Behavioral Health Facility Adoption of EHRs and Data Exchange

The Big Picture

On April 21, The Office of the National Coordinator for Health IT (ONC) released a detailing electronic health record (EHR) adoption and exchange capabilities among substance use disorder (SUD) and mental health treatment facilities (“facilities”). The annual Substance Abuse and Mental Health Services Association (SAMHSA) survey with more than 20,000 responses (>90% response rate) from treatment facilities found that:

• Approximately one-third of facilities use a combination of electronic and paper medical records, 68% of facilities had adopted an EHR and did not use paper for record keeping purposes;
• Only one-in-five facilities reported participating in a health information exchange (HIE) organization;
• Of those that did participate in an HIE, 44% reported electronically searching or querying for health information every day rather than sharing records with the HIE.

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act resulted in an estimated $36 billion in EHR adoption incentive payments issued to hospitals, practices and clinics, driving hospital adoption from about 10% to nearly 100% by 2024—but behavioral health facilities were left out. That exclusion has had lasting consequences, leaving substance use disorder and mental health treatment providers significantly behind other health care sectors in EHR adoption and data sharing.

The Details

The 2009 HITECH Act was designed to modernize the U.S. healthcare system by incentivizing the adoption of EHRs and improving HIE. While most eligible hospitals and clinics adopted EHRs and HIE with the support of the HITECH Act, behavioral health organizations were left out of HITECH’s funding and modernization mandates. This exclusion has had profound consequences in supporting behavioral health outcomes by perpetuating fragmented systems that frequently rely on manual processes and produce sub-optimal outcomes for individuals, especially those living with complex needs requiring care coordination across physical and behavioral health care settings.

The data brief released by ONC highlights advances that have been made by substance use disorder and facilities in adoption of EHR platforms and their capacity for data exchange.

Progress is being made on behavioral health facility adoption of EHRs. Overall, 68% of facilities reported having adopted an EHR. Those adoption rates varied significantly by facility ownership (see Figure 1). 97% of facilities operated by the federal government had the highest rates of full EHR adoption. Full adoption rates were lowest among facilities operated by state governments (38%). Full EHR adoption rates were similar among facilities operated by private for-profit organizations (68%), private non-profit organizations (68%), and tribal governments (65%). This wide gap in the full adoption of EHRs between state-operated facilities and all other private and public institutions is particularly notable, especially given that only 9% of state-government operated entities without an EHR plan to adopt one and facilities relying on combinations of EHR and paper charts were less likely to record referrals.  

While there has been substantial progress on EHR adoption, the report suggests that much work still needs to be done to enable behavioral health facility data exchange. Regardless of whether facilities have adopted an EHR or rely on a combination of paper charts and an EHR, facilities reported using their EHRs extensively for core patient care functions including recording patient information, treatment plans, progress notes, medication and problem lists, discharge plans and screening tools.

However, facility use of an EHR to exchange health information is relatively low (see Figure 2). Less then half of facilities with an EHR integrate any outside information into their EHRs, maintain a patient portal, or support secure messaging. Facilities that relied on both EHRs and paper records reported far lower rates of data sharing. Overall, only 19% of all facilities reported participating in an HIE. This suggests that many behavioral health facilities with EHRs or a combination of EHRs and paper may have systems in place that aren’t fully interoperable and may not easily support data exchange with patients and other institutions.

These findings are fairly consistent with findings from a that included a survey of California’s 58 county behavioral health agency use of EHRs and HIE. In that report, 50% of county behavioral health agencies reported exchanging data with few or no other care partners, even though 64% of county behavioral health agencies indicated being part of a health or community information exchange. 

While the ONC report did not publish statistics regarding barriers to EHR and HIE adoption amongst facilities, the CHCF report did. In that report, county behavioral health entities reported that a lack of standards and interoperability challenges (68%), insufficient financing (50%), lack of qualified staff to support technology adoption and use (57%), and unclear privacy laws and regulations (77%) were critical adoption barriers for them.

Federal Attention on Behavioral Health Data Exchange

ONC and SAMHSA recently announced nine nationwide pilot sites that include 45 exchange partners across nine state programs to test behavioral health IT standards through a larger Behavioral Health Information Technology (BHIT) Initiative. ONC is also supporting the Behavioral Health eCarePlan Collaborative Project to adapt and pilot open-source applications for three behavioral health use cases and pilots in outpatient specialty behavioral health clinics. They are also convening a public roundtable to examine how to use health information technology to improve mental health and substance use disorder outcomes for a report to Congress by the end of 2026. Initiatives such as BHIT have the potential to demonstrate how data exchange between behavioral health, primary care, public health and HIEs more generally can have a meaningful impact on quality of care and patient outcomes.

Collectively, data such as those published by ONC and CHCF continue to highlight the need for focus on bringing health information technology in specialty behavioral health systems into the 21 century. Federal and state efforts now underway are promising steps in that direction. Continuing to monitor, encourage, and incentivize full adoption of EHRs with data exchange capabilities in these settings will be critical to helping these institutions catch up with the physical health care sector.

Data are from the 2024 National Substance Use and Mental Health Services Survey (N-SUMHSS). The 2024 survey was conducted from March 29, 2024, through December 9, 2024. 23,948 facilities were deemed eligible to participate in the survey and 21,205 unique facilities completed the survey (90.4% response rate).

The report indicated that adoption of an electronic health record (EHR) means that no paper charts were used by the facility to maintain patient records.

These facilities are predominantly operated by U.S Department of Veterans Affairs.

ASTP/ONC Announces Selection of Nationwide Pilot Programs to Improve Behavioral Health Data Exchange [press release]. 2026.

Chickasaw Federal Health. Pilot Program for Behavioral Health Data Exchange Partners Behavioral Health Information Technology (BHIT) Pilot Program [Available from: .

Office of the National Coordinator for Health IT (ONC). 2024 LEAP in Health IT Projects 2026 [Available from: .

SUPPORT for Patients and Communities Reauthorization Act of 2025, 119th Congress (2025-2026)(2025).