A perinatal psychiatrist took the stand and described the problem in one sentence. Patients need "someone to help broker all these relationships," Dr. Nancy Byatt of UMass Chan Medical School testified, adding that "right now, that doesn't exist within our systems."
The testimony from the Lindsey Clancy trial has become an unintentional case study in what systemic care coordination failure looks like when it meets perinatal psychiatry. Across weeks of medical testimony in 2026, clinicians described what a fragmented mental health record actually looks like from the inside: roughly six providers across disconnected systems, concurrent prescribers with no contact between them, and 13 medications spread across multiple prescribers.
A Structural Problem, Not an Anomaly
It would be easy to read this as a single tragic failure. The data says otherwise. Nearly 85% of behavioral health providers rely on multiple systems that are partially integrated or fully siloed. Fragmentation is not the exception in this sector. It is the default setting.
The testimony traced the consequences with painful specificity. A psychiatric nurse practitioner testified that she knew her patient was seeking treatment elsewhere but never spoke to the other prescriber, never accessed those records, and was unaware of roughly 14 visits over a four-month period. Medication changes, discontinuations, and additions were being made by each prescriber in an informational vacuum.
When one clinician was asked whether anyone had even requested an authorization to release inpatient records from a voluntary admission weeks before the killings, the answer was that she had not been asked. The outpatient treatment plan was never revised based on inpatient findings.
The clinical stakes here are not abstract. Maternal mental health disorders are the leading complication of childbirth, affecting 20% of U.S. women, and postpartum psychosis, which affects 1 in 1,000 women and carries a 4% infanticide rate when untreated, is an inherently fluctuating condition. As Dr. Suzan Song testified, it is a "working formulation" that changes over time, demanding shared context that was simply absent.
And this is not a behavioral health problem alone. High care fragmentation affects 57.9% of the adult population, with costs and harm concentrated among patients with multiple chronic conditions.
Adoption Is Not the Same as Exchange
Here is the shift in thinking the Clancy testimony forces. For years, the assumed fix for fragmentation was technology adoption. Get everyone on an EHR and the records will flow. Behavioral health has largely caught up on the first part and remains stuck on the second.
Only 68% of mental health and substance use providers exclusively use EHRs, with another 25% still combining EHRs and paper, and adoption at private for-profit organizations lags far behind the 97% seen at federal facilities.
But adoption of the technology is not the exchange of information. Massachusetts law, notably, expressly allows providers to share records with ease. The permission existed. The infrastructure and, critically, the ownership of the coordination task did not. State law mandated postpartum depression screening and referral, but it never defined who is responsible for the patient after the handoff.
The Regulatory Floor Is Rising
The policy environment is beginning to treat coordination failures as consequences, not just clinical misfortunes. The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) carries Provider Access API provisions required by January 1, 2027.
CMS has already modified Hospital Conditions of Participation to require hospitals, including psychiatric hospitals, to send admission, discharge, and transfer notifications to the patient's other clinicians. And ONC dedicated $20 million to a Behavioral Health IT Initiative, acknowledging a sector left out of the 2009 HITECH incentives.
The Questions Worth Asking
The testimony offers care teams a clinical mirror. Three questions come out of it. Who owns this patient across the handoffs? Do all of my co-treating providers have access to the same comprehensive patient history I am working from? And when was the last time I proactively requested records from a co-treating clinician instead of waiting for a two-page discharge summary?
The deeper lesson is that coordination cannot depend on individual clinician initiative under time pressure. It has to be built into the system by design, so that comprehensive patient histories and closed-loop care coordination are the standard rather than the exception. At MedSync, this is the problem we work on: consolidating what has scattered across the healthcare system so that no clinician is asked to make decisions in an informational vacuum.
Before the next handoff, it is worth asking whether the record will actually follow the patient. In too many cases, it still does not.
Sources
- Clancy trial: Whose job is it to coordinate care?
- When the Record Doesn't Follow the Patient: Documentation Lessons from the Clancy Trial | Triad Blog
- Behavioral Health Providers Grapple with Fragmented Tech, Eye Smarter Investments - Behavioral Health Business
- Nurse practitioner who treated Lindsay Clancy testifies about Duxbury mother’s desperation to improve amid postpartum struggles - The Boston Globe
- Fact Sheet: Maternal Mental Health - Policy Center for Maternal Mental Health
- A systematic review of postpartum psychosis resulting in infanticide: missed opportunities in screening, diagnosis, and treatment - PubMed
- Healthcare fragmentation: what causes it, what it costs, and how to fix it - blueBriX
- Behavioral Health Has Caught Up on EHRs — But Data Sharing Is Still Stuck in the Past - Behavioral Health Business
- Lindsay Clancy and electronic health records in Massachusetts: What we know
- CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) | CMS
- Final CMS Interoperability Regulation: What You Need to Know | HIMSS
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