Challenges to Achieving Mental Healthcare Interoperability

Interoperability is defined as the ability of two or more systems to exchange and interpret shared data. When it comes to behavioural healthcare and social services, it has to do with the capacity of computer and software systems to exchange and share data from various sources such as medical providers, clinicians, treatment clinics, hospitals, and laboratories. To simplify, it allows other software programs to speak with each other, and the same results are expected through mental health interoperability.

Achieving true interoperability is a complex process. Compliance, patient privacy, clinical standards, disparate vendors, rising costs with reduced Medicare reimbursements, and increased pressure to improve the patient experience present unique challenges.

That is even more true in the behavioural healthcare sphere. The change in behavioural health has accelerated due to the COVID-19 pandemic. Studies have shown that the share of people reporting negative mental health impacts from the pandemic in the United States rose from 32% to 53% between March and July 2020.

Spikes in depression and anxiety are happening across the country as people attempt to navigate the complexity of the current moment. As a result, it has become clear that stakeholders across the behavioural health landscape, such as care providers, public insurers, employers, and government policymakers, must innovate to serve this population across the country better.

However, it is also clear that these players face significant challenges to achieving mental healthcare interoperability. These include lack of consistency when identifying patients, lack of standards for sending, receiving, and managing information between health systems, difficulty with measurement, analysis, improvement of interoperability between healthcare systems, and information blocking by vendors.

Single Patient Medical Records

Matching an individual to their correct health data is critical to their medical care, but the lack of consistency in identifying patients has proven to be a considerable challenge. Statistically, as many as one in five patient records may not be accurately matched even within the same health care system.

When transferred between systems, the numbers may be as high as 50% of records being mismatched. For decades, organizations like the Healthcare Information and Management Systems Society (HIMSS) and the American Health Information Management Association (AHIMA) have been petitioning to develop a national patient identifier. The identifier would be similar to a person’s Social Security number and would be theirs throughout their lifetime. Assigning this unique patient identifier to every individual can help ensure that health records are shared accurately, efficiently, and securely.

Lack of standards between health systems for sending, receiving, and managing information is another challenge to achieving mental healthcare interoperability. Although some standards development organizations (SDOs) have created and defined health data standards throughout healthcare, no single standard exists.

The lack of a common standard is a significant hurdle to interoperability efforts. Experts say that the disconnect between health IT systems is too big for one provider or healthcare entity to solve.

Because of this, groups are coming together to rally behind interoperability standards that might finally solve the issue. As stated by Joyce Sensmeier, vice president of informatics at the Healthcare Information and Management Systems Society (HIMSS), “Collaboration is critical. Interoperability is too important to patients and clinicians for the industry to be competing on it. We really need to work together to solve the challenges.”

Interoperability Standards

Since 2015, the Office of the National Coordinator for Health IT (ONC) has been publishing its Interoperability Standards Advisories. The Standards Advisory process represents the model used by ONC to coordinate the identification, assessment, and public awareness of interoperability standards and specifications that the healthcare industry can use to address interoperability needs.

The latest document published in 2021 identifies specifications for specific interoperability needs such as provider role in team care, labs, assessment and treatment plans, patient goals, emergency medical services, and more. Though compliance with the Standards is not yet required, ONC encourages all stakeholders to implement and use them to their specific needs.

In addition, the ONC has laid out a ten-year quality improvement roadmap in which they state: “Big data, clinical analytics, and data standards will be key to overall quality improvement in the healthcare system.” They envision “big data” turning into “fast data, ” encouraging preventative and predictive care.

The ONC collaborates with stakeholders and policymakers to develop roadmaps towards interoperability and champion the adoption of standards that align with quality improvement strategies.

An additional challenge faced by mental health care providers and their partners is the lack of a standardized way to measure patient outcomes, cost-effectiveness, and the impact of interoperability delays and failures. Appropriate measurements allow for easy analysis and monitoring for improved quality of care and better patient outcomes. Without measuring and analyzing data, health systems and organizations cannot improve their processes and achieve true interoperability.

Achieving Mental Healthcare Interoperability

To achieve true mental healthcare interoperability requires increasingly sophisticated and robust data application interfaces that must be cross-organizational, regional and national boundaries. Julota’s cloud platform provides the tools necessary for data access and sharing through its secure patented TouchPhrase Interface.

As more behavioural health practitioners implement electronic health record systems (EHR), it is essential to ensure that patient care information is leveraged across networks for the highest quality of care. Julota is bridging the gap between healthcare organizations that use different EHRS and EMS ePCR (electronic patient care reporting) systems. These tools will be potent in the mental health care field because of the array of complex factors involved that can come together through mental health interoperability.

Information Blocking by Healthcare Software Vendors

The practice of information blocking is another major impediment to interoperability in healthcare. Information blocking is a practice by a healthcare provider, a health information network or exchange, or a health IT developer to interfere with accessing, exchanging, or using electronic health information (EHI). It can occur in numerous ways.

Physicians may experience info blocking when trying to access patient records from other providers, migrating from one EHR to another, linking EHRs with a data registry, or connecting their EHR systems to local health information exchanges (HIEs). Patients can also experience blocking when attempting to access their records or sending them to another provider.

Due to longstanding concerns raised by the American Medical Association (AMA), health care community stakeholders, and patients, the 21st Century Cures Act (Cures) was enacted in December 2016. This landmark bipartisan health care innovation law defines information blocking as a practice that would be likely to interfere with, prevent, or discourage access, exchange, or use of electronic health information.

The second phase of the Act occurred in 2020. ONC adopted the Final Rule, which provides patients with proper access to their healthcare data, empowering them to take control of their care and make better and wiser healthcare decisions. It also sets out regulations to prevent info blocking practices by providers, HIEs, health IT developers, and health information networks.

Together, these actions mark the most extensive healthcare data sharing policies ever implemented by the United States government. The original deadline for compliance with the Cures Act information blocking rules was November 2, 2020. However, in October 2020, Health and Human Services moved the date to April 5, 2021, citing the desire to allow the healthcare system to focus on COVID-19 concerns. Sadly, more than a year after the Final Rule’s release, confusion still exists, and compliance remains a challenge to healthcare interoperability, particularly in the area of mental health.

Advancements in Mental Health Care Interoperability

Mental health care interoperability is an ongoing concern for providers, patients, and organizations of all types involved in the industry. It will continue to evolve commensurate with technological enhancements.

Invariably, these advancements will lead to greater integration over the entire healthcare spectrum. Many of these enhancements are already available with the Julota platform.

A single solution connects data between care teams, patients, and other organizations through cloud computing. Using the cloud means your own IT department will not be burdened with expanding server capacity or bandwidth capabilities as requests for information surge. You can also rest assured that the vital data you collect, maintain, and share will be safe, secure, HIPAA, and CFR 42 compliant.

It’s important to remember that interoperability is a journey – not a destination. Like a complex puzzle, full interoperability takes time, effort, and collaboration, and solving it is critical to reaching the desired levels of mental healthcare interoperability.

Without immediate access to crucial health information during a patient’s time of need, providers cannot offer effective treatment. Health care today goes far beyond the hospital or primary care provider.

Its focus has broadened into a whole continuum of care, and interoperability is the key to complete care. For example, fewer patients now receive all their care at one location, making sharing data between partners essential, especially as we move towards population health management and value-based care.


Though some challenges to achieving mental health care interoperability still exist, this country is making great strides. Hurdles are being overcome by implementing the Cures Act and the Standards Advisories published by ONC. In addition, in this age of digital data, health information management (HIM) professionals and health information technology (HIT) professionals are uniting to share their perspectives and ensure data and information integrity.