California Health Information Technology Landscape Assessment

In 2022, the California Department of Health Care Services commissioned research to assess the readiness of mental health, substance use disorder, and social service organizations to participate in data exchange. This presentation summarizes that work and paints an early picture of their widely varying levels of health information technology adoption, structured data capture, and cross-sector data exchange capability.

This work comes at an important time as California implements CalAIM (California Advancing and Innovating Medi-Cal), an ambitious initiative to transform Medi-Cal through integrated, whole-person care. The success of CalAIM depends on seamless information sharing between health care, behavioral health, and social service providers to care for populations with complex care needs.

Although traditional health care organizations have benefited from the HITECH Act’s $47 billion investment in 2009 to accelerate adoption of electronic health records (EHRs), many providers critical to CalAIM’s success — particularly those in behavioral health and social services — were left out and lag significantly behind.

Among the research findings are the following:

• State agencies or departments have created robust IT systems that serve as the system of record for community-based service providers. Although these systems help standardize data collection and workflows, they do not readily interface with EHRs to facilitate cross-sector care coordination. These systems include:
  • The Child Welfare Services-California Automated Response and Engagement System (CWS-CARES), which supports children in the foster care system
  • The Case Management Information and Payroll System, which supports older adults who may be at risk of institutionalization
  • The Correctional Health Care Services’ Electronic Health Records System, which manages people transitioning out of incarceration
• Service providers are leveraging shared services and systems to support scale and interoperability. For example, many county behavioral health organizations are collaborating with the California Mental Health Services Authority to use the SmartCare EHR platform.
• Many community-based organizations, such as sobering centers and medical respite organizations, combine manual and electronic processes to exchange information with their partners in coordinating care for their clients.
• Some organizations have set standards and processes for data collection. Continuum of Care Organizations use the Homeless Management Information System and must collect “Universal” or “Common” Data Elements to qualify for federal funding.
• The most common data elements captured across services provider types are race/ethnicity, housing status, language spoken, and contact information. Other information, such as food insecurity or behavioral health diagnoses, is collected if it is core to the service being provided.

To effectively establish reliable and secure data exchange capabilities at scale, a comprehensive mapping of the technology systems and data collection practices within the behavioral health and social services sectors is crucial. This foundational step will enable these sectors to integrate more seamlessly into broader data exchange networks, ultimately enhancing coordinated care for those with complex needs.