual clients
Flexible – an expanding array of quality measures, and capacity to search for cohorts of interest
Timely - updated monthly

32. Limitations of PSYCKES Data
Accuracy dependent on coding and billing
Data elements limited to what is shown on claims
e.g. See labs/ x-rays but without results
Time lag between services and billing is variable
Service data may lag by weeks or months
Client data affected by changes in eligibility, moves, hospitalizations (bundled services).

33. Accessing Client Data: PSYCKES CONSENT MODULE

34. Which Clients Can Be Accessed Through PSYCKES?
Two ways clients are “assigned” to you:
Automatically: Clients you billed in the past 9 months
Manually: through the Consent Module
Clients you consent
Clients you attest you are serving in a clinical emergency
Who is available for consent?
All Medicaid enrollees in the NYS BH population
MH or SUD diagnosis or service
Psychotropic medication

35. Client Level Data Access
Context
Data includes SUD, HIV, Family Planning?
Duration
Quality Flag No
As long as flag is active; up to 9 months after last service
Clinical Emergency
Yes
72 hours
Consent (PSYCKES, RHIO)
3 years after last service

36. What is an Emergency? Can occur in any setting
New York State Public Health Law Section
"Emergency condition" means a medical or behavioral condition, the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in (a) placing the health of the person afflicted with such condition in serious jeopardy, or in the case of a behavioral condition placing the health of such person or others in serious jeopardy; (b) serious impairment to such person's bodily functions; (c) serious dysfunction of any bodily organ or part of such person; or (d) serious disfigurement of such person.

37. Consent Process in Hospital Workflow
Hospital staff obtain written consent from clients OR determine that it is a clinical emergency.
PSYCKES consent
RHIO consent (if Medicaid data used/ addressed)
Clinical emergency
Registrar uses Consent Module in PSYCKES to attest to rationale for access to client data (consent or emergency).
Any PSYCKES user at the hospital can then access client data.

38. Registrar Menu
Consent Module is accessed through the Registrar Menu in PSYCKES.
Registrar Menu tab only appears if the user has been granted PSYCKES-Registrar access.
Clicking “Registrar Menu” tab opens a new row of tabs. 38

39. Consent Forms Menu
PSYCKES Consent Forms available in English and Spanish. 39

40. Using the Consent Module
From Registrar menu, go to Medicaid Consent Menu and click on “Grant Consent”

41. Step1: Find the Client
Enter client’s Medicaid ID number, and click “search.”
AA19 386GAA 41

42. Confirm Search Results Correct name, age, gender, address?
05/15/1969 42 F
AA19 386G
Mouse Minnie
7 Goofy Lane
Warnerville NY
13456
August 30, 2007 meeting 42

43. Step 2: Attest to Right to Access Data consent or clinical emergency43

44. Step 3: Confirm Client Identification Select forms of ID from drop-down list, or if known to setting can attest to identity without ID 44

45. Submit then Quit or Go to Clinical Summary45

46. Search for Consented Recipients
Once a client is consented, any hospital staff with PSYCKES access can view the client’s clinical data.

47. Steps for Setting up PSYCKES Access for Hospitals/ Detox Programs
Complete PSYCKES Access Packet ( ed to Hospital CEO)
Contact Sheet
Data Sharing Agreement (Note: GNYHA/PSYCKES Quality Collaborative participants have completed already)
CNDA - Confidentiality and Non-Disclosure Agreement (Note: agencies participating on OMH PCS have completed already)
CEO assigns local Security Managers
Security Managers use on-line Security Management System (SMS) to enroll PSYCKES users and registrars
OMH sends tokens to Security Manager
Security Manager activates tokens and gives to staff

48. Training and Technical Assistance
Webinars beginning in November
On Access to PSYCKES
On Using PSYCKES PSYCKES website materials
Users’ Guide, recorded Webinars, FAQs
Helpdesk assistance via

49. Next Steps
PSYCKES Access Packet will be sent out to all OMH or OASAS licensed inpatient or detox programs (Nov 2011)
Training Webinars (Nov 2011-April 2012)
Questions