Photo: Yuri Arcurs peopleimages.com/Getty Images
Despite the historical exclusion of behavioral health from federal IT incentives, new initiatives are utilizing artificial intelligence and standardized data exchange to bridge interoperability gaps, reduce provider burnout, and foster clinical collaboration across federal and private healthcare systems.
Leaders in healthcare, technology and policy shared their insights on these subjects at a day-long event convened by the Office of the National Coordinator for Health Information Technology last week in the session "Innovation in the Field: A Progress Report on Behavioral Health Transformation," moderated by Dr. Jason Funderburk, ONC's deputy national coordinator.
The 10 experts from the Department of Veterans Affairs, Indian Health Service, Oracle Health and other organizations on the frontlines of health information exchange and behavioral healthcare delivery discussed where they see health IT helping to address addiction, improve care coordination and strengthen mental healthcare – and which challenges still need to be addressed.
Mental health interoperability impediments
Behavioral health IT development has lagged behind that of medical providers, who were incentivized to digitize health records through federally funded meaningful use incentives under the 2009 Health Information Technology for Economic and Clinical Health Act, or HITECH.
That decision has splintered interoperability between medical and behavioral health providers that together deliver whole-person patient care, and the deep cracks are obvious.
"Particularly for state-funded programs, there's a lag in terms of using IT for care coordination, which, as we know, is really critical," said Kirsten Beronio, senior advisor at the National Association of State Mental Health Program Directors.
To improve clinical care, quality of care and patient outcomes, the Department of Health and Human Services is looking at how and where to solve behavioral health data exchange challenges.
"Interoperability of itself – it's just the means, right? It's not the ends. What value do we bring? How do we improve outcomes? How do we improve people's lives?" Funderbunk said.
A recent ONC analysis of 2024 Substance Abuse and Mental Health Services Administration survey data showed that EHR adoption was significantly higher among federal government mental health treatment facilities (97%) and local, county and community government facilities (73%) when compared to their private for-profit organization counterparts (68%).
Notably, state government facility adoption of EHRs was significantly lower – 38% – than adoption by the private facilities, according to ONC.
"People don't just come with one single diagnosis; they generally and often have comorbid conditions," Beronio noted. "And the interaction between those conditions, we know from research, really affects outcomes and cost of care."
A $20 million federal Behavioral Health IT Initiative, launched by ONC and SAMHSA, aims to repair the cracks and make mental health records interoperable by the end of the year using FHIR data exchange standards.
The BHIT initiative is testing the USCDI+ BH dataset, a health IT standard designed specifically for behavioral health, through nine nationwide pilot programs.
Dr. Susy Postal, chief health informatics officer at the IHS, cited the need for interoperability technology to serve diverse populations at her organization, which has 2.6 million patients across 575 tribes, and others.
"How can we make it more efficient for the provider?" she asked. "How can we use interoperability, health information exchange and more for our patients, recognizing traditional health and also recognizing the special, unique cultural sensitivities of our population?"
AI to reduce burdens and enhance care
Like their counterparts at medical practices, behavioral health clinicians are also using ambient AI scribes to record therapy sessions and generate clinical notes.
Studies over the last two years have shown how ambient AI can reduce documentation time by up to 30 minutes per day, significantly lowering burnout rates, according to Steve Herron, senior director of continuum solutions at Oracle Health.
Overall, AI has been a paradigm shift, helping to address a downside of digitizing medical records across physical healthcare.
While meaningful use incentives under the HITECH Act have accomplished digitizing medical records so they can be more easily accessed and shared, they have changed the work of clinical professionals and turned care teams physically away from patients and toward computers at the point of care.
"We did take a lot of doctors and nurses and, in some cases, turned them into data entry specialists," said Herron.
He added that by summarizing years of fragmented patient records into a "cheat sheet" for the provider before they enter a patient exam room, AI is now helping to return clinicians' focus toward patients at the point of care.
Ashley Newton, CEO at the Institute for Clinical Excellence and Innovation at Centerstone, the nation's largest behavioral health community organization, noted that data analysis is still needed "to understand what kinds of interventions work and for whom."
Based on her work helping Centerstone's clinical staff be "comfortably competent" in using evidence-based practices and new digital tools, she said interoperability should be about more than just solving the technical requirements of exchange.
There are other hurdles in mapping clinical data to behavioral health treatment, despite the excitement of clinical decision support tools, she said.
In real-world practice, "there are also quite a few constraints and barriers that we run into," Newton said.
Interoperability only the first step
Funderbunk asked Quinn Bastian, psychologist and the VA national mental health director for informatics, how the department leverages internal and external EHR data to improve mental health and substance use care coordination for veterans.
Bastian, who works within the Veterans Health Administration's Office of Mental Health, noted that the VA is transitioning from a fragmented legacy system to a unified federal EHR.
The VA EHR Modernization project is unifying 155 disparate legacy instances to a single, commercial Oracle EHR system.
The aim is to eliminate internal data silos, which will create more opportunities for national collaboration, he said.
"We will have all VAs converted to the federal EHR within a couple of years," said Bastian. "That inherently brings with it some new connections with the community that we never had before."
However, interoperability is only the first step toward improving veterans' health outcomes, he said.
Interoperability must evolve beyond superficial data sharing for administrative tasks at the agency to foster deeper clinical integration among VA and community providers.
"This can help us actually collaborate as a community in developing a shared joint treatment plan, so we're actually all working from a single community treatment plan, as opposed to a different treatment plan at each agency," said Bastian.
When viewed through this lens, the ultimate purpose of data exchange lies in its ability to improve patient quality of life.
"How does that actually lead to different mental health and substance use disorder outcomes? ... [It's about] whether quality of life, life activities are getting better. Whether from the perspective of the patient, there's improvement and recovery actually happening," Bastian said.
The VA is working with AI because the algorithms scan EHR data for patterns – like missed appointments, specific phrasing in notes and medication changes – for mental health crisis prevention.
Under the REACH VET initiative, VHA is using predictive analytics in clinical decision support to identify veterans who are at very high risk, statistically, of suicide, he said.
"We can then outreach those veterans, and make sure that they're engaged in care."
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
