Behavioral Health/Substance Use Disorders and Crisis Intervention: Interoperability - Same Game, Different Playbook

If you run an HIE, you already know the drill for traditional medical data exchange: demographics, problems, medications, allergies, labs, encounters. These can now flow through ADT feeds, C-CDAs, and FHIR APIs like water through a pipe.

But behavioral health (BH) and substance use disorder (SUD) data because of a crisis? That’s a different ball game. Not because it’s too technically complex to handle, but because the rules, the players and the stakes are different. We’re talking about care settings and situations where a missed detail can mean a suicide and although all data exchange uses many of the same technical standards, the content and context make this scenario anything but routine.

Why it’s different

1. The stakes – BH/SUD crisis providers often make decisions with little information about the people experiencing the crisis. A last methadone dose, a suicide risk score, or an involuntary court order hold can change the entire plan of care.

2. The timelines – In crisis care, a five-minute delay can be five minutes too long.

3. The context – Many BH/SUD organizations weren’t part of Meaningful Use and promoting interoperability.  They may not have certified EHRs, so data comes in all shapes, sizes, and formats.

High-value data elements worth prioritizing

Here’s a short list of fields that aren’t always on the “usual” HIE radar but are mission-critical for BH/SUD/Crisis care:

• Previous history of treatment – Inclusive of either BH or SUD services.  This includes any current Court Ordered Evaluation and/or Court Ordered Treatment details.

• Safety plan and/or crisis treatment plan  – A clear roadmap for what to do in a BH/SUD related crisis or prevent one. 

• Last observed Medication Assisted Treatment (MAT) dose – Prevents withdrawal and dosing errors when a patient moves between settings.

• Overdose history and naloxone administration – Vital for targeted outreach and relapse prevention.

• Care team roster (including peers and community partners) – Ensures the right people get alerts and follow-ups at the conclusion of a crisis episode of care.

Safety Plan vs. Crisis Treatment Plan — and why they matter to an HIE

HIEs often see “plan” fields in a C-CDA or FHIR CarePlan and treat them generically.

With BH/SUD crisis interventions, the type of plan matters.

Feature	Safety Plan	Crisis Treatment Plan
Purpose	Short, step-by-step prevention guide	Comprehensive blueprint for managing crises, including clinical care and coordination
Typical Content	People/places/resources for distraction and support	Legal documents like court orders and guardianship status
When Used	When warning signs occur, and person may be escalating.	Direct crisis intervention when someone is danger to self or others.
Format	Often a 1 or 2-page structured document (PDF or paper), can be coded with discrete fields for plan existence and date updated	Larger document or care plan module in EHR, may be narrative-heavy and less standardized
Exchange Path	FHIR CarePlan or Document Reference + metadata; possible to store key fields in structured form	FHIR CarePlan, C-CDA care plan section; often requires PDF attachment for full context

Crisis care teams should know that a safety plan or crisis treatment plan exists (and when it was last updated).  This can then trigger the right outreach and coordination. Ingesting them as PDFs is a start, but mapping certain key fields (date, author, whether a plan exists) into structured data lets you power alerts, dashboards, and targeted notifications.

How an HIE can incorporate BH/SUD crisis data without reinventing the wheel

Good news: You don’t have to build an entirely new infrastructure to support these.

• Use existing pipes – Many of these elements can travel through C-CDA sections or US Core FHIR profiles. The trick is getting them into structured fields on the sending side.

• Leverage your MPI – Identity matching is especially critical when working with BH/SUD data because you often deal with transient populations, multiple aliases, or incomplete demographics.

• Work at the program level – If a sending system can’t tag individual sensitive entries, exchange from specific programs or departments where the data set is already scoped.

• Add dashboards or limited viewers – Not every partner needs full clinical data; sometimes they just need to know if a patient meets certain criteria or has a follow-up scheduled.

• Pilot with motivated partners – Start with one crisis provider, one SUD program, and one behavioral health clinic to prove the concept before going wide.

The bottom line

BH/SUD crisis data exchange isn’t “harder” than other HIE work — it’s just different. It calls for a sharper eye on which data elements really matter, faster delivery, and workflows built for providers who may not have the latest EHR bells and whistles.

With the right priorities, standards, and partner engagement, HIEs can make this exchange as routine as sending an ADT.  They can give crisis and BH/SUD treatment teams the same thing they give medical teams every day: the information they need, when they need it, to make the best possible decisions.

At Converge Health, this is the work we live and breathe. If your HIE is ready to take on BH/SUD Crisis exchange but isn’t sure where to start, we can help you cut through the complexity, align your partners, and build an exchange model that works in the real world. Because in this space, “different” doesn’t have to mean “difficult” — it just means doing it right from the start.