NUBE 2024

Background: PSYCKES (Psychiatric Services and Clinical Knowledge Enhancement System) is a web-based, HIPAA-compliant platform developed and managed by the NYS Office of Mental Health that integrates statewide information on the patient’s mental health and general medical history including ER and inpatient services, medications, outpatient providers and service utilization, and high-risk alerts related to suicidality/self-harm and opioid overdoses. In 2018, the NYS Department of Health (DOH) and the Office of Mental Health (OMH) recommended emergency departments (EDs) use PSYCKES, and launched the Behavioral Health High Risk Quality Collaborative (HRQC) in 2019 which supported implementation of PSYCKES in as a tool to help identify and evaluate individuals with high behavioral health risks, including history of suicide attempts, overdose risk, and high utilization of emergency and inpatient mental health services. We examine the impact of HRQC learning collaborative participation on PSYCKES access and usage by ED staff, as well as lessons learned from implementing this health information tool in emergency departments.

Methods: The PSYCKES application was made available to all EDs in NYS in July 2018, and EDs were invited to enroll in the HRQC to support implementation. The HRQC was launched in January 2019, and participating EDs submitted action plans and participated in individual technical assistance calls to assess progress and troubleshoot implementation challenges. Notes taken during the calls identified implementation barriers and action steps to be taken by the ED project teams to address those barriers. We compared HRQC participating and non-participating EDs on PSYCKES use at baseline (year prior to launch) and monthly over the five years after the launch. Measures included the number of PSYCKES users per month by hospital/participation status (data source: PSYCKES usage logs), and the proportion of Medicaid patients receiving a behavioral health related ED service that had their PSYCKES clinical summary viewed (data source: Medicaid claims and encounter data, and PSYCKES usage logs). Additional information on PSYCKES use in the ED was obtained through a post-project survey administered in Spring 2024.

Results: The number of PSYCKES users, and the proportion of behavioral health presentation who had their clinical summary viewed in PSYCKES increased over time. We share the characteristics of hospitals with increased PSYCKES use including participation status, and ED type. Over half (52%) of HRQC-participating EDs reported implementing PSYCKES for all psychiatric presentations, and a third (32%) reported using for a subset of based on patient factors, with some EDs reporting variation in use by staff preference and ED shift. The PSYCKES clinical summary information EDs reported using most frequently was level of ER/inpatient utilization, identifying care coordination and outpatient providers, medication reconciliation, and risk information.

Lessons Learned: ED implementation experiences highlight the need for multi-department buy-in on the value of integrating behavioral health information into general ED processes, the challenge of incorporating external technology into ED workflows, and approaches for identifying and training staff during a time of significant bandwidth constraints and turnover. Despite challenges, the majority of EDs were able to successfully implement PSYCKES to support screening, assessment and discharge planning.

Learning Objectives:

Summarize the benefits of using a statewide mental health information sharing program in the emergency room.

Describe the strategies and challenges in implementing behavioral health information technology in general emergency services.

Explain the impact of the NYS High Risk Quality Collaborative on uptake of the PSYCKES application, a statewide mental health information sharing platform.