The push to create a national health information network has failed to take the behavioral healthcare community's needs into account, a recent Institute of Medicine report found.

Mental health and substance abuse healthcare providers are left out of both public and private sector national health information network initiatives and lag behind the rest of healthcare in their use of information technology, the report found. The IOM committee recommended that the National Coordinator for Health Information Technology and the Substance Abuse and Mental Health Services Administration jointly implement a plan to ensure that the behavioral health community has a voice in NHIN development. Among its recommendations, the group called for:

• Public and private sector groups in mental health/substance abuse healthcare to get involved with NHIN development and healthcare IT standards efforts;

• Standard national, state and local billing requirements for behavioral healthcare providers;

• The government and private sector to encourage electronic health records adoption in the behavioral healthcare community though financial incentives, technical assistance and providing funding for the development of virtual networks that could give individual providers and those practicing in small groups access to clinical software; and

• Increase collaboration and coordination of care between providers or mental health and substance abuse treatment services and the general healthcare community.

There are several reasons why the behavioral health community hasn't been included in the movement to create a national health information infrastructure, says Paul Appelbaum, MD, a member of the IOM committee and the chair of psychiatry of the University of Massachusetts Medical School. Many providers of mental healthcare and related services tend to practice in small groups or work in community-based non-profits, making it difficult to coordinate anything on a national level, Appelbaum said. Reimbursement rates for such services are often low, so IT investments are difficult.

"This is a sector of the healthcare system that has been largely impoverished," he said.

Then there's the thorny issue of securing the records of those who have sought treatment for mental health or substance abuse. There is a lack of consensus, even within the behavioral health community, on what information is appropriate to share with other healthcare providers. For example, many doctors would agree that sharing information about the kinds of psychotherapy medications a patient is taking would be valuable to share with other providers, who might prescribe medications that could have a dangerous interaction with other drugs. But there is less agreement on whether the notes a behavioral healthcare provider takes during a patient visit should be shared, Appelbaum said.

Providers in the mental health community also say electronic health records developers have largely ignored their needs.

"We're always an afterthought," said Mary Jane England, MD, chair of the IOM committee on mental health and addictive disorders.

That's part of the reason groups such as the Software and Technology Vendors' Association are pushing to ensure that the Certification Commission for Healthcare Information Technology includes the behavioral healthcare community's needs when it sets standards for ambulatory health records. SATVA represents software providers for mental health and substance abuse agencies. Tom Trabin, executive director of SATVA, said CCHIT, which holds a government contract to certify EHRs and other health IT applications, has not included elements that the behavioral health community would like to see in an EHR. The group is working to get CCHIT to include its recommendations in the upcoming ambulatory EHR standard.

SATVA also is working with officials from HHS' Substance Abuse and Mental Health Services Administration to advance some of the policy recommendations that came out of a behavioral healthcare IT summit held in Washington, D.C., this fall.

In the meantime, members of the IOM committee say including the behavioral health community in the development of a national health information infrastructure will ultimately benefit patients.

"Having information available is going to improve care," Appelbaum said.