Health information technology (HIT) promises new possibilities in the delivery of health and mental health care. Although President Bush set a goal to have electronic health records (EHR) for the majority of Americans by 2014, only a quarter of physicians use EHRs in ambulatory settings and five percent of hospitals use computerized physician order entry. The Centers for Medicare & Medicaid Services or CMS has instituted e-prescribing and EHR programs to increase the adoption and use of HIT in the United States. However, many health care and safety net providers feel there are significant gaps in their understanding of how implementation of HIT and EHR will improve health and behavioral health care. This perception of the value of HIT and the EHR creates critical challenges for the development of policies aimed at speeding adoption. This chapter describes problems in the use of electronic health information in decision-making, focusing on historical perspectives, program evaluation, outcomes assessment, and implementation of evidence-based practices. It then reviews federal reforms which assist in the implementation of HIT and its use in decision-making. Finally, it concludes with recommendations to assist in the adoption, implementation, and utilization of EHR in the decision-making process.