ONC shows EHR adoption gap

Electronic records are normal across most of American healthcare. But behavioral health still has a paper problem — and now a federal data brief puts real numbers on it. The Office of the National Coordinator for Health IT released new analysis in April 2026 using SAMHSA’s 2024 treatment-facility survey, and the gap is hard to miss: substance-use and mental-health providers have digitized unevenly, and many still struggle to exchange data in the first place. ### What actually got measured? The brief looks at substance-use and mental-health treatment facilities in the 2024 National Substance Use and Mental Health Services Survey, or N-SUMHSS. It tracks two separate things that are easy to blur together — whether a facility keeps records in an EHR at all, and whether that EHR is good enough, connected enough, and used broadly enough to support coordination with the rest of healthcare. ### How digital are these facilities now? More than two-thirds of facilities — 68% — said they use only an electronic health record with no paper charts. Another 25% said they still use a hybrid setup with both EHRs and paper. That means a big chunk of the sector is. ### Why is hybrid still a problem? Because “has an EHR” and “runs on digital workflows” are not the same thing. A hybrid setup creates handoff friction everywhere — intake, documentation, referrals, medication history, discharge planning. It is the healthcare version of keeping half your files in the cloud and half in a filing cabinet. You can function that way, but coordination slows down exactly when a patient’s care gets complicated. ### Are they at least using EHRs deeply? For basic clinical tasks, mostly yes. Facilities reported similar use of EHRs for core jobs like recording patient health information and monitoring patient progress whether they were fully electronic or hybrid. But use dropped for the harder stuff — exchanging health information, coordinating care, and engaging patients. So the issue is not just adoption. It is capability and workflow maturity. ### Where does exchange break down? The cleanest number is HIE participation. Only 1 in 5 facilities reported participating in a health information exchange organization. ONC says HIE participants were much more likely to search for and query patient information than nonparticipants. That sounds obvious, but it matters — joining the network is still a gating step for whether outside data can follow the patient. ### Why is behavioral health behind everyone else? Part of it is history. Hospitals and office-based physicians got a huge push from the HITECH era, with incentives that helped make EHR adoption close to universal. Behavioral health providers were not pulled into the broader behavioral-health interoperability work, including TEFCA and newer standards efforts. ### Why does this matter now? Because demand for mental-health and substance-use treatment has risen, and those patients often move between emergency departments, primary care, social services, and specialty treatment programs. If records do not move with them, the system falls back on phone calls, faxes, repeat intake, and incomplete histories. That is bad for efficiency, but more importantly it is bad for continuity of care. ### Bottom line? The new ONC brief does not show a sector stuck on paper everywhere. It shows something more frustrating — a sector that is partly digitized, unevenly connected, and still missing the last mile that makes EHRs actually useful across organizations. Until behavioral health closes that gap, the rest of healthcare’s interoperability progress will stay incomplete.