RD513 - Acute Psychiatric Bed Registry Workgroup Report – November 6, 2020

Executive Summary:

The purpose of this report is to provide a summary and recommendations from the Acute Psychiatric Bed Registry Workgroup (Chapter 235 of the 2020 Acts of Assembly, SB 739/HB 1453, to the Governor and the Chairmen of the Senate Committee on Education and Health, the House Committee on Health, Welfare and Institutions, and the Joint Subcommittee to Study Mental Health Services in the Commonwealth in the Twenty-First Century, based on the collective views of the behavioral health and developmental disability system stakeholders in addressing the Acute Psychiatric Bed Registry (the registry). The registry was initially created to assist Emergency Services Pre-screeners in finding an open bed for individuals who meet the criteria for civil commitment. It was intended to collect real-time data regarding availability of public and private inpatient psychiatric beds and Crisis Stabilization Unit (CSU) beds. Since changing vendors for the registry in 2018, some stakeholders have expressed concern that the registry is not user-friendly, which creates barriers to the level of participation necessary to get an accurate picture of bed availability across the Commonwealth. In addition, the current bed registry does not operate in real-time. Therefore, information on bed availability in the registry is not up-to-date and does not accurately portray available beds at any given time, preventing it from serving its primary purpose of identifying available beds.

The Department of Behavioral Health and Developmental Services (DBHDS) currently has the opportunity to restructure the registry as a part of the larger goal to develop the crisis continuum of care. DBHDS plans to issue a request for proposal (RFP) for a new registry vendor to meet the needs of the Department and stakeholder community. The workgroup was able to determine key features of the registry that are essential to informing the RFP process and to meeting the key goals of the registry.

The workgroup determined that the top barriers to utilization of the bed registry was the lack of a user-friendly platform and lack of accurate, up-to-date information. To address these issues, the workgroup determined the following recommended features and data points to be implemented by the registry.

• Interoperability with multiple electronic health records (EHR) or bed management systems – leveraging the best practice, HL7 messaging standard – with real-time or near real-time synchronization

• Fields that can be filtered by users such as clinical inclusion and exclusion criteria and other key bed characteristics including location, beds that are offline versus online, and occupied beds

• Ability to securely upload and store documents on patient profiles, including the emergency services pre-screening form, and send this information to an individual facility or group of facilities based on the filters outlined above

• High-quality user-experience design that allows users to quickly navigate the registry with minimal clicks and minimal manual updates

• Flexible user roles and permissions so that CSB pre-screeners, facility staff, and DBHDS staff are only able to access the functionalities they need

• Customized, aggregated, and identified reporting available in machine-readable format

• Analytics dashboard to real-time utilization and referral patterns at organization, regional, and state levels with appropriate user authorizations enabled

• Standardized digital screening, intake, and registration functionality to allow for CSB pre-screeners or case managers to minimize duplication if submitting requests to multiple programs

• Digital authentication to ensure only authorized users access the platform

• Secure digital referral capability to social support services and community treatment providers that include email and text capabilities

• Clinical decision support tool for providers and non-clinicians to support crisis call center staff in making the determination of the appropriate level of care

The workgroup also recommended specific data points that the bed registry should collect to allow for better information-sharing among emergency services pre-screeners and facility staff as well as system-wide analysis. Additionally, the workgroup recommended that specific protocols be developed for the use of the registry, including specific user roles and permissions and protocols for bed search process and the use of geographic filters. Finally, the workgroup recommended continuing to engage stakeholders in the RFP process and review as well as ongoing investment to maintain the bed registry.