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PSYCKES - Frequently Asked Questions

Updated August 2013

Contents

Overview: PSYCKES-Medicaid

Where does the data in PSYCKES come from?

  • Reports in PSYCKES-Medicaid are generated using New York State (NYS) Medicaid claims data provided by the NYS Department of Health (DOH) to the New York State Office of Mental Health (OMH). The data feed includes adjudicated claims and encounter data for all services paid for by Medicaid (both managed care and fee for service) 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. The comprehensive Medicaid treatment data contained in the client-level reports is updated monthly and includes important information that can be used in decisions about medications, care coordination, and risk assessment. Quality indicators are updated monthly and can be used to track performance at the state, region, county and provider level.  

What internet browser best supports PSYCKES performance?

  • For best results, please use Internet Explorer 9, 10, or 11, or latest versions of Mozilla Firefox, Safari, or Google Chrome to access PSYCKES-Medicaid. If you are experiencing any issues, please contact PSYCKES-Help with questions.

What PC requirements best support the PSYCKES Medicaid application?

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

    Operating System: Windows 7 or higher

    Memory: 2GB of RAM or Higher

    Browser: Internet Explorer 9, 10, or 11, or latest versions of Mozilla Firefox, Safari, or Google Chrome

    Minimum requirements to run operating systems below Windows 7:
    • 1 gigahertz (GHz) or faster 32-bit (x86) or 64-bit (x64) processor
    • 1 gigabyte (GB) RAM (32-bit) or 2 GB RAM (64-bit)
    • 16 GB available hard disk space (32-bit) or 20 GB (64-bit)

Data in PSYCKES

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

  • The PSYCKES-Medicaid application is based on data received from the Department of Health (DOH) that includes information about Medicaid enrollees with a behavioral health service or diagnosis, or who are on a psychotropic medication.  The information includes all adjudicated (paid) Medicaid fee for service claims and encounter data for Medicaid managed care, including mental health and non-mental health services across treatment settings.

    The application includes several sets of quality measures focused on utilization, care coordination, and medications. PSYCKES users are able to view aggregate quality data at the state, region, county, and provider level.  New quality indicators are added on a regular basis.

    The Clinical Summary provides an overview of medications and services provided across all treatment settings.  Data is available on diagnoses, outpatient services, and hospital and emergency room admissions.  Data is also available on pharmacy orders for both psychotropic and non-psychotropic medications, laboratory test orders, and dental and vision services.  Users can drill down to the level of individual order or service claim. 

    In accordance with relevant legislation and the Memorandum of Agreement between the Office of Mental Health and the Department of Health (DOH), PSYCKES allows users to access certain client-level information via the Clinical Summary if the client meets criteria for one or more quality measures.  Access to information about substance use, HIV/AIDS, family planning, and genetic disorders is available only with client consent.

What are the levels of access in PSYCKES?

  • The PSYCKES-Medicaid application is compliant with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.  Institutions request access to PSYCKES from the Office of Mental Health, and are then responsible for designating appropriate staff as PSYCKES users.

    Access to Medicaid data in PSYCKES requires an OMH issued user ID and a security token. Staff who use PSYCKES are designated by OMH as either provider level users or state level users; the designation determines the level of data the user can access. Please see the ‘Data and Quality Indicators in PSYCKES’ section of the User’s Guide PDF Document (6.34mb) for more information on these different levels.

    Providers request access to PSYCKES from OMH.  Once a provider organization has access, the designated Security Manager can enroll individual staff users.  Staff users will be able to view all aggregate data in PSYCKES, but will only be able to see client-level data for clients served at that agency who have quality flags or who have consented to release of their data.

We also serve clients in other programs not participating in a specific PSYCKES initiative – can we use PSYCKES to access their data as well?

  • Access to PSYCKES is at the agency level and agencies will be able to see certain information on all clients served. Agencies are responsible for ensuring that appropriate protocols are followed for anyone accessing information.

When are the PSYCKES-Medicaid reports updated?

  • Clinical information in the client-level reports is updated on a weekly basis.  PSYCKES-Medicaid quality indicator flags are calculated approximately every 6 weeks. PSYCKES-Help sends an e-mail to notify all users when new quality reports are available.

Which program types are available in PSYCKES?

  • Agency quality indicator reports include all behavioral health programs overseen by OMH and/or OASAS and billed for by the accessing agency (for example, Clinic, Continuing Day Treatment (CDT), Assertive Community Treatment (ACT), Personalized Recovery Oriented Services (PROS), 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.

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?

  • PSYCKES-Medicaid uses Medicaid claims data to link 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 National Provider Identifications number/locator code, or to bill all clinics through one code. These choices will affect how consumers are assigned to clinics within PSYCKES.

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

  • PSYCKES is populated using Medicaid claims data. When a provider submits a claim to Medicaid, they include an "attending physician." 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 Unduplicated Attending tab.

What do ‘N’ and ‘On Any’ mean?

  • ‘On Any’ refers to the eligible population for a specific indicator (i.e., the denominator) and ‘N’ refers to the number of individuals from the eligible population who are flagged as positive for that specific indicator (i.e., the numerator).

    For example, for the psychotropic polypharmacy in adults (four or more) (4PP(A)) indicator, ‘On Any’ refers to Medicaid enrollees 18 years and older who are prescribed any psychotropic medication for longer than 90 days, and ‘N’ refers to the number of enrollees (from the denominator) who are currently on four or more psychotropic medications for longer than 90 days as of the report date. For further details on how ‘N’ and ‘On Any’ are calculated for different indicators in PSYCKES, please refer to the Technical Specifications for each indicator in the Quality Concerns section of our website.

What does ‘None Identified’ mean when displayed in the prescriber field (such as in Unduplicated Attending)?

  • License number, profession code, and other agency information must be included to populate a prescriber name. When a clinic/place of service does not complete, or incorrectly completes, the ‘attending physician’ field on the Medicaid claim, the provider will be displayed as ‘None Identified’ 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 providers’ Medicaid claims data. 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.  

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 clinic’s address with Medicaid, you will need to change the address in at least two places: Medicaid FFS and Managed Care.

    Medicaid Fee For Service (FFS)/eMedNY: Please complete the Medicaid Fee for Service Provider Change of Address Form PDF DocumentLeaving OMH site.

    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 flagged individuals (to identify sites with larger numbers of positive cases) or to sort by percent (to review variation in performance across sites).

What is the User Role Survey?

  • After clicking ‘Agree,’ at first log-in the user will be asked to complete a short survey about his/her roles and responsibilities relevant to PSYCKES use.  This information will inform ongoing development efforts for the application and user activity reports.

PSYCKES Access and Information Survey

What is the Security Management System (SMS) and why is it important?

  • The Security Management System (SMS) is a web-based application that providers use to authorize staff members to access certain NYS Office of Mental Health (OMH) web applications, including PSYCKES.  The agency staff who create users and enable/revoke access are called Security Managers.  When an agency wants to add a PSYCKES user or edit access privileges, the designated Security Manager logs into the SMS website and edits the information displayed.  Security Managers also use SMS to connect users with tokens.  The SMS manual and website can be found at the following locations, respectively: (https://sms.omh.ny.gov/; /omhweb/sms/reference_manual.html).  Questions regarding use of SMS should be directed to OMH Help Desk or 518-474-5554.

Who can obtain access to PSYCKES?

  • Currently, access to PSYCKES-Medicaid is limited to providers participating in one or more initiatives sponsored by the Office of Mental Health.  These initiatives include quality improvement projects in free-standing mental health clinics and hospitals as well as learning collaboratives to support implementation in hospital Emergency Departments, Assertive Community Treatment teams, and Care Management teams.  If you would like to know whether your agency is eligible for participation, please contact PSYCKES-Help .

    We are currently exploring implementation of PSYCKES in other settings and welcome your comments and inquiries; please contact PSYCKES-Help.

How do we obtain access to PSYCKES?

  • All individual user access to PSYCKES is managed through the Office of Mental Health’s 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 Help Desk or call 1-800-HELP-NYS. For questions about PSYCKES access for a particular provider or agency, please contact PSYCKES-Help with your agency name and we can provide further information on steps to obtain access.

Should we give Case Managers or other staff members access to PSYCKES?

  • We do not require agencies follow a specific model when determining to whom they grant access, only that agencies develop policies and procedures around PSYCKES access and use for staff. Please note, however, that there is a wealth of additional details found in clients’ clinical summaries that cannot be printed from the PDF or Excel export. This information may be useful to direct service staff in engaging clients about their care, and we encourage agencies to give these staff access to PSYCKES.

Who should be designated as a PSYCKES Registrar?

  • Providers may select any member of their staff to be a Registrar(s). As a Registrar is able to enter client consents into PSYCKES, thereby providing all PSYCKES users at that agency/hospital access to client-level PHI data, it is important that the chosen individual understand the role’s high degree of responsibility. Other factors to take into consideration are an individual’s time constraints and regular access to a computer.

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

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

What resources are required to access PSYCKES?

  • Access to PSYCKES requires:

    • Agency registration in the on-line Security Management System (SMS)
    • An OMH-issued user ID
    • 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 their 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), she/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 new token (at no cost to the agency) and user ID.  OMH 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 in subsequent log-ins with the 6-digit token number.

Our Security Manager is unable to access the system and add users. What should we do?

  • Please contact the OMH Help Desk 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 (SMS).  Please note your ticket number (this allows the Help Desk to track your request).  If the Help Desk 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 solve this problem?

  • One reason may be that the Security Manager has attempted to activate a token more than once. Please call the OMH Help Desk 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 Help Desk 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 Help Desk 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 must use the OMH-issued user ID.

What should I do when an employee with a PSYCKES token leaves the agency?

  • If a PSYCKES user is leaving your agency, please have the Security Manager disable the user in the Security Management System (SMS) and return the token to the following address:

    NYS Office of Mental Health
    Information Security Unit
    CITER FLOOR # 2
    44 Holland Avenue
    Albany, NY 12229

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 (DUR) Board which is part of the NYS Department of Health and 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 for individuals who have 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 be authorized by the appropriate staff at your agency (your agency’s Security Manager). Your agency’s Security Manager will grant PSYCKES access using the web-based Security Management System.
    • 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, or who have granted consent for access to their data.
    • De-provisioning – Security Managers are able to revoke access to PSYCKES using the online Security Management System (SMS).
    • 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 what PHI was viewed in PSYCKES. 

Do we need to obtain consent from a consumer 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 and/or have data with special protections (for example, PHI associated with HIV, family planning, genetic information, and substance abuse). If your agency is interested in Consent Module access, please contact PSYCKES-Help for more information.

Can we use other consent forms (e.g. health home or RHIO consents) to consent clients in PSYCKES?

  • Discussions are underway with Counsel at the Department of Health and the Office of Mental Health regarding the applicability of other types of consents to release of PSYCKES data.   Since the PSYCKES consent forms were specifically designed to cover release of Medicaid data, and release of data with special protections such as substance use and HIV/AIDS, agencies should use the PSYCKES consent forms available within the Consent Module until these issues are resolved.

I entered a Medicaid ID in the Consent Module search field and no results were found. Why did this happen?

  • There are a couple of reasons why your search may not have yielded results, including:

    • The client’s Medicaid ID may be incorrect
    • The client may not meet criteria for inclusion   in the behavioral health population and therefore may not be included in the PSYCKES data feed from the Department of Health.

How long can I see a client’s data after entering the client’s consent form in the Consent Module?

  • For emergency access, client data is available for 72 hours after entering the consent into PSYCKES. Clinical data may be printed out during this time, but will not be accessible within PSYCKES after the 72-hour window has passed. Signed consent provides access to client-level data for 3 years after the last date of service at the agency.

What qualifies as an emergency?

  • NYS Public Law Section 4900.3 includes the following definition: ‘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.

Can I use the Emergency status in the Consent Module if the client refuses to give consent?

  • Refusal to grant consent does not in and of itself constitute an emergency.  Agencies should develop policies and procedures that specify what conditions should be considered emergencies, who is authorized to determine whether an emergency exists, and how the emergency should be documented in the client’s record.

Does participating in the Continuous Quality Improvement (CQI) project require a client consent form or IRB approval?

  • The PSYCKES-CQI Initiative is a quality improvement (QI) project designed to improve services provided by a participating agency, not a research study. The Department of Health (DOH) has authorized OMH to release Medicaid information to clinics in order to address 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.  We encourage providers participating in a PSYCKES QI initiative to inform consumers about the goals of the initiative. Let consumers know you will have access to additional information about their treatment history that will help clinicians work with them. 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. The brochures may be found on the PSYCKES website under each quality concern (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 logging into 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 Medication Reference Table PDF Document (386kb) 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?

  • 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 Medication Reference Table PDF Document (386kb) available on the PSYCKES website under Quality Concerns.

Why are side effect medications listed under Behavioral Health Medications? 

  • We classify medications such as Metoprolol Tartrate as side effect medications in the Behavioral Health section of the clinical summary because they are often used that way in our population, we have no way of knowing what the indication is for a given medication, and we want to be as inclusive for behavioral health medications as possible. Side-effect medications are not counted towards the polypharmacy indicator; we currently display all Behavioral Health medications in the Quality Flag evidence row so that users know all that are being prescribed.  

Education & Training

What resources are available to support us in Quality Improvement (QI) projects?

  • OMH has developed an array of technical assistance and training resources to support QI projects, including educational materials for prescribers and consumers, project tools, and web-based training on QI and clinical topics.

Can any member of the OMH Help Desk or PSYCKES-Help team assist us with PSYCKES navigation/technical questions, or should we ask for a specific person?

  • Any member of the OMH Help Desk or the PSYCKES-Help staff will be able to assist you or direct your inquiry to the correct person.

What training is available for prescribers?

Is there any information available for consumers about PSYCKES?

  • Yes. OMH has developed brochures to educate consumers and their families about the medication-focused quality concerns (polypharmacy, cardiometabolic risk, youth and dose). These are available on the PSYCKES website under the Quality Concerns tab (click on each indicator to find the brochure for that quality concern).  

Where can I locate the CQI project brochures on the PSYCKES website?

  • The OMH-developed brochures are available on the PSYCKES website – click on each indicator to find the brochure for that quality concern. They were created to educate consumers and their families about both the NYSOMH QI project overall and the medication-focused 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 a link that will be provided by PSYCKES-Help and/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 what the presenter is showing on your own computer screen.  Due to the number of participants, the telephone call is set up as broadcast-only, meaning that only the presenters will be heard. Participants are able to type and send in their 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 to Support Quality Improvement,” “Monthly Data Webinar,” and “Using PSYCKES for Clinicians.” 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 the 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 QI Projects: Overview

Do you recommend designing our CQI 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 Document (6.34mb), 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 CQI 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.  Please email PSYCKES-Help if you would like to set up an appointment.

If a consumer we are tracking as part of our CQI 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 includes a ‘New’ tab to make this process even easier.

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

  • We expect that every consumer who meets criteria for the selected indictor set will receive at least one clinical review to assess factors that are contributing to the quality concern.

    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 the treatment team 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 on the project's outcomes.

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.  You can set up an appointment by emailing PSYCKES-Help .

Who can we contact if we have additional questions?

  • If you have questions about the NYSOMH Continuous Quality Improvement (CQI) Initiative, PSYCKES implementation with Behavioral Health Inpatient Providers or Behavioral Health Organizations (BHOs), please contact Project Manager Terese Lawinski.

    For questions about the GNYHA/HAYNS-PSYCKES Quality Collaborative or ED/CPEP implementation, please contact Project Manager Kate Sherman.

    For questions about the MyPSYCKES Project, please contact Project Manager Rachael Steimnitz.

    If you have questions about the Security Management System (SMS), login issues, and token-related questions, please contact the OMH Help Desk or call 518-474-5554.

    If you have questions about other topics, including obtaining access to PSYCKES, getting technical assistance with the application, or needing support with implementation, please e-mail PSYCKES-Help.

Clinical Summary

Can I access the clinical summary for all my clients?

  • Providers have access to certain Medicaid data without client consent for those clients having a quality concern identified in PSYCKES and at least one billed service in the past nine months. Certain categories of protected health information (PHI), including data associated with HIV, family planning, genetic information and substance abuse, are legally subject to additional protection and will not be displayed in PSYCKES without client consent.  OMH has developed procedures and a Consent Module in PSYCKES that allows providers to obtain consent from clients for expanded access to their Medicaid data. Clinical data for clients currently not flagged for a quality concern and who have not consented will not be visible.

    Some users have been approved for state level access (e.g., some OMH employees, Behavioral Health Organization (BHO) staff and Local Government Unit (LGU) staff.  These users have access to all data for all clients in PSYCKES, including data that has special protections.

Why is my client showing up as still admitted to a hospital when they have been discharged from the inpatient unit?

  • Client level data is refreshed weekly, although billing practices can delay the appearance of discharges and other services changes. Depending on your agency’s billing practices, it may take from 1 – 3 months for data to appear in PSYCKES.

Why is my client showing up as discharged from a particular hospital when I know they are currently admitted?

  • Client level data is refreshed weekly, although billing practices can delay the appearance of new admissions and other services. Depending on your agency’s billing practices, it may take from 1 – 3 months for data to appear in PSYCKES.

Why is my client still flagged for polypharmacy (or cardiometabolic risk) when they are no longer taking a particular medication?

  • Quality indicator reports are calculated approximately every 5 weeks using data from the month prior to the report date (e.g., a report dated 1/01/13 includes data from December 2012). For this reason, flags may not reflect current medications or services.

When is a medication considered to have been ‘active’ in the past month?

  • If the last date of pick-up plus the days of supply falls within 35 days of the report date, this medication is considered to have been active in the past month. For instance, a particular medication that was picked up 60 days prior to today and had a 45-day supply would be considered active. This is because the supply for this medication would have run out only 15 days ago (which is within 35 days of today’s date). For information about specific indicators, please see the technical specifications of the indicators by clicking on the link to each one here.

The medication sections of the clinical summary only show trial summaries. How do I see individual medication pick-up dates?

  • Click on the ‘See Detail’ icon to bring up more data on trials and individual orders for a particular medication. Each entry shows a pick-up date associated with it.

Can I see lab results in PSYCKES?

  • PSYCKES data is based on Medicaid claims, which do not include results of labs and other procedures. 

What information from the clinical summary can I share with another person?

  • Information in the clinical summary is protected health information (PHI) and should be treated according to your agency’s policies and procedures regarding release of PHI.

Why are some prescriber names blank in the clinical summary?

  • PSYCKES data is based on Medicaid claims, some of which do not include the prescriber name. 

Agency Overview

What is the difference between the ‘Inpatient BH’ and ‘Hospital Psychiatric Unit’ filters?

  • The difference between the ‘Inpatient BH’ and ‘Hospital Psychiatric Unit’ filters has to do with whether a client's service(s) was billed as fee-for-service or as managed care claims. As a rule of thumb, filters with no parentheses in the filter name include both claim types while filters with parentheses are fee-for-service only. However, the ‘Hospital Psychiatric Unit’ filter is an exception to this rule.

    ‘Hospital Psychiatric Unit’ has no parentheses but it shows only clients for which inpatient psychiatric services were billed using fee-for-service only. ‘Inpatient BH’ shows clients who have been in the inpatient psychiatric unit whose services were billed through both fee-for-service and Encounter claims; for this reason, it is the most inclusive filter to use.

What is the difference between ‘MHClinic – Freestanding’ and ‘MH Clinic (CLINIC)?’

  • The difference between the two filters has to do with whether a client's service(s) was billed as fee-for-service or as managed care claims. As a rule of thumb, filters with no parentheses in the filter name include both claim types while filters with parentheses are fee-for-service only. For this reason, it is usually best to select ‘MHClinic – Free Standing,’ as it is the most inclusive.

PSYCKES Application Functions

I entered criteria in the Recipient Search function of the application and nothing happened. What could be going on?

  • If the search timed out, there may be too many results and your search should be narrowed. Try limiting the search with the various filters, if applicable. It is also possible to limit your search too narrowly. If you have selected multiple filters and are receiving no results, try removing search filters to broaden your search. If you searched for a specific individual, check to ensure name, SSN, or Medicaid ID are accurate and entered correctly.

I searched for a cohort of recipients and got a list of my clients. For some clients, though, the clinical summary is blank. Why is this?

  • If a client does not have a quality flag and has not consented to release of their PSYCKES data, you will not be able to access clinical data. Instead, you will receive this message when attempting to access a client’s clinical summary: “Access to clinical data on this individual is available only with the person's consent or in the case of a clinical emergency. This access is handled through the PSYCKES Consent Module, available to designated PSYCKES Registrars.”

How do I search for everyone at my program on an antipsychotic?

  • In Recipient Search you have the option to search on ‘Psychotropic Drug Class,’ which includes antipsychotics. If you are interested in a specific drug name, you may enter this in the ‘Drug Name’ field to generate a list of clients who have been prescribed this medication within the past year. Please note that to generate a list of only recipients with an active prescription to this drug, select the ‘Active Drug’ checkbox.

How do I see more recipient results from a search?

  • To see more results in Recipient Search, select a higher value in the ‘Maximum No. of Rows to be displayed’ dropdown menu.

Which data has special protections?

  • Substance use, family planning, HIV status, and genetic information are all considered data with special protections and require consent for access, even if the client is positive for a quality flag.

We suspect a client is doctor shopping for medications; can we use the emergency consent to ascertain this?

  • The Emergency Consent option in the Consent Module should only be used in situations that constitute an emergency, e.g. where the client requires immediate intervention to avoid serious harm to self or others. 

I am entering a client in the Consent Module in an emergency setting; what if the client does not have two forms of ID?

  • The person entering the consent into the Consent Module has the option to select ‘User Attests to Client Identity,’ in case you are reasonably certain of the client’s identity even in the absence of two forms of ID.

I try to log in, but I am seeing an Authentication Error. What should I do?

  • Please call the OMH Help Desk at 518-474-5554 and request a “PIN reset.”

Is it possible to get more details about a specific service provided to a client?

  • In the Clinical Summary, click on the ‘See Detail’ icon to bring up additional data on services and providers. This function will show dates of services received, medication pick-ups, attending physicians, and other details associated with the service.

What is the difference between a prescription “trial” and an “order”?

  • A trial is a continuous length of time the client has been picking up a specific medication. Orders are the individual pick-ups within the trial. Each trial allows for a possible 32 day gap between the last day with medication and the next pick-up date of the same agent (assuming less than perfect adherence and possible short inpatient stays). After this point, a new trial will be created with the next pick-up, even if it is the same medication.

CQI Phase III

Are the indicators we currently submit data for no longer going to be used in Phase III?

  • We encourage clinics to sustain best practices for psychotropic prescribing implemented during Phases I and II of the Initiative, and medication-quality measures will continue to be available in PSYCKES. However, the monthly report due in December (reporting on activities in November) is the last time clinics will report on medication projects selected in Phase I and II.  After December, clinics will no longer report on Phase I/II medication projects.  Monthly reporting in the next phase of the initiative will focus on key activities associated with the new projects.

To join Phase III, is there an option to stay with our current two indicator focuses, or are we required to choose one of the new projects?

  • Participating in the next phase of the CQI Initiative does entail selection of a new indicator: either Health Promotion and Coordination or Behavioral Health Care Coordination. Though it is not an OMH requirement to continue working on medication-related indicators, many clinics have embedded related practices into their routine clinical workflow to sustain gains made over the course of the project.

Applying the Project to Children

Will the new indicators for Phase III apply to all age groups, including children?

  • Phase III can be incorporated into an outpatient treatment facility for children.  In PSYCKES, you will see that each new indicator set includes a summary indicator identifying the number of unique individuals who meet criteria for any of the indicators.  If you review data for both new indicators it will give you an idea of the number of individuals who meet the criteria for those indicators and how many your staff would have to work with initially to reduce the rate of a chosen indicator.

Indicators and Project Activities

What information can you give regarding participating in the new project and what we will be required to report?

How many new indicators do we select?

  • Clinics participating in the next phase of the CQI Initiative will select a new indicator set (either 'Health Promotion and Coordination' or 'Behavioral Health Care Coordination').  Clinics will work on all seven of the indicators within the set that they have chosen, and monthly reporting will focus on key activities associated with the new indicators. 

    Project requirements for Phase III, including monthly reporting, were reviewed in the “OMH CQI Initiative for Health Promotion and Care Coordination – The Next Phase” webinar

How will the reporting change for Phase III of the clinic project? Will we still report on cases reviewed and changed?

What are the requirements for clinic staff to complete the 10 Center for Practice Innovations online training modules associated with the CQI Initiative for Health Promotion and Care Coordination?

  • In June 2013 OMH modified the requirements; the new requirements are as follows:

    December 31, 2013 is the deadline for completion of the 10 online CPI modules associated with your clinic’s selected CQI project. 

    Each clinic will choose at least 25% of direct care staff who work 20 or more hours per week to complete the 10 modules associated with their selected CQI project.  (Please note that all direct care staff working fewer than 20 hours per week, including psychiatrists, are welcome but not required to complete any of the modules.)  Completion requires passing the online quiz at the end of each module.  This will allow clinics to tailor training to staff needs and to take a flexible approach in disseminating the information more broadly.

    Although the number of staff required to complete the training has been reduced, each clinic is expected to develop strategies to share information with staff involved in the clinic’s CQI project.  On the interim report, OMH will ask clinics to briefly describe how they plan to disseminate the information learned from the modules to support the CQI project (e.g., turn-key or “train the trainer” approach, grand rounds, “lunch and learn” meetings, regular staff meetings, individual or group supervision with specific case examples).

What are the 10 online CPI training modules that must be completed for the CQI Initiative?

  • The list of required modules by CQI project is listed below.

    Health Promotion and Coordination PDF Document (111kb), Adults; CPI Modules:

    1. Integrating Medical, Psychiatric, and Addiction Treatment Services
    2. Wellness Self-Management
    3. Stage-wise Treatment
    4. Motivational Interviewing I
    5. Motivational Interviewing II
    6. Motivational Interviewing III
    7. Motivational Interviewing and Harm Reduction
    8. Practitioner Tools for Treating Tobacco Dependence
    9. Understanding the Use of Medications to Treat Tobacco Dependence
    10. Implementing Tobacco Dependence Treatment

    Health Promotion and Coordination PDF Document (111kb), Youth; CPI Modules:

    1. Co-Occurring Disorders in Adolescents
    2. Integrating Medical, Psychiatric, and Addiction Treatment Services
    3. Stage-wise Treatment
    4. Motivational Interviewing I
    5. Motivational Interviewing II
    6. Motivational Interviewing III
    7. Motivational Interviewing and Harm Reduction
    8. Practitioner Tools for Treating Tobacco Dependence
    9. Understanding the Use of Medications to Treat Tobacco Dependence
    10. Implementing Tobacco Dependence Treatment

    Behavioral Health Care Coordination PDF Document (110kb), Adults; CPI Modules:

    1. Engaging Consumers
    2. Stage-wise Treatment
    3. Early Stages of Change
    4. Motivational Interviewing I
    5. Motivational Interviewing II
    6. Motivational Interviewing III
    7. Motivational Interviewing and Harm Reduction
    8. Individual Interventions
    9. Generating the Collaborative Treatment Plan
    10. Persuasion Groups

    Behavioral Health Care Coordination PDF Document (110kb), Youth; CPI Modules:

    1. Co-Occurring Disorders in Adolescents
    2. Engaging Consumers
    3. Stage-wise Treatment
    4. Early Stages of Change
    5. Motivational Interviewing I
    6. Motivational Interviewing II
    7. Motivational Interviewing III
    8. Motivational Interviewing and Harm Reduction
    9. Individual Interventions
    10. Generating the Collaborative Treatment Plan

    In addition to the CQI modules related to a clinic’s project, direct care staff are welcome to view all available modules and participate in any of the supports offered by CPI.

How long does it take to complete a CPI module?

  • We estimate that a CPI module takes 30 minutes to complete.  The 30-minute estimate is based on median completion times which include the post-tests.  (We do know that a couple of modules are longer.)  For people who need longer than 30 minutes, the module is bookmarked so that they can come back to the page they left immediately (including the post-test) at their next training session. 

What happens if people do not pass a module quiz?

  • At the end of each module, people will be presented with 10 randomly selected questions related to the information in the module.  The person has to answer 8 out of 10 correctly for the module to be marked as completed.  People can re-take it as often as they need to without penalty.

Are you going to keep track of which staff members have taken/passed each module?

  • Yes, we will track who has registered for and completed each module within the learning community.

If our prescribers work in multiple agencies, will the modules count for one agency if the prescriber completed it at a different agency?

  • An individual has a single transcript and has to complete each module just one time. If a person is registered under a different agency/program, she/he should contact the CPI Help Desk to be sure that all of the agencies and programs are accounted for on the transcript.

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