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The Office of the National Coordinator for Health Information Technology, using Substance Abuse and Mental Health Services Administration data, recently examined the use of health IT in behavioral health settings.
The results showed that the use of electronic health records for various clinical and administrative tasks varied widely among facilities, despite the growing demand for substance use and mental health treatment services.
Further, the use of EHRs for exchanging health data also lagged.
"Results can help inform efforts to advance the adoption and use of health IT in behavioral health settings," said ONC researchers about the analysis. "Continued efforts to address behavioral health data exchange challenges are critical to improve the continuity of care and improve health outcomes."
WHY IT MATTERS
To improve clinical care, quality of care and patient outcomes, the Department of Health and Human Services seeks to advance the adoption and use of EHRs and improve health data interoperability.
To better understand the use of EHRs for clinical care and interoperability in behavioral health, ONC analyzed SAMHSA's 2024 National Substance Use and Mental Health Services Survey data for EHR adoption and exchange capabilities among substance use and mental health treatment facilities in the United States.
At the time, more than two-thirds of these facilities only used EHRs – no paper charts, ONC said in the new brief. However, adoption varied by ownership type.
The N-SUMHSS data showed that EHR adoption was significantly higher among federal government facilities (97%) and local, county and community government facilities (73%) when compared to private for-profit organizations (68%).
State government facility adoption, however, was significantly lower (38%) than adoption by the private facilities, according to ONC.
It's a significant gap that's "possibly due to cost, data fragmentation and workforce challenges," the agency said.
Overall, one in four facilities reported using a combination of an EHR system and paper charts to maintain patient records.
Combined patient charting rates were highest among state government facilities (51%), while the lowest rates were reported among private for-profit organizations (22%) and federal government facilities (3%).
Among facilities that use both EHRs and paper charts, nearly all surveyed said they use their EHRs to record patient demographic information (98%), diagnoses (98%), clinical notes (97%), patient histories (97%), discharge plans (95%) and treatment plans (94%), as well as for other clinical workflows.
While 84% said they rely on their digital records systems to record and process referrals, that's about 9% less than facilities that exclusively use EHRs for charting.
Notably, for national patient information interoperability goals, the percentage of substance use and mental health treatment facilities using EHRs (exclusively or in combination with paper charting) drops considerably with health information exchange, care coordination and patient engagement.
For 10 of these metrics, less than half of all facilities SAMHSA surveyed in 2024 said they use EHRs for patient messaging or patient access to medical records less than half of the time – 45% and 44%, respectively. For those facilities still using paper charts in some capacity, just 33% said they use their EHRs for these patient engagement workflows.
More facilities are using their EHRs for health information exchange, with one in five facilities participating in HIE.
"Six in ten facilities that participated in an HIE reported searching for patient health information daily or weekly, while fewer than four in ten non-HIE facility participants did the same," ONC said.
Integrating with health information networks seems to advance interoperability with other providers who also care for their patients.
"Participation was associated with substantially higher frequencies of searching and querying for patients’ health information compared to non-participants," ONC said in the brief.
Some facilities do use their EHRs for care coordination tasks, with 87% reviewing warnings or alerts (72% of those on combination charting) and 84% reconciling medications (69% of those on combination charting).
"The data suggest that there may be both gaps in the capabilities of implemented EHRs to perform certain tasks and gaps in how some facilities implemented and used their EHR, perhaps using computer-based tools outside their EHR workflow, other non-EHR methods or paper-based practices for some tasks versus others," ONC said.
THE LARGER TREND
ONC noted that studies attribute a lack of financial incentives for behavioral health clinicians, privacy concerns, workforce shortages, provider burnout and a lack of available resources to maintain IT infrastructure as key barriers to EHR adoption.
The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act did not include substance use and mental health treatment facilities for incentive payments for EHR adoption – a big reason they continue, more than 15 years later, to lag hospitals and ambulatory practices.
HHS and SAMHSA announced nine behavioral health data exchange pilot programs to test health IT standards and identify effective practices and opportunities under the Behavioral Health Information Technology Initiative earlier this year.
BHIT involves 45 exchange partners. The nine pilots will test the interoperability of behavioral health-specific data elements to strengthen care coordination and social referral workflows, streamline federal reporting and more.
ONC noted that under the Support Act Reauthorization, it is convening a public roundtable to examine how to use health information technology to improve mental health and substance use care outcomes, and a report to Congress is due by the end of the year.
ON THE RECORD
"Our findings demonstrate that while most behavioral health facilities use an EHR system and there is near universal adoption of using an EHR to record patient information among EHR users, potential interoperability and technology challenges may limit behavioral health data exchange," said ONC officials in the brief.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
