Characteristics of State 

Mental Health Agency Data Systems

1 Choke Cherry Road

Rockville, Maryland 20857

Characteristics

of State 

Mental Health 

Agency 

Data Systems

Theodore C. Lutterman

Bernadette E. Phelan, Ph.D.

Azeb Berhane

Robert Shaw

Verda Rana

Characteristics of State Mental Health Agency Data Systems iii

Acknowledgments

This report was prepared by the National Association of State Mental Health Program Directors Research Institute (NRI) for the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services (DHHS) under Contract No. 280-03-3205. The authors of the report are Theodore C. Lutterman, Bernadette E. 

Phelan, Ph.D., Azeb Berhane, Robert Shaw, and Verda Rana. Joanne Atay, M.A., of the Center 

for Mental Health Services (CMHS), SAMHSA, served as government project officer. The 

authors would like to acknowledge and thank the State Mental Health Agency Information 

Technology Directors for their time and effort in submitting information used to generate this 

report and in reviewing and commenting on the report.

Disclaimer

The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views or policies of SAMHSA or DHHS.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied 

without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA.

Electronic Access and Copies of Publication

This publication can be accessed electronically through the following World Wide Web connection: www.samhsa.gov. For additional free copies of this document, please call SAMHSA’s 

Health Information Network 1-877-SAMHSA-7 (1-877-726-4727).

Recommended Citation

Lutterman, T., Phelan, B., Berhane, A., Shaw, R., Rana, V. (2008). Characteristics of State 

Mental Health Agency Data Systems. DHHS Pub. No. (SMA) 08-4361. Rockville, MD: 

Center for Mental Health Services, Substance Abuse and Mental Health Services 

Administration.

Originating Office

Survey, Analysis and Financing Branch, Division of State and Community Systems Development, Center for Mental Health Services, Substance Abuse and Mental Health Services 

Administration, One Choke Cherry Road, Rockville MD 20857.

DHHS Publication No. (SMA) 08-4361

Printed 2008.

Characteristics of State Mental Health Agency Data Systems v

Contents

Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Executive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

I. Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.1 National Initiatives Impacting Mental Health IT Systems . . . . . . . . . . 6

1.1.1 The President’s New Freedom Commission on 

Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1.1.2 Institute of Medicine Report . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1.1.3 SAMHSA’s National Outcome Measures (NOMs) . . . . . . . . . 7

1.1.4 State-Level Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1.2 Types of Client Information Maintained in SMHA IT Systems . . . . . . 8

1.2.1 Encounter/Claims Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

1.2.2 Client-Level Outcome Data . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

1.2.3 Provider Databases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

1.2.4 Client Survey Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1.2.5 Client Sample-Based Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1.2.6 Linked Data Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1.3 Report Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

II. Study Approach and Limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2.1 Study Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2.2 Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

III. SMHA Information Technology, Structure, and Architecture. . . . . . . . . . . 13

3.1 SMHA Organizational Location Within State Government . . . . . . . . 13

3.2 Mental Health Information Technology Staffing and Budgets . . . . . . 13

3.3 Organizational Location of the Management and Operations of 

Computers for the SMHA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

3.4 Mental Health Information Management and Its Level of 

Integration with Substance Abuse and Developmental Disability . . . 15

3.5 SMHA Information Systems Architecture . . . . . . . . . . . . . . . . . . . . . 15

3.6 Databases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

3.6.1 Legacy Information Management Systems . . . . . . . . . . . . . . 16

3.6.2 Application Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
vi Characteristics of State Mental Health Agency Data Systems

3.6.3 Source Code of the Application Software for 

Recording Client Information . . . . . . . . . . . . . . . . . . . . . . . . 16

3.6.4 Source Code of the Application Software for 

Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3.6.5 Source Code of the Application Software for 

Report Generation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3.6.6 Source Code of the Application Software for 

Processing Claims/Encounters . . . . . . . . . . . . . . . . . . . . . . . . 17

3.7 Data Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3.7.1 Data Flow Between SMHAs and Community 

Mental Health Providers and/or County 

Mental Health Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3.7.2 Data Flow Between State Psychiatric Hospitals 

and Community Mental Health Providers . . . . . . . . . . . . . . 17

3.8 Data Edits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

IV. State Models for Client-Level Data Collection. . . . . . . . . . . . . . . . . . . . . . 19

4.1 SMHA Use of Unique Identifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

4.2 SMHAs Collect Client-Level Data . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

4.3 Frequency of Client-Level Data Transmission 

From Mental Health Service Providers to SMHA IT Systems . . . . . . 21

4.4 Frequency of Client-Level Data Update Submission 

From Providers to the SMHA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

4.5 SMHA Receipt of Client Data From County/Local 

Government and Managed Care Organizations (MCOs) . . . . . . . . . . 21

4.6 SMHA Relation to Local Providers to Receive CMHS 

Uniform Reporting System (URS) and Other Client Data . . . . . . . . . 22

4.7 SMHA IT Systems Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

4.8 SMHA Pattern of Admissions and Discharges . . . . . . . . . . . . . . . . . . 23

V. Mental Health Encounter/Claims Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

5.1 Medications/Pharmacy Information . . . . . . . . . . . . . . . . . . . . . . . . . . 26

VI. Linking SMHA Client Data With Other State Government 

Agency Databases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

6.1 Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

6.2 Linking SMHA Data With Other State Agency Data . . . . . . . . . . . . . 28
Characteristics of State Mental Health Agency Data Systems vii

VII. Electronic Health Records in SMHAs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

7.1 Implementation of Electronic Health Records . . . . . . . . . . . . . . . . . . 29

7.2 Implementation of EHR Components . . . . . . . . . . . . . . . . . . . . . . . . 30

7.3 Sharing EHR Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

7.4 Benefits of Using EHRs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

7.5 Electronic Pharmacy/Medication Ordering System . . . . . . . . . . . . . . 31

7.6 Medication Administration Recording (MAR) . . . . . . . . . . . . . . . . . . 32

7.7 Electronic Personal Health Records (PHR) . . . . . . . . . . . . . . . . . . . . 32

VIII. Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Appendix 1: Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

List of Tables

Table 1: Organizational Locations of Information Management Functions . . . 15

Table 2: Frequency of Client-Level Data Transmission to the SMHA . . . . . . . 21

Table 3: Frequency of Client-Level Data Update . . . . . . . . . . . . . . . . . . . . . . . 21

Table 4: Sources of Mental Health Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Table 5: Relation of SMHA to Local Providers to Receive URS 

and Other Client Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Table 6: Types of Encounter Data Received by SMHAs . . . . . . . . . . . . . . . . . 25

Table 7: Types of Medication Information Maintained by the SMHA . . . . . . . 26

Table 8: Other State Agencies With Which SMHAs Link Data . . . . . . . . . . . . 28

Table 9: Uses of EHR Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Table 10: Sharing EHR Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

List of Figures

Figure 1: Location of the Management and Operation of Computers . . . . . . . . 14

Figure 2: Types of Unique Identifiers Used by SMHAs . . . . . . . . . . . . . . . . . . . 20

Figure 3: Implementation of EHRs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Figure 4: EHR Status in State Psychiatric Hospitals . . . . . . . . . . . . . . . . . . . . . 30

Characteristics of State Mental Health Agency Data Systems 1

State mental health agencies (SMHAs) are responsible for funding and providing mental health services to more than 6 million persons every year. The 

backbone of their service infrastructure is the information technology (IT) 

systems that support SMHA functions such as paying providers for services 

rendered, assessing clients’ access to care, evaluating the quality of care 

provided, planning for adequate system capacity, and monitoring outcomes. 

SMHAs vary widely in their IT system capacities and structures. This report 

reviews the current status of mental health IT in the States and their efforts 

to improve these critical systems.

Characteristics of State Mental Health Agency Data Systems 1

All SMHAs have information technology 

systems that are used to identify and count 

mental health clients and measure system 

performance. However, States’ information 

technology systems vary widely in terms 

of the types of information collected and 

their ability to link data between hospitals 

and community mental health providers. 

SMHA IT systems usually have the capacity 

to receive records and/or process payment 

claims from their contracted service providers, which may range from large State 

psychiatric hospitals running the latest electronic health record systems (EHRs) to small 

community mental health clinics and consumer-operated programs that may have 

extremely limited information systems capacity. Additionally, in many SMHAs, major 

portions of the IT system rely on older “legacy” information systems that are proprietary and difficult to integrate into emerging 

information standards.

This report reviews the current IT capacities of SMHAs and describes their activities 

and challenges in enhancing their IT capacities. Information discussed in this report was 

Executive Summary

collected through the 2007 State Mental 

Health Agency Profiles System (IT Component) and is based on the responses from the 

50 States, the District of Columbia, and four 

territories (the Federated States of Micronesia, Palau, Puerto Rico, and the U.S. Virgin 

Islands). Hereafter, the 55 entities will be 

referred to collectively as “States.”

Key Findings

SMHA Information Technology and Structure

■ Every State devotes staff to mental health 

information management functions. 

Thirty-seven States reported spending 

a total of $99,564,957 for mental health 

information management functions in fiscal year 2007. The median State spending 

was $517,667 with a range from $84,552 

in Iowa to a $44,900,000 in New York.

■ In 27 SMHAs (53 percent), all or part of 

the IT infrastructure is located in a larger 

umbrella agency’s IT department. In 24 

States (47 percent), the mental health IT 

infrastructure is operated entirely within 

the SMHA.
2 Characteristics of State Mental Health Agency Data Systems

■ Depending on the organization of the 

SMHA within State government, some 

mental health information management 

may be combined with substance abuse 

services IT (30 States), while in others 

it is combined with mental retardation/

developmental disability services (14 States) 

or a combination of all three areas 

(10 States).

■ SMHAs and State psychiatric hospitals use 

a variety of IT platforms, often using multiple platforms, including Microsoft SQL, 

and Oracle. Often the State’s community 

mental health IT system is separate from 

the State psychiatric hospital platform.

■ Twenty-one States (42 percent) maintain a 

legacy system for mental health information, and out of these, 12 States use the 

legacy system for storing, processing and 

reporting data.

State Models for Client Level Data

■ Fifty-one States (93 percent) have a unique 

client identifier or a method of unduplicating clients across State psychiatric hospitals and community-based service providers. Of the 51 reporting States, 31 

(56 percent) use the same identifier for 

both State psychiatric hospitals and community mental health providers.

■ Thirty-four (64 percent) of the reporting 

SMHAs that maintain a client-level database receive unique client information 

from all community providers. Providers 

send these client-level data to the SMHA 

at a wide variety of intervals, ranging 

from instantly linked (10 States) to monthly (20 States) to every 2 years (1 State).

■ Most of the information needed for 

SAMHSA’s National Outcome Measures 

(NOMs) is maintained as client-level data; 

however, there is wide variation in the 

State practice of updating client information. Although most States collect client 

information at time of admission, this 

information may be updated at discharge, 

at varying time intervals, or not updated 

at all.

Mental Health Encounter/Claims Level Data

■ Fifty-one SMHAs receive client level 

encounters/claims data at the State level; 

34 States (64 percent) receive client level 

data for all individual encounters, while 

19 (36 percent) receive data for only a

certain percentage of total encounters.

■ Thirty-nine States maintain some information on the psychiatric medications of clients. Of these, 32 (82 percent) maintain 

client level information about medication. 

The level of detail collected, however, varies widely, ranging from all prescriptions 

in 22 States (56 percent) to summary level 

information in 8 States (21 percent) to 

only aggregate information in 9 states 

(23 percent).

■ Thirty-one (57 percent) of the reporting 

SMHAs receive and analyze Medicaid 

paid claims files. There is variation in how 

SMHAs receive these claims files, with 12 

(22 percent) States reporting they receive 

data from a data warehouse run by a separate agency, 22 (41 percent) use data 

linking, while 10 States (19 percent) have 

no method of linking Medicaid paid 

claims to SMHA client data files.

■ In addition to Medicaid claims files, 

SMHAs link the client-level data with 

data from other State agencies. Linking 

with the alcohol and drug abuse service 

agency is the most frequent (19 States). 

Other State agencies with which data 
Characteristics of State Mental Health Agency Data Systems 3

are linked include criminal justice, health, 

employment, child welfare, juvenile justice, and education.

Electronic Health Records (EHRs) in SMHAs

■ Almost all (46) reporting States (94 percent) are either implementing or considering the adoption of EHRs in their State 

psychiatric hospitals and/or community 

mental health systems. Five States have 

already implemented a complete EHR 

system in their State psychiatric hospitals, 

while 18 States have implemented some 

EHR components but do not yet have all 

parts of EHRs implemented. Twenty-one 

States reported that EHRs are installed 

(in full or part) in community mental 

health provider agencies.

■ Twenty States have agreements about sharing EHR client-level data between providers; however, there is some variation about 

these agreements.

■ Twenty-one (55 percent) of the reporting 

States have implemented an electronic 

pharmacy/medications ordering system.

These findings demonstrate that SMHAs 

are devoting considerable resources and 

effort to implementing EHR systems, building data warehouses, linking multiple data 

systems, and enhancing their information 

systems capacity. However, some SMHAs 

are also continuing to work with legacy 

computer systems and often with fragmented 

data systems.

While SMHAs report compiling common 

client data elements, there are inherent variations in the data collected and in the operational definitions used across the States. 

Caution should be exercised when interpreting and comparing data across States.

Characteristics of State Mental Health Agency Data Systems 5

1. Overview

State mental health agencies (SMHAs) are 

the part of State government responsible for 

operating and funding services for adults 

with serious mental illnesses and children 

and adolescents with serious emotional 

disturbances. SMHAs serve as a safety net, 

providing mental health services to the most 

vulnerable individuals. SMHAs are also 

responsible for planning and developing 

comprehensive community-based mental 

health systems, and in most States serve key 

public health functions including mental 

health awareness and promotion, anti-stigma 

programs, and suicide prevention. In 2007, 

SMHAs provided services to more than 

6 million persons (2 percent of the U.S. population) and spent more than $30 billion on 

these services (equivalent to $5,000 per person served).

Critical to the mission of SMHAs are 

monitoring the public mental health service 

system for service gaps; ensuring that persons 

with mental illness receive timely, appropriate, and needed services; reimbursing mental 

health providers for services provided; and 

building accountability performance targets 

and outcome measures. Having modern 

information systems that can count clients, 

measure outcomes, track system performance, facilitate care coordination, and at 

“Since 1773, providing services for persons with serious mental illness in the United States has been the responsibility 

of State governments,” (Torrey, Earman, Wolfe, & Flynn, 

1990, p. i).

times even reimburse for services is fundamental to the SMHA’s ability to fulfill these 

functions. Thus, information technology 

(IT) plays a major role in facilitating 

SMHA achievement of its core missions. 

However, little has been reported about 

SMHAs’ IT system capacities, organization, 

and directions.

SMHA service systems are complex and 

vary widely from State to State. In every 

State, the SMHA is responsible for operating 

inpatient psychiatric beds (usually in State 

psychiatric hospitals) and supporting a community based mental health system that is 

either State operated or State funded. In most 

States, the bulk of community mental health 

services are provided by local not-for-profit 

community mental health agencies that 

receive substantial portions of their funding 

from the SMHA; however, the majority of 

their funds come from other sources. For 

example, in fiscal year (FY) 2005, SMHAfunded community mental health programs 

received 50 percent of their funding from 

Medicaid, a State-Federal health insurance 

program for the poor or disabled that reimburses local providers for the services they 

render to clients (National Association of 

State Mental Health Program Directors 

Research Institute, Inc., 2007).
6 Characteristics of State Mental Health Agency Data Systems

Each community mental health agency 

funded by the SMHA usually maintains its 

own information management system, billing system, and clinical records. The SMHA 

information management systems rely on 

data reported by these local community 

mental health agencies, store these data in 

the central SMHA data system, and produce 

reports that portray a comprehensive picture 

of services provided statewide.

1.1 National Initiatives Impacting 

Mental Health IT Systems

Recent Federal initiatives have focused 

attention on the capacity of State mental 

health IT systems to generate common outcome measures for States and national 

reporting of State data. These initiatives 

are as follows:

1.1.1 The President’s New Freedom 

Commission (PNFC) on Mental Health

In 2002, President George W. Bush commissioned the New Freedom Commission on 

Mental Health to study the mental health 

service delivery system, and “to recommend 

improvements to enable adults with serious 

mental illnesses and children with serious 

emotional disturbances to live, work, learn, 

and participate fully in their communities” 

(Bush, G. W., 2002). The report of the President’s New Freedom Commission on Mental 

Health (PNFC, 2003) recommended “a fundamental transformation to the Nation’s 

approach to mental health care” (p. 1). To 

guide this transformation of mental health 

services, the PNFC established six major 

goals for transforming mental health services. Goal 6 focuses on improving the use of 

technology to improve access to care and the 

quality of mental health services:

Goal 6: Technology is Used to Access Mental 

Health Care and Information

6.1 Use health technology and telehealth to 

improve access and coordination of mental 

health care, especially for Americans in 

remote areas or in underserved populations.

6.2 Develop and implement integrated electronic health record and personal health 

information systems.

SMHAs are in the front lines of implementing the goals of the President’s New 

Freedom Commission. SMHAs have continuously been working to enhance their use of 

technology to improve care through the 

adoption of 21st century health information 

technologies such as electronic health records 

(EHRs), data warehouses, probabilistic 

record linking, and development of personal 

health records. However, to date not all 

States have been able to replace old “legacy” 

information systems. Without newer, more 

expensive technology it is difficult to collect 

all the information needed to measure outcomes or track system performance.

1.1.2 Institute of Medicine Report

In 2006, the Institute of Medicine (IOM) 

released its report, Improving the Quality 

of Health Care for Mental Health and 

Substance-Use Conditions, which reviews 

the status of mental health and substance 

abuse services and proposes a series of 

action steps using the framework of the 

earlier IOM report, Crossing the Quality 

Chasm (2001). The IOM found that in 

comparison to general health care “mental 

health IT is less well developed and less 

commonly used for clinical care support” 

(p. 60). The IOM report identifies a series 

of action steps to improve the use of mental 
Characteristics of State Mental Health Agency Data Systems 7

health information and outcome measures, 

promote the use of electronic health records, 

and enhance the electronic exchange of mental health information between providers 

and payers.

The IOM report includes a series of specific recommendations, among them recommendations 4-2 and 4-3 (monitoring quality 

of care and outcomes), 5-1 and 5-4 (linking 

and sharing service and outcome information among providers), and 6-1, 6-2, 6-3, 

and 6-4 (use of the national information 

infrastructure, including electronic health 

records, and clinical decision support systems), that reflect the importance of improving the IT and care monitoring of mental 

health and substance use services. State 

mental health agency data and IT needs are 

specifically identified as key areas for ensuring the provision of high-quality mental 

health services. The need for SMHA IT systems to collect high-quality process and outcome measures, to share these data electronically with other providers and systems, and 

to support the adoption and utilization of 

electronic health records by mental health 

providers is highlighted.

1.1.3 SAMHSA’s National Outcome 

Measures (NOMs)

In 2004, SAMHSA announced 10 NOMs 

for mental health and substance abuse. The 

NOMs, which are to be measured across all 

SAMHSA-funded programs, promote the use 

of information to improve services for persons with mental illnesses and substance use 

problems. The NOMs were selected to provide data for program accountability, with 

recovery and resiliency as the tenets in providing mental health services.

The mental health NOMs include measures of how well clients are managing their 

illnesses and living and working in the community, with a focus on recovery and resiliency-oriented measures. These NOMs are 

improved functioning for persons receiving 

mental health services; obtaining and keeping a job or enrolling and staying in school; 

decreased involvement with the criminal justice system; securing a safe, decent, and stable place to live; and having social connectedness to and support from others in the 

community such as family, friends, coworkers, and classmates. Two other NOMs directly address the availability of treatment: 

increased access to mental health services 

and decreased inpatient rehospitalizations 

for mental health treatment. The final three 

NOMs examine the quality of services 

provided: client perception of care, costeffectiveness, and use of evidenced-based 

practices in services.

SAMHSA uses a set of common data 

tables—the Uniform Reporting System 

(URS)—to generate the mental health NOMs 

for the Community Mental Health Block 

Grant. To facilitate SMHA reporting of the 

URS data used for the NOMs, CMHS/

SAMHSA has provided grants to 49 States, 

the District of Columbia, and 8 U.S. territories to support enhancing and modifying 

their mental health IT systems.

1.1.4 State-Level Systems

In addition to the SAMHSA NOMs initiative, many SMHAs have their own State-level 

performance and accountability systems that 

use the SMHA IT systems to generate outcome measures. In 43 States, the outcome 

measures of interest are specified by SMHA 

administrators, and in four States (Arizona, 

the District of Columbia, Hawaii, and Texas) 

the SMHA has agreed to court mandated 

outcome measures as a result of civil lawsuits. These additional data requirements 

often complicate the IT enhancement 
8 Characteristics of State Mental Health Agency Data Systems

undertaken by States. The varied data 

requirements from multiple sectors (funding 

institutions as well as political bodies) usually result in the SMHA collecting numerous 

client data and outcome measures, thereby 

burdening the entire system.

1.2 Types of Client Information 

Maintained in SMHA IT Systems

Every SMHA is collecting information about 

mental health clients. However, the level of 

detail and the content of the information 

about clients vary widely from State to State. 

The following are some categories of data 

that the States collect:

1.2.1 Encounter/Claims Data

Since October 16, 2004, all electronic claims 

records must be compliant with the Health 

Insurance Portability and Accountability Act 

of 1996 (HIPAA) transaction code standards.

Claims records contain details on specific 

clinician-client treatment interaction (procedure codes, provider ID, and billing amount); 

hence they do not always contain information on the overall client well-being, such as 

employment status, living situation, criminal 

justice contacts, and satisfaction with services, required for the NOMs reporting.

Encounter records are similar to claims 

records, except they may not include the 

actual billing amount. Encounter records are 

often reported instead of claims records when 

managed care, capitated or other financing 

strategies are used that do not require a billing claim be filed for each service event.

1.2.2 Client-Level Outcome Data

Client-level outcome data systems maintain 

information specific to each individual client 

enrolled for services, and are often updated 

at specified time intervals.

■ Client-level outcome systems maintained 

by SMHAs often do not include encounter/

claims data, but instead focus on a series 

of key client demographic variables: age, 

gender, race, ethnicity, primary language 

spoken, and service-related items: diagnosis, level of functioning, symptoms, current employment status, current living 

situation, school attendance, criminal justice involvement, serious mental illness/

serious emotional disturbance status, and 

marital status.

■ Client-level outcome data systems maintain much less information about specific 

clinicians and service events, and instead 

focus on client status.

■ Client-level variables that can change (such 

as employment status or living situation) 

are often (but not always) updated on a 

regular basis. States vary widely regarding 

how often these measures are updated, 

with annual updates most typical.

■ Some States collect outcome measures 

only for some identified “priority” population or persons receiving a specific mental health service such as assertive community treatment (ACT) or targeted case 

management.

■ SAMHSA’s NOMs for both mental health 

and substance abuse rely on this type of 

client outcome data.

1.2.3 Provider Databases

Many SMHAs require providers to submit 

information annually or more often about 

their operations, staffing, services, and 

financing. These provider reports may be 

linked to client data or may be used by the 

SMHA. For example, providers could report 

on the race/ethnicity and primary languages 

of both their clinicians and their clients. The 
Characteristics of State Mental Health Agency Data Systems 9

SMHA could use this information to assess 

cultural competence and potential health disparities without requiring the provider to submit information about specific clients.

1.2.4 Client Survey Data

All SMHAs conduct client surveys for adult clients and children and their families to ascertain 

their perspectives on the quality, appropriateness, and outcomes of services. In most States 

these client surveys are conducted as anonymous surveys that cannot be linked to other 

administrative or clinical information systems. 

A few States are using surveys coded “confidential” in which individual responses can be 

linked to administrative databases.

1.2.5 Client Sample-Based Data

In a few States, the SMHA does not receive client-level data on all clients but instead has 

developed a sample-based procedure for understanding care provided. This approach relies on 

a sample being drawn to gather detailed clientlevel information on some clients that can then 

be extrapolated to represent the overall system 

without placing on providers the costs and burden of reporting detailed client-level information on all clients. One State collects detailed 

data on all clients served during a 2-week window. In other States, the level of reporting varies, with providers of high-cost services (such as 

ACT Teams), reporting more detailed clientlevel data and providers of other community 

services reporting less detail.

1.2.6 Linked Data Systems

Several States have used advances in data warehouse technologies and data-matching statistical approaches to augment the client-level data 

collected from providers. For example, Vermont has been a leader in using population 

probabilistic estimation procedures to supplement its SMHA IT system with data from corrections, public health, and other State agencies. This procedure can generate outcome 

measures for the SMHA without requiring 

mental health providers to collect and report 

data on arrests or employment status. Using 

existing data compiled by other State agencies 

has the additional benefit of facilitating cooperation between State agencies in providing services to mental health clients and informing the 

agencies of the overlap in services between 

agencies.

1.3 Report Organization

Section I provides a brief overview of State 

Mental Health Agencies. 

Section II reviews the methodology used for 

collecting the information for this report, as 

well as the limitations of the information.

Section III discusses the overall structure 

of mental health IT systems in State 

government.

Section IV examines the extent to which 

SMHAs maintain client-level data systems, the 

content of their client-level database, and how 

frequently client data are updated.

Section V reviews the encounter/claims data 

contained within the SMHA information systems. It also reviews the level of medication/

pharmacy information maintained by SMHA 

information systems.

Section VI discusses the SMHA activities in 

linking databases with those of other State 

agencies. Often, data derived from this activity 

can generate outcome measures and provide 

opportunities to better coordinate the delivery 

of mental health services across State 

government.
10 Characteristics of State Mental Health Agency Data Systems

Section VII reviews the implementation 

of electronic health records within SMHA 

systems. This section includes a review 

of SMHA activities to share electronic health 

information, both between providers and 

with clients through personal health records.

Section VIII briefly summarizes the findings 

of the report.

Appendix 1 provides definitions of terms 

used in this report.
Characteristics of State Mental Health Agency Data Systems 11

II.

2.1 Study Approach

The National Association of State Mental 

Health Program Directors Research Institute, Inc. (NRI) maintains several databases 

about SMHAs. The SMHA Profiling System 

(SPS) provides a central database of information describing the organization, funding, 

operation, services, policies, statutes, and 

clients of SMHAs. This database describes 

each SMHA’s organization and structure, 

service systems, eligible populations, emerging policy issues, number of clients served, 

fiscal resources, client issues, information 

management structures, and the research and 

evaluation it conducts. Questions within each 

component are designed to address specific 

needs of SMHA managers and others interested in public mental health systems, and 

to support decision making, policy analysis, 

research, and evaluation.

Individual State responses to the Profiles 

are available on NRI’s Web site at www.

nri-inc.org. On the Profiles Web site, users 

can access State responses by keyword, by 

State, and by special topical reports (Center 

for Mental Health Services, 2006).

To better understand the current IT landscape of SMHA systems, CMHS partnered 

with the SMHAs’ national research organization, NRI. To provide a comprehensive 

review, NRI used the Profiling System to 

gather the relevant and necessary information by greatly expanding the SMHA Information Management (IT) Component of 

the 2007 cycle.

The expanded IT component was 

designed to gather information from SMHAs 

about how their IT systems are organized 

and staffed, types of data elements maintained, and the frequency of data updates. 

Staff from CMHS as well as an expert advisory panel reviewed and provided valuable 

insight into the development of the revised 

IT profiles component. The component was 

then reviewed by State IT staff in several 

States before being finalized.

Once NRI finalized the IT component of 

its SPS, copies of the component were sent to 

all SMHA commissioners/directors and to 

their agency’s information systems contact 

persons for completion during late spring of 

2007. States were offered several methods of 

data submission: they could input the 

requested information through the NRIdeveloped SPS online data entry system or 

complete the questions on the form itself and 

either fax, mail, or e-mail the completed 

form to NRI.

All 50 States, the District of Columbia, 

and four U.S. territories (the Federated 

Study Approach and 

Limitations

This section briefly describes the study approach and limitations of 

this report.
12 Characteristics of State Mental Health Agency Data Systems

States of Micronesia, Palau, Puerto Rico, and 

the Virgin Islands) submitted responses to 

the IT component (Connecticut submitted 

two forms—one for the adult State department and the second for the children’s 

State department).

Compiling information directly from 

each SMHA’s office responsible for maintaining the SMHA’s IT infrastructure provides a significant strength in that information about these technical systems comes 

irectly from the persons building and 

using them.

2.2 Limitations

While there was a high response rate from 

the States, the completion rate for individual 

items varied across States. Some States did 

not answer all questions asked; therefore, 

some data/information used in this report is 

based on response from less than the total 

number of reporting States.
Characteristics of State Mental Health Agency Data Systems 13

This section describes the structure of State mental health agencies’ 

information technology systems. It reviews the organizational locations of the information system architecture and implementaion of 

electronic health records (EHRs).

III.

agency, the SMHA’s IT system is under the 

control of the umbrella agency’s centralized 

information systems. Even where the SMHA 

is a cabinet-level department, a centralized 

State IT department in the Governor’s office 

may have a major role in determining the 

software, hardware, and types of data that 

the SMHA can collect and the reports it 

can generate.

Moving SMHA IT functions into a system coordinated across State divisions within a larger umbrella agency can have benefits 

by providing the opportunity for better data 

sharing; better integration of services and 

coordination of care can result.

3.2 Mental Health Information 

Technology Staffing and Budgets

In 2007, 52 States reported a total of 

986 full-time equivalents (FTEs) devoted 

to mental health information management 

functions. The number of FTEs devoted to 

mental health ranged from a low of 1 in 

North Dakota and West Virginia to a high 

of 227 in New York. Of the total number 

SMHA Information 

Technology, Structure, 

and Architecture

3.1 SMHA Organizational Location 

Within State Government

SMHAs are designated by the Governor and/

or State legislature in each State and are typically organizationally located as a division 

within a larger Department of Health or 

Department of Human Services (35 States). 

In 13 States, the SMHA is an independent 

cabinet-level agency.

Over the past 30 years, a number of 

SMHAs have been reorganized within State 

government, from independent departments 

to divisions within a larger umbrella agency. 

The logic behind this change is often to 

foster collaboration and coordination with 

the SMHA’s new “sister” divisions in the 

umbrella organization. In particular, Medicaid and State health divisions are often part 

of the same agency.

Given the recent changes in the administrative structure of most SMHAs it is important to understand where the operational 

control of the mental health information 

technology system lies. In many States where 

the SMHA is a part of a larger umbrella 
14 Characteristics of State Mental Health Agency Data Systems

of FTEs reported, 853 (87 percent) are located within the SMHA and 131 (13 percent) 

are located in an umbrella agency outside 

the SMHA.

Thirty-seven States (60 percent) were 

able to report expenditures for mental 

health information management functions. 

These States reported spending a total of 

$99,564,957 for mental health information 

management functions in FY2007. The 

median State spending was $517,667, with a 

range from $84,552 in Iowa to $44,900,000 

in New York. State expenditures for mental 

health IT functions represented an average 

of 18 percent (median of 14 percent, ranging 

from 1 percent in Maryland to 59 percent in 

Missouri) of SMHA expenditures for central 

office and other support activities such as 

research and training, and represented 0.5 percent (median of 0.2 percent, ranging from 

0.1 percent in Pennsylvania to 2 percent in 

Oklahoma) of total SMHA-controlled expenditures for mental health services (National 

Association of State Mental Health Program 

Directors Research Institute, Inc., 2007).

3.3 Organizational Location of the 

Management and Operations of 

Computers for the SMHA

In 34 (67 percent) of 51 reporting States, the 

management and operation of computers are 

part of an umbrella agency that either runs 

computer hardware systems for the SMHA 

or funds and controls hardware acquisition, 

or does both. Figure 1 depicts the location of 

the management and operation of computers 

in each State.

In 17 of the 54 reporting States (31 percent), the management and operation of 

computers are located within the SMHA, 

DC

NJ

MA

RI

CT

MD

DE

NH

VT

WA

ID

NV

CA

OR

NM AZ

UT

WY

MT ND

SD

NE

KS

MI

TX

CO

MS

LA

AR

MO

IA

MN

AL

KY

OH IN

OK

IL

WI

TN NC

SC

GA

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ME

NY

PA

WV

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HI

AK

VI

PR

GU FM

PW

Figure 1: Location of the Management and Operation of Computers

No Response (1)

Shared between the SMHA

and other agency (21)

Within the SMHA (17)

Outside the SMHA (16)
Characteristics of State Mental Health Agency Data Systems 15

while in 16 States (30 percent) these functions are located outside the SMHA in an 

umbrella agency. In 21 States (39 percent) 

these functions are shared between the 

SMHA and other agencies.

In 34 (64 percent) of the 53 reporting 

States, data management, such as updating 

data and quality control, are located within 

the SMHA. Similarly, 40 (73 percent) out of 

55 States reported that generating data and 

performance reports as well as data analysis 

functions are located within the SMHA. The 

warehousing of SMHA data that are linked 

with other State agency data is within the 

purview of the SMHA in 20 (45 percent) 

of the 44 States reporting. This function is 

shared between the SMHA and another 

agency in 12 States (27 percent), while in 

12 (27 percent) other States it is located 

outside the SMHA.

Table 1 depicts the organizational locations 

of the SMHAs data management function.

3.4 Mental Health Information 

Management and Its Level of 

Integration with Substance Abuse 

and Developmental Disability

A total of 34 States (67 percent) reported an 

integrated mental health data system with 

substance abuse or developmental disability 

agencies or both. Thirty States (59 percent) 

have integrated mental health and substance 

abuse data systems, while 14 States (27 percent) have integrated mental health and 

developmental disability systems. Ten States 

(20 percent) reported having integrated all 

three service areas: mental health, substance 

abuse, and developmental disabilities. Texas 

and Idaho pointed out that they are in the 

early stages of integrating the mental health 

information management functions with 

substance abuse (Texas’ mental health information management is currently integrated 

with mental retardation/developmental disabilities). Sixteen States (31 percent) reported 

that their mental health information management functions are only for mental health 

and are not combined with any other disability services.

3.5 SMHA Information Systems 

Architecture

SMHA information systems usually have two 

different components:

1. State psychiatric hospitals, which are 

operated by State government and staffed 

by State employees. States have operated 

such hospitals for more than 150 years. 

Table 1: Organizational Locations of Information Management Functions

Information

Management

Functions

Locations

Within the SMHA

Outside the SMHA 

(in Umbrella Agency)

Shared Between SMHA 

and Other Agency

# of States % # of States % # of States %

Management and operation of 

computers 17 31% 16 30% 21 39%

Data management, such as updating 

and quality control 34 64% 4 8% 15 28%

Generating data and performance 

reports, analysis of data 40 73% 1 2% 14 25%

Data warehouse of SMHA data 

linked with other State agency data 20 45% 12 27% 12 27%
16 Characteristics of State Mental Health Agency Data Systems

In these inpatient facilities, the SMHA 

has complete control over client data 

and medical records.

2. Community mental health systems, which 

are usually contracted with either private 

not-for-profit community-based providers or with county or city governments. 

Since community mental health services 

are usually funded but not operated by the 

SMHA, community mental health providers have their own information management systems and report data periodically 

to the SMHA as a funding program.

The information systems of many SMHAs 

reflect the duality of two different mental 

health service systems. Furthermore, the two 

different IT systems may contain vastly different levels of client information. To coordinate care and monitor performance across 

their entire system, SMHAs are working to 

merge, or at a minimum, develop the capacity to link, the two IT systems.

3.6 Databases

State Mental Health Agencies: SMHAs use 

a variety of IT platforms, often using multiple platforms within the agency. Various 

Microsoft products, IBM mainframe, UNIX, 

and AIX are the most popular platform systems. Microsoft SQL (used in 26 States) and 

Oracle (7 States) are the two most widely 

used database software programs. An additional nine States are using both Microsoft 

SQL and Oracle. Other software in use 

includes SPSS, Access, Cache, Sybase, IMS, 

and DB2.

State Psychiatric Hospitals: In 40 States the 

State psychiatric hospitals have separate IT 

architecture from the SMHA. Much like the 

SMHAs, State psychiatric hospitals use multiple platforms in their IT systems. Microsoft 

SQL (used in 10 States) and Oracle (4 States) 

are the two most popular database software 

programs (an additional 4 States are using 

both SQL and Oracle). State psychiatric hospitals use a variety of other software programs including Cache, Access, Linux, 

Informix, and Sybase.

3.6.1 Legacy Information Management 

Systems

In 21 of the 50 reporting States (42 percent), 

the SMHA maintains or uses legacy systems. 

Of these 21 States, 12 States (57 percent) use 

legacy systems to store, process, and report 

mental health data, 3 States (14 percent) use 

them to access old data files not migrated to 

the new system, and 6 States use legacy systems for both functions.

3.6.2 Application Software

The SMHAs and State psychiatric hospitals 

use a variety of State-owned and proprietary 

application software for recording client 

information, analyzing data, generating 

report, and processing claims and encounters. Application software used in the 

SMHAs and State psychiatric hospitals 

includes Lotus, SPSS, Crystal Reports, SQL, 

SAS, Excel, COBOL, Oracle, Access, COGNOS, Avatar, Java, and a variety of homegrown programs.

3.6.3 Source Code of the Application 

Software for Recording Client 

Information

State Mental Health Agencies: Forty-six 

States reported 72 software applications for 

recording client information, of which 43 (60 

percent) are State owned, 12 (17 percent) are 

combined State owned and proprietary, and 

17 (24 percent) are proprietary.

State Psychiatric Hospitals: Thirty-two States 

reported 42 software applications used for 
Characteristics of State Mental Health Agency Data Systems 17

recording client information, of which 22 

(52 percent) are State owned, 18 (43 percent) 

are proprietary, and 2 (5 percent) are combined State owned and proprietary.

3.6.4 Source Code of the Application 

Software for Data Analysis

State Mental Health Agencies: Forty-five 

States reported 70 software applications 

used for data analysis, of which 20 (29 percent) are State owned, 43 (61 percent) are 

proprietary, and 7 (10 percent) are combined 

State owned and proprietary.

State Psychiatric Hospitals: Twenty-six 

States reported 78 software applications, of 

which 30 (38 percent) are State owned, 42 

(54 percent) are proprietary, and 6 (8 percent) are combined State owned and 

proprietary.

3.6.5 Source Code of the Application 

Software for Report Generation

State Mental Health Agencies: Forty-five 

States reported 68 software applications, of 

which 21 (31 percent) are State owned, 39 

(57 percent) are proprietary and 8 (12 percent) are combined State owned and 

proprietary.

State Psychiatric Hospitals: Twenty-seven 

States reported 34 software applications, of 

which 13 (38 percent) are State owned, 18 

(53 percent) are proprietary, and 3 (9 percent) are combined State owned and 

proprietary.

3.6.6 Source Code of the Application 

Software for Processing Claims/

Encounters

State Mental Health Agencies: Thirty-five 

States reported 45 software applications, 

of which 19 (42 percent) are State owned, 

19 (42 percent) are proprietary, and 7 

(16 percent) are combined State owned 

and proprietary.

State Psychiatric Hospitals: Twenty-three 

States reported 27 software applications, of 

which 13 (48 percent) are State owned, 13 

(48 percent) are proprietary, and 1 (4 percent) 

is combined State owned and proprietary.

3.7 Data Flow

3.7.1 Data Flow Between SMHAs and 

Community Mental Health Providers 

and/or County Mental Health Providers

Twenty-eight of the 41 reporting SMHAs use 

a Web-based interface or data transfer system 

to collect data from local providers, while 13 

(32 percent) reported that data collection 

from the local providers is largely or entirely 

manual or paper based.

3.7.2 Data Flow Between State Psychiatric 

Hospitals and Community Mental Health 

Providers

Thirty-two States (69 percent) reported data 

interchange between the State and community mental health providers and/or county 

mental health authorities. In 10 of these 

States (31 percent), data flow between the 

State psychiatric hospital and community 

providers is Web based, while in 12 States 

(38 percent) data exchanges follow certain 

protocol or processes. Ten States (31 percent) 

reported that there is no data flow between 

State psychiatric hospitals and community 

mental health providers.

3.8 Data Edits

State Mental Health Agencies: Forty-three of 

the 49 reporting SMHAs are using standard 

edits in their data system to check data submitted by local providers prior to acceptance 

in the SMHA data system.
18 Characteristics of State Mental Health Agency Data Systems

State Psychiatric Hospitals: Seventeen of the 

28 reporting States use standard data edits in 

their State psychiatric hospital data system.

The questions about State ownership and 

control over source codes for software applications are important because they reflect 

the extent to which State governments are 

able to modify the software applications 

without having to pay outside providers to 

do so. If the State controls the software 

code, the State is responsible for making 

changes to the software to meet new data 

requirements (such as for SAMHSA’s mental 

health NOMs). If the ownership of the software code is proprietary, the SMHA must 

often pay private providers to make such 

changes. In some instances, the relatively 

small size of mental health IT systems may 

result in SMHAs having fairly low priority 

among large software vendors in getting 

code changes implemented.
Characteristics of State Mental Health Agency Data Systems 19

This section reviews the IT capacities of SMHAs related to client-level 

data and describes the capacity of States to generate unduplicated 

client-level information across their public mental health system.

State Models for 

Client-Level Data 

Collection

IV.

of clients, who may receive services at 

multiple community and hospital providers 

throughout their course of treatment or 

who may have multiple episodes of care. 

States use unique identifiers primarily to 

maintain client records unique for each individual. Unique identifiers are used to match 

encounter or payment records with the client’s clinical, demographic, and other information throughout the course of the client’s 

treatment.

Fifty-two out of 55 States (95 percent) 

reported that they have either a unique 

identifier or a method of unduplicating 

clients across their State psychiatric hospitals and community-based service providers. 

Forty-one (41) States (79 percent) use an 

assigned identifier (a unique identifier that 

does not use any portion of the client’s 

record in its creation), 25 States (48 percent) 

include the social security number (SSN) as 

an identifier (either using SSN only or SSN 

and a combination of other identifying data), 

16 States (31 percent) use a constructed 

identifier (an identifier formed by using 

parts of an individual record, such as 

Most SMHA IT systems maintain client-level 

data on clients treated in both the State psychiatric hospitals and community systems. 

These data systems often include client-level 

data for the entire community-based mental 

health system. States use a combination of 

unique identifiers and various database linking algorithms to develop unduplicated client-level data sets across SMHA entities and 

systems, and increasingly across Medicaid 

and other State agencies serving mental 

health clients.

States range from having regularly reported client-level data including detailed encounter-level information, to relying heavily on 

periodic client samples and aggregate reporting without routine reporting of client-level 

data from community providers to the 

SMHA. States that have client-level data 

vary widely regarding the specific data elements collected and how frequently these 

data are updated.

4.1 SMHA Use of Unique Identifiers

Many information systems use unique client 

identifiers to develop unduplicated counts 
20 Characteristics of State Mental Health Agency Data Systems

NJ

MA

RI

CT

MD

DE

DC

NH

VT

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ID

NV

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OR

NM AZ

UT

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MT ND

SD

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MI

TX

CO

MS

LA

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initials and date of birth), and 9 States 

(17 percent) use some other identifier, such 

as a Medicaid number, encrypted SSN, or 

county ID. Figure 2 illustrates the types of 

unique identifiers SMHAs use. Many States 

use multiple identifiers to unduplicate clients 

treated by two or more providers instead of 

relying on just one identifier.

The use of identifiers varies between State 

psychiatric hospitals and community mental 

health service providers. Thirty-one out of 55 

(56 percent) of the SMHAs reported using 

the same identifier for both State psychiatric 

hospitals and community mental health service providers. Seventeen SMHAs (32 percent) reported that the identifier used by the 

SMHA is also used by other State government agencies, thereby permitting linking of 

client records among multiple State social 

and health service systems.

4.2 SMHAs Collect Client-Level Data

Fifty-three out of 55 reporting States (96 percent) maintain an individual client-level dataset for clients served in community mental 

health settings. However, some SMHAs 

receive data only for selected client populations, or only certain types of mental 

health service providers provide data. Of 

the 53 SMHAs that maintain an individual 

client-level database, 34 (64 percent) receive 

unique client information from all community mental health services providers, while 

17 (32 percent) receive such information 

from only some community mental health 

service providers.

No Response (2)

Combination of IDs (26)

No Unique ID (2)

Assigned (17)

SSN based (5)

Constructed (3)

Figure 2: Types of Unique Identifiers Used by SMHAs
Characteristics of State Mental Health Agency Data Systems 21

4.3 Frequency of Client-Level Data 

Transmission From Mental Health 

Service Providers to SMHA IT 

Systems

Client-level data are sent to the SMHA from 

local providers at a variety of time intervals. 

Out of the 53 reporting States, 20 (38 percent) receive data from providers monthly, 

10 (19 percent) receive data instantaneously 

through direct interface between the providers and the SMHA, 8 (15 percent) receive 

data on both a daily and weekly basis, and 

3 (6 percent) receive data annually (see 

table 2).

Table 2: Frequency of Client-Level Data 

Transmission to the SMHA

Frequency

Number 

of States

% of 

States

Monthly 20 38%

Instantly—linked 10 9%

Weekly 7 6%

Daily 8 13%

Quarterly 5 15%

Annually 3 19%

4.4 Frequency of Client-Level 

Data Update Submission From 

Providers to the SMHA

SMHAs ask local community mental health 

providers update individual client data elements at specified times. As depicted in 

table 3, 41 States receive client-level information at admission, 20 receive updates 

annually, and 25 receive updates at other 

intervals, ranging from biweekly to semiannually. Only 6 States receive updates on 

client outcomes post discharge.

Table 3: Frequency of Client-Level Data 

Update

Frequency

Number 

of States

% of 

States

At admission 41 77%

At discharge 34 64%

Other period 25 47%

Annually 20 38%

Post discharge 6 11%

4.5 SMHA Receipt of Client Data 

From County/Local Government 

and Managed Care Organizations 

(MCOs)

SMHAs obtain client-level or aggregate 

client data from a variety of sources. In 

41 States, data are received directly from 

local providers. Data received directly from 

local providers are often sent at the client 

level; however, in seven States local providers submit aggregate data to the SMHA. 

In 11 States, the SMHA receives client-level 

data via county/city mental health government agencies, while in 1 State the SMHA 

receives aggregate data. In these instances, 

local mental health providers submit data 

to the city/county mental health authority, 

which in turn submits data to the SMHA. 

In many States, a Medicaid managed care 

organization (MCO) waiver covers some 

behavioral health services. In 9 States, the 

MCOs submit client-level data to the 

SMHA, while in 24 States the SMHA 

receives client-level data in the form of 

Medicaid paid claims, with additional 

data to supplement reporting (see table 4).
22 Characteristics of State Mental Health Agency Data Systems

Table 4: Sources of Mental Health Data

Sources of Data

Receiving 

ClientLevel Data

Receiving 

Aggregate 

Data

N % N %

Directly from Local 

Providers 41 77% 7 13%

County/City Authorities 11 21% 1 2%

Managed Care 

Organizations 9 17% 0 -

Medicaid Paid Claims data 24 45% 0 -

4.6 SMHA Relation to Local Providers 

to Receive CMHS Uniform 

Reporting System (URS) and Other 

Client Data

In 33 States, the SMHA contractually 

requires local entities to provide data to the 

SMHA. In 16 States, the SMHA offers financial support to local providers to report URS 

data, while 10 States provide financial assistance for reporting other client data. SMHAs 

also provide training in 28 States and technical assistance in 26 States to local entities on 

the reporting and use of data. SMHAs give 

local providers feedback reports showing the 

results of URS (22 States) and other data 

(27 States) (see table 5).

Table 5: Relation of SMHA to Local 

Providers to Receive URS and Other 

Client Data

Relationship

Number 

of States

% of 

States

Contractually requires local entities 

to report data 33 62%

Provides training to local entities to 

report data 28 53%

Provides reports based on other 

client data 27 51%

Provides technical assistance to 

local entities to report and use data 26 49%

Provides reports based on URS 

data 22 42%

Provides financial support for URS 

data reporting 16 30%

Provides financial support for other 

data reporting 10 19%

4.7 SMHA IT Systems Contents

SMHAs collect a variety of information at 

the client level. The types of information 

include basic client information, outcomesrelated information, billing and service 

encounter data, and information about the 

service providers and clinicians delivering 

care. The most frequently collected data 

elements are the client’s date of birth, living 

situation, employment status, and mental 

health diagnosis.

A few client-level data elements do not 

need to be updated at multiple time points, 

and can instead be collected at admission 

(such as a client’s date of birth, gender, race, 

ethnic origin or SSN). However, most clientlevel data elements can change over time. For 

example, a client’s diagnosis may change as 

he or she moves through treatment. The location where clients live may change frequently, 

and clients’ symptoms and level of functioning are likely to change as they receive mental health services.

SMHAs collect many of the same data 

elements on clients they serve, but not all 

SMHAs collect these data elements at the 

same intervals. SMHAs were asked how 

often they require various client-level data 

to be updated. Although most States receive 

the majority of these measures at admission, 

many States tend to select specific measures 

to be updated periodically-mostly data elements used for the NOMs and other State 

and Federal priority data requirements.

Most of the NOM-related measures are 

maintained by SMHAs as client-level data, 

but States vary widely regarding how often 

they update the client information. Several 

States reported that they do not update the 

measures at all and maintain only admission 

status. For example, eight States (15 percent) 

reported that they receive living situation 
Characteristics of State Mental Health Agency Data Systems 23

data only at admission, and an additional 

eight States (15 percent) reported that they 

receive an update only at discharge–they do 

not update a client’s living situation while the 

client is receiving services.

4.8 SMHA Pattern of Admissions and 

Discharges

The SMHAs report on more than 6 million 

individuals served through their mental health 

systems each year. The nature of serious 

mental illnesses and serious emotional disturbances means that many clients in the public 

mental health system remain on the rolls for 

long periods, and thus have neither an admission nor a discharge record during any particular 12-month period. This has major 

implications for measuring outcomes of mental health services, in that outcome systems 

that assess change in client status from admission to discharge will exclude more than half 

the clients served by SMHAs each year.

Twenty SMHAs reported data on the 

profile of clients in State data systems by 

admission and discharge status within a 

year. The 20 reporting SMHAs served more 

than 2 million clients, with a median of 

45,833 clients and a range from 5,957 in 

Delaware to 657,522 in California. The data 

from these States show that 961,096 (44 

percent) of the clients served during the year 

were admitted to services during the year, 

with a median of 22,735 clients and a range 

from 2,904 in Delaware to 335,536 in California. According to the reported data, 

1,203,137 (56 percent) were already clients 

at the start of the year, with a median of 

26,265 clients and a range from 3,053 in 

Delaware to 321,986 in California. There 

were 891,015 (41 percent) clients in services 

for the entire year (they were neither admitted nor discharged during the year), with a 

median of 18,132 clients and a range 2,500 

clients in Delaware to 294,540 clients in 

New Jersey.

The reported data suggest that many clients of the SMHAs are active recipients of 

services for longer than a year. Clients who 

were already on the mental health service 

rolls at the start of the year are significantly 

likely to be on the rolls at the end of the year 

(74 percent), while clients who were admitted 

into services during the year were more likely 

to be discharged during the year (49 percent 

of admissions).

Even among the clients admitted into public mental health services during the year, 

51 percent were still active clients at the end 

of the reporting year.

Characteristics of State Mental Health Agency Data Systems 25

Table 6: Types of Encounter Data Received 

by SMHAs

Types of Encounters

Number of 

States

% of 

States

Case management 15 79%

Medications 14 74%

Treatment services 

(counseling, therapy, etc.) 14 74%

Crisis services 13 68%

Inpatient/residential 11 58%

Partial hospitalization 9 47%

Support services 

(transportation, respite, etc.) 9 47%

Other services 3 16%

Forty-seven States reported that they link 

encounter data to other client data using a 

unique client identifier. Several States use 

a combination of SSNs, authorization numbers, and other client IDs to link data. Most 

States report that they receive client identifiers, information about the type of service 

(using several different coding schemes), 

and dates of service as components of the 

encounter data. Place and duration of service, treating clinician/provider, and diagnosis (using several diagnosis schemas) were 

frequently collected elements in encounter 

records as well. Thirty-two States (63 percent) reported that they link these encounter 

This section briefly reviews the encounter/claims data, as well as the 

medication/pharmacy information, maintained by the SMHA information management systems.

Mental Health 

Encounter/Claims Data

V.

Most SMHAs receive encounter data that 

include descriptions of the transactions 

between the provider and client. Many 

SMHAs report analyzing Medicaid paid 

claims records to identify mental health 

services and clients, and some SMHAs are 

regularly matching or linking SMHA client 

data with Medicaid paid claims records.

Fifty-one States reported that they receive 

client-level claims/encounter data; of these, 

10 States (20 percent) receive a combination 

of client-level claims/encounter data and 

aggregated provider level data. Three States 

(6 percent) reported that they receive only 

aggregated claims/encounter data from 

providers.

Thirty-four States (64 percent) reported 

that they receive client-level encounter data 

for all individual encounters, while 19 States 

(36 percent) reported that they do not receive 

all mental health encounters. In those 

19 States, medications, case management, 

and crisis and treatment services are the most 

common types of encounters for which the 

SMHAs receive data (see table 6). In 8 States, 

the SMHA receives claims/encounter data 

only for services the SMHA paid for (i.e., 

encounters for services that are not paid by 

the SMHA are not submitted to the SMHA).
26 Characteristics of State Mental Health Agency Data Systems

service types with Medicaid and/or other 

agency data.

5.1 Medications/Pharmacy Information

Thirty-nine out of 52 reporting SMHAs 

(75 percent) maintain information about 

some of the psychiatric medications clients 

use. Often, these data come from either Medicaid paid claims or prescriptions (23 States, 

or 44 percent) or from SMHA-paid prescription claims (24 States, or 46 percent). In 

12 States (23 percent), other sources of information about medications are maintained.

In 32 States (62 percent), client-level information about medications is maintained. 

This information is sometimes linked to 

other client-level mental health data. In 

22 States (56 percent), this includes detailed 

information about each prescription. In eight 

States (21 percent), summary-level information is available for individual clients (information about the types of medications a 

client receives, but not at the individual prescription level). In nine States (23 percent) 

aggregate data about medications are available, but not at the client level.

As depicted in table 7, the most common 

medication information maintained by 

SMHAs is the types of medications, quantity 

of drugs prescribed, and dates of prescription. States also maintain information about 

payments for medications, number of prescriptions written and medications delivered.

Table 7: Types of Medication Information 

Maintained by the SMHA

Medication Information

Number of 

States

% of 

States

Type of medication, quantity 

of drug prescribed, date of 

prescription 26 50%

Payments for medications 19 37%

Number of prescriptions 

written by prescribing 

clinicians 18 35%

Medications delivered or 

purchased 18 35%
Characteristics of State Mental Health Agency Data Systems 27

VI.

files. In 31 States (57 percent), the SMHA 

receives Medicaid paid claims files to analyze mental health services paid for by Medicaid. In 12 States (22 percent) the SMHA 

has established a central data warehouse 

run by a separate agency that combines 

SMHA data with Medicaid data. Twentytwo SMHAs (41 percent) utilize other 

mechanisms, such as a direct link to a paid 

claims contractor database, to link Medicaid paid claims data files with SMHA data, 

while 10 (19 percent) SMHAs Medicaid 

paid claims data are not linked to mental 

health data.

Of the States that link Medicaid paid 

claims data with SMHA client data, 14 

reported linking data on a monthly basis and 

7 reported linking data on an ad hoc basis.

SMHAs use linked Medicaid and mental 

health data for the following:

■ For analysis of mental health services 

(36 States)

This section discusses the SMHA activities in linking databases with 

other State agencies. Often, data derived from this activity can generate outcome measures and provide opportunities to better coordinate the delivery of mental health services across State government.

Linking SMHA Client 

Data With Other State 

Government Agency 

Databases

The President’s New Freedom Commission 

on Mental Health found that the provision 

of mental health services is highly fragmented, with clients having to negotiate a complicated system to receive the different services 

and supports they need. The commission 

found that this fragmentation is a major 

impediment to providing high-quality care. 

Within State government, mental health services and essential supports are being provided by a broad array of agencies. It is essential 

for specialty systems such as SMHAs to gain 

a better understanding of the role of these 

other State agencies (OSAs) in providing 

mental heath services in order to reduce fragmentation. The State profiles system asked 

SMHAs with which OSAs they are linking 

client-level data and how these data are 

being used.

6.1 Medicaid

Forty-five States (83 percent) reported that 

they have access to Medicaid paid claims 
28 Characteristics of State Mental Health Agency Data Systems

■ For administrative purposes (28 States)

■ For policy analysis (29 States)

■ To identify fraud and abuse (11 States)

Fourteen SMHAs are working with their 

State Medicaid Agency to combine data systems. In seven States, the SMHA is working 

with the State Medicaid Agency to utilize the 

Federal Centers for Medicare and Medicaid 

Services’ (CMS) Medicaid Information Technology Architecture (MITA). For example, 

Oklahoma has been developing a new information system around the MITA standards, 

while in Indiana, Maryland, Missouri, Ohio, 

and Rhode Island, the SMHA and Medicaid 

agency are exploring potential MITA-related 

collaborations for their data systems.

6.2 Linking SMHA Data With Other 

State Agency Data

In addition to linking mental health client 

data with Medicaid, many SMHAs reported 

efforts to integrate or match client-level mental health data with other State government 

agency client databases (see table 8). The 

most frequently linked data are for 

substance abuse services (often in States 

where the SMHA is responsible for both 

mental health and substance abuse services). 

While many SMHAs link their client-level 

data with other OSAs (such as criminal 

justice, health, employment, and child 

welfare), this procedure is not routine and 

usually happens only for designated special 

projects. Only Medicaid and substance 

abuse (alcohol/drug abuse) client files are 

regularly integrated or matched with mental 

health records in more than 10 States.

The availability of linked or integrated 

client-level data from OSAs suggests that 

SMHAs have recognized the importance 

of this activity. The information from OSAs 

that provide significant levels of mental 

health services will, in the future, become 

crucial for accurately understanding overall 

State government expenditures on mental 

health. The interagency database linking 

likewise help inform the mental health 

NOMs, in particular the employment and 

criminal justice NOMs. As more States build 

State data warehouses and routinely link 

client-level data across systems, linked systems data may become more useful in calculating the NOMs.

Table 8: Other State Agencies With Which SMHAs Link Data

Other State Agency

Update Frequency Purpose Agency Responsible

Regularly

Special 

Projects

Analysis of 

Mental 

Health 

Services

Admin 

Purposes

Policy 

Analysis SMHA OSA Other

Alcohol and drug 

abuse 19 9 22 22 20 21 8 7

Criminal justice 5 16 14 13 10 13 5 1

Health 5 14 12 10 6 11 2 1

Employment/vocational 

rehabilitation 4 11 12 8 7 12 3 0

Child welfare 5 12 12 12 11 12 3 3

Juvenile justice 0 9 7 6 3 9 2 0

Education 1 4 4 4 3 3 1 0
Characteristics of State Mental Health Agency Data Systems 29

7.1 Implementation of Electronic 

Health Records

Forty-six of the reporting 49 States (94 percent) are implementing or considering the 

adoption of an electronic health record 

(EHR) in their State psychiatric hospitals 

and/or community mental health system (see 

figure 3).

Five States (11 percent) reported that they 

are already operating an EHR with all components in their State psychiatric hospitals, 

while 18 States (40 percent) reported that 

they have EHR with some components 

This section reviews the implementation of electronic health records 

within SMHAs. It includes a review of SMHA activities to share 

electronic health information, both between providers and to clients, 

through personal health records.

Electronic Health 

Records in SMHAs

VII.

NJ

MA

RI

CT

MD

DE

DC

NH

VT

WA

ID

NV

CA

OR

NM AZ

UT

WY

MT ND

SD

NE

KS

MI

TX

CO

MS

LA

AR

MO

IA

MN

AL

KY

OH IN

OK

IL

WI

TN NC

SC

GA

FL

ME

NY

PA

WV

VA

HI

AK

VI

PR

Figure 3: Implementation of EHRs

No Response (2)

Considering Adopting EHR (9)

No EHR Activity (3)

State Hospitals only (17)

Community MH Providers Only (4)

Both State Hosp and Comm MH (16)
30 Characteristics of State Mental Health Agency Data Systems

7.2 Implementation of EHR 

Components

Some components of EHRs have been implemented in either State psychiatric hospitals or 

community programs, or in both. The most 

commonly implemented components are 

patient admission, discharge, transfer, billing, 

reporting, progress/case documentation, and 

pharmacy. The least implemented components are exchanging client information with 

other providers and external consultation 

(see table 9).

7.3 Sharing EHR Information

Twenty States have agreements that allow 

the sharing of EHR client data between providers to improve care. In 18 States, these 

agreements allow the sharing of client EHR 

information among the State psychiatric 

implemented. Ten additional States (22 percent) reported that they are installing an 

EHR system in their State psychiatric hospitals, and 12 States (27 percent) are currently 

considering the adoption of an EHR in their 

State psychiatric hospitals (see figure 4).

Twenty-one (58 percent) States reported 

they have EHRs operating in the community 

mental health providers that are part of the 

SMHA-funded or -operated system, and 

3 States (8 percent) reported that EHRs are 

being installed. An additional 12 States 

(33 percent) are considering the adoption of 

an EHR in their community mental health 

provider systems. In 4 States (11 percent), a 

single EHR system is used for all community 

mental health providers (all of which are 

operated by the SMHA), while in 32 States 

(89 percent), community providers use a 

variety of EHR systems.

NJ

MA

RI

CT

MD

DE

DC

NH

VT

WA

ID

NV

CA

OR

NM AZ

UT

WY

MT ND

SD

NE

KS

MI

TX

CO

MS

LA

AR

MO

IA

MN

AL

KY

OH IN

OK

IL

WI

TN NC

SC

GA

FL

ME

NY

PA

WV

VA

HI

AK

VI

PR

Figure 4: EHR Status in State Psychiatric Hospitals

No Response (3)

Some EHR Components (18)

No EHR (3)

Currently Installing EHR (10)

All EHR Components (5)

Considering Adoption of EHR (12)
Characteristics of State Mental Health Agency Data Systems 31

hospitals within the SMHA system. In 

North Dakota, South Carolina, Texas, 

Utah, and Virginia, these agreements allow 

sharing information between community 

mental health providers and State psychiatric hospitals, while New York allows the 

sharing of EHR client information between 

State psychiatric hospitals and general hospitals. Colorado and Massachusetts have 

agreements to allow sharing of EHR client 

information between health maintenance 

organizations (HMOs) and other managed 

care (MC) firms that are part of the public 

mental health system and the SMHA (see 

table 10).

Table 9: Uses of EHR Components

EHR Components

State 

Hospitals

Community 

Providers

N % N %

Patient admissions, 

discharge, transfers 27 84% 16 76%

Pharmacy 23 72% 5 24%

Billing as part of EHR 

system 23 72% 14 67%

Reporting 20 63% 16 76%

Progress/case 

documentation 18 56% 17 81%

Treatment planning 16 50% 14 67%

Physician order entry 17 53% 5 24%

Clinical assessments 17 53% 15 71%

Scheduling 12 38% 12 57%

Dietary 14 44% 2 10%

Medication algorithms 9 28% 2 10%

Exchanging client info 

with other providers 3 9% 5 24%

External consultations 2 6% 4 19%

Other EHR functions 1 3% 3 14%

Table 10: Sharing EHR Information

Sharing EHR Information 

Between N %

State hospitals within the 

State 18 55%

Community providers & 

State hospitals 5 16%

Community providers 5 17%

HMOs, other MC firms & the 

SMHA 1 3%

State hospitals & general 

hospitals 1 3%

Thirteen States have a regional health information organization (RHIO) that includes 

mental health in its plans to share electronic 

health information. A number of other States 

are beginning to assess the inclusion of mental health information in a RHIO.

7.4 Benefits of Using EHRs

SMHAs reported a variety of benefits from 

implementing and using EHR systems. The 

major benefits include improved reporting 

capabilities (15 States), enhanced quality 

assurance (14 States), improved productivity 

(12 States), and reduced billing errors 

(11 States).

7.5 Electronic Pharmacy/Medication 

Ordering System

Twenty-six States reported that they have 

implemented an electronic pharmacy/medications ordering system in their State psychiatric hospitals, while five States have implemented this system in their community mental health providers. The electronic pharmacy/

medications ordering system software being 

used includes HCS, Meta, Mediworx/Pyxis®

system, QSI, Quadramed, and WORXS.
32 Characteristics of State Mental Health Agency Data Systems

7.6 Medication Administration 

Recording (MAR)

Eleven States reported that they have implemented the MAR system in their State psychiatric hospitals. None reported having the 

MAR system in community providers.

7.7 Electronic Personal Health 

Records (PHR)

SMHAs are in the early stages of implementing PHRs. Missouri reported that it is 

in the process of implementing a PHR, and 

Oklahoma is designing a PHR system for 

mental health clients. The SMHAs in California, Missouri, New Jersey, Ohio, and 

Utah are working with other providers to 

support PHRs, while Connecticut’s Children’s Mental Health Department, Maryland, and Virginia are planning to implement PHR systems.
VIII.

Characteristics of State Mental Health Agency Data Systems 33

State mental health agencies are expending substantial resources 

in terms of staff, time, and money to improve their mental health 

information systems. Although a few States collect aggregate data, 

most SMHAs maintain client-level data on most, if not all, of the clients 

who receive public mental health services. However, not all SMHAs receive 

client-level data for every client served by the community mental health 

programs they fund. In some States, local community mental health service 

providers submit client-level data to the SMHA only for persons whose care 

was paid for by the SMHA or Medicaid (they do not report private pay 

clients). In other States, client-level data are reported to the SMHA only for 

some client groupings (e.g., adults with serious mental illness or adults in 

ACT services).

Summary

In some States, SMHA client-level data are 

based on enrollment and discharge information that is useful to generate outcome measures such as the NOMs, but they may not 

include detailed encounter-level information. 

Many of the client status measures included 

in State client datasets (such as employment 

status, living situation, and functional status) 

are collected at admission and then periodically updated, although the frequency of 

updating varies widely by State.

SMHAs are increasingly working to analyze Medicaid paid claims records and to link 

or match these files with their own clientlevel data. However, the methods used to link 

these systems are developed individually by 

each State and vary widely in how often data 

are matched or analyzed. A number of States 

have expressed interest in the new CMS 

MITA initiative as a potential resource to 

facilitate integrating SMHA-mental health 

client data with Medicaid claims data. 

SMHAs are also working with many other 

State government agencies to link datasets 

to understand the movement and overlap 

of clients between State government systems. 

However, States are not conducting and 

updating these data linkages with other agencies as often as they do with Medicaid files.

Most States are implementing or planning 

to implement electronic health records in 

their State psychiatric hospitals and to support their implementation in community 

mental health providers. States are optimistic 

that the real-time clinical records of EHRs 

can reduce the burden of maintaining separate administrative data systems and improve 

the ability of mental health programs to 

report outcomes. However, at this time, few 

States have fully addressed the requirements 

of sharing information between EHRs. Most 

EHR systems are proprietary and do not 

have common protocols to share data with 

other EHRs. As a result, in many States 
34 Characteristics of State Mental Health Agency Data Systems

individual providers are implementing and 

maintaining EHRs that contain data that 

could be used to provide a much more robust 

picture of public mental health services, but 

the rules, agreements, and systems to share 

this information between providers and the 

SMHA have not been fully developed. This 

inability to share and combine EHR information may limit the capability of States to 

use the EHRs to improve their capacity to 

answer the outcomes and services questions 

that are being asked.

The separate IT architectures maintained 

by State psychiatric hospitals and community 

mental health systems in a number of States 

as well as the wide variety of database platforms in use are indicative of the critical 

need for database integration between the 

State psychiatric hospitals and community 

mental health systems. Only a few State psychiatric hospital systems report using more 

modern databases, such as SQL, as the basis 

of their IT architecture. The continued reliance of some SMHAs on expensive and 

hard-to-modify legacy data systems is a factor that policy makers must consider when 

establishing new data requirements.

SMHA IT systems are the focus of major 

changes across the States. With leadership 

from CMHS/SAMHSA through their Data 

Infrastructure Grants, and work on data 

sharing and “interoperable” data systems 

such as Medicaid, health, and corrections, 

SMHA IT capacities are rapidly moving in 

a positive direction. Many States are now 

working to make mental health information 

on services and outcomes available to clients 

and their families. The next area of focus for 

many SMHAs is helping clients to build and 

use their own personal health records to 

empower clients to take better charge of 

their own treatment.
Characteristics of State Mental Health Agency Data Systems 35

References

2007 Uniform reporting system results. 

(2008). Rockville, MD: Center for 

Mental Health Services, Substance 

Abuse and Mental Health Services 

Administration, U.S. Department of 

Health and Human Services.

Bush, G. W. (2002, April 29). Executive 

Order: President’s new freedom 

commission on mental health. 

Washington, DC: Office of the Press 

Secretary, the White House. Available 

at http://www.whitehouse.gov/news/

releases/2002/04/20020429-2.html.

Center for Mental Health Services. (2006). 

Mental health, United States, 2004. R. 

W. Manderscheid & J. T. Berry (Eds.) 

(DHHS Pub. No. SMA-06-4195). 

Rockville, MD: Substance Abuse and 

Mental Health Services Administration.

Institute of Medicine. (2006). Adaptation of 

mental health and addictive disorders. 

Improving the quality of health care 

for mental health and substance-use 

conditions. Washington, DC: National 

Academies Press.

National Association of State Mental Health 

Program Directors Research Institute. 

(2007). Funding sources and expenditures 

of State mental health agencies: fiscal 

year 2005. Alexandria, VA: Lutterman,T. 

Available at www.nri-inc.org/projects/

profiles/revenuesexpenditures.cfm.

New Freedom Commission on Mental 

Health (2003). Achieving the promise: 

Transforming mental health care in 

America. Final report. (DHHS Pub. No. 

SMA-03-3832). Rockville, MD.

Torrey, E. F., Earman, K., Wolfe, S. M., & 

Flynn, L. (1990). Care of the seriously 

mentally ill: A rating of State programs.

Washington, DC: Public Citizen Health 

Research Group and the National 

Alliance for the Mentally Ill.

Characteristics of State Mental Health Agency Data Systems 37

Data Warehouse: A term coined in 1990 by 

Bill Inmon, who defined it as “a subject-oriented, integrated, time-variant and non-volatile collection of data in support of management’s decision making process.” The 

function of a data warehouse is to consolidate and reconcile information from across 

separate agencies and data systems and provide a context for reporting and analysis. 

Data in a warehouse are organized so that 

all the data elements relating to the same 

real-world event or object are linked together. For State governments, this means that 

data warehouses link client data from multiple State agencies and data systems. In a 

State data warehouse, an individual client’s 

Medicaid, mental health, vocational rehabilitation, employment status, and criminal 

justice data can all be combined to provide 

a comprehensive view of the client’s service 

use and costs.

Discharges: States vary in their practice and 

concept of discharge. For clients in State hospitals, discharges are easy to define as when 

the person is discharged and leaves the inpatient facility. However, in community mental 

health services, where some clients may be in 

services for many years, discharges are harder to define. Some States consider clients discharged only when they are given a medical 

discharge as a result of treatment completion. 

However, since many clients cease coming in 

for services before they complete treatment, 

they are never given a medical discharge. 

Most States have procedures to make an 

Appendix 1: 

Definitions

administrative discharge after a client does 

not appear for services for an extended period, which ranges from 90 to 180 days.

Electronic Health Record (EHR): EHR is a 

secure, real-time, point-of-care, client-centric 

information resource for clinicians. The EHR 

aids clinicians’ decision-making by providing 

access to client health record information 

where and when they need it and by incorporating evidence-based decision support. The 

EHR automates and streamlines the clinician’s workflow, closing loops in communication and response that result in delays or 

gaps in care. The EHR also supports the collection of data for uses other than direct clinical care, such as billing, quality management, outcomes reporting, resources planning, and public health disease surveillance 

and reporting.

Encounter/Claims Data: Encounter/claims 

data are defined as information about the 

contact between a client and a plan or a provider in which a covered service is provided. 

Encounter databases are information systems 

that are used to track the delivery of specific 

providers (and in the case of claims data, 

with specific billing amounts). Mental health 

claims data systems are used to bill fee-forservice systems such as Medicaid or other 

reimbursement-driven systems. Claims-based 

records contain information specific to each 

client-clinician interaction.

Health Insurance Portability and Accountability Act (HIPAA): HIPAA was passed by 
38 Characteristics of State Mental Health Agency Data Systems

Congress in 1996 and includes three major 

sections relevant to public mental health 

information systems:

The Transaction and Code Set: A standard set of allowable codes and record 

layout for all electronic billing records. 

The HIPAA Transaction standards are 

applicable to Medicaid paid claims 

records and all other health care billing 

records. HIPAA Transaction and Code 

standards became effective in 2004.

Privacy Rules: HIPAA Privacy Rules are 

designed to protect the privacy of all electronic medical records. The HIPAA Standards regulate consent procedures and 

how electronic health data can be shared 

among providers, payers, researchers, and 

government. The Privacy Rules became 

effective in 2003.

Security Standards: HIPAA Security Standards are designed to complement the 

HIPAA Privacy Rules and regulate how 

healthcare providers must ensure the 

security of electronic health information. 

The Security Rules were issued in 2003 

and became effective in 2005.

Legacy System: The Sci-Tech Dictionary of 

Answers.com defines legacy system as “a 

computer system that has been in operation 

for a long time, and whose functions are too 

essential to be disrupted by upgrading or 

integration with another system.”

Medicaid Information Technology Architecture (MITA): An initiative of the Center for 

Medicaid and State Operations (CMSO) that 

is intended to foster integrated business and 

IT transformation across the Medicaid enterprise to improve the administration of the 

Medicaid program.

National Outcome Measures (NOMs): A set 

of mental health outcome measures selected 

by the Substance Abuse and Mental Health 

Services Administration that covers 10 areas 

of mental health systems. The NOMs were 

selected to provide data on program accountability, with recovery and resiliency as a 

focus for serving consumer populations.

Personal Health Record (PHR): A collection 

of important information about a person’s 

health or the health of someone else they 

care for, such as a parent or child. The information comes from a variety of sources and 

may include medical records, family health 

history, Advance Health Care Directive (formerly called Durable Power of Attorney for 

Health Care or a Living Will), and any other 

health information.

State: For the purposes of this report, the 

term State refers to any of the 50 States, the 

District of Columbia, the Federated States of 

Micronesia, Palau, Puerto Rico, and the Virgin Islands.

State Mental Health Agency (SMHA): The 

State or territory government agency responsible for preparing the Mental Health Block 

Grant applications to CMHS and for the 

provision of mental health services in the 

State. In several States, two separate State 

government agencies are responsible for the 

provision of mental health services: the Adult 

Mental Health Services Agency and the Children’s Mental Health Services Agency. In the 

development of this report, both the Adult 

and Children SMHAs were asked about their 

IT system and the types of client-level data 

they maintain. Connecticut sent two responses, one for the Adult SMHA and another for 

the Children’s SMHA.

Substance Abuse and Mental Health Services 

Administration (SAMHSA): A Federal agency whose mission is to build resilience and 

facilitate recovery for people with or at risk 

for substance use and/or mental disorder.
Characteristics of State Mental Health Agency Data Systems 39

Uniform Reporting System (URS): A Federal 

reporting system used by SMHAs to compile 

and report annual data from each State as 

part of the Community Mental Health Block 

Grant. The URS, comprising 21 tables 

developed by the Federal government in consultation with SMHAs, compiles annual 

State-by-State and national aggregate information, including numbers and sociodemographic characteristics of persons served by 

the States, the outcomes of care, use of 

selected evidence-based practices, client 

assessment of care, and insurance status. 

SAMHSA uses these tables to calculate the 

10 mental health NOMs for State and 

national reporting.


DHHS Publication No. (SMA) 08-4361

Printed 2008