Nine pilot programs lead the charge in behavioral health data interoperability

Behavioral health providers continue to face barriers to achieving interoperability, including lower EHR adoption rates, documentation challenges and less mature data exchange standards than those available in other healthcare settings.  

However, in recent years, efforts to improve interoperability in behavioral health settings have gained momentum.  

In 2025, the Office of the National Coordinator for Health Information Technology (ONC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) partnered on the Behavioral Health Information Technology (BHIT) Initiative -- a $20 million effort to improve behavioral health data exchange. 

Talisha Searcy, senior advisor in the office of policy at ONC, spoke about the BHIT initiative during a March 24, 2026, webinar hosted by Open Minds.  

Searcy cited 2024 survey results highlighting persistent interoperability gaps among behavioral health providers. While most respondents said they use an EHR system exclusively, a quarter of respondents said they use EHRs as well as paper records.  

“Moreover, when we're talking about patient access, these facilities reported that only 39% allow clients to view medical information online," Searcy added. "And so, what we are trying to do is work in partnership with SAMHSA to really try to address some of these concerns in terms of behavioral health facilities' ability to electronically exchange data." 

In February 2026, ONC, formerly known as the Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (ASTP/ONC), announced the selection of nine nationwide pilot programs under the BHIT Initiative. 

The nine pilot programs are officially underway, with the goal of improving behavioral health data exchange and strengthening integration between behavioral and physical health. 

By the end of 2026, findings from the pilot programs, which will test the USCDI+ Behavioral Health (USCDI+ BH) dataset and the Fast Healthcare Interoperability Resources (FHIR) Behavioral Health Profiles Implementation Guide (BH IG) in real-world behavioral health settings, could provide key data to inform future standards and policy considerations. 

BHIT Initiative basics

The BHIT Initiative consists of three core goals. First, the initiative sought to establish data content standards for health IT that improve efficiency and reduce adoption costs. In line with this goal, ONC and SAMHSA collaborated to develop the USCDI+ BH dataset. 

"What we're trying to do here is establish data elements and standards that could be used within EHRs that would improve the efficiency and reduce the cost to adopt technology by avoiding providers having to do various customizations in order to meet either SAMHSA reporting requirements or to address some of the critical information that's currently captured in many providers' clinical notes within their EHRs," Talisha Searcy, senior advisor in the office of policy at ONC, said during a March 24, 2026, webinar hosted by Open Minds. 

"We're really trying to pull those core elements out and standardize them in a way that would enable easier exchange." 

Second, the BHIT Initiative directed funds to pilot the standards in the real world, further lowering implementation barriers.  

"Our pilots are really designed to, in a real-world way, further examine the barriers to implement the USCDI+ BH data elements," Searcy said. "It's really so that we can not only understand how these data elements will exchange, but also how they may be leveraged to address some of the critical and unique challenges that behavioral health providers encounter as a result of exchanging these data."  

The pilots are exploring a variety of topics, from consent to data aggregation challenges. 

Third, the initiative aims to develop a Behavioral Health Informational Resource (BHIR) using the lessons learned from the pilots. 

"This will be a list of different tools that could be used to help not only communicate the lessons learned but will better enable users of USCDI+ to understand how they can take the lessons learned from the pilot and put them into their respective systems," Searcy noted. 

Now in the pilot phase of the initiative, 45 exchange partners across nine states are working to improve behavioral health outcomes, conduct real-world testing of USCDI+ BH and identify the top information exchange priorities and current data exchange capabilities of behavioral health providers. 

Exploring the pilot programs 

ONC worked with SAMHSA because it heard from states that grantees were facing challenges with meeting the various reporting requirements for its grant programs, Searcy said. 

"They found it very burdensome and also some challenges with capturing those data electronically. And then additionally, [ONC] has really been focused on how we can further enhance interoperability amongst behavioral health providers,” she added. 

The pilot program leaders received awards ranging from $300,000 to $690,000. Each awardee has a lead entity and works alongside several partners to test USCDI+ BH in real-world care settings. 

For example, the Delaware Division of Substance Abuse and Mental Health (DSAMH) received an award for its DTRN 360 BH Interoperability project, which aims to automate submission of the state's consumer reporting form via FHIR APIs to improve care coordination. 

In Florida, PSYHealth LLC is spearheading the Florida Interconnect BH project, which aims to support communitybased housing and vocational providers by enabling the exchange of USCDI+BH and social determinants of health data. 

Connecticut's state-designated health information exchange (HIE), Connie, was awarded a pilot grant to enhance its consent tools for 42 CFR Part 2 data. Providers will test new mechanisms for sharing substance use disorder (SUD) information securely.  

In Washington, D.C., efforts are underway to exchange USCDI+BH data with the CRISP DC HIE, which it says will enable analysis of key SUD measures using a population health analytics platform. 

Similarly, the Massachusetts Department of Public Health's Bureau of Substance Addiction Services is using its pilot grant to enhance statewide tracking of SUD trends. 

Other pilots across Colorado, North Carolina, Oregon and Rhode Island aim to improve care for individuals exiting institutional settings, bolster crisis care pathways and enhance care plan accuracy and quality reporting. 

"We know that many behavioral health providers were left out of promoting interoperability or meaningful use. Those incentives were not provided for technology adoption," Searcy said.  

"We're seeing EHRs being adopted by this community, but we know that there are some challenges in terms of making sure that the EHRs that are being adopted are meeting the distinct technical, operational and policy challenges that providers face. And so, our hope is that this pilot will also help to address some of those concerns." 

Jill Hughes has covered health tech news since 2021.