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Preparing for a new era: EHR standards for behavioral healthcare

April 1, 2006
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It's a time-consuming but important process—and hardworking thought leaders are making the effort

We have moved into an era wherein widespread adoption of electronic health record (EHR) systems has become a national priority. President Bush recently underscored their importance to the nation's healthcare system in his 2006 State of the Union address. Department of Health and Human Services (HHS) Secretary Mike Leavitt declared EHRs to be among his three top priorities when he launched the American Health Information Community in June 2005.1

The Institute of Medicine (IOM) has defined EHRs as encompassing:

  • the longitudinal collection of electronic information pertaining to an individual's health and healthcare;

  • immediate electronic access—by authorized users only—to person- and population-level information;

  • provision of knowledge and decision support to enhance the quality, safety, and efficiency of patient care; and

  • support for efficient processors of healthcare delivery.2

The importance of EHR systems to patient safety and quality of care has been well established.3 Nevertheless, the rate of adoption has been slow. The obstacles most often cited are cost-related factors, risk aversion, and insufficient knowledge of how to manage a successful implementation. Underlying and contributing to these obstacles are a lack of nationwide standards for the collection, coding, classification, and exchange of clinical and administrative data.4 It is a daunting task to address all these challenges and promote widespread adoption of EHR systems. To intensify and coordinate efforts to accomplish this nationally, President Bush established the Office of the National Coordinator for Health Information Technology in 2004 and appointed David Brailer, MD, PhD, as its leader.

Summit Recommendations

The behavioral healthcare field has specific interests and concerns pertaining to EHRs that probably would not be addressed without an organized effort. In 2005, the Software and Technology Vendors’ Association (SATVA) and SAMHSA worked together to organize and cohost the National Summit on Defining a Strategy for Behavioral Health Information Management and Its Role Within the Nationwide Health Information Infrastructure. More than 140 behavioral healthcare leaders were invited from a comprehensive range of stakeholder groups to meet in Washington, D.C., on September 29 and 30 to begin laying the foundation for a nationwide information infrastructure for behavioral healthcare services. (You can access the complete set of Summit presentations and workgroup summaries in clear audio recordings with, if applicable, synchronized slide presentations at

Summit participants concluded that the behavioral healthcare field should set development of EHR standards as a top priority. They recommended the following:

  • Behavioral healthcare perspectives should be represented within general healthcare standards development organizations and within all EHR and regional health information network programs initiated through HHS and its agencies.

  • A public-private and broadly representative behavioral health group should be formed that can coordinate and harmonize data standard work pertaining to behavioral healthcare, as well as coordinate incentive strategies for widespread EHR adoption.

  • Basic clinical specifications for a behavioral health EHR should be defined and serve as the core of a broader set of behavioral health-specific software certification standards.

IOM Recommendations

A month after the Summit, on November 1, the National Academy of Sciences released the first IOM report to comprehensively review and address issues in the behavioral healthcare field. In Improving the Quality of Health Care for Mental and Substance-Use Conditions, an entire chapter was devoted to information management issues. Among the recommendations were the following:

  • HHS should create and support a continuing mechanism to engage mental and substance use (M/SU) healthcare stakeholders in the public and private sectors in developing consensus-based recommendations for the data elements, standards, and processes needed to address unique aspects of information management related to M/SU healthcare. The recommendations should be provided to the appropriate standard-setting entities and initiatives working with the Office of the National Coordinator for Health Information Technology.

  • Public- and private-sector persons and organizational leaders in M/SU healthcare should become involved in, and provide for staff involvement in, major national committees and initiatives involved in setting healthcare data and information technology standards to ensure that the unique needs of M/SU healthcare are designed into these initiatives at their earliest stages.