WASHINGTON, UNITED STATES — A new federal analysis shows United States behavioral health facilities are still struggling to keep up with the rest of the healthcare system on electronic health records and data exchange — a gap that’s now threatening national interoperability goals as demand for mental health and substance use treatment climbs.
According to a report from Healthcare IT News, the Office of the National Coordinator for Health Information Technology, drawing on 2024 SAMHSA survey data, found that one in four substance use and mental health treatment facilities still use a mix of electronic health records (EHRs) and paper charts.
Only one in five participates in a health information exchange, the backbone of modern care coordination.
The adoption gap is wider than it looks
While more than two-thirds of behavioral health facilities have moved fully off paper, adoption splits sharply by ownership.
Federal facilities lead at 97%, but state-run facilities sit at just 38% — a gap ONC called significant and “possibly due to cost, data fragmentation and workforce challenges.”
Private for-profit operators, at 68%, fall in the middle, exposing real disparities in care quality across the country.
The clinical implications hit hospitals and clinics directly. When behavioral health providers can’t exchange records with primary care physicians, emergency departments or specialty clinics, patients show up with incomplete histories, duplicated tests and missed medications.
That fragmentation drives up costs across every connected provider in the referral chain.
Where the real interoperability bottleneck sits
EHR use stays strong for clinical documentation — 98% for diagnoses, 97% for clinical notes, 94% for treatment plans. But the numbers fall sharply for the functions that actually move data between providers.
Just 45% of facilities use EHRs for patient messaging and 44% for patient access to medical records. The 2009 HITECH Act excluded behavioral health from EHR incentive payments, leaving the sector more than 15 years behind hospitals and ambulatory practices.
ONC pointed to a wider operational issue: “The data suggest that there may be both gaps in the capabilities of implemented EHRs to perform certain tasks and gaps in how some facilities implemented and used their EHR.”
That means hospitals and clinics integrating behavioral health are inheriting workflow problems, not just data problems.
This is where outsourcing has become a practical lever for U.S. providers. Specialized partners are taking on EHR optimization, health information exchange onboarding, medical records management, prior authorization and care coordination support — letting clinical teams focus on patients while back-office complexity gets handled by experts built for it.