By Demri Henderson, Manager, Grants and Programs, Civitas
Behavioral health providers have long faced barriers to participating in electronic health information exchange. Unique privacy requirements, inconsistent data standards, and limited technical infrastructure are just a few reasons behavioral health has often remained disconnected from broader health care interoperability efforts.
During the July Civitas Networks for Health® (Civitas) State Health Technology Commons meeting, participants heard firsthand updates from two states participating in the federal Behavioral Health Information Technology (BHIT) Pilot Program. Funded through the Substance Abuse and Mental Health Services Administration’s (SAMHSA) BHIT Initiative in partnership with the Office of the National Coordinator for Health IT (ONC), the BHIT initiative is testing how standardized behavioral health data can be exchanged across diverse care settings to improve care coordination, quality reporting, and patient outcomes. The BHIT pilots are also helping inform future national guidance for behavioral health interoperability. While each pilot is unique, several common themes emerged that offer valuable lessons for states, HIEs, providers, and policymakers working to advance behavioral health data exchange.
Beyond Data Exchange: Improving Care Coordination
The BHIT pilots are not simply testing whether data can move between systems. They are also evaluating whether standardized behavioral health data can meaningfully improve patient care.
In the nation’s capital, the District of Columbia Department of Health Care Finance (DHCF) BHIT pilot is integrating clinical data with existing claims-based quality measures to improve reporting for substance use disorder care. Today, these measures rely almost entirely on claims data, creating delays and limiting clinical context. By incorporating standardized clinical data from electronic health records, the pilot aims to provide more timely and complete information while supporting provider-facing dashboards that identify care gaps and opportunities for intervention.
Rhode Island’s Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) is tackling a different challenge. Certified Community Behavioral Health Clinics (CCBHCs) currently report on quality measures through multiple disconnected processes, including manual spreadsheet submissions. The Rhode Island BHDDH BHIT pilot seeks to replace this fragmented approach with a single clinical and claims-based reporting workflow, reducing administrative burden while improving data quality and consistency.
Technology Is Only Part of the Challenge
Many behavioral health providers have little or no prior experience participating in health information exchange. Even when electronic health record systems support standardized data exchange, organizations often discover that workflows and documentation practices prevent important information from appearing in Continuity of Care Documents (CCDs). Data elements may exist within an EHR but never reach the HIE because they are documented in fields that are not configured for exchange.
As a result, provider education and workflow redesign become foundational activities and not optional implementation tasks. The State Health Technology Commons discussion highlighted the importance of technical assistance teams that understand both behavioral health clinical workflows and health IT. Notably, the District of Columbia’s DHCF BHIT pilot partners have found success by combining clinical expertise with EHR configuration support, helping providers build confidence while addressing technical issues.
Privacy Remains a Critical Consideration
Behavioral health interoperability must also navigate complex federal privacy requirements, particularly those related to 42 CFR Part 2 governing substance use disorder treatment records. Participants discussed the challenges providers face distinguishing between records protected under Part 2 and those that may be shared under HIPAA. Many organizations historically apply overly restrictive practices because separating these records has been technically difficult.
Rhode Island’s BHDDH BHIT pilot offers one promising approach. Working with CRISP Shared Services, participating organizations use automated logic to identify records containing predetermined substance use disorder treatment codes. Protected records are separated into a Part 2-compliant repository while other behavioral health information continues to flow through standard HIE operations. Liv Keaton, State HIT Coordinator for Rhode Island, noted early implementation results have been encouraging.
Building Provider Engagement
Technology projects often focus on software and infrastructure, but the discussion reinforced that provider engagement is equally important. Both the District of Columbia’s DHCF and Rhode Island’s BHDDH BHIT pilots have found that behavioral health providers respond most positively when interoperability initiatives are framed around improving patient care rather than meeting technical requirements. Because many behavioral health organizations function as primary care providers for their patients, they experience the consequences of missing laboratory results, incomplete medication histories, and fragmented care coordination every day.
Discussion during the State Health Technology Commons meeting noted that pairing policy requirements with funding opportunities may significantly improve participation in technology improvement initiatives. Rhode Island, for example, incorporated HIE connectivity into its CCBHC certification requirements while simultaneously providing financial support through its broader behavioral health investment strategy. This combination created both the resources and incentives needed for successful implementation.
Looking Ahead
The BHIT Pilot Program represents more than a series of technology demonstrations, as it provides practical implementation experience across multiple states, EHR platforms, provider types, and policy environments. The lessons emerging from these early pilots reinforce several important principles:
- Interoperability initiatives should solve meaningful clinical and operational challenges.
- Workflow redesign and provider education are as important as technical implementation.
- Privacy requirements must be addressed through scalable, practical solutions.
- Strong technical assistance and sustained provider engagement are essential for long-term success.
- Policy, funding, and implementation strategies work best when developed together.
As these pilots continue, the findings will help shape future national guidance for behavioral health interoperability while offering valuable implementation lessons for states preparing to expand behavioral health information exchange.
