In 2022, community-based mental health agencies provided behavioral health/substance use treatment to 6.9 million adults and children in the United States. Community mental health agencies are considered safety net organizations as they provide mental health and substance use treatment to a large portion of Medicaid and uninsured populations. Despite some federal agencies moving towards pilot projects that incentivize adoption of electronic health record (EHR) systems, many community mental health centers are falling behind in the implementation of EHRs and information technology (IT) systems. 99 percent of non-behavioral health clinics have adopted EHR systems and while most behavioral health facilities have a EHR system, consistent use of the system varies. A recent report by the Department of Health and Human Services highlighted EHRs as critical to ensuring the delivery of quality care through tracking behavioral health outcomes, coordinating care, and integrating communication between health systems. Research has noted several barriers to large scale utilization of EHR in community mental health care, including concerns around revealing sensitive patient information, costs, lack of training, and a lack of standardized guidelines for cross-health system implementation.
With EHRs driving data collection, analysis, and sharing, community mental health agencies would benefit from federal and state policy support to creating a stronger IT infrastructure through the following paths:
Setting standardized guidelines on reporting sensitive patient information
Many providers express concern over sharing patient information when the information could potentially be stigmatizing. These worries are especially prevalent in community mental health care where the primary patient population usually has a severe mental illness/substance use diagnosis. Additionally, prior to 2020, there was an additional layer of protection for substance use where patients where consent was needed in order to report their diagnosis in a EHR system. With this being a more recent ruling, some clinicians may not have transitioned to the newer approach that has more flexibility around reporting substance use. To ensure that clinicians are comfortable including important information that guides a patient’s care, regulations can provide clearer guidelines about how much information should be shared in care coordination, how often this information is shared, and notifying the patient when their information is being shared.
Provide sustainable funding of EHR implementation and training
Building out and maintaining health IT systems is costly – a cost many community mental health agencies cannot afford. The original call for widespread health IT implementation came from the Health Information Technology for Economic and Clinical Health Act (HITECH Act) which provided federal incentives for adopting EHRs. Behavioral health was excluded from the original program. Additionally, community mental health agencies struggle with sustainable funding and are more likely to receive funding for providing patient care opposed to the implementation of administrative changes. The Behavioral Health Information Technology Initiative started a federal program for funding EHR adoption for community mental health care (among other behavioral health facilities) that take place over the next three years. To continue this progress, continuing to sustainably fund these systems can be done through state and federal incentives. For example, the Medicaid and CHIP Payment and Access Commission (MACPAC) suggested combining federal funding streams (e.g., Medicaid and SAMHSA block grants) or leveraging directed payments through managed care organizations as potential federal and state approaches to support IT implementation. Additionally, due to the high turnover rate in community mental health care, there would be a steady influx of new staff needing to be trained on using the EHR. Development of online modules or consistent trainers for EHR use would ensure a continuation in staff feeling comfortable in using this technology.
Supporting the move to integrated care
The move towards treating the whole person has generated an interest in integrating care. However, there are both infrastructure and cultural related barriers to effective communication between different types of health professionals. Currently, only 19 percent of health centers exchange patient information with community-based organizations. The process of referral and information exchange between mental health and physical health clinics is disjointed even with research indicating that creating an information system to facilitate communication improves coordination of care for patients. Federal policymakers have started to bridge this gap with the passing of the Cures Act which requires that mental health providers share patient data in a timely manner. Policymakers can go a step further to create a set of guidelines on the exact processes for data collection, information sharing and documentation for behavioral and physical health clinics.
There is room to improve the delivery of care in community mental health agencies through embracing technology as a tool to deliver this care. The current route to adoption of health IT is complex, costly, and not widely incentivized for community mental health care. However, the benefits outweigh the cons by encouraging more collaborative care, tracking patient outcomes, and streamlining processes to create an efficient system of care.
The opinions expressed in this blog post are the author's own and do not necessarily reflect the view of AcademyHealth or of their respective affiliated employers/organizations.