The Psychiatric Services The Psychiatric Services and Clinical Knowledge and Clinical Knowledge Enhancement System Enhancement System

(PSYCKES) (PSYCKES)

Molly Finnerty, MDMolly Finnerty, MDDirector, OMH Bureau of Evidence Based Director, OMH Bureau of Evidence Based Services and Implementation SciencesServices and Implementation SciencesFall 2011Fall 2011

Overview Introduction to PSYCKESIntroduction to PSYCKES Using PSYCKESUsing PSYCKES

QI ReportsQI Reports Clinical SummaryClinical Summary

Data access & the Consent ModuleData access & the Consent Module Next StepsNext Steps

PSYCKES AccessPSYCKES Access Technical AssistanceTechnical Assistance

What is PSYCKES?What is PSYCKES?

Secure, HIPAA-compliant portfolio of Web tools Secure, HIPAA-compliant portfolio of Web tools PSYCKES – State hospitals (2003)PSYCKES – State hospitals (2003) PSYCKES – Medicaid (2008)PSYCKES – Medicaid (2008) MyPSYCKES for consumers (2010)MyPSYCKES for consumers (2010)

Developed by OMH to support quality Developed by OMH to support quality improvement and clinical decision-makingimprovement and clinical decision-making Calculates performance on quality indicators at Calculates performance on quality indicators at

state/regional/agency/site levelsstate/regional/agency/site levels Provides treatment history across settings over time Provides treatment history across settings over time MyPSYCKES allows consumers to enter data on treatment MyPSYCKES allows consumers to enter data on treatment

process, outcomes and goalsprocess, outcomes and goals

Client Records Accessible in Client Records Accessible in PSYCKES-MedicaidPSYCKES-Medicaid

NYS Medicaid enrolleesNYS Medicaid enrollees Fee-for-service claimsFee-for-service claims Managed care encounter dataManaged care encounter data Dual-eligible (Medicare/Medicaid): includes Medicaid Dual-eligible (Medicare/Medicaid): includes Medicaid

data onlydata only

Behavioral health population, i.e., at least one of Behavioral health population, i.e., at least one of the following:the following: Mental health or SUD serviceMental health or SUD service Mental health or SUD diagnosisMental health or SUD diagnosis Psychotropic medicationPsychotropic medication

Currently over 2.5 million individualsCurrently over 2.5 million individuals

Data Available in PSYCKESData Available in PSYCKES

All Medicaid-reimbursable services for which a All Medicaid-reimbursable services for which a claim was submitted, across treatment settings claim was submitted, across treatment settings Behavioral health (outpatient and inpatient)Behavioral health (outpatient and inpatient) Pharmacy (psychotropic and medical)Pharmacy (psychotropic and medical) Medical (services, lab tests, and procedures)Medical (services, lab tests, and procedures) Living supports (if Medicaid-billable)Living supports (if Medicaid-billable)

Up to 5 years of dataUp to 5 years of data

Currently does not include data from Medicare Currently does not include data from Medicare or private insuranceor private insurance For dual-eligible clients (Medicare and Medicaid), For dual-eligible clients (Medicare and Medicaid),

includes services but not pharmacyincludes services but not pharmacy

PSYCKES ImplementationPSYCKES Implementation

State hospitals (2003): 27 hospitalsState hospitals (2003): 27 hospitals Mental health clinics (2008): 340 clinicsMental health clinics (2008): 340 clinics NYC Hospital affiliated clinics (2010): 25 clinics/ CDTsNYC Hospital affiliated clinics (2010): 25 clinics/ CDTs LGU pilot (2010): NYC, ErieLGU pilot (2010): NYC, Erie ACT Transitions Project (2010): 27 teamsACT Transitions Project (2010): 27 teams MyPSYCKES pilot (2010): 2 clinicsMyPSYCKES pilot (2010): 2 clinics ER pilot (2011): 4 ERsER pilot (2011): 4 ERs Access for OMH and OASAS licensed hospitals and Access for OMH and OASAS licensed hospitals and

detox programs (2011)detox programs (2011) Support goals of Phase I – Learning to use dataSupport goals of Phase I – Learning to use data

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USING PSYCKESUSING PSYCKES

PSYCKES Homepage PSYCKES Homepage (www.psyckes.org)(www.psyckes.org)

Logging in to PSYCKESLogging in to PSYCKES From PSYCKES Homepage, click “Log into From PSYCKES Homepage, click “Log into

PSYCKESPSYCKES At Login Page, enter:At Login Page, enter:

User ID (first box)User ID (first box) Password + token code (2nd box)Password + token code (2nd box)

Your PSYCKES Homepage: Your PSYCKES Homepage: QI Overview ScreenQI 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”)

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

Drill Down on Indicator Set Drill Down on Indicator Set (e.g. 4+ (e.g. 4+

Inpt/ER)Inpt/ER) to Individual Measures to Individual Measures (e.g. BH, (e.g. BH,

Medical, All)Medical, All)

Quality Indicators Link to List of Quality Indicators Link to List of Flagged ClientsFlagged Clients

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

Search ResultsSearch Results

Click on Recipient Name >> Clinical SummaryClick on Recipient Name >> Clinical Summary

Mapping

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

Clinical Summary Header: Clinical Summary Header: Report date,Report date, level of access, select time frame,

Name, DOB, Age, MCO, Quality Flags, Diagnoses

Clinical Summary: Clinical Summary: Integrated View of All Services Integrated View of All Services

Graph allows for rapid identification of utilization patterns, including medication adherence, outpatient and inpatient services.

Zoom on Period of InterestZoom on Period of Interest

Hovering the cursor over an individual record will show date and place of service.

Integrated View as TableIntegrated View as Table

Medications: PsychotropicsMedications: PsychotropicsDrug, dose, duration, start date, last pick up, prescriberDrug, dose, duration, start date, last pick up, prescriber

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

prescriberprescriber

Drill Down from Medication Trials Drill Down from Medication Trials to Individual Prescriptions:to Individual Prescriptions:

Dose, Quantity, Tabs/day, Days supply, Route, Dose, Quantity, Tabs/day, Days supply, Route, Prescriber, PharmacyPrescriber, Pharmacy

Outpatient BH Services Outpatient BH Services Summary: Summary:

Type of service, Provider, Date of First and Last, Type of service, Provider, Date of First and Last, # of visits, Diagnosis, Procedures, Practitioner, # of visits, Diagnosis, Procedures, Practitioner,

“See all Data” > Links to each invoice/claim“See all Data” > Links to each invoice/claim

Outpatient Medical ServicesOutpatient Medical ServicesType of service, Provider, Date of First and Last, Type of service, Provider, Date of First and Last, # of visits, Diagnosis, Procedures, Practitioner, # of visits, Diagnosis, Procedures, Practitioner,

“See all Data” > Links to each invoice/claim “See all Data” > Links to each invoice/claim

Inpatient and ER ServicesInpatient and ER ServicesService Type (ER or Inpt, BH or Medical), Hospital Name, Service Type (ER or Inpt, BH or Medical), Hospital Name,

Date of First and Last ER/Inpatient Admission, Date of First and Last ER/Inpatient Admission, # of Admits, Last Diagnosis, Procedures, # of Admits, Last Diagnosis, Procedures,

“See all Data” > Links to each invoice/claim“See all Data” > Links to each invoice/claim

Labs, Dental & Vision, Living Labs, Dental & Vision, Living SupportSupport

Export Data to PDF or ExcelExport Data to PDF or ExcelAll reports, all screens can be exported to PDF or excelAll reports, all screens can be exported to PDF or excel

Benefits & Uses of PSYCKES Benefits & Uses of PSYCKES Data: ClinicalData: Clinical

Evaluation and treatment planningEvaluation and treatment planning Medication reconciliation Medication reconciliation Coordination of care across clinical settingsCoordination of care across clinical settings Assess medication complianceAssess medication compliance Identify utilization patterns Identify utilization patterns (high use, readmission)(high use, readmission)

Discharge planningDischarge planning Timely – weekly updatesTimely – weekly updates

Benefits & Uses of PSYCKES Benefits & Uses of PSYCKES Data: Quality ImprovementData: Quality Improvement

Performance on measures – can select comparatorsPerformance on measures – can select comparators Transparency – all stakeholders see the same Transparency – all stakeholders see the same

information information Meaningful and Actionable Data - link to individual Meaningful and Actionable Data - link to individual

clientsclients Flexible – an expanding array of quality measures, Flexible – an expanding array of quality measures,

and capacity to search for cohorts of interestand capacity to search for cohorts of interest Timely - updated monthlyTimely - updated monthly

Limitations of PSYCKES DataLimitations of PSYCKES Data

Accuracy dependent on coding and billing Accuracy dependent on coding and billing

Data elements limited to what is shown on claimsData elements limited to what is shown on claims e.g. See labs/ x-rays but without resultse.g. See labs/ x-rays but without results

Time lag between services and billing is variableTime lag between services and billing is variable Service data may lag by weeks or monthsService data may lag by weeks or months

Client data affected by changes in eligibility, Client data affected by changes in eligibility, moves, hospitalizations (bundled services).moves, hospitalizations (bundled services).

Accessing Client Data: Accessing Client Data: PSYCKES CONSENT MODULEPSYCKES CONSENT MODULE

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

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)

Yes 3 years after last service

What is an Emergency?

Can occur in any setting

New York State Public Health Law Section 4900.3

"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.

Consent Process in Hospital Workflow

Hospital staff obtain written consent from clients Hospital staff obtain written consent from clients OR determine that it is a clinical emergency.OR determine that it is a clinical emergency. PSYCKES consentPSYCKES consent

RHIO consent (if Medicaid data used/ addressed)RHIO consent (if Medicaid data used/ addressed)

Clinical emergency Clinical emergency

Registrar uses Consent Module in PSYCKES to Registrar uses Consent Module in PSYCKES to attest to rationale for access to client data (consent attest to rationale for access to client data (consent or emergency).or emergency).

Any PSYCKES user at the hospital can then Any PSYCKES user at the hospital can then access client data.access client data.

Registrar Menu

Consent Module is accessed through the Consent Module is accessed through the Registrar Menu in PSYCKES.Registrar Menu in PSYCKES.

Registrar Menu tab only appears if the user has Registrar Menu tab only appears if the user has been granted PSYCKES-Registrar access.been granted PSYCKES-Registrar access.

Clicking “Registrar Menu” tab opens a new row of Clicking “Registrar Menu” tab opens a new row of tabs. tabs.

Consent Forms Menu

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

Using the Consent ModuleFrom Registrar menu, go to Medicaid Consent From Registrar menu, go to Medicaid Consent

Menu and click on “Grant Consent”Menu and click on “Grant Consent”

Step1: Find the ClientEnter client’s Medicaid ID number, and click “search.”Enter client’s Medicaid ID number, and click “search.”

AA19 386GAA

Confirm Search ResultsCorrect name, age, gender, address?

05/15/1969 42 F

F

AA19 386G

Mouse Minnie

7 Goofy Lane

Warnerville NY 13456

05/15/1969 42

Step 2: Attest to Right to Access Data consent or clinical emergency

Step 3: Confirm Client IdentificationSelect forms of ID from drop-down list, or if known to setting

can attest to identity without ID

Submit then Quit orGo to Clinical Summary

Search for Consented Recipients

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

Steps for Setting up PSYCKES Steps for Setting up PSYCKES Access for Hospitals/ Detox Access for Hospitals/ Detox

ProgramsPrograms Complete PSYCKES Access Packet (emailed to Hospital CEO)Complete PSYCKES Access Packet (emailed to Hospital CEO)

Contact SheetContact Sheet Data Sharing Agreement (Note: GNYHA/PSYCKES Quality Collaborative Data Sharing Agreement (Note: GNYHA/PSYCKES Quality Collaborative

participants have completed already)participants have completed already) CNDA - Confidentiality and Non-Disclosure Agreement (Note: agencies CNDA - Confidentiality and Non-Disclosure Agreement (Note: agencies

participating on OMH PCS have completed already)participating on OMH PCS have completed already)

CEO assigns local Security Managers CEO assigns local Security Managers Security Managers use on-line Security Management System Security Managers use on-line Security Management System

(SMS) to enroll PSYCKES users and registrars (SMS) to enroll PSYCKES users and registrars OMH sends tokens to Security ManagerOMH sends tokens to Security Manager Security Manager activates tokens and gives to staffSecurity Manager activates tokens and gives to staff

Training and Technical Training and Technical AssistanceAssistance

Webinars beginning in NovemberWebinars beginning in November On Access to PSYCKES On Access to PSYCKES On Using PSYCKES PSYCKES website On Using PSYCKES PSYCKES website

materialsmaterials www.PSYCKES.orgwww.PSYCKES.org

Users’ Guide, recorded Webinars, FAQsUsers’ Guide, recorded Webinars, FAQs Helpdesk assistance via Helpdesk assistance via

PSYCKES-help@omh.ny.gov

Next StepsNext Steps

PSYCKES Access Packet will be sent out to all OMH or OASAS licensed inpatient or detox PSYCKES Access Packet will be sent out to all OMH or OASAS licensed inpatient or detox programs (Nov 2011)programs (Nov 2011)

Training Webinars (Nov 2011-April 2012)Training Webinars (Nov 2011-April 2012)

QuestionsQuestions

www.psyckes.org

PSYCKES-help@omh.ny.gov