EHRs have been adopted by nearly all hospitals and physician practices thanks to incentives baked into the 2009 Health Information Technology for Economic and Clinical Health Act, or HITECH. However, the HITECH Act excluded substance use and mental health treatment facilities from receiving these incentive payments, leading to ongoing interoperability gaps.
A new data brief from the Office of the National Coordinator for Health IT (ONC) sheds light on EHR adoption rates at substance use and mental health treatment facilities, providing insights into how these facilities are using EHR systems and where gaps remain.
ONC pulled data from the 2024 National Substance Use and Mental Health Services Survey (N-SUMHSS), administered by the Substance Abuse and Mental Health Services Administration, to inform its data brief.
EHR adoption rates, use cases
More than two-thirds of substance use and mental health treatment facilities only use an EHR system, rather than paper charts, to maintain patient records, the data revealed. However, adoption rates varied by ownership. EHR adoption was high among federal government facilities (97%) and local government facilities (73%), but lower among state government facilities (38%).
What's more, one in four facilities reported using a combination of an EHR system and paper charts to maintain patient records. This statistic also varied by ownership type -- state government facilities reported the highest rates, at 51%, while private for-profit organizations (22%) and federal government facilities (3%) reported the lowest rates.
Approximately 4% of facilities reported that they had no plans to implement an EHR system.
The N-SUMHSS data also showed that, regardless of whether a facility used only an EHR or a combination of an EHR and paper records, facilities reported using EHRs for the same core tasks -- recording patient information and monitoring patient progress.
"Among facilities who used a combination of EHR and paper charts, 84% reported using an EHR to record referrals, nine percentage points less than facilities who reported only using an EHR," ONC noted.
Behavioral health data exchange remains limited
Facilities that exclusively used an EHR system reported higher rates of using it for care coordination, patient engagement and exchanging health information compared to those that used a combination of an EHR system and paper records, the data revealed.
For example, 48% of facilities that used only an EHR reported integrating external information electronically, compared with 36% of facilities that used both an EHR and paper charts. Facilities that used only an EHR had higher rates of using their systems for tasks such as sending prescriptions, reconciling medications, viewing lab results, ordering tests and secure messaging, compared to those that used a combination of EHR and paper records.
Just 19% of all facilities reported participating in a Health Information Exchange (HIE). The majority of facilities (67%) said they were not familiar with HIEs or were unaware of HIE availability in their service area.
Participation in an HIE has been linked to increased public health reporting and greater clinical information exchange, thereby promoting interoperability.
According to the ONC data brief, among facilities participating in an HIE, 44% reported daily electronic searches for health information, compared with 25% of facilities that did not participate in an HIE. Half of the facilities that did not participate in a HIE said they never search or query for patient health information or do not have the capability to do so.
"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," ONC stated.
"Factors such as technical barriers, workforce, cost, and privacy concerns may contribute to lower electronic exchange of health information."
Exploring efforts to improve behavioral health data exchange
ONC suggested that greater access to HIEs could improve interoperability at substance use and mental health treatment facilities.
At the state level, efforts are underway to address interoperability gaps. For example, Washington state's Health Care Management and Coordination System is currently in its early stages, with plans to improve data sharing across state agencies and various care settings.
By the end of 2026, findings from the pilot programs, which will test the USCDI+ Behavioral Health dataset and the Fast Healthcare Interoperability Resources (FHIR) Behavioral Health Profiles Implementation Guide in real-world behavioral health settings, could provide key data to inform future standards and policy considerations.
"Continued efforts to address behavioral health data exchange challenges are critical to improve the continuity of care and improve health outcomes," ONC stated in the data brief.
Jill Hughes has covered health tech news since 2021.
