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Frequently Asked Questions

Updated July 2011

Contents

Overview: PSYCKES-Medicaid

Where does the data in PSYCKES come from?

  • Reports in PSYCKES-Medicaid are generated using New York State Medicaid claims data obtained through a Memorandum of Understanding between the New York State (NYS) Office of Mental Health (OMH) and the NYS Department of Health (DOH). Medication data is obtained through claims submitted by the pharmacy, and service data is obtained from claims submitted by Medicaid providers. The data feed provided by DOH to OMH includes adjudicated claims for all services paid for by Medicaid Managed Care or Fee for Service in the past five years, both mental health and non-mental health, across treatment settings for any Medicaid recipient with a mental health diagnosis or service in the past year, and recipients on psychotropic medications with any diagnosis. All states are required by the Federal Government to monitor the quality of their Medicaid programs, and many states are using administrative data, such as Medicaid claims, to support quality improvement initiatives.

Why was PSYCKES developed?

  • PSYCKES was developed as a tool to support clinical decision-making and quality improvement activities related to psychotropic prescribing practices. The current polypharmacy, cardiometabolic risk, dose, and youth quality indicator sets focus on common quality concerns that research suggests can be improved through clinician interventions. The quality indicator sets help to identify Medicaid clients who are at increased risk for hospitalization, morbidity and mortality. It is our hope that improving quality of care for these clients will improve clinical outcomes and quality of life.

    We believe that high quality medication management and clinical care can reduce costs, (for example by decreasing hospitalizations), improve quality of life, and enhance client empowerment. Quality improvement initiatives need to be differentiated from other types of regulatory efforts focusing directly on cost containment, such as Preferred Drug Lists.

What internet browser best supports PSYCKES performance?

  • For best results, please use Internet Explorer version 7 to access PSYCKES-Medicaid. Some of our users have experienced loading and freezing errors when trying to access PSYCKES with earlier versions of Internet Explorer, or with other browsers.

What PC requirements best support the PSYCKES Medicaid application?

  • Computer/Processor: Computer with 800 MHz processor or higher (Pentium processor recommended)

    Operating System: Windows XP Service Pack 2 (SP2), Windows XP Service Pack 3 (SP3)

    Memory: 1 GIG system memory (Min)

    Browser: Internet Explorer 7 or Mozilla Firefox 3.5.2

Data in PSYCKES

What data can users see in the PSYCKES-Medicaid application?

  • PSYCKES users are able to view aggregate performance data statewide down to the program level. Prescriber- and client-level data is available only to users at that agency.

When are the PSYCKES-Medicaid reports updated?

  • PSYCKES-Medicaid quality indicator reports are refreshed monthly. PSYCKES-Help will send an e-mail notification of each data refresh to all registered users. Clinical information in the client-level reports is updated weekly.

Which program types are available in PSYCKES?

  • Agencies have access to PSYCKES reports for all programs licensed by OMH and billed for by the agency (Clinic, Continuing Day Treatment (CDT), Case Management (CM), Assertive Community Treatment (ACT), Personalized Recovery Oriented Services (PROS), Community Residence (CR), etc.). At the client level, PSYCKES includes all services paid for by Medicaid. We hope this information will be used to support coordination of care across services, program types and service settings.

What client information is included in PSYCKES Medicaid?

  • The PSYCKES-Medicaid application is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and we take Protected Health Information (PHI) very seriously. There are two ways in which agency staff can view client-level information. Providers with access to PSYCKES can view client-level reports for individuals served at that agency who meet criteria for any of the quality indicators included in PSYCKES (See Quality Concerns). Agencies that have access to the Consent Module can also obtain consent from clients to view their Medicaid data in PSYCKES-Medicaid. The information available includes Medicaid Managed Care and Medicaid Fee for Service claims across treatment settings, but does not include Medicare claims.

Our agency serves mostly Medicare clients. Will these clients show up in PSYCKES?

  • Data on Medicare recipients are not displayed in PSYCKES-Medicaid because the claims are not paid for by Medicaid. In addition, only services paid for by Medicaid will be listed for dual-eligible clients who receive both Medicare and Medicaid (e.g., medications paid for by Medicare Part D will not appear). In the future, OMH would like to expand PSYCKES to other payer types, such as Medicare and private insurers, but this is a long range effort.

My clinic’s clients are showing up in another clinic within our agency. Why? How can I fix it?

  • There are two potential reasons for this error. 1) PSYCKES-Medicaid uses Medicaid claims data to associate clients to clinics and generate the reports. When a client is "showing up in the wrong clinic," this may be due to agency billing practices. For example, an agency with multiple clinics might choose to bill each clinic through a separate locator code, or to bill all clinics through one locator code. These choices will affect how consumers are assigned to clinics within PSYCKES. 2) The recent federally mandated use of a National Provider Identification number (NPI) has affected the client location of service. Depending on use of NPI, the clients may be aggregated at an agency level, or into a single clinic. We are working with the NYS Department of Health to better understand the NPI agency and clinic matching process in order to provide improved information in the PSYCKES application.

How does PSYCKES link prescribers to my clinic and/or agency?

  • PSYCKES is populated using Medicaid claims data. When a place of service submits a claim to Medicaid, they include an "attending physician" on the claim. PSYCKES uses this "attending physician" field to associate the physician to the place of service. The physician listed on the claim in the attending field is the physician displayed in the prescriber by site and unduplicated prescriber tab.

What does "Other" mean when displayed in the prescriber field (such as in unduplicated prescriber)?

  • When a clinic/place of service does not complete, or incorrectly completes, the "attending physician" field on the Medicaid claim, the provider will be displaced as Other in PSYCKES.

How do I update PSYCKES information?

  • Because PSYCKES reports are based on Medicaid claims data, the application does not require any data entry on the part of the service provider. The data in PSYCKES is a direct reflection of agency and clinic billing practices, as well as that of the pharmacy. If you have questions about information within the application, we ask that you first review the concern with your agency's fiscal or billing staff (e.g. verify the billing codes being used by your agency to submit claims). Should you have additional questions, please contact PSYCKES-Help. (See also, How do I update or change my address in PSYCKES?)

How do I update or change my address in PSYCKES?

  • Information in PSYCKES is pulled from Medicaid service and pharmacy claims. There is no way to update or change the information in the PSYCKES application directly. If you would like to change your clinics address with Medicaid, you will need to change the address in at least two places: Medicaid FFS and Managed Care.
    1. Medicaid Fee For Service (FFS)/eMedNY: Please complete the Medicaid Fee for Service Provider Change of Address Form Leaving OMH site.
    2. Medicaid Managed Care: Please contact your County Department of Social Services. In New York, counties are the Medicaid Managed Care "contracting organizations" and will be able to help with this change of address. If you serve patients from more than one county, you will need to contact each county office.

Can I sort the information provided in PSYCKES?

  • Yes. To sort information in a table, click on the column heading. The table will be sorted in ascending order upon first click and descending order upon second click. For example, you can use this function in the Site tab to sort site by the number of outliers (to identify sites with larger numbers of positive cases) or to sort by percent (to review variation in performance across sites).

PSYCKES Access and Information Security

How do we obtain access to PSYCKES?

  • Currently, access to PSYCKES-Medicaid is limited to providers participating in one of the PSYCKES Initiatives, including the NYSOMH Continuous Quality Improvement Initiative (CQI) in freestanding mental health clinics and the Greater New York Hospital Association (GNYHA) PSYCKES Quality Collaborative in hospital mental health clinics. All participating agencies have access to the on-line Security Management System (SMS), and agency Security Managers are authorized to grant access to PSYCKES using SMS. If you have any questions about SMS, please contact the OMH Helpdesk or call 1-800-HELP-NYS. We are currently exploring implementation of PSYCKES in other settings and welcome your comments and inquiries; please contact PSYCKES-Help.

Why do we need to sign a CNDA for PSYCKES access?

  • The Confidentiality and Non-Disclosure Agreement (CNDA) is a legal document that defines your agency's responsibilities with regards to information obtained via OMH applications, such as PSYCKES. OMH requires all agencies accessing OMH information systems and data to sign the CNDA in order to ensure each agency understands its responsibilities regarding access to and use of the data.

What is required to access PSYCKES?

  • Access to PSYCKES requires:
    1. registration in the on-line Security Management System (SMS)
    2. an OMH-issued user ID
    3. a token (a small electronic device issued by OMH that generates a random six-digit number every 60 seconds)

    Staff who need access to PSYCKES should contact the agency's Security Manager. The Security Manager then uses SMS to enroll the user. If the user already has access to other OMH applications (e.g. CAIRS or NIMRS), s/he will be able to use the same OMH-issued user ID and token to access PSYCKES. If the user does not have such access, the Security Manager will enter the required information into SMS, and OMH will issue a token and user ID. OMH will provide the token at no cost to the agency. Central Office will send the token to the Security Manager for activation. Once the security manager has activated the token, the user will be able to use it and the OMH user ID to access PSYCKES-Medicaid. Upon first log-in, you will be asked to create a PIN that will be used subsequently during log-in together with the 6-digit token number.

Our security manager is unable to activate his token to access the system and sign up the QI team.

  • Please contact the OMH Helpdesk or call 1-800-HELP-NYS, or 518-474-5554. Be sure to specify that you are having trouble with the Web-based Security Management System. Please note your ticket number (this allows the Helpdesk to track your request). If the Helpdesk cannot resolve the situation, please e-mail PSYCKES-Help and a member of the PSYCKES team will follow up with you.

Our Security Manager gets an error message when they try to activate a token. What can we do to resolve this problem?

  • One reason may be that the Security Manager has attempted to activate a token more than once. Please call the OMH Helpdesk at 1-800-HELP-NYS or 518-474-5554 and OMH will assist you in putting the token back into "new PIN mode".

What if a user forgets his or her PIN or user ID?

  • If a user forgets his or her PIN or user ID, please call the OMH Helpdesk at 1-800-HELP-NYS or 518-474-5554. The Help Desk will assist you in the reset.

What should we do if a token is lost?

  • If a user loses his or her token, please call the OMH Helpdesk at 1-800-HELP-NYS or 518-474-5554. We will deactivate the token and issue a replacement.

Can we change the OMH-issued user ID?

  • No, not at this time. OMH policy states that users will use the OMH-issued user ID.

Confidentiality of Data

How does PSYCKES comply with the privacy requirements of HIPAA?

  • PSYCKES does not display protected health information (PHI) on its public pages. As in every state, New York has a Drug Utilization Review Board (DUR), part of the NYS Department of Health, which is responsible for ensuring the quality and safety of services provided by Medicaid. Under the auspices of the DUR, PSYCKES releases PHI without consent only on individuals where there is a quality or safety concern, and releases that information only to authorized users at the agency where such individuals receive services.

    PSYCKES uses several layers of security protection to ensure compliance with HIPAA regulations and protection of consumer privacy.

    • Authorization – All users must complete OMH Request for Access Forms, getting signatures from their supervisors and approval from designated OMH employees.
    • Authentication – Users must authenticate themselves using an RSA Token. RSA tokens provide a changing pass code that adds an additional level of security.
    • Role-Based Access – Users can only access data about individuals receiving services at their own agencies, for which there exists a potential safety or quality concern.
    • De-provisioning – Any user whose permission to access PSYCKES is revoked will be locked out of the system within 24 hours of Helpdesk receiving notification that the user's account should be suspended.
    • Audit Logging – Per HIPAA requirements, all access to individual-level data must be logged. OMH automated systems record who logged in when, which portions of the system were used, and which individual's data was viewed for all instances in which PHI was accessed via PSYCKES.

Do we need to obtain consumer consent to access their information in PSYCKES?

  • Generally under the Health Insurance Portability and Accountability Act (HIPAA), healthcare providers are allowed to share information about a client's services with other providers in order to coordinate care. Under the auspices of the NYS Drug Utilization Review Board, which oversees the quality and safety of the NYS Medicaid program, PSYCKES releases PHI without consent only on individuals where there is a quality or safety concern, and releases that information only to authorized users at the agency where such individuals receive services. Agencies do not need to obtain prior consent from consumers in order to see Medicaid data in PSYCKES for consumers with one or more quality flags. Agencies must use the Consent Module in PSYCKES to obtain consent from Medicaid consumers who do not have quality flags in order to view their data. If your agency is interested in Consent Module access, please contact PSYCKES-Help for more information.

Does the CQI project require a client consent form or IRB approval?

  • The PSYCKES-CQI Initiative is a quality improvement (QI) project designed to improve psychotropic prescribing practices, not a research study. The Department of Health (DOH) has authorized OMH to release this information to clinics in order to address serious quality and safety issues as identified by the quality indicators. Consumers with quality concerns are not required to consent to release of their Medicaid data, and clinics do not need IRB approval to conduct QI.

Do we need to inform consumers that we have additional access to information about their medication and medical history?

  • Engaging consumers in a dialogue about services and health is an important part of shared decision-making. Clinics should inform consumers about the NYSOMH CQI Initiative. Let them know you will have access to additional information about their treatment history that will help clinicians work with consumers to assess the risks and benefits of their current medications. This is an opportunity to educate consumers about these important quality concerns, and we encourage you to use the brochures developed by OMH as part of your efforts. (See Brochures)

How should we maintain confidentiality of downloaded files?

  • Information downloaded from PSYCKES, whether as an electronic file or as a print-out, that contains Protected Health Information (PHI) should be protected as you would protect any other PHI at your agency, and as outlined in the Confidentiality Standards that are agreed to upon log-on to PSYCKES.

Quality Indicators: Medication-Specific Questions

Trazodone is an antidepressant, but it is used mostly for sleep. In the PSYCKES quality indicators, does Trazodone count as an antidepressant?

  • No, Trazodone does not count as an antidepressant for the Antidepressant Polypharmacy indicators. However, use of Trazodone does count as a psychotropic for the purpose of the psychotropic polypharmacy indicator (4 or more in adults, 3 or more in youth). For a list of specific medications that qualify for the polypharmacy indicators, and their categorizations, please see the Psychotropic Medications list available on the PSYCKES website under Quality Concerns.

Would a combination medication, like Symbyax, count as one or two psychotropic medications?

  • Combination medications are counted separately for each component medication. For example, a client taking Symbyax would be considered as taking two psychotropic medications, an antidepressant (fluoxetine) and an antipsychotic (olanzapine).

Does Benadryl qualify as a psychotropic medication for this project?

  • Benadryl is not categorized as a psychotropic for the purpose of these quality indicators due to its numerous non-psychiatric indications. For a list of specific medications that qualify for the polypharmacy indicators, and their categorizations, please see the Psychotropic Medications list available on the PSYCKES website under Quality Concerns.

Education & Training

What resources are available to support us in medication-related QI projects?

  • OMH has developed an array of technical assistance and training resources to support medication-focused QI projects, including educational materials for prescribers and consumers, project tools, and web-based training on QI and clinical topics. Please see the PSYCKES website for more information.

Who can we call if we have QI questions?

  • If you have questions about the NYSOMH Continuous Quality Improvement Initiative, please contact Terese Lawinski. For questions about the GNYHA-PSYCKES Quality Collaborative, please contact Kate Sherman.

    If you have questions about access to PSYCKES, please contact the OMH Helpdesk or call 518-474-5554.

    If you have any other questions, including using PSYCKES, obtaining a psychiatric consultation, training for psychiatrists, etc. please e-mail PSYCKES-Help.

Can any member of the Helpdesk assist us with PSYCKES navigation/technical questions, or should we ask for a specific person?

  • Any member of the Helpdesk staff will be able to assist you or direct your inquiry to the correct person.

What training is available for prescribers?

  • In response to requests from providers, we have developed web-based Continuing Medical Education (CME) training materials for prescribers and other staff in collaboration with our Scientific Advisory Board and Columbia University. They are currently available on the PSYCKES website under "Resources for Clinicians". Prescribers that watch the presentation and complete a short post-test will qualify for CME credit. In addition, we offer clinical consultation for both groups and individual prescribers. Please e-mail PSYCKES-Help if you would like to schedule a clinical consultation. Prescribers are also encouraged to view the "Using PSYCKES for Prescribers" webinar available on the PSYCKES website that gives a brief tutorial of the PSYCKES application.

Is there any information available for consumers about PSYCKES?

  • Yes. OMH has developed brochures to educate consumers and their families about the quality concerns (polypharmacy, cardiometabolic risk, youth and dose). We have brochures available. Additionally, there is a webinar entitled "Engaging Consumers" available on the PSYCKES website that discusses ways some of our clinical partners have engaged consumers in the project.

Where can I locate the CQI Project Brochures on the PSYCKES website?

  • The OMH-developed brochures are available on the PSYCKES website under Quality Concerns. They were created to educate consumers and their families about both the NYSOMH QI project overall and the quality concerns (polypharmacy, cardiometabolic risk, youth and dose) targeted by the project.

Webinars

What is a Webinar? How can I register?

  • A Webinar is a live, web-based, interactive presentation. You need to register for each webinar using the link provided by PSYCKES-Help or available on the PSYCKES website. After registering, you will receive an e-mail that includes a toll-free number and an Internet link. When you click on the link, you will be brought to the GoToWebinar interface; once the Webinar starts, you will see on your computer what the presenter is showing. Due to the number of participants, the telephone call is set up as broadcast-only, meaning that only the presenters will be heard. Participants type questions using the GoToWebinar interface on the computer.

How are users notified of webinars?

  • The PSYCKES team holds periodic webinars on topics including Using PSYCKES, Monthly Reporting, and other special topics. Upcoming webinars will be announced via e-mail at least two weeks in advance, and will be posted to the PSYCKES Website under the News and Calendar sections.

Do we need to have access to PSYCKES during the webinars?

  • No. The only requirements for participation in Webinars are a phone and a computer with internet access.

I missed a webinar I wanted to attend. What should I do?

  • We recognize that staff are busy and may not always be able to attend the scheduled Webinars. Therefore, we record at least one example of each Webinar series and post it to the PSYCKES website. Please visit the website to see the list of recorded Webinars. Most are less than an hour long, and can be viewed from any computer with an internet connection.

Conducting Medication-Focused QI Projects: Overview

Do you recommend designing the project from an agency or clinic perspective?

  • Based on extensive site visits and feedback from providers, we believe that a successful QI project depends on engaging staff at the clinic level and integrating QI activities into routine workflow whenever possible. While large providers may wish to have some coordination at the agency level, we strongly encourage each clinic to have a QI team that carries out activities related to data collection, tracking, review, and feedback.

How do we access project materials?

  • Copies of the CQI Handbook, PSYCKES User's Guide PDF (5.7mb), and other project materials are available on the PSYCKES website. The website is organized to provide ready access to information by specific initiatives as well as by user role.

Do we need to engage a minimum number of consumers for the project?

  • In order to conduct a high-quality CQI project, clinics should have a goal of identifying and reviewing at least 10 positive cases. At a minimum, clinics are expected to review all positive cases identified in PSYCKES. Clinics with low numbers of positive cases identified in PSYCKES should discuss strategies for case finding with their PSYCKES Project Manager.

If a consumer we are tracking as part of our project has been discharged, should we conduct case finding to add another case to our project?

  • QI teams should have processes in place every month to identify new cases. The goal of the project is to identify all consumers who meet criteria for the selected indicator set, and to build in screening mechanisms to identify additional cases over time. PSYCKES is one tool clinics can use to identify new cases each month, and the application now includes a "New" tab to make this process even easier.

    Please note that if a consumer is discharged, you should not adjust the number of positive cases to date in the monthly reporting. That is intended to be a running count of all consumers identified for the project.

How often should we review cases that meet criteria for our selected project?

  • It depends on who is conducting the review and the intent of the review. There are two types of reviews that typically happen during the QI project, 1) clinical review by the prescriber, and 2) review by the QI team.

    We expect that every consumer who meets criteria for the selected indictor set will receive at least one clinical review to determine whether the client is a candidate for a medication change. This clinical review is conducted by the prescriber with all relevant information available and taking client preferences into account. If a client does not wish to change medications or there are other reasons why a medication change is not appropriate at the time, we encourage clinics to develop processes for revisiting that decision, e.g. during quarterly treatment plan reviews.

    We also recommend that the QI team review the list of all positive cases at the monthly QI team meetings and provide the list of positive cases to each prescriber each month. This helps ensure that everyone is aware of those consumers who have an ongoing quality concern, and provides an opportunity for feedback to the team and to the prescriber on the project's outcomes. However, review by the QI team does not quality as a clinical review and should not be reported as such in the monthly data submissions.

We have identified a large number of positive cases both in PSYCKES and through chart review. Due to staffing constraints we are not able to complete clinical reviews for all of the cases identified. How do you recommend we prioritize the clinical reviews?

  • We recommend you begin with the Medicaid recipients, in part because there will be more information available to you in PSYCKES to support the review, and also in recognition of the fact that this is a Medicaid-sponsored initiative. We also encourage clinics to integrate the clinical reviews into the routine workflow of the clinic, for example by including a structured progress note for the prescriber to complete during a routine medication visit, or incorporating the review at the time of the quarterly treatment plan review. Please consult with your PSYCKES Project Manager for more suggestions on how to incorporate best practices into your routine operations.

What about clinic clients who routinely obtain medications from private prescribers? How do we work with this population in this project? Do we have the option to exclude such recipients if we know for sure that the prescriber is from the outside? (See “Involving Prescribers in CQI” under NYSOMH CQI Project)

  • Consumers served at an agency who receive medication from outside prescribers should not be excluded. We encourage you to reach out to these prescribers in order to coordinate care. For example, some participating clinics have developed a letter that is sent to all outside prescribers who prescribe for a client with a quality flag. Other clinics have policies specifying that clients should not receive psychotropic medications from both an outside provider and the clinic prescriber. We also encourage clinics to use the PSYCKES data in the clinical encounter to explore why clients are obtaining medications from multiple sources. We do understand that it will be harder to engage prescribers that are not from your agency.

Are clinics participating in the Reducing Cardiometabolic Risk project required to monitor weight, labs, etc. and report on those measures?

  • No, you are not required to monitor such things as labs, BMI and weight for the QI project. While we do recognize this is good clinical practice, particularly for those at risk, this project is focused on medication. The Reducing Cardiometabolic Risk project focused on decreasing the use of antipsychotics with moderate to high risk for causing metabolic abnormalities among individuals with existing cardiometabolic conditions.

Obesity and its related complications are underreported at our agency. How do we identify consumers for our Reducing Cardiometabolic Risk project?

  • Often mental health providers lack information about their clients' physical health. PSYCKES was designed to help providers identify consumers who have a cardiometabolic condition and who are taking an antipsychotic medication that can make those conditions worse. The five metabolic problems reflected in the Cardiometabolic Risk set are: 1) diabetes/pre-diabetes, 2) ischemic vascular disease, 3) hyperlipidemia (high cholesterol), 4) hypertension (high blood pressure), and 5) obesity. Consumers will be counted as having any of these conditions if Medicaid claims data show they have received the diagnosis in the past five years or (in some cases) if they are on a medication used to treat the condition. Since PSYCKES has access to claims data across treatment settings, these conditions will be identified if any Medicaid provider has submitted relevant claims, not only the participating clinic.

    For those clinics with fewer Medicaid recipients, identifying consumers with cardiometabolic conditions can be more challenging. Clinics have worked with consumers to obtain copies of annual physicals or have developed processes to reach out to client's primary care physicians (with consent). If you have questions about strategies for identifying positive cases in the cardiometabolic risk project, please contact the Project Manager.

Involving Prescribers in CQI

Is it necessary for all prescribers to have PSYCKES access and use it?

  • We developed PSYCKES to be useful for both QI teams and prescribers, and encourage participating clinics to give prescribers direct access to PSYCKES. There is a wealth of treatment data in the PSYCKES client-level reports that is potentially valuable in clinical decision-making. For example, prescribers can review all medications prescribed in the past five years to determine whether clients have had adequate trials of monotherapy, or determine whether the client is receiving medications from other prescribers. The Project Planning Form requires QI teams to specify how clinical reviews will be conducted; if prescribers will not have access to PSYCKES, please describe how PSYCKES information contained in PSYCKES will be shared with them.

What about clinic clients who routinely obtain medications from private prescribers? How do we work with this population in this project? Do we have the option to exclude such recipients if we know for sure that the prescriber is from the outside?

  • Consumers served at an agency who receive medication from outside prescribers should not be excluded. We encourage you to reach out to these prescribers in order to coordinate care. For example, some participating clinics have developed a letter that is sent to all outside prescribers who prescribe for a client with a quality flag. Other clinics have policies specifying that clients should not receive psychotropic medications from both an outside provider and the clinic prescriber. We also encourage clinics to use the PSYCKES data in the clinical encounter to explore why clients are obtaining medications from multiple sources. We do understand that it will be harder to engage prescribers that are not from your agency.

Will we be able to print out data from PSYCKES for prescribers?

  • All reports in PSYCKES can be downloaded as a PDF and as an Excel spreadsheet to be printed.

How can the QI Project team talk to prescribers about their practices?

  • Medications are a cornerstone of psychiatric treatment. It is our hope that this project will foster increased communication between prescribers and other clinic staff about the quality concerns, particularly around clients in need of clinical review. Engaging your agency's Medical Director or an opinion leader among your prescribers to support the project is a critical step. Other ways to engage prescribers include:
    • Share the letter to prescribers from the Scientific Advisory Chairs, Drs. Jeff Lieberman and Lloyd Sederer, included at the front of the CQI Handbook.
    • Review the Handbook and training slides for recent findings related to your chosen project.
    • Encourage prescribers to take the Polypharmacy and/or Cardiometabolic Risk CMEs on the PSYCKES website.
    • Distribute the Scientific Summaries of relevant research articles (available for download on the PSYCKES website).
    • Request a psychiatrist consultation to discuss quality concerns in psychotropic prescribing.

What training is available for prescribers? (See Education and Training )

  • In response to requests from providers, we have developed web-based training materials for prescribers and other staff in collaboration with our Scientific Advisory Board and Columbia University. They are currently available on the PSYCKES website under "Scientific Summary and Clinical Resources" in the "Education and Training" tab. Prescribers that watch the presentation and complete a short post-test will qualify for Continuing Medical Education (CME) credit. In addition, we offer clinical consultation for both groups and individual prescribers. Please e-mail PSYCKES-Help if you would like to schedule a clinical consultation. In the Webinar Archive of our website, locating under Project Management Resources in the Education and Training tab, prescribers may view the "Using PSYCKES for Prescribers" webinar that gives a brief tutorial of the PSYCKES application.

Our prescribers have huge time constraints. How can we free up time for them to participate in training?

  • Based on recommendations from providers, we offer web-based training for prescribers with CME credit. This will allow busy prescribers to log on any time, at their convenience, to learn more about the quality concerns targeted by the QI project. We are also able to provide group or curbside clinical consultation from OMH psychiatrists for prescribers.

Monthly Data Reporting for Freestanding Mental Health Clinics: General Questions

Why are the monthly reporting data important?

  • Continuous quality improvement (CQI) is a data-driven process. All QI models specify that data is critical to tracking progress and informing each round of the Plan-Do-Check-Act cycle. The monthly reporting process was implemented in July 2009, after submission of the first Interim Reports statewide, for three main reasons: 1) to clarify the key data elements clinics need to monitor on a monthly basis for the project, 2) to provide the OMH PSYCKES-CQI team with information about the entire scope of clinics' QI work, including both Medicaid and non-Medicaid clients, and 3) to support targeted interventions for clinics that have achieved relatively lower rates of change. In order to make the reporting process as efficient as possible, OMH developed an on-line survey to capture three data elements from each participating clinic.

What are we asked to report in the Monthly Data survey?

  • Clinics are asked to report monthly on three critical data elements: 1) the number of positive cases identified, 2) the number of clinical reviews conducted, and 3) the number of positive cases whose medications were changed such that they no longer meet criteria for the selected indicator set. Clinics are asked to report on each of these elements for the previous month and cumulative to date. Reporting is always relative to the previous calendar month. For example, starting on July 1st clinics will report on the number of cases identified, reviewed, and changed in June and to date. The cumulative number for a given month should equal the previous month's cumulative number, plus the number for the present month.

When does the survey open? When is it due? How do I know where to go?

  • As a general rule, the monthly data survey opens on the 5th of each month and closes on the 10th of each month. If the closing date falls on a weekend or holiday, the deadline is extended to the next business day. Reporting is always relative to the previous calendar month. For example, starting on July 1st clinics will report on the number of cases identified, reviewed, and changed in June and to date. PSYCKES-Help will send e-mail notifications to each QI point when the survey is open and on the closing date with the link to the on-line survey. The link will also be posted to the PSYCKES-Medicaid website under the News tab.

How do we report for the previous month if PSYCKES is displaying old data?

  • The monthly reporting process is separate from the PSYCKES reports. As part of the CQI process, clinic QI teams should be identifying and tracking consumers who meet criteria for the project each month, and reviewing that number at the team's monthly meeting. Occasionally there are data or application errors that delay release of the PSYCKES data. Please report whatever number was reviewed at the most recent QI team meeting.

I think it will be difficult to get this data submitted by the 10th of every month. What can I do?

  • If you anticipate that there will be a problem submitting the data between the 5th and the 10th, for example due to staff vacations, please contact PSYCKES-Help. Options include sending the survey link to another member of the QI team or making arrangements to submit data early.

My QI team meets in the middle of the month, is this okay for the monthly data submission?

  • We do not expect an agency to change its meeting and data collection cycles based on the 10th of the month reporting requirement. However, we do request a completed submission based on a standard reporting period each month. For example, if your CQI meeting regularly takes place in the middle of the month, please report the number of cases identified, reviewed, and changed as of the meeting. Maintaining this reporting cycle will ensure you continuously review data across the same time period each month.

My agency has multiple service settings and all are listed in PSYCKES. Do I have to report on all of them?

  • The monthly data submission should reflect the work of the QI project at your clinic. Although agencies are welcome to implement QI projects in other program types, the focus of the current initiative is on the "Clinic." For State-operated clinics, clients who are enrolled in the pre-paid mental health plan (PMHP) currently appear under the PMHP service type in PSYCKES rather than the clinic service type. Please include PMHP clients in your clinic reporting by using the "MHClinic/PMHP – State Operated" filter.

I cannot find our clinic in the survey’s drop-down menu. What do I do?

  • Clinics are organized by region. The categories are Central NY, Hudson River, Long Island, New York City, Western NY and State-Operated clinics. If your clinic is participating in the CQI project as a licensed clinic and you cannot find your clinic in one of these regions, please email PSYCKES-Help. Please remember that only licensed clinics will appear in the drop-down menu. This means that satellite clinics and other program types will not be listed. If a licensed clinic has implemented the QI project in a satellite clinic, data for the satellite should be added to the licensed clinic's numbers. Please feel free to make a comment in the Comment field if you are reporting data on satellite programs.

If I start entering data and get interrupted, is there a way to save and pull it back up to finish?

  • You cannot save an incomplete survey and come back to it later. However, if you start entering data and leave your computer, the survey will not time out. This is a relatively short survey which should take no more than 5 minutes to complete. A helpful hint is to have all of your tracking documents, which include the monthly data numbers you reported for the previous month as well as what you will report this month, accessible when you begin the survey. We suggest you print the data numbers you are reporting for your records. Then make sure to press "submit" at the end of the survey to ensure data is received.

When was the start of the NYSOMH CQI Project? Is this the date we should use for calculating 1b, 2b, and 3b?

  • The "b" in the survey represents cumulative totals since the start of the project. Please begin counting cases identified, reviewed and changed based on your project start date. The official start date for Phase I New York City was November 15th, 2008. For all other regions and all State-operated clinics (including those located in NYC) the project start date for Phase I was February 15th, 2009. New York City clinics began reporting on Phase II in XXX and clinics in the rest of the state began reporting on Phase II in May 2011.

I am currently entering the monthly data but have not submitted my survey. However, I entered incorrect information. How do I go back to correct the data?

  • If you have not submitted your survey, you can use the "Previous" button within the survey to go back to prior pages. Please do not use the "back" button in your internet browser as this may reset data or cancel your submission. If you are unsure of your submission or continue to experience difficulties, please contact PSYCKES-Help.

After I submitted my Monthly Data I noticed I made an error in reporting. How do I make changes after the survey is submitted?

  • Please e-mail PSYCKES-Help and we will send you a correction form. We will then update your information to reflect the changes. Please do not attempt to re-enter the data as this will create a duplicate entry in the reporting system.

Are we required to report the names of the clients in the Monthly Data report?

  • No, you should not report any client information. The monthly data report will only ask for aggregate numbers. Please do not include any client identifying information in the Monthly Data report, including Medicaid ID, name, date of birth, etc.

How do I know my data has been received?

  • Upon completion of the survey a page entitled "Confirm Your Data Submission" will be displayed. Please confirm your information is correct and provide any additional comments. Press the "Submit" button at the bottom of the page. You will see the message,: "This confirms that submission of your Monthly data is complete." You will then press a second submit button. Once your data has been submitted you will be taken to the PSYCKES website.

Do we have access to previously submitted data?

  • As a part of the QI project, we encourage you to develop tracking systems to record your data over time. If you would like to keep a copy of your monthly data submission, please print the QI Indicator Page before pressing the "Submit" button. If for any reason you need access to a previous month's data, please e-mail PSYCKES-Help.

Monthly Data Reporting for Freestanding Mental Health Clinics: Question 1 (Positive Cases Identified)

Is the "number of positive cases" the number that PSYCKES identifies?

  • No, the number of positive cases your clinic has identified is generally not the same number in the PSYCKES reports. This question refers to the total number of clients identified as meeting criteria for the quality indicator, using any method, including PSYCKES (after confirming via chart review), chart reviews, upon intake, etc. Question 1a asks for the number of cases identified for the previous (calendar) month, and question 1b is the cumulative total from the start of the project.

What if a client is not on Medicaid but meets criteria for a quality indicator?

  • The number of positive cases identified should include any client included in the QI project, whether or not they are on Medicaid.

Should I count clients who have been discharged in question 1b?

  • Yes. The goal of question 1b, number of positive cases identified to date, is to track how many consumers are touched by the project over the course of the initiative. Please do not adjust 1b to reflect discharges.

Sometimes a client is listed in PSYCKES but is either not receiving medication therapy from us or has been discharged from our clinic. How do we account for this?

  • PSYCKES reports will include clients for up to nine months after discharge. If you review your clinic's PSYCKES reports and note that a consumer is listed who has already been discharged (and thus never became part of the project or was never monitored/tracked by the QI team), you do not need to include that individual in the monthly reporting. However, if a consumer is part of the project but then is discharged, do not subtract them from the cumulative total of cases identified (question 1b). Positive cases not receiving medication therapy at your clinic still count as positive cases, but you are welcome to notify us of the number of cases who fall into this category using the Comment field.

PSYCKES identified a client that does not receive services from our clinic but from a different program within our agency, such as a CDT program. Should they be included in this report?

  • The Monthly Data report should only include clients served in your clinic (and are viewable under the "clinic" filter). Your Monthly Data number does not have to match what the PSYCKES reports indicate.

We identified a positive case. The medication was discontinued, and the case was no longer positive. However, the medication change resulted in a negative outcome, and the patient has been returned to their original medication regimen. In this case, is that considered a new positive case? How should this be counted?

  • If you previously reported this individual as a "positive case changed," returning to the old medication regimen means that the client should be counted as a new case for the NYSOMH Monthly Indicator survey.

NYSOMH Monthly Data: Question 2 (Clinical Reviews)

What does the term ‘clinical review’ mean in relation to the NYSOMH CQI project?

  • For individuals with a quality flag, 'clinical review' means that the prescriber conducts a thorough review of the client's treatment history, taking into account all relevant information (including the PSYCKES clinical summary, input from the treatment team, and the consumer's preferences), to assess the risks and benefits of the current pharmacologic treatment plan, and determine whether the medication(s) can be changed to a less risky regimen. A clinical review does not mean a chart review to identify new cases or related case finding activities.

If we did a clinical review on a client with insurance other than Medicaid, should we include them in question 2?

  • Yes. All questions in the monthly data survey should reflect the actual activities of your QI team. If you are including clients who aren't on Medicaid in your project, please include them in the monthly data counts.

Would a regularly scheduled appointment with one of our prescribers constitute a clinical review - if the prescriber spoke with the consumer regarding their status in the project and options for treatment? Or is there a need for a separate meeting with the whole CQI team?

  • Yes, a regular appointment in which the prescriber discusses the quality concern, risks and benefits of medications, and treatment options with the consumer could count as a clinical review. The clinical review should incorporate as much information as possible, including the PSYCKES clinical summary, the chart, input from the therapist or other members of the treatment team, and the consumer.

If the prescriber conducts a chart review but has not shared the findings with the client, does this count as a clinical review or must we wait until the client is directly involved?

  • Clinical review refers to a review of the client's treatment and treatment preferences, discussion about the quality concern, and risks and benefits of treatment options with the consumer. Generally speaking, any reviews that do not involve a conversation with the consumer about the medications should not be counted as a clinical review.

If we conduct a second chart review on a client, do we count this as 1 or 2 chart reviews?

  • The monthly data submission on reviews (question 2) refers to clinical reviews of a client's medication(s) by the prescriber, conducted with the goal of determining whether or not the regimen can be changed. It is possible for one client to have more than one clinical review, and in fact clinic QI teams are encouraged to monitor and follow up on clients whose initial review did not result in a medication change with the goal of having the prescriber revisit the issue at a future date. The prescriber's second review would count as a clinical review for the month in which it took place. However, chart reviews done for case finding or tracking purposes do not count as clinical reviews.

NYSOMH Monthly Data Question 3 (Change in Positive Case Status)

If a client experiences a "change in status" and no longer qualifies to meet criteria for positive indicator status that is not due to a clinic intervention, should this client be counted as a “change” for 3a/b?

  • It depends on why the change in status occurred. If the prescriber and consumer agreed to change the client's medication, that can be counted as a change for the purpose of question 3. However, if the change in status is due to something other than a medication change (for example, discharge from the clinic, weight loss, etc.), that would not qualify as a change for question 3.

A consumer who met criteria for the indicator set no longer receives services at our clinic. How should we account for this?

  • Change in positive case status (question 3) is focused on those clients that have received a medication change from your prescribers or due to a clinic intervention (such as calling a community physician to discuss medication). Therefore, discharges do not qualify as a change in positive case status. Clinics can include this information in the Comment field of the monthly survey, but are not required to do so.

We have reduced some of the youth served at our clinic from 4 to 3 psychotropic medications. Can we count them as a change in status?

  • Our Scientific Advisory Committee determined that 3 or more psychotropic medications in children is considered polypharmacy. While reducing psychotropic medications in children from 4 to 3 does not qualify as a change in positive case status, it is certainly an important step and we thank you for your efforts. Clinics are welcome to report partial progress such as reductions in the numbers of medications in the Comment field of the monthly survey.

Can we report on medication changes in progress (i.e. tapers, dosage changes) that may eventually lead to a decrease in polypharmacy?

  • This is great progress toward reducing polypharmacy. Although this does not count as a change in positive case status, you are welcome to report such progress in the "Comments" section on the last page of the survey.

We have several clients who have either lost weight or lowered their cholesterol and are no longer medically considered obese or as having hyperlipidemia. Does this count as an intervention and a change in positive case status?

  • The goal of the cardiometabolic risk project is to reduce the number of consumers with serious and chronic health conditions who are on medications that have been shown to exacerbate those conditions. Clients qualify as a change in positive case status only if a change in medication to a lower-risk agent has occurred.

How should I count a consumer who previously met criteria for polypharmacy but has been temporarily been taken off their psychiatric medication for a medical reason and is awaiting medical clearance before they resume the psychiatric regimen?

  • If this is a temporary situation and there is no intent to reduce the use of psychotropic medication long-term, please do not count this as an intervention or change in medication status. Because of the temporary nature of the change, this would still be considered a positive case.

Comments or questions about the information on this page can be directed to the PSYCKES Team.