ences in adoption by practice setting can be explained by larger groups’ and HMOs’ readier access to capital and administrative support staff, the ability to spread acquisition and implementation costs among more physicians, and active physician leadership in IT adoption (Reed and Grossman, 2004).

Data and observations from experts in the use of information systems among managed behavioral health care organizations support this premise. With respect to administrative (as opposed to clinical) IT applications, smaller providers in behavioral health care have lagged behind in use of electronic claims submission (Trabin and Maloney, 2003). Consistent with this observation, the survey of substance-use treatment providers described above found that although approximately 20 percent of surveyed programs had no information services of any type, e-mail, or even voice mail for their phone system, most of those that were part of larger hospital or health systems (approximately 30 percent of the sample) had access to well-developed clinical information systems, e-mail, and Internet services (McLellan et al., 2003).

The Center for Studying Health System Change has suggested that because barriers to IT adoption appear to be greatest for smaller practices, policy incentives for the uptake of IT may need to pay particular attention to those barriers. According to the center, direct grants or loans to acquire IT and strategies to lower the cost of IT may be especially successful approaches for smaller practices; some have advocated a government-sponsored funding mechanism, similar to the Hill-Burton Act for hospitals, to provide capital for IT to physicians and other providers (Reed and Grossman, 2004).

Diverse Types of Health Care Providers

Crossing the Quality Chasm notes that the health care workforce overall is highly variable in terms of IT-related knowledge and experience, and probably also in terms of receptivity to learning or acquiring these new skills (IOM, 2001). This is likely to be equally or more so the case with respect to M/SU clinicians because of their greater variability in education and training (see Chapter 7). Information system executives at six major managed behavioral health organizations and one HMO interviewed in 1999 reported a wide gap between their organization’s interest in and readiness to adopt IT and that of their providers, as well as low acceptance of various technologies among clinical providers. For example, the managed behavioral health organizations and HMO reported that they could not require electronic transmission of claims and other forms because too few providers had the necessary skills and equipment to comply (Trabin and Maloney, 2003).

Varied Reimbursement and Reporting Requirements

Treatment providers, many of whom, as noted, are in solo or small group practices, must respond to varied and complex reimbursement and



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