The Fragmented State of Behavioral Health IT - Cover

The Fragmented State of Behavioral Health IT

I recently saw a video of a Tesla vehicle that responded to an accident happening two cars ahead of the driver, before the accident occurred. Apparently, the vehicle uses radar detection and visual sensors to “see” ahead of the car directly in front of the driver.

KLAS, who traditionally has focused on physical care and the IT surrounding it, has given me a deep well of data to help me “see” further. In many ways, I feel as though behavioral health is trailing behind physical health, much like cars on the freeway.

Several factors account for this, including a lack of the MU dollars that found their way into acute care and ambulatory settings. Regardless, there is an opportunity to highlight some of the road hazards that await behavioral health IT in hopes of avoiding a wreck.

Right now, I am neck deep in collecting provider feedback for our upcoming report on behavioral health systems. We still have much of the story to clarify and dig into, but already I’ve been struck by how fragmented this space is. That creates a lot of frustration and confusion for providers.

A Fragmented Space

Some of the problem is the nature of behavioral health. There are so many different types of behavioral health facilities that it’s difficult to unify under a single set of technology needs. For example, there are inpatient hospitals/departments, psychiatric hospitals, residential facilities, and outpatient clinics, and some programs offer things like employment services, housing services, foster care, and/or other therapies. That isn’t to mention the many different subspecialties. No two programs run quite the same.

Another challenge is that governmental reporting requirements differ from state to state. This can lead to inconsistent vendor performance from state to state and limit which states vendors sell in. Providers frequently bring these issues up, and it can be a major frustration if a vendor can’t perform as promised.

The fragmented state of behavioral health has led to a lack of unified thought leadership, particularly around the use of EMRs. While there are advocacy groups and associations, there’s no unified direction or voice stating what behavioral health needs. This makes sense because behavioral health providers in general are trying to do so much with so little inside their own four walls; many can’t think about going beyond what they’re already doing. So lacking technology is put on the back burner and remains a constant irritant.

Financial Constraints

In general, behavioral health practices or departments have very little money at their disposal; margins are notoriously low for these providers. Most behavioral health providers can’t qualify for government incentives to adopt EMRs. As a result, some behavioral health systems aren’t even meaningful-use certified.

Most who do adopt behavioral health EMRs justify the purchase with the promise of increased efficiency and are often larger practices. These providers may have more funding at their disposal to buy solutions from larger vendors like Cerner and Netsmart. Smaller providers are more likely to go for budget-friendly or free solutions, which often means trade-offs in functionality.

The massive financial constraints of behavioral health practices (even those that are part of a larger health system) also mean that vendors entering this space have trouble pricing their software. A hospital or primary care practice is used to paying much more for their software than behavioral health providers can afford. Vendors who come to potential behavioral health customers with the same costs are quickly dismissed. To stay competitive, they must either lower their prices significantly or demonstrate a much greater ROI to be a viable competitor.

This situation creates another challenge: when vendors charge less, how do they continue to deliver the same level of value? Often there is less support or slower development to balance the equation. Many providers have to make a painful choice between expensive (but more functional) solutions and free or budget systems that don’t meet all their needs.

Movement Toward Unification?

Across healthcare, the push for integration is making it even more vital for providers to have quality systems that support patient care. And integrated care is especially important in mental health, given the strong link between mental illness and physical illness. Benefits of integrated care continue to be researched, and along with improved health outcomes, there is real potential for fighting the stigma of mental illness by going to the same place as you would for a physical checkup.

Integrated care is gaining momentum among providers, and vendors have to be able to accommodate. Many niche behavioral health vendors have limited to no content for primary care providers, and interoperability between systems is far from the norm. This sets the stage for enterprise vendors to be the one-stop-shop for all providers as long as their behavioral health solutions have the right functionality.

Legislation passed by the US House of Representatives and Senate could provide incentives for behavioral health EMR adoption—another step in treating mental health the same as physical health. Once these incentives are green-lit, we expect to see an explosion of EMR adoption.

All of this could help move the market in a more unified direction and improve the state of behavioral health integration.

When providers are working together toward a common goal, they are a force to be reckoned with. At KLAS, our goal is to enable that unification by putting the voice of individual providers together. In our upcoming report on behavioral health EMRs, this shared voice will educate providers looking for a new solution and hold vendors accountable to those they serve.

To share your experience with your behavioral health solution contact me at