Speaker
Richelle J. Koopman, MD, MS
Jack M. and Winifred S. Colwill Professor and Vice Chair
Department of Family and Community Medicine
University of Missouri
Keywords
Electronic Health Record, Pragmatic Clinical Trial
Key Points
- Patients bring patient-generated home blood pressure data into the clinical workflow. It is difficult to enter and create visualizations of this data in the electronic health record (EHR), so the research team developed an EHR data visualization of home blood pressure from data entered via the patient portal.
- Starting in 2015, researchers held 10 focus groups with patients, family medicine and general internal medicine physicians and 1 CMIO. Researchers assessed the effect of the data visualization on patient risk perception and the interaction of health literacy, numeracy, and graph literacy with the data visualization.
- The team’s goals were to design for the primary care setting because 85% of hypertension care is in this setting. The team wanted the visualization designed for shared decision making, with an emphasis on patient information needs and comprehension and physician information needs and workflow. The visualization needed to have an intuitive design, and the team was cognizant of how data visualization can affect decision making.
- The data visualization started with a basic list of information needed, including systolic and diastolic data; clinic and home data; raw data numbers, effect of medications on blood pressure; goal ranges; out of range values; customizable goal ranges; patient burden of entry; data variability relative to control, and contextual life event data. From there, the team iterated based on patient-physician needs, resulting in the COACH (Collaborative Oriented Approach to Controlling High Blood Pressure) app.
- Later this year, the study team will launch the COACH trial, a pragmatic clinical trial with 550 adult primary care patients with uncontrolled hypertension who are portal users. The trial will take place across 3 sites, University of Missouri, OHSU, and Vanderbilt and across 2 EHR platforms, EPIC and Oracle. The primary outcome is blood pressure at 6 months. The trial is doing a consolidated framework for implementation research to understand the preferred workflows and concerns for patients and physicians.
Discussion Themes
-Who provided the text support for the app and how were they resourced and trained? We specified adverse events that were largely hypotension, ER visits and hospitalizations. We are evaluating the usability of the app. At MU we have a collaboratory called the Tiger Institution that does programming. They estimated 5,000 hours to put it in the EHR, and they did it for free. We are paying now. It works in the Oregon EPIC EHR, and we are working on translating it to Vanderbilt.
–Can you speak to sustainability and what you are doing with billing codes? It was data that was sitting there without alerts in our system. We need to have some way to create a better actionable alert. There is billing potential here. There are mechanisms to bill for home blood pressure monitoring for Medicare. The sustainability comes from being able to bill for these services and keeping it lean in messaging.
–What about the patients who are not in the portal? That is definitely a problem. At MU and OHSU we are at about 80-90%. You can access the portal from desktop and phones. Lots of people have smartphones but they do not have the portal. Vanderbilt has a plan for bridging this gap through care managers.
Tags
#pctGR, @Collaboratory1