SAMHSA and ONC Launch the Behavioral Health Information Technology Initiative

Micky Tripathi and Miriam E. Delphin-Rittmon | February 5, 2024

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the National Coordinator for Health Information Technology (ONC) will work together to invest more than $20 million of SAMHSA funds over the next three years in an initiative to advance health information technology (IT) in behavioral health care and practice settings. The project supports the HHS Roadmap for Behavioral Health Integration and is consistent with the President’s call to action to prevent, treat, and provide long-term recovery supports for mental illness and substance use disorders.

Health IT adoption among behavioral health providers currently lags behind other providers. This is due in part to their ineligibility to participate in health IT incentive programs, such as those under the Centers for Medicare & Medicaid Services. ONC analysis of American Hospital Association survey data from 2019 and 2021 found that 86% of non-federal, general acute care hospitals had adopted a 2015 Edition certified EHR; in contrast, only 67% of psychiatric hospitals had adopted a 2015 Edition certified EHR. Furthermore, ONC analysis of SAMHSA survey data from 2020 shows that psychiatric hospitals lag even further behind in adoption of interoperability and patient engagement functions.

Lack of access to health IT and associated higher-level capabilities and efficiencies (e.g., patient access, notifications, clinical decision support, care planning, data exchange, analytics, and reporting) impact behavioral health providers’ ability to provide access to treatment through tools such as telehealth. It also limits integration of behavioral health data with primary care and other physical health entities, posing a major barrier to the interoperable exchange of behavioral health data across the care continuum.

To address these challenges, the Behavioral Health Information Technology (BHIT) Initiative will identify and pilot a set of behavioral health-specific data elements with SAMHSA’s Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG) and Community Mental Health Services Block Grant (MHBG) grantees.  The data elements will be coordinated via a new USCDI+ domain for behavioral health to improve the effectiveness and reduce the costs of data capture, use, and exchange for behavioral health providers.

How the BHIT Initiative will Advance Health IT

USCDI+ for Behavioral Health

Behavioral health providers have a separate set of challenges compared to those providers practicing in other clinical settings. Documentation of behavioral health encounters is generally in the form of detailed narrative, often supplemented or accompanied by additional quantitative or other discrete information (such as symptom scale scores or indices). This can lead to difficulties in efficiently sharing behavioral health information with primary care providers and hospitals to support continuity of care. The content standards developed as part of this USCDI+ project will support capturing key behavioral health data at the point of care (e.g., depression screening) to enhance care continuity between behavioral health providers and other clinical providers caring for the same patient. This will alleviate the reporting burden experienced by SAMHSA’s grantees by improving the ability of mental health and substance use treatment providers to measure, evaluate, and report on the care they provide.

In 2024, ONC, SAMHSA, and other federal partners will begin to identify data elements for the USCDI+ project as part of the broader BHIT Initiative. This collaborative approach will incorporate input on behavioral health priorities from a variety of individuals and entities including clinicians, grantees, states, and advocates. SAMHSA and ONC will coordinate with technology developers and participating providers on how to best include USCDI+ behavioral health data elements in health IT and pilot their use.

A Resource for BHIT

ONC will develop a behavioral health information resource to support behavioral health care and integrated practice settings for HHS grantees and the public, similar to past ONC resources focused on pediatric health IT and Neonatal Abstinence Syndrome. The informational resource will support those who wish to use USCDI+ behavioral health data elements by providing specific details helpful for implementation. For example, it may include information on the use of health IT to address clinical priorities, support for improved workflows, and technical information regarding integration across behavioral health settings.

Technical Assistance

ONC will provide technical assistance to pilot participants from the SUPTRS BG and MHGB programs to inform implementation of health IT in support of improved capacity at the state and local level for substance use and mental health treatment as well as recovery support services. This may include, for example, deployment of educational resources on adoption of health IT capabilities and technical resources on BHIT data encoding and data quality.

Looking Forward – What Comes Next

The BHIT Initiative will advance health IT in behavioral health broadly across HHS programs, and beyond. We need your input, so please take time to comment on the USCDI+ Behavior Health data set. Moving forward, you can expect to see more updates and opportunities to engage and help inform this work. Sign up for email updates to get the latest on ONC’s activities.