New systems of care, such as collaborative care — a form of integrated mental health care — make use of measurement-based outcomes to track progress and help inform treatment decisions. They represent a powerful new opportunity for access to quality mental health care for patients and practice opportunities for providers. 

Often, these outcomes are tracked in record systems and formats separate from EHRs, creating parallel workflows and redundant data entry. As EHRs flesh out their capacity to deliver reports culled from data in clinical encounters, they will also need to be able to share that data with other systems to maximize efficiency and reliability between providers on collaborative care teams. 


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Safety-net settings are vulnerable to this lack of interoperability because they often invest in EHRs that do not have the adequate support capacity to adapt to newer interoperability expectations. Clinical systems rely on patient loyalty to one clinic, hospital or system to provide care — hoping that investment in a similar EHR across a care system would be sufficient to coordinate information — but people within the safety-net rarely receive continuity of care for an appreciable amount of time within one hospital or clinical system. Instead, they often seek care from the cheapest or most available entry point possible. 

Such heterogeneity in the provision of care should further incentivize interoperability between safety-net communities of providers and hospitals, but it doesn’t. Instead, safety-net systems and providers are often in fierce competition with each other for state, federal and local monies and are often just scraping by on the margin. Investing in interoperability may seem like a lofty utopian goal that may run counter to many organizations’ mission to attract and retain patient populations.

There are inherent challenges to implementing interoperability between systems. The priciest and most robust EHR systems have been slow to adopt full interoperability or build it into their platforms. Once they do, they often come at a price that is too high for smaller clinical systems, especially safety-net settings. Sometimes these costs aren’t disclosed up-front.

Even when interoperability is in place, ensuring that appropriate clinical information is shared with reliability, consistency and validity is an additional obstacle. It may be feasible to ensure that every EHR export data from every patient encounter, but how do we ensure that the data is clinically relevant and accurate?